title: Ultrasound imaging of infrainguinal arterial disease has a high interobserver agreement.
abstract: OBJECTIVE
  to evaluate and compare the operator dependency of duplex ultrasound and digital subtraction arteriography (DSA) in patients suffering from chronic lower limb ischaemia.
  
  
  METHODS
  prospective and blinded validation study.
  
  
  METHODS
  twenty-six consecutive patients (13 male and 13 females) with severe claudication (n=6, 23%), rest pain (n=7, 27%) or tissue loss (n=13, 50%).
  
  
  METHODS
  two physicians independently performed a duplex scan of the lower limb from groin to foot (15 segments). Segments were classified as insignificantly (<50% stenosis) or significantly (>50% stenosis or occlusion) diseased. DSA was performed within 24h of the duplex scanning and was independently reported by two radiologists in the same manner. Interobserver agreement was assessed for both diagnostic methods. After 10 months the arteriograms were reassessed and the intraobserver agreement calculated.
  
  
  RESULTS
  for the limb as a whole the interobserver agreement was good and similar for both duplex and DSA, with kappa-values of 0.79 (95%-CI: 0.72-0.86) and 0.80 (0.74-0.87). In the femoral, crural and pedal segments the interobserver agreement was similar for both methods. The intraobserver agreement between the two DSA readings was 0.84 (0.79-0.90).
  
  
  CONCLUSIONS
  ultrasound is comparable to arteriography when visualising arterial occlusive disease in patients with chronic lower limb ischaemia.
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007264:Inguinal Canal / Q000098:blood supply / Q000000981:diagnostic imaging*; D007511:Ischemia / Q000000981:diagnostic imaging*; D007866:Leg / Q000098:blood supply / Q000000981:diagnostic imaging*; D007871:Leg Ulcer / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D018616:Ultrasonography, Doppler, Duplex / Q000706:statistics & numerical data*