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Noncontrast-enhanced peripheral MRA: technical optimization of flow-spoiled fresh blood imaging for screening
Katsumi Nakamura1, Mitsue Miyazaki, Kiyomi Kuroki
1Department of Radiology, Tobata Kyoritsu Hospital, Kitakyushu, Fukuoka, Japan.
Abstract:
Flow-spoiled fresh blood imaging, a noncontrast peripheral MR angiography technique, allows the depiction of the entire tree of peripheral arteries by utilizing the signal difference between systolic- and diastolic-triggered data. The image quality of the technique relies on selecting the right triggering delay times and flow-dependent read-out spoiler gradient pulses. ECG triggering delays were verified using manual subtraction and automated software. The read-out spoiler gradients pulses were optimized on volunteers before utilizing the flow-spoiled fresh blood imaging technique to screen for peripheral arterial disease. Thirteen consecutive patients with suspected peripheral arterial disease underwent both flow-spoiled fresh blood imaging and 16-detector-row computed tomography angiography examinations. A total of 23 segments were evaluated in the arterial vascular system. Using computed tomography angiography as the reference standard, 56 diseased segments were detected with 22 nonsignificant stenoses (<50%) and 34 significant stenoses, 15 of which were totally occluded. Flow-spoiled fresh blood imaging had a sensitivity of 97%, a specificity of 96%, an accuracy of 96%, a positive predictive value of 88%, and a negative predictive value of 99%. With such a high negative predictive value, flow-spoiled fresh blood imaging has the potential to become the safest noninvasive screening tool for peripheral arterial disease, especially for patients with impaired renal function.
Insights
Flow-spoiled fresh blood imaging is a noncontrast MR angiography technique for peripheral arterial disease screening. It demonstrates high accuracy and a 99% negative predictive value, making it a safe option, particularly for patients with kidney issues.
Area of Science:
- Medical Imaging
- Cardiovascular Radiology
- Magnetic Resonance Imaging
Background:
- Peripheral arterial disease (PAD) diagnosis often relies on contrast-enhanced imaging, posing risks for patients with renal impairment.
- Noncontrast MR angiography techniques are sought to provide safe and effective PAD screening.
Purpose of the Study:
- To evaluate the diagnostic performance of flow-spoiled fresh blood imaging for peripheral arterial disease.
- To assess its potential as a safe, noninvasive screening tool for PAD.
Main Methods:
- Flow-spoiled fresh blood imaging, a noncontrast peripheral MR angiography technique, was employed.
- ECG triggering delays and flow-dependent read-out spoiler gradients were optimized.
- The technique was compared against 16-detector-row computed tomography angiography in 13 patients with suspected PAD.
Main Results:
- Flow-spoiled fresh blood imaging demonstrated high diagnostic accuracy (96%) with a sensitivity of 97% and specificity of 96%.
- It achieved a negative predictive value of 99%, indicating high reliability in ruling out disease.
- The technique successfully depicted the entire peripheral arterial tree.
Conclusions:
- Flow-spoiled fresh blood imaging is a highly accurate noncontrast MR angiography technique for PAD screening.
- Its excellent negative predictive value suggests it is a safe and effective alternative, especially for patients with compromised renal function.
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