title: Non-contrast-enhanced MR angiography in critical limb ischemia: performance of quiescent-interval single-shot (QISS) and TSE-based subtraction techniques.
abstract: OBJECTIVE
  The aim of this study was to evaluate diagnostic performance of non-contrast-enhanced 2D quiescent-interval single-shot (QISS) and 3D turbo spin-echo (TSE)-based subtraction magnetic resonance angiography (MRA) in the assessment of peripheral arteries in patients with critical limb ischemia (CLI).
  
  
  METHODS
  Nineteen consecutive patients (74 % male, 72.8 ± 9.9 years) with CLI underwent 2D QISS and 3D TSE-based subtraction MRA at 1.5 T. Axial-overlapping QISS MRA (3 mm/2 mm; 1 × 1 mm2) covered from the toes to the aortic bifurcation while coronal 3D TSE-based subtraction MRA (1.3 × 1.2 × 1.3 mm3) was restricted to the calf only. MRA data sets (two readers) were evaluated for stenosis (≥50 %) and image quality. Results were compared with digital subtraction angiography (DSA).
  
  
  RESULTS
  Two hundred and sixty-seven (267) segments were available for MRA-DSA comparison, with a prevalence of stenosis ≥50 % of 41.9 %. QISS MRA was rated as good to excellent in 79.5-96.0 % of segments without any nondiagnostic segments; 89.8-96.1 % of segments in 3D TSE-based subtraction MRA were rated as nondiagnostic or poor. QISS MRA sensitivities and specificities (segmental) were 92 % and 95 %, respectively, for reader one and 81-97 % for reader two. Due to poor image quality of 3D TSE-based subtraction MRA, diagnostic performance measures were not calculated.
  
  
  CONCLUSIONS
  QISS MRA demonstrates excellent diagnostic performance and higher robustness than 3D TSE-based subtraction MRA in the challenging patient population with CLI.
  
  
  CONCLUSIONS
  • QISS MRA allows reliable diagnosis of peripheral artery stenosis in critical limb ischemia. • Robustness of TSE-based subtraction MRA is limited in critical limb ischemia. • QISS MRA allows robust therapy planning in PAD patients with resting leg pain.
authors.affiliation: Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Mustafa A
authors.initials: MA
authors.lastname: Altaha
authors.affiliation: Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.|Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Jaskolka
authors.affiliation: Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.|Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kongteng
authors.initials: K
authors.lastname: Tan
authors.affiliation: Siemens Healthcare, Erlangen, Germany.
authors.forename: Manuela
authors.initials: M
authors.lastname: Rick
authors.affiliation: Siemens Healthcare, Erlangen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schmitt
authors.affiliation: Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.|Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ravi J
authors.initials: RJ
authors.lastname: Menezes
authors.affiliation: Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. Bernd.Wintersperger@uhn.ca.|Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada. Bernd.Wintersperger@uhn.ca.|Department of Medical Imaging, Toronto General Hospital, 1 PMB-273, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada. Bernd.Wintersperger@uhn.ca.
authors.forename: Bernd J
authors.initials: BJ
authors.lastname: Wintersperger
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000473:pathology; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Angiography, Digital subtraction; Ischemia; Magnetic resonance angiography; Magnetic resonance imaging; Peripheral arterial disease