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Peripheral arterial disease: gadolinium-enhanced MR angiography versus color-guided duplex US--a meta-analysis
1Departments of Epidemiology and Biostatistics, Erasmus Medical Center Rotterdam, Rm EE21-40a, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands.
Purpose:
To summarize and compare the published data on gadolinium-enhanced magnetic resonance (MR) angiography and color-guided duplex ultrasonography (US) for the work-up for peripheral arterial disease.
Materials And Methods:
Studies published between January 1984 and November 1998 were included if (a) gadolinium-enhanced MR angiography and/or color-guided duplex US were performed for evaluation of arterial stenoses and occlusions in the work-up for peripheral arterial disease of the lower extremities, (b) conventional angiography was the reference standard, and (c) absolute numbers of true-positive, false-negative, true-negative, and false-positive results were available or derivable.
Results:
With a random effects model, pooled sensitivity for MR angiography (97.5% [95% CI: 95.7%, 99.3%]) was higher than that for duplex US (87.6% [95% CI: 84.4%, 90.8%]). Pooled specificities were similar: 96.2% (95% CI: 94.4%, 97.9%) for MR angiography and 94.7% (95% CI: 93.2%, 96.2%) for duplex US. Summary receiver operating characteristic analysis demonstrated better discriminatory power for MR angiography than for duplex US. Regression coefficients for MR angiography versus US were 1.67 (95% CI: -0.23, 3.56) with adjustment for covariates, 2.11 (95% CI: 0.12, 4.09) without such adjustment, and 1.73 (95% CI: 0.44, 3.02) with a random effects model.
Conclusion:
Gadolinium-enhanced MR angiography has better discriminatory power than does color-guided duplex US and is a highly sensitive and specific method, as compared with conventional angiography, for the work-up for peripheral arterial disease.
Insights
Gadolinium-enhanced MR angiography shows superior accuracy for diagnosing peripheral arterial disease compared to duplex ultrasonography. This imaging technique offers higher sensitivity and specificity for detecting arterial issues in the lower extremities.
Area of Science:
- Vascular Imaging
- Diagnostic Accuracy
- Medical Technology Assessment
Background:
- Peripheral arterial disease (PAD) diagnosis relies on imaging techniques.
- Conventional angiography is the gold standard but is invasive.
- Non-invasive imaging modalities like MR angiography and duplex US are crucial for PAD work-up.
Purpose of the Study:
- To compare the diagnostic performance of gadolinium-enhanced MR angiography and color-guided duplex ultrasonography for peripheral arterial disease.
- To summarize and analyze published data on these two imaging modalities.
Main Methods:
- Systematic review of studies published between 1984 and 1998.
- Inclusion criteria: evaluation of lower extremity PAD, use of MR angiography and/or duplex US, and availability of data for calculating true/false positives/negatives.
- Conventional angiography served as the reference standard.
Main Results:
- Gadolinium-enhanced MR angiography demonstrated higher pooled sensitivity (97.5%) than duplex US (87.6%).
- Pooled specificities were comparable: MR angiography (96.2%) and duplex US (94.7%).
- Summary ROC analysis indicated superior discriminatory power for MR angiography.
Conclusions:
- Gadolinium-enhanced MR angiography is a highly sensitive and specific tool for diagnosing peripheral arterial disease.
- MR angiography exhibits better discriminatory power compared to color-guided duplex ultrasonography for PAD evaluation.