Prospective blinded evaluation of Gd-DOTA- versus Gd-BOPTA-enhanced peripheral MR angiography, as compared with digital subtraction angiography.

To compare the diagnostic accuracy of gadobenate dimeglumine (Gd-BOPTA)-enhanced versus gadoterate meglumine (Gd-DOTA)-enhanced magnetic resonance (MR) angiography in patients with peripheral arterial occlusive disease (PAOD). Fifty-six patients underwent MR angiography enhanced with either Gd-DOTA (28 patients) or Gd-BOPTA (28 patients). All arterial segments from the renal arteries to the distal run-off vessels were evaluated for disease severity. The sensitivity, specificity, and accuracy of MR angiography enhanced with both agents separately were evaluated with a paired t test; digital subtraction angiography was the reference standard. Interobserver variability was assessed by using the Cohen test. Diagnostic MR angiograms were obtained in all 56 patients. Overall, sensitivity and specificity of Gd-DOTA-enhanced MR angiography were 96% and 93%, respectively, for observer 1 and 96% and 85%, respectively, for observer 2 (kappa = 0.82). Corresponding values for Gd-BOPTA-enhanced MR angiography were 94% and 93%, respectively, for observer 1 and 94% and 89%, respectively, for observer 2 (kappa = 0.78). No consistent differences between the two contrast materials in assessment of PAOD in the renal to popliteal arteries were observed. For assessment below the knee, specificity was slightly higher in the Gd-BOPTA group-91% and 84% for observers 1 and 2, respectively-than in the Gd-DOTA group-89% and 77%, respectively (P <.01). The number of nonassessable below-the-knee segments was significantly lower in the Gd-BOPTA group: nine of 299 segments versus 25 of 312 segments in the Gd-DOTA group (P <.01). At MR angiography of the distal run-off vessels, Gd-BOPTA yielded higher specificity and a significantly smaller number of nonassessable segments than Gd-DOTA. The diagnostic accuracy of the two gadolinium chelates at peripheral MR angiography was comparable in the renal to popliteal arteries.