Accuracy of Noncontrast Quiescent-Interval Single-Shot Lower Extremity MR Angiography Versus CT Angiography for Diagnosis of Peripheral Artery Disease Comparison With Digital Subtraction Angiography

作者：Varga Szemes Akos; Wichmann Julian L; Schoepf U Joseph^*; Suranyi Pal; De Cecco Carlo N; Muscogiuri Giuseppe; Caruso Damiano; Yamada Ricardo T; Litwin Sheldon E; Tesche Christian; Duguay Taylor M; Giri Shivraman; Vliegenthart Rozemarijn; Todoran Thomas M

来源：JACC: Cardiovascular Imaging , 2017, 10(10): 1116-1124.

DOI：10.1016/j.jcmg.2016.09.030

• cardiovascular magnetic resonance
• noncontrast magnetic resonance angiography
• quiescent interval single shot

OBJECTIVES This study sought to evaluate the image quality and diagnostic accuracy of noncontrast quiescent-interval single-shot (QISS) magnetic resonance angiography (MRA) versus iodine-contrast computed tomography angiography (CTA) in patients with peripheral artery disease (PAD), with invasive digital subtraction angiography (DSA) as the reference standard.
BACKGROUND QISS is a recently introduced noncontrast MRA technique. Although the diagnostic accuracy of QISS is reportedly similar to that of contrast-enhanced MRA, its performance compared with contrast-enhanced CTA, the most frequently used noninvasive modality for evaluation of PAD, is unknown.
METHODS Thirty patients (66 +/- 7 years of age) with PAD underwent lower extremity CTA with third-generation dual-source dual-energy CT and 1.5-T MRA using a prototype noncontrast QISS sequence. DSA was performed within 50 days. The abdominal aorta and lower extremity run-off were imaged. Eighteen arterial segments were analyzed. Subjective image quality (3-point Likert scale) and stenosis (5-point grading) were evaluated by 2 observers and compared using the Mann-Whitney U and chi-square tests, respectively. Sensitivity and specificity of MRA and CTA for > 50% stenosis detection were compared using the McNemar-test.
RESULTS Of 540 segments, 15 (2.8%) and 42 (7.8%) inconclusive segments were excluded from MRA and CTA analysis, respectively (p = 0.0006). The DSA results were available for 410 of the remaining segments. Overall subjective image quality was rated similarly with QISS-MRA (2.52 [95% confidence interval: 2.46 to 2.57]) and CTA (2.49 [95% confidence interval: 2.43 to 2.55]; p = 0.5062). The sensitivity and specificity of MRA for > 50% stenosis were 84.9% and 97.2%, respectively, similar to those of CTA (87.3% and 95.4%, respectively). Interobserver agreement for stenosis detection was excellent for MRA (kappa > 0.81) and CTA (kappa > 0.81).
CONCLUSIONS Noncontrast QISS-MRA provides high diagnostic accuracy compared with DSA, while being less prone to image artifacts than CTA. QISS better visualizes heavily calcified segments with impaired flow. QISS-MRA obviates the need for contrast administration in PAD patients.

• 出版日期2017-10