Fausto Biancari, MD, PhD; Tatu Juvonen, MD, PhD
In adults with peripheral arterial disease (PAD), how accurate is contrast-enhanced magnetic resonance angiography (MRA) for assessing steno-occlusions?
Included studies compared contrast-enhanced MRA, including intravenous injection of gadolinium chelates (except from blood-pool contrast agents), with intraarterial digital subtraction angiography (DSA) in adults with known or suspected PAD of the lower extremities. Outcomes included sensitivity and specificity for detecting arterial steno-occlusions (50% to 100% lumen reduction) in the entire arterial tree and in each of the aortoiliac, femoropopliteal, and tibiofibular arterial regions.
MEDLINE, Scopus, BIOSIS Previews, Web of Science (1998 to 2009), and reference lists of retrieved articles were searched for prospective studies that included ≥ 10 patients, applied homogeneous imaging techniques, and reported sufficient data to reconstruct 2 x 2 or 3 x 3 contingency tables for the studied arterial segments. 32 studies (n = 1022, mean age 58 to 82 y, 46% to 90% men where reported), met the selection criteria. 20 studies examined the entire lower extremity region, and 12 investigated specific arterial subregions only. 7 studies compared 2 MRA techniques to intraarterial DSA; 4 of these assessed both techniques in the same patients. Median score on the Quality Assessment of Diagnostic Accuracy Studies tool was 13 out of 14 points (range 11.5 to 14).
The segmental prevalence of PAD ranged from 6% to 59%. The Table shows the diagnostic test characteristics for contrast-enhanced MRA. There was significant between-study heterogeneity for both sensitivity (I2 = 81%, P < 0.001) and specificity (I2 = 89%, P < 0.001).
In adults with peripheral arterial disease, contrast-enhanced magnetic resonance angiography has high sensitivity and specificity for assessing steno-occlusions.
Test characteristics of contrast-enhanced magnetic resonance angiography (MRA) for diagnosing steno-occlusions in patients with peripheral arterial disease*
*Abbreviations and diagnostic terms defined in Glossary. Gold standard was intraarterial digital subtraction angiography (DSA).
†7 studies compared 2 MRA techniques with DSA, resulting in more comparisons than studies. Patients contributing to 2 comparisons contributed to n twice.
Biancari F, Juvonen T. Review: Contrast-enhanced MRA is highly accurate for diagnosing steno-occlusions in peripheral arterial disease. Ann Intern Med. ;154:JC1–11. doi: 10.7326/0003-4819-154-2-201101180-02011
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Published: Ann Intern Med. 2011;154(2):JC1-11.
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