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Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography
Carlo Catalano1, Francesco Fraioli, Andrea Laghi
1Department of Radiology, University of Rome La Sapienza, Viale Regina Elena 324, 00161 Rome, Italy. carlo.catalano@uniroma1.it
Insights
Multi-detector row CT angiography is a consistent and accurate imaging technique for evaluating peripheral arterial occlusive disease, comparable to digital subtraction angiography. This method aids in assessing the infrarenal aorta and lower-extremity arteries for effective treatment planning.
Area of Science:
- Vascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Peripheral arterial occlusive disease (PAOD) significantly impacts lower limb circulation.
- Accurate imaging is crucial for diagnosing and managing PAOD.
- Digital subtraction angiography (DSA) is a traditional gold standard, but minimally invasive alternatives are sought.
Purpose of the Study:
- To compare the diagnostic performance of multi-detector row computed tomographic (CT) angiography against digital subtraction angiography (DSA).
- To evaluate the infrarenal aorta and the arterial system of the lower extremities in patients with PAOD.
Main Methods:
- Fifty patients diagnosed with PAOD underwent both multi-detector row CT angiography and DSA.
- Twenty-three specific arterial segments were assessed for stenosis severity by three independent readers.
- Interobserver agreement was analyzed using Cohen kappa statistics, and sensitivity, specificity, and accuracy were calculated against DSA as the reference standard.
Main Results:
- High interobserver agreement (substantial to almost perfect) was achieved for both imaging modalities.
- Multi-detector row CT angiography demonstrated high diagnostic accuracy: 96% sensitivity, 93% specificity, and 94% overall accuracy.
- Significant differences between CT angiography and DSA were noted only for mild stenotic lesions (grades 1 or 2).
Conclusions:
- Multi-detector row CT angiography is a reliable and accurate imaging modality for assessing patients with peripheral arterial occlusive disease.
- The technique shows consistency and high performance in evaluating the infrarenal aorta and lower-extremity arteries.
- Findings support the use of multi-detector row CT angiography as a viable alternative to DSA for PAOD assessment.
Purpose:
To compare multi-detector row spiral computed tomographic (CT) angiography with digital subtraction angiography (DSA) in evaluation of the infrarenal aorta and lower-extremity arterial system.
Materials And Methods:
Fifty patients with peripheral arterial occlusive disease were evaluated with multi-detector row CT angiography and DSA. Arteries depicted at CT angiography and DSA were graded separately for degree of stenosis as 23 anatomic segments (infrarenal aorta, right and left common iliac artery, internal iliac artery, external iliac artery, common femoral artery, superficial femoral artery, deep femoral artery, popliteal artery, anterior tibial artery, tibioperoneal trunk, posterior tibial artery, and peroneal artery). Grades included the following: 1, normal patency; 2, moderate (< or =50%) stenosis; 3, focal severe (>50%) stenosis; 4, multiple severe stenoses; and 5, occlusion. Three readers independently interpreted the images, and statistical analysis was performed. The results of image interpretation were evaluated for strength of agreement by using Cohen kappa statistics. On the basis of consensus readings, sensitivity, specificity, and accuracy for detection of stenotic lesions were calculated, with findings at DSA used as the reference standard.
Results:
Substantial to almost perfect interobserver agreement was achieved in all cases. At DSA, 349 diseased segments were found among the 1,137 segments evaluated. Sensitivity, specificity, and accuracy, based on a consensus reading of multi-detector row CT angiograms, were 96%, 93%, and 94%, respectively. A statistically significant difference (P <.05) between DSA and multi-detector row CT angiography was present only in arteries graded 1 or 2. Interobserver agreement was almost perfect among the three readers for treatment recommendations based on findings at CT angiography and DSA.
Conclusion:
Multi-detector row CT angiography appears consistent and accurate in the assessment of patients with peripheral arterial occlusive disease.
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