Novel Diagnostic Options without Contrast Media or Radiation: Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging in Treating Different Leg Venous Diseases

Abstract

Objectives: Venous diseases in the lower extremities long lacked an objective diagnostic tool prior to the advent of the triggered angiography non-contrast-enhanced (TRANCE) technique. Methods: An observational study with retrospective data analysis. Materials: Between April 2017 and June 2019, 66 patients were evaluated for venous diseases through TRANCE-magnetic resonance imaging (MRI) and were grouped according to whether they had occlusive venous (OV) disease, a static venous ulcer (SU), or symptomatic varicose veins (VV). The clinical appliance of TRANCE-MRI was analysed by groups. Results: In total, 63 patients completed the study. TRANCE-MRI could identify venous thrombosis, including that of the abdominal and pelvic vessels, and it enabled the timely treatment of underlying diseases in patients with OV disease. TRANCE-MRI was statistically compared with the duplex scan, the gold standard to exclude deep vein thrombosis (DVT) in the legs, with regard to their abilities to detect venous thrombosis by using Cohen’s kappa coefficient at a compatible value of 0.711. It could provide the occlusion degree of the peripheral artery for treating an SU. Finally, TRANCE-MRI can be used to outline all collateral veins and occult thrombi before treating symptomatic or recurrent VV to ensure a perfect surgical plan and to avoid complications. Conclusions: TRANCE-MRI is an innovative tool in the treatment of versatile venous pathology in the lower extremities and is widely used for vascular diseases in our institution.

Discriminating Reflux from Non-Reflux Diseases of Superficial Veins in Legs by Novel Non-Contrast MR with QFlow Technique

“…Most related studies on non-contrast-enhanced MR have used this technique to evaluate arterial diseases [ 21 , 22 , 23 , 24 , 25 ]. Our team has innovated the use of TRANCE-MRI for obtaining more valuable information for the management of complicated lower venous diseases [ 4 , 5 , 6 , 11 ]. Moreover, experienced radiological teams may require an examination time of less than 30 min.…”

“…Venous diseases in those legs may be caused by superficial venous reflux from valvular dysfunction, occlusion of the deep venous system by thrombi, and compression of the pelvic mass. The resulting signs include spider veins, foot pigmentation, claudication, stasis ulcers, swollen limbs with deep vein thrombosis, and the fatal consequence of the pulmonary emboli [ 1 , 2 , 3 , 4 , 5 , 6 ]. Ultrasound examination (US) is the standard procedure for venous disease of the legs and could provide most information by experienced operators [ 7 , 8 ].…”

“…This technique was initially evaluated for pelvic vessels. Our clinical applications of this technique have innovated the anatomy of the whole venous system in legs since 2017 and further proven its efficiency in different venous scenarios thereafter [ 6 , 10 , 11 ]. TRANCE-MRI helps to not only exclude venous compression but also reveal the major tributaries, thus providing better guidance for venous ablation.…”

Stasis Leg Ulcers: Venous System Revises by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging

“…Although there is some related literature on non-contrast-enhanced MRA, most of them are associated with researchers using this technique to evaluate arterial diseases [ 26 , 27 , 28 , 29 ]. Our team has innovated the use of TRANCE-MRI for providing more valuable information for management of complicated lower venous diseases [ 5 , 6 ].…”

“…The triggered angiography non-contrast-enhanced (TRANCE) technique records differences in vascular signal intensity during the cardiac cycle for subsequent image subtraction [ 4 ]. It provides both venograms and arteriograms without the use of contrast agents and currently serves as an alternative in the evaluation of possible complicated vascular status in the Wound and Vascular Center at our institution [ 5 , 6 ]. In this study, we present our experience of applying TRANCE-magnetic resonance imaging (MRI) for evaluating the venous status of patients with stasis leg ulcers.…”