title: TRICKS magnetic resonance angiography at 3-tesla for assessing whole lower extremity vascular tree in patients with high-grade critical limb ischemia: DSA and TASC II guidelines correlations.
abstract: The entire vascular tree of 58 lower extremities with high-grade critical limb ischemia (CLI) was assessed with three-station time resolved imaging of contrast kinetics (TRICKS) magnetic resonance angiography (T-MRA) and correlated with digital subtraction angiography (DSA) examinations and Trans-Atlantic Inter-Society Consensus II (TASC II) guidelines. Kappa (κ) statistics were utilized to evaluate the agreement of stenosis scores (5-point scale; 0 normal to 4 occlusion) based on T-MRA and DSA. With DSA as the standard, significant stenosis instances (stenosis score ≥2) among vascular segments were compared. The κ-statistics of image quality (4-point scale; 1 nondiagnostic to 4 excellent) of T-MRA and TASC II classification assessed by a radiologist and a vascular surgeon were also evaluated. Among 870 vascular segments, excellent agreement was observed between T-MRA and DSA (mean κ = 0.883) in revealing stenosis (mean stenosis score, 2.1  ±  1.3 versus 2.0  ±  1.3). T-MRA harbored overall high sensitivity (99.5%), specificity (93.6%), positive predictive value (95.4%), negative predictive value (99.6%), and accuracy (97.7%) in depicting significant stenosis. Excellent interobserver agreement (mean κ = 0.818) of superb image quality (mean score = 3.5-3.6) of T-MRA and outstanding agreement of TASC II classification of aortoiliac and femoral-popliteal lesions (κ = 0.912-0.917) between two raters further verified the clinical feasibility of T-MRA for treatment planning.
authors.affiliation: Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan. sfa.ko@msa.hinet.net
authors.forename: Sheung-Fat
authors.initials: SF
authors.lastname: Ko
authors.forename: Jiunn-Jye
authors.initials: JJ
authors.lastname: Sheu
authors.forename: Chen-Chang
authors.initials: CC
authors.lastname: Lee
authors.forename: Chung-Cheng
authors.initials: CC
authors.lastname: Huang
authors.forename: Fan-Yen
authors.initials: FY
authors.lastname: Lee
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Lee
authors.forename: Hon-Kan
authors.initials: HK
authors.lastname: Yip
authors.forename: Min-Chi
authors.initials: MC
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods / Q000592:standards*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging*; D018810:Magnetic Resonance Angiography / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D012189:Retrospective Studies