Evaluation of Peripheral Arterial Disease Using Noncontrast Magnetic Resonance Angiography

Introduction: Peripheral arterial disease is common in older age group. PAD is evaluated using Doppler, contrast CT and MR angiography. Many PAD patients have comorbidities like diabetes, hypertension and renal dysfunction. CT and MR contrast administration is considered risky in patients with impaired renal function. CT contrast agents are nephrotoxic. Gadolinium-based MRI contrast are associated with nephrogenic systemic fibrosis in patients with severe renal dysfunction. Aims: The aim of our study was to evaluate the usefulness of non contrast enhanced MR angiography in imaging of peripheral arteries in patients with impaired renal function. Materials and Method: This prospective study was done using ECG-triggered 2D TOF MR Angiograpgy on 1.5 Tesla MR unit in PAD patients having renal dysfunction. We studied various arterial segments of lower limb for the degree of narrowing on MRA and compared the findings in all patients with duplex scan and in some patients with DSA. We determined accuracy, sensitivity, specificity, PPV and NPV of MRA compared to duplex scan for assessment of arterial luminal narrowing. Results: Our study results have demonstrated that in patients with high grade blockage (>50 diameter reduction or arterial occlusion) NC MRA had almost 100 accuracy, sensitivity, specificity, PPV and NPV when compared to duplex scan in iliac, femoro-popliteal and tibioperoneal segment. In patients with low grade blockage (