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PubMedDate not supplied

The role of infrapopliteal MR angiography in patients undergoing optimal contrast angiography for chronic limb-threatening ischemia.

PURPOSE: To determine the benefit of infrapopliteal magnetic resonance angiography (MRA) in patients with chronic limb-threatening ischemia who have undergone optimal contrast angiography (CA). PATIENTS AND METHODS: Thirty-four patients (37 limbs) with limb-threatening chronic lower extremity ischemia underwent MRA and CA of the symptomatic extremity. Selective, vasodilator-enhanced digital subtraction angiography of the infrapopliteal vessels was possible for 34 limbs. Two vascular surgeons retrospectively formulated treatment plans based on CA. They then formulated treatment plans based on CA and MRA together. RESULTS: CA clearly visualized 495 of 888 vascular segments as patent, while MRA clearly visualized 412 of 888 segments. Treatment plans differed for at least one of two surgeons in eight limbs, but MRA would possibly have improved clinical outcome in only one. The amount of inflow disease did not appear to influence segment visualization or treatment planning. In eight of 11 limbs that eventually required below- or above-knee amputation, CA clearly visualized more vascular segments than MRA. One patient developed renal insufficiency after CA. CONCLUSION: Most patients undergoing optimal CA for chronic limb-threatening ischemia will not benefit from the addition of MRA. However, MRA should be considered when CA is suboptimal and when it is necessary to conserve contrast material.

Adult↗

PubMed1999

Comparison of intra-arterial digital subtraction angiography, magnetic resonance angiography and duplex ultrasonography for measuring carotid artery stenosis.

BACKGROUND: Duplex ultrasonography and magnetic resonance angiography (MRA) are becoming competitive alternatives to angiography for determining the degree of internal carotid artery (ICA) stenosis. Varying reports have been published regarding the suitability of each technique for grading ICA disease. This retrospective study compared the merits of these three modalities for measuring ICA stenosis. METHODS: One hundred and eleven patients being considered for carotid endarterectomy underwent intra-arterial digital subtraction angiography (DSA) via arch injection. Duplex imaging was performed in all patients and MRA in 50. The degree of carotid stenosis estimated by the three modalities was compared. RESULTS: There was good correlation between subjectively graded MRA and DSA images (r = 0.87, P < 0.001, n = 82 carotids) but poor correlation for objective estimates. MRA tended to underestimate the degree of stenosis (bias - 4.5 per cent) compared with DSA, but showed good correlation with duplex ultrasonography estimates (r = 0. 86, P < 0.001, n = 87 carotids). Both non-invasive modalities produced high values of sensitivity and specificity in estimating stenoses of greater than 70 per cent. MRA was less sensitive for distinguishing between severe stenosis and complete occlusion. CONCLUSION: This study did not resolve the debate regarding the method of choice as both MRA and duplex ultrasonography were accurate for imaging carotid stenoses.

Aged↗

PubMed2000

Imaging of aortoiliac arterial disease. Duplex ultrasound and MR angiography versus digital subtraction angiography.

PURPOSE: To evaluate and compare the diagnostic accuracy of duplex ultrasound (US) and MR angiography (MRA) at 1.0 T in aortoiliac arterial disease using digital subtraction angiography (DSA) as the reference standard. In addition, a comparison of the 2D time-of-flight (TOF) and 3D contrast-enhanced MRA (CE MRA) techniques was performed. MATERIAL AND METHODS: Prospectively, 39 patients with symptoms of lower-extremity arterial occlusive disease were examined using US, TOF MRA, CE MRA and DSA. Significant lesions (stenosis > or =50%) and occlusions were evaluated blindly for each method. RESULTS: For all segments, the sensitivity for US, TOF MRA and CE MRA with regard to significant lesions was 0.72, 0.81 and 0.81, respectively, and the specificity for each was 0.97, 0.91 and 0.92, respectively. For significant lesions above the inguinal ligament the corresponding sensitivity was 0.84, 0.89 and 0.94 and the specificity 0.93, 0.82 and 0.73, respectively. The specificity was higher when the two MRA methods were combined. TOF MRA overgraded 7 segments as occluded. In most cases, the length of the occlusions was correctly determined on CE MRA, overestimated on TOF MRA and uncertain on US. CONCLUSION: Neither US nor MRA were sufficiently accurate to fully replace angiography. MRA was preferable to US as a non-invasive test when vascular intervention was contemplated. Although CE MRA was superior to TOF MRA, the most accurate results were achieved when the two methods were combined.

Aged↗

PubMed2001

Comparison of magnetic resonance angiography and digital subtraction angiography for visualization of lower extremity arteries.

Objective vascular assessment is frequently required before microvascular reconstruction involving the lower extremities. The purpose of this study was to evaluate the reliability of magnetic resonance angiography (MRA) for preoperative assessment before free flap surgery. Five patients underwent preoperative MRA: one before fibula harvest for oromandibular reconstruction, and four before muscle free flap reconstruction of the lower extremity. In all patients, the tibioperoneal trunk, anterior tibial, posterior tibial, and peroneal arteries were well visualized to the ankle, including pathological occlusions. The radiographic findings were demonstrated at surgery and were confirmed to be accurate. These findings facilitated and guided the surgical procedure. This study strongly suggests the accuracy and surgical relevance of MRA before free flap surgery. MRA is desirable over angiography because of its noninvasive nature. It may also be better than ultrasonography because the latter is highly dependent on the technician (particularly in identifying the peroneal artery). MRA may likely replace angiography as the objective procedure of choice before microvascular surgery.

Adult↗

PubMed1998

X-ray digital subtraction angiography to magnetic resonance-digital subtraction angiography using three-dimensional TRICKS. Historical perspective and computer simulations: a review.

Seventeen years after the introduction of x-ray digital subtraction angiography (DSA), gadolinium-enhanced magnetic resonance (MR) angiography techniques have become available for the performance of MR-DSA. For the purposes of this article, we will consider this to include two-dimensional and three-dimensional approaches using time-resolved and non-time-resolved applications. Magnetic resonance-DSA is one in a historical progression of techniques which have aimed to produce less invasive forms of angiography. After outlining some historical milestones, several current issues regarding current methods for MR-DSA are discussed.

Angiography, Digital Subtraction↗

PubMedDate not supplied

Contrast-enhanced subtraction MR angiography in occlusive disease of the pelvic and lower limb arteries: results of a prospective intraindividual comparative study with digital subtraction angiography in 76 patients.

PURPOSE: The purpose of this work was to evaluate the feasibility and clinical use of MR angiography (MRA) for examining the pelvic and lower limb arteries in patients with arterial occlusive disease. METHOD: Seventy-six patients with clinical signs of peripheral arterial occlusive disease were included in the study. MRA was performed using a fast contrast-enhanced high-resolution 3D technique that covered the area from the distal abdominal aorta to the distal lower limbs in two examination steps. RESULTS: In all patients, diagnostic images comparable with those of conventional intraarterial digital subtraction angiography (DSA) could be obtained. No false-negative findings were seen in the iliac, femoral, or popliteal arteries. Ten to 16% of the mild stenoses and 6-14% of the severe stenoses, mainly in the crural vessels, were overgraded compared with intraarterial DSA. Particularly in patients with proximal severe obstructions or occlusions, the crural segments could be depicted more clearly due to decreased arterial runoff in conventional angiography. CONCLUSION: The consistency of the excellent depiction of the vascular territories of the distal aorta and the pelvic and lower limb arteries in a standardized setting suggests great potential for the use of MRA in the primary diagnosis of peripheral arterial occlusive disease.

Aged↗

PubMedDate not supplied

Postoperative multidetector computed tomography angiography after aneurysm clipping: comparison with digital subtraction angiography.

OBJECTIVES: To evaluate the usefulness of multidetector computed tomography angiography (MDCTA) as a noninvasive diagnostic modality for the detection of aneurysm remnants after clipping of intracranial aneurysms. METHODS: Thirty-eight patients who had aneurysm clipping and had undergone MDCTA and digital subtraction angiography (DSA) were enrolled in this study. In 16 of the 38 patients, MDCTA was performed with 16-channel MDCTA, in 20 patients with 4-channel MDCTA, and in 2 with both. Two neuroradiologists evaluated the image quality of MDCTA with a 3-point rating scale and the presence of the residual aneurysm sac with a 5-point rating scale. Receiver operating characteristic analysis was used to measure the diagnostic performance of MDCTA. RESULTS: Forty-nine surgically clipped aneurysms were evaluated in this study. The overall diagnostic accuracy of MDCTA was 88.1% (95% confidence interval: 0.761-0.954). The ability of 16-channel MDCTA to discriminate between surgical clips and parent vessels was superior to that of 4-channel MDCTA (P=0.005). CONCLUSION: Multidetector computed tomography angiography is a valuable noninvasive diagnostic modality for the assessment of aneurysm remnants in patients after aneurysm clipping.

Adult↗

PubMed2005

High-spatial-resolution MR angiography of renal arteries with integrated parallel acquisitions: comparison with digital subtraction angiography and US.

PURPOSE: To retrospectively compare three-dimensional gadolinium-enhanced magnetic resonance (MR) angiography, performed with an integrated parallel acquisition technique for high isotropic spatial resolution, with selective digital subtraction angiography (DSA) and intravascular ultrasonography (US) for accuracy of diameter and area measurements in renal artery stenosis. MATERIALS AND METHODS: The study was approved by the institutional review board, and consent was obtained from all patients. Forty-five patients (17 women, 28 men; mean age, 62.2 years) were evaluated for suspected renal artery stenosis. Three-dimensional gadolinium-enhanced MR angiograms were acquired with isotropic spatial resolution of 0.8 x 0.8 x 0.9 mm in 23-second breath-hold with an integrated parallel acquisition technique. In-plane diameter of stenosis was measured along vessel axis, and perpendicular diameter and area of stenosis were assessed in cross sections orthogonal to vessel axis, on multiplanar reformations. Interobserver agreement between two radiologists in measurements of in-plane and perpendicular diameters of stenosis and perpendicular area of stenosis was assessed with mean percentage of difference. In a subset of patients, degree of stenosis at MR angiography was compared with that at DSA (n = 20) and intravascular US (n = 11) by using Bland-Altman plots and correlation analyses. RESULTS: Mean percentage of difference in stenosis measurement was reduced from 39.3% +/- 78.4 (standard deviation) with use of in-plane views to 12.6% +/- 9.5 with use of cross-sectional views (P < .05). Interobserver agreement for stenosis grading based on perpendicular area of stenosis was significantly better than that for stenosis grading based on in-plane diameter of stenosis (mean percentage of difference, 15.2% +/- 24.2 vs 54.9% +/- 186.9; P < .001). Measurements of perpendicular area of stenosis on MR angiograms correlated well with those on intravascular US images (r(2) = 0.90). CONCLUSION: Evaluation of cross-sectional images reconstructed from high-spatial-resolution three-dimensional gadolinium-enhanced MR renal angiographic data increases the accuracy of the technique and decreases interobserver variability.

Adult↗

PubMed2000

Abdomen, pelvis, and extremities: diagnostic accuracy of dynamic contrast-enhanced turbo MR angiography compared with conventional angiography-initial experience.

To determine the value of contrast material-enhanced three-dimensional turbo magnetic resonance (MR) angiography compared with conventional cut-film or digital subtraction angiography for evaluating arterial stenosis in the abdomen, pelvis, and extremities. For detection of significant stenosis, MR angiography had 91% sensitivity and 89% specificity. This technique is highly sensitive in lesion detection, but stenosis tended to be overestimated.

Abdomen↗

PubMed2001

Three-dimensional computed tomography angiography and magnetic resonance angiography of carotid bifurcation stenosis.

PURPOSE: To evaluate the role of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) in the quantification of atherosclerotic stenosis of carotid artery bifurcation in comparison with digital substraction angiography (DSA) and Doppler sonography (DS). MATERIALS AND METHODS: Twenty-five patients with atherosclerotic disease of the carotid arteries with proven stenosis by DSA, had spiral CTA, MRA using two- and three-dimensional time-of-flight gradient echo techniques, and DS using Doppler flow signal recording (total 47 carotid artery bifurcations). The degree of stenosis was measured according to the North American Symptomatic Carotid Endarterectomy Trial criteria: total occlusion (100%), severe (70-99%), moderate (30-69%) and mild (0-29%). The degree of stenosis measured by CTA, MRA and DS was compared to DSA, used as the gold standard. RESULTS: Ninety-seven percent of MRA measures were equivalent to DSA, and 3% were underestimated; 96% of CTA measures were equivalent to DSA, and 4% were underestimated; 77% of DS measures were equivalent to DSA, 21% were overestimated and 2% were underestimated. CONCLUSIONS: CTA and MRA are equally accurate methods in quantifying the degree of carotid bifurcation stenosis.

Aged↗

PubMed2002

Gadolinium-enhanced 3-dimensional magnetic resonance angiography of pulmonary blood supply in patients with complex pulmonary stenosis or atresia: comparison with x-ray angiography.

BACKGROUND: In patients with complex pulmonary stenosis or atresia, a detailed delineation of all sources of pulmonary blood supply is necessary for planning surgical and transcatheter procedures and usually requires diagnostic cardiac catheterization. The goals of this study were to determine whether gadolinium-enhanced 3D magnetic resonance angiography (MRA) can provide a noninvasive alternative to diagnostic catheterization and to compare MRA and x-ray angiography measurements of pulmonary arteries and aortopulmonary collaterals (APCs). METHODS AND RESULTS: Thirty-two patients with pulmonary stenosis or atresia (median age: 4.7 years, range: 1 day to 46.9 years) underwent both MRA and cardiac catheterization (median time: 1 month). Diagnoses included tetralogy of Fallot (TOF) with pulmonary atresia (n=13), TOF with pulmonary stenosis (n=4), post-Fontan palliation (n=5), and other complex congenital heart disease (n=10). Compared with catheterization and surgical observations, MRA had a 100% sensitivity and specificity for the diagnosis of main (n=10) and branch pulmonary artery (PA) stenosis or hypoplasia (n=38), as well as absent (n=5) or discontinuous (n=4) branch PAs. All 48 major APCs diagnosed by catheterization were correctly diagnosed by MRA. Three additional APCs were diagnosed by MRA but not by catheterization. The mean difference between MRA and catheterization measurements of 33 pulmonary vessel diameters was 0.5+/-1.5 mm, with a mean interobserver difference of 0.4+/-1.5 mm. CONCLUSIONS: Gadolinium-enhanced 3D MRA is a fast and accurate technique for delineation of all sources of pulmonary blood supply in patients with complex pulmonary stenosis and atresia and can be considered a noninvasive alternative to diagnostic catheterization with x-ray angiography.

Adolescent↗

PubMed1989

Relative safety of intravenous digital subtraction angiography over other methods of carotid angiography and impact on clinical management of cerebrovascular disease.

Data from a multicentre survey based on three London teaching hospitals on the relative safety and clinical utility of intravenous carotid digital subtraction angiography (DSA) over intra-arterial DSA and conventional carotid angiography are presented. The incidence of stroke during intra-arterial DSA was 0.7% (n = 538) and during conventional angiography was 0.8% (n = 780). The incidence of stroke during intravenous DSA was zero (n = 3710). When it constituted the initial investigation, intravenous DSA achieved a 93.8% replacement value over intra-arterial studies as a whole (n = 474) and 89% replacement value for patients having carotid endarterectomy (n = 99). It was also noted that the installation of DSA equipment at one unit coincided with a sixfold increase in the number of carotid angiographic examinations and an almost threefold increase in carotid endarterectomies.

Angiography, Digital Subtraction↗

PubMed2006

Comparison between digital subtraction angiography and magnetic resonance angiography in investigation of nonlacunar ischemic stroke in young patients: preliminary results.

PURPOSE: We preliminarily investigated the relevance of performing digital subtraction angiography (DSA) in addition to magnetic resonance angiography (MRA) in definition of ischemic stroke etiology in young patients. METHOD: DSAs and MRAs from 17 young patients with nonlacunar ischemic stroke were blindly analyzed and their impact on stroke management was evaluated. RESULTS: Etiologies were the same considering results of either DSA or MRA in 12/17 cases. In 15/17 patients no changes would have been made in treatment, regardless of the modality of angiography considered. CONCLUSION: These preliminary results suggest that DSA may be redundant in two thirds of ischemic strokes in young patients. Further larger prospective studies are necessary to determine indications of DSA in this age group.

Adolescent↗

PubMed1996

Prospective comparison of CT angiography of the legs with intraarterial digital subtraction angiography.

OBJECTIVE: The aim of this study was to determine the accuracy of CT angiography (CTA) with a single spiral acquisition for the diagnosis of arterial stenoses and occlusion in patients with peripheral vascular occlusive disease. SUBJECTS AND METHODS: In a prospective study, intraarterial digital subtraction angiography and i.v. CTA from the groin to the lower calves were performed on 50 patients with vascular occlusive disease. Maximum-intensity-projection images in multiple views were produced. The accuracy of CTA with and without analysis of the axial scans was determined with digital subtraction angiography as the standard. RESULTS: The sensitivities of CTA were 100% for the diagnosis of femoral artery occlusion, 100% for the detection of popliteal artery (including tibial-peroneal arterial trunk) occlusion, and 94% for the detection of tibial artery occlusion. The specificities were 100%, 99%, and 98%, respectively. When maximum-intensity-projection images were interpreted without axial scans, sensitivities were 98%, 85%, and 92% and specificities were 100%, 99%, and 97%, respectively. For the accurate grading of high-grade (75-99%) stenoses of the superficial femoral artery and the popliteal artery (including tibial-peroneal arterial trunk), the sensitivities of CTA were 88% and 73% and the specificities were 94% and 100%, respectively. When maximum-intensity-projection images alone were used, the sensitivities for the correct grading of high-grade stenoses were 58% and 36% and the specificities were 99% and 100%, respectively. CONCLUSION: CTA from the groin to the lower calves is feasible, and the short examination time is a significantly advantage over the time required for other noninvasive techniques. CTA is particularly accurate in the depiction of femoral artery occlusions. Maximum-intensity-projection images are useful, but analysis of axial scans is more accurate for the grading of arterial stenoses. The results of CTA are encouraging enough to warrant further studies. A CTA protocol covering the pelvic and pedal vessels remains to be established and evaluated.

Aged↗

PubMed2002

Comparison of three-dimensional rotational angiography with digital subtraction angiography in the assessment of ruptured cerebral aneurysms.

BACKGROUND AND PURPOSE: Rotational angiography (RA) and digital subtraction angiography (DSA) together may depict more intracranial aneurysms than DSA alone. We compared the diagnostic value of 3D RA and biplanar DSA in detecting, classifying, and planning treatment for ruptured intracranial aneurysms. METHODS: A total of 53 patients with acute subarachnoid hemorrhage (Hunt and Hess grades I-V) underwent angiography with both methods. DSA was performed in two to six standard projections in every vascular territory. Three-dimensional RA datasets were evaluated by using surface-shaded display and maximum intensity projection. The usefulness of DSA images and 3D datasets in detecting aneurysms (number, configuration) and treatment planning were retrospectively analyzed in a blinded manner. RESULTS: In 42 patients, 56 aneurysms were detected, (one to five per patient; size, 0.6-20.4 mm); no aneurysm was found in 11 patients. RA revealed seven aneurysms not seen at conventional DSA. RA failed to depict one aneurysm visible only in a compression series. Delineation of the aneurysmal neck improved with RA in 71% of cases; the parent vessel and its relationship to adjacent vessels was demonstrated better with RA than with DSA in 45% and 50%, respectively. Endovascular treatment was proposed in nine patients; microsurgical therapy, in 26. In seven patients, both options were rated as being equal. Actual treatment consisted of eight endovascular procedures and 30 neurosurgical operations. Four patients died before therapy. CONCLUSION: Compared with DSA, 3D RA allows more exact depiction of anatomic details that are important in planning surgery and interventional therapy for intracranial aneurysms. RA depicted more aneurysms.

Adult↗

PubMedDate not supplied

Clinical usefulness of unsubtracted 3D digital angiography compared with rotational digital angiography in the pretreatment evaluation of intracranial aneurysms.

BACKGROUND AND PURPOSE: Three-dimensional digital subtraction angiography (DSA) is useful as a supplement to 2D DSA in the pretreatment evaluation of intracranial aneurysms. However, the clinical efficacy of 3D digital angiography (DA) that is generated from unsubtracted rotational images has not been established. The purpose of this study was to assess whether 3D DA provides additional useful information to that of rotational DA in the preoperative evaluation of intracranial aneurysms. METHODS: This prospective study comprised 23 patients (age range, 37-83 years) with ruptured aneurysms who underwent angiography. Two radiologists independently evaluated the rotational DA images and the maximum intensity projection, shaded surface display, and volume-rendering 3D DA images, in combination with 2D DSA images. A four-point scoring system was used to evaluate aneurysm detection and delineation. Referring neurosurgeons were questioned as to whether the information obtained with 3D DA was useful for treatment decisions. RESULTS: Thirty aneurysms were confirmed by surgery or endovascular treatment. In detection and delineation of the 30 confirmed aneurysms, overall mean scores were highest with volume-rendering 3D DA and lowest with rotational DA. Compared with rotational DA, volume-rendering 3D DA demonstrated 27 additional findings in 14 (47%) of 30 aneurysms: detection of an aneurysm (n = 2), and delineation of aneurysm neck, shape, and relationship to adjacent arteries (n = 25). The information provided by 3D DA was useful for following treatment in five (22%) of 23 patients. CONCLUSION: In the preoperative evaluation of intracranial aneurysms, 3D DA can provide additional useful information to that of rotational DA.

Adult↗

PubMed2005

Three-dimensional fusion digital subtraction angiography: new reconstruction algorithm for simultaneous three-dimensional rendering of osseous and vascular information obtained during rotational angiography.

This report describes three-dimensional (3D) fusion digital subtraction angiography (FDSA), a new algorithm for rotational angiography that combines reconstructions of the blood vessels and the osseous frame in a single 3D representation. 3D-FDSA is based on separate reconstructions of the mask and contrast sequences of the rotational acquisition. The two independent 3D data sets (3D-bone and 3D-digital subtraction angiography [DSA]) are fused in a single 3D representation. The algorithm uses a modification of the Feldkamp method that compensates for signal intensity inhomogeneity inherent to the reconstruction of nonsubtracted rotational acquisitions. By separately reconstructing the osseous and vascular information obtained from the rotational angiogram, 3D-FDSA provides optimal angiographic resolution and precise topographic analysis even when the studied vascular tree is in the immediate vicinity of bone.

Algorithms↗

PubMed2005

CT angiography and MR angiography in the evaluation of carotid cavernous sinus fistula prior to embolization: a comparison of techniques.

BACKGROUND AND PURPOSE: This study compared CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA) in elucidating the size and location of carotid cavernous sinus fistulas (CCFs) before embolization treatment. METHODS: This was a retrospective study of 53 patients with angiographically confirmed CCF. All patients underwent pre- and postcontrast-enhanced CTA and DSA, and 50 patients also underwent MRA. Two neuroradiologists rated detectability of the fistula tract as "good," "moderate," or "poor" in source images obtained by using each procedure. The chi(2) test was used to compare the imaging modalities with respect to their ability to detect fistulas. RESULTS: CTA did not differ significantly from DSA (P = .155), and both CTA (P = .001) and DSA (P = .007) performed significantly better than MRA in the population as a whole. Differences in performance among the methods, however, depended upon the segmental location of the fistula along the internal carotid artery (ICA). CTA and MRA were similar in detection of CCFs in patients with a fistula at segment 3. CTA significantly outperformed MRA in patients with a fistula at segment 4, who accounted for approximately half of the population. CONCLUSIONS: CTA source imaging has proved itself as useful as DSA for detecting CCFs. Of the 2 noninvasive techniques, CTA performed better than MRA in the population as a whole and in most patients whose fistula was located at segment 4 or 5 of the ICA.

Adolescent↗