First-Pass and High-Resolution Steady-State Magnetic Resonance Angiography of the Peripheral Arteries With Gadobenate Dimeglumine An Assessment of Feasibility and Diagnostic Performance

Purpose: To assess the feasibility of combined first-pass (FP) and steady-state (SS) contrast-enhanced magnetic resonance angiography (MRA) of the peripheral arteries with gadobenate dimeglumine (MultiHance) and to evaluate diagnostic performance relative to digital subtraction angiography (DSA). Materials and Methods: A total of 35 patients with symptomatic peripheral arterial occlusive disease (PAOD) underwent FP MRA (repetition time [TR]/echo time [TE]/flip angle [FA]/acquisition time [TA] = 3.5/1.2/30 degrees/14s) at 1.5T after intravenous injection of 10 mL of gadobenate dimeglumine. Thereafter, SS imaging of the calf (TR/TE/FA/TA = 7.5/2.3/20 degrees/40130s) and femoropopliteal (TR/TE/FA/TA = 7.5/2.3/18 degrees/130-240s) regions was performed after a second injection of 5 mL of gadobenate dimeglumine. All patients underwent conventional DSA. Three readers reviewed separate FP and FP+SS MRA datasets for image quality and presence/absence of clinically relevant PAOD. A fourth independent observer evaluated DSA images. The diagnostic performance (sensitivity, specificity, positive and negative predictive values) achieved with each dataset was determined and compared. Inter-reader agreement was assessed using kappa statistics. Results: The image quality of 134 of 140 vascular regions was optimal or adequate on SS MRA. Inter-reader agreement was good to very good for assessments of FP (kappa = 0.725) and combined FP+SS images (kappa = 0.866). SS images improved diagnostic confidence in 34 (48.6%) femoropoliteal and 46 (65.7%) crural regions and altered final diagnosis in 8 (11.4%) and 10 (14.3%) regions, respectively. Global diagnostic accuracy increased from 92.9% on FP images to 95.9% on FP+SS images, with significant (P = 0.0384) improvement in the crural region. Conclusion: SS MRA of the peripheral arteries is feasible with gadobenate dimeglumine and potentially improves diagnostic performance in patients with symptomatic PAOD.