Simultaneous MR Arteriography and Venography With Blood Pool Contrast Agent Detects Deep Venous Thrombosis in Suspected Arterial Disease

Hadizadeh, Dariusch R.; Kukuk, Guido; Fahlenkamp, Ute Lina; Pressacco, Joséphine; Schäfer, Christian; Rabe, Eberhard; Koscielny, Arne; Verrel, F.; Schild, Hans H.; Willinek, Winfried A.

doi:10.2214/ajr.11.7306

Cited by 30 publications

(33 citation statements)

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“…Similar to our sample size 245 patients were included. Incidental DVT was observed in 11%, comparable to our results with 14% of incidental thrombi [21]. The image quality of the steady state VIBE images tended to be worse at the calf station in our study.…”

Section: Discussionsupporting

confidence: 87%

Steady state vascular imaging with extracellular gadobutrol: evaluation of the additional diagnostic benefit in patients who have undergone a peripheral magnetic resonance angiography protocol

Ong

Hausotter

Pilz

et al. 2013

Journal of Cardiovascular Magnetic Resonance

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BackgroundTo evaluate the feasibility and additional diagnostic benefit of a high-resolution steady state 3D-volume interpolated breath-hold exam (VIBE) sequence between a continuous table movement (CTM) MR angiography of the entire runoff vasculature and a time-resolved (TWIST) MRA of the calves.MethodsIn this retrospective IRB approved study 224 patients (72 women, 152 men, mean age 67.29 ± 13.9) were included who had undergone a low-dose MR angiographic protocol at 3T (Siemens TimTrio) after injection of 0.1 mmol/kg gadobutrol including a CTM MRA, a time-resolved MRA of the calf station and a steady state 3D VIBE sequence prior to the time-resolved MRA. One board-certified radiologist rated the image quality of the steady state VIBE sequences on an ordinal three point scale (excellent, good, poor) and analyzed the images for additional diagnostic findings of and beyond the vascular system in comparison to the CTM MRA and the time-resolved MRA. Descriptive statistics and demographic patient data were used for further evaluation.ResultsThe image quality of the steady state imaging of the pelvis, upper and lower leg was excellent in up to 88%, 84% and 47%, respectively, while poor image quality was only detected in the upper (2%) and lower leg (6%). An additional diagnostic benefit was found in 44% of the patients overall. The most common relevant pathologies included inflammatory processes of the soft tissues (26%), thrombi (14%), abscesses (13%) and tumors (11%). In subgroups of patients above the age of 60, 65, 70, 75 and 80 years an additional pathology was found in 50% 33%, 44%, 65% and 58%, respectively. There was no significant difference in terms of additional findings between men and women (46% and 39%, p > 0.05) and inpatients and outpatients (42% and 45%, p > 0.05).ConclusionSteady state imaging is also feasible with extracellular contrast agents with good image quality yielding additional diagnostic findings in up to 44% and above in patients older than 60 years of age irrespective of gender or patient status. Given the short acquisition time of 4 minutes this sequence could be added to all peripheral MRA exams.

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Section: Discussionsupporting

confidence: 87%

Steady state vascular imaging with extracellular gadobutrol: evaluation of the additional diagnostic benefit in patients who have undergone a peripheral magnetic resonance angiography protocol

Ong

Hausotter

Pilz

et al. 2013

Journal of Cardiovascular Magnetic Resonance

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“…As long as the central parts of k-space are sampled during the arterial first pass of the contrast agent this does not represent a problem in terms of achieved signal. Sampling of the peripheral parts of k-space without the contrast agent bolus being present, theoretically leads to blurring of the vessel edges[24]. …”

Section: Introductionmentioning

confidence: 99%

Dynamic and Static Magnetic Resonance Angiography of the Supra-aortic Vessels at 3.0 T

Kramer¹,

Arnoldi²,

François³

et al. 2013

Investigative Radiology

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Purpose Intraindividual comparison of a 1.0 molar and two 0.5 molar Gadolinium (Gd) based contrast agents (GBCA) with weak/no protein binding using equimolar dosing in dynamic and static Magnetic Resonance Angiography (MRA) of the supraaortic vessels. Material & Methods In this IRB approved study a total of 20 healthy volunteers (29±6y) underwent three consecutive supraaortic MRA exams on a 3T MR system. Order of GBCA (Gadobutrol, Gadobenate dimeglumine, Gadoterate meglumine) was randomized with a minimum interval of 48h between exams. Prior to and 45 minutes after each exam circulatory parameters were recorded. Total GBCA dose per MRA exam was 0.1mmol/kg with a 0.03/0.07 mmol/kg split for dynamic and static MRA respectively, injected at a rate of 2ml/s. Two blinded readers qualitatively assessed static MRA data sets independently using pairwise rankings (superior, inferior, equal). In addition quantitative analysis was performed with SNR and CNR evaluation as well as vessel sharpness analysis of static MRA employing an in house developed semi-automated tool. Dynamic MRA was evaluated in terms of maximal SNR. Statistical analysis was performed using Cohen’s kappa, Wilcoxon rank tests as well as mixed effects models. Results No significant differences of hemodynamic parameters were observed. In static MRA Gadobutrol was rated superior to Gadoterate meglumine(p0.0002) and equal to Gadobenate dimeglumine(p0.057) with good to excellent reader agreement (kappa 0.663 – 0.83). In static MRA SNR was significantly higher using1M Gadobutrol as compared to either 0.5M agent (p0.0458/0.0325) and CNR significantly higher as compared to Gadoterate meglumine (p 0.033) while CNR values of Gadobutrol datasets were not significantly different as compared to Gadobenate dimeglumine(p 0.134). Differences in CNR between Gadobenate dimeglumine and Gadoterate meglumine were not significant (p 0.779). Differences in vessel sharpness between the different GBCAs were also not significant (p > 0.05). Maximal SNR in dynamic MRA using Gadobutrol was significantly higher to both comparators at the level of the proximal and distal ICA (p 0.022, 0.002/p 0.04, 0.012). Conclusion At equimolar doses 1MGadobutrol demonstrates higher SNR/CNR to Gadobenate dimeglumine and Gadoterate meglumine with superior image quality as compared to Gadoterate meglumine for dynamic and static carotid MRA. Despite the shortened bolus with Gadobutrol no blurring of vessel edges is observed.

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“…While ultimately this patient expired, possibly due to a delay in presentation to the emergency department, this case demonstrates the importance of rapid diagnosis of this time-sensitive condition and the ease and feasibility of point-of-care ultrasound in diagnosing peripheral arterial occlusion. Additionally, to the authors' best knowledge, while rarely noted on CTA or MRA, no previous reports of a concurrent discovery of both arterial and venous thrombosis in the same limb have been noted on point-of-care ultrasound to date [16][17][18].…”

Section: Discussionmentioning

confidence: 78%

Diagnosis of abdominal mural aortic thrombus following discovery of common femoral artery and vein thrombosis by point-of-care ultrasound

et al. 2015

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Acute limb ischemia (ALI) is a limb-threatening and life-threatening disease process. Mural aortic thrombosis (MAT) is a rare cause of ALI. While there is limited evidence on the use of bedside ultrasound for the detection of ALI or MAT, duplex ultrasound remains the standard in the diagnosis and ultimate medical decision-making in patients with acute and chronic limb ischemia. Point-of-care ultrasound may be used in the evaluation of patients with signs and symptoms of this disease entity. This is a case of a 79-year-old female with a complicated medical history, who presented with a pulseless right leg and abdominal tenderness. The patient quickly decompensated requiring intubation for airway protection. A post-intubation arterial blood gas (ABG) was unsuccessfully attempted in the right femoral artery, prompting an ultrasound-guided ABG. On B-mode ultrasound evaluation, echogenic material was visualized in the right common femoral artery without evidence of Doppler flow signal. Additionally, a partially obstructing echogenic material was also noted at the femorosaphenous vein junction with only partial compressibility by compression sonography. A computed tomography angiography of the aorta was performed indicating extensive infrarenal aortic thrombosis. The patient expired despite the relatively prompt diagnosis, highlighting the importance of early identification of acute arterial occlusion.Keywords Mural aortic thrombus Á Acute limb ischemia Á Point-of-care ultrasound Á Bedside ultrasound Á Arterial thrombus Á Deep vein thrombosis Riassunto L'ischemia acuta degli arti inferiori (ALI) è una malattia che mette in pericolo gli arti e la vita stessa del paziente. La trombosi parietale dell'aorta (MAT) è una causa rara di ALI. Mentre vi è una limitata evidenza sull'uso dell'ecografia al letto del paziente per la rilevazione di ALI o MAT, il Doppler rimane lo standard nella diagnosi e nel processo decisionale medico finale, in pazienti con ischemia acuta e cronica degli arti. L'ecografia può essere utilizzata nella valutazione dei pazienti con segni e sintomi di questa malattia. Presentiamo il caso di una donna di 79 anni, con una complicata storia clinica che si è presentata senza polso nella gamba destra e tensione addominale. La paziente si scompensava rapidamente, richiedendo l'intubazione per la protezione delle vie respiratorie. Dopo l'intubazione è stato tentato un arterial blood gas test (ABG) nell'arteria femorale destra, senza successo spingendo verso un ABG con guida ecografica. La valutazione ecografica in B-mode ha evidenziato materiale ecogeno nell'arteria femorale comune destra senza evidenza di segnali Doppler. Inoltre materiale ecogeno ostruente è stato osservato a livello della giunzione femoro-safena con solo parziale compressibilità con la compressione ecografica. E' stata effettuata un'angio tomografia computerizzata dell'aorta che ha evidenziato un'ampia trombosi dell'aorta sotto-renale. Il paziente moriva, nonostante la diagnosi in tempi relativamente brevi, mettendo in evidenza l...

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Simultaneous MR Arteriography and Venography With Blood Pool Contrast Agent Detects Deep Venous Thrombosis in Suspected Arterial Disease

Abstract: Incidental DVT was prevalent in 11% of patients with clinically suspected PAOD. MRA with blood pool contrast agent has a potential role in the simultaneous assessment of arteries and veins and can detect concomitant venous disease affecting therapeutic management.

Cited by 30 publications

References 35 publications

Steady state vascular imaging with extracellular gadobutrol: evaluation of the additional diagnostic benefit in patients who have undergone a peripheral magnetic resonance angiography protocol

Steady state vascular imaging with extracellular gadobutrol: evaluation of the additional diagnostic benefit in patients who have undergone a peripheral magnetic resonance angiography protocol

Dynamic and Static Magnetic Resonance Angiography of the Supra-aortic Vessels at 3.0 T

Diagnosis of abdominal mural aortic thrombus following discovery of common femoral artery and vein thrombosis by point-of-care ultrasound

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