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Contrast enhanced MR angiography in the assessment of relevant stenoses in occlusive disease of the pelvic and lower limb arteries: diagnostic value of a two-step examination protocol in comparison to conventional DSA

2002; Elsevier BV; Volume: 41; Issue: 2 Linguagem: Inglês

10.1016/s0720-048x(01)00386-2

1872-7727

Jan Thorsten Winterer, Oliver Schaefer, P. Uhrmeister, Gesine G. Zimmermann‐Paul, S. Lehnhardt, Carsten Altehoefer, J. Laubenberger,

Cardiac Imaging and Diagnostics

Contrast-enhanced MRA (ce-MRA) has been claimed by many authors as a replacement of conventional angiography evaluating peripheral arterial occlusive disease. However, reliable detection of relevant stenoses (>70%) has to be provided for planning vascular interventions. Only few data in the literature focuses on this crucial problem. The purpose of this study was to evaluate this topic using a two-step body-coil-based MRA protocol.Forty three patients presenting with 82 stenoses >/=50% and 61 stenoses >70% on conventional catheter angiogram received fast Gadolinium-DTPA-enhanced high resolution 3D MR angiography at 1.5 T covering the pelvic and peripheral vascular tree in two examination steps using the body-coil. The data were evaluated double-blinded by three readers distinguishing moderate (50-70%) from severe stenoses (>70%).Overall sensitivity/specificity/accuracy was 84/60/70% evaluating 143 segments. Specificity was rather poor in the iliac (58%) and crural (50%) region and moderate in the femoral and popliteal level (73%). The negative predictive value ranged between 78 and 91%. The grade of stenosis tend to be overestimated rather than underestimated in all levels with positive predictive values between 55 and 78%.Body-coil-based contrast-enhanced MRA has limited potential in distinguishing moderate from severe stenoses in peripheral occlusive disease. Overestimations are more common than underestimations. Both occur mainly in small-sized crural arteries but also in larger iliac arteries where vessel course in partition direction may cause inadequacy between voxel size and lumen diameter in severe stenosis.