Biphasic blood pool contrast agent-enhanced whole-body MR angiography for treatment planning in patients with significant arterial stenosis.

Abstract

OBJECTIVE:

To prospectively evaluate diagnostic accuracy of first pass and combined first pass and steady state high-spatial-resolution whole-body magnetic resonance (MR) angiography with a blood pool contrast agent for quantification of arterial stenosis in different vascular territories.

MATERIALS AND METHODS:

After Institutional Review Board approval and informed consent, 50 patients with known 50% or greater stenosis in at least one vascular territory; as shown by the standard-of-reference (14 digital subtraction angiographies, 4 computed tomographies, 32 ultrasound examinations), were included. The patients underwent MR angiography at 1.5 Tesla, using a standardized nonbody-weight-adapted i.v. bolus injection of 11 mL gadofosveset trisodium. First pass imaging with 4 different table positions in a whole-body MR scanner (MAGNETOM Avanto, Siemens Healthcare), using individual circulation time determined by a test bolus, was performed. Steady state imaging was performed using an isometric spatial resolution of 1.0 mm. Image quality was rated. Each vascular segment in MR angiography was evaluated by 2 independent and blinded reviewers and the stenosis degree was compared with the preferred standard-of-reference, using a 5-point scale. Differences between first pass and combined MR angiography were assessed with a 95% confidence interval (CI) by applying the adjusted modified chi(2) test. Changes in therapy based on the whole-body examination strategy were evaluated.

RESULTS:

The number of nondiagnostic territories was 24 of 197 (12.2%) for first pass MR angiography and decreased to 3 of 197 (1.5%) after addition of steady state MR angiography. The diagnostic accuracy for quantification of arterial stenosis in combined MR angiography (94.7%; 95% CI: 92.4-97.1) was superior to first pass MR angiography (81.7%; 95% CI: 73.7-89.8; statistically significant). Patient management was changed in 12 of 49 patients, in 7 of 12 patients the change was applied to an additional lesion detected by the whole-body examination strategy.

CONCLUSION:

The quantification and detection of arterial stenosis is improved by the steady state high-resolution gadofosveset trisodium-enhanced MR angiography. Additional lesions detected by whole-body examination strategy or differences in stenosis quantification may lead to changes in therapy.

• Authors: Alexander Huppertz, Hannes Kroll, Christian Klessen, Matthias Taupitz, Ralph I Rückert, Ralf-Juergen Schröder, Thomas Albrecht, Bernd Frericks, Matthias Voth, Moritz Wagner, Bernd Hamm, Patrick Asbach
• Journal: Investigative radiology (Invest Radiol) Vol. 44 Issue 7 Pg. 422-32 (Jul 2009) ISSN: 1536-0210 [Electronic] United States
• PMID: 19448555 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Contrast Media
• Organometallic Compounds
• Gadolinium
• gadofosveset trisodium

Topics

• Adult
• Aged
• Arterial Occlusive Diseases (diagnosis)
• Contrast Media
• Female
• Gadolinium
• Humans
• Image Enhancement (methods)
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Organometallic Compounds
• Reproducibility of Results
• Sensitivity and Specificity
• Whole Body Imaging (methods)