Aortic and lower-extremity arterial disease: evaluation with MR angiography versus conventional angiography

S F Quinn, R C Sheley, K G Semonsen, V J Leonardo, K Kojima, J Szumowski
Radiology 1998, 206 (3): 693-701

PURPOSE: To compare magnetic resonance (MR) angiography with conventional angiography in evaluation of the aorta and lower-extremity arterial system.

MATERIALS AND METHODS: Fifty-seven patients were evaluated with femoral conventional and MR angiography. Iliac artery segments were evaluated with two-dimensional and contrast material-enhanced three-dimensional time-of-flight MR angiography. Infrainguinal regions were evaluated with two-dimensional time-of-flight MR angiography with a dedicated lower-extremity coil. Arteries depicted on femoral images were separately interpreted as 20 anatomic segments. Disease classification included normal to moderate disease (0%-50% stenosis), severe stenosis (> 50% stenosis), diffuse disease (more than one severe stenosis), and occlusion. Four readers interpreted the images and rendered treatment recommendations.

RESULTS: Substantial to almost perfect interobserver agreement (kappa, 0.66-1.00) was achieved in most cases for MR angiogram interpretation. The three most experienced readers achieved substantial to almost perfect intraobserver agreement (kappa, 0.61-1.00) between conventional and MR angiogram interpretation in most cases. Among three readers, moderate agreement (kappa, 0.43-0.53) was found between treatment recommendations based on conventional versus MR angiographic findings; for the most experienced reader, this agreement was almost perfect (kappa, 0.90).

CONCLUSION: For experienced readers, there was substantial to almost perfect agreement between conventional and MR angiographic image interpretations of the aorta and lower-extremity arterial system.

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