title: [Peripheral artery disease: clinical and cost comparison between duplex ultrasonography and contrast-enhanced magnetic resonance angiography--a multicenter randomized trial].
abstract: OBJECTIVE
  To determine the clinical and economic consequences of replacing duplex ultrasonography (DUS) by contrast-enhanced magnetic resonance angiography (CE-MRA) for the initial diagnostic work-up of patients with peripheral artery disease (PAD).
  
  
  METHODS
  Randomised multicentre study.
  
  
  METHODS
  In the period from January 2002 to August 2003, consecutive patients with PAD were randomly assigned to CE-MRA or DUS. The primary outcome measure was the costs. Secondary outcome measures included the confidence with which the specialist could take a therapeutic decision on the basis of the imaging study, the change in disease severity, and the change in quality of life (QOL) assessed during 6 months of follow-up. In addition, all costs of imaging, therapeutic interventions and outpatient visits were calculated.
  
  
  RESULTS
  After 6 months of follow-up the data on 352 patients were analysed. Use of CE-MRA reduced the number of additional vascular-imaging procedures by 42% ((69-40)/69) and the specialists felt more confident about their therapeutic decisions. The diagnostic costs of all imaging studies taken together were Euro 167,- higher, on average, in the CE-MRA group (p < 0.001). However, after 6 months of follow-up, no statistically significant differences were found between the two groups with regard to the change in disease severity, the QOL, or the total costs (p > 0.05).
  
  
  CONCLUSIONS
  Based on these findings, a specialist that replaces DUS by CE-MRA will feel more confident about taking a therapeutic decision and will feel less need for additional imaging. However, the diagnostic costs were higher with CE-MRA.
authors.affiliation: Afd. Radiologie, Academisch Ziekenhuis Maastricht, Maastricht. mdvr@rdia.azm.nl
authors.forename: M
authors.initials: M
authors.lastname: de Vries
authors.forename: R
authors.initials: R
authors.lastname: Ouwendijk
authors.forename: K
authors.initials: K
authors.lastname: Flobbe
authors.forename: P J
authors.initials: PJ
authors.lastname: Nelemans
authors.forename: A G H
authors.initials: AG
authors.lastname: Kessels
authors.forename: G W H
authors.initials: GW
authors.lastname: Schurink
authors.forename: J A
authors.initials: JA
authors.lastname: van der Vliet
authors.forename: P W M
authors.initials: PW
authors.lastname: Cuypers
authors.forename: L E M
authors.initials: LE
authors.lastname: Duijm
authors.forename: J M A
authors.initials: JM
authors.lastname: van Engelshoven
authors.forename: M G M
authors.initials: MG
authors.lastname: Hunink
authors.forename: M W
authors.initials: MW
authors.lastname: de Haan