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Aortoiliac and Renal Arteries: Prospective Intraindividual Comparison of Contrast-enhanced Three-dimensional MR Angiography and Multi–Detector Row CT Angiography¹

¹ From the Institute of Diagnostic Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (J.K.W., S.W., T.P., J.E.R., P.R.H., B.M., D.W.); and Department of Biostatistics, University of Zurich, Switzerland (B.S.). From the 2002 RSNA scientific assembly. Received February 1, 2002; revision requested April 1; revision received June 11; accepted October 4. Address correspondence to D.W. (e-mail: dominik.weishaupt@dmr.usz.ch).

View larger version (115K): [in a new window]   Figure 1a. Images in an 81-year-old man with aneurysms in both common iliac arteries. (a) Frontal intraarterial DSA image demonstrates a large aneurysm (large arrows) in the right common iliac artery and a smaller aneurysm (small arrows) in the left common iliac artery. Note additional infrarenal aortic elongation and buckling, as well as ectasia of both external iliac arteries. (b) Anteroposterior volume-rendered image of coronal contrast-enhanced 3D MR angiogram (5/1; flip angle, 30°) obtained in the same patient as in a shows the same findings (arrows) as those on the DSA image. (c) The same aneurysms (arrows) are also depicted on the anteroposterior volume-rendered multi-detector row CT angiogram (nominal section thickness, 1 mm; pitch, 6). Both aneurysms were detected by both readers on the basis of analysis of the standardized volume-rendered images and MIPs. No additional interactive reformatting was needed with either modality.

View larger version (78K): [in a new window]   Figure 1b. Images in an 81-year-old man with aneurysms in both common iliac arteries. (a) Frontal intraarterial DSA image demonstrates a large aneurysm (large arrows) in the right common iliac artery and a smaller aneurysm (small arrows) in the left common iliac artery. Note additional infrarenal aortic elongation and buckling, as well as ectasia of both external iliac arteries. (b) Anteroposterior volume-rendered image of coronal contrast-enhanced 3D MR angiogram (5/1; flip angle, 30°) obtained in the same patient as in a shows the same findings (arrows) as those on the DSA image. (c) The same aneurysms (arrows) are also depicted on the anteroposterior volume-rendered multi-detector row CT angiogram (nominal section thickness, 1 mm; pitch, 6). Both aneurysms were detected by both readers on the basis of analysis of the standardized volume-rendered images and MIPs. No additional interactive reformatting was needed with either modality.

View larger version (89K): [in a new window]   Figure 1c. Images in an 81-year-old man with aneurysms in both common iliac arteries. (a) Frontal intraarterial DSA image demonstrates a large aneurysm (large arrows) in the right common iliac artery and a smaller aneurysm (small arrows) in the left common iliac artery. Note additional infrarenal aortic elongation and buckling, as well as ectasia of both external iliac arteries. (b) Anteroposterior volume-rendered image of coronal contrast-enhanced 3D MR angiogram (5/1; flip angle, 30°) obtained in the same patient as in a shows the same findings (arrows) as those on the DSA image. (c) The same aneurysms (arrows) are also depicted on the anteroposterior volume-rendered multi-detector row CT angiogram (nominal section thickness, 1 mm; pitch, 6). Both aneurysms were detected by both readers on the basis of analysis of the standardized volume-rendered images and MIPs. No additional interactive reformatting was needed with either modality.

View larger version (127K): [in a new window]   Figure 2a. Images in a 68-year-old man with right leg claudication. (a) Frontal DSA image demonstrates hemodynamically significant arterial stenosis (grade 3, 50%-99% luminal narrowing; arrow) of the right common iliac artery. (b, c) Both readers graded the arterial stenosis of the right common iliac artery as hemodynamically significant stenosis (grade 3; arrows) on the basis of standardized volume-rendered images obtained from coronal contrast-enhanced 3D MR angiographic data (b; anteroposterior view) and multi-detector row CT angiographic data (c; anteroposterior view). Interactive reformatting was not performed by both readers. In addition, hemodynamically significant stenosis (grade 3) of the proximal segment of the left external iliac artery was also noted by both readers on volume-rendered images from MR and multi-detector row CT angiography and DSA.

View larger version (46K): [in a new window]   Figure 2b. Images in a 68-year-old man with right leg claudication. (a) Frontal DSA image demonstrates hemodynamically significant arterial stenosis (grade 3, 50%-99% luminal narrowing; arrow) of the right common iliac artery. (b, c) Both readers graded the arterial stenosis of the right common iliac artery as hemodynamically significant stenosis (grade 3; arrows) on the basis of standardized volume-rendered images obtained from coronal contrast-enhanced 3D MR angiographic data (b; anteroposterior view) and multi-detector row CT angiographic data (c; anteroposterior view). Interactive reformatting was not performed by both readers. In addition, hemodynamically significant stenosis (grade 3) of the proximal segment of the left external iliac artery was also noted by both readers on volume-rendered images from MR and multi-detector row CT angiography and DSA.

View larger version (89K): [in a new window]   Figure 2c. Images in a 68-year-old man with right leg claudication. (a) Frontal DSA image demonstrates hemodynamically significant arterial stenosis (grade 3, 50%-99% luminal narrowing; arrow) of the right common iliac artery. (b, c) Both readers graded the arterial stenosis of the right common iliac artery as hemodynamically significant stenosis (grade 3; arrows) on the basis of standardized volume-rendered images obtained from coronal contrast-enhanced 3D MR angiographic data (b; anteroposterior view) and multi-detector row CT angiographic data (c; anteroposterior view). Interactive reformatting was not performed by both readers. In addition, hemodynamically significant stenosis (grade 3) of the proximal segment of the left external iliac artery was also noted by both readers on volume-rendered images from MR and multi-detector row CT angiography and DSA.

View larger version (142K): [in a new window]   Figure 3a. Images in a 67-year-old man with left leg claudication. (a) Frontal DSA image demonstrates high-grade arterial stenosis (grade 3, 50%-99% luminal narrowing; arrow) of the left common iliac artery, which was also diagnosed by both readers on (b) the corresponding standardized volume-rendered image (anteroposterior view; arrow) reconstructed from coronal contrast-enhanced 3D MR angiographic data. Additional interactive reformatting was not needed by both readers. (c) Because of overlying calcifications, grading of arterial stenosis was not considered possible on standardized volume-rendered images (anteroposterior view) obtained with multi-detector row CT angiography. (d) After evaluating transverse source images, however, arterial stenosis of the left common iliac artery (arrow) was diagnosed correctly as grade 3 by both readers. In addition, a hemodynamically significant arterial stenosis of the right common iliac artery is noted on the DSA image, as well as on the MR angiogram. Because of overlaying calcification, the stenosis is not seen on c. However, the stenosis was correctly classified on the basis of source data (not shown). Extensive calcifications (white areas) of both renal arteries, the infrarenal aorta, the splenic artery, and both internal iliac arteries are noted on the volume-rendered image obtained with multi-detector row CT angiography.

View larger version (90K): [in a new window]   Figure 3b. Images in a 67-year-old man with left leg claudication. (a) Frontal DSA image demonstrates high-grade arterial stenosis (grade 3, 50%-99% luminal narrowing; arrow) of the left common iliac artery, which was also diagnosed by both readers on (b) the corresponding standardized volume-rendered image (anteroposterior view; arrow) reconstructed from coronal contrast-enhanced 3D MR angiographic data. Additional interactive reformatting was not needed by both readers. (c) Because of overlying calcifications, grading of arterial stenosis was not considered possible on standardized volume-rendered images (anteroposterior view) obtained with multi-detector row CT angiography. (d) After evaluating transverse source images, however, arterial stenosis of the left common iliac artery (arrow) was diagnosed correctly as grade 3 by both readers. In addition, a hemodynamically significant arterial stenosis of the right common iliac artery is noted on the DSA image, as well as on the MR angiogram. Because of overlaying calcification, the stenosis is not seen on c. However, the stenosis was correctly classified on the basis of source data (not shown). Extensive calcifications (white areas) of both renal arteries, the infrarenal aorta, the splenic artery, and both internal iliac arteries are noted on the volume-rendered image obtained with multi-detector row CT angiography.

View larger version (95K): [in a new window]   Figure 3c. Images in a 67-year-old man with left leg claudication. (a) Frontal DSA image demonstrates high-grade arterial stenosis (grade 3, 50%-99% luminal narrowing; arrow) of the left common iliac artery, which was also diagnosed by both readers on (b) the corresponding standardized volume-rendered image (anteroposterior view; arrow) reconstructed from coronal contrast-enhanced 3D MR angiographic data. Additional interactive reformatting was not needed by both readers. (c) Because of overlying calcifications, grading of arterial stenosis was not considered possible on standardized volume-rendered images (anteroposterior view) obtained with multi-detector row CT angiography. (d) After evaluating transverse source images, however, arterial stenosis of the left common iliac artery (arrow) was diagnosed correctly as grade 3 by both readers. In addition, a hemodynamically significant arterial stenosis of the right common iliac artery is noted on the DSA image, as well as on the MR angiogram. Because of overlaying calcification, the stenosis is not seen on c. However, the stenosis was correctly classified on the basis of source data (not shown). Extensive calcifications (white areas) of both renal arteries, the infrarenal aorta, the splenic artery, and both internal iliac arteries are noted on the volume-rendered image obtained with multi-detector row CT angiography.

View larger version (108K): [in a new window]   Figure 3d. Images in a 67-year-old man with left leg claudication. (a) Frontal DSA image demonstrates high-grade arterial stenosis (grade 3, 50%-99% luminal narrowing; arrow) of the left common iliac artery, which was also diagnosed by both readers on (b) the corresponding standardized volume-rendered image (anteroposterior view; arrow) reconstructed from coronal contrast-enhanced 3D MR angiographic data. Additional interactive reformatting was not needed by both readers. (c) Because of overlying calcifications, grading of arterial stenosis was not considered possible on standardized volume-rendered images (anteroposterior view) obtained with multi-detector row CT angiography. (d) After evaluating transverse source images, however, arterial stenosis of the left common iliac artery (arrow) was diagnosed correctly as grade 3 by both readers. In addition, a hemodynamically significant arterial stenosis of the right common iliac artery is noted on the DSA image, as well as on the MR angiogram. Because of overlaying calcification, the stenosis is not seen on c. However, the stenosis was correctly classified on the basis of source data (not shown). Extensive calcifications (white areas) of both renal arteries, the infrarenal aorta, the splenic artery, and both internal iliac arteries are noted on the volume-rendered image obtained with multi-detector row CT angiography.

View larger version (148K): [in a new window]   Figure 4a. Images in a 73-year-old man with generalized atherosclerosis and left leg claudication. (a) Frontal DSA image shows hemodynamically insignificant stenosis (grade 2, 10%-50% luminal narrowing; arrow) of the proximal segment of the left renal artery. (b, c) Arterial stenosis was graded as hemodynamically insignificant (grade 2; arrow) by both readers on the basis of anteroposterior standardized volume-rendered images reconstructed from coronal contrast-enhanced 3D MR angiographic data, without the need for additional interactive reformatting. Neither reader was able to assess the proximal segment of the left renal artery due to overlying arterial wall calcification (arrow) on standardized volume-rendered images obtained with multi-detector row CT angiography. Therefore, analysis of the source data was required by both readers. (d) On the transverse source image of multi-detector row CT angiographic data, reader 2 correctly graded arterial stenosis as grade 2 (arrow). Reader 1 overestimated arterial stenosis as grade 3 (50%-99% luminal narrowing). Note calcification of the right proximal renal artery.

View larger version (100K): [in a new window]   Figure 4b. Images in a 73-year-old man with generalized atherosclerosis and left leg claudication. (a) Frontal DSA image shows hemodynamically insignificant stenosis (grade 2, 10%-50% luminal narrowing; arrow) of the proximal segment of the left renal artery. (b, c) Arterial stenosis was graded as hemodynamically insignificant (grade 2; arrow) by both readers on the basis of anteroposterior standardized volume-rendered images reconstructed from coronal contrast-enhanced 3D MR angiographic data, without the need for additional interactive reformatting. Neither reader was able to assess the proximal segment of the left renal artery due to overlying arterial wall calcification (arrow) on standardized volume-rendered images obtained with multi-detector row CT angiography. Therefore, analysis of the source data was required by both readers. (d) On the transverse source image of multi-detector row CT angiographic data, reader 2 correctly graded arterial stenosis as grade 2 (arrow). Reader 1 overestimated arterial stenosis as grade 3 (50%-99% luminal narrowing). Note calcification of the right proximal renal artery.

View larger version (127K): [in a new window]   Figure 4c. Images in a 73-year-old man with generalized atherosclerosis and left leg claudication. (a) Frontal DSA image shows hemodynamically insignificant stenosis (grade 2, 10%-50% luminal narrowing; arrow) of the proximal segment of the left renal artery. (b, c) Arterial stenosis was graded as hemodynamically insignificant (grade 2; arrow) by both readers on the basis of anteroposterior standardized volume-rendered images reconstructed from coronal contrast-enhanced 3D MR angiographic data, without the need for additional interactive reformatting. Neither reader was able to assess the proximal segment of the left renal artery due to overlying arterial wall calcification (arrow) on standardized volume-rendered images obtained with multi-detector row CT angiography. Therefore, analysis of the source data was required by both readers. (d) On the transverse source image of multi-detector row CT angiographic data, reader 2 correctly graded arterial stenosis as grade 2 (arrow). Reader 1 overestimated arterial stenosis as grade 3 (50%-99% luminal narrowing). Note calcification of the right proximal renal artery.

View larger version (92K): [in a new window]   Figure 4d. Images in a 73-year-old man with generalized atherosclerosis and left leg claudication. (a) Frontal DSA image shows hemodynamically insignificant stenosis (grade 2, 10%-50% luminal narrowing; arrow) of the proximal segment of the left renal artery. (b, c) Arterial stenosis was graded as hemodynamically insignificant (grade 2; arrow) by both readers on the basis of anteroposterior standardized volume-rendered images reconstructed from coronal contrast-enhanced 3D MR angiographic data, without the need for additional interactive reformatting. Neither reader was able to assess the proximal segment of the left renal artery due to overlying arterial wall calcification (arrow) on standardized volume-rendered images obtained with multi-detector row CT angiography. Therefore, analysis of the source data was required by both readers. (d) On the transverse source image of multi-detector row CT angiographic data, reader 2 correctly graded arterial stenosis as grade 2 (arrow). Reader 1 overestimated arterial stenosis as grade 3 (50%-99% luminal narrowing). Note calcification of the right proximal renal artery.