Peripheral Arterial Disease: Clinical and Cost Comparisons between Duplex US and Contrast-enhanced MR Angiography—A Multicenter Randomized Trial

Vries, Marianne de; Ouwendijk, Rody; Flobbe, Karin; Nelemans, Patricia J.; Kessels, Alphons G.H.; Schurink, Geert-Willem; Vliet, J.A. van der; Heijstraten, F.M.J.; Cuypers, Philippe W.M.; Duijm, Luciën E. M.; Engelshoven, Jos M. A. van; Hunink, M. G. Myriam; Haan, Michiel W. de

doi:10.1148/radiol.2402050223

Cited by 37 publications

(18 citation statements)

References 35 publications

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“…A prospective multicenter trial of patients318 randomized to either CE-MRA or duplex ultrasound for PAD evaluation found the results of both studied to have similar ability to predict changes in disease severity and quality of life. Importantly, patients that received peripheral CE-MRA experienced a reduction of additional vascular imaging procedures by 42%.…”

Section: Important Applicationsmentioning

confidence: 99%

ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance

Hundley

Bluemke²,

Finn³

et al. 2010

Circulation

493

119

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Section: Important Applicationsmentioning

confidence: 99%

ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance

Hundley

Bluemke²,

Finn³

et al. 2010

Circulation

493

119

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“…38 Recent studies in Europe on patients being evaluated for peripheral arterial disease indicated that MR and CT provide higher cost alternatives to US due to the fewer number of reimaging studies sometimes required, but no differences were found in patient outcomes or quality of life. 39,40 US also provides an accurate assessment of peripheral vascular disease (PVD), especially in the setting of patients undergoing interventions. US is often superior to angiography and MR in this diagnosis, and the use of US provides lower costs and significantly shortens the patient's hospital stay.…”

Section: Vascularmentioning

confidence: 99%

Accuracy and Cost Comparison of Ultrasound Versus Alternative Imaging Modalities, Including CT, MR, PET, and Angiography

Bierig

Jones²

2009

Journal of Diagnostic Medical Sonography

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Ultrasound (US) has become widely used in clinical medicine for the diagnosis of a variety of disease processes. The unique ability of US to provide accurate information through an efficacious, painless, portable, and nonionizing method has expanded its role and application in diverse medical settings. Given the current economic environment and the related interest in creating the greatest value for health care expenditures, US has been evaluated to compare its clinical accuracy/efficacy and cost-effectiveness versus other imaging modalities. The following literature review reports the results of research studies aimed at comparing the accuracy/efficacy and cost of US versus alternative imaging modalities, including magnetic resonance imaging, computed tomography, contrast angiography, and single-photon emission computed tomography.

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“…The radiologic approach to the diagnosis of PAD has changed substantially in the past few years [6]. Typically the ankle-brachial index (ABI) is the first noninvasive imaging test performed in the investigation of PAD.…”

mentioning

confidence: 99%

Peripheral Arterial Disease in a Symptomatic Diabetic Population: Prospective Comparison of Rapid Unenhanced MR Angiography (MRA) With Contrast-Enhanced MRA

Hodnett

Ward

Davarpanah³

et al. 2011

American Journal of Roentgenology

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OBJECTIVE The joint guidelines of the American College of Cardiology and American Heart Association support the use of contrast-enhanced MR angiography (CEMRA) to diagnose the location and degree of stenosis in patients with known or suspected peripheral arterial disease (PAD). The high prevalence of chronic renal impairment in diabetic patients with PAD and the need for high doses of gadolinium-based contrast agents place them at risk for nephrogenic systemic fibrosis. The purpose of our study was to evaluate the accuracy of the rapid technique of quiescent-interval single-shot (QISS) unenhanced MR angiography (MRA) compared with CEMRA for the diagnosis in diabetic patients referred with symptomatic chronic PAD. SUBJECTS AND METHODS This prospective two-center study evaluated 25 consecutive diabetic patients with documented or suspected symptomatic PAD. Both centers used identical imaging protocols. Images were independently analyzed by two radiologists. A subgroup analysis was performed of patients who were also assessed with digital subtraction angiography (DSA) as part of the standard-of-care protocol before revascularization. RESULTS For this study, 775 segments were analyzed. On a per-segment basis, the mean values of the diagnostic accuracy of unenhanced MRA compared with reference CEMRA for two reviewers, reviewers 1 and 2, were as follows: sensitivity, 87.4% and 92.1%; specificity, 96.8% and 96.0%; positive predictive value, 90.8% and 94.0%; and negative predictive value, 95.5% and 94.6%. Substantial agreement was found when overall DSA results were compared with QISS unenhanced MRA (κ = 0.68) and CEMRA (κ = 0.63) in the subgroup of patients who also underwent DSA. There was almost perfect agreement between the two readers for stenosis scores, with Cohen’s kappa values being greater than 0.80 for both MRA techniques. CONCLUSION The results of our study indicate that QISS unenhanced MRA is an accurate noncontrast alternative to CEMRA for showing clinically significant arterial disease in patients with diabetes with symptomatic PAD.

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Peripheral Arterial Disease: Clinical and Cost Comparisons between Duplex US and Contrast-enhanced MR Angiography—A Multicenter Randomized Trial

Abstract: Replacing duplex US with contrast-enhanced MR angiography for the initial imaging work-up of patients with PAD reduces the need for additional imaging, although diagnostic costs are higher.

Cited by 37 publications

References 35 publications

ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance

ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance

Accuracy and Cost Comparison of Ultrasound Versus Alternative Imaging Modalities, Including CT, MR, PET, and Angiography

Peripheral Arterial Disease in a Symptomatic Diabetic Population: Prospective Comparison of Rapid Unenhanced MR Angiography (MRA) With Contrast-Enhanced MRA

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