Off-resonance magnetic resonance angiography improves visualization of in-stent lumen in peripheral nitinol stents compared to conventional T1-weighted acquisitions: an in vitro comparison study

ACR Appropriateness Criteria® Sudden Onset of Cold, Painful Leg: 2023 Update

Acute onset of a cold, painful leg, also known as acute limb ischemia, describes the sudden loss of perfusion to the lower extremity and carries significant risk of morbidity and mortality. Acute limb ischemia requires rapid identification and the management of suspected vascular compromise and is inherently driven by clinical considerations. The objectives of initial imaging include confirmation of diagnosis, identifying the location and extent of vascular occlusion, and preprocedural/presurgical planning. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Positive visualization of MR-compatible nitinol stent using a susceptibility-based imaging technique

Background

MR-compatible metallic stents have been widely used for the treatment of arterial occlusive diseases. However, conventional MR techniques have difficulty in accurately localizing the stent position and access the stent restenosis because of the susceptibility and radiofrequency (RF) shielding artifacts caused by the stent mesh. Previous studies have demonstrated that a susceptibility-based positive contrast MR method exhibits excellent efficacy for visualizing MR compatible metal devices. However, the method had not been evaluated in the visualization of stents and for the assessment of stent restenosis.

Methods

The susceptibility-based positive contrast MR method was used to visualize the nitinol stents and assess the stent restenosis by comparing two typical MR positive contrast techniques, i.e., susceptibility gradient mapping using the original resolution (SUMO) and the gradient echo acquisition for super-paramagnetic particles (GRASP) with positive contrast.

Results

Three sets of experiments were respectively performed to investigate the influence of stent orientation and spatial resolution on the susceptibility-based method, and to demonstrate the feasibility of the susceptibility-based method in evaluating the stent restenosis comparing to the two typical MR positive contrast methods, GRASP and SUMO.

Conclusions

The susceptibility-based method provides better visualization and localization of the stent than SUMO and GRASP and has the capability of assessing the stent restenosis.

Contemporary follow-up imaging after endovascular repair of lower extremity atherosclerotic lesions

Atherosclerotic disease is currently one of the most important problems of modern medicine because it is a leading cause of increased morbidity, morbidity and mortality, and disability in the Western World. Atherosclerosis of the lower limbs (peripheral arterial disease - PAD) significantly affects the quality of life and in a considerable proportion of patients is a cause of disability. Radical treatment of PAD, both surgical and endovascular, aims at revascularisation of ischaemic tissues distal to obstructed arteries. Surveillance imaging is an important part of patient management after endovascular repair of PAD. Apart from availability and contraindications, challenges of imaging include calcifications, flow dynamics, and stent-related artefacts. The aim of this paper was to review the current literature on imaging methods for follow-up after endovascular repair of atherosclerotic lesions, with special attention paid to novel techniques. As a non-invasive modality, ultrasound is still the first-line examination, but computed tomography angiography remains a current state-of-the art technique for follow-up. However, since current imaging recommendations seem not to adhere to contemporary imaging possibilities, more attention should be paid to recent improvements in magnetic resonance angiography technology.