title: A comparative analysis of noncontrast ﬂow-spoiled versus contrast-enhanced magnetic resonance angiography for evaluation of peripheral arterial disease.
abstract: OBJECTIVE
  This feasibility study aimed to obtain initial data to assess the performance of a novel noncontrast spoiled magnetic resonance (MR) angiography technique (fresh-blood imaging [FBI]) compared to gadolinium-enhanced MR (Gd-MR) angiography for evaluation of the aorto-iliac and lower extremity arteries.
  
  
  METHODS
  Thirteen patients with suspected lower extremity arterial disease that had undergone Gd-MR angiography and FBI at the same session were randomly included in the study. FBI was performed using an ECG-gated ow-spoiled T2-weighted half-Fourier fast spin-echo sequence. For analysis, the aortoiliac and lower limb arteries were divided into 18 anatomical segments. Two blinded readers individually graded image quality of FBI and also assessed the presence and severity of any stenotic lesions. A similar analysis was performed for the Gd-MR angiography images.
  
  
  RESULTS
  A total of 385 arterial segments were analyzed; 34 segments were excluded due to degraded image quality (1.3% of Gd- MR vs. 8% of FBI-MR angiography images). FBI-MR angiography had comparable accuracy to Gd-MR angiography for assessment of the above knee vessels with high kappa statistics (large arteries, 0.91; small arteries, 0.86) and high sensitivity (large arteries, 98.1%; small arteries, 88.6%) and specificity (large arteries, 97.2%; small arteries, 97.6%) using Gd-MR angiography as the gold standard.
  
  
  CONCLUSIONS
  Initial results show good agreement between FBI-MR angiography and Gd-MR angiography in the diagnosis of peripheral arterial disease, making FBI a potential alternative in patients with renal impairment. FBI showed highest accuracy in the above knee vessels. Technological refinements are required to improve accuracy for assessing the calf and pedal vessels.
authors.affiliation: Department of Cardiovascular and Interventional Radiology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom. rahil.kassamali@gmail.com
authors.forename: Rahil Hussein
authors.initials: RH
authors.lastname: Kassamali
authors.forename: Edward T D
authors.initials: ET
authors.lastname: Hoey
authors.forename: Arul
authors.initials: A
authors.lastname: Ganeshan
authors.forename: Tracey
authors.initials: T
authors.lastname: Littlehales
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D005682:Gadolinium; D006801:Humans; D007083:Iliac Artery / Q000473:pathology; D007089:Image Enhancement / Q000379:methods*; D007866:Leg / Q000098:blood supply* / Q000473:pathology; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D058729:Peripheral Arterial Disease / Q000175:diagnosis*; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media; D005682:Gadolinium