Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany.
Eur J Radiol. 2018 Nov;108:140-146. doi: 10.1016/j.ejrad.2018.09.029. Epub 2018 Sep 28.
Non-contrast-enhanced quiescent-interval single-shot magnetic resonance angiography (QISS-MRA) and invasive carbon dioxide (CO2) angiography are suggested as nephroprotective methods for accurate staging of peripheral arterial disease (PAD) in patients with chronic renal insufficiency (CRI). The aim of our study was to compare the image quality of both examinations.
16 consecutive PAD patients with highly impaired renal function (estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m²) who underwent 3 T MRA with QISS and catheter angiography with CO2 within 90 days were retrospectively included. Subjective image quality was determined using a five-point Likert scale (1, non-diagnostic; 5, excellent) and presence of significant (≥50%) stenoses of pelvic and lower extremity arteries (21-segment-model) was evaluated per-region and per-segment, respectively, in random order by four independent readers with different levels of experience. CO2 angiography of an experienced interventional radiologist was considered the standard reference method.
167 segments were available for direct comparison with a prevalence of ≥50% stenoses of 28.1%. QISS-MRA yield was: sensitivity 91.5%, specificity 94.2%, positive predictive value 86.0% and negative predictive value 96.6%, with an intraclass correlation coeffcient (ICC) of 0.88. Median values of qualitative imaging parameters for QISS-MRA were as follows: arterial signal intensity: 4 (pelvis), 5 (thigh), 5 (calf); venous overlay: 4, 5, 5; susceptibility artifacts: 5, 5, 5; motion artifacts: 4, 5, 5; ECG-related artifacts: 5, 5, 5. ICC-values for image quality were 0.74, 0.73, 0.93, 0.69 and 0.79, respectively. Arterial opacification at CO2 angiography was rated 3, 4, 3, with an ICC of 0.63.
Image quality of non-invasive unenhanced MR angiography with QISS was preferred over invasive CO2 angiography, whilst taking into account that it offers high diagnostic performance for the detection and ruling out of PAD.
非对比增强静息期单次激发磁共振血管成像（QISS-MRA）和有创二氧化碳（CO2）血管造影被认为是保护肾功能的方法，可用于准确分期慢性肾功能不全（CRI）患者的外周动脉疾病（PAD）。本研究旨在比较两种检查的图像质量。
回顾性纳入 16 例连续的肾功能严重受损（估算肾小球滤过率（eGFR）<30ml/min/1.73m²）的 PAD 患者，他们在 90 天内行 3T MRA 检查采用 QISS 和 CO2 导管血管造影。使用五点李克特量表（1，无法诊断；5，优秀）对主观图像质量进行评估，并分别对盆腔和下肢动脉（21 节段模型）进行区域和节段评估，由 4 名具有不同经验水平的独立读者随机进行。有经验的介入放射科医生的 CO2 血管造影被认为是标准参考方法。
167 个节段可与≥50%狭窄的患病率直接比较，为 28.1%。QISS-MRA 的检出率为：敏感性 91.5%，特异性 94.2%，阳性预测值 86.0%，阴性预测值 96.6%，内类相关系数（ICC）为 0.88。QISS-MRA 定性成像参数的中位数如下：动脉信号强度：4（骨盆）、5（大腿）、5（小腿）；静脉覆盖：4、5、5；磁敏感伪影：5、5、5；运动伪影：4、5、5；心电图相关伪影：5、5、5。图像质量的 ICC 值分别为 0.74、0.73、0.93、0.69 和 0.79。CO2 血管造影的动脉显影评分为 3、4、3，ICC 值为 0.63。
考虑到 QISS 非侵入性无增强磁共振血管成像具有较高的诊断性能，可用于检测和排除 PAD，其图像质量优于有创 CO2 血管造影。
