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Non-contrast-enhanced MRA of renal artery stenosis: validation against DSA in a porcine model

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare 3D-inversion-recovery balanced steady-state free precession (IR-bSSFP) non-contrast-enhanced magnetic resonance angiography (MRA) with 3D-contrast-enhanced MRA (CE-MRA) for assessment of renal artery stenosis (RAS) using digital subtraction angiography (DSA) as the reference standard.

Methods

Bilateral RAS were surgically created in 12 swine. IR-bSSFP and CE-MRA were acquired at 1.5 T and compared to rotational DSA. Three experienced cardiovascular radiologists evaluated the IR-bSSFP and CE-MRA studies independently. Linear regression models were used to calibrate and assess the accuracy of IR-bSSFP and CE-MRA, separately, against DSA. The coefficient of determination and Cohen's kappa coefficient were also generated.

Results

Calibration of the three readers’ RAS grading revealed R2 values of 0.52, 0.37 and 0.59 for NCE-MRA and 0.48, 0.53 and 0.71 for CE-MRA. Inter-rater agreement demonstrated Cohen’s kappa values ranging from 0.25 to 0.65. Distal renal artery branch vessels were visible to a significantly higher degree with NCE-MRA compared to CE-MRA (p < 0.001). Image quality was rated excellent for both sequences, although image noise was higher with CE-MRA (p < 0.05). In no cases did noise interfere with image interpretation.

Conclusions

In a well-controlled animal model of surgically induced RAS, IR-bSSFP based NCE-MRA and CE-MRA accurately graded RAS with a tendency for stenosis overestimation, compared to DSA.

Key Points

• IR-bSSFP and CE-MRA are accurate methods for diagnosis of renal artery stenosis

• IR-bSSFP and CE-MRA demonstrate excellent agreement with DSA

• Both IR-bSSFP and CE-MRA have a tendency to overestimate renal artery stenosis

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Abbreviations

bSSFP:

Balanced steady-state free precession

CE-MRA:

Contrast-enhanced magnetic resonance angiography

CTA:

Contrast-enhanced computed tomography angiography

DSA:

Digital subtraction angiography

FMD:

Fibromuscular dysplasia

GBCA:

Gadolinium-based contrast agent

IACUC:

Institutional Animal Care and Use Committee

IR-bSSFP:

Inversion-recovery bSSFP

NCE-MRA:

Non-contrast-enhanced magnetic resonance angiography

PC:

Phase contrast

RAS:

Renal artery stenosis

SAH:

Systemic arterial hypertension

SNR:

Signal-to-noise ratio

TOF:

Time of flight

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Acknowledgments

The scientific guarantor of this publication is Scott Reeder. Two of the authors (NT, JB) were employees of GE Healthcare at the time of this study. All other 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 University of Wisconsin receives research support from GE Healthcare and Bracco Diagnostics, although no support was received for this study. This study was funded by the University of Wisconsin Department of Radiology Research and Development fund. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because this study did not involve human subjects. Approval for animal use was obtained from the University of Wisconsin Institutional Animal Care and Use Committee (IACUC). Methodology: prospective, experimental, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University of Würzburg, Würzburg, Germany

    T. A. Bley

  2. Department of Radiology, University of Wisconsin, 600 Highland Ave, E1/374, Madison, WI, 53792, USA

    T. A. Bley, C. J. François, M. L. Schiebler, O. Wieben, J. H. Brittain, A. Munoz Del Rio, T. M. Grist & S. B. Reeder

  3. Department of Medical Physics, University of Wisconsin, Madison, WI, USA

    O. Wieben, A. Munoz Del Rio, T. M. Grist & S. B. Reeder

  4. MR Applied Sciences Laboratory, GE Healthcare, Tokyo, Japan

    N. Takei

  5. MR Applied Sciences Laboratory, GE Healthcare, Madison, WI, USA

    J. H. Brittain

  6. Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA

    S. B. Reeder

  7. Department of Medicine, University of Wisconsin, Madison, WI, USA

    S. B. Reeder

  8. Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA

    S. B. Reeder

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  1. T. A. Bley
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  2. C. J. François
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  4. O. Wieben
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Correspondence to S. B. Reeder.

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Bley, T.A., François, C.J., Schiebler, M.L. et al. Non-contrast-enhanced MRA of renal artery stenosis: validation against DSA in a porcine model. Eur Radiol 26, 547–555 (2016). https://doi.org/10.1007/s00330-015-3833-x

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  • DOI: https://doi.org/10.1007/s00330-015-3833-x

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