Diagnostic Accuracy of Contrast-Enhanced Magnetic Resonance Angiography and Duplex Ultrasound in Patients With Peripheral Vascular Disease

Bueno, Dra Alicia; Aciń, Francisco; Cañibano, Dra Cristina; Fernández-Casado, Jose L.; Castillo, Ernesto

doi:10.1177/1538574410377018

Cited by 11 publications

(8 citation statements)

References 44 publications

(71 reference statements)

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“…Nine patients underwent DSA for correlation in 115 segments. The lack of the invasive reference standard for all patients reflects the fact that CEMRA—because of its excellent diagnostic accuracy [21] and noninvasive nature—has in recent years emerged as an alternative to intraarterial DSA [22, 23]. …”

Section: Methodsmentioning

confidence: 99%

Peripheral Arterial Disease in a Symptomatic Diabetic Population: Prospective Comparison of Rapid Unenhanced MR Angiography (MRA) With Contrast-Enhanced MRA

Hodnett

Ward

Davarpanah³

et al. 2011

American Journal of Roentgenology

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OBJECTIVE The joint guidelines of the American College of Cardiology and American Heart Association support the use of contrast-enhanced MR angiography (CEMRA) to diagnose the location and degree of stenosis in patients with known or suspected peripheral arterial disease (PAD). The high prevalence of chronic renal impairment in diabetic patients with PAD and the need for high doses of gadolinium-based contrast agents place them at risk for nephrogenic systemic fibrosis. The purpose of our study was to evaluate the accuracy of the rapid technique of quiescent-interval single-shot (QISS) unenhanced MR angiography (MRA) compared with CEMRA for the diagnosis in diabetic patients referred with symptomatic chronic PAD. SUBJECTS AND METHODS This prospective two-center study evaluated 25 consecutive diabetic patients with documented or suspected symptomatic PAD. Both centers used identical imaging protocols. Images were independently analyzed by two radiologists. A subgroup analysis was performed of patients who were also assessed with digital subtraction angiography (DSA) as part of the standard-of-care protocol before revascularization. RESULTS For this study, 775 segments were analyzed. On a per-segment basis, the mean values of the diagnostic accuracy of unenhanced MRA compared with reference CEMRA for two reviewers, reviewers 1 and 2, were as follows: sensitivity, 87.4% and 92.1%; specificity, 96.8% and 96.0%; positive predictive value, 90.8% and 94.0%; and negative predictive value, 95.5% and 94.6%. Substantial agreement was found when overall DSA results were compared with QISS unenhanced MRA (κ = 0.68) and CEMRA (κ = 0.63) in the subgroup of patients who also underwent DSA. There was almost perfect agreement between the two readers for stenosis scores, with Cohen’s kappa values being greater than 0.80 for both MRA techniques. CONCLUSION The results of our study indicate that QISS unenhanced MRA is an accurate noncontrast alternative to CEMRA for showing clinically significant arterial disease in patients with diabetes with symptomatic PAD.

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Section: Methodsmentioning

confidence: 99%

Peripheral Arterial Disease in a Symptomatic Diabetic Population: Prospective Comparison of Rapid Unenhanced MR Angiography (MRA) With Contrast-Enhanced MRA

Hodnett

Ward

Davarpanah³

et al. 2011

American Journal of Roentgenology

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“…These studies have also been shown to be sensitive and specific in detection of PAD while being less invasive than standard angiography. 3,14 However, these diagnostic modalities have risks of contrast-induced nephropathy, additional contrast load, systemic sclerosis, and patient limitations (e.g., pacemakers). Additionally, they are more expensive when compared with DUS and angiography may still be required for an intervention once completed.…”

Section: Discussionmentioning

confidence: 99%

“…1 Duplex ultrasonography (DUS) is a primary screening tool used to evaluate arterial disease in carotid arteries, renal arteries, and peripheral arteries. [2][3][4][5][6][7][8] It is also used as a surveillance tool in postintervention patients to monitor re-stenosis or to detect disease development in another location. 9-17 DUS is an optimal modality for these applications, as it is noninvasive and safe, with relatively no morbidity.…”

mentioning

confidence: 99%

Accuracy of Duplex Ultrasonography in Estimation of Severity of Peripheral Vascular Disease

et al. 2013

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Duplex ultrasonography (DUS) is a safe, noninvasive method for imaging vasculature when compared with conventional angiography. Our goal is to assess the accuracy of DUS compared with angiography of the lower extremities. We reviewed a total of 373 lesions in 278 patients from July 2005 through June 2010. Patients underwent DUS followed by angiography within 30 days. Peak systolic velocities (PSV) were stratified into one of four categories and compared with the angiographic findings. Seventy-five chronic total occlusions were found. Of the remaining 298 lesions, a significant relationship was found between PSV and degree of angiographic stenosis (p < 0.001). DUS was found to demonstrate a sensitivity of 79.7%, specificity of 79.2%, positive predictive value of 88.2%, and negative predictive value of 66.7% for lesions ≥ 70%. The 66.7% of the false-negative lesions with the lowest velocities were below the knee joint. DUS of the lower extremities is accurate in determining the degree of stenosis ranging from mild-to-severe disease. Some limitation may exist in estimating the degree of stenosis below the knee.

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“…Der klinische Benefit bzw. der Einfluss auf eventuelle Therapieentscheidungen muss jedoch noch in größeren, klinischen Studien untersucht werden [4]. Eine verlässliche Diagnostik der Fußarterien mittels CE-MRA ist durch den Einsatz eines gadoliniumhaltigen Kontrastmittels (Gd-KM) mit höherer Relaxivität (stärkeres T1-Signal) möglich.…”

Section: Indikationen Und Rolle Der Mra In Der Klinischen Praxisunclassified

“…MR-Angiografien sollten immer gemeinsam mit funktionellen Untersuchungsverfahren beurteilt werden. Die CE-MRA wird durch eine Duplexsonografie sinnvoll ergänzt, wobei die aortoiliakale Strombahn eine bekannte Schwachstelle der Duplexsonografie darstellt [4]. Als Vorteil gegenüber der CTA ist zu erwähnen, dass die MRA ohne ionisierende Strahlung (insbesondere relevant bei jüngeren Patienten) auskommt und dass Kontrastmittel, die in diagnostischer Dosis potenziell nephrotoxisch sind, vermieden werden können.…”

Section: Wertigkeit Der Mraunclassified

MR-Angiografie zur Gefäßdiagnostik

Blondin

Heiß

2013

Aktuel Kardiol

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Zusammenfassung Die Magnetresonanzangiografie (MRA) mit gadoliniumhaltigem Kontrastmittel ist mittlerweile ein nicht invasives bildgebendes Standardverfahren, bei der mit ?blichen MR-Tomografen unter Verwendung von Oberfl?chenspulen und 3-D-Gradientenechosequenzen qualitativ hochwertige 3-D-Gef??rekonstruktionen erstellt werden k?nnen. Die Hauptindikationen liegen in der Diagnostik und Behandlungsplanung der peripheren arteriellen Verschlusskrankheit. Mit hoher Sensitivit?t und Spezifit?t k?nnen klinisch relevante Stenosen erfasst und Kollateralgef??e dargestellt werden. Diagnostische Limitationen liegen vor allem in der Darstellung peripherer kleiner Arterien sowie im Bereich von Stents. Die wichtigsten Kontraindikationen umfassen Herzschrittmacher, implantierte Defibrillatoren und unklare Metallimplantate sowie Schwangerschaft im 1.?Trimenon. Bei niereninsuffizienten Patienten mit einer glomerul?ren Filtrationsrate von

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Diagnostic Accuracy of Contrast-Enhanced Magnetic Resonance Angiography and Duplex Ultrasound in Patients With Peripheral Vascular Disease

Abstract: Combined CE-MRA and DU is the first diagnostic approach in the preoperative assessment of PAD, leading to the use of DSA for selected cases.

Cited by 11 publications

References 44 publications

Peripheral Arterial Disease in a Symptomatic Diabetic Population: Prospective Comparison of Rapid Unenhanced MR Angiography (MRA) With Contrast-Enhanced MRA

Peripheral Arterial Disease in a Symptomatic Diabetic Population: Prospective Comparison of Rapid Unenhanced MR Angiography (MRA) With Contrast-Enhanced MRA

Accuracy of Duplex Ultrasonography in Estimation of Severity of Peripheral Vascular Disease

MR-Angiografie zur Gefäßdiagnostik

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