NCE-MRA Study Of Lower Extremity Arterial Disease In Patients With Type 2 Diabetes

PURPOSE:This study aims to obtain initial data to assess the performance of a novel non-contrast magnetic resonance angiography technique (fresh-blood imaging, FBI) in comparison to contrast-enhanced magnetic resonance angiography (CE-MRA) for the evaluation of lower extremity peripheral arterial disease (PAD) with type 2 diabetes patients.MATERIALS AND METHODS:1、The 44 patients with diabetes suspected of lower extremity peripheral vascular disease were selected for FBI and CE-MRA examination.2、Two readers experienced cardiovascular radiologist, to negotiate image quality of FBI and CE-MRA, also assessed the presence and severity of stenotic lesions. The similar analysis was performed for the CE-MRA images.3、 FBI combined with CE-MRA as a diagnostic reference standard evaluated FBI image quality whether significant differences from CE-MRA.4、The artery stenosis evaluated by CE-MRA as a standard, evaluated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden’s index of the FBI.5、The correlation analysis of Fontaine stage with all indexes of FBI.RESULTS:1、44 patients image quality scores of FBI and CE-MRA demonstrated no statistical differences in Fontaine Ⅰ-Ⅲstages (P>0.05), while the Fontaine IV period was statistical differences (P< 0.05), the FBI image quality a little poor in Fontaine IV period,2、FBI and CE-MRA were showed 885 and 904 arterial branches. Fontaine Ⅰ-Ⅲ artery branches of the FBI and CE-MRA showed no statistical difference (P> 0.05), Fontaine IV artery branches of FBI slightly less than CE-MRA.3、FBI vs. CE-MRA of tissue interference FBI was less than CE-MRA.4、The average sensitivity, specificity, positive predictive value, negative predictive value, and Youden’s index of FBI were 90.4%,98.1%,98.1%, 99.0%,and 0.88,which was by using CE-MRA as the gold standard.5、The study showed that with Fontaine stages going on the FBI’s image quality and arterial branches reduced gradually, and the degree of tissue interference and artery stenosis rising gradually. The diagnosis accuracy of FBI in Fontaine Ⅰ-Ⅲ periods were higher than Fontaine IV, but it still showed high sensitivity(87.5%) and specificity (91.9%)in Fontaine IV.CONCLUSION:This study suggests that FBI in lower extremity PAD of liabetics has good quality and high diagnostic accuracy, and no tissue interference. Especially in Fontaine Ⅰ-Ⅲ patients, FBI can be used as an alternative of CE-MRA, while the Fontaine Ⅳ diabetic patients with renal impairment can also be used.