Cardiovascular magnetic resonance imaging of aorto-iliac and ilio-femoral vascular calcifications using proton density-weighted in-phase stack of stars

Ali Serhal, Ioannis Koktzoglou, Pascale Aouad, James C. Carr, Shivraman Giri, Omar Morcos, Robert R. Edelman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Comparing cardiovascular magnetic resonance (CMR) angiography with computed tomography angiography (CTA), a major deficiency has been its inability to reliably image peripheral vascular calcifications that may impact the choice of interventional strategy and influence patient prognosis. Recently, MRI using a proton density-weighted, in-phase stack of stars (PDIP-SOS) technique has proved capable of detecting these calcifications. The goal of the present study was two-fold: (1) to determine whether magnetic field strength impacts the apparent size and conspicuity of ilio-femoral arterial calcifications; and (2) to determine whether the technique can be accurately applied to image aorto-iliac arterial calcifications. Main body: Two patient cohorts were studied. For the first cohort, ilio-femoral arterial calcifications were imaged at 1.5 Tesla in 20 patients and at 3 Tesla in 12 patients. For the second cohort, aorto-iliac arterial calcifications were imaged in 10 patients at 3 Tesla and one patient at 1.5 Tesla. Qualitative image analysis as well as quantitative analysis using a semi-automated technique were performed using CTA as the reference standard. Qualitatively, most PDIP-SOS CMR images showed good-to-excellent confidence to detect vascular calcifications, with good-to-excellent inter-reader agreement (κ = 0.67 for ilio-femoral region, P < 0.001; κ = 0.80 for aorto-iliac region, P < 0.01). There was an overall excellent correlation (r = 0.98, P < 0.001) and agreement (intraclass correlation coefficient = 0.97, P < 0.001) between PDIP-SOS CMR and CTA measures of calcification volume in both regions, with no overt difference in performance at 1.5 Tesla vs. 3 Tesla for ilio-femoral calcifications. CMR lesion volumes were slightly lower than those measured for CTA. Conclusion: Using PDIP-SOS CMR, aorto-iliac and ilio-femoral calcifications could be simultaneously evaluated at 3 Tesla in less than six minutes with excellent correlation and agreement to CTA. Our results suggest that PDIP-SOS CMR provides a reliable alternative to CT for pre-interventional evaluation of peripheral vascular calcium burden.

Original languageEnglish (US)
JournalJournal of Cardiovascular Magnetic Resonance
Issue number1
StatePublished - Aug 6 2018


  • CT angiography
  • Magnetic resonance imaging
  • Peripheral arterial disease
  • Quiescent-interval slice-selective
  • Stack of stars
  • Vascular calcification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging


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