European Radiology

, Volume 27, Issue 3, pp 1218–1226 | Cite as

Non-contrast-enhanced MR angiography in critical limb ischemia: performance of quiescent-interval single-shot (QISS) and TSE-based subtraction techniques

  • Mustafa A. Altaha
  • Jeffrey D. Jaskolka
  • Kongteng Tan
  • Manuela Rick
  • Peter Schmitt
  • Ravi J. Menezes
  • Bernd J. Wintersperger



The aim of this study was to evaluate diagnostic performance of non-contrast-enhanced 2D quiescent-interval single-shot (QISS) and 3D turbo spin-echo (TSE)-based subtraction magnetic resonance angiography (MRA) in the assessment of peripheral arteries in patients with critical limb ischemia (CLI).

Materials and methods

Nineteen consecutive patients (74 % male, 72.8 ± 9.9 years) with CLI underwent 2D QISS and 3D TSE-based subtraction MRA at 1.5 T. Axial-overlapping QISS MRA (3 mm/2 mm; 1 × 1 mm2) covered from the toes to the aortic bifurcation while coronal 3D TSE-based subtraction MRA (1.3 × 1.2 × 1.3 mm3) was restricted to the calf only. MRA data sets (two readers) were evaluated for stenosis (≥50 %) and image quality. Results were compared with digital subtraction angiography (DSA).


Two hundred and sixty-seven (267) segments were available for MRA-DSA comparison, with a prevalence of stenosis ≥50 % of 41.9 %. QISS MRA was rated as good to excellent in 79.5–96.0 % of segments without any nondiagnostic segments; 89.8–96.1 % of segments in 3D TSE-based subtraction MRA were rated as nondiagnostic or poor. QISS MRA sensitivities and specificities (segmental) were 92 % and 95 %, respectively, for reader one and 81–97 % for reader two. Due to poor image quality of 3D TSE-based subtraction MRA, diagnostic performance measures were not calculated.


QISS MRA demonstrates excellent diagnostic performance and higher robustness than 3D TSE-based subtraction MRA in the challenging patient population with CLI.

Key Points

QISS MRA allows reliable diagnosis of peripheral artery stenosis in critical limb ischemia.

Robustness of TSE-based subtraction MRA is limited in critical limb ischemia.

QISS MRA allows robust therapy planning in PAD patients with resting leg pain.


Peripheral arterial disease Magnetic resonance angiography Ischemia Angiography, Digital subtraction Magnetic resonance imaging 



Peripheral artery disease



The scientific guarantor of this publication is Dr. Bernd Wintersperger, Department of Medical Imaging, University Health Network, Toronto ON, Canada ( The authors of this manuscript declare relationships with the following companies:

Manuela Rick is an employee of Siemens Healthcare GmbH

Peter Schmitt is an employee of Siemens Healthcare GmbH

Bernd J. Wintersperger receives research support from Siemens Healthcare GmbH

Bernd J. Wintersperger receives honorarium from Siemens Healthcare GmbH as a speaker’s bureau member.

The authors state that this work has not received any funding. Ravi J. Menezes, epidemiologist and coauthor of this manuscript, kindly provided statistical advice. Institutional (UHN) Research Ethics Board (REB) approval was obtained. Written informed consent was obtained from all patients. Study patients or cohorts were not previously reported. This was a prospective, diagnostic, or prognostic study performed at one institution.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Mustafa A. Altaha
    • 1
  • Jeffrey D. Jaskolka
    • 1
    • 2
  • Kongteng Tan
    • 1
    • 2
  • Manuela Rick
    • 3
  • Peter Schmitt
    • 3
  • Ravi J. Menezes
    • 1
    • 2
  • Bernd J. Wintersperger
    • 1
    • 2
    • 4
  1. 1.Department of Medical Imaging, Peter Munk Cardiac CentreUniversity Health NetworkTorontoCanada
  2. 2.Department of Medical ImagingUniversity of TorontoTorontoCanada
  3. 3.Siemens HealthcareErlangenGermany
  4. 4.Department of Medical ImagingToronto General HospitalTorontoCanada

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