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Pedal Angiography in Peripheral Arterial Occlusive Disease: First-Pass IV Contrast-Enhanced MR Angiography with Blood Pool Contrast Medium Versus Intraarterial Digital Subtraction Angiography

¹ Division of Interventional Radiology, Institute of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
² Institute of Radiology, University Hospital Basel, Basel, Switzerland.
³ Institute of Angiology, University Hospital Basel, Basel, Switzerland.

OBJECTIVE. The purpose of this study was to prospectively evaluate first-pass IV gadofosveset–enhanced MR angiography in patients with peripheral arterial occlusive disease for visualization of the pedal arteries and stenosis or occlusion of those arteries with intraarterial digital subtraction angiography as the reference standard.

SUBJECTS AND METHODS. Twenty patients with peripheral arterial occlusive disease (nine women, 11 men; age-range 58–83 years) were prospectively enrolled. Gadofosveset first-pass contrast-enhanced MR angiography was performed with a 1.5-T system, a dedicated foot coil, and cuff compression to the calf. Arterial segments were assessed for degree of arterial stenosis, arterial visibility, diagnostic utility, and venous contamination. Detection of vessel stenosis or occlusion was evaluated in comparison with findings at digital subtraction angiography. The unpaired Student's t test was used to test arterial visibility with the two techniques.

RESULTS. First-pass MR angiography with gadofosveset had good diagnostic utility in 83.9% of all segments and no venous contamination in 96.8% of all segments. There was no difference between the performance of intraarterial digital subtraction angiography and that of IV contrast-enhanced MR angiography in arterial visibility overall (p = 0.245) or in subgroup analysis of surgical arterial bypass targets (p = 0.202). The overall sensitivity, specificity, and accuracy of IV gadofosveset–enhanced MR angiography for characterization of clinically significant stenosis and occlusion were 91.4%, 96.1%, and 93.9%. In the subgroup analysis, the sensitivity, specificity, and accuracy were 85.5%, 96.5%, and 92.1%.

CONCLUSION. Gadofosveset-enhanced MR angiography of the pedal arteries in patients with peripheral arterial occlusive disease has arterial visibility equal to that of digital subtraction angiography and facilitates depiction of clinically significant stenosis and occlusion.

Keywords: blood vessels • contrast-enhanced MR angiography • cuff compression • foot • gadofosveset • peripheral arterial occlusive disease

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