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Duplex scanning and effect of multisegmental arterial disease on its accuracy in lower limb arteries
S Aly1, M P Jenkins, F H Zaidi
1Department of Surgery, University College London and Medical School, UK.
Insights
Duplex ultrasound accurately diagnoses lower limb arterial disease, even with multiple affected segments. This study confirms its reliability for assessing peripheral arterial disease (PAD) across various lesion types.
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
- Medical Technology
Background:
- Peripheral arterial disease (PAD) significantly impacts patient mobility and quality of life.
- Accurate diagnostic tools are crucial for effective PAD management.
- Duplex ultrasound is a non-invasive imaging modality used to assess arterial health.
Purpose of the Study:
- To evaluate the diagnostic accuracy of duplex ultrasound in identifying lower limb arterial disease.
- To determine if the presence of multisegmental disease affects duplex ultrasound's accuracy compared to single lesions.
Main Methods:
- 177 lower limbs from 90 patients with suspected arterial disease were examined.
- A double-blind comparison was performed between duplex ultrasound and intra-arterial digital subtraction angiography (IA DSA).
- Patients were categorized into groups based on single or multiple stenotic lesions and occlusions.
Main Results:
- Duplex ultrasound demonstrated high accuracy in differentiating normal from diseased arterial segments (sensitivity 92%, specificity 99%).
- Accuracy remained high for both single lesions (stenosis: 87% sensitivity, 99% specificity; occlusion: 92% sensitivity, 100% specificity) and multisegmental disease.
- For multisegmental disease, duplex showed high sensitivity and specificity across stenosis, occlusion, and mixed pathologies (e.g., 95% sensitivity, 96% specificity for multisegmental stenosis).
Conclusions:
- Duplex ultrasound is a highly accurate diagnostic tool for lower limb arterial disease.
- The presence of multisegmental pathology does not compromise the diagnostic accuracy of duplex ultrasound.
Aim:
To assess the accuracy of duplex in assessment of peripheral arterial disease and determine the effect of multisegmental disease on the accuracy duplex as opposed to single lesion.
Patients And Methods:
One hundred and seventy-seven lower limbs were examined in 90 patients who presented with lower limb arterial disease, (59 male, 31 female, median age 68 years--81 with intermittent claudication, eight rest pain, one ulceration). Patients were examined with duplex US, and arteriography (IA DSA). Two radiologists and two technologists were involved in this double-blind study. Patients were classified into five groups; groups with single stenotic lesions, single occlusions, multiple stenotic lesions or occlusions, and multiple mixed disease. Duplex accuracy was determined in each group.
Results:
Duplex was able to differentiate between normal and disease arterial segment with a sensitivity of 92%, specificity 99%, PPV 91%, and NPV 100% and Kappa 0.87. Sixty-six limbs were found to have single lesions, and 68 multisegmental disease. Duplex showed accuracy with a sensitivity of 87%, and specificity of 99%, for single stenotic lesion and 95%, 96% respectively for multisegmental. For single occlusions duplex accuracy showed sensitivity 92% and specificity 100%, and for multisegmental occlusions, sensitivity 97%, and specificity 99%. For mixed multisegmental pathology (stenosis and occlusion), sensitivity 94% and specificity 97%.
Conclusion:
Duplex is an accurate tool in diagnosis of lower limb arterial disease and multisegmental pathology does not adversely effect this accuracy.