Assessment of occlusive disease of lower extremity arteries on the basis of anatomic region: Value of 128-slice multidetector CT angiography in comparison with digital subtraction angiography

Abstract

Background & Objectives:The Pr evious studies of multidetector CT (MDCT) of the lower extremities for the detection of peripheral vascular disease showed high diagnostic accuracy but were performed with older generation systems. Our study aimed at assessing the diagnostic value of 128 MDCTA compared with that of digital subtraction angiography (DSA) in the grading of focal arterial disease of lower extremity arteries on the basis of anatomic regions. Materials & Methods: Forty-two patients with peripheral arterial occlusive diseases underwent both MDCTA and DSA. Lower extremity arteries depicted at MDCTA and DSA were graded separately for the degree of stenosis into 3 anatomic regions and 33 segments. Grading by MDCTA and DSA was done independently. Homogeneity analysis was used between MDCTA and DSA measurements in each patient. The sensitivity, specificity, positive predictive value and negative predictive value for detection of stenotic lesions were calculated for all anatomic regions, with findings at DSA used as the reference standard. Results: No statistically significant difference (P>.05) between DSA and MDCTA was present in Aorto-iliac and poplitiofemoral regions while there was statistically significant difference (P<.05) in the infrapopliteal region. The Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value based on a reading of MDCTA were 84.3%, 93.8%, 89.4% and 90.6% for aorto-iliac 86.6%, 94.7%, 84.1% and 94.7% for poplitiofemoral and 95.7%, 86.1%, 85.6% and 95.9% for infra-popliteal region respectively. Conclusion: MDCTA is excellent alter native in diagnosing lower extremity arterial occlusive diseases above the knee. DSA remains better on illustrating distal runoff vessels. Key words: Digital Subtr action Angiogr aphy; Multidetector CT Angiography; Peripheral Arterial Occlusive Disease Citation: Pangeni R, Han P, Pan F, Lamsal LP, Zhang Z, Yu J , Rizal R. Assessment of occlusive disease of lower extremity arteries on the basis of anatomic region: Value of 128-slice multidetector CT angiography in comparison with digital subtraction angiography. JCMS Nepal. 2016;12(4):179-86. 180 high accuracy for detection of steno-occlusive diseases compared with DSA. 4 Its advantages over DSA includes minimal invasiveness, smaller required volume of contrast material, shorter scan time and fast data acquisition. Other advantages of MDCT angiography include three dimensional (3D) volumetric data analysis and display, visualization of mural plaque and calcium. Unlike catheter angiography, MDCTA not only depicts the vessels but also allows assessment of perfusion in adjacent organs. These advantages have led to CTA replacing DSA for diagnosis at many centers. 5 However, there is a paucity of studies comparing the 128-slice MDCTA with DSA on the basis of region of blood vessel regarding grading in lower extremity. The purpose of the present study was to evaluate the diagnostic accuracy of 128-slice MDCTA in comparison with DSA in patients with PAD depending on the region o...