Pelvic and lower extremity arterial imaging: Diagnostic performance of three-dimensional contrast-enhanced MR angiography

OBJECTIVE, The diagnostic performance of a three-dimensional MR angiography -based strategy was assessed with regard to its ability to characterize the arterial vasculature from the aortic bifurcation to the lower extremity ru noff vessels. A single-injection, two-station protocol in combination with a lower-extremity vascular coil was used. SUBJECTS AND METHODS. Both conventional digital subtraction angiography and three-dimensional contrast-enhanced MR angiography with a dedicated periph eral vascular coil were performed in 61 patients with suspected peripheral vascular disease. In a prospective analysis, one reviewer evaluated the dig ital subtraction angiographic images and a second reviewer evaluated the MR angiographic images; both were unaware of the results of the other imaging technique. Each vascular segment (29 segments per patient) was evaluated f or the presence of occlusive vessel disease. The following grading system w as applied: 0, normal; 1, vessel irregularity with a luminal reduction of l ess than 10%; 2, mild stenosis (lumen reduction, 10-49%); 3, severe stenosi s (lumen reduction, 50-99%); and 4, occlusion (lumen reduction, 100%). In 1 1 patients surgical graft patency was assessed. RESULTS. MR angiography provided an image quality comparable with that of d igital subtraction angiography. Overall sensitivity and specificity for MR angiography were 92% and 96.6%, respectively, for the detection of hemodyna mically significant disease and 92.3% and 99.4%, respectively, for the dete ction of occlusions. CONCLUSION. Two-station contrast-enhanced three-dimensional MR angiography with a dedicated lower-extremity vascular coil proved effective enough to c onsider it as a noninvasive alternative to digital subtraction angiography in the assessment of the pelvic and lower extremity arterial vasculature.