Accuracy of non‐contrast quiescent‐interval single‐shot and quiescent‐interval single‐shot arterial spin‐labelled magnetic resonance angiography in assessment of peripheral arterial disease in a diabetic population
Introduction Diabetic patients with peripheral arterial disease (PAD) are challenging to assess. Non‐contrast magnetic resonance angiography (MRA) offers a safe alternative in patients with renal impairment. The study objective is to evaluate accuracy of lower limb quiescent‐interval single‐shot (QI...
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| Veröffentlicht in: | Journal of medical imaging and radiation oncology 2020-02, Vol.64 (1), p.35-43 |
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| creator | Lam, Adrienne Perchyonok, Yuliya Ranatunga, Dinesh Lukies, Matthew W Richmond, Danielle Hornsey, Emma K McColl, Brenden Heidrich, Jason Ko, Pei‐Heng Spelman, Tim Chuen, Jason Edelman, Robert R Lim, Ruth P |
| description | Introduction
Diabetic patients with peripheral arterial disease (PAD) are challenging to assess. Non‐contrast magnetic resonance angiography (MRA) offers a safe alternative in patients with renal impairment. The study objective is to evaluate accuracy of lower limb quiescent‐interval single‐shot (QISS) MRA and pedal QISS‐arterial spin‐labelled (ASL) MRA for detection of significant stenosis in diabetic patients with PAD.
Methods
Combined QISS and QISS‐ASL MRA was performed in 32 diabetic PAD patients (20 male, 12 female; mean 69 years; 8 with critical ischaemia). Two readers assessed haemodynamically significant (>50%) stenosis and diagnostic confidence on MRA, against digital subtraction angiography (DSA) as the reference standard, with subgroup analysis of patients with severe renal impairment (n = 7). Inter‐reader agreement of stenosis and diagnostic confidence were evaluated. Test–retest reproducibility was evaluated in 10 subjects who underwent repeat MRA on a different day.
Results
At DSA, 262/645 segments (40.6%) had haemodynamically significant stenoses. MRA accuracy was 78.1% (478/612) and 75.6% (464/614), sensitivity 64.7% (161/249) and 77.5% (193/249), and specificity 87.3% (317/363) and 74.2% (271/365) for 2 readers. MRA accuracy was 80.9% and 80.7% for readers 1 and 2, respectively, in patients with severe renal impairment. QISS MRA but not pedal QISS‐ASL MRA was considered of diagnostic image quality. Inter‐reader agreement was moderate for stenosis (ĸ = 0.60) and diagnostic confidence (ĸ = 0.41). Test–retest reproducibility was high (ĸ = 0.87) and moderate (ĸ = 0.54) for individual readers.
Conclusions
Quiescent‐interval single‐shot MRA has reasonable accuracy in a diabetic PAD population with high burden of disease, providing a non‐contrast option in patients with renal impairment. QISS‐ASL MRA requires further optimisation to be clinically feasible. |
| doi_str_mv | 10.1111/1754-9485.12987 |
| format | Article |
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Diabetic patients with peripheral arterial disease (PAD) are challenging to assess. Non‐contrast magnetic resonance angiography (MRA) offers a safe alternative in patients with renal impairment. The study objective is to evaluate accuracy of lower limb quiescent‐interval single‐shot (QISS) MRA and pedal QISS‐arterial spin‐labelled (ASL) MRA for detection of significant stenosis in diabetic patients with PAD.
Methods
Combined QISS and QISS‐ASL MRA was performed in 32 diabetic PAD patients (20 male, 12 female; mean 69 years; 8 with critical ischaemia). Two readers assessed haemodynamically significant (>50%) stenosis and diagnostic confidence on MRA, against digital subtraction angiography (DSA) as the reference standard, with subgroup analysis of patients with severe renal impairment (n = 7). Inter‐reader agreement of stenosis and diagnostic confidence were evaluated. Test–retest reproducibility was evaluated in 10 subjects who underwent repeat MRA on a different day.
Results
At DSA, 262/645 segments (40.6%) had haemodynamically significant stenoses. MRA accuracy was 78.1% (478/612) and 75.6% (464/614), sensitivity 64.7% (161/249) and 77.5% (193/249), and specificity 87.3% (317/363) and 74.2% (271/365) for 2 readers. MRA accuracy was 80.9% and 80.7% for readers 1 and 2, respectively, in patients with severe renal impairment. QISS MRA but not pedal QISS‐ASL MRA was considered of diagnostic image quality. Inter‐reader agreement was moderate for stenosis (ĸ = 0.60) and diagnostic confidence (ĸ = 0.41). Test–retest reproducibility was high (ĸ = 0.87) and moderate (ĸ = 0.54) for individual readers.
Conclusions
Quiescent‐interval single‐shot MRA has reasonable accuracy in a diabetic PAD population with high burden of disease, providing a non‐contrast option in patients with renal impairment. QISS‐ASL MRA requires further optimisation to be clinically feasible.</description><identifier>ISSN: 1754-9477</identifier><identifier>EISSN: 1754-9485</identifier><identifier>DOI: 10.1111/1754-9485.12987</identifier><identifier>PMID: 32043319</identifier><language>eng</language><publisher>Australia: Wiley Subscription Services, Inc</publisher><subject>Accuracy ; Aged ; Aged, 80 and over ; Angiography ; clinical trial ; data accuracy ; Diabetes ; diabetes mellitus ; Diabetes Mellitus, Type 2 - complications ; Diagnostic systems ; Evaluation ; Female ; Humans ; Image quality ; Impairment ; Ischemia ; Lower Extremity - blood supply ; Lower Extremity - diagnostic imaging ; Magnetic resonance ; magnetic resonance angiography ; Magnetic Resonance Angiography - methods ; Male ; Medical imaging ; Middle Aged ; Optimization ; Peripheral Arterial Disease - complications ; Peripheral Arterial Disease - diagnostic imaging ; peripheral vascular disease ; Prospective Studies ; Reproducibility ; Reproducibility of Results ; Sensitivity and Specificity ; Shot ; Spin Labels ; Subgroups</subject><ispartof>Journal of medical imaging and radiation oncology, 2020-02, Vol.64 (1), p.35-43</ispartof><rights>2020 The Royal Australian and New Zealand College of Radiologists</rights><rights>2020 The Royal Australian and New Zealand College of Radiologists.</rights><rights>Copyright © 2020 The Royal Australian and New Zealand College of Radiologists</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4197-b2214da1fa92deb438b64d911e9fae0f7290df061144dd0ecdd843c45c7a4b623</citedby><cites>FETCH-LOGICAL-c4197-b2214da1fa92deb438b64d911e9fae0f7290df061144dd0ecdd843c45c7a4b623</cites><orcidid>0000-0002-2842-5997 ; 0000-0001-9701-8175 ; 0000-0001-6746-1184 ; 0000-0003-1890-1870</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2F1754-9485.12987$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2F1754-9485.12987$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32043319$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lam, Adrienne</creatorcontrib><creatorcontrib>Perchyonok, Yuliya</creatorcontrib><creatorcontrib>Ranatunga, Dinesh</creatorcontrib><creatorcontrib>Lukies, Matthew W</creatorcontrib><creatorcontrib>Richmond, Danielle</creatorcontrib><creatorcontrib>Hornsey, Emma K</creatorcontrib><creatorcontrib>McColl, Brenden</creatorcontrib><creatorcontrib>Heidrich, Jason</creatorcontrib><creatorcontrib>Ko, Pei‐Heng</creatorcontrib><creatorcontrib>Spelman, Tim</creatorcontrib><creatorcontrib>Chuen, Jason</creatorcontrib><creatorcontrib>Edelman, Robert R</creatorcontrib><creatorcontrib>Lim, Ruth P</creatorcontrib><title>Accuracy of non‐contrast quiescent‐interval single‐shot and quiescent‐interval single‐shot arterial spin‐labelled magnetic resonance angiography in assessment of peripheral arterial disease in a diabetic population</title><title>Journal of medical imaging and radiation oncology</title><addtitle>J Med Imaging Radiat Oncol</addtitle><description>Introduction
Diabetic patients with peripheral arterial disease (PAD) are challenging to assess. Non‐contrast magnetic resonance angiography (MRA) offers a safe alternative in patients with renal impairment. The study objective is to evaluate accuracy of lower limb quiescent‐interval single‐shot (QISS) MRA and pedal QISS‐arterial spin‐labelled (ASL) MRA for detection of significant stenosis in diabetic patients with PAD.
Methods
Combined QISS and QISS‐ASL MRA was performed in 32 diabetic PAD patients (20 male, 12 female; mean 69 years; 8 with critical ischaemia). Two readers assessed haemodynamically significant (>50%) stenosis and diagnostic confidence on MRA, against digital subtraction angiography (DSA) as the reference standard, with subgroup analysis of patients with severe renal impairment (n = 7). Inter‐reader agreement of stenosis and diagnostic confidence were evaluated. Test–retest reproducibility was evaluated in 10 subjects who underwent repeat MRA on a different day.
Results
At DSA, 262/645 segments (40.6%) had haemodynamically significant stenoses. MRA accuracy was 78.1% (478/612) and 75.6% (464/614), sensitivity 64.7% (161/249) and 77.5% (193/249), and specificity 87.3% (317/363) and 74.2% (271/365) for 2 readers. MRA accuracy was 80.9% and 80.7% for readers 1 and 2, respectively, in patients with severe renal impairment. QISS MRA but not pedal QISS‐ASL MRA was considered of diagnostic image quality. Inter‐reader agreement was moderate for stenosis (ĸ = 0.60) and diagnostic confidence (ĸ = 0.41). Test–retest reproducibility was high (ĸ = 0.87) and moderate (ĸ = 0.54) for individual readers.
Conclusions
Quiescent‐interval single‐shot MRA has reasonable accuracy in a diabetic PAD population with high burden of disease, providing a non‐contrast option in patients with renal impairment. QISS‐ASL MRA requires further optimisation to be clinically feasible.</description><subject>Accuracy</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiography</subject><subject>clinical trial</subject><subject>data accuracy</subject><subject>Diabetes</subject><subject>diabetes mellitus</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diagnostic systems</subject><subject>Evaluation</subject><subject>Female</subject><subject>Humans</subject><subject>Image quality</subject><subject>Impairment</subject><subject>Ischemia</subject><subject>Lower Extremity - blood supply</subject><subject>Lower Extremity - diagnostic imaging</subject><subject>Magnetic resonance</subject><subject>magnetic resonance angiography</subject><subject>Magnetic Resonance Angiography - methods</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Middle Aged</subject><subject>Optimization</subject><subject>Peripheral Arterial Disease - complications</subject><subject>Peripheral Arterial Disease - diagnostic imaging</subject><subject>peripheral vascular disease</subject><subject>Prospective Studies</subject><subject>Reproducibility</subject><subject>Reproducibility of Results</subject><subject>Sensitivity and Specificity</subject><subject>Shot</subject><subject>Spin Labels</subject><subject>Subgroups</subject><issn>1754-9477</issn><issn>1754-9485</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkUFvFCEYhonR2Fo9ezMkXrxsOzDMMhw3jdaamiaNngkD3-zSMDCFGc3e_An9jf0lwm67By8ql2HePN8D4UXoLalOSV5nhDdsIVjbnBIqWv4MHR-S54c950foVUq3VbUkhImX6KimFatrIo7Rw0rrOSq9xaHHPviHX_c6-CmqNOG72ULS4KccWj9B_KEcTtavHeQkbcKElTf_hMUc2xKPthzhVAfOgcGDWnuYrMYRUvDKa8jKtQ3rqMbNFluPVUqQ0pD15YZj1owbiFl1cBqbQCXYwfknq4twDOPs1GSDf41e9MolePP4PUHfP338dv55cXV9cXm-ulpoRgRfdJQSZhTplaAGOla33ZIZQQiIXkHVcyoq0--ekBlTgTamZbVmjeaKdUtan6APe-8Yw90MaZKDze_inPIQ5iRp3dRNy0UjMvr-D_Q2zNHn2xWKZqalhTrbUzqGlCL0cox2UHErSSVL_bIULEvZcld_nnj36J27AcyBf-o7A3wP_LQOtn_zyS9fL2-un9TN_0yublb7ud9RjNeF</recordid><startdate>202002</startdate><enddate>202002</enddate><creator>Lam, Adrienne</creator><creator>Perchyonok, Yuliya</creator><creator>Ranatunga, Dinesh</creator><creator>Lukies, Matthew W</creator><creator>Richmond, Danielle</creator><creator>Hornsey, Emma K</creator><creator>McColl, Brenden</creator><creator>Heidrich, Jason</creator><creator>Ko, Pei‐Heng</creator><creator>Spelman, Tim</creator><creator>Chuen, Jason</creator><creator>Edelman, Robert R</creator><creator>Lim, Ruth P</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2842-5997</orcidid><orcidid>https://orcid.org/0000-0001-9701-8175</orcidid><orcidid>https://orcid.org/0000-0001-6746-1184</orcidid><orcidid>https://orcid.org/0000-0003-1890-1870</orcidid></search><sort><creationdate>202002</creationdate><title>Accuracy of non‐contrast quiescent‐interval single‐shot and quiescent‐interval single‐shot arterial spin‐labelled magnetic resonance angiography in assessment of peripheral arterial disease in a diabetic population</title><author>Lam, Adrienne ; Perchyonok, Yuliya ; Ranatunga, Dinesh ; Lukies, Matthew W ; Richmond, Danielle ; Hornsey, Emma K ; McColl, Brenden ; Heidrich, Jason ; Ko, Pei‐Heng ; Spelman, Tim ; Chuen, Jason ; Edelman, Robert R ; Lim, Ruth P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4197-b2214da1fa92deb438b64d911e9fae0f7290df061144dd0ecdd843c45c7a4b623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Accuracy</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angiography</topic><topic>clinical trial</topic><topic>data accuracy</topic><topic>Diabetes</topic><topic>diabetes mellitus</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diagnostic systems</topic><topic>Evaluation</topic><topic>Female</topic><topic>Humans</topic><topic>Image quality</topic><topic>Impairment</topic><topic>Ischemia</topic><topic>Lower Extremity - blood supply</topic><topic>Lower Extremity - diagnostic imaging</topic><topic>Magnetic resonance</topic><topic>magnetic resonance angiography</topic><topic>Magnetic Resonance Angiography - methods</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Middle Aged</topic><topic>Optimization</topic><topic>Peripheral Arterial Disease - complications</topic><topic>Peripheral Arterial Disease - diagnostic imaging</topic><topic>peripheral vascular disease</topic><topic>Prospective Studies</topic><topic>Reproducibility</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><topic>Shot</topic><topic>Spin Labels</topic><topic>Subgroups</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lam, Adrienne</creatorcontrib><creatorcontrib>Perchyonok, Yuliya</creatorcontrib><creatorcontrib>Ranatunga, Dinesh</creatorcontrib><creatorcontrib>Lukies, Matthew W</creatorcontrib><creatorcontrib>Richmond, Danielle</creatorcontrib><creatorcontrib>Hornsey, Emma K</creatorcontrib><creatorcontrib>McColl, Brenden</creatorcontrib><creatorcontrib>Heidrich, Jason</creatorcontrib><creatorcontrib>Ko, Pei‐Heng</creatorcontrib><creatorcontrib>Spelman, Tim</creatorcontrib><creatorcontrib>Chuen, Jason</creatorcontrib><creatorcontrib>Edelman, Robert R</creatorcontrib><creatorcontrib>Lim, Ruth P</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of medical imaging and radiation oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lam, Adrienne</au><au>Perchyonok, Yuliya</au><au>Ranatunga, Dinesh</au><au>Lukies, Matthew W</au><au>Richmond, Danielle</au><au>Hornsey, Emma K</au><au>McColl, Brenden</au><au>Heidrich, Jason</au><au>Ko, Pei‐Heng</au><au>Spelman, Tim</au><au>Chuen, Jason</au><au>Edelman, Robert R</au><au>Lim, Ruth P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Accuracy of non‐contrast quiescent‐interval single‐shot and quiescent‐interval single‐shot arterial spin‐labelled magnetic resonance angiography in assessment of peripheral arterial disease in a diabetic population</atitle><jtitle>Journal of medical imaging and radiation oncology</jtitle><addtitle>J Med Imaging Radiat Oncol</addtitle><date>2020-02</date><risdate>2020</risdate><volume>64</volume><issue>1</issue><spage>35</spage><epage>43</epage><pages>35-43</pages><issn>1754-9477</issn><eissn>1754-9485</eissn><abstract>Introduction
Diabetic patients with peripheral arterial disease (PAD) are challenging to assess. Non‐contrast magnetic resonance angiography (MRA) offers a safe alternative in patients with renal impairment. The study objective is to evaluate accuracy of lower limb quiescent‐interval single‐shot (QISS) MRA and pedal QISS‐arterial spin‐labelled (ASL) MRA for detection of significant stenosis in diabetic patients with PAD.
Methods
Combined QISS and QISS‐ASL MRA was performed in 32 diabetic PAD patients (20 male, 12 female; mean 69 years; 8 with critical ischaemia). Two readers assessed haemodynamically significant (>50%) stenosis and diagnostic confidence on MRA, against digital subtraction angiography (DSA) as the reference standard, with subgroup analysis of patients with severe renal impairment (n = 7). Inter‐reader agreement of stenosis and diagnostic confidence were evaluated. Test–retest reproducibility was evaluated in 10 subjects who underwent repeat MRA on a different day.
Results
At DSA, 262/645 segments (40.6%) had haemodynamically significant stenoses. MRA accuracy was 78.1% (478/612) and 75.6% (464/614), sensitivity 64.7% (161/249) and 77.5% (193/249), and specificity 87.3% (317/363) and 74.2% (271/365) for 2 readers. MRA accuracy was 80.9% and 80.7% for readers 1 and 2, respectively, in patients with severe renal impairment. QISS MRA but not pedal QISS‐ASL MRA was considered of diagnostic image quality. Inter‐reader agreement was moderate for stenosis (ĸ = 0.60) and diagnostic confidence (ĸ = 0.41). Test–retest reproducibility was high (ĸ = 0.87) and moderate (ĸ = 0.54) for individual readers.
Conclusions
Quiescent‐interval single‐shot MRA has reasonable accuracy in a diabetic PAD population with high burden of disease, providing a non‐contrast option in patients with renal impairment. QISS‐ASL MRA requires further optimisation to be clinically feasible.</abstract><cop>Australia</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32043319</pmid><doi>10.1111/1754-9485.12987</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-2842-5997</orcidid><orcidid>https://orcid.org/0000-0001-9701-8175</orcidid><orcidid>https://orcid.org/0000-0001-6746-1184</orcidid><orcidid>https://orcid.org/0000-0003-1890-1870</orcidid></addata></record> |
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| subjects | Accuracy Aged Aged, 80 and over Angiography clinical trial data accuracy Diabetes diabetes mellitus Diabetes Mellitus, Type 2 - complications Diagnostic systems Evaluation Female Humans Image quality Impairment Ischemia Lower Extremity - blood supply Lower Extremity - diagnostic imaging Magnetic resonance magnetic resonance angiography Magnetic Resonance Angiography - methods Male Medical imaging Middle Aged Optimization Peripheral Arterial Disease - complications Peripheral Arterial Disease - diagnostic imaging peripheral vascular disease Prospective Studies Reproducibility Reproducibility of Results Sensitivity and Specificity Shot Spin Labels Subgroups |
| title | Accuracy of non‐contrast quiescent‐interval single‐shot and quiescent‐interval single‐shot arterial spin‐labelled magnetic resonance angiography in assessment of peripheral arterial disease in a diabetic population |
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