Noncontrast ultrashort echo time magnetic resonance imaging-guided staging predicts in vivo lower extremity...

Our understanding of plaque morphology and its relationship with procedural complexity and immediate technical failure (ITF) in percutaneous vascular intervention is poorly understood, particularly in tibial disease due to significant limitations of computed tomographic angiography, digital subtraction angiography, and duplex ultrasound imaging. Ultrashort echo time magnetic resonance imaging (UTE MRI) is a noncontrast, 3T MRI technique that can identify and differentiate plaque morphology and characteristics. The aim of this study was to create a UTE MRI-defined staging system to support clinicians in evaluating endovascular procedural complexity.

Patients scheduled for percutaneous vascular intervention underwent preoperative UTE MRI. Lesions were graded based on MRI-defined anatomical characteristics and plaque morphology on a four-scale staging system, where stage A was least severe and stage D was most severe. The primary outcome was the association of UTE stage with ITF and was evaluated using logistic regression. Secondary outcomes included associations between UTE stage and the number of wire/catheter escalations required during the procedure, and UTE stage and the number of treatment devices used. Transatlantic Intersociety Consensus (TASC) scoring was also evaluated and investigated for any influence on ITF.

A total of 47 patients with 90 arterial lesions were included. Stage D and stage C UTE MRI-defined disease strongly influenced ITF (odds ratio [OR], 114.3; 95% confidence interval [CI], 10.4-1257.5; P < .001 and OR, 21.0; 95% CI, 2.33-189.3; P = .007, respectively). Logistic regression identified that stage D disease was 99 times more likely to require catheter/wire escalations for crossing (OR, 0.01; 95% CI, 0.00-0.24; P = .004). The UTE MRI stage did not influence the number of treatment devices used (χ² = 2.53; P = .47). Logistic regression showed that TASC score had no influence on ITF (χ² = 2.13; P = .55).

UTE MRI-defined staging is strongly associated with ITF, crossing time, and the need for crossing device escalation, whereas TASC staging had no influence on ITF. This study supports the notion that an understanding of plaque morphology and plaque characteristics is pivotal to procedural planning.