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Unenhanced Velocity‐Selective MR Angiography (VS‐MRA): Initial Clinical Evaluation in Patients With Peripheral Artery Disease
Author(s) -
Shin Taehoon,
Me Rajiv G.,
Thomas Rahul B.,
Cavallo Armando U.,
Sarkar Rajabraka,
Crawford Robert S.,
Rajagopalan Sanjay
Publication year - 2019
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.26268
Subject(s) - medicine , digital subtraction angiography , magnetic resonance angiography , radiology , stenosis , image quality , nuclear medicine , occlusion , prospective cohort study , magnetic resonance imaging , population , angiography , environmental health , artificial intelligence , computer science , image (mathematics)
Background Safe and accurate imaging of the peripheral arterial system is important for diagnosis and treatment planning of patients with peripheral artery disease (PAD). Purpose To evaluate image quality and diagnostic performance of unenhanced magnetic resonance angiography (MRA) based on velocity‐selective (VS) magnetization preparation (termed VS‐MRA). Study Type Prospective. Population Thirty‐one symptomatic PAD patients underwent VS‐MRA. Twenty‐four of them underwent clinical digital subtraction angiography (DSA) examination, 18.8 ± 5.2 days after the MR scans. Field Strength/Sequence 1.5T MRI that included VS‐MRA (homemade research sequence) and phase‐contrast flow imaging (clinical sequence). Assessment Image quality (0: nondiagnostic, 3: excellent) and stenosis severity (0: normal, 3: occlusion) of VS‐MRA images were assessed independently by three reviewers. Arterial signal‐to‐noise‐ratio (SNR) and artery‐to‐muscle contrast‐to‐noise ratio (CNR) were calculated. Statistical Tests The sensitivity and specificity of VS‐MRA were calculated for the detection of significant stenosis (>50%) with DSA as the reference standard. Interobserver agreement among the three reviewers was evaluated by using Cohen κ‐statistics. Results The image quality score of VS‐MRA was 2.7 ± 0.5 for Reader 1, 2.8 ± 0.5 for Reader 2, and 2.8 ± 0.4 for Reader 3; SNR and CNR were 37.8 ± 12.5 and 30.5 ± 11.8, respectively. Segment‐based analysis revealed that VS‐MRA had sensitivities of 85.3%, 74.5%, and 78.4%, respectively, for the three reviewers, and specificities of 93.5%, 96.8%, and 95.2%. The interobserver agreement for the stenosis grading was good, as demonstrated by Cohen κ values of 0.76 (Reader 1 vs. Reader 2), 0.82 (Reader 1 vs. Reader 3), and 0.79 (Reader 2 vs. Reader 3). Data Conclusion Unenhanced VS‐MRA allows clear depiction of the peripheral arteries and accurate stenosis grading, as evidenced by high image quality scores and strong agreement with DSA. Level of Evidence: 2 Technical Efficacy : Stage 2 J. Magn. Reson. Imaging 2019;49:744–751.