Patient Perception of Lower Limb Non-Contrast Magnetic Resonance Angiography and Digital Subtraction Angiography in Diabetic Patients with Peripheral Arterial Disease

Objective: Non-contrast magnetic resonance angiography (NC-MRA) is an attractive technique for imaging peripheral arterial disease (PAD) in diabetic patients where arterial calcification and renal impairment are common. Our purpose was to evaluate patient perception of lower limb NC-MRA and compare this perception to that of digital subtraction angiography (DSA). Materials and Methods: Thirty-one diabetic patients (18 male, 13 female, mean age=69 years) with symptomatic PAD (critical ischemia, n=10) referred for DSA were prospectively recruited, and 1.5T quiescent-interval single-shot NC-MRA was performed before DSA (intervention performed during DSA, n=23). Patients rated anxiety, pain, discomfort, willingness to repeat (Likert scale: 1 most favorable to 7 least favorable), and difficulty compared to expectations (-3 better to +3 worse). Results: Twenty-nine patients’ results were analyzed (DSA under general anesthesia, n=1; incomplete NC-MRA due to morbid obesity, n=1). NC-MRA and DSA median scores were 1 vs. 3, 1 vs. 2, 2 vs. 2, and 1 vs. 1 for anxiety, pain, discomfort, and willingness to repeat, respectively. The median score for difficulty compared to expectations was 0 (as expected) for both examinations. The anxiety and pain scores for NC-MRA were significantly lower than those for DSA (p=0.006 and p=0.001, respectively). Reasons for the less favorable NC-MRA experience included machine noise (n=3), pain from coil pressure (n=3), and claustrophobia (n=1). Conclusion: NC-MRA was well tolerated overall, and better than DSA for anxiety and pain. Although DSA is commonly required for intervention in PAD, NC-MRA may inform disease management and potentially obviate DSA where conservative management, or open surgery, are indicated. Reduced acoustic noise, lighter receiver coils, and wider scan bores may improve procedural tolerance