Magnetic resonance angiography of aorto-iliac disease

BACKGROUND: Four different techniques for aortoiliac magnetic resonance ang iography (MRA) were assessed for accuracy using a digital subtraction angio graphy (DSA) gold standard. Surgeons' confidence in their ability to genera te treatment plans with MRA and DSA was assessed, in consultation with a ra diologist. METHODS: TWO different two-dimensional (2D) time-of-flight (TOF) sequences, a phase-contrast sequence, and a contrast-enhanced (CE) MRA sequence were used. Receiver operating characteristic (ROC) curves were plotted and areas (A(z)) calculated from radiologists' readings. Surgeons' confidence in the ir ability to utilize the images for treatment planning was assessed with a 5-point Likert scale. Thirty-six patients were evaluated. RESULTS: CE MRA had a sensitivity, specificity, and A(z) of .92,.93, and .9 6, respectively, for stenoses 50% or greater. CE MRA performed better than other sequences, but the improvement compared with gated 2D TOF was not sta tistically significant. Interobserver agreement for CE MRA and DSA yielded identical Kappa values. Surgeons were most confident in DSA, followed by CE MRA, which was significantly preferred to other techniques. CONCLUSIONS: CE MRA closely approximates DSA in terms of diagnostic accurac y. Surgeons considering treatment plans are confident in the CE MRA techniq ue, relative to other MRA methods. (C) 2000 by Excerpta Medica, Inc.