Peripheral Arterial Disease. Contrast-Enhanced 3D Mr Angiography of the Lower Leg and Foot Compared with Conventional Angiography

Abstract

Purpose: To determine whether contrast‐enhanced 3D MR angiography (CE MRA) could replace digital subtraction angiography (DSA) for the evaluation of atherosclerotic peripheral vascular disease of the lower leg and foot. Material and Methods: Thirty‐five patients with symptoms of atherosclerotic disease of the leg were examined prospectively with CE MRA of the foot and the lower legs as well as with DSA from the aorta to the pedal arches. The MRA technique was focused on optimal imaging of the arteries of the foot. Results: The agreement between CE MRA and DSA for grading of stenosis was moderate to good (weighted κ‐values 0.48–0.80). The sensitivity of CE MRA for detection of significant stenosis (≥50%) was 92% and the specificity was 64% with DSA as gold standard. Conclusion: CE MRA is a fairly accurate method for the demonstration of atherosclerotic disease below the knee including the pedal arches. It can replace DSA for the assessment of distal arteries in patients with impaired renal function. However, image quality and resolution still needs to be improved before CE MRA can become the method of choice in all patients.

MR angiography of the pedal arteries with gadobenate dimeglumine, a contrast agent with increased relaxivity, and comparison with selective intraarterial DSA

“…As yet only a few studies have investigated the accuracy of pedal CE‐MRA in comparison with DSA (4, 6, 10, 11, 25). Kreitner et al (4) showed in a study involving 24 diabetic patients that the pedal arch vessels were identified significantly more often on MR angiograms than on DSA images (22 [92%] of 24 feet vs. 9 [38%] of 24 feet).…”

“…Based on their findings, Hofmann et al (10) questioned whether DSA should still be considered a standard of reference. However, Cronberg et al (11), in a study conducted in 35 consecutive patients with PAOD, found that whereas CE‐MRA yielded a sensitivity of 92% for the detection of significant stenosis in the crural and pedal vessels when compared with DSA as the standard of reference, the specificity was only 64%. They therefore concluded that while CE‐MRA can be considered a useful diagnostic adjunct, it should not replace DSA as a standard of reference.…”

“…However, in the era of nephrogenic systemic fibrosis, the administration of any gadolinium‐based MR contrast agent may be a concern, especially in diabetic patients with impaired renal function (9). As yet, comparatively few studies have been performed to assess the value of CE‐MRA in patients with stenoocclusive disease of the pedal arteries (4, 6, 10, 11).…”

High temporal and spatial resolution 3D time‐resolved contrast‐enhanced magnetic resonance angiography of the hands and feet

“…(8–15) for the hands and from Refs. (16–24) for the feet. Another approach studied previously but not included in the tables is one using high frame rate 2D acquisition (25, 26).…”

Identification of candidate target genes for human peripheral arterial disease using weighted gene co-expression network analysis

“…The major risk factors for PAD are older age (>40 years), cigarette smoking and diabetes mellitus (2). Patients diagnosed with PAD suffer from a limitation in exercise capacity and reduced quality of life, and are at increased risk of cardiovascular-associated morbidity and mortality (3,4).…”