Lower extremity arterial disease: multidetector CT angiography meta-analysis.
OBJECTIVE
To obtain the best available estimates of the diagnostic performance of multidetector computed tomographic (CT) angiography compared with that of digital subtraction angiography (DSA) in the assessment of symptomatic lower extremity arterial disease and to identify the most important sources of variation in diagnostic performance between studies.


METHODS
Reports of studies published from January 2000 through April 2006 in English, German, French, or Spanish were searched for by using the MEDLINE, EMBASE, and Cochrane databases. Studies were included if they allowed construction of 2 x 2 contingency tables for the detection of stenosis of 50% or greater at multidetector CT angiography compared with that at DSA -- the reference standard -- in patients with claudication or critical ischemia. Two observers extracted data about study design, patient characteristics, arterial tracts, and technical protocols. Random-effects summary receiver operating characteristic analysis was performed to examine the influence of these data on diagnostic performance.


RESULTS
Of the 70 studies initially identified, 12 were included in which multidetector CT angiography was used to evaluate 9541 arterial segments in 436 patients. The pooled sensitivity and specificity for detecting a stenosis of at least 50% per segment were 92% (95% confidence interval: 89%, 95%) and 93% (95% confidence interval: 91%, 95%), respectively. Three studies provided data about the diagnostic performance of multidetector CT angiography in subdivisions of the arterial tract. The diagnostic performance of multidetector CT angiography in the infrapopliteal tract was lower than but not significantly different from that in the aortoiliac (P > .11) and femoropopliteal (P > .40) tracts. Regression analysis showed that diagnostic performance was not significantly influenced by differences in study characteristics.


CONCLUSIONS
Multidetector CT angiography is an accurate diagnostic test in the assessment of arterial disease (> or =50% stenosis) of the entire lower extremity.
Heijenbrok-Kal
Majanka H
MH
Program for the Assessment of Radiological Technology, Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Dr Molewaterplein 50, Room H Ee 2140b, 3015 GD, Rotterdam, The Netherlands. m.heijenbrok@erasmusmc.nl
Kock
Marc C J M
MC
Hunink
M G Myriam
MG
D000792:Angiography / Q000379:methods / Q000706:statistics & numerical data*; D015901:Angiography, Digital Subtraction / Q000706:statistics & numerical data*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology; D035002:Lower Extremity / Q000098:blood supply* / Q000000981:diagnostic imaging*; D016239:MEDLINE; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data