Rationale and Objectives
Whole-body magnetic resonance angiography (WB-MRA) at 3 T with body coil acquisition has not previously been investigated. In this study, WB-MRA was performed in this manner using the blood pool contrast agent gadofosveset trisodium.
Materials and Methods
Eleven consecutive patients (five men, six women) with symptomatic peripheral arterial disease (two with critical limb ischemia, nine with claudication) were examined. Conventional digital subtraction angiography (DSA) of the aorta and the inflow and runoff arteries was used as the reference method. WB-MRA was performed using four slightly overlapping stations covering the arteries from the neck to the ankles. The arterial system was divided into 42 segments that were analyzed for the presence of significant arterial disease (≥50% luminal narrowing or occlusion) by two blinded observers.
Results
Sensitivities for detecting a significant arterial lesion with WB-MRA using gadofosveset as the contrast agent were 0.66 (95% confidence interval [CI], 0.49–0.79) and 0.68 (95% CI, 0.52–0.81) for the two observers. Specificities were 0.82 (95% CI, 0.74–0.88) and 0.93 (95% CI, 0.87–0.96), respectively. Intermodality agreement between WB-MRA and DSA was moderate to good, with overall κ values of 0.44 (95% CI, 0.29–0.59) and 0.63 (95% CI, 0.5–0.77) for the two observers. Interobserver agreement for WB-MRA was good, at κ = 0.60 (95% CI, 0.50–0.71).
Conclusion
WB-MRA at 3 T with body coil acquisition in patients with peripheral arterial disease showed good reproducibility but only moderate to good agreement with DSA. Further assessment of the method’s clinical application is warranted.
Exact visualization of the arteries and the extent of atherosclerotic disease is essential before peripheral arterial reconstruction. Today, digital subtraction angiography (DSA) is still the routine modality for lower-limb imaging at most centers. However, DSA is invasive and carries a small but constant risk for major complications of approximately 2% . Therefore, replacing DSA with a noninvasive alternative, such as duplex ultrasound, computed tomographic angiography, or contrast-enhanced magnetic resonance angiography (MRA), seems promising. These techniques focus on a specific part of the arterial system, despite the fact that atherosclerosis is a systemic disease affecting the entire arterial system. In this point of view, imaging procedures examining the whole arterial system are interesting .
Recent developments in magnetic resonance imaging (MRI), including faster gradient systems and extended tabletops, have made contrast-enhanced whole-body MRA (WB-MRA) from head to feet possible . The feasibility and clinical importance of WB-MRA at 1.5 T have been investigated in recent years, leading to acceptance of the method as a valuable diagnostic tool . WB-MRA can be performed with a magnetic resonance system’s built-in body coil or different systems of surface coils, allowing better signal-to-noise ratio (SNR) and higher spatial resolution .
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Materials and methods
Patients
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MRA
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DSA
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Image Evaluation
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Statistical Analysis
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Results
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Table 1
Nondiagnostic Segments on 3-T Whole-body Magnetic Resonance Angiography
Reason Observer 1 Observer 2 Segment partly outside field of view 7 9 Susceptibility artifact 4 7 Bolus/data acquisition mistiming 4 6 Motion artifact 2 5 Overall 17 28
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Table 2
Sensitivities and Specificities for the Detection of Significant Arterial Disease on 3-T Whole-body Magnetic Resonance Angiography
Observer 1 Observer 2 Region Sensitivity Specificity Sensitivity Specificity Pelvic ∗ 0.80 (0.51–0.95) 0.88 (0.74–0.96) 0.91 (0.65–1) 0.95 (0.83–0.99) Proximal femur † 0.78 (0.40–0.96) 0.93 (0.76–0.94) 0.80 (0.44–0.96) 0.91 (0.76–0.98) Distal femur ‡ 0.78 (0.40–0.96) 0.94 (0.68–0.94) 0.77 (0.40–0.96) 0.94 (0.69–0.99) Proximal crus § 0.20 (0.01–0.70) 0.80 (0.64–0.90) 0.20 (0.01–0.70) 0.93 (0.76–0.99) Distal crus || 0.50 (0.14–0.86) 0.61 (0.36–0.81) 0.20 (0.01–0.70) 0.91 (0.57–0.99) Overall 0.66 (0.49–0.79) 0.82 (0.74–0.88) 0.68 (0.52–0.81) 0.93 (0.87–0.96)
Values in parentheses are 95% confidence intervals.
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Table 3
Intermodality Agreement (κ) Between Whole-body Magnetic Resonance Angiography and Digital Subtraction Angiography
Region Observer 1 Observer 2 Pelvic ∗ 0.65 (0.44–0.87) 0.84 (0.65–1) Proximal femur † 0.71 (0.44–0.98) 0.69 (0.44–0.94) Distal femur ‡ 0.73 (0.45–1) 0.78 (0.46–1) Proximal crus § 0.22 (0–0.62) 0.16 (0.61) Distal crus || 0.09 (0–0.55) 0.13 (0.77) Overall 0.44 (0.29–0.59) 0.63 (0.5–0.77)
Values in parentheses are 95% confidence intervals.
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Table 4
Interobserver Agreement for 3-T Whole-body Magnetic Resonance Angiography
Region κ Neck ∗ 0.79 (0.38–1) Thorax † 0.84 (0.53–1) Abdomen ‡ 0.70 (0.32–1) Pelvis § 0.70 (0.50–0.91) Proximal femur || 0.59 (0.36–0.82) Distal femur ¶ 0.81 (0.63–0.99) Proximal crus # 0.58 (0.31–0.86) Distal crus ∗∗ 0.57 (0.27–0.88) Overall 0.60 (0.50–0.71)
Values in parentheses are 95% confidence intervals.
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Table 5
Significant Arterial Stenoses Detected on 3-T Whole-body Magnetic Resonance Angiography
Arterial Segment Observer 1 Observer 2 Internal carotid 3 2 Common carotid 2 1 Subclavian artery 4 3 Renal artery 4 3 Abdominal aorta 1 1
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Discussion
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