Non-contrast-enhanced MR angiography in critical limb ischemia: performance of quiescent-interval single-shot (QISS) and TSE-based subtraction techniques

Abstract

• QISS MRA allows reliable diagnosis of peripheral artery stenosis in critical limb ischemia. • Robustness of TSE-based subtraction MRA is limited in critical limb ischemia. • QISS MRA allows robust therapy planning in PAD patients with resting leg pain.

Accuracy of non‐contrast quiescent‐interval single‐shot and quiescent‐interval single‐shot arterial spin‐labelled magnetic resonance angiography in assessment of peripheral arterial disease in a diabetic population

“…With regards to image quality, despite including clinically obese patients, patients with arrhythmias, implanted hardware and severe renal impairment, readers still judged imaging of overall diagnostic quality in the pelvis, thigh and calf, speaking to the robustness of QISS MRA. This was shown in initial work by Edelman et al, in which two patients had cardiac arrhythmias, with excellent QISS MRA image quality, and previous work demonstrating superior performance of QISS MRA compared with turbo spin echo‐based subtraction MRA . Despite non‐diagnostic image quality reported in the foot for per‐region analysis, diagnostic image quality was achieved in the dorsalis pedis and lateral plantar artery, the main pedal targets for bypass surgery.…”

“…Two smaller studies comparing QISS MRA to contrast‐enhanced MRA reported even higher sensitivity and specificity; Klasen et al’s study of 27 patients, sensitivity (98.6%) and specificity (96%), and Ward et al’s study of 20 patients referred for chronic lower limb ischaemia, mean combined regional sensitivity (90.8%) and specificity (94.5%). Furthermore, Altaha et al’s study of 19 patients with CLI comparing QISS MRA against DSA showed sensitivities of 92% and 81% for 2 readers and specificities of 95% and 97%.…”

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

“…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].…”

Noncontrast MR angiography: An update

“…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).…”

“…In eight studies of the lower extremities (four of which were limited to the calf or foot) involving a total of 238 patients using either CEMRA (seven studies) or CTA (one study) as the reference standard exam, cardiac‐gated subtractive noncontrast MRA using a fast spin‐echo based readout provided a median sensitivity of ∼86%, and a median specificity of ∼86% for the detection of ≥50% stenosis (evidence level 1b) . However, three other studies involving a total of 75 patients have reported poor image quality and a high rate of nondiagnostic vessel segments …”