title: Changing trends in a decade of vascular radiology-the impact of technical developments of non-invasive techniques on vascular imaging.
abstract: OBJECTIVE
  This review aims to establish the impact on conventional angiography and endovascular intervention of contrast-enhanced magnetic resonance angiography (CE-MRA) and contrast-enhanced computed tomography angiography (CE-CTA) on a background of evolving technology, changing clinical requirements and resulting clinical repercussions.
  
  
  METHODS
  The angiographic and interventional caseload was prospectively recorded between 1997 and 2010, along with the CE-MRA and CE-CTA caseload. Waiting times and the marginal cost analyses for 2001 and 2009 were also prospectively established.
  
  
  RESULTS
  Conventional diagnostic angiographies declined from a peak of 847 to 121 per year while endovascular interventions continue in similar numbers. CE-MRA increased from effectively none initially to 620 per year while CE-CTA has currently risen to 396 per year. Total diagnostic study numbers have increased but at reduced cost. Various influences are clear, including on-site modality availability, capability and accuracy along with impact of new therapies, research studies and adverse events.
  
  
  CONCLUSIONS
  Vascular imaging has undergone a metamorphosis in little over a decade because of CE-MRA and CE-CTA. With waiting times significantly reduced since the start of the study and the cost-effectiveness of both CE-MRA and CE-CTA as primary diagnostic investigations established, further development of these services is inevitable.
  
  
  CONCLUSIONS
  • The availability of CE-MRA and CE-CTA has reduced the need for conventional angiography.                                                  • Both waiting times and the marginal cost analyses for CE-MRA and CE-CTA have reduced.                                                  • The impact of new therapies, research studies (e.g. ASTRAL) and adverse events is illustrated.
authors.affiliation: Department of Radiology, Glasgow Royal Infirmary, Alexandra Parade, Glasgow, G4 0SF,, Scotland, United Kingdom, gordoncowell@nhs.net.
authors.forename: Gordon W
authors.initials: GW
authors.lastname: Cowell
authors.forename: Allan W
authors.initials: AW
authors.lastname: Reid
authors.forename: Giles H
authors.initials: GH
authors.lastname: Roditi