title: Dual-energy CT angiography in peripheral arterial occlusive disease-accuracy of maximum intensity projections in clinical routine and subgroup analysis.
abstract: OBJECTIVE
  To evaluate the accuracy of dual-energy CT angiography (DE-CTA) maximum intensity projections (MIPs) in symptomatic peripheral arterial occlusive disease (PAOD).
  
  
  METHODS
  In 58 patients, DE-CTA of the lower extremities was performed on dual-source CT. In a maximum of 35 arterial segments, severity of the most stenotic lesion was graded (<10%, 10-49% and 50-99% luminal narrowing or occlusion) independently by two radiologists, with DSA serving as the reference standard.
  
  
  RESULTS
  In DSA, 52.3% of segments were significantly stenosed or occluded. Agreement of DE-CTA MIPs with DSA was good in the aorto-iliac and femoro-popliteal regions (κ = 0.72; κ = 0.66), moderate in the crural region (κ = 0.55), slight in pedal arteries (κ = 0.10) and very good in bypass segments (κ = 0.81). Accuracy was 88%, 78%, 74%, 55% and 82% for the respective territories and moderate (75%) overall, with good sensitivity (84%) and moderate specificity (67%). Sensitivity and specificity was 82% and 76% in claudicants and 84% and 61% in patients with critical limb ischaemia.
  
  
  CONCLUSIONS
  While correlating well with DSA above the knee, accuracy of DE-CTA MIPs appeared to be moderate in the calf and largely insufficient in calcified pedal arteries, especially in patients with critical limb ischaemia.
authors.affiliation: General Hospital of Klagenfurt, Institute of Diagnostic and Interventional Radiology, Klinikum Klagenfurt, Sankt Veiter Strasse 47, 9020 Klagenfurt, Austria. t.kau@gmx.at
authors.forename: Thomas
authors.initials: T
authors.lastname: Kau
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Eicher
authors.forename: Christian
authors.initials: C
authors.lastname: Reiterer
authors.forename: Martin
authors.initials: M
authors.lastname: Niedermayer
authors.forename: Egon
authors.initials: E
authors.lastname: Rabitsch
authors.forename: Birgit
authors.initials: B
authors.lastname: Senft
authors.forename: Klaus A
authors.initials: KA
authors.lastname: Hausegger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging*; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*