[Diagnostic performance of contrast-enhanced MR angiography of the aortoiliac arteries with the blood pool agent Vasovist: initial results in comparison to intra-arterial DSA]. / Diagnostische Wertigkeit der kontrastverstärkten Magnetresonanzangiografie der Beckenstrombahn mit dem intravaskulären Kontrastmittel Vasovist: Erste klinische Erfahrungen im Vergleich zur i. a. DSA.

ABSTRACT

PURPOSE: To prospectively assess the accuracy of contrast-enhanced MR angiography of the aortoiliac arteries using the blood pool agent Vasovist compared to unenhanced time-of-flight MRA. Conventional digital subtraction angiography served as the standard of reference. MATERIALS AND METHODS: Twenty-nine patients with suspected or known peripheral arterial occlusive disease (PAOD) were examined by means of contrast-enhanced aortoiliac MR angiography using a dosage of 0.03 mmol/kg bodyweight Vasovist. Unenhanced two-dimensional time-of-flight (TOF) MRA of the same anatomic region was performed immediately prior to injection of the contrast agent. This study was approved by the local Institutional Review Board and informed consent was obtained from all subjects. Both contrast-enhanced and unenhanced MRA images were compared to conventional angiography with respect to the presence of vascular stenosis. Three independent, blinded readers evaluated vessel stenosis and occlusion on the basis of DSA and MR angiographic image readings. Sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve were analyzed. Correlations between readers of conventional angiograms were calculated and compared to the MR results. RESULTS: In the case of pooled readings, unenhanced TOF MR angiography had a sensitivity of 42.6 %, a specificity of 78.4 % and an accuracy of 74.9 % for detection of clinically significant (>50 %) stenosis. Vasovist-enhanced MRA showed significant improvement in sensitivity (83.3 %), specificity (88.8 %) and accuracy (88.3 %) compared to TOF MRA (p<0.01). The areas under the receiver operating characteristic curve for quantitative measurements increased significantly (p<0.01) in the case of Vasovist-enhanced MRA compared to TOF MRA. All readers found fewer images uninterpretable with Vasovist enhancement and the agreement regarding stenosis location and degree of stenosis between MR angiography and DSA improved substantially after Vasovist administration compared to the noncontrast examination. CONCLUSION: MR angiography using the blood pool agent Vasovist is a feasible and minimally invasive alternative to DSA and provides angiograms of the aortoiliac region with high sensitivity, specificity, and diagnostic accuracy.