Diagnostic Accuracy of Contrast-Enhanced Magnetic Resonance Angiography and Duplex Ultrasound in Patients With Peripheral Vascular Disease

Abstract

Introduction: Noninvasive techniques such as duplex ultrasound (DU) and contrast-enhanced magnetic resonance angiography (CE-MRA) are valid alternatives in the preoperative evaluation of such patients. Our aim is to assess the diagnostic accuracy of CE-MRA and DU in patients with peripheral arterial disease (PAD). Methods: Forty consecutive patients underwent DU, hybrid CE-MRA, and digital subtraction angiography (DSA). Magnetic resonance angiography and DSA images were evaluated independently and in a blinded fashion. Every segment was graded as normal, stenosed less than 50%, stenosed more than 50%, or occluded. Results: There were 1720 segments for analysis. Duplex ultrasound depicting stenosis >50% demonstrated a sensitivity (S) 81.4%, specificity (E) 99%, positive predictive value (PPV) 96.2%, and negative predictive value (NPV) 94.8%. Occlusions showed S 90%, E 97%, PPV 98.1%, and NPV 88.4%. Magnetic resonance angiography depicting stenosis >50% demonstrated a S 91%, E 99%, PPV 96.7%, and NPV 97.6%. Occlusions showed S 95.4%, E 98%, PPV 98.4%, and NPV 94.7%. Conclusion: Combined CE-MRA and DU is the first diagnostic approach in the preoperative assessment of PAD, leading to the use of DSA for selected cases

Keywords

contrast-enhanced magnetic resonance angiography duplex ultrasound peripheral arterial disease

Get full access to this article

View all access options for this article.

References

Eiberg JP , Lundorf E. , Thomsen C. , Schroeder TV Peripheral vascular surgery and magnetic resonance arteriography- a review . Eur J Endovasc Surg. 2001;22(5):396-402.

Coffi SB , Ubbink DT , Zwiers I. , van Gurp AJM , Legemate DA The value of the peak sustolic velocity ratio in the assessment of the haemodynamic significance of subcritical iliac artery stenoses. Eur J Vasc Endovasc Surg. 2001;22(5):424-428.

Moneta GL , Strandness DE Jr. Peripheral arterial duplex scanning. J Clin Ultrasound . 1987;15(9):645-51.

de Vries M. , Ouwendijk R. , Flobbe K. , et al. Peripheral arterial disease: clinical and cost comparisons between duplex US and contrast-enhanced MR Angiography-a multicenter randomized trial . Radiology. 2006;240(2):401-410.

Mell M. , Tefera G. , Thornton F. , Siepman D. , Turnipseed W. Clinical utility of time-resolved imaging of contrast kinetics (TRICKS) magnetic resonance angiography for infrageniculate arterial occlusive disease . J Vasc Surg. 2007;45(3):543-548.

Binkert CA , Baker PD , Petersen BD , Szumowski J. , Kaufman JA Peripheral vascular disease: blinded study of dedicated calf MR angiography versus standard bolus-chase MR angiography and film hard-copy angiography . Radiology. 2004;232(3):860-866.

Pereless FS , Collins JD , Carr JC , et al. Accuracy of stepping-table lower extremity MR angiography with dual-level bolus timing and separate calf acquisition: hybrid peripheral MR angiography. Radiology. 2006;240(1):283-290.

Janka R. , Wenkel E. , Fellner C. , Lang W. , Bautz W. , Uder M. Magnetic resonance angiography of the peripheral vessels in patients with peripheral arterial occlusive disease: when is an additional conventional angiography required? Cardiovasc Intervent Radiol. 2006;29(2):220-229.

Visser K. , Bosch JL , Leiner T. , van Engelshoven JMA , Passchier J. , Hunink MGM. Patients’ preferences for MR angiography and duplex US in the work-up of peripheral arterial disease. Eur J Vasc Endovasc Surg. 2003;26(5):537-534.

10.

Bossuyt PM , Reitsma JB , Bruns DE , et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med. 2003;138(1):W1-W12.

11.

Prince MR , Narasimham DL , Stanley JC , et al. Breath-hold gadolinium-enhanced MR angiography of the aorta and its major branches. Radiology. 1995;197(3):785-792.

12.

Pennell DJ , Sechtem UP , Higgins CB , et al. Society for Cardiovascular Magnetic Resonance; Working Group on Cardiovascular Magnetic Resonance of the European Society of Cardiology . Clinical indications for cardiovascular magnetic resonance (CMR): Consensus panel report. Eur Heart J. 2004;25(21): 1940-1965.

13.

Dellegrottaglie S. , Sanz J. , Macaluso F. , et al. Technology insight: magnetic resonance angiography for the evaluation of patients with peripheral disease. Nat Clin Pract Cardiovasc Med. 2007; 4(12):677-687.

14.

Leiner T. , Kessels AGH , Nelemans PJ , et al. Peripheral arterial disease: comparison of color duplex US and contrast-enhanced MR angiography for diagnosis. Radiology . 2005;235(2):699-708.

15.

Gjønnaess E. , Morken B. , Sandbaek G. , et al. Gadolinium-enhanced magnetic resonance angiography, colour duplex and digital subtraction angiography of the lower limb arteries from the aorta to the tibio-peroneal trunk in patients with intermittent claudication. Eur J Vasc Endovasc Surg. 2006;31(1):53-58.

16.

Cronberg CN , Sjoberg S. , Albrechtsson U. , Leander P. , Lindh M. , Norgren L. Peripheral arterial disease. Contrast-enhanced 3D MR angiography of the lower leg and foot compared with conventional angiography . Acta Radiol. 2003;44(1):59-66.

17.

Steffens JC , Schafer FK , Oberscheid B. , Link J. , Jahnke T. , Heller M. Bolus-chasing contrast-enhanced 3D MRA of the lower extremity. Comparison with intraarterial DSA. Acta Radiol. 2003; 44(2):185-192.

18.

Hatsukami TS , Primozich JF , Zierler RE , Harley JD , Strandness DE Jr. Color Doppler imaging of infrainguinal arterial occlusive disease. J Vasc Surg. 1992 ;16(4):527-33.

19.

Sensier Y. , Hartshome T. , Thrush A. , Handford H. , Nydahl S. , London NJ The effect of adjacent segment disease on the accuracy of colour duplex scanning for the diagnosis of lower limb arterial disease. Eur J Vasc Endovasc Surg. 1996;12(2):238-242.

20.

Meissner OA , Rieger J. , Weber C. , et al. Critical limb ischemia: hybrid MR angiography compared with DSA. Radiology . 2005; 235(1):308-318.

21.

Wikstrom J. , Holmberg A. , Johansson L. , et al. Gadolinium-enhanced magnetic resonance angiography, digital subtraction angiography and duplex of the iliac arteries compared with intra-arterial pressure gradient measurements . Eur J Vasc Endovasc Surg. 2000;19(5):516-523.

22.

Lundin P. , Svensson A. , Henriksen E. , et al. Imaging of aortoiliac arterial disease: duplex ultrasound and MR angiography versus digital subtraction angiography. Acta Radiol. 2000;41(2):125-132.

23.

Morasch MD , Collins J. , Pereles FS , Carr JC , Eskandari MK , Pearce WH Lower extremity stepping-table magnetic resonance angiography with multilevel contrast timing and segmented contrast infusion. J Vasc Surg . 2003;37(1):62-71.

24.

Winterer JT , Laubenberger J. , Scheffer K. , Neumann K. , Bayraktarli YR , Allman KH Contrast-enhanced subtraction MR angiography in occlusive disease of the pelvic and lower limb arteries: results of a prospective individual comparative study with digital subtraction angiography in 76 patients . J Comp Assist Tomogr . 1999;23(4):583-589.

25.

Hingorani A. , Ascher E. , Marks N. Preprocedural imaging: new options to reduce need for contrast angiography. Semin Vasc Surg. 2007;20(1):15-28.

26.

Kalle TV , Gerlach A. , Hatopp A. , Klinger S. , Prodehl P. , Arlat IP Contrast-enhanced MR angiography (CEMRA) in peripheral arterial occlusive disease (PAOD): conventional moving table technique versus hybrid technique . Rofo. 2004;176(1):62-69.

27.

Low G. , Mizzi A. , Ong K. , Lau PF , McKinstery J. Technical inadequacies of peripheral contrast-enhanced magnetic resonance angiography: incidence, causes and management strategies. Clin Radiol. 2006;61(11):937-945.

28.

Dorweiler B. , Neufang A. , Kreitner KF , Schmiedt W. , Oelert H. Magnetic resonance angiography unmasks reliable target vessels for pedal bypass grafting in patients with diabetes mellitus . J Vasc Surg. 2002 ;35(4):766-772.

29.

Deutschmann HA , Schoellnast H. , Portugaller HR , et al. Routine use of three-dimensional contrast-enhanced moving-table MR angiography in patients with peripheral arterial occlusive disease: comparison with selective digital substraction angiography. Cardiovasc Intervent Radiol. 2006;29(5):762-770.

30.

Hofmann WJ , Forstner R. , Kofler B. , Binder K. , Ugurluoglu A. , Magometschnigg H. Pedal artery imaging-a comparison of selective digital subtraction angiography, contrast enhanced magnetic resonance angiography and duplex ultrasound . Eur J Vasc Endovasc Surg. 2002;24(4):287-292.

31.

Lapeyre M. , Kobeiter H. , Desgranges P. , Rahmouni A. , Becquemin JP , Luciani A. Assessment of critical limb ischemia in patients with diabetes: comparison of MR angiography and digital subtraction angiography. AJR J Roentgenol. 2005; 185(6):1641-1650.

32.

Loewe C. , Schoder M. , Rand T. , et al. Peripheral vascular occlusive disease: evaluation with contrast-enhanced moving-bed MR angiography versus digital subtraction angiography in 106 patients . AJR J Roentgenol. 2002;179(4):1013-1021.

33.

Collis R. , Burch J. , Cranny G. , et al. Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: systematic review. BMJ. 2007; 334(7606):1257.

34.

Wang Y. , Truong TN , Yen C. , et al. Quantitative evaluation of susceptibility and shielding effects of nitinol, platinum, cobalt-alloy, and stainless-steel stents. Magn Reson Med. 2003;49(5):972-976.

35.

Hingorani A. , Ascher E. Dyless vascular surgery. Cardiovas Surg. 2003;11:12-18.

36.

Grassbaugh JA , Nelson PR , Rzucidlo EM , et al. Blinded comparison of preoperative duplex ultrasound scanning and contrast arteriography for planning revascularización at the level of the tibia. J Vasc Surg. 2003 ;37(6):1186-1190.

37.

Shaalan WE , French-Sherry E. , Castilla M. , Loranski L. , Bassiouny HS Reliability of common femoral artery hemodynamics in assessing the severity of aortoiliac inflow disease. J Vasc Surg. 2003;37(5):960-969.

38.

Wikström J. , Johansson L. , Karacagil S. , Ahlström H. Correlation of femoral artery flow velocity waveform with ipsilateral iliac artery stenoses assessed with magnetic resonance imaging. Acta Radiol. 2007;48(4):422-430.

39.

Eiberg JP , Jensen F. , Gronvall Rasmussen JB , Schoeder TV Screening for aorotoiliac lesions by visual interpretation of the common femoral doppler waveform. Eur J Vasc Endovasc Surg . 2001;22(4):331-336.

40.

Staffa R. , Gregor Z. , Vlachovsky R. , Vojtisek B. , Hofirek I. Pedal bypass grafting on arteriographycally invisible foot arteries detected by duplex ultrasound for limb salvage. Minerva Chir . 2007;62(2):115-124.

41.

Ascher E. , Marks NA , Schutzer RW , Hingorani AP Duplex-assisted internal carotid artery balloon angioplasty and stent placement: a novel approach to minimize or eliminate the use of contrast material . J Vasc Surg. 2005;41(3):409-415.

42.

Grassbaugh JA , Nelson PR , Rzucidlo EM , et al. Blinded comparison of preoperative duplex ultrasound scanning and contrast arteriography for planning revascularization at the level of the tibia. J Vasc Surg. 2003 ;37(6):1186-90.

43.

Moneta GL , Yeager RA , Antonovic R. Angiography and colour duplex ultrasonography in the evaluation of Peripherals ischaemic occlusive arterial disease. Acta Radiol . 1994;35(3): 270-274.

44.

Zeuchner J. , Geitung JT , Lukes P. , Göthlin JH Angiography and colour flow duplex ultrasonography in the evaluation of peripheral ischaemic occlusive arterial disease. Acta Radiol. 1994; 35(3):270-274.