title: Combination of pulse volume recording (PVR) parameters and ankle-brachial index (ABI) improves diagnostic accuracy for peripheral arterial disease compared with ABI alone.
abstract: The ankle-brachial index (ABI) measurement is widely used as a screening tool to detect peripheral arterial disease (PAD). With the advent of the oscillometric ABI device incorporating a system for the measurement of pulse volume recording (PVR), not only ABI but also other parameters, such as the percentage of mean arterial pressure (%MAP) and the upstroke time (UT), can be obtained automatically. The purpose of the present study was to compare the diagnostic accuracy for PAD with ABI alone with that of a combination of ABI, %MAP and UT. This study included 108 consecutive patients on whom 216 limb measurements were performed. The sensitivity, specificity and positive and negative predictive values of ABI, %MAP, UT and their combination were evaluated and compared with CT angiography that was used as a gold standard for the detection of PAD. The diagnostic accuracy as well as the optimal cutoff values of %MAP and UT were evaluated using receiver operating characteristic (ROC) curve analysis. The combination of ABI, %MAP and UT achieved higher sensitivity, negative predictive value and accuracy than ABI alone, particularly for mild stenosis. The areas under the ROC curve for the detection of 50% stenosis with UT and %MAP were 0.798 and 0.916, respectively. The optimal UT and %MAP values to detect ≧50% stenosis artery were 183 ms and 45%, respectively. The combination of ABI, %MAP and UT contributed to the improvement of the diagnostic accuracy for PAD. Consideration of the values of %MAP and UT in addition to ABI may have a significant impact on the detection of early PAD lesions.
authors.affiliation: Department of Radiology, Nara Medical University, Nara, Japan.|Technology Development Department, Omron Healthcare, Kyoto, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Hashimoto
authors.affiliation: Department of Radiology, Nara Medical University, Nara, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Ichihashi
authors.affiliation: Department of Radiology, Nara Medical University, Nara, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Iwakoshi
authors.affiliation: Department of Radiology, Nara Medical University, Nara, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D062186:Arterial Pressure / Q000502:physiology*; D001916:Brachial Artery / Q000503:physiopathology; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity