Comparison of gadofosveset-enhanced three-dimensional magnetic resonance angiography with digital subtraction angiography for lower-extremity peripheral arterial occlusive disease.
BACKGROUND
Minimally invasive imaging techniques are increasingly used for clinical decision making in patients with peripheral arterial occlusive disease (PAOD).


OBJECTIVE
To assess whether gadofosveset-enhanced three-dimensional (3D) magnetic resonance (MR) angiography could replace digital subtraction angiography (DSA) for the evaluation of lower-extremity PAOD.


METHODS
Thirty patients with symptomatic PAOD underwent prospectively both MR angiography and DSA. Gadofosveset-enhanced 3D MR angiography was performed on a 1.5T system equipped with a peripheral angio matrix coil. Four blinded observers independently analyzed MR angiograms and DSA images. The lower arterial vascular system was divided into three anatomic segments (aortoiliac, femoropopliteal, infrapopliteal) for review. The status of each segment was graded as normal, stenosis less than 50%, stenosis greater than 50%, or occluded and/or aneurismatic. Principal and secondary lesions were reported.


RESULTS
Although interobserver agreement for both was excellent, it was higher for DSA (kappa=0.92) than for MR angiography (kappa=0.86) for reporting the principal and secondary lesions in all segments. For different anatomic locations, the interobserver agreement of MR angiography and DSA was as follows: aortoiliac (kappa=0.93, k=0.95), femoropopliteal (kappa=0.86, k=0.90), and infrapopliteal (kappa=0.78, k=0.85). The lowest agreement was found for MR angiography on infrapopliteal segments (kappa=0.78). In four (13.3%) cases, MR angiography showed lesions that were not found by DSA. Five (16.6%) aneurysm cases, not observed by DSA, were shown by MR angiography.


CONCLUSIONS
Gadofosveset-enhanced 3D MR angiography can be proposed for first-line imaging in the management of lower-limb PAOD patients and permits the selective use of DSA as a second-line examination when MR angiography fails or in an endovascular approach.
Grijalba
Fermín Urtasun
FU
Vascular Radiology Unit, Department of Radiology, Navarra Hospital, Pamplona, Spain. furtasun@telefonica.net
Esandi
Mercedes Ciriza
MC
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis*; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009942:Organometallic Compounds; D016491:Peripheral Vascular Diseases / Q000175:diagnosis*; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D012720:Severity of Illness Index
D003287:Contrast Media; D009942:Organometallic Compounds; D005682:Gadolinium; C109932:gadofosveset trisodium