Diagnosis of lower extremity arterial disease based on multi-sequence magnetic resonance vessel wall imaging

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• Clinical Article •

WANG Li HE Xueping DENG Wei YE Yufeng

Cite this article as: WANG L, HE X P, DENG W, et al. Diagnosis of lower extremity arterial disease based on multi-sequence magnetic resonance vessel wall imaging[J]. Chin J Magn Reson Imaging, 2024, 15(7): 130-136. DOI:10.12015/issn.1674-8034.2024.07.022.

Abstract

[Abstract] Objective To investigate the clinical utility of delay alternating with nutation for tailored excitation (DANTE) and sampling perfection with application-optimized contrasts by using different flip angle evolutions (SPACE) in multi-sequence magnetic resonance vessel wall imaging (MR-VWI) for diagnosing lower extremity arterial disease (LEAD).Materials and Methods The case and imaging data from 57 LEAD patients and 26 without LEAD patients were retrospectively included. All patients underwent T2-weighted turbo spin echo (T2w-TSE), T1-weighted DANTE-SPACE, contrast-enhanced T1-weighted DANTE-SPACE, and contrast-enhanced magnetic resonance angiography (CE-MRA) MR-VWI scans on 3.0 T MRI equipment. Lumen area (LA), vessel wall area (VWA), and average vessel wall thickness (AVW) were measured by two radiologists in a double-blind procedure. The intra-class correlation coefficient (ICC) and Bland-Altman method were used to assess inter-observer agreement and agreement between different scanning techniques. Receiver operating characteristic (ROC) curves were used to evaluate accuracy.Results Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) values were significantly different between T1w DANTE-SPACE and 2D TSE imaging techniques (P<0.05). ICC values for morphological measurements ranged from 0.85 to 0.99 between two observers and from 0.90 to 0.99 for repeated measurements. Bland-Altman analysis showed good agreement between observers and measurements. The T1w DANTE-SPACE technique was applied to the morphological measurement index ROC of different vascular segments in the LEAD group, resulting in area under the curve (AUC) values of 0.904 [95% confidence interval (CI): 0.825-0.983] and 0.905 (95% CI: 0.835-0.976), respectively. When the vessel wall thickness of the popliteal artery segment was 1.00 mm and the lumen area (LA) was 10.88 mm, serving as the critical values, the sensitivity for LEAD was 79.2% and 85.4%, the specificity was 96.2% and 92.3%, the positive predictive value was 97.4% and 95.3%, and the negative predictive value was 71.4% and 77.4%, respectively.Conclusions Multi-sequence MR-VWI demonstrates good repeatability and high accuracy in evaluating morphological indicators of LEAD plaques, supporting its application in MRI examinations of LEAD.

[Keywords] lower limb arterial disease；magnetic resonance imaging；magnetic resonance vessel wall imaging；diagnose

Contributor Information

WANG Li^{1,
2} HE Xueping¹ DENG Wei¹ YE Yufeng^{1,
2*}

¹ Department of Radiology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou 511400, China

² Medical Imaging Institute of Panyu District, Guangzhou 511400, China.

Corresponding author: YE Y F, E-mail: yeyufengpy@qq.com

Conflicts of interest None.

Publication Information

Received 2024-01-05

Accepted 2024-07-09

DOI: 10.12015/issn.1674-8034.2024.07.022

Text

References

[1]

GERHARD-HERMAN M D, GORNIK H L, BARRETT C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American college of cardiology/american heart association task force on clinical practice guidelines[J/OL]. Circulation, 2017, 135(12): e726-e779 [2023-04-12]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477786/. DOI: 10.1161/CIR.0000000000000471.

[2]

VOS T, FLAXMAN A D, NAGHAVI M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010[J]. Lancet, 2012, 380(9859): 2163-2196. DOI: 10.1016/S0140-6736(12)61729-2.

[3]

AGHAYEV A, STEIGNER M. Magnetic resonance angiography of the arteries of the upper and lower extremities[J]. Magn Reson Imaging Clin N Am, 2023, 31(3): 361-372. DOI: 10.1016/j.mric.2023.04.002.

[4]

KOMAKI S, KIDA K, HAYASHI Y, et al. Non-electrocardiogram-gated and non-contrast-enhanced magnetic resonance angiography of the lower limb arteries using three-dimensional multishot T1-weighted fast-field echo-echo planar imaging[J]. Nihon Hoshasen Gijutsu Gakkai Zasshi, 2022, 78(4): 333-341. DOI: 10.6009/jjrt.2022-1239.

[5]

REGI S S, IRODI A, KESHAVA S N, et al. Balanced steady-state free precision and time of flight noncontrast magnetic resonance angiography in peripheral arterial disease[J]. J Clin Interv Radiol ISVIR, 2022, 06(2): 098-105. DOI: 10.1055/s-0041-1730845.

[6]

NORGREN L, HIATT W R, DORMANDY J A, et al. Inter-society consensus for the management of peripheral arterial disease (TASC Ⅱ)[J]. Eur J Vasc Endovasc Surg, 2007, 33(1): S1-S75. DOI: 10.1016/j.ejvs.2006.09.024.

[7]

CONTE M S, POMPOSELLI F B. Society for Vascular Surgery Practice guidelines for atherosclerotic occlusive disease of the lower extremities management of asymptomatic disease and claudication. Introduction[J/OL]. J Vasc Surg, 2015, 61(3Suppl): 1S [2023-04-12]. https://www.sciencedirect.com/science/article/pii/S0741521414022848. DOI: 10.1016/j.jvs.2014.12.006.

[8]

XIE G X, ZHANG N, XIE Y B, et al. DANTE-prepared three-dimensional FLASH: a fast isotropic-resolution MR approach to morphological evaluation of the peripheral arterial wall at 3 Tesla[J]. J Magn Reson Imaging, 2016, 43(2): 343-351. DOI: 10.1002/jmri.24986.

[9]

SIMAAN N, JUBEH T, SHALABI F, et al. Diagnostic yield of high-resolution vessel wall magnetic resonance imaging in the evaluation of young stroke patients[J/OL]. J Clin Med, 2023, 13(1): 189 [2023-04-12]. https://www.mdpi.com/2077-0383/13/1/189. DOI: 10.3390/jcm13010189.

[10]

FENG Q, BAI Y, WANG M K, et al. Application of high-resolution magnetic resonance vessel wall imaging in evaluation of intracranial arterial dissection according to stage[J]. Chin J Magn Reson Imag, 2021, 12(2): 6-9, 14. DOI: 10.12015/issn.1674-8034.2021.02.002.

[11]

LI J, BIAN Y Y, WU F, et al. Association of morphology of lenticulostriate arteries and proximal plaque characteristics with single subcortical infarction: a whole-brain high-resolution vessel wall imaging study[J/OL]. J Am Heart Assoc, 2024, 13(10): e032856 [2024-06-14]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11179825/. DOI: 10.1161/JAHA.123.032856.

[12]

TAN S, ZHOU X, XU X, et al. Diagnostic performance of high-resolution vessel wall MR imaging combined with TOF-MRA in the follow-up of intracranial vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment[J]. AJNR Am J Neuroradiol, 2023, 44(4): 453-459. DOI: 10.3174/ajnr.A7838.

[13]

LIU D Q, ZHAO C Y, ZHAO D L, et al. Association between the fetal-type posterior cerebral artery and intracranial anterior and posterior circulating atherosclerotic plaques using multi-contrast magnetic resonance vessel wall imaging[J]. Quant Imaging Med Surg, 2023, 13(12): 8383-8394. DOI: 10.21037/qims-23-611.

[14]

ISBELL D C, MEYER C H, ROGERS W J, et al. Reproducibility and reliability of atherosclerotic plaque volume measurements in peripheral arterial disease with cardiovascular magnetic resonance[J]. J Cardiovasc Magn Reson, 2007, 9(1): 71-76. DOI: 10.1080/10976640600843330.

[15]

CHIU B, SUN J, ZHAO X H, et al. Fast plaque burden assessment of the femoral artery using 3D black-blood MRI and automated segmentation[J]. Med Phys, 2011, 38(10): 5370-5384. DOI: 10.1118/1.3633899.

[16]

CHEN H W, HE X P, XIE G X, et al. Cardiovascular magnetic resonance black-blood thrombus imaging for the diagnosis of acute deep vein thrombosis at 1.5 Tesla[J/OL]. J Cardiovasc Magn Reson, 2018, 20(1): 42 [2024-06-14]. https://pubmed.ncbi.nlm.nih.gov/29936910/. DOI: 10.1186/s12968-018-0459-6.

[17]

ZHANG Z L, FAN Z Y, CARROLL T J, et al. Three-dimensional T2-weighted MRI of the human femoral arterial vessel wall at 3.0 Tesla[J]. Invest Radiol, 2009, 44(9): 619-626. DOI: 10.1097/RLI.0b013e3181b4c218.

[18]

BALU N, YARNYKH V L, CHU B C, et al. Carotid plaque assessment using fast 3D isotropic resolution black-blood MRI[J]. Magn Reson Med, 2011, 65(3): 627-637. DOI: 10.1002/mrm.22642.

[19]

WANG L, DENG W, LIANG J K, et al. Value of fast three-dimensional MR vessel wall imaging in assessment of peripheral atherosclerotic plaque[J]. J Pract Radiol, 2020, 36(4): 571-573, 619. DOI: 10.3969/j.issn.1002-1671.2020.04.016.

[20]

Vascular Surgery Group of the Chinese Medical Association Surgery Branch. Guidelines for diagnosis and treatment of arteriosclerosis obliterans of lower limbs (Ⅱ)[J/OL]. Chin J Vasc Surg Electron Version, 2015, 7(4): 229-238 [2024-06-14]. https://doi.org/10.3969/j.issn.1674-7429.2015.03.005. DOI: 10.3969/j.issn.1674-7429.2015.03.005.

[21]

SINHAROY A, REDDY N, LIN J K, et al. Magnetic resonance imaging based superficial femoral artery velocity measurements in peripheral artery disease[J]. Magn Reson Imaging, 2022, 93: 128-134. DOI: 10.1016/j.mri.2022.08.003.

[22]

MCDERMOTT M M, CARROLL T J, KIBBE M, et al. Proximal superficial femoral artery occlusion, collateral vessels, and walking performance in peripheral artery disease[J]. JACC Cardiovasc Imaging, 2013, 6(6): 687-694. DOI: 10.1016/j.jcmg.2012.10.024.

[23]

SPORKIN H L, PATEL T R, BETZ Y, et al. Chemical exchange saturation transfer magnetic resonance imaging identifies abnormal calf muscle-specific energetics in peripheral artery disease[J/OL]. Circ Cardiovasc Imaging, 2022, 15(7): e013869 [2024-06-15]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9310050/. DOI: 10.1161/CIRCIMAGING.121.013869.

[24]

HOSADURG N, KRAMER C M. Magnetic resonance imaging techniques in peripheral arterial disease[J]. Adv Wound Care, 2023, 12(11): 611-625. DOI: 10.1089/wound.2022.0161.

[25]

GAO S L. Practical anatomical Atlas: Lower Limb volume[M]. Shanghai: Shanghai Science and Technology Press, 2012.

[26]

MITANI K, FUNAKI T, TANJI M, et al. Detecting immunoglobulin G4-related intracranial arteriopathy with magnetic resonance vessel wall imaging: a preliminary experience in two cases[J/OL]. BMC Neurol, 2022, 22(1): 476 [2023-04-12]. https://pubmed.ncbi.nlm.nih.gov/36510148/. DOI: 10.1186/s12883-022-03010-8.

[27]

ZHAO H Y, CHEN Y K, CHEN L G, et al. Quantitative assessment of arterial wall by magnetic resonance 3D DANTE CUBE sequence: an experimental study compared with pathology[J]. Chin J Magn Reson Imag, 2022, 13(12): 111-116, 123. DOI: 10.12015/issn.1674-8034.2022.12.019.

[28]

ZHANG N. Magnetic resonance vessel wall imaging for early and accurate diagnosis of cerebrovascular disease[D].Shenzhen: Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 2018.

[29]

SHAO Q J. Application of 3D T1-SPACE high resolution MR vessel wall imaging in the follow-up of cerebral artery stenting[D].Zhengzhou: Zhengzhou University, 2021.

[30]

WAN L W, ZHANG N, ZHANG L, et al. Reproducibility of simultaneous imaging of intracranial and extracranial arterial vessel walls using an improved T1-weighted DANTE-SPACE sequence on a 3 T MR system[J]. Magn Reson Imag, 2019, 62: 152-158. DOI: 10.1016/j.mri.2019.04.016.

[31]

WEISS K J, EGGERS H, STEHNING C, et al. Feasibility and robustness of 3T magnetic resonance angiography using modified Dixon fat suppression in patients with known or suspected peripheral artery disease[J/OL]. Front Cardiovasc Med, 2020, 7: 549392 [2024-06-15]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661693/. DOI: 10.3389/fcvm.2020.549392.

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