CT Versus MR for the Runoff
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1 CT Versus MR for the Runoff Robert R. Edelman, M.D. Dept. of Radiology NorthShore University HealthSystem Feinberg School of Medicine, Northwestern University
2 Magnetic Resonance Computed Tomography Radio waves/magnetic fields Arbitrary slice orientation Easy to suppress bone/calcium Contrast agents safer* Anatomy + function Ionizing radiation Axial slice orientation only Must segment out bone/calcium Nephrotoxicity, allergic rxn Anatomy only *NSF!
3 Aortoiliac and Renal Arteries: Prospective Intraindividual Comparison of Contrast-enhanced Three-dimensional MR Angiography and Multi Detector Row CT Angiography Radiology 2003; 226:
4 Aortoiliac and Renal Arteries: Prospective Intraindividual Comparison of Contrast-enhanced Three-dimensional MR Angiography and Multi Detector Row CT Angiography Radiology 2003; 226:
5 Aortoiliac and Renal Arteries: Prospective Intraindividual Comparison of Contrast-enhanced Three-dimensional MR Angiography and Multi Detector Row CT Angiography Radiology 2003; 226:
6 Renal Artery Stenosis: MRA may overestimate stenosis
7 CTA Better for Renal Stent Evaluation Edison Imaging
8 Accuracy of Computed Tomographic Angiography and Magnetic Resonance Angiography for Diagnosing Renal Artery Stenosis Ann Intern Med. 2004;141: Prospective multicenter comparative study conducted from 1998 to 2001 COMMENTARY 402 hypertensive patients with suspected renal artery In stenosis this study, were the included average pretest probability was 0.20 (pretest odds, 1:4). Combined Given the sensitivity negative likelihood and specificity ratio were of % for and CTA 92% and for 0.45 CTA for MRA, and 62% the post-test and 84% odds for MRA would be about 1:10 after negative test results. Therefore, Is that not low recommended enough to stop as testing? substitute for DSA 38% incidence of FMD Variety of CT and MR scanners and protocols
9 Fibromuscular Dysplasia of the Main Renal Arteries: Comparison of Contrast-enhanced MR Angiography with Digital Subtraction Angiography Radiology: Volume 241: Number 3 December 2006 p922 *retrospective study of 25 patients over 6 years, various MR scanners
10 Multidetector spiral CT renal angiography in the diagnosis of renal artery fibromuscular dysplasia Eur J Radiol Mar;61(3): patients with proven FMD, Age range years CTA identified all 42 main renal arteries (100%) and all 10 accessory renal arteries (100%) visualized on CA. In the diagnosis of FMD, CTA detected all 40 (100%) lesions detected by CA.
11 Fibromuscular Dysplasia MRA CTA
12 Peripheral MRA Year # Patients Technique Sensitivity Specificity Owen (NEJM) D TOF superior to DSA Baum (JAMA) D TOF Prince (Radiology) D Gd Snidow (Radiology) D Gd Hany (Radiology) D Gd Ho (Radiology) Bolus chase Meaney (Radiology) Bolus Chase Yamashita (JMRI) D Gd Lee (Radiology) D Gd Winchester (JMRI) D Gd Link (Radiology) D Gd (post stent)
13 Recommendations MRA: CTA: Distal disease (e.g. limb-threatening ischemia), but Pulmonary good for Embolism proximal disease as well Aorta, RAS except proximal (maybe) peripheral for suspected artery disease FMD (e.g. Time-resolved claudication) imaging, function Subtle Note Gadolinium abnormalities chelates (e.g. renal generally FMD) safe in patients Suboptimal with MR abnormal capability renal function or diabetes, but now have to worry about NSF! Note Pacemakers, stents ok No pacemakers; stents give artifacts But requires iodinated contrast medium; must consider renal function; radiation exposure in younger patients
14 Peripheral CTA: Faster, Easier Set-up Than MRA Edison Imaging / NJ Neuroscience
15 Interobserver Agreement for the Interpretation of Contrast-Enhanced 3D MR Angiography and MDCT Angiography in Peripheral Arterial Disease AJR 2005; 185:
16 Interobserver Agreement for the Interpretation of Contrast-Enhanced 3D MR Angiography and MDCT Angiography in Peripheral Arterial Disease AJR 2005; 185:
17 CTA Excellent for Evaluation of Stent Grafts Edison Imaging
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