IMAGING OF AORTOILIAC ARTERIAL DISEASE. Duplex ultrasound and MR angiography versus digital subtraction angiography

Abstract

Purpose: To evaluate and compare the diagnostic accuracy of duplex ultrasound (US) and MR angiography (MRA) at 1.0 T in aortoiliac arterial disease using digital subtraction angiography (DSA) as the reference standard. In addition, a comparison of the 2D time‐of flight (TOF) and 3D contrast‐enhanced MRA (CE MRA) techniques was performed. Material and Methods: Prospectively, 39 patients with symptoms of lower‐extremity arterial occlusive disease were examined using US, TOF MRA, CE MRA and DSA. Significant lesions (stenosis 50%) and occlusions were evaluated blindly for each method. Results: For all segments, the sensitivity for US, TOF MRA and CE MRA with regard to significant lesions was 0.72, 0.81 and 0.81, respectively, and the specificity for each was 0.97, 0.91 and 0.92, respectively. For significant lesions above the inguinal ligament the corresponding sensitivity was 0.84, 0.89 and 0.94 and the specificity 0.93, 0.82 and 0.73, respectively. The specificity was higher when the two MRA methods were combined. TOF MRA overgraded 7 segments as occluded. In most cases, the length of the occlusions was correctly determined on CE MRA, overestimated on TOF MRA and uncertain on US. Conclusion: Neither US nor MRA were sufficiently accurate to fully replace angiography. MRA was preferable to US as a non‐invasive test when vascular intervention was contemplated. Although CE MRA was superior to TOF MRA, the most accurate results were achieved when the two methods were combined.

Peripheral Arterial Disease: Comparison of Color Duplex US and Contrast-enhanced MR Angiography for Diagnosis

“…In both studies, results similar to those observed in the current study were reported: sensitivities and specificities of duplex US of 72% and 88%, respectively (21), and of 72% and 97%, respectively (22). Sensitivities and specificities of contrast-enhanced MR angiography were 81% and 86%, respectively (21), and 88% and 92%, respectively (22). In the study by Wikstrom et al (21), however, there was considerable selection bias because nonconsecutive patients with iliac artery stenosis found at duplex US also underwent contrast-enhanced MR angiography and intraarterial DSA.…”

“…Thus far, two studies (21,22) in which duplex US was compared with contrastenhanced MR angiography in the same patients have been published. In both studies, results similar to those observed in the current study were reported: sensitivities and specificities of duplex US of 72% and 88%, respectively (21), and of 72% and 97%, respectively (22).…”

“…In the study by Wikstrom et al (21), however, there was considerable selection bias because nonconsecutive patients with iliac artery stenosis found at duplex US also underwent contrast-enhanced MR angiography and intraarterial DSA. In the study by Lundin et al (22), 39 patients who were already referred for intraarterial DSA also underwent contrast-enhanced MR angiography and duplex US.…”

Diagnostic accuracy of three-dimensional contrast-enhanced automatic moving-table MR angiography in patients with peripheral arterial occlusive disease in comparison with digital subtraction angiography

“…Although phase contrast MRA was superior to time of light (TOF) MRA, the most accurate results were achieved when the two methods were combined (4).…”

Nichtinvasive diagnostische Methoden der Makro- und Mikroangiopathie der peripheren Gef��e und Karotiden

“…16-Zeilen-Technik stellen eine ernst zu nehmende Alternative zur intraarteriellen digitalen Subtraktionsangiographie (i.a. DSA) vor allem der proximalen Extremitätenstrombahn dar [15,16]. Die Wertigkeit insbesondere der MR-Angiographie wird an anderer Stelle in diesem Heft vorgestellt.…”