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Comparison of auto-moving table contrast-enhanced 3-D MRA and iodinated contrast-enhanced DSA for evaluating the
Cheng-Feng Ho1, Mei-Han Wu, Hsiu-Mei Wu
1Department of Radiology, Catholic Cardinal Tien Hospital, Taipei, Taiwan, ROC.
Insights
Contrast-enhanced 3-D MRA shows good agreement for peripheral arterial occlusive diseases (PAOD) but is limited by venous contamination, especially below the knee. Conventional DSA remains the gold standard for precise diagnosis in these cases.
Area of Science:
- Vascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Peripheral arterial occlusive diseases (PAOD) require accurate diagnostic imaging.
- Conventional x-ray iodinated digital subtraction angiography (DSA) is the established standard for PAOD diagnosis.
- Contrast-enhanced 3-dimensional magnetic resonance angiography (3-D MRA) offers a non-invasive alternative for evaluating PAOD.
Purpose of the Study:
- To compare the diagnostic efficacy of 3-D MRA with conventional DSA in patients with PAOD.
- To assess the image quality and agreement between 3-D MRA and DSA for lower extremity arteries.
- To identify limitations of 3-D MRA in diagnosing PAOD.
Main Methods:
- Twenty patients with diagnosed PAOD underwent both 3-D MRA and DSA of their lower extremities.
- DSA involved selective catheterization, while 3-D MRA used a single contrast bolus and auto-moving table.
- Arteries were segmented and graded for stenosis or occlusion; image quality was compared between modalities.
Main Results:
- High inter-observer agreement (k=0.6-1.0) was found between 3-D MRA and DSA.
- Intra-observer agreement was moderate to fair (k=0.32-0.57), better above than below the knee.
- 3-D MRA showed similar image quality to DSA in 57.5% (aortofemoral), 55% (femoropopliteal), and 37.5% (distal leg) of cases.
Conclusions:
- Venous contamination is a significant limitation of 3-D MRA, particularly in distal leg vessels.
- 3-D MRA can serve as an initial screening tool for PAOD.
- Conventional DSA remains superior for precise diagnosis of peripheral vascular diseases, especially in distal segments.
Background:
This study was conducted to compare diagnostic efficacy of contrast-enhanced 3-dimensional magnetic resonance angiography (3-D MRA) with that of the conventional x-ray iodinated digital subtraction angiography (DSA) in patients with peripheral arterial occlusive diseases (PAOD).
Methods:
Twenty patients with a clinical diagnosis of PAOD participated in this study. All patients were evaluated with both contrast-enhanced 3-D MRA and conventional x-ray iodinated DSA for the arteries of their lower extremities. The DSA was performed by a selective catheterization into the bilateral common or superficial femoral arteries, whereas 3-D MRA was performed with an auto-moving table covering the vascular tree from aorta to the arteries of ankle regions with 1 bolus injection of a triple-dose (0.3 mmol/kg) contrast medium. The arteries were divided into 23 anatomic segments and graded by their appearance on a 1-4 scale (1 = normal, 4 = total occlusion or no visible vessel). Evaluators also compared the images of 3-D MRA with those of the conventional x-ray iodinated DSA (as gold standard) with respect to image quality.
Results:
There was a high agreement (k = 0.6-1.0) between 2 observers' interpretations of the images obtained from 3-D MRA and conventional DSA. The agreement within each observer was moderate to fair (k = 0.32-0.57), and the better agreement was found with the images above knee level than those below knee level. As for the image quality of 3-D MRA, the frequencies of showing a similar image quality were 57.5%, 55%, and 37.5% at the aortofemoral, femoropopliteal, and distal leg levels, respectively.
Conclusions:
The main problem of the 3-D contrast enhanced MRA was the returned venous contamination of the image. It was particularly problematic for the areas below knee level. MRA can provide an initial evaluation for patients with PAOD, but cannot substitute for the conventional DSA as a precise diagnostic image modality for peripheral vascular diseases, especially for the distal legs.
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