Diagnostic accuracy of 64 multidetector computed tomographic angiography in peripheral vascular disease.
BACKGROUND
Previous studies of multidetector CT (MDCT) of the lower extremities for the detection of peripheral vascular disease showed high diagnostic accuracy but were performed with older generation systems.


OBJECTIVE
The purpose of this study was to evaluate the diagnostic accuracy of 64 MDCT for the detection of hemodynamically significant disease within the lower extremity peripheral vasculature as compared to digital subtraction angiography (DSA).


METHODS
Twenty-eight consecutive patients with symptomatic lower extremity intermittent claudication and an abnormal ankle-brachial index (ABI; less than 0.9) were evaluated by both 64 MDCT and DSA. Axial images were acquired with a 64 multidetector general electric light speed VCT scanner. Images were analyzed using a GE Advantage workstation (AW 4.3) capable of advanced image processing and manipulation. The aorto-iliac and lower extremity arteries were divided into 15 segments per limb (30 segments per patient). Eight hundred forty segments were analyzed in a blinded fashion by physicians with level III CT certification. Segments were classified as grade I (<10% stenosis), grade II (10-49%), grade III (50-99%), and grade IV (occlusion).


RESULTS
For all segments evaluated, the overall diagnostic accuracy for detecting grade III and IV lesions was 98% with a sensitivity of 99% and a specificity of 98%. For the aorto-iliac segments, the diagnostic accuracy was 98% with a sensitivity of 100% and a specificity of 99%. For the femoro-popliteal segments, the overall accuracy was 98% with a sensitivity of 100% and a specificity of 99%. For the infra-popliteal segments, the overall accuracy was 98% with a sensitivity of 97% and a specificity of 99%. One segment could not be visualized by MDCT compared to 49 segments that could not be visualized by DSA.


CONCLUSIONS
This study demonstrates excellent diagnostic accuracy of 64 MDCT in the detection of hemodynamically significant disease of the lower extremities. More segments are visualized using 64 MDCT than DSA, allowing more complete visualization of the vascular tree. CT angiography should be considered in the diagnostic evaluation of symptomatic patients with peripheral vascular disease.
Shareghi
Shahrzad
S
Division of Cardiology, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
Gopal
Ambarish
A
Gul
Khawar
K
Matchinson
James C
JC
Wong
Christopher B
CB
Weinberg
Nicole
N
Lensky
Mark
M
Budoff
Matthew J
MJ
Shavelle
David M
DM
D000368:Aged; D015901:Angiography, Digital Subtraction; D000842:Ankle / Q000098:blood supply; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed