[Peripheral artery disease: clinical and cost comparison between duplex ultrasonography and contrast-enhanced magnetic resonance angiography--a multicenter randomized trial].
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.
de Vries
M
M
Afd. Radiologie, Academisch Ziekenhuis Maastricht, Maastricht. mdvr@rdia.azm.nl
Ouwendijk
R
R
Flobbe
K
K
Nelemans
P J
PJ
Kessels
A G H
AG
Schurink
G W H
GW
van der Vliet
J A
JA
Cuypers
P W M
PW
Duijm
L E M
LE
van Engelshoven
J M A
JM
Hunink
M G M
MG
de Haan
M W
MW