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Nonenhanced magnetic resonance angiography (MRA) of the calf arteries at 3 Tesla: intraindividual comparison of 3D flow-dependent subtractive MRA and 2D flow-independent non-subtractive MRA

  • Magnetic Resonance
  • Published:
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Abstract

Purpose

To prospectively compare 3D flow-dependent subtractive MRA vs. 2D flow-independent non-subtractive MRA for assessment of the calf arteries at 3 Tesla.

Methods

Forty-two patients with peripheral arterial occlusive disease underwent nonenhanced MRA of calf arteries at 3 Tesla with 3D flow-dependent subtractive MRA (fast spin echo sequence; 3D-FSE-MRA) and 2D flow-independent non-subtractive MRA (balanced steady-state-free-precession sequence; 2D-bSSFP-MRA). Moreover, all patients underwent contrast-enhanced MRA (CE-MRA) as standard-of-reference. Two readers performed a per-segment evaluation for image quality (4 = excellent to 0 = non-diagnostic) and severity of stenosis.

Results

Image quality scores of 2D-bSSFP-MRA were significantly higher compared to 3D-FSE-MRA (medians across readers: 4 vs. 3; p < 0.0001) with lower rates of non-diagnostic vessel segments on 2D-bSSFP-MRA (reader 1: <1 % vs. 15 %; reader 2: 1 % vs. 29 %; p < 0.05). Diagnostic performance of 2D-bSSFP-MRA and 3D-FSE-MRA across readers showed sensitivities of 89 % (214/240) vs. 70 % (168/240), p = 0.0153; specificities: 91 % (840/926) vs. 63 % (585/926), p < 0.0001; and diagnostic accuracies of 90 % (1054/1166) vs. 65 % (753/1166), p < 0.0001.

Conclusion

2D flow-independent non-subtractive MRA (2D-bSSFP-MRA) is a robust nonenhanced MRA technique for assessment of the calf arteries at 3 Tesla with significantly higher image quality and diagnostic accuracy compared to 3D flow-dependent subtractive MRA (3D-FSE-MRA).

Key Points

• 2D flow-independent non-subtractive MRA (2D-bSSFP-MRA) is a robust NE-MRA technique at 3T

• 2D-bSSFP-MRA outperforms 3D flow-dependent subtractive MRA (3D-FSE-MRA) as NE-MRA of calf arteries

• 2D-bSSFP-MRA is a promising alternative to CE-MRA for calf PAOD evaluation

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Abbreviations

2D:

Two dimensional

3D:

Three dimensional

bSSFP:

Balanced steady state free precession

CE-MRA:

Contrast-enhanced magnetic resonance angiography

CNR:

Contrast-to-noise ratio

DSA:

Digital subtraction angiography

ECG:

Echocardiography

eGFR:

Estimated glomerular filtration rate

FOV:

Field of view

FSE:

Fast spin echo

GRAPPA:

Generalized autocalibrating partially parallel acquisition

MIPs:

Maximum intensity projections

MPRs:

Multiplanar reconstructions

MRA:

Magnetic resonance angiography

NATIVE SPACE:

Non-contrast Angiography of Arteries and Veins Sampling Perfection with Application optimized Contrast by using different flip angle Evolution

NE-MRA:

Nonenhanced magnetic resonance angiography

NSF:

Nephrogenic systemic fibrosis

PACS:

Picture Archiving and Communication System

PAOD:

Peripheral arterial occlusive disease

QI:

Quiescent interval

QISS:

Quiescent interval single shot

RF:

Radiofrequency

SAR:

Specific absorption rate

SNR:

Signal-to-noise ratio

SOR:

Standard of reference

TE:

Echo time

TR:

Repetition time

TOF:

Time of flight

TSE:

Turbo spin echo

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Acknowledgments

The scientific guarantor of this publication is Gesine Knobloch. 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. Dr. Carsten Schwenke kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: prospective, randomized controlled trial, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany

    Gesine Knobloch, Marie-Teres Lauff, Sebastian Hirsch, Bernd Hamm & Moritz Wagner

  2. SCO:SSiS Statistical Consulting, Berlin, Germany

    Carsten Schwenke

Authors
  1. Gesine Knobloch
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  2. Marie-Teres Lauff
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  3. Sebastian Hirsch
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  4. Carsten Schwenke
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  5. Bernd Hamm
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  6. Moritz Wagner
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Corresponding author

Correspondence to Gesine Knobloch.

Additional information

This work is part of the dissertation of Marie-Teres Lauff.

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Knobloch, G., Lauff, MT., Hirsch, S. et al. Nonenhanced magnetic resonance angiography (MRA) of the calf arteries at 3 Tesla: intraindividual comparison of 3D flow-dependent subtractive MRA and 2D flow-independent non-subtractive MRA. Eur Radiol 26, 4585–4594 (2016). https://doi.org/10.1007/s00330-016-4246-1

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  • DOI: https://doi.org/10.1007/s00330-016-4246-1

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