Is 64-Row Multi-Detector Computed Tomography Angiography Equal to Digital Subtraction Angiography in Treatment
Vesna Đurović Sarajlić1, Dragan Totić, Amina Bičo Osmanagić
1Department for Vascular and Interventional Radiology, Clinic for Radiology, Clinical Center University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina, vesnasarajlic8@gmail.com.
Insights
Multi-detector computed tomography angiography (MDCTA) is a highly effective tool for evaluating peripheral arterial disease (PAD) and planning treatment for critical limb ischemia (CLI). This non-invasive imaging method shows strong agreement with digital subtraction angiography (DSA), supporting its use in clinical practice.
Area of Science:
- Vascular Imaging
- Radiology
- Cardiovascular Medicine
Background:
- Critical limb ischemia (CLI) is the advanced stage of peripheral arterial disease (PAD), characterized by ischemic rest pain, ulcers, or gangrene.
- Intra-arterial digital subtraction angiography (IA DSA) has been the standard for evaluating arterial occlusive disease.
- Non-invasive multi-detector computed tomography angiography (MDCTA) is increasingly replacing DSA for lesion assessment.
Purpose of the Study:
- To prospectively compare the diagnostic performance of MDCTA versus DSA.
- To evaluate treatment planning in patients with CLI based on both imaging modalities.
- To assess diagnostic performance according to TransAtlantic Inter-Society Consensus Document (TASC II) guidelines.
Main Methods:
- Prospective study including 60 patients with CLI (Fontaine stage III-IV) from March 2014 to August 2016.
- MDCTA performed prior to DSA for peripheral artery evaluation.
- Classification of aorto-iliac, femoro-popliteal, and infra-popliteal lesions using TASC II guidelines.
- Inter-modality agreement assessed using Kendall's tau-b statistics.
Main Results:
- Statistically significant inter-modality agreement observed across all vascular beds.
- Excellent agreement (>0.81) in aortoiliac and femoropopliteal regions; very good agreement (>0.61) in infrapopliteal regions.
- Identical treatment recommendations in 90% of patients (54/60); MDCTA was uninterpretable in 1.7% and disagreed on treatment in 8.3%.
Conclusions:
- 64-row MDCT angiography demonstrates high competitiveness with DSA for evaluating steno-occlusive disease in CLI patients.
- MDCTA provides reliable data for treatment planning in critical limb ischemia.
- This non-invasive technique supports clinical decision-making in PAD management.
Background:
Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease (PAD). It is defined as a chronic ischemic rest pain, ulcers or gangrene, attributable to proven arterial occlusive disease. Intra-arterial digital subtraction angiography (IA DSA) still represents the gold standard for the evaluation of steno-occlusive lesions, but it has greatly been replaced with non-invasive multi-detector computed tomography angiography (MDCTA). The purpose of this prospective study was to compare diagnostic performance of MDCTA versus DSA in treatment planning in patients with CLI according to TransAtlantic Inter-Society Consensus Document on Management of Peripheral Arterial disease (TASC II).
Subjects And Methods:
The study was designed as prospective; it was conducted from March 2014 to August 2016, and included 60 patients with symptoms of CLI, Fontaine stage III and IV. MDCTA of the peripheral arteries was performed first, followed by DSA. The lesions of aorto-iliac, femoro-popliteal and infra-popliteal regions were classified according to the TASC II guidelines, and inter-modality agreement between MDCTA and DSA was determined by using Kendall's tau-b statistics.
Results:
Inter-modality agreement was statistically significant in all three vascular beds, with excellent agreement >0.81 in aortoiliac and femoropopliteal regions, and a very good agreement >0.61 in infrapopliteal region. Treatment recommendations based on MDCTA findings and DSA findings were identical in 54 (90%) patients. In one patient (1.7%), CTA was not interpretable. In five patients (8.3%), CTA findings disagreed with DSA findings in regard to the preferable treatment option.
Conclusion:
64-row MDCT angiography is highly competitive to DSA in evaluation of steno-occlusive disease and treatment planning in patients with critical limb ischemia.
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