Adrienne Lam MBBS, Presenter: Nothing to Disclose

Matthew William Lukies MBBS, Abstract Co-Author: Nothing to Disclose

Dinesh Gerard Ranatunga MBBS, Abstract Co-Author: Nothing to Disclose

Yuliya Perchyonok MBBS, Abstract Co-Author: Nothing to Disclose

Emma Hornsey, Abstract Co-Author: Nothing to Disclose

Brenden McColl, Abstract Co-Author: Nothing to Disclose

Jason Chuen, Abstract Co-Author: Nothing to Disclose

Pei-Heng Ko, Abstract Co-Author: Nothing to Disclose

Robert R. Edelman MD, Abstract Co-Author: Research support, Siemens AG Royalties, Siemens AG

Ruth P. Lim MBBS, MMed, Abstract Co-Author: Nothing to Disclose

Jason Heidrich, Abstract Co-Author: Nothing to Disclose

To assess feasibility of non-contrast quiescent interval single shot arterial spin labeled MRA (QISS-ASL MRA) for pedal artery evaluation. 

5 subjects, comprising 1 healthy (67y) volunteer and 4 diabetic patients (mean 81y) with symptomatic peripheral arterial disease (PAD) were prospectively recruited for bilateral foot QISS-ASL MRA at 1.5T. Imaging was performed using a head-coil with two consecutive QISS acquisitions: a) slice-selective saturation to suppress non-arterial signal, and b) non-selective saturation. Subsequently, subtraction of the two datasets (a-b) was performed. Total imaging time was approximately 8 minutes. Two radiologists independently analysed anonymized source and subtraction datasets for: image quality (IQ), 1=non-diagnostic, 3=sufficient for diagnosis, 5=excellent; and, presence of hemodynamically significant (≥50%) stenosis in defined arterial segments, including the dorsalis pedis and plantar arteries. Weighted kappa statistics were performed to evaluate inter-rater agreement for stenosis assessment. DSA correlation of stenosis assessment was performed where available.

All subjects completed QISS-ASL MRA. 64 segments were identified in 10 feet. 60/64 segments and 53/64 segments were diagnostic for readers 1 and 2 respectively, with susceptibility artifact from orthopaedic hardware and image noise degrading image quality in the remainder. Mean IQ scores were 3.8±0.6 and 3.0±0.7 for readers 1 and 2 respectively. Inter-rater agreement for hemodynamically significant stenosis was 0.54. DSA was available in 19 segments (n=2 patients) with 17/19 demonstrating hemodynamically significant stenosis at the reference standard. MRA concordance in identifying hemodynamically significant stenosis was 14/19 and 15/19 for readers 1 and 2 respectively. 

QISS-ASL MRA is feasible for visualisation of pedal segments in diabetic patients with severe PAD. It provides a potential alternative to contrast-enhanced techniques, which are challenging and carry associated risk in renal impairment. Further evaluation in a larger clinical population is required to assess accuracy and effectiveness of the technique. 

QISS-ASL MRA is a safe, feasible non-contrast alternative for analysis of distal bypass targets in diabetic patients with symptomatic peripheral arterial disease.

Lam, A, Lukies, M, Ranatunga, D, Perchyonok, Y, Hornsey, E, McColl, B, Chuen, J, Ko, P, Edelman, R, Lim, R, Heidrich, J, Non-contrast Quiescent Interval Single Shot Arterial Spin Labeled MRA: Feasibility for Pedal Artery Imaging in Diabetic Patients with Symptomatic Peripheral Arterial Disease.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012988.html