Peripheral vascular disease: combined 3D bolus chase and dynamic 2D MR angiography compared with x-ray angiography for treatment planning

PURPOSE: To compare combined three-dimensional (3D) and two-dimensional (2D) contrast material-enhanced magnetic resonance (MR) angiography with x-ray angiography for planning treatment of peripheral vascular disease. MATERIALS AND METHODS: Three radiologists retrospectively reviewed the pretreatment x-ray angiographic and MR angiographic studies obtained in 30 consecutive patients: 15 patients (15 limbs) evaluated for limb salvage and 15 patients (20 limbs) evaluated because of claudication. MR angiography included acquisition of 2D contrast-enhanced MR digital subtraction angiograms of the area from the adductor canal to the feet and 3D spoiled gradient-recalled-echo bolus chase MR angiograms obtained in three stations from the aorta to the middle portion of the calf. Each reader reviewed the x-ray and MR angiograms to determine the inflow and outflow segments for a hypothetical bypass graft placement. RESULTS: The three readers selected identical segments for inflow at MR angiography and x-ray angiography in 32, 32, and 35 of the 35 limbs evaluated (mean percentages of agreement [95% CI ]: 91% [77%, 98%], 91% [77%, 98%], and 95% [90%, 100%], respectively). The readers selected identical segments for outflow in 32, 32, and 34 of the 35 limbs evaluated (mean percentages of agreement [95% CI]: 91% [77%, 98%], 91% [77%, 98%], and 97% [85%, 100%], respectively). CONCLUSION: Preliminary data support the combining of 2D MR digital subtraction angiography with 3D bolus chase MR angiography to extend the utility of 3D MR angiography in treatment planning to include patients being evaluated for limb salvage, as well as those being evaluated for claudication.