title: Multidetector (64+) Computed Tomography Angiography of the Lower Limb in Symptomatic Peripheral Arterial Disease: Assessment of Image Quality and Accuracy in a Tertiary Care Setting.
abstract: OBJECTIVE
  The aim of this study was to evaluate image quality and accuracy of 64+ detector multidetector computed tomography angiography (MDCTA) for hemodynamically significant (≥50%) stenosis in patients with symptomatic peripheral arterial disease (PAD) using digital subtraction angiography as the reference standard.
  
  
  METHODS
  This is a retrospective study of 29 patients with PAD (19 men, 10 women) who underwent lower limb MDCTA (64- or 80-detector) and digital subtraction angiography. Image quality and accuracy of MDCTA for hemodynamically significant stenosis were assessed in the infrarenal aorta and 15 lower extremity segments.
  
  
  RESULTS
  Four hundred fifty-three segments were adequately visualized at both modalities. Multidetector CTA had 84.8% sensitivity, 87.7% specificity, and 86.3% accuracy for significant stenosis. Accuracy was decreased in the calf when compromising arterial wall calcifications were present versus absent (55.9% vs 82.4%, P < 0.0001).
  
  
  CONCLUSIONS
  64+ MDCTA is accurate in patients with symptomatic PAD. However, diagnostic accuracy in below-knee vessels remains relatively poorer. Alternative imaging modalities should be considered where below-knee disease is suspected.
authors.affiliation: From the *Austin Health; †Centre for Population Health, Burnet Institute; and Departments of ‡Surgery and §Radiology, The University of Melbourne, Melbourne, Australia.
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: Lim
authors.forename: Dinesh
authors.initials: D
authors.lastname: Ranatunga
authors.forename: Andrew
authors.initials: A
authors.lastname: Owen
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.forename: Michael
authors.initials: M
authors.lastname: Galea
authors.forename: Jason
authors.initials: J
authors.lastname: Chuen
authors.forename: Ruth P
authors.initials: RP
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D063128:Tertiary Health Care