title: Comparison of noninvasive imaging modalities for stenosis grading in mesenteric arteries.
abstract: OBJECTIVE
  To prospectively analyze duplex sonography, CTA, and MRA with respect to stenosis grading of the celiac trunk (TC) and the superior mesenteric artery (SMA), with DSA as the reference.
  
  
  METHODS
  52 subjects were enrolled (mean age: 71). The image quality was graded: 1-insufficient, 2-bad, 3-moderate, 4-good or 5-excellent. Stenosis was graded: 1 (< 25 %), 2 (25 - < 50 %), 3 (50 - 75 %) or 4 (75 %). Two-sided chi-square tests were used to check for correlation of stenosis grading between modalities. The weighted Cohen's kappa was calculated to assess the strength of correlation. With a threshold of 50 % for non-relevant stenosis vs. relevant stenosis, the sensitivity, specificity, PPV, NPV, and accuracy were calculated.
  
  
  RESULTS
  The mean image quality was 3.8 ± 0.7, 3.1 ± 1.0, 4.4 ± 0.7, and 3.8 ± 0.9 for DSA, duplex sonography, CTA, and MRA, respectively. For both TC and SMA, stenosis grading reached a significant level of correlation between each noninvasive modality with DSA (p < 0.001, each). The weighted Cohen's kappa for duplex sonography/CTA/MRA was 0.94/0.93/0.74, respectively, for the TC and 0.64/0.91/0.56, respectively, for the SMA. Highest sensitivity/specificity/NPV/PPV/accuracy were found for CTA with 100 %/95 %/85 %/100 %/96 % for the TC and with na/98 %/na/100 %/98 %, respectively, for the SMA.
  
  
  CONCLUSIONS
  CTA provided the best image quality, reached the highest level of agreement and significance in correlation in stenosis grading, and offered the best diagnostic accuracy.
authors.affiliation: Diagnostic Radiology, University Hospital Schleswig-Holstein Campus Kiel. jp.schaefer@rad.uni-kiel.de
authors.forename: P J
authors.initials: PJ
authors.lastname: Schaefer
authors.forename: J
authors.initials: J
authors.lastname: Pfarr
authors.forename: J
authors.initials: J
authors.lastname: Trentmann
authors.forename: A M
authors.initials: AM
authors.lastname: Wulff
authors.forename: C
authors.initials: C
authors.lastname: Langer
authors.forename: M
authors.initials: M
authors.lastname: Siggelkow
authors.forename: J
authors.initials: J
authors.lastname: Groß
authors.forename: H
authors.initials: H
authors.lastname: Knabe
authors.forename: F K W
authors.initials: FK
authors.lastname: Schaefer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic / Q000473:pathology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D065666:Mesenteric Ischemia; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*; D014652:Vascular Diseases / Q000175:diagnosis*