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Isei T, Abe M, Ikegami R, Kato H, Sakurai E, Tanizaki H, Nakanishi T, Matsuo K, Yamasaki O, Asai J, Asano Y, Amano M, Ishii T, Isogai Z, Ito T, Inoue Y, Irisawa R, Iwata Y, Otsuka M, Omoto Y, Kadono T, Kaneko S, Kanoh H, Kawakami T, Kawaguchi M, Kukino R, Kono K, Koga M, Kodera M, Sakai K, Sarayama Y, Shintani Y, Tanioka M, Tsujita J, Doi N, Hashimoto A, Hasegawa M, Hayashi M, Hirosaki K, Fujita H, Fujimoto M, Fujiwara H, Maekawa T, Madokoro N, Motegi S, Yatsushiro H, Yoshino Y, Pavoux ALE, Tachibana T, Ihn H. Wound, pressure ulcer, and burn guidelines - 3: Guidelines for the diagnosis and treatment of diabetic ulcers and gangrene, second edition. J Dermatol 2025. [PMID: 40292848 DOI: 10.1111/1346-8138.17697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 02/19/2025] [Accepted: 02/26/2025] [Indexed: 04/30/2025]
Abstract
The Japanese Dermatological Association aimed to prepare a second edition of guidelines for the management of diabetic ulcer/gangrene with emphasis on the diagnosis and treatment of skin symptoms. This new edition serves as a tool to improve the quality of the diagnosis and treatment in each patient and, further, to improve the level of care for such skin conditions. All sections have been updated by collecting documents published since the publication of the first edition. In the antibacterial drug treatment for bacterial infection of ulcers, oral administration was added after consideration. In the treatment of antibacterial drugs for bacterial infection of ulcers, not only infusion but also oral administration was mentioned. In addition, clinical questions (CQs) for imaging tests for diagnosing ischemia of the limbs were newly created. The titles of some CQs were changed to conform to the actual clinical setting. (i) The content has been updated by adding and collecting documents for all sections; (ii) we have additionally included oral antibiotic treatment for bacterial infection of ulcers; (iii) we have added CQs pertaining to imaging tests for diagnosing ischemia of the limbs; and (iv) we have revised the titles of some CQs to conform to the actual clinical setting. In particular, the recommendation levels of dressing materials newly covered by Japanese national health insurance are mentioned. In addition, CQs regarding the initial treatment of electrical (CQ15) and chemical burns (CQ16), and the use of escharotomy (CQ22) have been created.
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Affiliation(s)
- Taiki Isei
- Department of Dermatology, Osaka National Hospital, Osaka, Japan
| | | | - Ryuta Ikegami
- Department of Dermatology, JCHO Osaka Hospital, Osaka, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | | | - Hideaki Tanizaki
- Department of Dermatology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takeshi Nakanishi
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | | | - Osamu Yamasaki
- Department of Dermatology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Jun Asai
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshihide Asano
- Department of Dermatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masahiro Amano
- Department of Dermatology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takayuki Ishii
- Division of Dermatology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Zenzo Isogai
- Division of Dermatology and Connective Tissue Medicine, Department of Advanced Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takaaki Ito
- Department of Dermatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuji Inoue
- Suizenji Dermatology Clinic, Kumamoto, Japan
| | - Ryokichi Irisawa
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Yohei Iwata
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masaki Otsuka
- Division of Dermatology, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Yoichi Omoto
- Department of Dermatology, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Takafumi Kadono
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sakae Kaneko
- Department of Dermatology, School of Medicine, Shimane University, Izumo, Japan
| | - Hiroyuki Kanoh
- Department of Dermatology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Tamihiro Kawakami
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masakazu Kawaguchi
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | | | - Ken Kono
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzei, Japan
| | - Monji Koga
- Department of Dermatology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Masanari Kodera
- Department of Dermatology, JCHO Chukyo Hospital, Nagoya, Japan
| | - Keisuke Sakai
- Department of Dermatology, Minamata City General Hospital & Medical Center, Minamata, Japan
| | | | | | | | - Jun Tsujita
- Department of Dermatology, Social Insurance Inatsuki Hospital, Kama, Japan
| | - Naotaka Doi
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Akira Hashimoto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Minoru Hasegawa
- Division of Medicine, Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Japan
| | - Masahiro Hayashi
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Kuninori Hirosaki
- Department of Dermatology, Hokkaido Medical Care Center, Sapporo, Japan
| | - Hideki Fujita
- Department of Dermatology, School of Medicine, Nihon University, Tokyo, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Fujiwara
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- Department of Dermatology, Uonuma Kikan Hospital, Minamiuonuma, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Naoki Madokoro
- Department of Dermatology, MAZDA Hospital, Aki-gun, Japan
| | - Seiichiro Motegi
- Department of Dermatology, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | | | - Yuichiro Yoshino
- Department of Dermatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | | | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Sinharoy A, Reddy N, Lin JK, Nambi V, Yang EY, Kougias P, Taylor AA, Lumsden AB, Ballantyne CM, Brunner G. Longitudinal Magnetic Resonance Imaging-Based Superficial Femoral Artery Velocity Measurements in Diabetic and Nondiabetic Patients With Peripheral Artery Disease. Top Magn Reson Imaging 2023; 32:57-65. [PMID: 38051028 PMCID: PMC11742609 DOI: 10.1097/rmr.0000000000000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/11/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Longitudinal associations of noninvasive 2-dimensional phase-contrast magnetic resonance imaging (2D-PC-MRI) velocity markers of the superficial femoral artery (SFA) were analyzed along with the characteristics of peripheral artery disease (PAD). We hypothesized that the 2-year differences in MRI-based measures of SFA velocity were associated with longitudinal changes in markers of PAD. METHODS A total of 33 (11 diabetic, 22 nondiabetic) patients with PAD with baseline and 2-year follow-up MRI scans were included in this secondary analysis of the Effect of Lipid Modification on Peripheral Artery Disease after Endovascular Intervention Trial (ELIMIT). Electrocardiographically gated 2D-PC-MRI was performed at a proximal and a distal location of the distal SFA territory. SFA lumen, wall, and total vessel volumes and the normalized wall index (NWI) were analyzed. RESULTS Baseline characteristics did not differ between diabetic and nondiabetic PAD patients. Maximum proximal and distal SFA velocity measures did not differ between baseline and 2 years (41.98 interquartile range (IQR) (23.58-72.6) cm/s vs. 40.31 IQR (26.69-61.29) cm/s; P = 0.30). Pooled analysis (N = 33) showed that the 24-month change in the NWI was inversely associated with the 24-month change in the proximal maximal SFA velocity (beta = -168.36, R2 = 0.150, P value = 0.03). The 24-month change of the maximum velocity differences between the proximal and distal SFA locations was inversely associated with the 24-month changes in peak walking distance (beta = -0.003, R2 = 0.360, P value = 0.011). CONCLUSION The 2-year change of SFA plaque burden is inversely associated with the 2-year change of proximal peak SFA blood flow velocity. 2D-PC-MRI measured SFA velocity may be of interest in assessing PAD longitudinally.
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Affiliation(s)
- Ankita Sinharoy
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Neeti Reddy
- Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John Kent Lin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Vijay Nambi
- Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Eric Y Yang
- University of Texas Health Science Center, San Antonio, TX, USA
| | - Panagiotis Kougias
- Department of Surgery, Downstate Health Sciences University, Brooklyn, NY
| | - Addison A Taylor
- Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Alan B Lumsden
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Christie M Ballantyne
- Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Gerd Brunner
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA
- Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Browne WF, Sung J, Majdalany BS, Khaja MS, Calligaro K, Contrella BN, Ferencik M, Gunn AJ, Kapoor BS, Keefe NA, Kokabi N, Kramer CM, Kwun R, Shamoun F, Sharma AM, Steenburg SD, Trout AT, Vijay K, Wang DS, Steigner ML. ACR Appropriateness Criteria® Sudden Onset of Cold, Painful Leg: 2023 Update. J Am Coll Radiol 2023; 20:S565-S573. [PMID: 38040470 DOI: 10.1016/j.jacr.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Acute onset of a cold, painful leg, also known as acute limb ischemia, describes the sudden loss of perfusion to the lower extremity and carries significant risk of morbidity and mortality. Acute limb ischemia requires rapid identification and the management of suspected vascular compromise and is inherently driven by clinical considerations. The objectives of initial imaging include confirmation of diagnosis, identifying the location and extent of vascular occlusion, and preprocedural/presurgical planning. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Jeffrey Sung
- Research Author, Weill Cornell Medical College, New York, New York
| | - Bill S Majdalany
- Panel Chair, University of Vermont Medical Center, Burlington, Vermont
| | - Minhaj S Khaja
- Panel Vice-Chair, University of Michigan, Ann Arbor, Michigan
| | - Keith Calligaro
- Pennsylvania Hospital, Philadelphia, Pennsylvania; Society for Vascular Surgery
| | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Society of Cardiovascular Computed Tomography
| | - Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Nicole A Keefe
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Christopher M Kramer
- University of Virginia Health, Charlottesville, Virginia; Society for Cardiovascular Magnetic Resonance
| | - Richard Kwun
- Swedish Medical Center, Issaquah, Washington; American College of Emergency Physicians
| | - Fadi Shamoun
- Mayo Clinic Arizona, Phoenix, Arizona; American Society of Echocardiography
| | - Aditya M Sharma
- University of Virginia Health System, Charlottesville, Virginia, Primary care physician
| | - Scott D Steenburg
- Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana; Committee on Emergency Radiology-GSER
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Commission on Nuclear Medicine and Molecular Imaging
| | - Kanupriya Vijay
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - David S Wang
- Stanford University Medical Center, Stanford, California
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Hosadurg N, Kramer CM. Magnetic Resonance Imaging Techniques in Peripheral Arterial Disease. Adv Wound Care (New Rochelle) 2023; 12:611-625. [PMID: 37058352 PMCID: PMC10468560 DOI: 10.1089/wound.2022.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/12/2023] [Indexed: 04/15/2023] Open
Abstract
Significance: Peripheral arterial disease (PAD) leads to a significant burden of morbidity and impaired quality of life globally. Diabetes is a significant risk factor accelerating the development of PAD with an associated increase in the risk of chronic wounds, tissue, and limb loss. Various magnetic resonance imaging (MRI) techniques are being increasingly acknowledged as useful methods of accurately assessing PAD. Recent Advances: Conventionally utilized MRI techniques for assessing macrovascular disease have included contrast enhanced magnetic resonance angiography (MRA), noncontrast time of flight MRA, and phase contrast MRI, but have significant limitations. In recent years, novel noncontrast MRI methods assessing skeletal muscle perfusion and metabolism such as arterial spin labeling (ASL), blood-oxygen-level dependent (BOLD) imaging, and chemical exchange saturation transfer (CEST) have emerged. Critical Issues: Conventional non-MRI (such as ankle-brachial index, arterial duplex ultrasonography, and computed tomographic angiography) and MRI based modalities image the macrovasculature. The underlying mechanisms of PAD that result in clinical manifestations are, however, complex, and imaging modalities that can assess the interaction between impaired blood flow, microvascular tissue perfusion, and muscular metabolism are necessary. Future Directions: Further development and clinical validation of noncontrast MRI methods assessing skeletal muscle perfusion and metabolism, such as ASL, BOLD, CEST, intravoxel incoherent motion microperfusion, and techniques that assess plaque composition, are advancing this field. These modalities can provide useful prognostic data and help in reliable surveillance of outcomes after interventions.
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Affiliation(s)
- Nisha Hosadurg
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher M. Kramer
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
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Wang X, Nai YH, Gan J, Lian CPL, Ryan FK, Tan FSL, Chan DYS, Ng JJ, Lo ZJ, Chong TT, Hausenloy DJ. Multi-Modality Imaging of Atheromatous Plaques in Peripheral Arterial Disease: Integrating Molecular and Imaging Markers. Int J Mol Sci 2023; 24:11123. [PMID: 37446302 DOI: 10.3390/ijms241311123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral artery disease (PAD) is a common and debilitating condition characterized by the narrowing of the limb arteries, primarily due to atherosclerosis. Non-invasive multi-modality imaging approaches using computed tomography (CT), magnetic resonance imaging (MRI), and nuclear imaging have emerged as valuable tools for assessing PAD atheromatous plaques and vessel walls. This review provides an overview of these different imaging techniques, their advantages, limitations, and recent advancements. In addition, this review highlights the importance of molecular markers, including those related to inflammation, endothelial dysfunction, and oxidative stress, in PAD pathophysiology. The potential of integrating molecular and imaging markers for an improved understanding of PAD is also discussed. Despite the promise of this integrative approach, there remain several challenges, including technical limitations in imaging modalities and the need for novel molecular marker discovery and validation. Addressing these challenges and embracing future directions in the field will be essential for maximizing the potential of molecular and imaging markers for improving PAD patient outcomes.
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Affiliation(s)
- Xiaomeng Wang
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Ying-Hwey Nai
- Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
| | - Julian Gan
- Siemens Healthineers, Singapore 348615, Singapore
| | - Cheryl Pei Ling Lian
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Fraser Kirwan Ryan
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Forest Su Lim Tan
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Dexter Yak Seng Chan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Jun Jie Ng
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore 258499, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore 168752, Singapore
- Surgical Academic Clinical Programme, Singapore General Hospital, Singapore 169608, Singapore
- Vascular SingHealth Duke-NUS Disease Centre, Singapore 168752, Singapore
| | - Derek John Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore 117597, Singapore
- The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
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Azene EM, Steigner ML, Aghayev A, Ahmad S, Clough RE, Ferencik M, Hedgire SS, Hicks CW, Kirsch DS, Lee YJ, Myers LA, Nagpal P, Osborne N, Pillai AK, Ripley B, Singh N, Thomas R, Kalva SP. ACR Appropriateness Criteria® Lower Extremity Arterial Claudication-Imaging Assessment for Revascularization: 2022 Update. J Am Coll Radiol 2022; 19:S364-S373. [PMID: 36436963 PMCID: PMC9876734 DOI: 10.1016/j.jacr.2022.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Arterial claudication is a common manifestation of peripheral artery disease. This document focuses on necessary imaging before revascularization for claudication. Appropriate use of ultrasound, invasive arteriography, MR angiography, and CT angiography are discussed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Ezana M Azene
- Director of PERT, Chair Cancer Advisory Council, Medical Governor, Gundersen Health System, La Crosse, Wisconsin.
| | - Michael L Steigner
- Panel Chair; Director, Vascular CT/MR, Medical Director 3D Lab, Brigham & Women's Hospital, Boston, Massachusetts
| | - Ayaz Aghayev
- Panel Vice-Chair, Brigham & Women's Hospital, Boston, Massachusetts
| | - Sarah Ahmad
- University of Toronto, Toronto, Ontario, Canada; American College of Physicians
| | - Rachel E Clough
- St. Thomas' Hospital, King's College, School of Biomedical Engineering and Imaging Science, London, United Kingdom; Society for Cardiovascular Magnetic Resonance
| | - Maros Ferencik
- Section Head of Cardiovascular Imaging, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Society of Cardiovascular Computed Tomography
| | - Sandeep S Hedgire
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Caitlin W Hicks
- Director of Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland; Editor-in-Chief, Seminars in Vascular Surgery; Society for Vascular Surgery
| | | | - Yoo Jin Lee
- University of California, San Francisco, San Francisco, California
| | - Lee A Myers
- Keck School of Medicine of USC, Los Angeles, California; Committee on Emergency Radiology-GSER
| | - Prashant Nagpal
- Head, Cardiovascular Imaging, University of Wisconsin, Madison, Wisconsin
| | - Nicholas Osborne
- University of Michigan, Ann Arbor, Michigan; Society for Vascular Surgery
| | - Anil K Pillai
- Section Chief, Interventional Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Beth Ripley
- VA Puget Sound Health Care System and University of Washington, Seattle, Washington
| | | | - Richard Thomas
- Section Chief of Thoracic Imaging and Cardiac CT and Associate Magnetic Resonance Medical Director, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Sanjeeva P Kalva
- Specialty Chair; Chief of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Quiescent-Interval Single-Shot Magnetic Resonance Angiography May Outperform Carbon-Dioxide Digital Subtraction Angiography in Chronic Lower Extremity Peripheral Arterial Disease. J Clin Med 2022; 11:jcm11154485. [PMID: 35956102 PMCID: PMC9369435 DOI: 10.3390/jcm11154485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023] Open
Abstract
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.
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8
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Verma M, Pandey NN, Singh V, Jagia P. A meta-analysis of the diagnostic performance of quiescent-interval-single-shot magnetic resonance angiography in peripheral arterial disease. Eur Radiol 2021; 32:2393-2403. [PMID: 34766201 DOI: 10.1007/s00330-021-08349-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/30/2021] [Accepted: 09/20/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate by meta-analysis the diagnostic accuracy of non-contrast quiescent-interval-single-shot (QISS) magnetic resonance angiography (MRA) in patients with peripheral arterial disease (PAD) using digital subtraction angiography (DSA) or contrast-enhanced magnetic resonance angiography (CE-MRA) as reference standard. METHODS This study was performed and reported according to the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines. A systematic literature search of MEDLINE, Embase and Scopus was done for studies reporting the diagnostic accuracy of QISS in PAD published up to 31 May 2021. The pooled sensitivity, specificity and diagnostic accuracy of QISS were calculated on a per-segment basis for the entire arterial tree. RESULTS Seventeen studies including 459 patients were found eligible for the meta-analysis. There was significant heterogeneity among studies as depicted by chi-square test (p = 0.02) and moderate heterogeneity by I2 statistic (I2: 69 [95% CI: 30-100]). The pooled sensitivity and specificity of QISS on a per-segment basis with DSA/CE-MRA as reference standard was 0.88 (95% CI: 0.85-0.91) and 0.94 (95% CI: 0.92-0.96) respectively. The area under hierarchical summary receiver-operating characteristic reflected a high accuracy of 0.96 (95% CI: 0.94-0.98). There was a low likelihood of publication bias as indicated by Deeks' funnel plot. CONCLUSIONS The present meta-analysis has consolidated the evidence that QISS has high accuracy for identifying as well as excluding arterial stenosis/occlusions in patients with symptoms of PAD. It can thus be considered the test of choice in patients with renal failure and in "at-risk patients" including pregnant women and patients with contrast allergy. KEY POINTS • The pooled sensitivity and specificity of QISS magnetic resonance angiography on a per-segment basis with DSA or contrast-enhanced MRA as reference standard are 88% and 94% respectively. • The diagnostic accuracy of QISS in patients with peripheral arterial disease as reflected by area under hierarchical summary receiver-operating characteristic is high (0.96 (95% CI: 0.94-0.98)). • There is moderate to significant heterogeneity among studies as depicted by I2 statistic and chi-square test.
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Affiliation(s)
- Mansi Verma
- All India Institute of Medical Sciences, Department of Cardiovascular Radiology and Endovascular Interventions, New Delhi, 110029, India
| | - Niraj Nirmal Pandey
- All India Institute of Medical Sciences, Department of Cardiovascular Radiology and Endovascular Interventions, New Delhi, 110029, India
| | - Vishwajeet Singh
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Priya Jagia
- All India Institute of Medical Sciences, Department of Cardiovascular Radiology and Endovascular Interventions, New Delhi, 110029, India.
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9
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Breen MA, Hassan MM, Johnston P, Upton J, Bixby SD. Quantification of popliteal artery narrowing with QISS MRA during active ankle plantarflexion in healthy, asymptomatic volunteers and its potential application in the diagnosis of popliteal artery entrapment syndrome (PAES). Skeletal Radiol 2021; 50:2091-2102. [PMID: 33797565 DOI: 10.1007/s00256-021-03751-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/27/2021] [Accepted: 02/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the degree of narrowing of the popliteal artery during active ankle plantar flexion in healthy volunteers using a non-contrast quiescent-interval single-shot (QISS) magnetic resonance angiography (MRA) technique. MATERIALS AND METHODS Following IRB approval, 10 healthy volunteers were recruited and following informed consent underwent QISS MRA of the lower extremity at rest and during ankle plantarflexion. Two pediatric musculoskeletal radiologists independently reviewed MR images in random order and recorded a number of subjective and objective anatomic variables including branch pattern, proximity of vessel to bony structures, gastrocnemius bulk, and presence of accessory muscle. Arterial narrowing with plantarflexion was recorded by a subjective assessment of 3D reconstructions (negligible or non-negligible) and objectively by measuring the narrowest diameter during plantarflexion and at rest. Agreement between reader scores was assessed using the concordance correlation coefficient (CCC) for continuous variables, and kappa and the proportion of agreement for categorical variables. RESULTS Mean reduction in arterial diameter during plantar flexion was 17.1% (min 1.9%, max 64.1%, SD 16.7%) for reader 1 and 17.2% (min 1.7%, max 50.0%, SD 14.3%.) for reader 2 with high agreement between readers: CCC = 0.92 and CI = 0.82, 0.96. Arterial narrowing was described subjectively as "non-negligible" in 7/20 legs by reader 1 and 5/20 legs by reader 2 with proportion of agreement = 0.90, CI (0.77, 1.00). CONCLUSION We observed a wide range of popliteal arterial narrowing with plantarflexion in asymptomatic volunteers. Larger studies, for which QISS is well suited, may be invaluable for distinguishing physiologic from pathologic arterial narrowing in patients with suspected popliteal artery entrapment syndrome (PAES).
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Affiliation(s)
- Micheál A Breen
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Mahad M Hassan
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Patrick Johnston
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Joseph Upton
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
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10
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Raczeck P, Fries P, Massmann A, Minko P, Frenzel F, Woerner T, Buecker A, Schneider GK. Diagnostic Performance of a Lower-dose Contrast-Enhanced 4D Dynamic MR Angiography of the Lower Extremities at 3 T Using Multisegmental Time-Resolved Maximum Intensity Projections. J Magn Reson Imaging 2021; 54:763-774. [PMID: 33825259 DOI: 10.1002/jmri.27631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND For peripheral artery disease (PAD), MR angiography (MRA) is a well-established diagnostic modality providing morphologic and dynamic information comparable to digital subtraction angiography (DSA). However, relatively large amounts of contrast agents are necessary to achieve this. PURPOSE To evaluate the diagnostic accuracy of time-resolved 4D MR-angiography with interleaved stochastic trajectories (TWIST-MRA) by using maximum intensity projections (MIPs) of dynamic images acquired with reduced doses of contrast agent. STUDY TYPE Retrospective. POPULATION Forty adult PAD patients yielding 1088 artery segments. FIELD STRENGTH/SEQUENCE A 3.0 T, time-resolved 4D MR-angiography with TWIST-MRA and MIP of dynamic images. ASSESSMENT DSA was available in 14 patients (256 artery segments) and used as reference standard. Three-segmental MIP reconstructions of TWIST-images after administration of 3 mL of gadolinium-based contrast agent (Gadoteridol/Prohance®, 0.5 M) per anatomical level (pelvis, thighs, and lower legs) yielded 256 artery segments for correlation between MRA and DSA. Three independent observers rated image quality (scale: 1 [nondiagnostic] to 4 [excellent]) and the degree of venous overlay (scale: 0 [none] to 2 [significant]) for all segments. Diagnostic accuracy for the detection of >50% stenosis and artery occlusion was calculated for all observers. STATISTICAL TESTS Binary classification test (sensitivity, specificity, positive/negative predictive values, diagnostic accuracy). Intraclass correlation coefficients (ICCs), logistic regression analysis with comparison of areas under the receiver-operating-characteristics (ROC) curves (AUCs) with the DeLong method. Bland-Altman-comparison. RESULTS High diagnostic performance was achieved for the detection of >50% stenosis (sensitivity 92.9% [84.3-99.9% (95%-CI)] and specificity 98.5% [95.7-99.8% (95%-CI)]) and artery occlusion (sensitivity 93.1% [77.2-99.2% (95%-CI)] and specificity 99.1% [96.9-99.9% (95%-CI)]). Inter-reader agreement was excellent with ICC values ranging from 0.95 to 1.0 for >50% artery stenosis and occlusion. Image quality was good to excellent for both readers (3.41 ± 0.72, 3.33 ± 0.65, and 3.38 ± 0.61 [mean ± SD]) with good correlation between observer ratings (ICC 0.71-0.81). No significant venous overlay was observed (0.06 ± 0.24, 0.23 ± 0.43 and 0.11 ± 0.45 [mean ± SD]). DATA CONCLUSION MIPs of dynamic TWIST-MRA offer a promising diagnostic alternative necessitating only reduced amounts (50%) of gadolinium-based contrast agents for the entire runoff vasculature. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Paul Raczeck
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Peter Fries
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Alexander Massmann
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Peter Minko
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Felix Frenzel
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Tobias Woerner
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Arno Buecker
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Guenther K Schneider
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
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11
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Noncontrast Magnetic Resonance Angiography in the Era of Nephrogenic Systemic Fibrosis and Gadolinium Deposition. J Comput Assist Tomogr 2021; 45:37-51. [PMID: 32976265 DOI: 10.1097/rct.0000000000001074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT Gadolinium-based contrast agents for clinical magnetic resonance imaging are overall safe. However, the discovery of nephrogenic systemic fibrosis in patients with severe renal impairment and gadolinium deposition in patients receiving contrast have generated developments in contrast-free imaging of the vasculature, that is, noncontrast magnetic resonance angiography. This article presents an update on noncontrast magnetic resonance angiography techniques, with comparison to other imaging alternatives. Potential benefits and challenges to implementation, and evidence to date for various clinical applications are discussed.
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12
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Knobloch G, Lauff MT, Hanke M, Schwenke C, Hamm B, Wagner M. Non-contrast-enhanced MR-angiography (MRA) of lower extremity peripheral arterial disease at 3 tesla: Examination time and diagnostic performance of 2D quiescent-interval single-shot MRA vs. 3D fast spin-Echo MRA. Magn Reson Imaging 2020; 76:17-25. [PMID: 33157187 DOI: 10.1016/j.mri.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/24/2020] [Accepted: 10/31/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Non-contrast enhanced MRA is a promising diagnostic alternative to contrast-enhanced (CE-) MRA or CT in patients with lower extremity peripheral arterial disease (PAD) but potentially associated with prolonged examination times and inferior diagnostic performance. We aimed to compare examination times and diagnostic performance of non-contrast enhanced quiescent-interval slice-selective (QISS)-MRA and fast-spin-echo (FSE)-MRA at 3.0 T. MATERIALS AND METHODS Forty-five patients with PAD were recruited for this IRB approved prospective study. Subjects underwent lower extremity MRA with 1) QISS-MRA, 2) FSE-MRA, and 3) CE-MRA (continuous table movement MRA and time-resolved MRA of the calf), which served as the standard of reference. Scan times for each examination step and total examination times for each of the three techniques was determined. Image quality and degree of stenosis were rated by two readers on a 5-point Likert scale. Sensitivity, specificity and diagnostic accuracy for relevant (>50%) stenosis were calculated. RESULTS Median total examination time was 27:02 min for QISS-MRA (IQR, 25:13-31:01 min), 28:37 min for FSE-MRA (IQR, 25:51-33:12 min), and 31:22 min for CE-MRA (IQR, 26:41-33:23 min). Acquisition time for QISS-MRA was significantly longer compared to FSE-MRA and CE-MRA (p ≤ 0.0001), while time for localizers, scouts and planning of the MRA sequence was significantly shorter for QISS-MRA compared to FSE-MRA and CE-MRA (p ≤ 0.0001). QISS-MRA had significantly better image quality compared to FSE-MRA with less segments classified as non-diagnostic (Reader 1: 3% vs. 35%; Reader 2: 3% vs. 50%, p ≤ 0.0001). Overall, QISS-MRA showed significantly better diagnostic performance than FSE-MRA (sensitivity, 85% vs. 54%; specificity, 90% vs. 47%, diagnostic accuracy, 89% vs. 48%; p ≤ 0.0001). CONCLUSION Total examination time of QISS-MRA and FSE-MRA was comparable with a conventional CE-MRA protocol. QISS-MRA showed significantly higher diagnostic performance than FSE-MRA.
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Affiliation(s)
- Gesine Knobloch
- Department of Radiology, Charité - University Medicine Berlin, Germany.
| | - Marie-Teres Lauff
- Department of Radiology, Charité - University Medicine Berlin, Germany
| | - Moritz Hanke
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Bernd Hamm
- Department of Radiology, Charité - University Medicine Berlin, Germany
| | - Moritz Wagner
- Department of Radiology, Charité - University Medicine Berlin, Germany
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13
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Varga-Szemes A, Penmetsa M, Emrich T, Todoran TM, Suranyi P, Fuller SR, Edelman RR, Koktzoglou I, Schoepf UJ. Diagnostic accuracy of non-contrast quiescent-interval slice-selective (QISS) MRA combined with MRI-based vascular calcification visualization for the assessment of arterial stenosis in patients with lower extremity peripheral artery disease. Eur Radiol 2020; 31:2778-2787. [PMID: 33068186 DOI: 10.1007/s00330-020-07386-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/04/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The proton density-weighted, in-phase stack-of-stars (PDIP-SOS) MRI technique provides calcification visualization in peripheral artery disease (PAD). This study sought to investigate the diagnostic accuracy of a combined non-contrast quiescent-interval slice-selective (QISS) MRA and PDIP-SOS MRI protocol for the detection of PAD, in comparison with CTA and digital subtraction angiography (DSA). METHODS Twenty-six prospectively enrolled PAD patients (70 ± 8 years) underwent lower extremity CTA and 1.5-T or 3-T PDIP-SOS/QISS MRI prior to DSA. Two readers rated image quality and graded stenosis (≥ 50%) on QISS MRA without/with calcification visualization. Sensitivity, specificity, and area under the curve (AUC) were calculated against DSA. Calcification was quantified and compared between MRI and non-contrast CT (NCCT) using paired t test, Pearson's correlation, and Bland-Altman analysis. RESULTS Image quality ratings were significantly higher for CTA compared to those for MRA (4.0 [3.0-4.0] and 3.0 [3.0-4.0]; p = 0.0369). The sensitivity and specificity of QISS MRA, QISS MRA with PDIP-SOS, and CTA for ≥ 50% stenosis detection were 85.4%, 92.2%, and 90.2%, and 90.3%, 93.2%, and 94.2%, respectively, while AUCs were 0.879, 0.928, and 0.923, respectively. A significant increase in AUC was observed when PDIP-SOS was added to the MRA protocol (p = 0.0266). Quantification of calcification showed significant differences between PDIP-SOS and NCCT (80.6 ± 31.2 mm3 vs. 88.0 ± 29.8 mm3; p = 0.0002) with high correlation (r = 0.77, p < 0.0001) and moderate mean of differences (- 7.4 mm3). CONCLUSION QISS MRA combined with PDIP-SOS MRI provides improved, CTA equivalent, accuracy for the detection of PAD, although its image quality remains inferior to CTA. KEY POINTS • Agreement in stenosis detection rate using non-contrast quiescent-interval slice-selective MRA compared to DSA improved when calcification visualization was provided to the readers. • An increase was observed in both sensitivity and specificity for the detection of ≥ 50% stenosis when MRI-based calcification assessment was added to the protocol, resulting in a diagnostic accuracy more comparable to CTA. • Quantification of calcification showed statistical difference between MRI and non-contrast CT; however, a high correlation was observed between the techniques.
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Affiliation(s)
- Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Megha Penmetsa
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
| | - Thomas M Todoran
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Stephen R Fuller
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Robert R Edelman
- Department of Radiology, NorthShore University, Evanston, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ioannis Koktzoglou
- Department of Radiology, NorthShore University, Evanston, IL, USA.,University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.
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14
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Edelman RR, Koktzoglou I. "Push-button" noncontrast MR angiography using balanced T 1 relaxation-enhanced steady-state (bT1RESS). Magn Reson Med 2020; 85:1248-1257. [PMID: 32936486 DOI: 10.1002/mrm.28492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/29/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE We introduce a MR imaging technique, balanced T1 relaxation-enhanced steady-state (bT1RESS), that provides the unique capability to efficiently impart a flexible amount of T1 weighting to a balanced steady-state free precession acquisition using periodically applied contrast-modifying RF pulses. Leveraging this capability to suppress the signal intensity of background tissues, we implemented a 3D noncontrast MR angiography technique that continuously acquires thin overlapping 3D volumes and tested it for evaluation of the peripheral arteries. METHODS bT1RESS used a fast interrupted steady-state readout with a 45° cslab-selective ontrast-modifying RF pulse applied at 262 msec intervals. A series of 16.4-mm thick overlapping 3D volumes was acquired using a radial stack-of-stars k-space trajectory. The combination of slice oversampling, slab overlap, and averaging of edge slices was helpful to reduce venetian blind artifact. Spatial resolution was near isotropic with reconstructed slice thickness = 0.7 mm and in-plane resolution = 0.5 mm. RESULTS Pilot studies in the peripheral arteries demonstrated improved vessel sharpness compared with cardiac-gated quiescent interval slice-selective noncontrast MR angiography. bT1RESS noncontrast MR angiography reliably identified stenotic and occlusive arterial disease in a small cohort of patients with peripheral artery disease. CONCLUSIONS bT1RESS provides the basis for a simplified, completely "push button" approach for noncontrast MR angiography that obviates the need for contrast agents, electrocardiographic gating, scout imaging, breath holding, or tailoring of imaging parameters for the individual patient. Further work is needed for technical optimization and clinical validation.
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Affiliation(s)
- Robert R Edelman
- Department of Radiology, Northshore University HealthSystem, Evanston, Illinois, USA.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ioannis Koktzoglou
- Department of Radiology, Northshore University HealthSystem, Evanston, Illinois, USA.,Pritzker School of Medicine, University of Chicago,, Chicago, Illinois, USA
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15
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Abstract
MR angiography is a flexible imaging technique enabling morphologic assessment of mesenteric arterial and venous vasculature. Conventional gadolinium-based contrast media and ferumoxytol are used as contrast agents. Ferumoxytol, an intravenous iron replacement therapy approved by the US Food and Drug Administration for iron deficiency anemia, is an effective and well tolerated blood pool contrast agent. The addition of 4D flow MR imaging enables a functional assessment of the arterial and venous vasculature; when coupled with a meal challenge, the severity of mesenteric arterial stenosis is well appreciated. Noncontrast MR angiographic techniques are useful for evaluating suspected mesenteric ischemia.
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16
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Cavallo AU, Koktzoglou I, Edelman RR, Gilkeson R, Mihai G, Shin T, Rajagopalan S. Noncontrast Magnetic Resonance Angiography for the Diagnosis of Peripheral Vascular Disease. Circ Cardiovasc Imaging 2019; 12:e008844. [DOI: 10.1161/circimaging.118.008844] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Armando Ugo Cavallo
- Departments of Medicine and Radiology, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland OH (A.U.C., R.G., T.S., S.R.)
- Division of Diagnostic and Interventional Radiology, University Hospital Policlinico “Tor Vergata”, Roma, Italy (A.U.C.)
| | - Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL (I.K., R.R.E.)
- University of Chicago Pritzker School of Medicine, IL (I.K.)
| | - Robert R. Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL (I.K., R.R.E.)
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (R.R.E.)
| | - Robert Gilkeson
- Departments of Medicine and Radiology, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland OH (A.U.C., R.G., T.S., S.R.)
| | - Georgeta Mihai
- Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA (G.M.)
| | - Taehoon Shin
- Departments of Medicine and Radiology, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland OH (A.U.C., R.G., T.S., S.R.)
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, South Korea (T.S.)
| | - Sanjay Rajagopalan
- Departments of Medicine and Radiology, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland OH (A.U.C., R.G., T.S., S.R.)
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Cooper K, Majdalany BS, Kalva SP, Chandra A, Collins JD, Francois CJ, Ganguli S, Gornik HL, Kendi AT, Khaja MS, Minocha J, Norton PT, Obara P, Reis SP, Sutphin PD, Rybicki FJ. ACR Appropriateness Criteria ® Lower Extremity Arterial Revascularization-Post-Therapy Imaging. J Am Coll Radiol 2019; 15:S104-S115. [PMID: 29724414 DOI: 10.1016/j.jacr.2018.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 02/07/2023]
Abstract
Peripheral arterial disease (PAD) affects millions across the world and in the United States between 9% to 23% of all patients older than 55 years. The refinement of surgical techniques and evolution of endovascular approaches have improved the success rates of revascularization in patients afflicted by lower extremity PAD. However, restenosis or occlusion of previously treated vessels remains a pervasive issue in the postoperative setting. A variety of different imaging options are available to evaluate patients and are reviewed within the context of asymptomatic and symptomatic patients with PAD who have previously undergone endovascular or surgical revascularization. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Kyle Cooper
- Research Author, University of Michigan Health System, Ann Arbor, Michigan
| | - Bill S Majdalany
- Principal Author and Panel Vice-Chair, University of Michigan Health System, Ann Arbor, Michigan.
| | | | - Ankur Chandra
- Scripps Green Hospital, La Jolla, California; Society for Vascular Surgery
| | | | | | | | - Heather L Gornik
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; American College of Cardiology
| | | | | | - Jeet Minocha
- University of California, San Diego, San Diego, California
| | | | - Piotr Obara
- Loyola University Medical Center, Maywood, Illinois
| | | | | | - Frank J Rybicki
- Specialty Chair, Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada
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18
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Edelman RR, Koktzoglou I. Noncontrast MR angiography: An update. J Magn Reson Imaging 2019; 49:355-373. [PMID: 30566270 PMCID: PMC6330154 DOI: 10.1002/jmri.26288] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 12/12/2022] Open
Abstract
Both computed tomography (CT) angiography (CTA) and contrast-enhanced MR angiography (CEMRA) have proven to be useful and accurate cross-sectional imaging modalities over a wide range of vascular territories and vascular disorders. A key advantage of MRA is that, unlike CTA, it can be performed without the administration of a contrast agent. In this review article we consider the motivations for using noncontrast MRA, potential contrast mechanisms, imaging techniques, advantages, and drawbacks with respect to CTA and CEMRA, and the level of evidence for using the various MRA techniques. In addition, we explore new developments that promise to expand the reliability and range of clinical applications for noncontrast MRA, along with functional MRA capabilities not available with CTA or CEMRA. Level of Evidence: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:355-373.
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Affiliation(s)
- Robert R. Edelman
- Radiology, Northshore University HealthSystem, Evanston, IL
- Radiology, Northwestern Memorial Hospital, Chicago, IL
| | - Ioannis Koktzoglou
- Radiology, Northshore University HealthSystem, Evanston, IL
- Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL
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19
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Wei LM, Zhu YQ, Zhang PL, Lu HT, Zhao JG. Evaluation of Quiescent-Interval Single-Shot Magnetic Resonance Angiography in Diabetic Patients With Critical Limb Ischemia Undergoing Digital Subtraction Angiography: Comparison With Contrast-Enhanced Magnetic Resonance Angiography With Calf Compression at 3.0 Tesla. J Endovasc Ther 2018; 26:44-53. [PMID: 30580695 DOI: 10.1177/1526602818817887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE To assess the diagnostic performance of quiescent-interval single-shot magnetic resonance angiography (QISS-MRA) at 3 tesla in diabetic patients with critical limb ischemia (CLI) vs contrast-enhanced MR angiography (CE-MRA) using digital subtraction angiography (DSA) as the standard of reference. METHOD Thirty-seven consecutive diabetic patients (mean age 71.8±7.2 years; 30 men) with CLI (Fontaine stage III-IV) underwent QISS-MRA and CE-MRA with calf compression; DSA was the standard. Image quality (5-point Likert-type scale) and stenosis severity (5-point grading) for QISS-MRA and CE-MRA were evaluated by 2 blinded readers in 1147 and 654 vessel segments, respectively. Per-segment and per-region (pelvis, thigh, calf) sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS Image quality of QISS-MRA was lower compared with CE-MRA in the pelvic region (p<0.001 in both readers) and thigh region (p=0.033 in reader 1 and p=0.018 in reader 2), whereas in the calf region, the image quality of QISS-MRA was better than CE-MRA (p=0.009 in reader 1 and p=0.001 in reader 2). In segment-based analyses, there was no difference between QISS-MRA and CE-MRA in sensitivity [89.5% vs 90.3% in reader 1 (p=0.774) and 87.6% vs 90.6% in reader 2 (p=0.266)] or specificity [94.2% vs 92.9% in reader 1 (p=0.513) and 92.9% vs 92.9% in reader 2 (p>0.999)]. In region-based analyses, QISS-MRA and CE-MRA yielded similar sensitivity and specificity in all areas but the pelvic region for reader 2 (specificity 95.5% vs 84.8%, p=0.041). CONCLUSION QISS-MRA performed very well in diabetic patients with CLI and was a good alternative for patients with contraindications to CE-MRA.
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Affiliation(s)
- Li-Ming Wei
- 1 Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yue-Qi Zhu
- 1 Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Pei-Lei Zhang
- 1 Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hai-Tao Lu
- 1 Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun-Gong Zhao
- 1 Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Saini A, Wallace A, Albadawi H, Naidu S, Alzubaidi S, Knuttinen MG, Panda A, Oklu R. Quiescent-Interval Single-Shot Magnetic Resonance Angiography. Diagnostics (Basel) 2018; 8:diagnostics8040084. [PMID: 30567304 PMCID: PMC6315503 DOI: 10.3390/diagnostics8040084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/15/2018] [Accepted: 12/15/2018] [Indexed: 01/22/2023] Open
Abstract
Lower extremity peripheral arterial disease (PAD) is a chronic, debilitating disease with a significant global burden. A number of diagnostic imaging techniques exist, including computed tomography angiography (CTA) and contrast-enhanced magnetic resonance angiography (CEMRA), to aid in PAD diagnosis and subsequent treatment planning. Due to concerns of renal toxicity or nephrogenic systemic fibrosis (NSF) for iodinated and gadolinium-based contrasts, respectively, a number of non-enhanced MRA (NEMRA) protocols are being increasingly used in PAD diagnosis. These techniques, including time of flight and phase contrast MRA, have previously demonstrated poor image quality, long acquisition times, and/or susceptibility to artifacts when compared to existing contrast-enhanced techniques. In recent years, Quiescent-Interval Single-Shot (QISS) MRA has been developed to overcome these limitations in NEMRA methods, with promising results. Here, we review the various screening and diagnostic tests currently used for PAD. The various NEMRA protocols are discussed, followed by a comprehensive review of the literature on QISS MRA to date. A particular emphasis is placed on QISS MRA feasibility studies and studies comparing the diagnostic accuracy and image quality of QISS MRA versus other diagnostic imaging techniques in PAD.
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Affiliation(s)
- Aman Saini
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Alex Wallace
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Hassan Albadawi
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Sailendra Naidu
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Sadeer Alzubaidi
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - M Grace Knuttinen
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Anshuman Panda
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
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Hanrahan CJ, Lindley MD, Mueller M, Kim D, Sommers D, Morrell G, Redd A, Carlston K, Lee VS. Diagnostic Accuracy of Noncontrast MR Angiography Protocols at 3T for the Detection and Characterization of Lower Extremity Peripheral Arterial Disease. J Vasc Interv Radiol 2018; 29:1585-1594.e2. [DOI: 10.1016/j.jvir.2018.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 02/01/2023] Open
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22
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Mathew RC, Kramer CM. Recent advances in magnetic resonance imaging for peripheral artery disease. Vasc Med 2018; 23:143-152. [PMID: 29633922 DOI: 10.1177/1358863x18754694] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The global burden of peripheral artery disease (PAD) is significant. This has led to numerous recent advances in magnetic resonance imaging (MRI) techniques in PAD. Older techniques such as time of flight MRI or phase contrast MRI are burdened by long acquisition times and significant issues with artifacts. In addition, the most used MRI modality, contrast-enhanced MR angiography (CE-MRA) is limited by the use of gadolinium contrast and its potential toxicity. Novel MRI techniques such as arterial spin labeling (ASL), blood-oxygen-level dependent imaging (BOLD), and first-pass perfusion gadolinium enhancement are advancing the field by providing skeletal muscle perfusion/oxygenation data while maintaining excellent spatial and temporal resolution. Perfusion data can be critical to providing objective clinical data of a visualized stenosis. In addition, there are a number of new MRI sequences assessing plaque composition and lesion severity in the absence of contrast. These approaches used in combination can provide useful clinical and prognostic data and provide critical endpoints in PAD research.
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Affiliation(s)
- Roshin C Mathew
- Departments of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Christopher M Kramer
- Departments of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, VA, USA
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23
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Edelman RR, Carr M, Koktzoglou I. Advances in non-contrast quiescent-interval slice-selective (QISS) magnetic resonance angiography. Clin Radiol 2018; 74:29-36. [PMID: 29336780 DOI: 10.1016/j.crad.2017.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is a pressing clinical need to develop accurate, efficient non-contrast magnetic resonance angiography (NC-MRA) techniques. Our efforts in the field have focused on a novel non-subtractive technique called quiescent-interval slice-selective (QISS) MRA. Compared with other NC-MRA techniques, QISS has the advantage of being more accurate while enabling a simpler and more efficient workflow. The original implementation, which uses electrocardiogram (ECG) gating and a Cartesian k-space trajectory, is a reliable technique for the evaluation of peripheral arterial disease (PAD). Recent advances in QISS technology include the use of a radial k-space trajectory, which facilitates rapid imaging of the coronary, renal, and pulmonary arteries as well as other vascular beds, and ungated ("UnQISS") acquisitions for PAD.
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Affiliation(s)
- R R Edelman
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL, USA; Department of Radiology, Northshore University Health System, Evanston, IL, USA.
| | - M Carr
- Department of Radiology, Northshore University Health System, Evanston, IL, USA
| | - I Koktzoglou
- Department of Radiology, Northshore University Health System, Evanston, IL, USA; Department of Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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24
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Accuracy of Noncontrast Quiescent-Interval Single-Shot Lower Extremity MR Angiography Versus CT Angiography for Diagnosis of Peripheral Artery Disease. JACC Cardiovasc Imaging 2017; 10:1116-1124. [DOI: 10.1016/j.jcmg.2016.09.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 11/23/2022]
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25
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Schreiner MM, Platzgummer H, Unterhumer S, Weber M, Mistelbauer G, Loewe C, Schernthaner RE. A BMI-adjusted ultra-low-dose CT angiography protocol for the peripheral arteries—Image quality, diagnostic accuracy and radiation exposure. Eur J Radiol 2017; 93:149-156. [DOI: 10.1016/j.ejrad.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 05/13/2017] [Accepted: 06/01/2017] [Indexed: 11/30/2022]
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26
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Ahmed O, Hanley M, Bennett SJ, Chandra A, Desjardins B, Gage KL, Gerhard-Herman MD, Ginsburg M, Gornik HL, Oliva IB, Steigner ML, Strax R, Verma N, Rybicki FJ, Dill KE. ACR Appropriateness Criteria® Vascular Claudication—Assessment for Revascularization. J Am Coll Radiol 2017; 14:S372-S379. [DOI: 10.1016/j.jacr.2017.02.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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27
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De Cecco CN, Muscogiuri G, Varga-Szemes A, Schoepf UJ. Cutting edge clinical applications in cardiovascular magnetic resonance. World J Radiol 2017; 9:1-4. [PMID: 28144400 PMCID: PMC5241535 DOI: 10.4329/wjr.v9.i1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/04/2016] [Accepted: 11/29/2016] [Indexed: 02/06/2023] Open
Abstract
Today, the use of cardiovascular magnetic resonance (CMR) is widespread in clinical practice. The increased need to evaluate of subtle myocardial changes, coronary artery anatomy, and hemodynamic assessment has prompted the development of novel CMR techniques including T1 and T2 mapping, non-contrast angiography and four dimensional (4D) flow. T1 mapping is suitable for diagnosing pathologies affecting extracellular volume such as myocarditis, diffuse myocardial fibrosis and amyloidosis, and is a promising diagnostic tool for patients with iron overload and Fabry disease. T2 mapping is useful in depicting acute myocardial edema and estimating the amount of salvageable myocardium following an ischemic event. Novel angiography techniques, such as the self-navigated whole-heart or the quiescent-interval single-shot sequence, enable the visualization of the great vessels and coronary artery anatomy without the use of contrast material. The 4D flow technique overcomes the limitations of standard phase-contrast imaging and allows for the assessment of cardiovascular hemodynamics in the great arteries and flow patterns in the cardiac chambers. In conclusion, the future of CMR is heading toward a more reliable quantitative assessment of the myocardium, an improved non-contrast visualization of the coronary artery anatomy, and a more accurate evaluation of the cardiac hemodynamics.
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Finn JP, Nguyen KL, Han F, Zhou Z, Salusky I, Ayad I, Hu P. Cardiovascular MRI with ferumoxytol. Clin Radiol 2016; 71:796-806. [PMID: 27221526 DOI: 10.1016/j.crad.2016.03.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 11/28/2022]
Abstract
The practice of contrast-enhanced magnetic resonance angiography (CEMRA) has changed significantly in the span of a decade. Concerns regarding gadolinium (Gd)-associated nephrogenic systemic fibrosis in those with severely impaired renal function spurred developments in low-dose CEMRA and non-contrast MRA as well as efforts to seek alternative MR contrast agents. Originally developed for MR imaging use, ferumoxytol (an ultra-small superparamagnetic iron oxide nanoparticle), is currently approved by the US Food and Drug Administration for the treatment of iron deficiency anaemia in adults with renal disease. Since its clinical availability in 2009, there has been rising interest in the scientific and clinical use of ferumoxytol as an MR contrast agent. The unique physicochemical and pharmacokinetic properties of ferumoxytol, including its long intravascular half-life and high r1 relaxivity, support a spectrum of MRI applications beyond the scope of Gd-based contrast agents. Moreover, whereas Gd is not found in biological systems, iron is essential for normal metabolism, and nutritional iron deficiency poses major public health challenges worldwide. Once the carbohydrate shell of ferumoxytol is degraded, the elemental iron at its core is incorporated into the reticuloendothelial system. These considerations position ferumoxytol as a potential game changer in the field of CEMRA and MRI. In this paper, we aim to summarise our experience with the cardiovascular applications of ferumoxytol and provide a brief synopsis of ongoing investigations on ferumoxytol-enhanced MR applications.
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Affiliation(s)
- J P Finn
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - K-L Nguyen
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - F Han
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Z Zhou
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - I Salusky
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - I Ayad
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - P Hu
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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29
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Langham MC, Desjardins B, Englund EK, Mohler ER, Floyd TF, Wehrli FW. Rapid High-resolution, Self-registered, Dual Lumen-contrast MRI Method for Vessel-wall Assessment in Peripheral Artery Disease:: A Preliminary Investigation. Acad Radiol 2016; 23:457-67. [PMID: 26916248 DOI: 10.1016/j.acra.2015.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES Contrast-enhanced angiographic evaluation by magnetic resonance imaging (MRI) and computed tomography (CT) is the reference standard for assessing peripheral artery disease (PAD). However, because PAD and diabetes often coexist, the prevalence of renal insufficiency is a major challenge to contrast-based angiography. The objective of this work is to describe and demonstrate a new application of three-dimensional double-echo steady-state (3D DESS) as a noncontrast vascular MRI method for evaluating peripheral atherosclerosis at 3 Tesla (3T). MATERIALS AND METHODS A water-selective 3D DESS pulse sequence was designed to simultaneously collect two steady-state free-precession signals (free induction decay and Echo) yielding "black blood" (BB) and "gray blood" (GB) images. For completeness Bloch equation, simulations were performed to characterize DESS signals of various tissues including blood at different velocities and to assess two healthy subjects for the purpose of pulse sequence optimization. Exploratory studies were performed as an add-on protocol to an existing study involving patients with PAD. To evaluate the method's specificity for detecting calcification, images from select patients were compared against CT angiography. RESULTS Simulations agreed qualitatively with in vivo images supporting DESS' potential for generating distinct lumen contrast (GB vs BB). Lesions representing calcium were easily identifiable on the basis of signal void occurring on both image types and were confirmed by CT angiography. Further, BB allowed visualization of stent restenosis, and data suggest its ability to visualize acute thrombus by virtue of T2 weighting. CONCLUSION Preliminary investigation and results suggest noncontrast 3D DESS to have the potential to improve diagnosis of PAD patients by providing detailed structural assessment of vessel-wall architecture.
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30
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Nonenhanced magnetic resonance angiography (MRA) of the calf arteries at 3 Tesla: intraindividual comparison of 3D flow-dependent subtractive MRA and 2D flow-independent non-subtractive MRA. Eur Radiol 2016; 26:4585-4594. [DOI: 10.1007/s00330-016-4246-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 01/19/2016] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
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31
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Abstract
Many noncontrast magnetic resonance angiography techniques have recently been developed in response to concerns about gadolinium in patients with renal impairment. This article describes the theory behind established and recently described techniques and how and where they can be performed in clinical practice.
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32
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Mirsharifi SR, Noparast M, Khazravi M, Ghanaati H, Shakiba M, Sharifi A. Gadolinium Enhanced MR-angiography Results in Patients With Peripheral Arterial Disease: Positive Predictive Value Compared to Surgery. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 16:e26033. [PMID: 25763247 PMCID: PMC4341249 DOI: 10.5812/ircmj.26033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 12/23/2014] [Accepted: 12/27/2014] [Indexed: 11/16/2022]
Abstract
Background: Peripheral arterial disease (PAD) represents systematic atherosclerosis of great vessels. PAD affects approximately 10-20 % of patients older than 60 years and is associated with high mortality and morbidity rate debilitating individuals’ life. Objectives: To compare the results of Gadolinium enhanced MR-Angiography and surgery in patients suspected to have peripheral arterial disease. Materials and Methods: In this prospective cohort study, 30 consecutive patients matching the inclusion criteria were enrolled and MR-Angiography was performed prior to surgery for each one. Results: 22 patients were male (73.3%) and the mean age was 60.3 ± 10.6 years in our study group. The most common artery for cut off and run off was superior femoral artery in both assessments. Proximal section of each artery was the most common anatomical section for cut off and run off. There was a same report of cut off artery by MR-Angiography and surgery (kappa coefficient of agreement was 0.96, P value < 0.001) and positive predictive value was 0.97 (95% CI: 0.83-0.99). Conclusions: According to our findings MR-angiography is an appropriate alternative imaging modality for patients suspected to have peripheral arterial disease and it facilitates the early diagnosis proposed by the clinical findings. Also beneficial characteristics of this method such as low exposure to ionizing radiation, repeatability, and low risk of contrast agent-induced nephropathy make it a modality of choice in patients with renal impairment.
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Affiliation(s)
- Seyed Rasool Mirsharifi
- Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Morteza Noparast
- Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Morteza Noparast, Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166581657, Fax: +98-2161191609, E-mail:
| | - Mona Khazravi
- Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Majid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Amirsina Sharifi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran
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Wagner M, Knobloch G, Gielen M, Lauff MT, Romano V, Hamm B, Kröncke T. Nonenhanced peripheral MR-angiography (MRA) at 3 Tesla: evaluation of quiescent-interval single-shot MRA in patients undergoing digital subtraction angiography. Int J Cardiovasc Imaging 2015; 31:841-50. [DOI: 10.1007/s10554-015-0612-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/03/2015] [Indexed: 11/24/2022]
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Bosanquet DC, Wright AM, White RD, Williams IM. A review of the surgical management of heel pressure ulcers in the 21st century. Int Wound J 2015; 13:9-16. [PMID: 25683573 DOI: 10.1111/iwj.12416] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/09/2014] [Indexed: 12/11/2022] Open
Abstract
Heel ulceration, most frequently the result of prolonged pressure because of patient immobility, can range from the trivial to the life threatening. Whilst the vast majority of heel pressure ulcers (PUs) are superficial and involve the skin (stages I and II) or underlying fat (stage III), between 10% and 20% will involve deeper tissues, either muscle, tendon or bone (stage IV). These stage IV heel PUs represent a major health and economic burden and can be difficult to treat. The worst outcomes are seen in those with large ulcers, compromised peripheral arterial supply, osteomyelitis and associated comorbidities. Whilst the mainstay of management of stage I-III heel pressure ulceration centres on offloading and appropriate wound care, successful healing in stage IV PUs is often only possible with surgical intervention. Such intervention includes simple debridement, partial or total calcanectomy, arterial revascularisation in the context of coexisting peripheral vascular disease or using free tissue flaps. Amputation may be required for failed surgical intervention, or as a definitive first-line procedure in certain high-risk or poor prognosis patient groups. This review provides an overview of heel PUs, alongside a comprehensive literature review detailing the surgical interventions available when managing such patients.
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Affiliation(s)
| | - Ann M Wright
- Department of Surgery, Royal Gwent Hospital, Newport, UK
| | - Richard D White
- Regional Vascular Unit, University Hospital of Wales, Cardiff, UK
| | - Ian M Williams
- Regional Vascular Unit, University Hospital of Wales, Cardiff, UK
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Atanasova IP, Lim RP, Chandarana H, Storey P, Bruno MT, Kim D, Lee VS. Quadruple inversion-recovery b-SSFP MRA of the abdomen: initial clinical validation. Eur J Radiol 2014; 83:1612-9. [PMID: 24998363 PMCID: PMC4706232 DOI: 10.1016/j.ejrad.2014.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 11/18/2022]
Abstract
The purpose of this study is to assess the image quality and diagnostic accuracy of non-contrast quadruple inversion-recovery balanced-SSFP MRA (QIR MRA) for detection of aortoiliac disease in a clinical population. QIR MRA was performed in 26 patients referred for routine clinical gadolinium-enhanced MRA (Gd-MRA) for known or suspected aortoiliac disease. Non-contrast images were independently evaluated for image quality and degree of stenosis by two radiologists, using consensus Gd-MRA as the reference standard. Hemodynamically significant stenosis (≥50%) was found in 10% (22/226) of all evaluable segments on Gd-MRA. The sensitivity and specificity for stenosis evaluation by QIR MRA for the two readers were 86%/86% and 95%/93% respectively. Negative predictive value and positive predictive value were 98%/98% and 63%/53% respectively. For stenosis evaluation of the aortoiliac region QIR MRA showed good agreement with the reference standard with high negative predictive value and a tendency to overestimate mild disease presumably due to the flow-dependence of the technique. QIR MRA could be a reasonable alternative to Gd-MRA for ruling out stenosis when contrast is contraindicated due to impaired kidney function or in patients who undergo abdominal MRA for screening purposes. Further work is necessary to improve performance and justify routine clinical use.
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Affiliation(s)
- Iliyana P Atanasova
- Department of Radiology, New York University School of Medicine and Department of Biomedical Engineering, Columbia University, United States.
| | - Ruth P Lim
- Department of Radiology, Austin Health, Heidelberg, Victoria 3084, Australia; University of Melbourne, Melbourne, Victoria, Australia.
| | - Hersh Chandarana
- Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY 10016, United States.
| | - Pippa Storey
- Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY 10016, United States.
| | - Mary T Bruno
- Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY 10016, United States.
| | - Daniel Kim
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, United States.
| | - Vivian S Lee
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, United States.
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36
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Knobloch G, Gielen M, Lauff MT, Romano V, Schmitt P, Rick M, Kröncke T, Huppertz A, Hamm B, Wagner M. ECG-gated quiescent-interval single-shot MR angiography of the lower extremities: Initial experience at 3 T. Clin Radiol 2014; 69:485-91. [DOI: 10.1016/j.crad.2013.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
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37
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Evaluating Peripheral Arterial Disease With Unenhanced Quiescent-Interval Single-Shot MR Angiography at 3 T. AJR Am J Roentgenol 2014; 202:886-93. [DOI: 10.2214/ajr.13.11243] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Thierfelder KM, Meimarakis G, Nikolaou K, Sommer WH, Schmitt P, Kazmierczak PM, Reiser MF, Theisen D. Non-contrast-enhanced MR angiography at 3 Tesla in patients with advanced peripheral arterial occlusive disease. PLoS One 2014; 9:e91078. [PMID: 24608937 PMCID: PMC3946661 DOI: 10.1371/journal.pone.0091078] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 02/07/2014] [Indexed: 11/26/2022] Open
Abstract
Purpose The aim of this study was to assess the diagnostic performance of ECG-gated non-contrast-enhanced quiescent interval single-shot (QISS) magnetic resonance angiography at a magnetic field strength of 3 Tesla in patients with advanced peripheral arterial occlusive disease (PAOD). Method and Materials A total of 21 consecutive patients with advanced PAOD (Fontaine stage IIb and higher) referred for peripheral magnetic resonance angiography (MRA) were included. Imaging was performed on a 3 T whole body MR. Image quality and stenosis diameter were evaluated in comparison to contrast-enhanced continuous table and TWIST MRA (CE-MRA) as standard of reference. QISS images were acquired with a thickness of 1.5 mm each (high-resolution QISS, HR-QISS). Two blinded readers rated the image quality and the degree of stenosis for both HR-QISS and CE-MRA in 26 predefined arterial vessel segments on 5-point Likert scales. Results With CE-MRA as the reference standard, HR-QISS showed high sensitivity (94.1%), specificity (97.8%), positive (95.1%), and negative predictive value (97.2%) for the detection of significant (≥50%) stenosis. Interreader agreement for stenosis assessment of both HR-QISS and CE-MRA was excellent (κ-values of 0.951 and 0.962, respectively). As compared to CR-MRA, image quality of HR-QISS was significantly lower for the distal aorta, the femoral and iliac arteries (each with p<0.01), while no significant difference was found in the popliteal (p = 0.09) and lower leg arteries (p = 0.78). Conclusion Non-enhanced ECG-gated HR-QISS performs very well in subjects with severe PAOD and is a good alternative for patients with a high risk of nephrogenic systemic fibrosis.
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Affiliation(s)
- Kolja M. Thierfelder
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
- * E-mail:
| | - Georgios Meimarakis
- Department of Vascular and Endovascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Konstantin Nikolaou
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Wieland H. Sommer
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | | | - Philipp M. Kazmierczak
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Maximilian F. Reiser
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Daniel Theisen
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
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Lin K, Lloyd-Jones DM, Li D, Carr JC. Quantitative imaging biomarkers for the evaluation of cardiovascular complications in type 2 diabetes mellitus. J Diabetes Complications 2014; 28:234-42. [PMID: 24309215 DOI: 10.1016/j.jdiacomp.2013.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 09/19/2013] [Accepted: 09/19/2013] [Indexed: 01/24/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is a prevalent condition in aged populations. Cardiovascular diseases are leading causes of death and disability in patients with T2DM. Traditional strategies for controlling the cardiovascular complications of diabetes primarily target a cluster of well-defined risk factors, such as hyperglycemia, lipid disorders and hypertension. However, there is controversy over some recent clinical trials aimed at evaluating efficacy of intensive treatments for T2DM. As a powerful tool for quantitative cardiovascular risk estimation, multi-disciplinary cardiovascular imaging have been applied to detect and quantify morphological and functional abnormalities in the cardiovascular system. Quantitative imaging biomarkers acquired with advanced imaging procedures are expected to provide new insights to stratify absolute cardiovascular risks and reduce the overall costs of health care for people with T2DM by facilitating the selection of optimal therapies. This review discusses principles of state-of-the-art cardiovascular imaging techniques and compares applications of those techniques in various clinical circumstances. Individuals measurements of cardiovascular disease burdens from multiple aspects, which are closely related to existing biomarkers and clinical outcomes, are recommended as promising candidates for quantitative imaging biomarkers to assess the responses of the cardiovascular system during diabetic regimens.
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Affiliation(s)
- Kai Lin
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737N Michigan Avenue, Suite 1600, Chicago, IL 60611, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680N Lake shore drive, Suite 1400, Chicago, IL 60611, USA
| | - Debiao Li
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737N Michigan Avenue, Suite 1600, Chicago, IL 60611, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737N Michigan Avenue, Suite 1600, Chicago, IL 60611, USA.
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Impact of Time-Resolved MRA on Diagnostic Accuracy in Patients With Symptomatic Peripheral Artery Disease of the Calf Station. AJR Am J Roentgenol 2013; 201:1368-75. [DOI: 10.2214/ajr.13.10584] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Koktzoglou I, Mistretta CA, Giri S, Dunkle EE, Amin P, Edelman RR. Simultaneous static and cine nonenhanced MR angiography using radial sampling and highly constrained back projection reconstruction. Magn Reson Med 2013; 72:1079-86. [PMID: 24407879 DOI: 10.1002/mrm.25008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 09/12/2013] [Accepted: 09/28/2013] [Indexed: 11/06/2022]
Abstract
PURPOSE To describe a pulse sequence for simultaneous static and cine nonenhanced magnetic resonance angiography (NEMRA) of the peripheral arteries. METHODS The peripheral arteries of 10 volunteers and 6 patients with peripheral arterial disease (PAD) were imaged with the proposed cine NEMRA sequence on a 1.5 Tesla (T) system. The impact of multi-shot imaging and highly constrained back projection (HYPR) reconstruction was examined. The propagation rate of signal along the length of the arterial tree in the cine nonenhanced MR angiograms was quantified. RESULTS The cine NEMRA sequence simultaneously provided a static MR angiogram showing vascular anatomy as well as a cine display of arterial pulse wave propagation along the entire length of the peripheral arteries. Multi-shot cine NEMRA improved temporal resolution and reduced image artifacts. HYPR reconstruction improved image quality when temporal reconstruction footprints shorter than 100 ms were used (P < 0.001). Pulse wave propagation within the arterial tree as displayed by cine NEMRA was slower in patients with PAD than in volunteers. CONCLUSION Simultaneous static and cine NEMRA of the peripheral arteries is feasible. Multi-shot acquisition and HYPR reconstruction can be used to improve arterial conspicuity and temporal resolution.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA; The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Liu X, Zhang N, Fan Z, Feng F, Yang Q, Zheng H, Liu P, Li D. Detection of infragenual arterial disease using non-contrast-enhanced MR angiography in patients with diabetes. J Magn Reson Imaging 2013; 40:1422-9. [PMID: 24925770 DOI: 10.1002/jmri.24477] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 09/24/2013] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the diagnostic performance of a newly developed non-contrast-enhanced MR angiography (NCE-MRA) technique using flow-sensitive dephasing (FSD) prepared steady-state free precession (SSFP) for detecting calf arterial disease in patients with diabetes. MATERIALS AND METHODS Forty-five patients with diabetes who underwent routine contrast-enhanced MR angiography (CE-MRA) of lower extremities were recruited for NCE-MRA at the calf on a 1.5 Tesla MR system. Image quality evaluated on a 4-point scale and diagnostic performance for detecting more than 50% arterial stenosis were statistically analyzed, using CE-MRA as the standard of reference. RESULTS A total of 264 calf arterial segments were obtained in the 45 patients with 88 legs. The percentage of diagnostic arterial segments was all 98% for NCE- and CE-MRA. The image quality, SNR, CNR was 3.3, 177, 138, and 3.5, 103, 99, for NCE-MRA and CE-MRA, respectively. The average sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of NCE-MRA were 97%, 96%, 90%, 99%, and 96%, respectively on a per-segment basis and 90%, 84%, 82%, 91%, and 87%, respectively, on a per-patients basis. CONCLUSION The NCE-MRA technique demonstrates adequate image quality in the delineation of calf arteries and consistent diagnostic performance for detecting significant stenosis with CE-MRA in patients with diabetes.
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Affiliation(s)
- Xin Liu
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology of Chinese Academy of Sciences, Shenzhen Key Laboratory for MRI, Shenzhen, China
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Hansmann J, Morelli JN, Michaely HJ, Riester T, Budjan J, Schoenberg SO, Attenberger UI. Nonenhanced ECG-gated quiescent-interval single shot MRA: Image quality and stenosis assessment at 3 tesla compared with contrast-enhanced MRA and digital subtraction angiography. J Magn Reson Imaging 2013; 39:1486-93. [DOI: 10.1002/jmri.24324] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/05/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jan Hansmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim; Medical Faculty Mannheim - Heidelberg University; Mannheim Germany
| | - John N. Morelli
- The Russell H. Morgan Department of Radiology and Radiological Science; Johns Hopkins Hospital Baltimore; Maryland USA
| | - Henrik J. Michaely
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim; Medical Faculty Mannheim - Heidelberg University; Mannheim Germany
| | - Thomas Riester
- Department of Surgery, Section of Vascular Surgery, University Medical Center Mannheim; Medical Faculty Mannheim - Heidelberg University; Mannheim Germany
| | - Johannes Budjan
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim; Medical Faculty Mannheim - Heidelberg University; Mannheim Germany
| | - Stefan O. Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim; Medical Faculty Mannheim - Heidelberg University; Mannheim Germany
| | - Ulrike I. Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim; Medical Faculty Mannheim - Heidelberg University; Mannheim Germany
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Unenhanced 3D Turbo Spin-Echo MR Angiography of Lower Limbs in Peripheral Arterial Disease: A Comparative Study With Gadolinium-Enhanced MR Angiography. AJR Am J Roentgenol 2013; 200:1145-50. [DOI: 10.2214/ajr.12.8730] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Wang J, Yan F, Liu J, Lu J, Li D, Luan J, Wang X, Li Y, Iezzi R, De Cobelli F. Multicenter, intra-individual comparison of single dose gadobenate dimeglumine and double dose gadopentetate dimeglumine for MR angiography of the peripheral arteries (the Peripheral VALUE Study). J Magn Reson Imaging 2013; 38:926-37. [PMID: 23371919 DOI: 10.1002/jmri.24040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/13/2012] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To prospectively compare single dose gadobenate dimeglumine with double dose gadopentetate dimeglumine for CE-MRA in patients with peripheral arterial occlusive disease (PAOD) using an intra-individual crossover study design in which all patients received both contrast agents in otherwise identical CE-MRA examinations. MATERIALS AND METHODS Institutional review board and regulatory approval were granted and all patients provided written informed consent. Sixty-eight patients (53M/15F; 62.4 ± 15.7 years) with mild-to-severe PAOD were enrolled for randomized 3-station CE-MRA with 0.1 mmol/kg gadobenate dimeglumine and 0.2 mmol/kg gadopentetate dimeglumine. Three blinded readers assessed images for vessel anatomical delineation, disease detection/exclusion, and global preference. Diagnostic performance for detection of ≥51% stenosis was determined for 53 patients who underwent DSA. Noninferiority was assessed using the Wilcoxon Signed Rank, McNemar, and Wald tests. Quantitative enhancement was compared. RESULTS No differences (P ≥ 0.25) were noted for any qualitative parameter at any station. Equivalence was reported in at least 62/64 patients (93.8% 3-reader agreement) for diagnostic preference. Superiority for gadobenate dimeglumine was reported by all readers for diagnostic performance (sensitivity: 80.4-88.0% versus 75.2-85.8%; specificity: 89.8-96.0% versus 88.7-94.8%; accuracy: 87.4-91.7% versus 84.9-90.6%; PPV: 84.0-92.8% versus 82.3-90.8%; NPV: 88.5-92.4% versus 85.7-91.1%). Quantitative enhancement was similar in the pelvis but significantly (P < 0.05) greater with gadobenate dimeglumine in the thigh for two readers. CONCLUSION Image quality and diagnostic performance on peripheral CE-MRA with 0.1 mmol/kg gadobenate dimeglumine is at least equivalent to that with 0.2 mmol/kg gadopentetate dimeglumine.
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Affiliation(s)
- Jian Wang
- Radiology Department, Shanghai Changhai Hospital, Shanghai, China
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Lim RP, Fan Z, Chatterji M, Baadh A, Atanasova IP, Storey P, Kim DC, Kim S, Hodnett PA, Ahmad A, Stoffel DR, Babb JS, Adelman MA, Xu J, Li D, Lee VS. Comparison of nonenhanced MR angiographic subtraction techniques for infragenual arteries at 1.5 T: a preliminary study. Radiology 2013; 267:293-304. [PMID: 23297320 DOI: 10.1148/radiol.12120859] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate diagnostic performance of three nonenhanced methods: variable-refocusing-flip angle (FA) fast spin-echo (SE)-based magnetic resonance (MR) angiography (variable FA MR) and constant-refocusing-FA fast SE-based MR angiography (constant-FA MR) and flow-sensitive dephasing (FSD)-prepared steady-state free precession MR angiography (FSD MR) for calf arteries, with dual-injection three-station contrast material-enhanced MR angiography (gadolinium-enhanced MR) as reference. MATERIALS AND METHODS This prospective study was institutional review board approved and HIPAA compliant, with informed consent. Twenty-one patients (13 men, eight women; mean age, 62.6 years) underwent calf-station variable-FA MR, constant-FA MR, and FSD MR at 1.5 T, with gadolinium-enhanced MR as reference. Image quality and stenosis severity were assessed in 13 segments per leg by two radiologists blinded to clinical data. Combined constant-FA MR and FSD MR reading was also performed. Methods were compared (logistic regression for correlated data) for diagnostic accuracy. RESULTS Of 546 arterial segments, 148 (27.1%) had a hemodynamically significant (≥ 50%) stenosis. Image quality was satisfactory for all nonenhanced MR sequences. FSD MR was significantly superior to both other sequences (P < .0001), with 5-cm smaller field of view; 9.6% variable-FA MR, 9.6% constant-FA MR, and 0% FSD MR segmental evaluations had nondiagnostic image quality scores, mainly from high diastolic flow (variable-FA MR) and motion artifact (constant-FA MR). Stenosis sensitivity and specificity were highest for FSD MR (80.3% and 81.7%, respectively), compared with those for constant-FA MR (72.3%, P = .086; and 81.8%, P = .96) and variable-FA MR (75.9%, P = .54; and 75.6%, P = .22). Combined constant-FA MR and FSD MR had superior sensitivity (81.8%) and specificity (88.3%) compared with constant-FA MR (P = .0076), variable-FA MR (P = .0044), and FSD MR (P = .0013). All sequences had an excellent negative predictive value (NPV): 93.2%, constant-FA MR; 94.7%, variable-FA MR; 91.7%, FSD MR; and 92.9%, combined constant-FA MR and FSD MR. CONCLUSION At 1.5 T, all evaluated nonenhanced MR angiographic methods demonstrated satisfactory image quality and excellent NPV for hemodynamically significant stenosis. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120859/-/DC1.
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Affiliation(s)
- Ruth P Lim
- Department of Radiology, New York University Medical Center, New York, NY, USA.
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Nielsen YW, Thomsen HS. Contrast-enhanced peripheral MRA: technique and contrast agents. Acta Radiol 2012; 53:769-77. [PMID: 22843836 DOI: 10.1258/ar.2012.120008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the last decade contrast-enhanced magnetic resonance angiography (CE-MRA) has gained wide acceptance as a valuable tool in the diagnostic work-up of patients with peripheral arterial disease. This review presents current concepts in peripheral CE-MRA with emphasis on MRI technique and contrast agents. Peripheral CE-MRA is defined as an MR angiogram of the arteries from the aortic bifurcation to the feet. Advantages of CE-MRA include minimal invasiveness and lack of ionizing radiation. The basic technique employed for peripheral CE-MRA is the bolus-chase method. With this method a paramagnetic MRI contrast agent is injected intravenously and T1-weighted images are acquired in the subsequent arterial first-pass phase. In order to achieve high quality MR angiograms without interfering venous contamination or artifacts, a number of factors need to be taken into account. This includes magnetic field strength of the MRI system, receiver coil configuration, use of parallel imaging, contrast bolus timing technique, and k-space filling strategies. Furthermore, it is possible to optimize peripheral CE-MRA using venous compression techniques, hybrid scan protocols, time-resolved imaging, and steady-state MRA. Gadolinium(Gd)-based contrast agents are used for CE-MRA of the peripheral arteries. Extracellular Gd agents have a pharmacokinetic profile similar to iodinated contrast media. Accordingly, these agents are employed for first-pass MRA. Blood-pool Gd-based agents are characterized by prolonged intravascular stay, due to macromolecular structure or protein binding. These agents can be used for first-pass, as well as steady-state MRA. Some Gd-based contrast agents with low thermodynamic stability have been linked to development of nephrogenic systemic fibrosis in patients with severe renal insufficiency. Using optimized technique and a stable MRI contrast agent, peripheral CE-MRA is a safe procedure with diagnostic accuracy close to that of conventional catheter X-ray angiography.
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Affiliation(s)
- Yousef W Nielsen
- Deparment of Radiology, Copenhagen University Hospital Bispebjerg, Bispebjerg
| | - Henrik S Thomsen
- Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, Denmark
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