title: Peripheral arterial occlusive disease: diagnostic performance and effect on therapeutic management of 64-section CT angiography.
abstract: OBJECTIVE
  To evaluate the diagnostic performance and effect on therapeutic management of 64-section computed tomographic (CT) angiography in the assessment of steno-occlusive disease in patients with peripheral arterial disease (PAD), with conventional digital subtraction angiography (DSA) as the reference standard.
  
  
  METHODS
  The study protocol was approved by the institutional review board, and written informed consent was obtained from all patients. A total of 212 patients with symptomatic PAD underwent CT angiography and subsequent DSA. For stenosis analysis (≥ 70% stenosis), the arterial bed was divided into 35 segments and evaluated by three readers. Interobserver agreement was determined with generalized κ statistics. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated. In addition, according to the TransAtlantic Inter-Society Consensus (TASC) Document on Management of Peripheral Arterial Disease guidelines, treatment recommendations based on CT angiographic and DSA findings were compared. McNemar test was used to prove significant differences between CT angiographic and DSA findings.
  
  
  RESULTS
  A total of 7420 arterial segments were evaluated, with excellent agreement between readers (κ ≥ 0.928). On a segmental basis, both sensitivity and specificity for stenosis of 70% or more were at least 96% (3072 of 3113 segments and 4141 of 4279 segments, respectively), with an accuracy of 98% (7213 of 7392 segments), a PPV of 96% (3072 of 3187 segments), an NPV of 99% (3141 of 3187 segments), a PLR of 36.7, and an NLR of 0.013. There was no significant difference between CT angiographic and DSA findings (P = .62-.87). In accordance with TASC II guidelines, 49 patients were referred for conservative treatment, 87 underwent endovascular procedures, 38 underwent surgery, and 17 received hybrid treatment. Therapy recommendations based on CT angiographic findings alone were identical to those based on DSA findings in all but one patient.
  
  
  CONCLUSIONS
  The diagnostic performance of 64-section CT angiography is excellent in patients with clinical symptoms of PAD. The results can be used to effectively guide therapeutic decision making in these patients.
authors.affiliation: Department of Radiological Sciences, University of Rome La Sapienza, Viale Regina Elena 324, 00161 Rome, Italy. alessandro.napoli@uniroma1.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Napoli
authors.forename: Michele
authors.initials: M
authors.lastname: Anzidei
authors.forename: Fulvio
authors.initials: F
authors.lastname: Zaccagna
authors.forename: Beatrice
authors.initials: B
authors.lastname: Cavallo Marincola
authors.forename: Chiara
authors.initials: C
authors.lastname: Zini
authors.forename: Giulia
authors.initials: G
authors.lastname: Brachetti
authors.forename: Gaia
authors.initials: G
authors.lastname: Cartocci
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fanelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods*; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D003287:Contrast Media; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol