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A Blood Flow Volume Linear Inversion Model Based on Electromagnetic Sensor for Predicting the Rate of Arterial Stenosis. SENSORS 2019; 19:s19133006. [PMID: 31288428 PMCID: PMC6651440 DOI: 10.3390/s19133006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 11/16/2022]
Abstract
This paper presents a mathematical model of measuring blood flow based on electromagnetic induction for predicting the rate of arterial stenosis. Firstly, an electrode sensor was used to collect the induced potential differences from human skin surface in a uniform magnetic field. Then, the inversion matrix was constructed by the weight function theory and finite element method. Next, the blood flow volume inversion model was constructed by combining the induction potential differences and inversion matrix. Finally, the rate of arterial stenosis was predicted based on mathematical relationship between blood flow and the area of arterial stenosis. To verify the accuracy of the model, a uniform magnetic field distribution of Helmholtz coil and a 3D geometric model of the ulnar artery of the forearm with different rates of stenosis were established in COMSOL, a finite element analysis software. Simulation results showed that the inversion model had high accuracy in the measurement of blood flow and the prediction of rate of stenosis, and is of great significance for the early diagnosis of arterial stenosis and other vessel diseases.
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Burbelko M, Augsten M, Kalinowski MO, Heverhagen JT. Comparison of contrast-enhanced multi-station MR angiography and digital subtraction angiography of the lower extremity arterial disease. J Magn Reson Imaging 2012. [DOI: 10.1002/jmri.23944] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Haider CR, Riederer SJ, Borisch EA, Glockner JF, Grimm RC, Hulshizer TC, Macedo TA, Mostardi PM, Rossman PJ, Vrtiska TJ, Young PM. High temporal and spatial resolution 3D time-resolved contrast-enhanced magnetic resonance angiography of the hands and feet. J Magn Reson Imaging 2011; 34:2-12. [PMID: 21698702 DOI: 10.1002/jmri.22469] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Methods are described for generating 3D time-resolved contrast-enhanced magnetic resonance (MR) angiograms of the hands and feet. Given targeted spatial resolution and frame times, it is shown that acceleration of about one order of magnitude or more is necessary. This is obtained by a combination of 2D sensitivity encoding (SENSE) and homodyne (HD) acceleration methods. Image update times from 3.4-6.8 seconds are provided in conjunction with view sharing. Modular receiver coil arrays are described which can be designed to the targeted vascular region. Images representative of the technique are generated in the vasculature of the hands and feet in volunteers and in patient studies.
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Affiliation(s)
- Clifton R Haider
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Kim SM, Kang JY, Eo MY, Myoung H, Lee SK, Lee JH. Anatomical review of dorsalis pedis artery flap for the oral cavity reconstruction. J Korean Assoc Oral Maxillofac Surg 2011. [DOI: 10.5125/jkaoms.2011.37.3.184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Soung-Min Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Ji-Young Kang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Mi-Young Eo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hoon Myoung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Suk-Keun Lee
- Department of Oral Pathology, College of Dentistry, Gangnung-Wonju National University, Gangneung, Korea
| | - Jong-Ho Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
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Bonel HM, Saar B, Hoppe H, Keo HH, Husmann M, Nikolaou K, Ludwig K, Szucs-Farkas Z, Srivastav S, Kickuth R. MR Angiography of Infrapopliteal Arteries in Patients with Peripheral Arterial Occlusive Disease by Using Gadofosveset at 3.0 T: Diagnostic Accuracy Compared with Selective DSA. Radiology 2009; 253:879-90. [DOI: 10.1148/radiol.2533081627] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Hahn WY, Hecht EM, Friedman B, Babb JS, Jacobowitz GR, Lee VS. Distal lower extremity imaging: prospective comparison of 2-dimensional time of flight, 3-dimensional time-resolved contrast-enhanced magnetic resonance angiography, and 3-dimensional bolus chase contrast-enhanced magnetic resonance angiography. J Comput Assist Tomogr 2007; 31:29-36. [PMID: 17259830 DOI: 10.1097/01.rct.0000235073.72926.4d] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the 2-dimensional time of flight, the 3-dimensional time-resolved contrast-enhanced magnetic resonance (MR) angiography, and the 3-dimensional 3-station bolus chase contrast-enhanced MR angiography in assessing distal station atherosclerosis. METHODS Two-dimensional time of flight, 3-dimensional time-resolved contrast-enhanced MR angiography, and 3-dimensional bolus chase contrast-enhanced MR angiography were performed from the knees to the metatarsal heads of 40 patients. Blinded to the patients' identity, 2 readers independently reviewed the 3 sequences in random order; differences were resolved by consensus. Anterior tibial, peroneal, and posterior tibial arterial lengths to the talar dome were scored as follows: 1, greater than 50% of the length of a normal artery; 2, less than 50%; and 3, total occlusion. Stenoses were scored as follows: 1, less than 50%; and 2, greater than 50%. The pedal vessels (dorsalis pedis, posterior tibial, and plantar pedal arch arteries) were scored as follows: 1, less than 50% stenosis; and 2, greater than 50% stenosis. The reference standard was a combined interpretation of all 3 sequences by both readers in consensus. RESULTS For the 240 calf segments scored for length, concordance with reference assessment was poorer for the time of flight than for either the bolus chase or time-resolved angiography (P = 0.0021 and P = 0.0082, respectively), and the latter two were statistically indistinguishable. For stenosis grading of the 461 calf and pedal segments, the time-resolved and bolus chase methods were superior to the time of flight (P = <0.0001 and P = 0.0041, respectively), and the contrast-enhanced methods were statistically indistinguishable. CONCLUSIONS Both contrast-enhanced time-resolved and bolus chase MR angiography are superior to the time of flight in diagnosing distal station peripheral vascular disease.
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Affiliation(s)
- Winnie Y Hahn
- Department of Radiology, Georgetown University Hospital, Washington, DC 20007, USA.
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Magnet Resonance Angiography versus Conventional Angiography for the Planning of Reconstructive Surgeries. Eur J Trauma Emerg Surg 2007; 33:40-5. [PMID: 26815973 DOI: 10.1007/s00068-007-5130-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 05/29/2006] [Indexed: 10/23/2022]
Abstract
UNLABELLED Assessing the vascular status and anatomy of the lower extremity is of crucial importance when planning the coverage of a tissue defect with a free flap. The standard techniques comprise the clinical examination, Doppler ultrasound and Doppler sonography for healthy patients without suspected direct trauma to the vascular system, and conventional digital subtraction angiography (DSA), respectively, in case of traumatized vessels or patients with peripheral arterial obstructive disease. MATERIALS We have conducted a prospective study for the comparison of the magnetic resonance angiography (MRA) to the conventional DSA. Fourteen patients were examined presurgically by means of both a conventional DSA and an MRA before undergoing planned microvascular coverage of tissue defects of the lower extremity. The surgeon, based on a questionnaire, assessed and compared both examination results according to their information content. Furthermore, the presurgically planned level and localization of the vascular anastomoses and the intraoperative findings were compared postoperatively. RESULTS The MRA examination yielded sufficient information on the vascular anatomy to enable the surgeon to carry out a detailed presurgical planning. Additionally, the use of MRA showed clear advantages with regard to both patient and user comfort. CONCLUSION Taking into account the advantages for the assessment of vessels using MRA, in particular when considering the impact of the frequently varying vascular anatomy of the lower leg on reconstructive surgery, as well as the significantly lower morbidity rate of the examination itself, then the MRA must be regarded as a safe alternative to the DSA.
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Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore JC, Schuberth JM, Wukich DK, Andersen C, Vanore JV. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg 2006; 45:S1-66. [PMID: 17280936 DOI: 10.1016/s1067-2516(07)60001-5] [Citation(s) in RCA: 453] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The prevalence of diabetes mellitus is growing at epidemic proportions in the United States and worldwide. Most alarming is the steady increase in type 2 diabetes, especially among young and obese people. An estimated 7% of the US population has diabetes, and because of the increased longevity of this population, diabetes-associated complications are expected to rise in prevalence. Foot ulcerations, infections, Charcot neuroarthropathy, and peripheral arterial disease frequently result in gangrene and lower limb amputation. Consequently, foot disorders are leading causes of hospitalization for persons with diabetes and account for billion-dollar expenditures annually in the US. Although not all foot complications can be prevented, dramatic reductions in frequency have been achieved by taking a multidisciplinary approach to patient management. Using this concept, the authors present a clinical practice guideline for diabetic foot disorders based on currently available evidence, committee consensus, and current clinical practice. The pathophysiology and treatment of diabetic foot ulcers, infections, and the diabetic Charcot foot are reviewed. While these guidelines cannot and should not dictate the care of all affected patients, they provide evidence-based guidance for general patterns of practice. If these concepts are embraced and incorporated into patient management protocols, a major reduction in diabetic limb amputations is certainly an attainable goal.
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Affiliation(s)
- Robert G Frykberg
- Podiatric Surgery, Carl T. Hayden VA Medical Center, Phoenix, Arizona 85012, USA.
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Herborn CU, Watkins DM, Runge VM, Gendron JM, Montgomery ML, Naul LG. Renal Arteries: Comparison of Steady-State Free Precession MR Angiography and Contrast-enhanced MR Angiography. Radiology 2006; 239:263-8. [PMID: 16493015 DOI: 10.1148/radiol.2383050058] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
All participants provided informed consent to participate in this study, which was approved by the institutional review board. Breath-hold three-dimensional (3D) steady-state free precession (SSFP) magnetic resonance (MR) angiography was compared with 3D contrast material-enhanced MR angiography in patients suspected of having renal artery stenosis. Two radiologists assessed visualization of renal arteries and detection of vascular disease. With SSFP MR angiography, 39 of 41 renal arteries in 19 patients were correctly detected. Relevant stenoses were correctly identified with SSFP MR angiography in two patients. In two patients, SSFP MR angiographic data sets led to false-positive overgrading of vascular disease. Fast breath-hold 3D SSFP MR angiography appears to be feasible for MR angiography of renal arteries.
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Affiliation(s)
- Christoph U Herborn
- Department of Radiology, Scott and White Clinic and Hospital, Texas A&M University, Temple, TX, USA.
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Gjønnaess E, Morken B, Sandbaek G, Stranden E, Slagsvold CE, Jørgensen JJ, Nylaende M, Abdelnoor M, Dullerud R. Gadolinium-enhanced Magnetic Resonance Angiography, Colour Duplex and Digital Subtraction Angiography of the Lower Limb Arteries from the Aorta to the Tibio-peroneal Trunk in Patients with Intermittent Claudication. Eur J Vasc Endovasc Surg 2006; 31:53-8. [PMID: 16269254 DOI: 10.1016/j.ejvs.2005.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Accepted: 09/12/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the sensitivity, specificity, positive and negative predictive value of contrast-enhanced (gadolinium) magnetic resonance imaging (CE-MRA) and colour duplex ultrasound (CDU) of lower limb arteries. DESIGN Prospective, single centre study. MATERIAL AND METHODS A consecutive series of 58 patients with intermittent claudication (IC) were examined with CE-MRA and CDU from the infrarenal aorta to the tibio-peroneal trunk with digital subtraction angiography (DSA) as reference. The arterial tree was divided into 15 segments, pooled into three regions; suprainguinal, thigh and knee. Sensitivity, specificity, positive and negative predictive values for significant obstructions were calculated. Cohen Kappa statistics was used to establish agreement between the three methods. RESULTS The sensitivity (specificity in parentheses) for significant obstructions in the suprainguinal region were 96% (94%) for CE-MRA and 91% (96%) for CDU, in the thigh region 92% (95%) for CE-MRA and 76% (99%) for CDU, and in the knee region 93% (96%) for CE-MRA and 33% (98%) for CDU. CDU failed to visualize 10% of suprainguinal, 2% of thigh and 13% of knee-region arterial segments. CONCLUSIONS Both CE-MRA and CDU are good alternatives to DSA in the suprainguinal- and thigh-region. In the knee region only CE-MRA can be relied upon as an alternative to DSA. Imaging by CDU is not suited to situations were evaluation of runoff vessels is important.
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Affiliation(s)
- E Gjønnaess
- Department of Radiology, Aker University Hospital, Oslo, Norway.
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Evans AL, Coley SC, Wilkinson ID, Griffiths PD. First-line investigation of acute intracerebral hemorrhage using dynamic magnetic resonance angiography. Acta Radiol 2005; 46:625-30. [PMID: 16334846 DOI: 10.1080/02841850510021779] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report the initial experience of magnetic resonance (MR) digital subtraction angiography (MR-DSA) in the dynamic assessment of the cerebral circulation in acute non-traumatic intracerebral hemorrhage (ICH). MATERIAL AND METHODS Twelve patients with acute ICH were investigated within 6 days of the ictus using a dynamic contrast-enhanced 2-D MR angiogram that produces subtracted images with a temporal resolution of 1-2 frame/s. The MR-DSA examinations were assessed for evidence of an intracranial vascular abnormality and were compared with (i) the routine MR sequences, (ii) non-dynamic time-of-flight MR angiography, and (iii) catheter angiogram performed during the same admission. RESULTS All 12 MR-DSA examinations were considered to be technically satisfactory. MR-DSA detected an intracranial vascular abnormality in 7 patients (3 arteriovenous malformations, 2 aneurysms, 1 dural arteriovenous fistula, and 1 venous thrombosis). All abnormalities were confirmed by catheter angiography with the exception of one patient with venous sinus thrombosis found on MR imaging that did not undergo catheter angiography. All four arteriovenous shunts were detected by MR-DSA by virtue of early venous filling. CONCLUSION MR-DSA can be performed satisfactorily in the setting of acute ICH and provides an alternative method to catheter angiography for identifying shunting vascular abnormalities such as arteriovenous malformations and fistulae, as well as large aneurysms and venous occlusions. MR-DSA is a contrast-medium-based technique that does not suffer from the T1 shortening effects of acute hemorrhage that can obscure abnormalities on conventional flow-based non-dynamic techniques.
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Affiliation(s)
- A L Evans
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK.
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Schulte AC, Bongartz G, Huegli R, Aschwanden M, Jaeger KA, Ostheim-Dzerowycz W, Jacob AL, Bilecen D. Intraarterial Versus IV Gadolinium Injections for MR Angiography: Quantitative and Qualitative Assessment of the Infrainguinal Arteries. AJR Am J Roentgenol 2005; 185:735-40. [PMID: 16120927 DOI: 10.2214/ajr.185.3.01850735] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our purpose was to quantitatively and qualitatively compare 3D intraarterial (IA) gadolinium-enhanced MR angiography (IA MRA) versus the standard of reference of MR angiography, 3D IV gadolinium-enhanced MR angiography (IV MRA), in patients with peripheral arterial occlusive disease (PAOD) for use during catheter-based MR-guided endovascular interventions. CONCLUSION IA MRA provides image quality of the infrainguinal arteries in PAOD patients comparable to IV MRA with a significantly improved assessment of the infrapopliteal arteries due to reduced venous contamination. Further benefits of IA MRA include usage of only very low doses of gadolinium and simplified bolus timing.
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Gülicher D, Wersebe A, Reinert S. Stellenwert der farbkodierten Duplexsonographie zur präoperativen Darstellung der Unterschenkelarterien bei mikrochirurgischem Fibulatransfer. ACTA ACUST UNITED AC 2005; 9:161-8. [PMID: 15821945 DOI: 10.1007/s10006-005-0609-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In patients being considered for a microsurgical fibular transfer, thorough examination of the vascular supply to the lower leg is indisputably necessary. The aim of this study was to evaluate the validity of color-coded duplex sonography (CCDS) in the assessment of the arteries of the lower leg. PATIENTS AND METHODS In 13 patients needing bony reconstruction of the jaw 22 legs were examined using CCDS. The three arteries of the lower leg were visualized and traced from the ankle to the popliteal fossa. At every arterial segment Doppler sonographic examination was also performed. All 13 patients underwent digital subtraction arteriography (DSA) of the lower extremities, additionally. RESULTS We were able to visualize and to assess all but one of the arteries using CCDS. In 13 extremities of 9 patients CCDS exhibited a normal vascular supply to the lower leg provided by three regular arteries. DSA confirmed this and the patients underwent fibular transfer. In the other 4 patients a regular vascular situation could not be shown by CCDS because of nonvisualization of arterial segments or pathological findings. Two of these patients received alternative bony transplants. In the remaining two patients angiography exhibited one leg to have a normal three vessel supply, respectively. Fibular transplants could be raised from this leg. In all patients CCDS was able to localize between 3 and 7 perforators branching off the peroneal artery. Their position determined the placement of the skin paddle to be raised with the bone. Further advantages of CCDS were the universal applicability to all patients and the possibility of performing it at our own department. The time required for the examination and the necessity of having adequate technical equipment were the disadvantages. CONCLUSION In patients being considered for a microsurgical fibular transplantation, we recommend CCDS of the lower leg as a screening tool for the vascular supply of the lower leg. DSA and MRA are predominantly advocated for those patients, in whom CCDS reveals pathological or uncertain findings.
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Affiliation(s)
- D Gülicher
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Tübingen.
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Affiliation(s)
- James F M Meaney
- Department of Diagnostic Imaging, St. James's Hospital, James's Street, Dublin 8, Ireland.
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Ajaj W, Veit P, Kuehle C, Joekel M, Lauenstein TC, Herborn CU. Digital subtraction dark-lumen MR colonography: Initial experience. J Magn Reson Imaging 2005; 21:841-4. [PMID: 15906327 DOI: 10.1002/jmri.20332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To evaluate image subtraction for the detection of colonic pathologies in a dark-lumen MR colonography exam. MATERIALS AND METHODS A total of 20 patients (12 males; 8 females; mean 51.4 years of age) underwent MR colonography after standard cleansing and a rectal water enema on a 1.5-T whole-body MR system. After suppression of peristaltic motion, native and Gd-contrast-enhanced three-dimensional T1-w gradient echo images were acquired in the coronal plane. Two radiologists analyzed the MR data sets in consensus on two separate occasions, with and without the subtracted images for lesion detection, and assessed the value of the subtracted data set on a five-point Likert scale (1=very helpful to 5=very unhelpful). All imaging results were compared with endoscopy. RESULTS Without subtracted images, MR-colonography detected a total of five polyps, two inflammatory lesions, and one carcinoma in eight patients, which were all verified by endoscopy. Using subtraction, an additional polyp was found, and readout time was significantly shorter (6:41 vs. 7:39 minutes; P<0.05). In two patients, endoscopy detected a flat adenoma and a polyp (0.4 cm) that were missed in the MR exam. Sensitivity and specificity without subtraction were 0.67/1.0, and 0.76/1.0 with the subtracted images, respectively. Subtraction was assessed as helpful in all exams (mean value 1.8+/-0.5; Likert scale). CONCLUSION We consider subtraction of native from contrast-enhanced dark-lumen MR colonography data sets as a beneficial supplement to the exam.
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Affiliation(s)
- Waleed Ajaj
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Nicolas M, Laurent V, Tissier S, Cannard L, Leclerc J, Béot S, Régent D. La perspective d’une étude dynamique des artères des membres inférieurs en IRM grâce à la séquence ECTRICKS. ACTA ACUST UNITED AC 2005; 86:49-59. [PMID: 15785417 DOI: 10.1016/s0221-0363(05)81322-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This article presents a new MR angiography technique, Elliptic Centric Time Resolved Imaging on Contrast KineticS (ECTRICKS), which allows dynamic evaluation of the lower limb arteries opacification when venous return prevents adequate diagnostic evaluation of calf arteries. PATIENTS AND METHODS Comparative examinations could be compared. Additional arteries in 59 patients using a standard MRA technique and the ECTRICKS technique. RESULTS A total of 33 examinations could be compared. Additional arteries could be evaluated in 10% of our patient population using the ECTRICKS technique, and in 20% for our diabetic population. Arterial evaluation was better with the ECTRICKS technique in patients with diabetes and venous insufficiency. CONCLUSION ECTRICKS is a good complementary sequence for evaluation the calf arteries in patients with diabetes or early venous return.
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Affiliation(s)
- M Nicolas
- CHU de Nancy, Hôpitaux de Brabois, Service de Radiologie Adultes, Allée de Morvan, 54511 Vandoeuvre les Nancy Cedex, France.
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Peripheral MR angiography. Magn Reson Imaging Clin N Am 2004. [DOI: 10.1016/j.mric.2004.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Binkert CA, Baker PD, Petersen BD, Szumowski J, Kaufman JA. Peripheral Vascular Disease: Blinded Study of Dedicated Calf MR Angiography versus Standard Bolus-Chase MR Angiography and Film Hard-Copy Angiography. Radiology 2004; 232:860-6. [PMID: 15333800 DOI: 10.1148/radiol.2323030244] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the accuracy of contrast material-enhanced three-dimensional (3D) dedicated calf magnetic resonance (MR) angiography with that of bolus-chase MR angiography, with conventional angiography as the reference standard, in patients with symptomatic peripheral vascular disease (PVD). MATERIALS AND METHODS Thirty men with symptomatic PVD were examined. MR angiography was performed at 1.5 T before conventional angiography. MR angiographic examination included 3D contrast-enhanced dedicated calf MR angiography and three-station bolus-chase MR angiography. Two radiologists blinded to conventional angiographic results evaluated the MR angiograms independently. Two angiographers evaluated the conventional angiograms in consensus. Calf artery segments were graded as having 50% or less stenosis, greater than 50% stenosis, or occlusion or as being nondiagnostic. Statistical analyses were performed with paired permutation testing. RESULTS Analyses of 472 calf segments and 420 pelvic and thigh segments were performed. Of the 472 calf segments, three and 75 segments (reader 1) and seven and 91 segments (reader 2) were graded as nondiagnostic at dedicated calf MR angiography and bolus-chase MR angiography, respectively. Differences in diagnostic grade between the two examinations were significant (P <.001), accounting for within-subject correlations, with a mean estimated difference of -17.1% (95% confidence interval [CI]: -25.8%, -8.4%). In the calf arteries, the dedicated and bolus-chase MR angiographic sequences had diagnostic accuracies, respectively, of 81.5% (reader 1) and 79.1% (reader 2) and of 67.8% (reader 1) and 63.4% (reader 2). The dedicated calf sequence was significantly more accurate than the bolus-chase sequence (P =.001). The point estimate of the difference was 14.7%, with estimated correct diagnosis rates of 80.3% and 65.6% for the dedicated calf and bolus-chase examinations, respectively (95% CI for difference: 4.0%, 25.4%). The diagnostic accuracy of bolus-chase MR angiography at the pelvis-thigh level was slightly higher when it was performed first: 81.9% (reader 1) and 83.8% (reader 2) versus 74.3% (reader 1) and 80.0% (reader 2) when it was performed last. The difference was not significant (P =.21). CONCLUSION Use of dedicated calf MR angiography led to significantly increased diagnostic accuracy in the calf arteries compared with standard bolus-chase MR angiography. Use of the dual-bolus technique did not jeopardize the diagnostic accuracy in the pelvic and thigh arteries.
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Affiliation(s)
- Christoph A Binkert
- Dotter Interventional Institute and Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore, USA.
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Vavrik J, Rohrmoser GM, Madani B, Ersek M, Tscholakoff D, Bucek RA. Comparison of MR Angiography Versus Digital Subtraction Angiography as a Basis for Planning Treatment of Lower Limb Occlusive Disease. J Endovasc Ther 2004; 11:294-301. [PMID: 15174919 DOI: 10.1583/03-1144.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare contrast-enhanced moving-bed magnetic resonance angiography (MRA) with digital subtraction angiography (DSA) for the ability to provide adequate information on which to construct a therapeutic strategy in patients suffering from peripheral arterial occlusive disease (PAOD). METHODS A prospective study was conducted involving 48 consecutive patients (25 men; mean age 65.7+/-10.2 years) with PAOD who underwent MRA and DSA of the peripheral arteries on 2 consecutive days. Every leg was divided into 3 anatomical regions (suprainguinal, femoropopliteal, calf), and the sensitivity and specificity for the detection of significant (>70%) lesions, as well as the interobserver variability, were calculated. The potential differences in the therapeutic strategy based on the results of both modalities were evaluated. RESULTS The MRA and DSA studies in the 48 study patients produced 864 arterial segments for interpretation. The sensitivity of MRA for the detection of significant lesions was 94.7% for the suprainguinal, 89.5% for the femoropopliteal, and 91.3% for the calf arteries. Corresponding specificity was 98.1%, 96.2% and 93.4%, respectively. The interobserver correlation for the detection of significant lesions by MRA and DSA was excellent (kappa>0.8) for all 3 segments, with slightly superior values for MRA. MRA and DSA agreed in the grading of 821 (95.0%) segments. In 8 (16.7%) patients, MRA suggested an additional intervention, and in 3 (6.3%) patients, additional DSA was necessary for the final diagnosis. CONCLUSIONS The accuracy of MRA for the detection of significant lesions is comparable to DSA. Basing the therapeutic strategy solely on the results of MRA can reduce the number of DSAs by three quarters, but at the risk of incurring lesion overestimation in approximately 17%.
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Affiliation(s)
- Joachim Vavrik
- Zentralröntgeninstiut der KA Rudolfstiftung, Vienna, Austria
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Abstract
Diabetes is a common disease with potentially devastating complications affecting the foot and ankle. Ischemia and infarction, neuropathic osteoarthropathy, callus, ulceration, and infection result from the underlying neurologic and vascular disease. The MR imaging appearance of these complications is discussed. Recognition of these MR imaging patterns is important for formulation of an appropriate treatment plan.
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Affiliation(s)
- Mark E Schweitzer
- Department of Radiology, New York University Hospital for Joint Disease, 301 East 17th Street, New York, NY 10003, USA.
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Loewe C, Cejna M, Schoder M, Loewe-Grgurin M, Wolf F, Lammer J, Thurnher SA. Contrast Material–enhanced, Moving-Table MR Angiography versus Digital Subtraction Angiography for Surveillance of Peripheral Arterial Bypass Grafts. J Vasc Interv Radiol 2003; 14:1129-37. [PMID: 14514804 DOI: 10.1016/s1051-0443(07)60526-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the accuracy of moving-table MR angiography (MRA) in the evaluation of peripheral bypass grafts. MATERIALS AND METHODS There were 39 patients who had had peripheral bypass graft surgery and then subsequently underwent digital subtraction angiography (DSA) and contrast material-enhanced MRA, which was performed with moving-table software on a 1.0-T system before and during administration of 40 mL gadolinium. For evaluation, every bypass graft was divided into three parts and every leg into 14 segments. Disease severity was scored in four categories (0%-29%, 30%-69%, 70%-99%, 100%). Results were compared with those of the DSA. A total of 147 bypass graft segments and 938 vessel segments were classified. RESULTS In 132 of the assessable 147 bypass segments, disease gradings with both methods were congruent; however, 13 stenoses were misinterpreted by MRA for one grade and two additional lesions by two grades, leading to an accuracy in precise stenoses detection of 89.9%. The sensitivity and specificity values in the detection of bypass graft stenoses >69% (grade 3 + 4 lesions) reached 90.0% and 98.3%, respectively. In 821 of 938 vessel segments the accuracy of MRA in stenoses detection reached 87.5%. The sensitivity and specificity values in the detection of grade 3 + 4 lesions were 95.6% and 94.0% for the native vessels, respectively. CONCLUSION Moving-table MRA was as accurate in assessing bypass grafts as it was for the native arteries and showed a great accuracy in stenosis detection compared with DSA. Therefore, MRA is a promising modality for bypass graft surveillance and might be a noninvasive alternative to DSA in this regard.
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Affiliation(s)
- Christian Loewe
- Section of Angiography and Interventional Radiology, Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Abstract
Peripheral arterial occlusive disease is a chronic and progressive disease with a reported incidence rate from 4.5% to 8.8% in men over 55 years of age. The diagnosis is usually made clinically, but for treatment planning and control, imaging of the peripheral arteries is required. Since its introduction in 1994, contrast-enhanced MR angiography has demonstrated a high diagnostic confidence and has replaced the invasive intra-arterial DSA, which is still the current gold standard for many different indications. For the peripheral arteries, clinical use of MR angiography was hampered for some years by the unsolved problem of the large imaging volume and the small diameter of the distal arteries. However, since the availability of ultra-fast high-gradient sequences and the possibility of moving-bed imaging, contrast-enhanced MR angiography, over the last few years, has shown its enormous potential and high accuracy in the diagnosis and follow-up of patients suffering from peripheral arterial occlusive disease. Exciting innovations in hardware and software allows very fast, very accurate, and very robust noninvasive imaging of the peripheral arteries, and both treatment planning as well as follow-up can be performed using contrast-enhanced MR angiography. The following review introduces the basic concepts of peripheral MR angiography--focusing on contrast enhanced imaging--and presents the different techniques as well as some potential limitations and how they could be solved. Finally, this article provides a look into the already-begun future of peripheral contrast-enhanced MR angiography with hybrid and combination techniques.
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Affiliation(s)
- Christian Loewe
- Department of Radiology, Section of Angiography and Interventional Radiology, University of Vienna, Vienna, Austria.
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Loewe C, Schoder M, Rand T, Hoffmann U, Sailer J, Kos T, Lammer J, Thurnher S. Peripheral vascular occlusive disease: evaluation with contrast-enhanced moving-bed MR angiography versus digital subtraction angiography in 106 patients. AJR Am J Roentgenol 2002; 179:1013-21. [PMID: 12239057 DOI: 10.2214/ajr.179.4.1791013] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The purpose of our study was to compare contrast-enhanced moving-bed MR angiography and digital subtraction angiography in the evaluation of peripheral vascular occlusive disease. MATERIALS AND METHODS This retrospective report includes 106 patients (45 women, 61 men) with known or suspected peripheral vascular occlusive disease who underwent MR angiography and intraarterial digital subtraction angiography of the peripheral arteries. MR angiography was performed on a 1.0-T unit using a moving-bed technique. Every leg was divided into 14 vascular segments, and severity of disease was scored in four categories. Digital subtraction angiography was the standard of reference. RESULTS In the 106 patients, 2378 vessel segments were evaluated with both imaging modalities. In 2156 segments, MR angiography and digital subtraction angiography were concordant for stenosis classification, in 188 segments the two modalities differed in one category, and in 24 segments they differed in two categories. MR angiography achieved sensitivity and specificity of 96.7% and 95.8%, respectively, for differentiating nonsignificant from hemodynamically significant stenosis (kappa = 0.91). CONCLUSION This study indicates that MR angiography is an accurate imaging modality in clinical practice. Our data support the concept that MR angiography can modify the diagnosis of suspected peripheral vascular occlusive disease.
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Affiliation(s)
- Christian Loewe
- Department of Radiology, Section of Angiography and Interventional Radiology, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Abstract
Diabetes is a common disease with potentially devastating complications affecting the foot and ankle. A combination of vascular disease, peripheral neuropathy, and immunopathy results in a cascade of conditions including ischemia and infarction, tendinopathy, atrophy, edema, deformity, neuropathic osteoarthropathy, callus, ulceration, and infection. MRI is useful for evaluation of these complications, and assists the clinician in medical or surgical planning.
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Affiliation(s)
- William B Morrison
- Department of Radiology, Thomas Jefferson University Hospital, 111 South 11th Street, 3390 Gibbon, Philadelphia, PA 19107, USA.
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Abstract
Contrast-enhanced 3D MRA is emerging as a powerful noninvasive imaging modality for the assessment of patients with PVD. Its clinical utility using current technology has already been well established, and the continuous development of hard- and software will likely result in significantly improved performance. Thus, Gd-enhanced MRA is likely to emerge as the dominant noninvasive imaging modality for PVD worldwide.
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Affiliation(s)
- Mathias Goyen
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Germany.
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Khilnani NM, Winchester PA, Prince MR, Vidan E, Trost DW, Bush HL, Watts R, Wang Y. Peripheral vascular disease: combined 3D bolus chase and dynamic 2D MR angiography compared with x-ray angiography for treatment planning. Radiology 2002; 224:63-74. [PMID: 12091663 DOI: 10.1148/radiol.2241010415] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare combined three-dimensional (3D) and two-dimensional (2D) contrast material-enhanced magnetic resonance (MR) angiography with x-ray angiography for planning treatment of peripheral vascular disease. MATERIALS AND METHODS Three radiologists retrospectively reviewed the pretreatment x-ray angiographic and MR angiographic studies obtained in 30 consecutive patients: 15 patients (15 limbs) evaluated for limb salvage and 15 patients (20 limbs) evaluated because of claudication. MR angiography included acquisition of 2D contrast-enhanced MR digital subtraction angiograms of the area from the adductor canal to the feet and 3D spoiled gradient-recalled-echo bolus chase MR angiograms obtained in three stations from the aorta to the middle portion of the calf. Each reader reviewed the x-ray and MR angiograms to determine the inflow and outflow segments for a hypothetical bypass graft placement. RESULTS The three readers selected identical segments for inflow at MR angiography and x-ray angiography in 32, 32, and 35 of the 35 limbs evaluated (mean percentages of agreement [95% CI ]: 91% [77%, 98%], 91% [77%, 98%], and 95% [90%, 100%], respectively). The readers selected identical segments for outflow in 32, 32, and 34 of the 35 limbs evaluated (mean percentages of agreement [95% CI]: 91% [77%, 98%], 91% [77%, 98%], and 97% [85%, 100%], respectively). CONCLUSION Preliminary data support the combining of 2D MR digital subtraction angiography with 3D bolus chase MR angiography to extend the utility of 3D MR angiography in treatment planning to include patients being evaluated for limb salvage, as well as those being evaluated for claudication.
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Affiliation(s)
- Neil M Khilnani
- Department of Radiology, New York Presbyterian Hospital, Weill Medical College of Cornell University, 525 E 68th St, Rm P-519, New York, NY 10021, USA.
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Konkus CJ, Czum JM, Jacobacci JT. Contrast-enhanced MR angiography of the aorta and lower extremities with routine inclusion of the feet. AJR Am J Roentgenol 2002; 179:115-7. [PMID: 12076917 DOI: 10.2214/ajr.179.1.1790115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Christopher J Konkus
- The Heart and Vascular Institute, 111 Madison Ave., 4th Floor, Morristown, NJ 07960, USA
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Sharafuddin MJ, Stolpen AH, Sun S, Leusner CR, Safvi AA, Hoballah JJ, Sharp WJ, Corson JD. High-resolution multiphase contrast-enhanced three-dimensional MR angiography compared with two-dimensional time-of-flight MR angiography for the identification of pedal vessels. J Vasc Interv Radiol 2002; 13:695-702. [PMID: 12119328 DOI: 10.1016/s1051-0443(07)61846-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The authors prospectively evaluated optimized multiphase high-resolution (HR) Gadolinium (Gd)-enhanced three-dimensional (3D) magnetic resonance (MR) angiography and standard two-dimensional (2D) time-of-flight (TOF) MR angiography for their ability to delineate distal calf and pedal vessels. MATERIALS AND METHODS Twelve patients (20 limbs) with limb-threatening peripheral arterial occlusive disease underwent HR Gd-enhanced and 2D TOF MR angiography to identify targets for distal bypass. Imaging of the region of the ankle and foot was performed on a 1.5 T system with a head coil. A standard 2D TOF MR angiography sequence was performed first. The HR Gd-enhanced MR angiography sequence was then performed after injection of 0.01-0.2 mmol/kg of gadodiamide, allowing the acquisition of multiple consecutive coronal partitions, each in 18-25 seconds. Two experienced angiographers independently analyzed both studies. Comparison with intraoperative conventional angiography was available in 10 limbs. RESULTS HR Gd-enhanced MR angiography allowed significantly faster imaging time (P <.0001) and larger coverage area (P <.0001) than 2D TOF MR angiography. All segments seen on 2D TOF MR angiography were visualized on HR Gd MR angiography, and significantly more suitable targets were seen well on HR Gd-enhanced MR angiography than on 2D TOF MR angiography (mean targets per limb: 3.9 +/- 1.9 vs 2.6 +/- 1.5, respectively; P =.02). In addition, HR Gd-enhanced MR angiography allowed better visualization of the arcuate pedal branch than 2D TOF MR angiography (P <.0001). Excellent correlation was demonstrated between HR Gd-enhanced MR angiography and intraoperative angiography in 29 segments (binary similarity coefficient, 0.90). A significantly higher percentage of artifacts adversely affected image interpretation with 2D TOF MR angiography than with HR Gd-enhanced MR angiography (14 limbs vs five limbs, P <.001). Artifacts on HR Gd-enhanced MR angiography included suboptimal mask in two limbs, venous contamination in one patient (two limbs), and motion artifact in one limb, although the studies remained diagnostic in all cases. CONCLUSION HR Gd-enhanced MR angiography identified more distal target vessels with greater confidence than 2D TOF MR angiography. Optimized HR Gd-enhanced MR angiography may replace 2D TOF MR angiography as the gold standard examination for evaluation of distal runoff.
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Affiliation(s)
- Melhem J Sharafuddin
- Department of Radiology, University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, Iowa 52242-1077, USA.
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29
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Abstract
Peripheral vascular disease (PVD) is a common disorder in western society. Reflecting on the risks and costs of contrast arteriography, magnetic resonance angiography is a powerful noninvasive imaging modality for the diagnostic workup of patients with peripheral vascular disease. This article reviews the current state of the art of magnetic resonance angiography of the peripheral vasculature.
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Affiliation(s)
- M Goyen
- Department of Diagnostic Radiology, University Hospital Essen, Essen, Germany.
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30
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31
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Wang Y, Winchester PA, Khilnani NM, Lee HM, Watts R, Trost DW, Bush HL, Kent KC, Prince MR. Contrast-enhanced peripheral MR angiography from the abdominal aorta to the pedal arteries: combined dynamic two-dimensional and bolus-chase three-dimensional acquisitions. Invest Radiol 2001; 36:170-7. [PMID: 11228581 DOI: 10.1097/00004424-200103000-00006] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Wang Y, Winchester PA, Khilnani NM, et al. Contrast-enhanced peripheral MR angiography from the abdominal aorta to the pedal arteries: Combined dynamic two-dimensional and bolus-chase three-dimensional acquisitions. Invest Radiol 2001;36:170-177. RATIONALE AND OBJECTIVES To obtain reliable contrast-enhanced peripheral MR angiography for imaging peripheral vascular disease from the abdominal aorta to the pedal arteries. METHODS A protocol consisting of contrast-enhanced, dynamic two-dimensional (2D) acquisition at the feet and calf and bolus-chase three-dimensional (3D) acquisition from the abdominal aorta to the calf was developed and applied in patients with peripheral vascular disease. The performance of this integrated protocol was assessed in 89 consecutive patients. RESULTS The bolus-chase 3D acquisition was of diagnostic quality in 100% of the acquisitions in the abdomen, 96% in the thigh, and 43% in the calf. The poor quality of the calf acquisitions was due to insufficient spatial resolution, poor arterial signal, and venous contamination. Diagnostic-quality images were obtained in 100% of the dynamic 2D acquisitions of the calf and 98% of the feet. CONCLUSIONS The combined dynamic 2D and bolus-chase 3D contrast-enhanced MR angiography technique provides diagnostic images of the entire lower extremity.
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Affiliation(s)
- Y Wang
- Department of Radiology, Weill Medical College of Cornell University, 515 E. 71st Street, New York City, NY 10021, USA.
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Toursarkissian B, Mejia A, Smilanich RP, Schoolfield J, Shireman PK, Sykes MT. Noninvasive localization of infrainguinal arterial occlusive disease in diabetics. Ann Vasc Surg 2001; 15:73-8. [PMID: 11221949 DOI: 10.1007/s100160010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A retrospective review of 101 diabetics without aortoiliac disease was carried out to analyze the ability of various noninvasive tests to predict the level of significant (>50% stenosis) infrainguinal arterial disease. Patients were studied with anklebrachial indices (ABI), toebrachial indices (TBI), segmental pulse volume recordings (PVR), segmental pressures (SEGP), segmental Doppler waveforms (DWF), and arteriography. Results were classified as normal, disease at the femoropopliteal level, infrapopliteal level, or both levels (multilevel), or noninterpretable. Our findings for the entire study showed that, as a single test, DWF appears to have the best angiographic correlation, although the summed diagnosis of combined DWF and PVR data is superior in distinguishing multilevel disease from isolated tibial disease. SEGP are of very limited use in diabetics, even in multimodality testing, and we no longer include that test in our routine evaluation of diabetics.
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Affiliation(s)
- B Toursarkissian
- Section of Vascular Surgery, University of Texas Health Science Center at San Antonio, 78229-3900, USA.
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34
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Aoki S, Yoshikawa T, Hori M, Nanbu A, Kumagai H, Nishiyama Y, Nukui H, Araki T. MR digital subtraction angiography for the assessment of cranial arteriovenous malformations and fistulas. AJR Am J Roentgenol 2000; 175:451-3. [PMID: 10915693 DOI: 10.2214/ajr.175.2.1750451] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S Aoki
- Department of Radiology, Yamanashi Medical University, Tamaho-cho, Nakakoma-gun, Japan
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35
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Abstract
Magnetic resonance (MR) angiography of lower extremity occlusive vascular disease has evolved into a feasible diagnostic imaging option. The previous emphasis on time-of-flight techniques was associated with lengthy acquisition times and artifactual signal losses. Those limitations presented an obstacle to widespread clinical implementation. However, the emergence of rapid imaging sequences combined with gadolinium chelate enhancement offers time-efficient alternatives that can yield a truer representation of the vascular anatomic structure. The technology is now poised to serve as a routine screening study, provided that radiologists understand all factors needed to generate clinically relevant MR angiograms. This article is intended to provide a useful resource directed toward achieving that understanding.
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Affiliation(s)
- N M Rofsky
- Department of Radiology, New York University Medical Center, MRI-Basement, Schwartz Bldg, 530 First Ave, New York, NY 10016, USA.
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Kreitner KF, Kalden P, Neufang A, Düber C, Krummenauer F, Küstner E, Laub G, Thelen M. Diabetes and peripheral arterial occlusive disease: prospective comparison of contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography. AJR Am J Roentgenol 2000; 174:171-9. [PMID: 10628475 DOI: 10.2214/ajr.174.1.1740171] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography (DSA) for identifying and evaluating arteries of the distal calf and foot in diabetic patients with severe arterial occlusive disease who will undergo distal bypass surgery. SUBJECTS AND METHODS Twenty-four feet of 24 consecutive patients with diabetes and limb-threatening lower extremity ischemia were prospectively imaged using an ultrafast three-dimensional fast low-angle shot sequence on a 1.5-T MR scanner. All patients also underwent DSA of the diseased extremity within 5 days. Images were interpreted in a randomized manner by two observers in conference. Each lower extremity was divided into seven potential arterial segments. Image analysis included the detection of patent, stenosed, or occluded vessel segments. A vascular surgeon formulated treatment plans on the basis of findings from DSA and then formulated treatment plans on the basis of findings from both DSA and MR angiography. RESULTS MR angiography was significantly better than DSA in revealing peripheral runoff vessels (p < 0.001). In nine (38%) of the 24 patients, MR angiography showed patent pedal vessels suitable for distal bypass grafting that were not revealed by DSA. Because of the results of MR angiography, treatment plans changed in seven of the nine patients in whom patent vessels were subsequently used as target vessels for distal pedal bypass grafts. CONCLUSION Contrast-enhanced three-dimensional MR angiography is superior to DSA in revealing patent vessel segments of the foot in diabetic patients with severe arterial occlusive disease. Contrast-enhanced three-dimensional MR angiography should be part of the diagnostic algorithm for patients in whom pedal bypass grafting is a therapeutic option.
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Affiliation(s)
- K F Kreitner
- Department of Radiology, Johannes Gutenberg-University Mainz, Germany
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37
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Abstract
Atherosclerotic involvement of the aorta and lower extremity vessels is a common clinical problem, especially in developed countries. While x-ray angiography has been the method of choice for preoperative evaluation of patients with atherosclerotic disease, magnetic resonance angiography (MRA) is emerging as a powerful noninvasive tool that is capable of providing information critical to the care of these patients. The objective of this manuscript is to review the current state-of-the-art of MRA of the abdominal aorta and lower extremity vessels. The techniques are described, the clinical indications for MRA are discussed, and the diagnostic accuracy and pitfalls of the various methods are presented.
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Affiliation(s)
- T M Grist
- Department of Radiology, University of Wisconsin-Madison, 53792-3252, USA.
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Winchester PA, Lee HM, Khilnani NM, Wang Y, Trost DW, Bush HL, Sos TA. Comparison of two-dimensional MR digital subtraction angiography of the lower extremity with x-ray angiography. J Vasc Interv Radiol 1998; 9:891-9; discussion 900. [PMID: 9840032 DOI: 10.1016/s1051-0443(98)70417-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To perform a preliminary evaluation of the diagnostic accuracy of contrast-enhanced, two-dimensional (2D) magnetic resonance (MR) digital subtraction angiography (DSA) of the lower extremity by comparison with x-ray angiography (XRA). MATERIALS AND METHODS Forty lower extremities in 22 patients were imaged at multiple levels with both XRA and 2D MR DSA. Images were retrospectively analyzed by three radiologists in a randomized blinded manner. Seventeen vascular segments were graded as an insignificant lesion, a significant lesion, or as an occlusion. With the use of segments well depicted with XRA as the gold standard, the sensitivity, specificity, and accuracy of 2D MR DSA, as compared with XRA, were evaluated. The McNemar-Stuart-Maxwell test was performed to determine the significance of any differences found. RESULTS Three hundred eighty-three arterial segments were evaluated with both techniques. Three hundred one segments were well depicted with XRA. There was no significant difference between 2D MR DSA and XRA for assessing the degree of occlusive disease in these 301 segments (.25 < P < .5). The sensitivity, specificity, and diagnostic accuracy of 2D MR DSA were found to be 90%, 98%, and 93%, respectively. CONCLUSION Two-dimensional MR DSA is an accurate method for assessing arterial lesions in the lower extremity.
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Affiliation(s)
- P A Winchester
- Department of Radiology, Cornell University Medical College, New York, NY 10021, USA
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Affiliation(s)
- V S Lee
- Department of Radiology, New York University Medical Center 10016, USA
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