Non-Contrast UTE MRI Guided Staging Predicts In-Vivo Lower Extremity Endovascular Procedural Complexity
Alexander B Crichton1, Eniko Pomozi2, Judit Csore3
1Houston Methodist DeBakey Heart and Vascular Center, Houston, Tx, USA; Birmingham University, Birmingham, UK.
Journal of Vascular Surgery
|July 24, 2026
Summary
Ultrashort echo time (UTE) MRI effectively stages tibial artery disease, predicting procedural complexity and immediate technical failure in percutaneous vascular intervention (PVI). This UTE MRI staging system offers superior insight compared to traditional TASC scoring for endovascular planning.
Area of Science:
- Vascular Surgery
- Radiology
- Medical Imaging
Background:
- Percutaneous vascular intervention (PVI) for tibial disease faces challenges due to poor understanding of plaque morphology and limitations of conventional imaging (CTA, DSA, DUS).
- Ultrashort echo time (UTE) MRI, a non-contrast 3T technique, shows promise in characterizing plaque morphology and characteristics.
- A standardized UTE MRI staging system is needed to aid clinicians in evaluating endovascular procedural complexity.
Purpose of the Study:
- To develop and validate a UTE MRI-defined staging system for tibial artery lesions.
- To assess the association between UTE MRI stages and immediate technical failure (ITF) in PVI.
- To compare the predictive value of UTE MRI staging with TASC scoring for procedural outcomes.
Main Methods:
- Patients undergoing PVI for tibial disease received pre-operative UTE MRI.
- Lesions were classified into four stages (A-D) based on MRI-defined plaque characteristics.
- Logistic regression analyzed the correlation between UTE MRI stages, ITF, and procedural escalations.
Main Results:
- UTE MRI stages C and D were significantly associated with ITF (p<0.001 and p=0.007, respectively).
- Stage D disease increased the likelihood of requiring catheter/wire escalations for lesion crossing (OR 0.01, p=0.004).
- TASC scoring did not demonstrate a significant influence on ITF (p=0.55).
Conclusions:
- UTE MRI-defined staging strongly correlates with ITF and procedural complexity, including the need for escalation.
- The UTE MRI staging system provides valuable insights into plaque morphology, crucial for procedural planning in PVI.
- UTE MRI offers a promising alternative to conventional imaging for assessing tibial disease severity and predicting PVI outcomes.
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