title: Biphasic blood pool contrast agent-enhanced whole-body MR angiography for treatment planning in patients with significant arterial stenosis.
abstract: OBJECTIVE
  To prospectively evaluate diagnostic accuracy of first pass and combined first pass and steady state high-spatial-resolution whole-body magnetic resonance (MR) angiography with a blood pool contrast agent for quantification of arterial stenosis in different vascular territories.
  
  
  METHODS
  After Institutional Review Board approval and informed consent, 50 patients with known 50% or greater stenosis in at least one vascular territory; as shown by the standard-of-reference (14 digital subtraction angiographies, 4 computed tomographies, 32 ultrasound examinations), were included. The patients underwent MR angiography at 1.5 Tesla, using a standardized nonbody-weight-adapted i.v. bolus injection of 11 mL gadofosveset trisodium. First pass imaging with 4 different table positions in a whole-body MR scanner (MAGNETOM Avanto, Siemens Healthcare), using individual circulation time determined by a test bolus, was performed. Steady state imaging was performed using an isometric spatial resolution of 1.0 mm. Image quality was rated. Each vascular segment in MR angiography was evaluated by 2 independent and blinded reviewers and the stenosis degree was compared with the preferred standard-of-reference, using a 5-point scale. Differences between first pass and combined MR angiography were assessed with a 95% confidence interval (CI) by applying the adjusted modified chi(2) test. Changes in therapy based on the whole-body examination strategy were evaluated.
  
  
  RESULTS
  The number of nondiagnostic territories was 24 of 197 (12.2%) for first pass MR angiography and decreased to 3 of 197 (1.5%) after addition of steady state MR angiography. The diagnostic accuracy for quantification of arterial stenosis in combined MR angiography (94.7%; 95% CI: 92.4-97.1) was superior to first pass MR angiography (81.7%; 95% CI: 73.7-89.8; statistically significant). Patient management was changed in 12 of 49 patients, in 7 of 12 patients the change was applied to an additional lesion detected by the whole-body examination strategy.
  
  
  CONCLUSIONS
  The quantification and detection of arterial stenosis is improved by the steady state high-resolution gadofosveset trisodium-enhanced MR angiography. Additional lesions detected by whole-body examination strategy or differences in stenosis quantification may lead to changes in therapy.
authors.affiliation: Imaging Science Institute Charité Berlin, Berlin, Germany. Alexander.Huppertz@charite.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Huppertz
authors.forename: Hannes
authors.initials: H
authors.lastname: Kroll
authors.forename: Christian
authors.initials: C
authors.lastname: Klessen
authors.forename: Matthias
authors.initials: M
authors.lastname: Taupitz
authors.forename: Ralph I
authors.initials: RI
authors.lastname: Rückert
authors.forename: Ralf-Juergen
authors.initials: RJ
authors.lastname: Schröder
authors.forename: Thomas
authors.initials: T
authors.lastname: Albrecht
authors.forename: Bernd
authors.initials: B
authors.lastname: Frericks
authors.forename: Matthias
authors.initials: M
authors.lastname: Voth
authors.forename: Moritz
authors.initials: M
authors.lastname: Wagner
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.forename: Patrick
authors.initials: P
authors.lastname: Asbach
mesh_terms: D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis*; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D005682:Gadolinium; C109932:gadofosveset trisodium