Department of Radiology, Tokai University Hospital, Kanagawa, Japan; Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan.
Department of Radiological Technology, Juntendo University, Tokyo, Japan.
Magn Reson Imaging. 2024 Jul;110:43-50. doi: 10.1016/j.mri.2024.04.008. Epub 2024 Apr 9.
Lower extremity magnetic resonance angiography (MRA) without electrocardiography (ECG) or peripheral pulse unit (PPU) triggering and contrast enhancement is beneficial for diagnosing peripheral arterial disease (PAD) while avoiding synchronization failure and nephrogenic systemic fibrosis. This study aimed to compare the diagnostic performance of turbo spin-echo-based enhanced acceleration-selective arterial spin labeling (eAccASL) (TSE-Acc) of the lower extremities with that of turbo field-echo-based eAccASL (TFE-Acc) and triggered angiography non-contrast enhanced (TRANCE).
Nine healthy volunteers and a patient with PAD were examined on a 3.0 Tesla magnetic resonance imaging (MRI) system. The artery-to-muscle signal intensity ratio (SIR) and contrast-to-noise ratio (CNR) were calculated. The arterial visibility (1: poor, 4: excellent) and artifact contamination (1: severe, 4: no) were independently assessed by two radiologists. Phase-contrast MRI and digital subtraction angiography were referenced in a patient with PAD. Friedman's test and a post-hoc test according to the Bonferroni-adjusted Wilcoxon signed-rank test were used for the SIR, CNR, and visual assessment. p < 0.05 was considered statistically significant.
No significant differences in nearly all the SIRs were observed among the three MRA methods. Higher CNRs were observed with TSE-Acc than those with TFE-Acc (anterior tibial artery, p = 0.014; peroneal artery, p = 0.029; and posterior tibial artery, p = 0.014) in distal arterial segments; however, no significant differences were observed upon comparison with TRANCE (all p > 0.05). The arterial visibility scores exhibited similar trends as the CNRs. The artifact contamination scores with TSE-Acc were significantly lower (but within an acceptable level) compared to those with TFE-Acc. In the patient with PAD, the sluggish peripheral arteries were better visualized using TSE-Acc than those using TFE-Acc, and the collateral and stenosis arteries were better visualized using TSE-Acc than those using TRANCE.
Peripheral arterial visualization was better with TSE-Acc than that with TFE-Acc in lower extremity MRA without ECG or PPU triggering and contrast enhancement, which was comparable with TRANCE as the reference standard. Furthermore, TSE-Acc may propose satisfactory diagnostic performance for diagnosing PAD in patients with arrhythmia and chronic kidney disease.
无心电图（ECG）或外周脉搏单元（PPU）触发和对比增强的下肢磁共振血管造影（MRA）有益于诊断外周动脉疾病（PAD），同时避免同步失败和肾源性系统性纤维化。本研究旨在比较基于涡轮自旋回波的增强加速选择动脉自旋标记（eAccASL）（TSE-Acc）与基于涡轮现场回波的 eAccASL（TFE-Acc）和触发非对比增强血管造影（TRANCE）的下肢诊断性能。
在 3.0T 磁共振成像（MRI）系统上检查 9 名健康志愿者和 1 名 PAD 患者。计算动脉-肌肉信号强度比（SIR）和对比噪声比（CNR）。两名放射科医生独立评估动脉可视性（1：差，4：优）和伪影污染（1：严重，4：无）。在 PAD 患者中参考相位对比 MRI 和数字减影血管造影。采用 Friedman 检验和基于 Bonferroni 调整的 Wilcoxon 符号秩检验的事后检验对 SIR、CNR 和视觉评估进行分析。p<0.05 被认为具有统计学意义。
在三种 MRA 方法中，几乎所有 SIR 均无显著差异。与 TFE-Acc 相比，TSE-Acc 在后段动脉中具有更高的 CNR（胫前动脉，p=0.014；腓动脉，p=0.029；胫后动脉，p=0.014）；然而，与 TRANCE 相比，无显著差异（均 p>0.05）。动脉可视性评分与 CNR 具有相似的趋势。与 TFE-Acc 相比，TSE-Acc 的伪影污染评分显著降低（但仍处于可接受水平）。在 PAD 患者中，与 TFE-Acc 相比，TSE-Acc 更好地显示了缓慢的外周动脉，与 TRANCE 相比，TSE-Acc 更好地显示了侧支和狭窄的动脉。
在无 ECG 或 PPU 触发和对比增强的下肢 MRA 中，与 TFE-Acc 相比，TSE-Acc 可更好地显示外周动脉，与作为参考标准的 TRANCE 相比具有可比性。此外，TSE-Acc 可能为心律失常和慢性肾病患者的 PAD 诊断提供令人满意的诊断性能。
