Grijalba Fermín Urtasun, Esandi Mercedes Ciriza
Vascular Radiology Unit, Department of Radiology, Navarra Hospital, Pamplona, Spain.
Acta Radiol. 2010 Apr;51(3):284-9. doi: 10.3109/02841850903536060.
Minimally invasive imaging techniques are increasingly used for clinical decision making in patients with peripheral arterial occlusive disease (PAOD).
To assess whether gadofosveset-enhanced three-dimensional (3D) magnetic resonance (MR) angiography could replace digital subtraction angiography (DSA) for the evaluation of lower-extremity PAOD.
Thirty patients with symptomatic PAOD underwent prospectively both MR angiography and DSA. Gadofosveset-enhanced 3D MR angiography was performed on a 1.5T system equipped with a peripheral angio matrix coil. Four blinded observers independently analyzed MR angiograms and DSA images. The lower arterial vascular system was divided into three anatomic segments (aortoiliac, femoropopliteal, infrapopliteal) for review. The status of each segment was graded as normal, stenosis less than 50%, stenosis greater than 50%, or occluded and/or aneurismatic. Principal and secondary lesions were reported.
Although interobserver agreement for both was excellent, it was higher for DSA (kappa=0.92) than for MR angiography (kappa=0.86) for reporting the principal and secondary lesions in all segments. For different anatomic locations, the interobserver agreement of MR angiography and DSA was as follows: aortoiliac (kappa=0.93, k=0.95), femoropopliteal (kappa=0.86, k=0.90), and infrapopliteal (kappa=0.78, k=0.85). The lowest agreement was found for MR angiography on infrapopliteal segments (kappa=0.78). In four (13.3%) cases, MR angiography showed lesions that were not found by DSA. Five (16.6%) aneurysm cases, not observed by DSA, were shown by MR angiography.
Gadofosveset-enhanced 3D MR angiography can be proposed for first-line imaging in the management of lower-limb PAOD patients and permits the selective use of DSA as a second-line examination when MR angiography fails or in an endovascular approach.
微创成像技术越来越多地用于外周动脉闭塞性疾病（PAOD）患者的临床决策。
评估钆弗塞特增强三维（3D）磁共振（MR）血管造影是否可替代数字减影血管造影（DSA）用于评估下肢PAOD。
30例有症状的PAOD患者前瞻性地接受了MR血管造影和DSA检查。在配备外周血管造影矩阵线圈的1.5T系统上进行钆弗塞特增强3D MR血管造影。4名盲法观察者独立分析MR血管造影和DSA图像。将下肢动脉血管系统分为三个解剖节段（腹主动脉-髂动脉、股动脉-腘动脉、腘动脉以下）进行评估。每个节段的状态分为正常、狭窄小于50%、狭窄大于50%或闭塞和/或动脉瘤形成。报告主要和次要病变。
尽管两者的观察者间一致性都很好，但在报告所有节段的主要和次要病变时，DSA的一致性（kappa=0.92）高于MR血管造影（kappa=0.86）。对于不同的解剖位置，MR血管造影和DSA的观察者间一致性如下：腹主动脉-髂动脉（kappa=0.93，k=0.95）、股动脉-腘动脉（kappa=0.86，k=0.90）和腘动脉以下（kappa=0.78，k=0.85）。腘动脉以下节段的MR血管造影一致性最低（kappa=0.78）。在4例（13.3%）病例中，MR血管造影显示了DSA未发现的病变。MR血管造影显示了5例（16.6%）DSA未观察到的动脉瘤病例。
钆弗塞特增强3D MR血管造影可作为下肢PAOD患者管理中的一线成像方法，当MR血管造影失败或用于血管内介入时，允许选择性地使用DSA作为二线检查。
Zotero 插件