Diagnostic Accuracy of Noncontrast MR Angiography Protocols at 3T for the Detection and Characterization of Lower Extremity Peripheral Arterial Disease

Christopher J. Hanrahan*, Marc D. Lindley, Michelle Mueller, Daniel Kim, Daniel Sommers, Glen Morrell, Andrew Redd, Kristi Carlston, Vivian S. Lee

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Purpose: To compare the diagnostic accuracy of established non–gadolinium (Gd)-enhanced magnetic resonance (MR) angiography protocols with Gd-enhanced MR angiography at 3T for evaluating lower extremity peripheral arterial disease (PAD). Materials and Methods: From February 2014 to 2015, 20 patients with PAD and intermittent claudication (16 men; age range, 51–76 y; Fontaine stage II) underwent 3-station (abdominopelvic, thigh, and calf) non-Gd MR angiography and bolus-chase Gd MR angiography protocols performed at 3T (Siemens Tim Trio), including quiescent-interval single-shot (QISS) MR angiography for all 3 stations and a combination of quadruple inversion recovery (QIR) MR angiography for the abdominopelvic station and electrocardiogram-gated fast spin echo (ECG-FSE) MR angiography for the extremities. Two radiologists independently evaluated vessel segments for vascular stenosis, diagnosis confidence, graft presence, and Trans-Atlantic Inter-Society Consensus (TASC) II classification for each station. Diagnostic accuracies and κ agreement were assessed. Results: Of 573 vascular segments imaged, 16.9% (97/573, 19/20 patients) demonstrated hemodynamically significant abnormalities. Reader confidence was sufficient for diagnosis in 98% of segments with Gd MR angiography, 93% with QIR/ECG-FSE, and 95% with QISS. Overall reader confidence was higher with QISS than QIR/ECG-FSE within all 3 stations combined (P <.05). With low-confidence segments treated as misdiagnosis, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and κ agreement for all 3 stations combined were 81.4/87.2/57.0/95.8/86.2%/0.578 for QIR/ECG-FSE and 75.0/90.6/61.6/94.7/88.0%/0.597 for QISS. Using TASC II criteria to assess severity, QISS and QIR/ECG-FSE had no statistical difference in agreement with Gd MR angiography. Conclusions: QISS and QIR/ECG-FSE MR angiography protocols demonstrate comparable diagnostic accuracies with high specificity. Either protocol provides an alternative to Gd MR angiography at 3T for patients with PAD.

Original languageEnglish (US)
Pages (from-to)1585-1594.e2
JournalJournal of Vascular and Interventional Radiology
Volume29
Issue number11
DOIs
StatePublished - Nov 1 2018

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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