MR angiography of infrapopliteal arteries in patients with peripheral arterial occlusive disease by using Gadofosveset at 3.0 T: diagnostic accuracy compared with selective DSA.
OBJECTIVE
To prospectively compare the diagnostic accuracy of steady-state, high-spatial-resolution magnetic resonance (MR) angiography of the lower leg, performed with a blood pool contrast agent, with selective digital subtraction angiography (DSA) as the reference standard in patients with symptomatic peripheral arterial disease.


METHODS
Local ethics committee approval and written informed consent were obtained. In a nonrandomized trial, selective DSA and MR angiography were performed at 3.0 T with a blood pool contrast agent on 22 calves in 20 patients (mean age, 69.4 years +/- 11.3 [standard deviation]), 16 men (mean age, 67.8 years +/- 12.4) and four women (mean age, 75.6 years +/- 3.6 years), to evaluate 352 arterial segments. DSA and MR angiography were performed within 24 hours of each other and directly compared by three experienced, blinded radiologists by using high-spatial-resolution steady-state MR angiograms. Consensus reading for both DSA and MR angiography served as the reference standard.


RESULTS
MR angiography was successful and occurred without serious adverse events in all patients. Seven significantly stenosed and 40 occluded segments were rated equally in both modalities. In three cases, the tibial arteries were shown to be occluded or significantly stenosed at DSA but appeared normal or significantly stenosed at MR angiography. The respective average segment sensitivity, specificity, and accuracy were 98.3% (59 of 60), 98% (113.7 of 116), and 98.1% (172.7 of 176) for DSA and 100% (60 of 60), 100% (116 of 116), and 100% (176 of 176) for MR angiography. Steady-state MR angiography was especially useful for the distal peroneal artery and the proximal anterior tibial artery.


CONCLUSIONS
MR angiography performed with blood pool agents has an accuracy comparable with that of selective DSA in the lower leg but with less risk involved. Steady-state imaging performed with blood pool agents facilitates evaluation of MR angiography of infrapopliteal arteries.
Institute for Diagnostic, Interventional and Pediatric Radiology and Division of Angiology, Swiss Cardiovascular Center, University of Bern-Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland. bonel@gmx.ch
Harald Marcel
HM
Bonel
Bettina
B
Saar
Hanno
H
Hoppe
Hak Hong
HH
Keo
Marc
M
Husmann
Konstantin
K
Nikolaou
Karin
K
Ludwig
Zsolt
Z
Szucs-Farkas
Sudesh
S
Srivastav
Ralph
R
Kickuth
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007866:Leg / Q000098:blood supply*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000473:pathology; D011150:Popliteal Artery / Q000473:pathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
D003287:Contrast Media; D009942:Organometallic Compounds; D005682:Gadolinium; C109932:gadofosveset trisodium