Synopsis

Keywords: Cardiovascular: Cardiovascular

The aim of this presentation is to highlight the issues that will clinically dictate whether to perform CE-MRA or CTA, providing a framework to approach the problem illustrated with case studies

CE-MRA vs. CTA: Which Exam to Perform

When choosing which examination to perform for any particular patient there are a host of considerations to take into account including fundamentally an interpretation of the clinical question being asked. The aim of this presentation is to highlight the issues that will clinically dictate whether to perform CE-MRA or CTA, providing a framework to approach the problem illustrated with case studies. An increasing number of clinical scenarios have recommended imaging protocols via guidelines and Appropriateness criteria and these resources are available either on the internet or through Clinical Decision Support software. Such deliberations as to which investigation to perform will often have been informed via a process such as PICO where the clinical question is considered in terms of factors at the Patient (or Population) level, the Intervention (Technique) level, the Comparison level, and finally at the Outcome level as follows -

Patient / Population - Here we need to consider standard MRI contra-indications and patient specific features that may preclude or favour the use of either CE-MRA or CTA. We can also consider the population as a whole from which the patient comes in terms of need and risk and here a sense of pre-test-probability is needed which will be informed by the clinical question.

Intervention/Technique - Which technique has greater safety (e.g. radiation safety, contrast safety) and which is most practically applied in the clinical scenario to answer the question posed.

Comparison - What other imaging investigations are available and which technique performs best in terms of accuracy, including in disease-specific contexts. Additionally which technique offers best value.

Outcome - Here we need to consider the available evidence for the techniques and their synthesis into Guidelines which may dictate which technique is favoured These considerations will all be considered in the context of the application of ionising radiation which may have legal enforcement depending upon jurisdiction.

As regards vascular imaging in particular there are additional technique and disease specific considerations that will weigh on the decision as to imaging modality such as the need to visualise calcifications, the extent of coverage required, presence of stents etc. and any need for quantification of flow. Indeed in many instances both CE-MRA and CTA may be complimentary for full diagnosis and specific instances for this will be discussed.

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