Unenhanced 3D turbo spin echo MR angiography of lower extremity arteries: comparison with 128-MDCT angiography

This study aimed to investigate the feasibility and diagnostic power of unenhanced 3D turbo spin echo MR angiography sequence (a technique based on subtraction of corresponding images acquired in diastole and systole, Syngo Native Space-Siemens healthcare) to identify peripheral artery disease (PAD).

Thirty patients (619 arterial segments in total) suspected with PAD and who were assessed with lower extremity MDCT angiography were examined starting from the level of aortic bifurcation for both lower extremities by 3D native space MR angiography. Two readers assessed the image quality of native space MR angiography and number of lesions, their degrees of stenosis and localizations. The differences and compliance between the readers in the parameters assessed were investigated.

Out of 619 segments; Reader 1 considered 187 segments (30.2 %) and Reader 2 considered 177 segments (28.6 %) to have poor and inadequate MR image quality. When compared to CTA, sensitivity, specificity and diagnostic accuracy of native space MR angiography were calculated as 81.0, 83.1, 82.6 %, respectively, by Reader 1, while the same parameters were calculated as 69.9, 92.6, 84.9 %, respectively, by Reader 2. When the two readers were examined together, sensitivity, specificity, diagnostic accuracy were found to be 76.3, 88.1, 83.7 %, respectively, and the positive predictive value and negative predictive value was 70.3 and 89.9 %, respectively. A significantly better image quality was acquired with the age group below 50 years (p = 0.002).

Native space MR angiography technique can be used as the first-step imaging technique before contrast-enhanced examinations in young and middle age patients with suspected PAD and for patients with the risk of nephrogenic systemic fibrosis in chronic renal failure.