Comparison of three diagnostic imaging modalities for use in diabetic inferior arterial lesions

Underdiagnosis of peripheral arterial disease results in inadequate treatment and more serious consequences. Hence, clinicians have focused on early diagnosis and treatment.

To investigate the effectiveness of the combination of doppler ultrasonography (DUS), three-dimensional dynamic contrast-enhanced magnetic resonance angiography (CE-MRA), and CT angiography (CTA) in assessing lower extremity arterial disease in diabetes mellitus (DM).

This study retrospectively analyzed the imaging and clinical data of 116 patients diagnosed with DM complicated with lower extremity vascular diseases from January 2021 to June 2023. All patients underwent unilateral or bilateral DUS, CTA, and CE-MRA as well as invasive digital subtraction angiography (DSA). The application values of DUS, CE-MRA, and CTA were compared.

A total of 152 lower extremity arteries in the 116 patients were graded following the classification of vascular branches. The Kappa values between DUS and DSA were 0.780, 0.755, and 0.806 for diagnosing moderate stenosis and 0.484, 0.699, and 0.449 for severe stenosis of grade 1 arteries, grade 2 arteries, and grade 3 arteries, respectively. The Kappa values between CE-MRA and DSA were 0.784, 0.814, and 0.835 for diagnosing moderate stenosis and 0.694, 0.748, and 0.606 for severe stenosis of grade 1 arteries, grade 2 arteries, and grade 3 arteries, respectively. The Kappa values between CTA and DSA were 0.900, 0.858, and 0.878 for diagnosing moderate stenosis and 0.882, 0.823, and 0.756 for severe stenosis of grade 1 arteries, grade 2 arteries, and grade 3 arteries, respectively.

DUS, CE-MRA, and CTA demonstrated comparable accuracy in diagnosing lower extremity arterial disease in DM, and the consistency between CTA and DSA diagnoses was higher than the other two imaging methods.