Comparison of Magnetic Resonance Angiography and Digital Subtraction Angiography for the Assessment of Infrapopliteal Arterial Occlusive Lesions, Based on the TASC II Classification Criteria

Erik Baubeta Fridh; Karin Ludwigs; Angelica Svalkvist; Manne Andersson; Joakim Nordanstig; Mårten Falkenberg; Åse A Johnsson

doi:10.3390/diagnostics10110892

Comparison of Magnetic Resonance Angiography and Digital Subtraction Angiography for the Assessment of Infrapopliteal Arterial Occlusive Lesions, Based on the TASC II Classification Criteria

Diagnostics (Basel). 2020 Oct 31;10(11):892. doi: 10.3390/diagnostics10110892.

Authors

Erik Baubeta Fridh¹, Karin Ludwigs^{2

3}, Angelica Svalkvist^{4

5}, Manne Andersson^{6

7}, Joakim Nordanstig⁸, Mårten Falkenberg^{2

9}, Åse A Johnsson^{2

9}

Affiliations

¹ Diagnostic Radiology, Department of Translational Medicine, Lund University, Skåne University Hospital, 22185 Lund, Sweden.
² Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41296 Gothenburg, Sweden.
³ Section of Vascular Surgery, Surgical and Ear Clinic, Södra Älvsborg Hospital, 50182 Borås, Sweden.
⁴ Department of Medical Imaging and Biomedical Engineering, Sahlgrenska University Hospital, S-41685 Gothenburg, Sweden.
⁵ Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden.
⁶ Department of Vascular Surgery, Ryhov County Hospital, 55185 Jönköping, Sweden.
⁷ Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 58183 Linköping, Sweden.
⁸ Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden.
⁹ Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, 41685 Gothenburg, Sweden.

Abstract

This paper aimed to study the agreement and repeatability, both intra- and interobserver, of infrapopliteal lesion assessment with magnetic resonance angiography (MRA), using the TransAtlantic Inter-Society Consensus (TASC) II criteria, with perioperative digital subtraction angiography (DSA) as a reference. Sixty-eight patients with an MRA preceding an endovascular infrapopliteal revascularization were included. Preoperative MRAs and perioperative DSAs were evaluated in random order by three independent observers using the TASC II classification. The results were analyzed using visual grading characteristics (VGC) analysis and Krippendorff's α. No systematic difference was found between modalities: area under the VGC curve (AUC_VGC) = 0.48 (p = 0.58) or intraobserver; AUC_VGC for Observer 1 and 2 respectively, 0.49 (p = 0.85) and 0.53 (p = 0.52) for MRA compared with 0.54 (p = 0.30) and 0.49 (p = 0.81) for DSA. Interobserver differences were seen: AUC_VGC of 0.63 (p < 0.01) for DSA and 0.80 (p < 0.01) for MRA. These results were confirmed using Krippendorff's α for the three observers showing 0.13 (95% confidence interval (CI) -0.07-0.31) for MRA and 0.39 (95% CI 0.23-0.53) for DSA. Poor interobserver agreement was also found in the choice of a target vessel on preoperative MRA: Krippendorff's α = 0.19 (95% CI 0.01‒0.36). In conclusion, infrapopliteal lesions can be reliably determined on preoperative MRA, but interobserver variability regarding the choice of a target vessel is a major concern that appears to affect the overall TASC II grade.

Keywords: GLASS; MRA; TASC II; angiography; chronic limb-threatening ischemia; digital subtraction angiography; magnetic resonance angiography.

Grants and funding

ALFGBG-218331 to MF/Västra Götaland Region