Comparison of treatment plans for lower extremity arterial occlusive disease made with electrocardiography-triggered two-dimensional time-of-flight magnetic resonance angiography and digital subtraction angiography

• Published in: The American journal of surgery 1999-08, Vol.178 (2), p.166-172
• Main Authors: Hoch, John R, Kennell, Todd W, Hollister, Mary S, Sproat, Ian A, Swan, J.Shannon, Acher, Charles W, Burks, Janice, Heisey, Dennis M
• Format: Article
• Language: English
• Subjects: Accuracy; Aged; Angiography; Angiography, Digital Subtraction; Arterial Occlusive Diseases - classification; Arterial Occlusive Diseases - diagnosis; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - surgery; Biological and medical sciences; Blood pressure; Blood Pressure - physiology; Cardiovascular system; Diabetes; EKG; Electrocardiography; Follow-Up Studies; Forecasting; Heart rate; Humans; Hypertension; Image Processing, Computer-Assisted - methods; Inguinal Canal - blood supply; Intraoperative Care; Investigative techniques, diagnostic techniques (general aspects); Ischemia; Ischemia - classification; Ischemia - diagnosis; Ischemia - diagnostic imaging; Ischemia - surgery; Leg - blood supply; Magnetic resonance; Magnetic Resonance Angiography - methods; Male; Medical imaging; Medical sciences; Observer Variation; Patient Care Planning; Prospective Studies; Pulse; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography, Interventional; Sensitivity and Specificity; Single-Blind Method; Ulcers; Vascular Patency; Veins & arteries
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(99)00158-0

Background: The purpose of the study was to determine whether preoperative treatment plans for patients with lower extremity ischemia can be made with electrocardiography (EKG)-triggered two-dimensional (2D) time-of-flight (TOF) magnetic resonance angiography (MRA) as accurately as digital subtraction angiography (DSA). Methods: Forty patients were prospectively evaluated with the combination of EKG-triggered 2D TOF MRA, DSA, and pulse volume recordings. Blinded reviewers graded arterial segments for disease severity. Accuracy of separate MRA- and DSA-based treatment plans was compared with the procedures performed based on all available information. Results: There was an 86% exact match between MRA- and DSA-based plans (92% MRA and 94% DSA accuracy). The MRA-based plan accurately predicted 90% of suprainguinal and 95% of infrainguinal procedures, whereas the DSA-based plan accurately predicted 100% of suprainguinal and 85% of infrainguinal procedures. Two-year primary patency was 83% for all procedures. Radiologists’ review of disease severity resulted in a mean exact correlation between studies of 81% (κ = 0.64). The agreement between radiologists interpreting the MRA was 84% (κ = 0.7) compared with 82% (κ = 0.66) for the DSA. Conclusions: MRA- and DSA-based preoperative management plans were of comparable efficacy. Significant interobserver variability was seen with the interpretations of both preoperative studies. EKG-triggered 2D TOF MRA can be used to plan arterial reconstructions; however, all patients require arterial pressure measurements prior to suprainguinal repair and confirmatory intraoperative angiography during infrainguinal revascularization.