Evaluating Peripheral Arterial Disease With Unenhanced Quiescent-Interval Single-Shot MR Angiography at 3 T

Amin, Parag; Collins, Jeremy D.; Koktzoglou, Ioannis; Molvar, Christopher; Markl, Michael; Edelman, Robert R.; Carr, James C.

doi:10.2214/ajr.13.11243

Cited by 38 publications

(33 citation statements)

References 22 publications

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“…Studies at 1.5 T demonstrated high sensitivity (87.0-98.6 %) and specificity (94.6-96.0 %) of QISS-MRA for detection of significant stenosis, using mainly CE-MRA as SOR [12][13][14]. QISS-MRA at 3 T was also investigated for assessment of PAD, again using mainly CE-MRA as SOR [17][18][19][20]. These studies demonstrated the feasibility of QISS-MRA at 3 T but yielded mixed results regarding diagnostic performance with sensitivity and specificity of 87.5-100 % and 76.5-98.5 %, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The arterial vascular tree was divided into 32 segments for analysis of image quality and diagnostic performance: abdominal aorta (1), pelvic vessel segments including right and left common iliac artery (2, 3), right and left external iliac artery (4,5), and right and left common femoral artery (6,7), thigh vessel segments including right and left deep femoral artery (8,9), right and left proximal and distal superficial femoral artery (10-13), right and left proximal, middle, and distal popliteal artery (14)(15)(16)(17)(18)(19), and calf vessel segments including right and left proximal and distal anterior tibial artery (20)(21)(22)(23), right and left tibiofibular trunk (24,25), right and left proximal and distal posterior tibial artery (26)(27)(28)(29), and right and left proximal and distal fibular artery (30-33). Two blinded readers (M.W.…”

Section: Methodsmentioning

confidence: 99%

“…At 3 T, however, bSSFP imaging is also more challenging due to the increased sensitivity to off-resonance artifacts at higher field strengths [16]. Initial studies demonstrated the feasibility of QISS-MRA at 3 T but yielded mixed results regarding image quality and diagnostic performance [17][18][19][20]. To the best of our knowledge, diagnostic performance of QISS-MRA at 3 T has been correlated with DSA as standard of reference (SOR) only in small groups of \10 patients [17,20].…”

Section: Introductionmentioning

confidence: 99%

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Nonenhanced peripheral MR-angiography (MRA) at 3 Tesla: evaluation of quiescent-interval single-shot MRA in patients undergoing digital subtraction angiography

Wagner¹,

Knobloch²,

Gielen³

et al. 2015

Int J Cardiovasc Imaging

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Quiescent-interval single-shot MRA (QISS-MRA) is a promising nonenhanced imaging technique for assessment of peripheral arterial disease (PAD). Previous studies at 3 Tesla included only very limited numbers of patients for correlation of QISS-MRA with digital subtraction angiography (DSA) as standard of reference (SOR). The aim of this prospective institutional review board-approved study was to compare QISS-MRA at 3 Tesla with DSA in a larger patient group. Our study included 32 consecutive patients who underwent QISS-MRA, contrast-enhanced MRA (CE-MRA), and DSA. Two readers independently performed a per-segment evaluation of QISS-MRA and CE-MRA for image quality and identification of non-significant stenosis (<50%) versus significant stenosis (50-100%). The final dataset included 1,027 vessel segments. Reader 1 and 2 rated image quality as diagnostic in 96.8 and 98.0% of the vessel segments on QISS-MRA and in 99.3 and 98.4% of the vessel segments on CE-MRA, respectively. DSA was available for 922 segments and detected significant stenosis in 133 segments (14.4%). Consensus reading yielded the following diagnostic parameters for QISS-MRA versus CE-MRA: sensitivity: 83.5% (111/133) versus 82.7% (110/133), p = 0.80; specificity: 93.9% (741/789) versus 95.7% (755/789), p = 0.25; and diagnostic accuracy: 92.4% (852/922) versus 93.8% (865/922), p = 0.35. In conclusion, using DSA as SOR, QISS-MRA and CE-MRA at 3 Tesla showed similar diagnostic accuracy in the assessment of PAD. A limitation of QISS-MRA was the lower rate of assessable vessel segments compared to CE-MRA.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nonenhanced peripheral MR-angiography (MRA) at 3 Tesla: evaluation of quiescent-interval single-shot MRA in patients undergoing digital subtraction angiography

Wagner¹,

Knobloch²,

Gielen³

et al. 2015

Int J Cardiovasc Imaging

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“…NC-MRA has emerged as a potential diagnostic technique for PAD [20][21][22][23][24][25], with QISS MRA specifically demonstrating good accuracy for hemodynamic stenosis in diabetic patients. Whilst DSA can be performed with carbon dioxide as a contrast agent to prevent nephrotoxicity, image quality is poorer [15,16] and DSA remains an invasive procedure with attendant risks.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several non-contrast MRA (NC-MRA) techniques have been developed to image peripheral arteries [20][21][22][23][24][25][26]. These include fresh-blood imaging, quiescent-interval single-shot (QISS) imaging, and flow-sensitizing dephasing gradient-prepared steady-state free precession imaging [20,25,[27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Patient Perception of Lower Limb Non-Contrast Magnetic Resonance Angiography and Digital Subtraction Angiography in Diabetic Patients with Peripheral Arterial Disease

Lukies

Richmond

Hornsey

et al. 2017

Cardiovasc Imaging Asia

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Peripheral arterial disease (PAD) is common in diabetic patients, with an estimated prevalence of 20-29% in those over 50 years of age, and causes significant morbidity, with amputation or limb loss occurring in around 4% of patients [1]. The imaging diagnosis of PAD in diabetic patients is challenging because renal impairment is common and vessels tend to be cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective: Non-contrast magnetic resonance angiography (NC-MRA) is an attractive technique for imaging peripheral arterial disease (PAD) in diabetic patients where arterial calcification and renal impairment are common. Our purpose was to evaluate patient perception of lower limb NC-MRA and compare this perception to that of digital subtraction angiography (DSA). Materials and Methods:Thirty-one diabetic patients (18 male, 13 female, mean age=69 years) with symptomatic PAD (critical ischemia, n=10) referred for DSA were prospectively recruited, and 1.5T quiescent-interval single-shot NC-MRA was performed before DSA (intervention performed during DSA, n=23). Patients rated anxiety, pain, discomfort, willingness to repeat (Likert scale: 1 most favorable to 7 least favorable), and difficulty compared to expectations (-3 better to +3 worse).Results: Twenty-nine patients' results were analyzed (DSA under general anesthesia, n=1; incomplete NC-MRA due to morbid obesity, n=1). NC-MRA and DSA median scores were 1 vs. 3, 1 vs. 2, 2 vs. 2, and 1 vs. 1 for anxiety, pain, discomfort, and willingness to repeat, respectively. The median score for difficulty compared to expectations was 0 (as expected) for both examinations. The anxiety and pain scores for NC-MRA were significantly lower than those for DSA (p=0.006 and p=0.001, respectively). Reasons for the less favorable NC-MRA experience included machine noise (n=3), pain from coil pressure (n=3), and claustrophobia (n=1).Conclusion: NC-MRA was well tolerated overall, and better than DSA for anxiety and pain. Although DSA is commonly required for intervention in PAD, NC-MRA may inform disease management and potentially obviate DSA where conservative management, or open surgery, are indicated. Reduced acoustic noise, lighter receiver coils, and wider scan bores may improve procedural tolerance.

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Unenhanced Velocity‐Selective MR Angiography (VS‐MRA): Initial Clinical Evaluation in Patients With Peripheral Artery Disease

Shin

Menon

Thomas

et al. 2018

Magnetic Resonance Imaging

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Evaluating Peripheral Arterial Disease With Unenhanced Quiescent-Interval Single-Shot MR Angiography at 3 T

Abstract: QISS MRA maintains high diagnostic performance at 3 T despite the challenges inherent to image acquisition at higher field strengths.

Cited by 38 publications

References 22 publications

Nonenhanced peripheral MR-angiography (MRA) at 3 Tesla: evaluation of quiescent-interval single-shot MRA in patients undergoing digital subtraction angiography

Nonenhanced peripheral MR-angiography (MRA) at 3 Tesla: evaluation of quiescent-interval single-shot MRA in patients undergoing digital subtraction angiography

Patient Perception of Lower Limb Non-Contrast Magnetic Resonance Angiography and Digital Subtraction Angiography in Diabetic Patients with Peripheral Arterial Disease

Unenhanced Velocity‐Selective MR Angiography (VS‐MRA): Initial Clinical Evaluation in Patients With Peripheral Artery Disease

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