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Diagnostic accuracy of 64 multidetector computed tomographic angiography in peripheral vascular disease
Shahrzad Shareghi1, Ambarish Gopal, Khawar Gul
1Division of Cardiology, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
Insights
Sixty-four multidetector computed tomography (MDCT) accurately detects significant peripheral vascular disease in lower extremities. This advanced imaging visualizes more of the vascular tree than digital subtraction angiography (DSA), aiding diagnosis.
Area of Science:
- Radiology
- Vascular Imaging
- Computed Tomography
Background:
- Previous multidetector CT (MDCT) studies for peripheral vascular disease (PVD) used older systems.
- These studies demonstrated high diagnostic accuracy for lower extremity PVD detection.
Purpose of the Study:
- To assess the diagnostic accuracy of 64-slice MDCT for detecting hemodynamically significant lower extremity peripheral vascular disease.
- To compare 64-slice MDCT findings with digital subtraction angiography (DSA).
Main Methods:
- Twenty-eight patients with symptomatic intermittent claudication and abnormal ankle-brachial index underwent both 64-slice MDCT and DSA.
- Lower extremity arteries were divided into 30 segments per patient and analyzed for stenosis (grades I-IV) or occlusion.
- Image analysis was performed by blinded, certified physicians.
Main Results:
- Overall diagnostic accuracy for detecting significant lesions (grade III/IV) was 98% (sensitivity 99%, specificity 98%).
- Accuracy remained high across aorto-iliac (98%), femoro-popliteal (98%), and infra-popliteal (98%) segments.
- 64-slice MDCT visualized more segments (1 non-visualized) compared to DSA (49 non-visualized).
Conclusions:
- 64-slice MDCT exhibits excellent diagnostic accuracy for hemodynamically significant lower extremity PVD.
- 64-slice MDCT offers more comprehensive visualization of the vascular tree than DSA.
- CT angiography is recommended for diagnosing symptomatic PVD.
Background:
Previous studies of multidetector CT (MDCT) of the lower extremities for the detection of peripheral vascular disease showed high diagnostic accuracy but were performed with older generation systems.
Objective:
The purpose of this study was to evaluate the diagnostic accuracy of 64 MDCT for the detection of hemodynamically significant disease within the lower extremity peripheral vasculature as compared to digital subtraction angiography (DSA).
Methods:
Twenty-eight consecutive patients with symptomatic lower extremity intermittent claudication and an abnormal ankle-brachial index (ABI; less than 0.9) were evaluated by both 64 MDCT and DSA. Axial images were acquired with a 64 multidetector general electric light speed VCT scanner. Images were analyzed using a GE Advantage workstation (AW 4.3) capable of advanced image processing and manipulation. The aorto-iliac and lower extremity arteries were divided into 15 segments per limb (30 segments per patient). Eight hundred forty segments were analyzed in a blinded fashion by physicians with level III CT certification. Segments were classified as grade I (<10% stenosis), grade II (10-49%), grade III (50-99%), and grade IV (occlusion).
Results:
For all segments evaluated, the overall diagnostic accuracy for detecting grade III and IV lesions was 98% with a sensitivity of 99% and a specificity of 98%. For the aorto-iliac segments, the diagnostic accuracy was 98% with a sensitivity of 100% and a specificity of 99%. For the femoro-popliteal segments, the overall accuracy was 98% with a sensitivity of 100% and a specificity of 99%. For the infra-popliteal segments, the overall accuracy was 98% with a sensitivity of 97% and a specificity of 99%. One segment could not be visualized by MDCT compared to 49 segments that could not be visualized by DSA.
Conclusions:
This study demonstrates excellent diagnostic accuracy of 64 MDCT in the detection of hemodynamically significant disease of the lower extremities. More segments are visualized using 64 MDCT than DSA, allowing more complete visualization of the vascular tree. CT angiography should be considered in the diagnostic evaluation of symptomatic patients with peripheral vascular disease.
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