An international multicenter comparison of time-SLIP unenhanced MR angiography and contrast-enhanced CT angiography for assessing renal artery stenosis: the renal artery contrast-free trial

Timothy S E Albert, Masaaki Akahane, Isabelle Parienty, Nancy Yellin, Violeta Catalá, Xavier Alomar, Antoine Prot, Nobuo Tomizawa, Huadan Xue, Venkata Katabathina, Jorge E Lopera, Zhengyu Jin

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Abstract

OBJECTIVE: The unenhanced MR angiography (MRA) technique time-spatial labeling inversion pulse (time-SLIP) may provide a safe alternative for evaluating the renal arteries for stenosis. This international multicenter trial tested the hypothesis that time-SLIP unenhanced MRA is accurate and robust for assessing the renal arteries for stenosis in comparison with contrast-enhanced CT angiography (CTA).

SUBJECTS AND METHODS: Four centers (United States, Europe, Asia) enrolled 75 patients (average age ± SD, 58 ± 13 years; 41 [55%] men and 34 [45%] women). Each patient underwent abdominal contrast-enhanced CTA and abdominal unenhanced MRA using time-SLIP with balanced steady-state free precession. All images were visually assessed for quality (arterial signal intensity) and for the absence or presence of renal artery stenosis (≤ 50% or > 50% stenosis, respectively). In addition, for arteries with any visible disease, the severity of the stenosis was quantified. Two blinded readers evaluated each study. No arteries were excluded from analysis.

RESULTS: Unenhanced MRA image quality was excellent for 56 of 75 patients (75%) and good for 16 of 75 patients (21%). CTA was used as the reference standard and showed that 23 of 161 renal arteries (14.3%) had stenosis > 50%. Unenhanced MRA correctly classified 17 of the 23 renal arteries with > 50% stenosis and correctly classified 128 of the 138 renal arteries as not having disease (≤ 50% stenosis) to yield a sensitivity of 74%, specificity of 93%, and accuracy of 90% (χ(2) = 0.56; p = 0.45, no statistically significant difference). Of the 16 misclassified arteries, only three had a clinically relevant misclassification (CTA ≥ 70% stenosis and unenhanced MRA ≤ 50% stenosis or unenhanced MRA ≥ 70% stenosis and CTA ≤ 50% stenosis). On average, measured stenotic severity (n = 28 arteries) was similar for unenhanced MRA (64% ± 17%) and CTA (62% ± 16%) (p = 0.51).

CONCLUSION: Compared with contrast-enhanced CTA, the unenhanced MRA technique time-SLIP shows promise for assessing the renal arteries for stenosis. The unenhanced MRA technique time-SLIP may provide a safe alternative for evaluating the renal arteries for stenosis.

Original languageEnglish (US)
Pages (from-to)182-188
Number of pages7
JournalAJR. American journal of roentgenology
Volume204
Issue number1
DOIs
StatePublished - Jan 1 2015

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Renal Artery Obstruction
Renal Artery
Angiography
Pathologic Constriction
Arteries
Computed Tomography Angiography
Multicenter Studies
Sensitivity and Specificity

Keywords

  • CT angiography
  • multicenter clinical trial
  • renal artery stenosis
  • unenhanced MR angiography

ASJC Scopus subject areas

  • Medicine(all)

Cite this

An international multicenter comparison of time-SLIP unenhanced MR angiography and contrast-enhanced CT angiography for assessing renal artery stenosis : the renal artery contrast-free trial. / Albert, Timothy S E; Akahane, Masaaki; Parienty, Isabelle; Yellin, Nancy; Catalá, Violeta; Alomar, Xavier; Prot, Antoine; Tomizawa, Nobuo; Xue, Huadan; Katabathina, Venkata; Lopera, Jorge E; Jin, Zhengyu.

In: AJR. American journal of roentgenology, Vol. 204, No. 1, 01.01.2015, p. 182-188.

Research output: Contribution to journalArticle

Albert, TSE, Akahane, M, Parienty, I, Yellin, N, Catalá, V, Alomar, X, Prot, A, Tomizawa, N, Xue, H, Katabathina, V, Lopera, JE & Jin, Z 2015, 'An international multicenter comparison of time-SLIP unenhanced MR angiography and contrast-enhanced CT angiography for assessing renal artery stenosis: the renal artery contrast-free trial', AJR. American journal of roentgenology, vol. 204, no. 1, pp. 182-188. https://doi.org/10.2214/AJR.13.12022
Albert, Timothy S E ; Akahane, Masaaki ; Parienty, Isabelle ; Yellin, Nancy ; Catalá, Violeta ; Alomar, Xavier ; Prot, Antoine ; Tomizawa, Nobuo ; Xue, Huadan ; Katabathina, Venkata ; Lopera, Jorge E ; Jin, Zhengyu. / An international multicenter comparison of time-SLIP unenhanced MR angiography and contrast-enhanced CT angiography for assessing renal artery stenosis : the renal artery contrast-free trial. In: AJR. American journal of roentgenology. 2015 ; Vol. 204, No. 1. pp. 182-188.
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title = "An international multicenter comparison of time-SLIP unenhanced MR angiography and contrast-enhanced CT angiography for assessing renal artery stenosis: the renal artery contrast-free trial",
abstract = "OBJECTIVE: The unenhanced MR angiography (MRA) technique time-spatial labeling inversion pulse (time-SLIP) may provide a safe alternative for evaluating the renal arteries for stenosis. This international multicenter trial tested the hypothesis that time-SLIP unenhanced MRA is accurate and robust for assessing the renal arteries for stenosis in comparison with contrast-enhanced CT angiography (CTA).SUBJECTS AND METHODS: Four centers (United States, Europe, Asia) enrolled 75 patients (average age ± SD, 58 ± 13 years; 41 [55{\%}] men and 34 [45{\%}] women). Each patient underwent abdominal contrast-enhanced CTA and abdominal unenhanced MRA using time-SLIP with balanced steady-state free precession. All images were visually assessed for quality (arterial signal intensity) and for the absence or presence of renal artery stenosis (≤ 50{\%} or > 50{\%} stenosis, respectively). In addition, for arteries with any visible disease, the severity of the stenosis was quantified. Two blinded readers evaluated each study. No arteries were excluded from analysis.RESULTS: Unenhanced MRA image quality was excellent for 56 of 75 patients (75{\%}) and good for 16 of 75 patients (21{\%}). CTA was used as the reference standard and showed that 23 of 161 renal arteries (14.3{\%}) had stenosis > 50{\%}. Unenhanced MRA correctly classified 17 of the 23 renal arteries with > 50{\%} stenosis and correctly classified 128 of the 138 renal arteries as not having disease (≤ 50{\%} stenosis) to yield a sensitivity of 74{\%}, specificity of 93{\%}, and accuracy of 90{\%} (χ(2) = 0.56; p = 0.45, no statistically significant difference). Of the 16 misclassified arteries, only three had a clinically relevant misclassification (CTA ≥ 70{\%} stenosis and unenhanced MRA ≤ 50{\%} stenosis or unenhanced MRA ≥ 70{\%} stenosis and CTA ≤ 50{\%} stenosis). On average, measured stenotic severity (n = 28 arteries) was similar for unenhanced MRA (64{\%} ± 17{\%}) and CTA (62{\%} ± 16{\%}) (p = 0.51).CONCLUSION: Compared with contrast-enhanced CTA, the unenhanced MRA technique time-SLIP shows promise for assessing the renal arteries for stenosis. The unenhanced MRA technique time-SLIP may provide a safe alternative for evaluating the renal arteries for stenosis.",
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T1 - An international multicenter comparison of time-SLIP unenhanced MR angiography and contrast-enhanced CT angiography for assessing renal artery stenosis

T2 - the renal artery contrast-free trial

AU - Albert, Timothy S E

AU - Akahane, Masaaki

AU - Parienty, Isabelle

AU - Yellin, Nancy

AU - Catalá, Violeta

AU - Alomar, Xavier

AU - Prot, Antoine

AU - Tomizawa, Nobuo

AU - Xue, Huadan

AU - Katabathina, Venkata

AU - Lopera, Jorge E

AU - Jin, Zhengyu

PY - 2015/1/1

Y1 - 2015/1/1

N2 - OBJECTIVE: The unenhanced MR angiography (MRA) technique time-spatial labeling inversion pulse (time-SLIP) may provide a safe alternative for evaluating the renal arteries for stenosis. This international multicenter trial tested the hypothesis that time-SLIP unenhanced MRA is accurate and robust for assessing the renal arteries for stenosis in comparison with contrast-enhanced CT angiography (CTA).SUBJECTS AND METHODS: Four centers (United States, Europe, Asia) enrolled 75 patients (average age ± SD, 58 ± 13 years; 41 [55%] men and 34 [45%] women). Each patient underwent abdominal contrast-enhanced CTA and abdominal unenhanced MRA using time-SLIP with balanced steady-state free precession. All images were visually assessed for quality (arterial signal intensity) and for the absence or presence of renal artery stenosis (≤ 50% or > 50% stenosis, respectively). In addition, for arteries with any visible disease, the severity of the stenosis was quantified. Two blinded readers evaluated each study. No arteries were excluded from analysis.RESULTS: Unenhanced MRA image quality was excellent for 56 of 75 patients (75%) and good for 16 of 75 patients (21%). CTA was used as the reference standard and showed that 23 of 161 renal arteries (14.3%) had stenosis > 50%. Unenhanced MRA correctly classified 17 of the 23 renal arteries with > 50% stenosis and correctly classified 128 of the 138 renal arteries as not having disease (≤ 50% stenosis) to yield a sensitivity of 74%, specificity of 93%, and accuracy of 90% (χ(2) = 0.56; p = 0.45, no statistically significant difference). Of the 16 misclassified arteries, only three had a clinically relevant misclassification (CTA ≥ 70% stenosis and unenhanced MRA ≤ 50% stenosis or unenhanced MRA ≥ 70% stenosis and CTA ≤ 50% stenosis). On average, measured stenotic severity (n = 28 arteries) was similar for unenhanced MRA (64% ± 17%) and CTA (62% ± 16%) (p = 0.51).CONCLUSION: Compared with contrast-enhanced CTA, the unenhanced MRA technique time-SLIP shows promise for assessing the renal arteries for stenosis. The unenhanced MRA technique time-SLIP may provide a safe alternative for evaluating the renal arteries for stenosis.

AB - OBJECTIVE: The unenhanced MR angiography (MRA) technique time-spatial labeling inversion pulse (time-SLIP) may provide a safe alternative for evaluating the renal arteries for stenosis. This international multicenter trial tested the hypothesis that time-SLIP unenhanced MRA is accurate and robust for assessing the renal arteries for stenosis in comparison with contrast-enhanced CT angiography (CTA).SUBJECTS AND METHODS: Four centers (United States, Europe, Asia) enrolled 75 patients (average age ± SD, 58 ± 13 years; 41 [55%] men and 34 [45%] women). Each patient underwent abdominal contrast-enhanced CTA and abdominal unenhanced MRA using time-SLIP with balanced steady-state free precession. All images were visually assessed for quality (arterial signal intensity) and for the absence or presence of renal artery stenosis (≤ 50% or > 50% stenosis, respectively). In addition, for arteries with any visible disease, the severity of the stenosis was quantified. Two blinded readers evaluated each study. No arteries were excluded from analysis.RESULTS: Unenhanced MRA image quality was excellent for 56 of 75 patients (75%) and good for 16 of 75 patients (21%). CTA was used as the reference standard and showed that 23 of 161 renal arteries (14.3%) had stenosis > 50%. Unenhanced MRA correctly classified 17 of the 23 renal arteries with > 50% stenosis and correctly classified 128 of the 138 renal arteries as not having disease (≤ 50% stenosis) to yield a sensitivity of 74%, specificity of 93%, and accuracy of 90% (χ(2) = 0.56; p = 0.45, no statistically significant difference). Of the 16 misclassified arteries, only three had a clinically relevant misclassification (CTA ≥ 70% stenosis and unenhanced MRA ≤ 50% stenosis or unenhanced MRA ≥ 70% stenosis and CTA ≤ 50% stenosis). On average, measured stenotic severity (n = 28 arteries) was similar for unenhanced MRA (64% ± 17%) and CTA (62% ± 16%) (p = 0.51).CONCLUSION: Compared with contrast-enhanced CTA, the unenhanced MRA technique time-SLIP shows promise for assessing the renal arteries for stenosis. The unenhanced MRA technique time-SLIP may provide a safe alternative for evaluating the renal arteries for stenosis.

KW - CT angiography

KW - multicenter clinical trial

KW - renal artery stenosis

KW - unenhanced MR angiography

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