Accuracy of Noncontrast Quiescent-Interval Single-Shot Lower Extremity MR Angiography Versus CT Angiography for Diagnosis of Peripheral Artery Disease

Varga-Szemes, Ákos; Wichmann, Julian L.; Schoepf, U. Joseph; Surányi, Pál; Cecco, Carlo N. De; Muscogiuri, Giuseppe; Caruso, Damiano; Yamada, Ricardo; Litwin, Sheldon E.; Tesche, Christian; Duguay, Taylor M.; Giri, Shivraman; Vliegenthart, Rozemarijn; Todoran, Thomas M.

doi:10.1016/j.jcmg.2016.09.030

Cited by 51 publications

(48 citation statements)

References 26 publications

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“…Interestingly, the majority of segments excluded from CTA (7 of 8) due to heavy calcifications were diagnostic with QISS. Furthermore, QISS diagnostically visualized all of the segments that were excluded from CTA due to insufficient opacification [32]. These results support the use of QISS for the diagnosis of PAD, particularly in patients with diffuse calcific disease, and underscore its utility in patients for whom contrast is contraindicated.…”

Section: Discussionmentioning

confidence: 67%

“…In a study of 30 patients with PAD, the ability to detect clinically significant stenosis was compared between third-generation, dual-source, dual-energy CTA and 1.5T QISS MRA with DSA as the reference standard. Two readers analyzed 483 total segments, of which DSA results were also available for 410, and found the subjective image quality to be similar among the two techniques [32]. The diagnostic accuracy among the techniques was also similar; sensitivity/specificity for QISS were 84.9% and 97.2%, while for CTA they were 87.3% and 95.4%.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnostic accuracy among the techniques was also similar; sensitivity/specificity for QISS were 84.9% and 97.2%, while for CTA they were 87.3% and 95.4%. Of note, certain stents and radiofrequency noise rendered a small portion of QISS segments non-diagnostic, whereas stenting, heavy calcifications and suboptimal opacification rendered a small portion of CTA images non-diagnostic [32]. Interestingly, the majority of segments excluded from CTA (7 of 8) due to heavy calcifications were diagnostic with QISS.…”

Section: Discussionmentioning

confidence: 99%

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Quiescent-Interval Single-Shot Magnetic Resonance Angiography

et al. 2018

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Lower extremity peripheral arterial disease (PAD) is a chronic, debilitating disease with a significant global burden. A number of diagnostic imaging techniques exist, including computed tomography angiography (CTA) and contrast-enhanced magnetic resonance angiography (CEMRA), to aid in PAD diagnosis and subsequent treatment planning. Due to concerns of renal toxicity or nephrogenic systemic fibrosis (NSF) for iodinated and gadolinium-based contrasts, respectively, a number of non-enhanced MRA (NEMRA) protocols are being increasingly used in PAD diagnosis. These techniques, including time of flight and phase contrast MRA, have previously demonstrated poor image quality, long acquisition times, and/or susceptibility to artifacts when compared to existing contrast-enhanced techniques. In recent years, Quiescent-Interval Single-Shot (QISS) MRA has been developed to overcome these limitations in NEMRA methods, with promising results. Here, we review the various screening and diagnostic tests currently used for PAD. The various NEMRA protocols are discussed, followed by a comprehensive review of the literature on QISS MRA to date. A particular emphasis is placed on QISS MRA feasibility studies and studies comparing the diagnostic accuracy and image quality of QISS MRA versus other diagnostic imaging techniques in PAD.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Quiescent-Interval Single-Shot Magnetic Resonance Angiography

et al. 2018

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“…Our MRI evaluation of aortoiliofemoral access routes in 26 patients referred for TAVI planning was based on QISS-MRA measurements. This unenhanced MRA technique was first introduced in 2010 by Edelman et al and until now has been evaluated in a large field of clinical applications at 1.5 T and 3 T [16][17][18][19], mainly for the detection and characterization of lower extremity arterial disease [20][21][22][23][24], and also in the demonstration of the pulmonary embolism [19], for coronary imaging [25], and for intracranial MRA [26].…”

Section: Discussionmentioning

confidence: 99%

Non-contrast MRI protocol for TAVI guidance: quiescent-interval single-shot angiography in comparison with contrast-enhanced CT

et al. 2020

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Objectives To prospectively compare unenhanced quiescent-interval single-shot MR angiography (QISS-MRA) with contrastenhanced computed tomography angiography (CTA) for contrast-free guidance in transcatheter aortic valve intervention (TAVI). Methods Twenty-six patients (mean age 83 ± 5 years, 15 female [58%]) referred for TAVI evaluation underwent QISS-MRA for aortoiliofemoral access guidance and non-contrast three-dimensional (3D) "whole heart" MRI for prosthesis sizing on a 1.5-T system. Contrast-enhanced CTA was performed as imaging gold standard for TAVI planning. Image quality was assessed by a 4point Likert scale; continuous MRA and CTA measurements were compared with regression and Bland-Altman analyses.Results QISS-MRA and CTA-based measurements of aortoiliofemoral vessel diameters correlated moderately to very strong (r = 0.572 to 0.851, all p ≤ 0.002) with good to excellent inter-observer reliability (intra-class correlation coefficient (ICC) = 0.862 to 0.999, all p < 0.0001) regarding QISS assessment. Mean diameters of the infrarenal aorta and iliofemoral vessels differed significantly (bias 0.37 to 0.98 mm, p = 0.041 to < 0.0001) between the two modalities. However, inter-method decision for transfemoral access route was comparable (κ = 0.866, p < 0.0001). Aortic root parameters assessed by 3D whole heart MRI strongly correlated (r = 0.679 to 0.887, all p ≤ 0.0001) to CTA measurements. Conclusion QISS-MRA provides contrast-free access route evaluation in TAVI patients with moderate to strong correlations compared with CTA and substantial inter-observer agreement. Despite some significant differences in minimal vessel diameters, inter-method agreement for transfemoral accessibility is strong. Combination with 3D whole heart MRI facilitates unenhanced TAVI guidance. Key Points • QISS-MRA and CTA inter-method agreement for transfemoral approach is strong. • QISS-MRA is a very good alternative to CTA and MRA especially in patients with Kidney Disease Outcomes Quality Initiative stages 4 and 5. • Combination of QISS-MRA and 3D "whole heart" MRI facilitates fully unenhanced TAVI guidance.

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“…In nine studies that included a total of 254 patients and used CEMRA as the reference standard examination, QISS provided a median sensitivity of ∼89% and a median specificity of ∼96% (evidence level 1b) . In eight studies with reference to DSA as the gold standard (154 total patients), median values for the sensitivity and specificity of QISS have been ∼91% and ∼96%, respectively (evidence level 1b) . Using either CEMRA or DSA as the reference standard, the median diagnostic sensitivity and specificity values of QISS at 1.5T (174 total patients) are 89% and 96%, respectively; corresponding values at 3.0T (193 total patients) are 92% and 96%, respectively (evidence level 1b).…”

Section: Level Of Evidence For Noncontrast Mramentioning

confidence: 99%

Noncontrast MR angiography: An update

Edelman

Koktzoglou

2018

Magnetic Resonance Imaging

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Both computed tomography (CT) angiography (CTA) and contrast-enhanced MR angiography (CEMRA) have proven to be useful and accurate cross-sectional imaging modalities over a wide range of vascular territories and vascular disorders. A key advantage of MRA is that, unlike CTA, it can be performed without the administration of a contrast agent. In this review article we consider the motivations for using noncontrast MRA, potential contrast mechanisms, imaging techniques, advantages, and drawbacks with respect to CTA and CEMRA, and the level of evidence for using the various MRA techniques. In addition, we explore new developments that promise to expand the reliability and range of clinical applications for noncontrast MRA, along with functional MRA capabilities not available with CTA or CEMRA.

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Accuracy of Noncontrast Quiescent-Interval Single-Shot Lower Extremity MR Angiography Versus CT Angiography for Diagnosis of Peripheral Artery Disease

Abstract: Noncontrast QISS-MRA provides high diagnostic accuracy compared with DSA, while being less prone to image artifacts than CTA. QISS better visualizes heavily calcified segments with impaired flow. QISS-MRA obviates the need for contrast administration in PAD patients.

Cited by 51 publications

References 26 publications

Quiescent-Interval Single-Shot Magnetic Resonance Angiography

Quiescent-Interval Single-Shot Magnetic Resonance Angiography

Non-contrast MRI protocol for TAVI guidance: quiescent-interval single-shot angiography in comparison with contrast-enhanced CT

Noncontrast MR angiography: An update

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