Diagnostic performance of gadobenate dimeglumine enhanced MR angiography of the iliofemoral and calf arteries: a large-scale multicenter trial.

Abstract

OBJECTIVE:

The purpose of this study was to compare gadobenate dimeglumine-enhanced MR angiography and unenhanced time-of-flight MR angiography for the detection of significant peripheral arterial occlusive disease using digital subtraction angiography as our reference standard.

SUBJECTS AND METHODS:

Two hundred seventy-two patients underwent MR angiography and digital subtraction angiography of the iliofemoral arteries. MR angiography was performed before (2D time-of-flight acquisitions) and after (spoiled gradient-echo acquisitions) the administration of 0.1 mmol/kg of gadobenate dimeglumine at 1-2 mL/s. Contrast-enhanced MR angiography and digital subtraction angiography of the calf arteries were performed in 241 of 272 participants. Images were evaluated on-site and by four blinded reviewers (three for MR angiography, one for digital subtraction angiography). Comparative diagnostic performance for the detection of significant (> or = 51% vessel lumen narrowing) disease was evaluated using the McNemar test and generalized estimating equations. Interobserver agreement was assessed with generalized kappa statistics. The chi-square test was used to compare technical failure rates.

RESULTS:

Digital subtraction angiography confirmed significant disease (597 stenoses, 386 occlusions) in 983 iliofemoral segments. The sensitivity (54-80.9%), specificity (89.7-95.3%), and accuracy (85-87.5%) of contrast-enhanced MR angiography for the detection of significant iliofemoral disease were significantly (p < 0.001, all reviewers) better than those of time-of-flight MR angiography (33.2-62.8%, 74.3-88.9%, and 68-77.3%, respectively). Similar diagnostic performance was obtained for the calf arteries. The technical failure rate with contrast-enhanced MR angiography (2.5-3.4%) was similar to that of digital subtraction angiography (1.4%) and significantly (p < 0.001) lower than that of time-of-flight MR angiography (6.2-18.0%). Significantly better reproducibility (p < 0.001) was obtained with contrast-enhanced MR angiography (82% vs 65.2% agreement; kappa = 0.66 vs 0.45).

CONCLUSION:

Improved diagnostic performance and reproducibility are achievable with gadobenate dimeglumine-enhanced MR angiography in patients with peripheral arterial occlusive disease.

• Authors: Siegfried Thurnher, Stephan Miller, Günther Schneider, Claudio Ballarati, Georg Bongartz, Christoph U Herborn, Stefan Schoenberg, Maria Assunta Cova, Giovanni Morana, Khusrow Niazi, Roberto Iezzi, Matthias Taupitz, David A Bluemke, Karl-Friedrich Kreitner, Miles A Kirchin, Gianpaolo Pirovano
• Journal: AJR. American journal of roentgenology (AJR Am J Roentgenol) Vol. 189 Issue 5 Pg. 1223-37 (Nov 2007) ISSN: 1546-3141 [Electronic] United States
• PMID: 17954665 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Contrast Media
• Organometallic Compounds
• gadobenic acid
• Meglumine

Topics

• Adult
• Aged
• Arterial Occlusive Diseases (diagnosis)
• Contrast Media
• Europe
• Female
• Humans
• Image Enhancement (methods)
• Magnetic Resonance Angiography (methods)
• Male
• Meglumine (analogs & derivatives, therapeutic use)
• Middle Aged
• Organometallic Compounds (therapeutic use)
• Peripheral Vascular Diseases (diagnosis)
• Reproducibility of Results
• Sensitivity and Specificity
• South America
• Thigh (blood supply, pathology)