Evaluation the venous pathology of the lower extremities with triggered angiography non-contrast-enhanced sequence magnetic resonance imaging (TRANCE-MRI)
Abstract Background To explore the diagnostic performance of non-contrast-enhanced magnetic resonance imaging using triggered angiography non-contrast-enhanced sequence (TRANCE-MRI) in evaluation of venous pathology of the lower extremity. Methods This is a single-center prospective cohort study of 25 patients with suspected venous disease in their lower extremities. Each patient received a Doppler ultrasound exam before the scheduled TRANCE-MRI on a 1.5T MR scanner (Philips Ingenia, Philips Healthcare, Best, The Netherlands). The following lymphography and CTA were arranged according to the diagnostic indications. Results The venous scenarios of the 25 patient were divided as follows: 11 had deep venous thrombosis (DVT), seven had a static ulcer, three had symptomatic varicose veins (VV), two had recurrent VV after surgery, and two had lymphedema. TRANCE-MRI unexpectedly found that 4 patients (16%) had occult peripheral arterial occlusive disease. Of the 11 patients with scenario of DVT, 4 patients (36.4%) did not actually have DVT on TRANCE-MRI, and the symptoms were due to malignancy, external compression, and congenital anomalies. One patient (4%) with radiation-related lymphedema was falsely diagnosed as external iliac vein compression. Interrater agreement for DVT in the thigh between the ultrasonography and TRANCE-MRI was substantial agreement (Cohen's kappa κ, 0.72). The sensitivity, specificity and accuracy of TRANCE-MRI were 85.7%, 88/9% and 88%, respectively. Venous thrombi and collateral veins could be clearly outlined by TRANCE-MRI, including in middle femoral veins that might be difficult to detect by ultrasound. Conclusion TRANCE-MRI provided not only vascular image of the lower extremity but also information about the pelvis and abdomen. However, false positive results may occur in iliac vessels. TRANCE-MRI could outline venous thrombi and collateral veins from the abdomen to both calves, and thus, could be a powerful tool in the treatment of venous pathology in the lower extremities.