[Cardiovascular whole-body MR imaging in patients with symptomatic peripheral arterial occlusive disease]
1Abteilung für Radiologie, Eberhard-Karls-Universität Tübingen. michael.fenchel@med.uni-tuebingen.de
Insights
Whole-body MRI effectively screens patients with peripheral arterial occlusive disease (PAOD) for systemic atherosclerosis, detecting cardiovascular and cerebral complications. This comprehensive MR exam aids in staging systemic atherosclerotic disease.
Area of Science:
- Cardiovascular Imaging
- Neuroradiology
- Vascular Imaging
Background:
- Peripheral arterial occlusive disease (PAOD) is a manifestation of systemic atherosclerosis.
- Comprehensive assessment of atherosclerosis extent is crucial for patient management.
- Whole-body MRI offers a non-invasive method for systemic evaluation.
Purpose of the Study:
- To evaluate the utility of a comprehensive whole-body MRI protocol for detecting systemic atherosclerotic effects in PAOD patients.
- To assess cardiovascular and cerebral involvement in patients with suspected systemic atherosclerosis.
Main Methods:
- Sixty patients with suspected PAOD underwent multi-station whole-body 3D MR angiography at 1.5 T.
- The protocol included cardiac imaging (functional and delayed enhancement) and brain imaging (FLAIR, TOF angiography).
- MR findings were compared to digital subtraction angiography (DSA) for vascular pathology assessment.
Main Results:
- Whole-body MRI demonstrated high sensitivity (94%) and specificity (96%) for detecting significant vascular stenosis (>70%).
- Systemic findings included microangiopathic alterations (n=7), cerebral infarction (n=18), left ventricular wall motion abnormalities (n=38), and myocardial infarction (n=24).
- Comprehensive diagnosis of cardiovascular pathology and staging of systemic atherosclerotic disease was feasible in a single MR examination.
Conclusions:
- A comprehensive whole-body MR examination is effective for diagnosing systemic atherosclerotic disease in PAOD patients.
- This approach facilitates the staging of systemic atherosclerosis by identifying associated cardiovascular and cerebral pathologies.
- Whole-body MRI provides a valuable tool for a holistic assessment of patients with PAOD.
Purpose:
To examine patients with peripheral-arterial-occlusive-disease (PAOD) for systemic effects associated with atherosclerosis using a comprehensive state-of-the-art whole-body MR examination protocol. The protocol comprises the assessment of the complete arterial vasculature (except coronary arteries), the brain, and the heart.
Materials And Methods:
Multi-station whole-body 3D MR angiography was performed in sixty consecutive patients with clinical suspicion for PAOD at 1.5 T (Magnetom Avanto, Siemens, Erlangen, Germany). Functional and delayed enhancement cardiac images were acquired, as well as FLAIR images of the brain and TOF angiography of intracranial vessels. MR and DSA images were assessed by independent observers for atherosclerotic manifestations and other pathology. Sensitivity and specificity for the detection of vascular pathology was calculated for MR data using conventional DSA of the symptomatic region as standard-of-reference.
Results:
Sensitivity and specificity for the detection of significant vascular stenosis (> 70 % luminal narrowing) was 94 % and 96 % (PPV 87 %, NPV 98 %). Significant microangiopathic tissue alterations (n = 7) and/or cerebral infarction (n = 18) were diagnosed in 23/60 patients. Thirty-eight of 60 patients presented with systolic left ventricular wall motion abnormalities. In 24 patients subendocardial or transmural delayed enhancement was detected in corresponding regions, indicating prior myocardial infarction.
Conclusion:
For patients with PAOD and suspected systemic atherosclerotic disease a comprehensive diagnosis of accompanying cardiovascular pathology and therefore staging of systemic atherosclerotic disease is feasible within one MR examination.
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