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A meta-analysis of the diagnostic performance of quiescent-interval-single-shot magnetic resonance angiography in peripheral arterial disease

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate by meta-analysis the diagnostic accuracy of non-contrast quiescent-interval-single-shot (QISS) magnetic resonance angiography (MRA) in patients with peripheral arterial disease (PAD) using digital subtraction angiography (DSA) or contrast-enhanced magnetic resonance angiography (CE-MRA) as reference standard.

Methods

This study was performed and reported according to the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines. A systematic literature search of MEDLINE, Embase and Scopus was done for studies reporting the diagnostic accuracy of QISS in PAD published up to 31 May 2021. The pooled sensitivity, specificity and diagnostic accuracy of QISS were calculated on a per-segment basis for the entire arterial tree.

Results

Seventeen studies including 459 patients were found eligible for the meta-analysis. There was significant heterogeneity among studies as depicted by chi-square test (p = 0.02) and moderate heterogeneity by I2 statistic (I2: 69 [95% CI: 30–100]). The pooled sensitivity and specificity of QISS on a per-segment basis with DSA/CE-MRA as reference standard was 0.88 (95% CI: 0.85–0.91) and 0.94 (95% CI: 0.92–0.96) respectively. The area under hierarchical summary receiver-operating characteristic reflected a high accuracy of 0.96 (95% CI: 0.94–0.98). There was a low likelihood of publication bias as indicated by Deeks’ funnel plot.

Conclusions

The present meta-analysis has consolidated the evidence that QISS has high accuracy for identifying as well as excluding arterial stenosis/occlusions in patients with symptoms of PAD. It can thus be considered the test of choice in patients with renal failure and in “at-risk patients” including pregnant women and patients with contrast allergy.

Key Points

• The pooled sensitivity and specificity of QISS magnetic resonance angiography on a per-segment basis with DSA or contrast-enhanced MRA as reference standard are 88% and 94% respectively.

• The diagnostic accuracy of QISS in patients with peripheral arterial disease as reflected by area under hierarchical summary receiver-operating characteristic is high (0.96 (95% CI: 0.94–0.98)).

• There is moderate to significant heterogeneity among studies as depicted by I 2 statistic and chi-square test.

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Abbreviations

CE-MRA:

Contrast-enhanced magnetic resonance angiography

QISS:

Quiescent interval single shot

SSFP:

Steady-state free precession

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Authors and Affiliations

  1. All India Institute of Medical Sciences, Department of Cardiovascular Radiology and Endovascular Interventions, New Delhi, 110029, India

    Mansi Verma, Niraj Nirmal Pandey & Priya Jagia

  2. Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India

    Vishwajeet Singh

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Correspondence to Priya Jagia.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Vishwajeet Singh, AIIMS New Delhi) has significant statistical expertise (PhD biostatistics).

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Written informed consent was not required for this study because it was a meta-analysis.

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Mansi Verma and Niraj Nirmal Pandey contributed equally to the manuscript and share the first authorship

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Verma, M., Pandey, N.N., Singh, V. et al. A meta-analysis of the diagnostic performance of quiescent-interval-single-shot magnetic resonance angiography in peripheral arterial disease. Eur Radiol 32, 2393–2403 (2022). https://doi.org/10.1007/s00330-021-08349-z

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