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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

Example of a run-off CTA with sufficient diagnostic confidence and diagnostic image quality and disagreement of intended and undertaken therapy.69 y old male presenting with Fontaine stage IIb of the left leg. Run-off CTA revealed a calcified stenosis rated to be haemodynamic relevant in the curved multiplanar reformat (a) and the axial image (b, white arrow). In DSA (c), the stenosis could not be confirmed.
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pone.0119900.g004: Example of a run-off CTA with sufficient diagnostic confidence and diagnostic image quality and disagreement of intended and undertaken therapy.69 y old male presenting with Fontaine stage IIb of the left leg. Run-off CTA revealed a calcified stenosis rated to be haemodynamic relevant in the curved multiplanar reformat (a) and the axial image (b, white arrow). In DSA (c), the stenosis could not be confirmed.

Mentions: This was mainly attributable to a change of the therapeutic concept during the surgical or endovascular procedure as given in detail in Table 6. The most frequent reason for a modification of the revascularisation therapy in patients with chronic PAD was a prior hidden stenosis after thrombectomy. In patients with acute PAD the main reason for a modification of the revascularisation therapy was a new thrombosis requiring catheter derived thrombolysis or amputation. In four patients (acute PAD: 1 patient, chronic PAD: 3 patients), false-positive findings of run-off CTA were accountable for disagreement (Fig. 4).


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)

Example of a run-off CTA with sufficient diagnostic confidence and diagnostic image quality and disagreement of intended and undertaken therapy.69 y old male presenting with Fontaine stage IIb of the left leg. Run-off CTA revealed a calcified stenosis rated to be haemodynamic relevant in the curved multiplanar reformat (a) and the axial image (b, white arrow). In DSA (c), the stenosis could not be confirmed.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0119900.g004: Example of a run-off CTA with sufficient diagnostic confidence and diagnostic image quality and disagreement of intended and undertaken therapy.69 y old male presenting with Fontaine stage IIb of the left leg. Run-off CTA revealed a calcified stenosis rated to be haemodynamic relevant in the curved multiplanar reformat (a) and the axial image (b, white arrow). In DSA (c), the stenosis could not be confirmed.
Mentions: This was mainly attributable to a change of the therapeutic concept during the surgical or endovascular procedure as given in detail in Table 6. The most frequent reason for a modification of the revascularisation therapy in patients with chronic PAD was a prior hidden stenosis after thrombectomy. In patients with acute PAD the main reason for a modification of the revascularisation therapy was a new thrombosis requiring catheter derived thrombolysis or amputation. In four patients (acute PAD: 1 patient, chronic PAD: 3 patients), false-positive findings of run-off CTA were accountable for disagreement (Fig. 4).

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