Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography.
OBJECTIVE
To compare multi-detector row spiral computed tomographic (CT) angiography with digital subtraction angiography (DSA) in evaluation of the infrarenal aorta and lower-extremity arterial system.


METHODS
Fifty patients with peripheral arterial occlusive disease were evaluated with multi-detector row CT angiography and DSA. Arteries depicted at CT angiography and DSA were graded separately for degree of stenosis as 23 anatomic segments (infrarenal aorta, right and left common iliac artery, internal iliac artery, external iliac artery, common femoral artery, superficial femoral artery, deep femoral artery, popliteal artery, anterior tibial artery, tibioperoneal trunk, posterior tibial artery, and peroneal artery). Grades included the following: 1, normal patency; 2, moderate (< or =50%) stenosis; 3, focal severe (>50%) stenosis; 4, multiple severe stenoses; and 5, occlusion. Three readers independently interpreted the images, and statistical analysis was performed. The results of image interpretation were evaluated for strength of agreement by using Cohen kappa statistics. On the basis of consensus readings, sensitivity, specificity, and accuracy for detection of stenotic lesions were calculated, with findings at DSA used as the reference standard.


RESULTS
Substantial to almost perfect interobserver agreement was achieved in all cases. At DSA, 349 diseased segments were found among the 1,137 segments evaluated. Sensitivity, specificity, and accuracy, based on a consensus reading of multi-detector row CT angiograms, were 96%, 93%, and 94%, respectively. A statistically significant difference (P <.05) between DSA and multi-detector row CT angiography was present only in arteries graded 1 or 2. Interobserver agreement was almost perfect among the three readers for treatment recommendations based on findings at CT angiography and DSA.


CONCLUSIONS
Multi-detector row CT angiography appears consistent and accurate in the assessment of patients with peripheral arterial occlusive disease.
Catalano
Carlo
C
Department of Radiology, University of Rome La Sapienza, Viale Regina Elena 324, 00161 Rome, Italy. carlo.catalano@uniroma1.it
Fraioli
Francesco
F
Laghi
Andrea
A
Napoli
Alessandro
A
Bezzi
Mario
M
Pediconi
Federica
F
Danti
Massimiliano
M
Nofroni
Italo
I
Passariello
Roberto
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods* / Q000706:statistics & numerical data; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data