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

Abstract

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.

Cardiovascular imaging 2015 in the International Journal of Cardiovascular Imaging

“…long latency periods were found to have a significantly negative impact on the image quality of free-breathing coronary wall Mri [26]. Quiescent-interval single-shot (QiSS) MrA was evaluated in patients undergoing digital subtraction angiography [27]. Similar diagnostic accuracy in the assessment of PAD was found.…”

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].…”

Dynamic Quantitative Contrast-enhanced Ultrasound for Assessment of Cilostazol Induced Pro-angiogenic Therapeutic Effects on Skeletal Muscle Microcirculation in Peripheral Arterial Disease

“…The most commonly used diagnostic tools for the management of patients with peripheral arterial occlusive disease (PAOD) are clinical examination, ankle-brachial index (ABI), walking distance, color coded and pulsed wave duplex ultrasound, magnetic resonance angiography (MRA), computed tomography angiography (CTA), and conventional angiography for therapeutic purposes [1][2][3]. These radiological techniques have in common that they primarily focus on the macrovasculature evaluation including stenotic and occluded sites.…”

“…However they are unable to assess the microvasculature which plays a fundamental role in the PAOD pathogenesis since the skeletal muscle and the skin are the functional end-organs causing eventually the clinical picture in this patient population [1]. Therefore microperfusion assessment is key in PAOD patients to assess the effects of proangiogenic drugs on the functional end organ of interest, namely the skeletal muscle [2,3].…”

“…Low-mechanical index quantitative contrast-enhanced ultrasound (low-MI CEUS) in combination with transient arterial occlusion as an evolving paradigm has been introduced as a useful und suitable method to evaluate changes in the micro-perfusion of skeletal muscles [1][2][3][4][5][6]. Further it should be considered is a cost effective and therefore clinically attractive imaging method [1].…”