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Comparison of Contrast-Enhanced Magnetic Resonance Angiography and Digital Subtraction Angiography in Patients With Chronic Critical Ischemia and Tissue Loss

Leiner, Tim MD, PhD*; Kessels, Alphons G. H. MD, MSc†; Schurink, Geert Willem MD, PhD‡; Kitslaar, Peter J. E. H. M. MD, PhD‡; de Haan, Michiel W. MD, PhD*; Tordoir, Jan H. M. MD, PhD‡; van Engelshoven, Jos M. A. MD, PhD*

Original Article

Rationale and Objectives: To compare the ability of intra-arterial digital subtraction angiography (IA-DSA) and total runoff contrast-enhanced magnetic resonance angiography (CE-MRA) to demonstrate peripheral arterial anatomy, specifically in patients with chronic critical ischemia and tissue loss.

Materials and Methods: Twenty-three consecutive patients with chronic critical ischemia and tissue loss underwent CE-MRA and IA-DSA within 2 days. Two teams, consisting of an interventional radiologist and vascular surgeon who were blinded to each other's results, determined the number of named arteries (21 segments) and the presence of ≥50% stenosis or occlusion.

Results: Compared with IA-DSA, both teams detected significantly more arterial segments with CE-MRA, both above and below the knee (team 1: above knee 7.0 versus 5.2, P = 0.002, and below knee 8.5 versus 5.4, P < 0.001; team 2: above knee 7.1 versus 5.4, P = 0.004, and below knee 8.3 versus 5.9, P < 0.001). Interobserver agreement between the 2 teams with regard to presence of arteries and the presence of stenoses and/or occlusions yielded kappa values of 0.76 (95% confidence interval 0.71–0.81) for IA-DSA and 0.73 (95% confidence interval 0.66–0.80) for CE-MRA. Treatment was changed based on the CE-MRA findings in 8/23 (35%) patients.

Conclusions: In the present study CE-MRA detected more patent arteries than IA-DSA in patients with chronic critical ischemia and tissue loss. CE-MRA can modify the choice of therapeutic strategy in these patients.

From the *Departments of Radiology, †Clinical Epidemiology and Medical Technology Assessment, and ‡Vascular Surgery, Maastricht University Hospital, Maastricht, Netherlands.

Received January 15, 2004 and accepted for publication, after revision, February 26, 2004.

Funded in part by the Dutch Heart Foundation/Grant 98–150.

Dr. Leiner is a Niels Stensen Foundation Fellow.

Reprints: Tim Leiner, MD, PhD, Department of Radiology, Maastricht University Hospital, Peter Debijelaan 25, 6229 HX, Maastricht, Netherlands. E-mail: leiner@rad.unimaas.nl

© 2004 Lippincott Williams & Wilkins, Inc.