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Diagnostic confidence of run-off CT-angiography as the primary diagnostic imaging modality in patients presenting with acute or chronic peripheral arterial disease.

Werncke T, Ringe KI, von Falck C, Kruschewski M, Wacker F, Meyer BC - PLoS ONE (2015)

Bottom Line: To investigate the reliability of CT-angiography of the lower extremities (run-off CTA) to derive a treatment decision in patients with acute and chronic peripheral artery disease (PAD). 314 patients referred for run-off CTA were includ-ed in this retrospective study.Second, reliability of treatment decision was verified in all patients undergoing re-vascularization therapy.Reliability of treatment decision was superior for patients with chronic (123/133 = 92%) than for patients with acute PAD (64/78 = 82%, P = 0.02).

View Article: PubMed Central - PubMed

Affiliation: Klinik für Radiologie, Charité Universitätsmedizin Berlin, Berlin, Germany.

ABSTRACT

Objectives: To investigate the reliability of CT-angiography of the lower extremities (run-off CTA) to derive a treatment decision in patients with acute and chronic peripheral artery disease (PAD).

Materials and methods: 314 patients referred for run-off CTA were includ-ed in this retrospective study. First, diagnostic confidence of run-off CTA to derive a treat-ment decision was assessed in an interdisciplinary vascular conference using a 2 point scale (sufficient or not sufficient diagnostic confidence) and compared with the image quality eval-uated by two readers in consensus in four different levels (abdominopelvic, thigh, calf, foot arteries). Second, reliability of treatment decision was verified in all patients undergoing re-vascularization therapy.

Results: Diagnostic confidence of run-off CTA to derive a treatment deci-sion was sufficient in all patients with acute and in 97% of patients (215/221) with chronic PAD, whereas the rate of run-off CTA with non-diagnostic image quality was considerably higher in the calf and foot level (acute vs. chronic; calf: 28% vs.17%; foot: 52% vs. 20%). Reliability of treatment decision was superior for patients with chronic (123/133 = 92%) than for patients with acute PAD (64/78 = 82%, P = 0.02).

Conclusion: Run-off CTA is a reliable imaging modality for primary diag-nostic work-up of patients with acute and chronic PAD.

No MeSH data available.


Related in: MedlinePlus

Proportion of patients with non-diagnostic image quality (IQ-) due to severe vessel calcifications (A) or insufficient vessel contrast (B) dependent on peripheral arterial disease (PAD) manifestation and arterial level.The total number of patients (black numbers) as well as the subset of patients with insufficient diagnostic confidence of run-off CTA (DC−, white numbers) is given for each subgroup. DC− = insufficient, DC+ = sufficient diagnostic confidence. * = P <0.05, *** = P<0.001, n.s. = no significance, P-Value of χ2-test.
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pone.0119900.g003: Proportion of patients with non-diagnostic image quality (IQ-) due to severe vessel calcifications (A) or insufficient vessel contrast (B) dependent on peripheral arterial disease (PAD) manifestation and arterial level.The total number of patients (black numbers) as well as the subset of patients with insufficient diagnostic confidence of run-off CTA (DC−, white numbers) is given for each subgroup. DC− = insufficient, DC+ = sufficient diagnostic confidence. * = P <0.05, *** = P<0.001, n.s. = no significance, P-Value of χ2-test.

Mentions: With regards to artery levels with non-diagnostic IQ (Fig. 3), insufficient vessel enhancement was significantly more frequently observed at the calf (acute: 24% vs. chronic: 5%, P<0.001) and foot level (acute: 49% vs. chronic: 11%, P<0.001) in patients with acute PAD as compared to patients with chronic PAD. Severe vessel wall calcifications were not significantly more frequently observed at the calf level compared between patients with acute and chronic PAD. At the foot level severe calcifications were significantly more often the reason for insufficient vessel delineation (acute: 3% vs. chronic: 11%, P = 0.03) in patients with chronic PAD compared to patients with acute PAD. The risk that the diagnostic confidence of a run-off CTA in patients with chronic PAD was insufficient, if the image quality was non-diagnostic, was approximately 16% (6/37).


Diagnostic confidence of run-off CT-angiography as the primary diagnostic imaging modality in patients presenting with acute or chronic peripheral arterial disease.

Werncke T, Ringe KI, von Falck C, Kruschewski M, Wacker F, Meyer BC - PLoS ONE (2015)

Proportion of patients with non-diagnostic image quality (IQ-) due to severe vessel calcifications (A) or insufficient vessel contrast (B) dependent on peripheral arterial disease (PAD) manifestation and arterial level.The total number of patients (black numbers) as well as the subset of patients with insufficient diagnostic confidence of run-off CTA (DC−, white numbers) is given for each subgroup. DC− = insufficient, DC+ = sufficient diagnostic confidence. * = P <0.05, *** = P<0.001, n.s. = no significance, P-Value of χ2-test.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4383442&req=5

pone.0119900.g003: Proportion of patients with non-diagnostic image quality (IQ-) due to severe vessel calcifications (A) or insufficient vessel contrast (B) dependent on peripheral arterial disease (PAD) manifestation and arterial level.The total number of patients (black numbers) as well as the subset of patients with insufficient diagnostic confidence of run-off CTA (DC−, white numbers) is given for each subgroup. DC− = insufficient, DC+ = sufficient diagnostic confidence. * = P <0.05, *** = P<0.001, n.s. = no significance, P-Value of χ2-test.
Mentions: With regards to artery levels with non-diagnostic IQ (Fig. 3), insufficient vessel enhancement was significantly more frequently observed at the calf (acute: 24% vs. chronic: 5%, P<0.001) and foot level (acute: 49% vs. chronic: 11%, P<0.001) in patients with acute PAD as compared to patients with chronic PAD. Severe vessel wall calcifications were not significantly more frequently observed at the calf level compared between patients with acute and chronic PAD. At the foot level severe calcifications were significantly more often the reason for insufficient vessel delineation (acute: 3% vs. chronic: 11%, P = 0.03) in patients with chronic PAD compared to patients with acute PAD. The risk that the diagnostic confidence of a run-off CTA in patients with chronic PAD was insufficient, if the image quality was non-diagnostic, was approximately 16% (6/37).

Bottom Line: To investigate the reliability of CT-angiography of the lower extremities (run-off CTA) to derive a treatment decision in patients with acute and chronic peripheral artery disease (PAD). 314 patients referred for run-off CTA were includ-ed in this retrospective study.Second, reliability of treatment decision was verified in all patients undergoing re-vascularization therapy.Reliability of treatment decision was superior for patients with chronic (123/133 = 92%) than for patients with acute PAD (64/78 = 82%, P = 0.02).

View Article: PubMed Central - PubMed

Affiliation: Klinik für Radiologie, Charité Universitätsmedizin Berlin, Berlin, Germany.

ABSTRACT

Objectives: To investigate the reliability of CT-angiography of the lower extremities (run-off CTA) to derive a treatment decision in patients with acute and chronic peripheral artery disease (PAD).

Materials and methods: 314 patients referred for run-off CTA were includ-ed in this retrospective study. First, diagnostic confidence of run-off CTA to derive a treat-ment decision was assessed in an interdisciplinary vascular conference using a 2 point scale (sufficient or not sufficient diagnostic confidence) and compared with the image quality eval-uated by two readers in consensus in four different levels (abdominopelvic, thigh, calf, foot arteries). Second, reliability of treatment decision was verified in all patients undergoing re-vascularization therapy.

Results: Diagnostic confidence of run-off CTA to derive a treatment deci-sion was sufficient in all patients with acute and in 97% of patients (215/221) with chronic PAD, whereas the rate of run-off CTA with non-diagnostic image quality was considerably higher in the calf and foot level (acute vs. chronic; calf: 28% vs.17%; foot: 52% vs. 20%). Reliability of treatment decision was superior for patients with chronic (123/133 = 92%) than for patients with acute PAD (64/78 = 82%, P = 0.02).

Conclusion: Run-off CTA is a reliable imaging modality for primary diag-nostic work-up of patients with acute and chronic PAD.

No MeSH data available.


Related in: MedlinePlus