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Lower extremity arterial disease: multidetector CT angiography meta-analysis
Majanka H Heijenbrok-Kal1, Marc C J M Kock, M G Myriam Hunink
1Program for the Assessment of Radiological Technology, Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Dr Molewaterplein 50, Room H Ee 2140b, 3015 GD, Rotterdam, The Netherlands. m.heijenbrok@erasmusmc.nl
Insights
Multidetector CT angiography demonstrates high accuracy in diagnosing lower extremity arterial disease with significant stenosis. This imaging technique is a reliable tool for assessing symptomatic patients, offering excellent sensitivity and specificity.
Area of Science:
- Vascular Imaging
- Radiology
- Diagnostic Performance Evaluation
Background:
- Symptomatic lower extremity arterial disease requires accurate diagnostic methods.
- Digital subtraction angiography (DSA) is the reference standard but is invasive.
- Multidetector computed tomographic (CT) angiography offers a non-invasive alternative.
Purpose of the Study:
- To estimate the diagnostic performance of multidetector CT angiography versus DSA.
- To identify factors influencing diagnostic performance variations between studies.
Main Methods:
- Systematic review of studies (2000-2006) comparing multidetector CT angiography and DSA.
- Inclusion criteria: studies enabling 2x2 contingency tables for >=50% stenosis detection.
- Random-effects summary receiver operating characteristic analysis was used.
Main Results:
- 12 studies evaluated 9541 arterial segments in 436 patients.
- Pooled sensitivity: 92% (95% CI: 89%-95%); Pooled specificity: 93% (95% CI: 91%-95%).
- Performance was consistent across aortoiliac, femoropopliteal, and infrapopliteal tracts.
Conclusions:
- Multidetector CT angiography is an accurate diagnostic test for lower extremity arterial disease (>=50% stenosis).
- It provides reliable assessment of the entire lower extremity arterial tree.
Purpose:
To obtain the best available estimates of the diagnostic performance of multidetector computed tomographic (CT) angiography compared with that of digital subtraction angiography (DSA) in the assessment of symptomatic lower extremity arterial disease and to identify the most important sources of variation in diagnostic performance between studies.
Materials And Methods:
Reports of studies published from January 2000 through April 2006 in English, German, French, or Spanish were searched for by using the MEDLINE, EMBASE, and Cochrane databases. Studies were included if they allowed construction of 2 x 2 contingency tables for the detection of stenosis of 50% or greater at multidetector CT angiography compared with that at DSA -- the reference standard -- in patients with claudication or critical ischemia. Two observers extracted data about study design, patient characteristics, arterial tracts, and technical protocols. Random-effects summary receiver operating characteristic analysis was performed to examine the influence of these data on diagnostic performance.
Results:
Of the 70 studies initially identified, 12 were included in which multidetector CT angiography was used to evaluate 9541 arterial segments in 436 patients. The pooled sensitivity and specificity for detecting a stenosis of at least 50% per segment were 92% (95% confidence interval: 89%, 95%) and 93% (95% confidence interval: 91%, 95%), respectively. Three studies provided data about the diagnostic performance of multidetector CT angiography in subdivisions of the arterial tract. The diagnostic performance of multidetector CT angiography in the infrapopliteal tract was lower than but not significantly different from that in the aortoiliac (P > .11) and femoropopliteal (P > .40) tracts. Regression analysis showed that diagnostic performance was not significantly influenced by differences in study characteristics.
Conclusion:
Multidetector CT angiography is an accurate diagnostic test in the assessment of arterial disease (> or =50% stenosis) of the entire lower extremity.
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