Author + information
- Received March 11, 2016
- Revision received September 26, 2016
- Accepted September 29, 2016
- Published online October 2, 2017.
- Akos Varga-Szemes, MD, PhDa,
- Julian L. Wichmann, MDa,b,
- U. Joseph Schoepf, MDa,c,∗ (, )
- Pal Suranyi, MD, PhDa,c,
- Carlo N. De Cecco, MD, PhDa,
- Giuseppe Muscogiuri, MDa,d,
- Damiano Caruso, MDa,e,
- Ricardo T. Yamada, MDa,
- Sheldon E. Litwin, MDc,
- Christian Tesche, MDa,f,
- Taylor M. Duguay, BSa,
- Shivraman Giri, PhDg,
- Rozemarijn Vliegenthart, MD, PhDa,h and
- Thomas M. Todoran, MDc
- aDivision of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
- bDepartment of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
- cDivision of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
- dDepartment of Medical-Surgical Sciences and Translational Medicine, University of Rome “Sapienza,” Rome, Italy
- eDepartment of Radiological, Oncological and Pathological Sciences, University of Rome “Sapienza,” Rome, Italy
- fDepartment of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
- gSiemens Medical Solutions, Chicago, Illinois
- hUniversity of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Department of Radiology, Groningen, the Netherlands
- ↵∗Address for correspondence:
Dr. U. Joseph Schoepf, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, MSC 226, Charleston, South Carolina 29425-2260.
Objectives This study sought to evaluate the image quality and diagnostic accuracy of noncontrast quiescent-interval single-shot (QISS) magnetic resonance angiography (MRA) versus iodine-contrast computed tomography angiography (CTA) in patients with peripheral artery disease (PAD), with invasive digital subtraction angiography (DSA) as the reference standard.
Background QISS is a recently introduced noncontrast MRA technique. Although the diagnostic accuracy of QISS is reportedly similar to that of contrast-enhanced MRA, its performance compared with contrast-enhanced CTA, the most frequently used noninvasive modality for evaluation of PAD, is unknown.
Methods Thirty patients (66 ± 7 years of age) with PAD underwent lower extremity CTA with third-generation dual-source dual-energy CT and 1.5-T MRA using a prototype noncontrast QISS sequence. DSA was performed within 50 days. The abdominal aorta and lower extremity run-off were imaged. Eighteen arterial segments were analyzed. Subjective image quality (3-point Likert scale) and stenosis (5-point grading) were evaluated by 2 observers and compared using the Mann–Whitney U and chi-square tests, respectively. Sensitivity and specificity of MRA and CTA for >50% stenosis detection were compared using the McNemar-test.
Results Of 540 segments, 15 (2.8%) and 42 (7.8%) inconclusive segments were excluded from MRA and CTA analysis, respectively (p = 0.0006). The DSA results were available for 410 of the remaining segments. Overall subjective image quality was rated similarly with QISS-MRA (2.52 [95% confidence interval: 2.46 to 2.57]) and CTA (2.49 [95% confidence interval: 2.43 to 2.55]; p = 0.5062). The sensitivity and specificity of MRA for >50% stenosis were 84.9% and 97.2%, respectively, similar to those of CTA (87.3% and 95.4%, respectively). Interobserver agreement for stenosis detection was excellent for MRA (κ > 0.81) and CTA (κ > 0.81).
Conclusions Noncontrast QISS-MRA provides high diagnostic accuracy compared with DSA, while being less prone to image artifacts than CTA. QISS better visualizes heavily calcified segments with impaired flow. QISS-MRA obviates the need for contrast administration in PAD patients.
- cardiovascular magnetic resonance
- noncontrast magnetic resonance angiography
- quiescent interval single shot
Drs. Varga-Szemes and De Cecco have received consulting fees from Guerbet and Siemens. Dr. Schoepf is a consultant for Guerbet; and has received research grants from Astellas, Bayer, Bracco, GE Healthcare, Medrad, and Siemens Healthineers. Dr. Giri is an employee of Siemens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 11, 2016.
- Revision received September 26, 2016.
- Accepted September 29, 2016.
- 2017 American College of Cardiology Foundation