title: Digital obstructive arterial disease can be detected by laser Doppler measurements with high sensitivity and specificity.
abstract: OBJECTIVE
  This study was conducted to determine the sensitivity and specificity of laser Doppler flowmetry (LDF) measurements for digital obstructive arterial disease (DOAD) using angiography as the reference standard and to compare the accuracy of different classical tests used to assess DOAD. Diagnosis of vascular abnormalities at the digital level is challenging. Angiography is the gold standard for assessment of DOAD but is invasive and expensive to perform.
  
  
  METHODS
  We performed a retrospective analysis of consecutive patients referred at Mayo Clinic (Rochester, Minn) for upper extremity arterial assessment during a 27-month period. Finger-brachial index, skin blood flow (in arbitrary units [a.u.]), and skin temperature (in degrees Celsius) were recorded in each digit on the pulp at baseline and after a thermal challenge test (hand placed in a thermal box at 47.0°C for 15 minutes). Angiogram analysis was blinded and performed by a radiologist using a vascularization scale ranging from 0 (no vessel) to 4 (normal). The receiver operating characteristic curve was used to define a specific cutoff point to detect DOAD. Twenty-two patients had LDF measurements and complete angiograms.
  
  
  RESULTS
  A total of 185 digits were analyzed because some patients had only analysis of one hand. The best area under the curve (AUC) was 0.98 (range, 0.94-0.99) for postwarming skin blood flow, with a cutoff point of ≤206 a.u. This AUC was statistically different from AUCs of all the other tests (P < .01). Sensitivity and specificity were 93% (95% confidence interval, 85%-97%) and 96% (95% confidence interval, 90%-99%), respectively.
  
  
  CONCLUSIONS
  LDF combined with a thermal challenge is highly accurate, safe, and noninvasive means to detect DOAD.
authors.affiliation: Gonda Vascular Center, Mayo Clinic, Rochester, Minn; L'Université Nantes Angers Le Mans, Institut National de la Santé et de la Recherche Médicale 1083/CNRS 6214, Faculty of Medicine, Angers, France. Electronic address: maheguillaume@yahoo.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Mahe
authors.affiliation: Gonda Vascular Center, Mayo Clinic, Rochester, Minn.
authors.forename: David A
authors.initials: DA
authors.lastname: Liedl
authors.affiliation: Gonda Vascular Center, Mayo Clinic, Rochester, Minn.
authors.forename: Charlene
authors.initials: C
authors.lastname: McCarter
authors.affiliation: Gonda Vascular Center, Mayo Clinic, Rochester, Minn.
authors.forename: Roger
authors.initials: R
authors.lastname: Shepherd
authors.affiliation: Gonda Vascular Center, Mayo Clinic, Rochester, Minn.
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
authors.affiliation: Gonda Vascular Center, Mayo Clinic, Rochester, Minn.
authors.forename: Ian R
authors.initials: IR
authors.lastname: McPhail
authors.affiliation: Gonda Vascular Center, Mayo Clinic, Rochester, Minn.
authors.forename: Thom W
authors.initials: TW
authors.lastname: Rooke
authors.affiliation: Gonda Vascular Center, Mayo Clinic, Rochester, Minn. Electronic address: wennberg.paul@mayo.edu.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Wennberg
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000503:physiopathology; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006358:Hot Temperature; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011237:Predictive Value of Tests; D012372:ROC Curve; D011859:Radiography; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012867:Skin / Q000098:blood supply*; D012881:Skin Temperature