Noncontrast‐enhanced peripheral MRA: Technical optimization of flow‐spoiled fresh blood imaging for screening peripheral arterial diseases

Flow‐spoiled fresh blood imaging, a noncontrast peripheral MR angiography technique, allows the depiction of the entire tree of peripheral arteries by utilizing the signal difference between systolic‐ and diastolic‐triggered data. The image quality of the technique relies on selecting the right triggering delay times and flow‐dependent read‐out spoiler gradient pulses. ECG triggering delays were verified using manual subtraction and automated software. The read‐out spoiler gradients pulses were optimized on volunteers before utilizing the flow‐spoiled fresh blood imaging technique to screen for peripheral arterial disease. Thirteen consecutive patients with suspected peripheral arterial disease underwent both flow‐spoiled fresh blood imaging and 16‐detector‐row computed tomography angiography examinations. A total of 23 segments were evaluated in the arterial vascular system. Using computed tomography angiography as the reference standard, 56 diseased segments were detected with 22 nonsignificant stenoses (<50%) and 34 significant stenoses, 15 of which were totally occluded. Flow‐spoiled fresh blood imaging had a sensitivity of 97%, a specificity of 96%, an accuracy of 96%, a positive predictive value of 88%, and a negative predictive value of 99%. With such a high negative predictive value, flow‐spoiled fresh blood imaging has the potential to become the safest noninvasive screening tool for peripheral arterial disease, especially for patients with impaired renal function. Magn Reson Med, 2011. © 2010 Wiley‐Liss, Inc.