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Original Research |
1 Department of Radiology and Nuclear Medicine, Hospital Brothers of St. John of
God, Grosse Mohrengasse 9, Vienna, Austria A-1020.
2 Department of Diagnostic Radiology, Eberhardt Karls University, Tuebingen,
Germany.
3 Department of Diagnostic Radiology, Homburg University Hospital, Homburg/Saar,
Germany.
4 Department of Radiology, Hospital Valduce, Como, Italy.
5 Institute for Diagnostic Radiology, University Hospital, Basel,
Switzerland.
6 Medical Prevention Center, University Mxedical Center, Hamburg-Eppendorf,
Germany.
7 Institute of Clinical Radiology, Ludwig Maximilians University, Munich,
Germany.
8 U.C.O. di Radiologia, Ospedale di Cattinara, Trieste, Italy.
9 Department of Radiology, Ospedale Cà Foncello, Treviso, Italy.
10 Crawford Long Hospital, Atlanta, GA.
11 Department of Radiology, Università G. D'Annunzio, Chieti, Italy.
12 Institut für Radiologie, Charité-Universitäts medizin,
Berlin, Germany.
13 Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD.
14 Klinikum der Johannes, Gutenberg Universität, Mainz, Germany.
15 Worldwide Medical and Regulatory Affairs, Bracco Imaging SpA, Milan,
Italy.
16 Worldwide Medical and Regulatory Affairs, Bracco Diagnostics Inc., Princeton,
NJ.
OBJECTIVE. The purpose of this study was to compare gadobenate dimeglumine–enhanced MR angiography and unenhanced time-of-flight MR angiography for the detection of significant peripheral arterial occlusive disease using digital subtraction angiography as our reference standard.
SUBJECTS AND METHODS. Two hundred seventy-two patients underwent MR
angiography and digital subtraction angiography of the iliofemoral arteries.
MR angiography was performed before (2D time-of-flight acquisitions) and after
(spoiled gradient-echo acquisitions) the administration of 0.1 mmol/kg of
gadobenate dimeglumine at 1–2 mL/s. Contrast-enhanced MR angiography and
digital subtraction angiography of the calf arteries were performed in 241 of
272 participants. Images were evaluated on-site and by four blinded reviewers
(three for MR angiography, one for digital subtraction angiography).
Comparative diagnostic performance for the detection of significant (
51%
vessel lumen narrowing) disease was evaluated using the McNemar test and
generalized estimating equations. Interobserver agreement was assessed with
generalized kappa statistics. The chi-square test was used to compare
technical failure rates.
RESULTS. Digital subtraction angiography confirmed significant
disease (597 stenoses, 386 occlusions) in 983 iliofemoral segments. The
sensitivity (54–80.9%), specificity (89.7–95.3%), and accuracy
(85–87.5%) of contrast-enhanced MR angiography for the detection of
significant iliofemoral disease were significantly (p < 0.001, all
reviewers) better than those of time-of-flight MR angiography
(33.2–62.8%, 74.3–88.9%, and 68–77.3%, respectively).
Similar diagnostic performance was obtained for the calf arteries. The
technical failure rate with contrast-enhanced MR angiography (2.5–3.4%)
was similar to that of digital subtraction angiography (1.4%) and
significantly (p < 0.001) lower than that of time-of-flight MR
angiography (6.2–18.0%). Significantly better reproducibility
(p < 0.001) was obtained with contrast-enhanced MR angiography
(82% vs 65.2% agreement; 
= 0.66 vs 0.45).
CONCLUSION. Improved diagnostic performance and reproducibility are achievable with gadobenate dimeglumine–enhanced MR angiography in patients with peripheral arterial occlusive disease.
Keywords: contrast agents • diagnostic performance • gadobenate dimeglumine • MR angiography • peripheral arterial occlusive disease
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