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European Radiology

, Volume 26, Issue 9, pp 2871–2880 | Cite as

3D non-contrast-enhanced ECG-gated MR angiography of the lower extremities with dual-source radiofrequency transmission at 3.0 T: Intraindividual comparison with contrast-enhanced MR angiography in PAOD patients

  • Michael RasperEmail author
  • Moritz Wildgruber
  • Marcus Settles
  • Hans-Henning Eckstein
  • Alexander Zimmermann
  • Christian Reeps
  • Ernst J. Rummeny
  • Armin M. Huber
Magnetic Resonance

Abstract

Objective

To compare prospectively image quality and diagnostic confidence of flow-sensitive 3D turbo spin echo (TSE)-based non-contrast-enhanced MR angiography (NE-MRA) at 3.0 T using dual-source radiofrequency (RF) transmission with contrast-enhanced MRA (CE-MRA) in patients with peripheral arterial occlusive disease (PAOD).

Methods

After consent was obtained, 35 patients (mean age 69.1 ± 10.6 years) with PAOD stage II-IV underwent NE-MRA followed by CE-MRA. Signal-to-noise ratio and contrast-to-noise ratio were calculated. Subjective image quality was independently assessed by two radiologists and stenosis scoring was performed in 875 arterial segments. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for stenosis classification were calculated using CE-MRA as a reference method. Diagnostic agreement with CE-MRA was evaluated with Cohen’s kappa statistics.

Results

NE-MRA provided high objective and subjective image quality at all levels of the arterial tree. Sensitivity and specificity for the detection of relevant stenosis was 91 % and 89 %, respectively; the NPV was 96 % and the PPV 78 %. There was good concordance between CE-MRA and NE-MRA in stenosis scoring.

Conclusions

3D electrocardiography (ECG)-gated TSE NE-MRA with patient-adaptive dual-source RF transmission at 3.0 T is a promising alternative for PAOD patients with contraindications for gadolinium-based contrast agents. It offers high sensitivity and NPV values in the detection of clinically relevant arterial stenosis.

Key points

Flow-sensitive TSE NE-MRA is a promising technique for PAOD evaluation.

Diagnostic accuracy is comparable to contrast-enhanced MRA.

NE-MRA eliminates the risk of NSF in patients with renal insufficiency.

Costs arising from the use of contrast agents can be avoided.

Keywords

Non-contrast enhanced MRA MRA at 3.0 T Dual-source RF transmission Flow-sensitive MRA TSE-based MRA 

Abbreviations

CE

contrast-enhanced

CNR

contrast-to-noise ratio

ECG

electrocardiography

FFE

fast-field echo

FOV

field of view

IQ

image quality

MIP

maximum intensity projection

MRA

magnetic resonance angiography

NE

non-enhanced

NPV

negative predictive value

NSF

nephrogenic systemic fibrosis

PAOD

peripheral arterial occlusive disease

PPV

positive predictive value

QISS

quiescent-interval single-shot

RF

radiofrequency

ROI

region of interest

SNR

signal-to-noise ratio

TOF

time-of-flight

TSE

turbo spin echo

Notes

Acknowledgments

The scientific guarantor of this publication is Michael Rasper. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, performed at one institution.

References

  1. 1.
    Selvin E, Erlinger TP (2004) Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation 110:738–743CrossRefPubMedGoogle Scholar
  2. 2.
    Hartung MP, Grist TM, Francois CJ (2011) Magnetic resonance angiography: current status and future directions. J Cardiovasc Magn Reson 13:19CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Meaney JF (2003) Magnetic resonance angiography of the peripheral arteries: current status. Eur Radiol 13:836–852PubMedGoogle Scholar
  4. 4.
    Deutschmann HA, Schoellnast H, Portugaller HR, Preidler KW, Reittner P, Tillich M et al (2006) Routine use of three-dimensional contrast-enhanced moving-table MR angiography in patients with peripheral arterial occlusive disease: comparison with selective digital subtraction angiography. Cardiovasc Intervent Radiol 29:762–770CrossRefPubMedGoogle Scholar
  5. 5.
    Hentsch A, Aschauer MA, Balzer JO, Brossmann J, Busch HP, Davis K et al (2003) Gadobutrol-enhanced moving-table magnetic resonance angiography in patients with peripheral vascular disease: a prospective, multi-centre blinded comparison with digital subtraction angiography. Eur Radiol 13:2103–2114CrossRefPubMedGoogle Scholar
  6. 6.
    Huber A, Heuck A, Baur A, Helmberger T, Waggershauser T, Billing A et al (2000) Dynamic contrast-enhanced MR angiography from the distal aorta to the ankle joint with a step-by-step technique. AJR Am J Roentgenol 175:1291–1298CrossRefPubMedGoogle Scholar
  7. 7.
    Schaefer FK, Schaefer PJ, Altjohann C, Bourne M, Decobelli F, Goyen M et al (2007) A multicenter, site-independent, blinded study to compare the diagnostic accuracy of contrast-enhanced magnetic resonance angiography using 1.0M gadobutrol (Gadovist) to intraarterial digital subtraction angiography in body arteries. Eur J Radiol 61:315–323CrossRefPubMedGoogle Scholar
  8. 8.
    Marckmann P, Skov L, Rossen K, Dupont A, Damholt MB, Heaf JG et al (2006) Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast- enhanced magnetic resonance imaging. J Am Soc Nephrol 17:2359–2362CrossRefPubMedGoogle Scholar
  9. 9.
    Thomsen HS (2006) Nephrogenic systemic fibrosis: a serious late adverse reaction to gadodiamide. Eur Radiol 16:2619–2621CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Garimella PS, Hart PD, O’Hare A, DeLoach S, Herzog CA, Hirsch AT (2012) Peripheral artery disease and CKD: a focus on peripheral artery disease as a critical component of CKD care. Am J Kidney Dis 60:641–654CrossRefPubMedGoogle Scholar
  11. 11.
    O’Hare AM, Feinglass J, Sidawy AN, Bacchetti P, Rodriguez RA, Daley J et al (2003) Impact of renal insufficiency on short-term morbidity and mortality after lower extremity revascularization: data from the Department of Veterans Affairs’ National Surgical Quality Improvement Program. J Am Soc Nephrol 4:1287–1295CrossRefGoogle Scholar
  12. 12.
    O’Hare AM, Sidawy AN, Feinglass J, Merine KM, Daley J, Khuri S et al (2004) Influence of renal insufficiency on limb loss and mortality after initial lower extremity surgical revascularization. J Vasc Surg 39:709–716CrossRefPubMedGoogle Scholar
  13. 13.
    Hahn WY, Hecht EM, Friedman B, Babb JS, Jacobowitz GR, Lee VS (2007) Distal lower extremity imaging: prospective comparison of 2-dimensional time of flight, 3- dimensional time-resolved contrast-enhanced magnetic resonance angiography, and 3- dimensional bolus chase contrast-enhanced magnetic resonance angiography. J Comput Assist Tomogr 31:29–36CrossRefPubMedGoogle Scholar
  14. 14.
    Partovi S, Rasmus M, Schulte AC, Rengier F, Jacob AL, Aschwanden M et al (2013) ECG-triggered non-enhanced MR angiography of peripheral arteries in comparison to DSA in patients with peripheral artery occlusive disease. MAGMA 26:271–280CrossRefPubMedGoogle Scholar
  15. 15.
    Gutzeit A, Sutter R, Froehlich JM, Roos JE, Sautter T, Schoch E et al (2011) ECG-triggered non-contrast enhanced MR angiography (TRANCE) versus digital subtraction angiography (DSA) in patients with peripheral arterial occlusive disease of the lower extremities. Eur Radiol 21:1979–1987CrossRefPubMedGoogle Scholar
  16. 16.
    Lim RP, Hecht EM, Xu J, Babb JS, Oesingmann N, Wong S et al (2008) 3D nongadolinium-enhanced ECG-gated MRA of the distal lower extremities: preliminary clinical experience. J Magn Reson Imaging 28:181–189CrossRefPubMedGoogle Scholar
  17. 17.
    Mohrs OK, Petersen SE, Heidt MC, Schulze T, Schmitt P, Bergemann S et al (2011) High-resolution 3D non-contrast-enhanced, ECG-gated, multi-step MR angiography of the lower extremities: comparison with contrast-enhanced MR angiography. Eur Radiol 21:434–442CrossRefPubMedGoogle Scholar
  18. 18.
    Miyazaki M, Lee VS (2008) Nonenhanced MR angiography. Radiology 248:20–43CrossRefPubMedGoogle Scholar
  19. 19.
    Haneder S, Attenberger UI, Riffel P, Henzler T, Schoenberg SO, Michaely HJ (2011) Magnetic resonance angiography (MRA) of the calf station at 3.0 T: intraindividual comparison of non-enhanced ECG-gated flow-dependent MRA, continuous table movement MRA and time-resolved MRA. Eur Radiol 21:1452–1461CrossRefPubMedGoogle Scholar
  20. 20.
    Storey P, Atanasova IP, Lim RP, Xu J, Kim D, Chen Q et al (2010) Tailoring the flow sensitivity of fast spin-echo sequences for noncontrast peripheral MR angiography. Magn Reson Med 64:1098–1108CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mueller A, Kouwenhoven M, Naehle CP, Gieseke J, Strach K, Willinek WA et al (2012) Dual-source radiofrequency transmission with patient-adaptive local radiofrequency shimming for 3.0-T cardiac MR imaging: initial experience. Radiology 263:77–85CrossRefPubMedGoogle Scholar
  22. 22.
    Nelles M, König RS, Gieseke J, Guerand-van Battum MM, Kukuk GM, Schild HH et al (2010) Dual-source parallel RF transmission for clinical MR imaging of the spine at 3.0 T: intraindividual comparison with conventional single-source transmission. Radiology 257:743–753CrossRefPubMedGoogle Scholar
  23. 23.
    Willinek WA, Gieseke J, Kukuk GM, Nelles M, König R, Morakkabati-Spitz N et al (2010) Dual-source parallel radiofrequency excitation body MR imaging compared with standard MR imaging at 3.0 T: initial clinical experience. Radiology 256:966–975CrossRefPubMedGoogle Scholar
  24. 24.
    Pruessmann KP, Weiger M, Scheidegger MB, Boesiger P (1999) SENSE: sensitivity encoding for fast MRI. Magn Reson Med 42:952–962CrossRefPubMedGoogle Scholar
  25. 25.
    Baum RA, Rutter CM, Sunshine JH, Blebea JS, Blebea J, Carpenter JP et al (1995) Multicenter trial to evaluate vascular magnetic resonance angiography of the lower extremity. American College of Radiology Rapid Technology Assessment Group. JAMA 74:875–880CrossRefGoogle Scholar
  26. 26.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMedGoogle Scholar
  27. 27.
    Gutberlet M, Noeske R, Schwinge K, Freyhardt P, Felix R, Niendorf T (2006) Comprehensive cardiac magnetic resonance imaging at 3.0 Tesla: feasibility and implications for clinical applications. Invest Radiol 41:154–167CrossRefPubMedGoogle Scholar
  28. 28.
    Wieben O, Francois C, Reeder SB (2008) Cardiac MRI of ischemic heart disease at 3 T: potential and challenges. Eur J Radiol 65:15–28CrossRefPubMedGoogle Scholar
  29. 29.
    Mihara H, Iriguchi N, Ueno S (1998) A method of RF inhomogeneity correction in MR imaging. MAGMA 7:115–120CrossRefPubMedGoogle Scholar
  30. 30.
    Ishimori Y, Yamada K, Kimura H, Fujiwara Y, Yamaguchi I, Monma M et al (2007) Correction of inhomogeneous RF field using multiple SPGR signals for high-field spin-echo MRI. Magn Reson Med Sci 6:67–73CrossRefPubMedGoogle Scholar
  31. 31.
    Jia H, Wang C, Wang G, Qu L, Chen W, Chan Q et al (2013) Impact of 3.0 T cardiac mr imaging using dual-source parallel radiofrequency transmission with patient- adaptive B1 shimming. PLoS One 8:e66946CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Lanzman RS, Blondin D, Schmitt P, Orzechowski D, Godehardt E, Scherer A et al (2010) Non-enhanced 3D MR angiography of the lower extremity using ECG- gated TSE imaging with non-selective refocusing pulses--initial experience. Röfo 182:861–867PubMedGoogle Scholar
  33. 33.
    Hodnett PA, Koktzoglou I, Davarpanah AH, Scanlon TG, Collins JD, Sheehan JJ et al (2011) Evaluation of peripheral arterial disease with nonenhanced quiescent-interval single-shot MR angiography. Radiology 260:282–293CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Amin P, Collins JD, Koktzoglou I, Molvar C, Markl M, Edelman RR et al (2014) Evaluating peripheral arterial disease with unenhanced quiescent-interval single-shot MR angiography at 3 T. AJR Am J Roentgenol 202:886–893CrossRefPubMedGoogle Scholar
  35. 35.
    Knobloch G, Gielen M, Lauff MT, Romano VC, Schmitt P, Rick M et al (2014) ECG-gated quiescent-interval single-shot MR angiography of the lower extremities: Initial experience at 3 T. Clin Radiol 69:485–491CrossRefPubMedGoogle Scholar
  36. 36.
    Thierfelder KM, Meimarakis G, Nikolaou K, Sommer WH, Schmitt P, Kazmierczak PM et al (2014) Non-contrast-enhanced MR angiography at 3 Tesla in patients with advanced peripheral arterial occlusive disease. PLoS One 9:e91078CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Hansmann J, Morelli JN, Michaely HJ, Riester T, Budjan J, Schoenberg SO et al (2014) Nonenhanced ECG-gated quiescent-interval single shot MRA: Image quality and stenosis assessment at 3 tesla compared with contrast-enhanced MRA and digital subtraction angiography. J Magn Reson Imaging 39:1486–1493CrossRefPubMedGoogle Scholar
  38. 38.
    Aschwanden M, Partovi S, Jacobi B, Fergus N, Schulte AC, Robbin MR et al (2014) Assessing the end-organ in peripheral arterial occlusive disease-from contrast- enhanced ultrasound to blood-oxygen-level-dependent MR imaging. Cardiovasc Diagn Ther 4:165–172PubMedPubMedCentralGoogle Scholar
  39. 39.
    Thomsen HS, Morcos SK, Almén T, Bellin MF, Bertolotto M, Bongartz G et al (2013) Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 23:307–318CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Michael Rasper
    • 1
    Email author
  • Moritz Wildgruber
    • 1
  • Marcus Settles
    • 1
  • Hans-Henning Eckstein
    • 2
  • Alexander Zimmermann
    • 2
  • Christian Reeps
    • 2
  • Ernst J. Rummeny
    • 1
  • Armin M. Huber
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyKlinikum rechts der Isar der Technischen Universität MünchenMunichGermany
  2. 2.Department of Vascular and Endovascular SurgeryKlinikum rechts der Isar der Technischen Universität MünchenMunichGermany

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