Csőre Judit, Suhai Ferenc Imre, Gyánó Marcell, Pataki Ákos András, Juhász Georgina, Vecsey-Nagy Milán, Pál Dániel, Fontanini Daniele Mariastefano, Bérczi Ákos, Csobay-Novák Csaba
Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122 Budapest, Hungary.
Department of Interventional Radiology, Semmelweis University, 68 Városmajor Street, 1122 Budapest, Hungary.
J Clin Med. 2022 Aug 1;11(15):4485. doi: 10.3390/jcm11154485.
Nephroprotective imaging in peripheral arterial disease (PAD) is often crucial. We compared the diagnostic performance of non-contrast Quiescent-interval single-shot magnetic resonance angiography (QISS MRA) and carbon-dioxide digital subtraction angiography (CO2 DSA) in chronic lower extremity PAD patients. A 19-segment lower extremity arterial model was used to assess the degree of stenosis (none, <50%, 50−70%, >70%) and the image quality (5-point Likert scale: 1-non-diagnostic, 5-excellent image quality). Intra-class correlation coefficient (ICC) was calculated for inter-rater reliability. Diagnostic accuracy and interpretability were evaluated using CO2 DSA as a reference standard. 523 segments were evaluated in 28 patients (11 male, mean age: 71 ± 9 years). Median and interquartile range of subjective image quality parameters for QISS MRA were significantly better compared to CO2 DSA for all regions: (aortoiliac: 4 [4−5] vs. 3 [3−4]; femoropopliteal: 4 [4−5] vs. 4 [3−4]; tibioperoneal: 4 [3−5] vs. 3 [2−3]; all regions: 4 [4−5] vs. 3 [3−4], all p < 0.001). QISS MRA out-performed CO2 DSA regarding interpretability (98.3% vs. 86.0%, p < 0.001). Diagnostic accuracy parameters of QISS MRA for the detection of obstructive luminal stenosis (70%<) as compared to CO2 DSA were as follows: sensitivity 82.6%, specificity 96.9%, positive predictive value 89.1%, negative predictive value 94.8%. Regarding the degree of stenosis, interobserver variability for all regions was 0.97 for QISS MRA and 0.82 for CO2 DSA. QISS MRA proved to be superior to CO2 DSA regarding subjective image quality and interpretability for the imaging of chronic lower extremity PAD.
外周动脉疾病（PAD）中的肾保护成像通常至关重要。我们比较了非对比剂静态间隔单次激发磁共振血管造影（QISS MRA）和二氧化碳数字减影血管造影（CO2 DSA）在慢性下肢PAD患者中的诊断性能。采用19节段下肢动脉模型评估狭窄程度（无、<50%、50−70%、>70%）和图像质量（5分李克特量表：1 - 非诊断性，5 - 图像质量极佳）。计算组内相关系数（ICC）以评估评分者间的可靠性。以CO2 DSA作为参考标准评估诊断准确性和可解释性。对28例患者（11例男性，平均年龄：71±9岁）的523个节段进行了评估。QISS MRA主观图像质量参数的中位数和四分位间距在所有区域均显著优于CO2 DSA：（腹主动脉 - 髂动脉：4[4 - 5]对3[3 - 4]；股 - 腘动脉：4[4 - 5]对4[3 - 4]；胫 - 腓动脉：4[3 - 5]对3[2 - 3]；所有区域：4[4 - 5]对3[3 - 4]，所有p<0.001）。在可解释性方面，QISS MRA优于CO2 DSA（98.3%对86.0%，p<0.001）。与CO2 DSA相比，QISS MRA检测阻塞性管腔狭窄（>70%）的诊断准确性参数如下：敏感性82.6%，特异性96.9%，阳性预测值89.1%，阴性预测值94.8%。关于狭窄程度，QISS MRA在所有区域的观察者间变异性为0.97，CO2 DSA为0.82。对于慢性下肢PAD成像，QISS MRA在主观图像质量和可解释性方面被证明优于CO2 DSA。
