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Diagnostic Accuracy of Intraarterial and IV MR Angiography for the Detection of Stenoses of the Infrainguinal Arteries

¹ Department of Radiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, Bavaria D-93053, Germany.

OBJECTIVE. The objective of our study was to prospectively evaluate the diagnostic accuracy of intraarterial (IA) and IV MR angiography (MRA) of the infrainguinal arteries in comparison with the reference standard selective digital subtraction angiography (DSA).

SUBJECTS AND METHODS. Twenty consecutive patients with symptomatic peripheral arterial occlusive disease (PAOD) underwent IV MRA and IA MRA of the infrainguinal arteries and DSA, which served as the reference standard. For IV MRA, 27 mL of gadodiamide was injected through a peripheral arm vein; for IA MRA, 30 mL of diluted contrast agent (5 mL of gadodiamide in 55 mL of 0.9% saline solution) was twice injected in the superficial femoral artery with a flow rate of 2.5 mL/s through a 5-French sheath that was placed on the occasion of DSA before vascular intervention. A 3D gradient-echo sequence was performed using a dedicated coil system on a 1.5-T MR scanner. Three independent blinded observers localized and quantitatively graded stenoses on IV MRA and IA MRA. The overall impression of image quality of IV MRA and IA MRA was documented using a 4-point scale (1, excellent; 4, poor). Interobserver agreement was calculated.

RESULTS. The mean sensitivity and mean specificity for the detection of stenoses 50% of the upper leg arteries (i.e., superficial femoral artery and popliteal artery) were 85.5% and 83.3% for IA MRA and 82.2% and 86.7% for IV MRA, respectively. The mean sensitivity and mean specificity for the detection of stenoses 50% of the lower leg arteries (i.e., proximal anterior tibial artery, tibiofibular trunk, proximal posterior tibial artery, and proximal peroneal artery) were 91.7% and 75.0% for IA MRA, respectively, and 87.5% each for IV MRA. The diagnostic quality of IA MRA images and IV MRA images was assessed as excellent or good.

CONCLUSION. IA MRA provides sensitivity and specificity for the detection of hemodynamically significant stenoses of the infrainguinal arteries comparable to IV MRA and therefore is a good diagnostic tool especially for MR-guided vascular interventions.

Keywords: arterial stenoses • digital subtraction angiography • infrainguinal arteries • intraarterial MR angiography • IV MR angiography

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