Unmasking pedal arteries in patients with critical ischemia using time-resolved contrast-enhanced 3D MRA
Objective To test the diagnostic relevance of fast Gadobenate dimeglumine (Gd-BOPTA) enhanced, time-resolved, three-dimensional magnetic resonance angiography (t3D MRA) of distal calf and pedal vasculature in critical limb ischemia in a prospective comparison with conventional selective digital subt...
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| Veröffentlicht in: | Journal of vascular surgery 2009-05, Vol.49 (5), p.1196-1202 |
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| creator | Langer, Stephan, MD Krämer, Nils, MD Mommertz, Gottfried, MD Koeppel, Thomas A., MD Jacobs, Michael J., MD Wazirie, Noor A Ocklenburg, Christina, MSC Spüntrup, Elmar, MD |
| description | Objective To test the diagnostic relevance of fast Gadobenate dimeglumine (Gd-BOPTA) enhanced, time-resolved, three-dimensional magnetic resonance angiography (t3D MRA) of distal calf and pedal vasculature in critical limb ischemia in a prospective comparison with conventional selective digital subtraction angiography (DSA) and high-resolution duplex ultrasound (US) scan. Methods From April 2007 to June 2008, 34 feet of 29 consecutive patients suffering from limb-threatening ischemia underwent diagnostic US scan, DSA, and t3D MRA before treatment. The investigations took place within 3 days. A t3D MRA was performed using a 3 Tesla whole-body magnetic resonance (MR) system with an eight-element phased-array coil. Image quality and diagnostic findings were subjectively analyzed by two radiologists and one vascular surgeon. Each distal calf and foot was divided into six arterial segments for DSA and t3D MRA, and four segments were investigated by US scan. Patency or occlusion was studied with all the techniques, whereby DSA and t3D MRA were additionally evaluated in patients having greater or less than 50% stenosis. Finally, images were visually assessed by the three observers by applying a six-point grading scale. The acquired data was statistically analyzed using McNemar's test and Wilcoxon's matched-pairs signed-rank sum test. The P values of less than an alpha level of .05 were considered to be statistically significant. Results We achieved MRA images of diagnostic quality in all patients. Significantly more patent pedal arteries were identified by applying t3D MRA than DSA ( P < .001) and US scan ( P < .02). For estimating the degree of stenosis, no technique proved to be superior ( P > .28). Overall image quality was rated best for t3D MRA. Additionally, potential bypass target vessels could be clearly discriminated from pedal veins due to the temporal resolution. Conclusion In our prospective study, t3D MRA has been proven to be superior to DSA and US scan in pedal vasculature imaging in critical limb ischemia. This is a valuable, noninvasive method for detecting potential pedal bypass target arteries. |
| doi_str_mv | 10.1016/j.jvs.2008.12.025 |
| format | Article |
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Methods From April 2007 to June 2008, 34 feet of 29 consecutive patients suffering from limb-threatening ischemia underwent diagnostic US scan, DSA, and t3D MRA before treatment. The investigations took place within 3 days. A t3D MRA was performed using a 3 Tesla whole-body magnetic resonance (MR) system with an eight-element phased-array coil. Image quality and diagnostic findings were subjectively analyzed by two radiologists and one vascular surgeon. Each distal calf and foot was divided into six arterial segments for DSA and t3D MRA, and four segments were investigated by US scan. Patency or occlusion was studied with all the techniques, whereby DSA and t3D MRA were additionally evaluated in patients having greater or less than 50% stenosis. Finally, images were visually assessed by the three observers by applying a six-point grading scale. The acquired data was statistically analyzed using McNemar's test and Wilcoxon's matched-pairs signed-rank sum test. The P values of less than an alpha level of .05 were considered to be statistically significant. Results We achieved MRA images of diagnostic quality in all patients. Significantly more patent pedal arteries were identified by applying t3D MRA than DSA ( P < .001) and US scan ( P < .02). For estimating the degree of stenosis, no technique proved to be superior ( P > .28). Overall image quality was rated best for t3D MRA. Additionally, potential bypass target vessels could be clearly discriminated from pedal veins due to the temporal resolution. Conclusion In our prospective study, t3D MRA has been proven to be superior to DSA and US scan in pedal vasculature imaging in critical limb ischemia. This is a valuable, noninvasive method for detecting potential pedal bypass target arteries.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2008.12.025</identifier><identifier>PMID: 19394548</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Arterial Occlusive Diseases - complications ; Arterial Occlusive Diseases - diagnostic imaging ; Arterial Occlusive Diseases - pathology ; Arteries - pathology ; Biological and medical sciences ; Cardiovascular system ; Constriction, Pathologic ; Contrast Media ; Critical Illness ; Female ; Foot - blood supply ; Humans ; Image Enhancement ; Image Interpretation, Computer-Assisted ; Imaging, Three-Dimensional ; Ischemia - diagnostic imaging ; Ischemia - etiology ; Ischemia - pathology ; Magnetic Resonance Angiography - methods ; Male ; Medical sciences ; Meglumine - analogs & derivatives ; Middle Aged ; Organometallic Compounds ; Pharmacology. Drug treatments ; Predictive Value of Tests ; Prospective Studies ; Severity of Illness Index ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Time Factors ; Ultrasonography, Doppler, Duplex ; Vascular Patency ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels ; Vascular wall</subject><ispartof>Journal of vascular surgery, 2009-05, Vol.49 (5), p.1196-1202</ispartof><rights>Society for Vascular Surgery</rights><rights>2009 Society for Vascular Surgery</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-cb939baadf3c735d994f1158dbcec74651971f3769d32b2cd0c070fc71d5ea4b3</citedby><cites>FETCH-LOGICAL-c479t-cb939baadf3c735d994f1158dbcec74651971f3769d32b2cd0c070fc71d5ea4b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521408022623$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21433294$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19394548$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Langer, Stephan, MD</creatorcontrib><creatorcontrib>Krämer, Nils, MD</creatorcontrib><creatorcontrib>Mommertz, Gottfried, MD</creatorcontrib><creatorcontrib>Koeppel, Thomas A., MD</creatorcontrib><creatorcontrib>Jacobs, Michael J., MD</creatorcontrib><creatorcontrib>Wazirie, Noor A</creatorcontrib><creatorcontrib>Ocklenburg, Christina, MSC</creatorcontrib><creatorcontrib>Spüntrup, Elmar, MD</creatorcontrib><title>Unmasking pedal arteries in patients with critical ischemia using time-resolved contrast-enhanced 3D MRA</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Objective To test the diagnostic relevance of fast Gadobenate dimeglumine (Gd-BOPTA) enhanced, time-resolved, three-dimensional magnetic resonance angiography (t3D MRA) of distal calf and pedal vasculature in critical limb ischemia in a prospective comparison with conventional selective digital subtraction angiography (DSA) and high-resolution duplex ultrasound (US) scan. Methods From April 2007 to June 2008, 34 feet of 29 consecutive patients suffering from limb-threatening ischemia underwent diagnostic US scan, DSA, and t3D MRA before treatment. The investigations took place within 3 days. A t3D MRA was performed using a 3 Tesla whole-body magnetic resonance (MR) system with an eight-element phased-array coil. Image quality and diagnostic findings were subjectively analyzed by two radiologists and one vascular surgeon. Each distal calf and foot was divided into six arterial segments for DSA and t3D MRA, and four segments were investigated by US scan. Patency or occlusion was studied with all the techniques, whereby DSA and t3D MRA were additionally evaluated in patients having greater or less than 50% stenosis. Finally, images were visually assessed by the three observers by applying a six-point grading scale. The acquired data was statistically analyzed using McNemar's test and Wilcoxon's matched-pairs signed-rank sum test. The P values of less than an alpha level of .05 were considered to be statistically significant. Results We achieved MRA images of diagnostic quality in all patients. Significantly more patent pedal arteries were identified by applying t3D MRA than DSA ( P < .001) and US scan ( P < .02). For estimating the degree of stenosis, no technique proved to be superior ( P > .28). Overall image quality was rated best for t3D MRA. Additionally, potential bypass target vessels could be clearly discriminated from pedal veins due to the temporal resolution. Conclusion In our prospective study, t3D MRA has been proven to be superior to DSA and US scan in pedal vasculature imaging in critical limb ischemia. This is a valuable, noninvasive method for detecting potential pedal bypass target arteries.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiography, Digital Subtraction</subject><subject>Arterial Occlusive Diseases - complications</subject><subject>Arterial Occlusive Diseases - diagnostic imaging</subject><subject>Arterial Occlusive Diseases - pathology</subject><subject>Arteries - pathology</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular system</subject><subject>Constriction, Pathologic</subject><subject>Contrast Media</subject><subject>Critical Illness</subject><subject>Female</subject><subject>Foot - blood supply</subject><subject>Humans</subject><subject>Image Enhancement</subject><subject>Image Interpretation, Computer-Assisted</subject><subject>Imaging, Three-Dimensional</subject><subject>Ischemia - diagnostic imaging</subject><subject>Ischemia - etiology</subject><subject>Ischemia - pathology</subject><subject>Magnetic Resonance Angiography - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Meglumine - analogs & derivatives</subject><subject>Middle Aged</subject><subject>Organometallic Compounds</subject><subject>Pharmacology. Drug treatments</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Severity of Illness Index</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Time Factors</subject><subject>Ultrasonography, Doppler, Duplex</subject><subject>Vascular Patency</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><subject>Vascular wall</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kl2L1DAUhoMo7uzqD_BGeqN3rflomwZBWNb1A1YEda9Dmpw6mW3TMScd2X9v6gwKXngVCM978vKcEPKM0YpR1r7aVbsDVpzSrmK8orx5QDaMKlm2HVUPyYbKmpUNZ_UZOUfcUcpY08nH5Iwpoeqm7jZkexsmg3c-fC_24MxYmJggesDCh2JvkoeQsPjp07aw0SdvM-LRbmHyplhwzSU_QRkB5_EArrBzSNFgKiFsTbD5RrwtPn25fEIeDWZEeHo6L8jtu-tvVx_Km8_vP15d3pS2liqVts_VemPcIKwUjVOqHtbWrrdgZd02TEk2CNkqJ3jPraOWSjpYyVwDpu7FBXl5nLuP848FMOkp94VxNAHmBXUrWds1qs4gO4I2zogRBr2PfjLxXjOqV716p7NeverVjOusN2een4Yv_QTub-LkMwMvToDBrGqIWYHHP1xehRD89-OvjxxkFQcPUaPNqrMuH8Em7Wb_3xpv_knb0Yd1N3dwD7iblxiyY8005oD-uv6D9RvQjnLeciF-ASTjrhY</recordid><startdate>20090501</startdate><enddate>20090501</enddate><creator>Langer, Stephan, MD</creator><creator>Krämer, Nils, MD</creator><creator>Mommertz, Gottfried, MD</creator><creator>Koeppel, Thomas A., MD</creator><creator>Jacobs, Michael J., MD</creator><creator>Wazirie, Noor A</creator><creator>Ocklenburg, Christina, MSC</creator><creator>Spüntrup, Elmar, MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><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></search><sort><creationdate>20090501</creationdate><title>Unmasking pedal arteries in patients with critical ischemia using time-resolved contrast-enhanced 3D MRA</title><author>Langer, Stephan, MD ; Krämer, Nils, MD ; Mommertz, Gottfried, MD ; Koeppel, Thomas A., MD ; Jacobs, Michael J., MD ; Wazirie, Noor A ; Ocklenburg, Christina, MSC ; Spüntrup, Elmar, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-cb939baadf3c735d994f1158dbcec74651971f3769d32b2cd0c070fc71d5ea4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angiography, Digital Subtraction</topic><topic>Arterial Occlusive Diseases - complications</topic><topic>Arterial Occlusive Diseases - diagnostic imaging</topic><topic>Arterial Occlusive Diseases - pathology</topic><topic>Arteries - pathology</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular system</topic><topic>Constriction, Pathologic</topic><topic>Contrast Media</topic><topic>Critical Illness</topic><topic>Female</topic><topic>Foot - blood supply</topic><topic>Humans</topic><topic>Image Enhancement</topic><topic>Image Interpretation, Computer-Assisted</topic><topic>Imaging, Three-Dimensional</topic><topic>Ischemia - diagnostic imaging</topic><topic>Ischemia - etiology</topic><topic>Ischemia - pathology</topic><topic>Magnetic Resonance Angiography - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Meglumine - analogs & derivatives</topic><topic>Middle Aged</topic><topic>Organometallic Compounds</topic><topic>Pharmacology. Drug treatments</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Severity of Illness Index</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Time Factors</topic><topic>Ultrasonography, Doppler, Duplex</topic><topic>Vascular Patency</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><topic>Vascular wall</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Langer, Stephan, MD</creatorcontrib><creatorcontrib>Krämer, Nils, MD</creatorcontrib><creatorcontrib>Mommertz, Gottfried, MD</creatorcontrib><creatorcontrib>Koeppel, Thomas A., MD</creatorcontrib><creatorcontrib>Jacobs, Michael J., MD</creatorcontrib><creatorcontrib>Wazirie, Noor A</creatorcontrib><creatorcontrib>Ocklenburg, Christina, MSC</creatorcontrib><creatorcontrib>Spüntrup, Elmar, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><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 vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Langer, Stephan, MD</au><au>Krämer, Nils, MD</au><au>Mommertz, Gottfried, MD</au><au>Koeppel, Thomas A., MD</au><au>Jacobs, Michael J., MD</au><au>Wazirie, Noor A</au><au>Ocklenburg, Christina, MSC</au><au>Spüntrup, Elmar, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Unmasking pedal arteries in patients with critical ischemia using time-resolved contrast-enhanced 3D MRA</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2009-05-01</date><risdate>2009</risdate><volume>49</volume><issue>5</issue><spage>1196</spage><epage>1202</epage><pages>1196-1202</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>Objective To test the diagnostic relevance of fast Gadobenate dimeglumine (Gd-BOPTA) enhanced, time-resolved, three-dimensional magnetic resonance angiography (t3D MRA) of distal calf and pedal vasculature in critical limb ischemia in a prospective comparison with conventional selective digital subtraction angiography (DSA) and high-resolution duplex ultrasound (US) scan. Methods From April 2007 to June 2008, 34 feet of 29 consecutive patients suffering from limb-threatening ischemia underwent diagnostic US scan, DSA, and t3D MRA before treatment. The investigations took place within 3 days. A t3D MRA was performed using a 3 Tesla whole-body magnetic resonance (MR) system with an eight-element phased-array coil. Image quality and diagnostic findings were subjectively analyzed by two radiologists and one vascular surgeon. Each distal calf and foot was divided into six arterial segments for DSA and t3D MRA, and four segments were investigated by US scan. Patency or occlusion was studied with all the techniques, whereby DSA and t3D MRA were additionally evaluated in patients having greater or less than 50% stenosis. Finally, images were visually assessed by the three observers by applying a six-point grading scale. The acquired data was statistically analyzed using McNemar's test and Wilcoxon's matched-pairs signed-rank sum test. The P values of less than an alpha level of .05 were considered to be statistically significant. Results We achieved MRA images of diagnostic quality in all patients. Significantly more patent pedal arteries were identified by applying t3D MRA than DSA ( P < .001) and US scan ( P < .02). For estimating the degree of stenosis, no technique proved to be superior ( P > .28). Overall image quality was rated best for t3D MRA. Additionally, potential bypass target vessels could be clearly discriminated from pedal veins due to the temporal resolution. Conclusion In our prospective study, t3D MRA has been proven to be superior to DSA and US scan in pedal vasculature imaging in critical limb ischemia. This is a valuable, noninvasive method for detecting potential pedal bypass target arteries.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>19394548</pmid><doi>10.1016/j.jvs.2008.12.025</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Angiography, Digital Subtraction Arterial Occlusive Diseases - complications Arterial Occlusive Diseases - diagnostic imaging Arterial Occlusive Diseases - pathology Arteries - pathology Biological and medical sciences Cardiovascular system Constriction, Pathologic Contrast Media Critical Illness Female Foot - blood supply Humans Image Enhancement Image Interpretation, Computer-Assisted Imaging, Three-Dimensional Ischemia - diagnostic imaging Ischemia - etiology Ischemia - pathology Magnetic Resonance Angiography - methods Male Medical sciences Meglumine - analogs & derivatives Middle Aged Organometallic Compounds Pharmacology. Drug treatments Predictive Value of Tests Prospective Studies Severity of Illness Index Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Time Factors Ultrasonography, Doppler, Duplex Vascular Patency Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels Vascular wall |
| title | Unmasking pedal arteries in patients with critical ischemia using time-resolved contrast-enhanced 3D MRA |
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