title: First-pass and high-resolution steady-state magnetic resonance angiography of the peripheral arteries with gadobenate dimeglumine: an assessment of feasibility and diagnostic performance.
abstract: OBJECTIVE
  To assess the feasibility of combined first-pass (FP) and steady-state (SS) contrast-enhanced magnetic resonance angiography (MRA) of the peripheral arteries with gadobenate dimeglumine (MultiHance) and to evaluate diagnostic performance relative to digital subtraction angiography (DSA).
  
  
  METHODS
  A total of 35 patients with symptomatic peripheral arterial occlusive disease (PAOD) underwent FP MRA (repetition time [TR]/echo time [TE]/flip angle [FA]/acquisition time [TA] = 3.5/1.2/30°/14s) at 1.5T after intravenous injection of 10 mL of gadobenate dimeglumine. Thereafter, SS imaging of the calf (TR/TE/FA/TA = 7.5/2.3/20°/40-130s) and femoropopliteal (TR/TE/FA/TA = 7.5/2.3/18°/130-240s) regions was performed after a second injection of 5 mL of gadobenate dimeglumine. All patients underwent conventional DSA. Three readers reviewed separate FP and FP+SS MRA datasets for image quality and presence/absence of clinically relevant PAOD. A fourth independent observer evaluated DSA images. The diagnostic performance (sensitivity, specificity, positive and negative predictive values) achieved with each dataset was determined and compared. Inter-reader agreement was assessed using kappa statistics.
  
  
  RESULTS
  The image quality of 134 of 140 vascular regions was optimal or adequate on SS MRA. Inter-reader agreement was good to very good for assessments of FP (κ = 0.725) and combined FP+SS images (κ = 0.866). SS images improved diagnostic confidence in 34 (48.6%) femoropoliteal and 46 (65.7%) crural regions and altered final diagnosis in 8 (11.4%) and 10 (14.3%) regions, respectively. Global diagnostic accuracy increased from 92.9% on FP images to 95.9% on FP+SS images, with significant (P = 0.0384) improvement in the crural region.
  
  
  CONCLUSIONS
  SS MRA of the peripheral arteries is feasible with gadobenate dimeglumine and potentially improves diagnostic performance in patients with symptomatic PAOD.
authors.affiliation: Department of Radiological Sciences, University of Rome "La Sapienza," Italy. michele.anzidei@gmail.com
authors.forename: Michele
authors.initials: M
authors.lastname: Anzidei
authors.forename: Alessandro
authors.initials: A
authors.lastname: Napoli
authors.forename: Fulvio
authors.initials: F
authors.lastname: Zaccagna
authors.forename: Beatrice
authors.initials: B
authors.lastname: Cavallo Marincola
authors.forename: Chiara
authors.initials: C
authors.lastname: Zini
authors.forename: Miles A
authors.initials: MA
authors.lastname: Kirchin
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001158:Arteries; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D018810:Magnetic Resonance Angiography / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives*; D008875:Middle Aged; D009942:Organometallic Compounds; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D013223:Statistics as Topic
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine