Ultrasound contrast-agent improves imaging of lower limb occlusive disease.
OBJECTIVE
to evaluate if ultrasound contrast-agent infusion could improve duplex-ultrasound imaging of peripheral arterial disease (PAD) and increase the agreement with digital subtraction arteriography (DSA).


METHODS
prospective and consecutive study.


METHODS
of 60 consecutive PAD patients, 15 were found to have an inconclusive duplex-ultrasound scan of the trifurcation and were included in the study. All 15 patients (53% male) were scheduled for DSA, all being candidates for vascular surgery due to claudication (n = 3, 20%), rest pain (n = 5, 33%) and tissue loss (n = 7, 47%).


METHODS
on the day before DSA, a duplex-ultrasound scan of the trifurcation was performed. If the duplex-ultrasound scan was found inconclusive, it was repeated during continuous ultrasound contrast-agent infusion. DSA was performed unaware of the duplex-ultrasound results and served as the gold standard.


RESULTS
after contrast-agent administration, the number of inconclusively diagnosed segments was significantly reduced by 26 (70%), from 37 to 11(p < 0.001). In 19 segments (73%) contrast-agent infusion changed the diagnosis in accordance with the DSA (p < 0.05). Values of sensitivity and positive predictive value were improved from 0.20 (0.04-0.62) to 0.47 (0.26-0.69) and 0.50 (0.10-0.91) to 0.80 (0.49-0.93), respectively. Specificity and negative predictive value were unchanged. Agreement between duplex-ultrasound and DSA were improved from poor (kappa = 0.18 (95% CI: 0-0.82)) to moderate (kappa = 0.45 (0.17-0.74)) (p = 0.44).


CONCLUSIONS
ultrasound contrast-agents improve the diagnostic ability of duplex-ultrasound when scanning difficult arterial segments in patients suffering from PAD.
Eiberg
J P
JP
Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.
Hansen
M A
MA
Jensen
F
F
Rasmussen
J B Grønvall
JB
Schroeder
T V
TV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000494:pharmacology*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D011134:Polysaccharides; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016909:Tibial Arteries / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508