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Purpose:to evaluate the diagnostic accurateness and healing management of multidetector computed tomographic angiography(MDCTA)in the valuation of arterial tree in patients with peripheral arterial obstructive disease(PAOD),with the reference process for elaborating arterial patency,digital subtraction angiography(DSA).
Methodology:After acquirement approval from virtuous committee,written permission was obtained from all members.A single-center nonrandomized forthcoming study was steered in Union Hospital,Tongji medical School,Wuhan,China.
From February2017to October2017,according to inclusion criteria and exclusion criteria,comparison between CTA and DSA in critical lower limb ischemia was completed on fifty patients with diabetics,smokers and hypertension.All images were processed in dedicated workstation,by means of maximum intensity projection(MIP),volume-rendering(VR),and curved multiplane reconstruction(cMPR)techniques.
To recognize and describe stenosis and plaque morphology and composition,Image investigation was accomplished by separating the arterial vascular system into divisions.Gradation of disease of each segment was graded into four scores:mild stenosis≤4(9%luminal narrowing),moderate stenosis(50%–69%luminal narrowing),severe stenosis(70%–99%luminal narrowing),occlusion(100%lumen blockage).DSA and CT angiography(CTA)images were blinded analyzed by two different consultant radiologists respectively.
The diagnostic presentation of CTA was dogged on a per-patient,per-segment,and per-region origins in terms of accurateness,sensitivity,specificity,positive and negative prophetic standards,and positive and negative likelihood proportions by means of DSA as the orientation average.The x2,McNemar,and Wilcoxon luxuriant examinations were casted-off to inspect statistical importance,as suitable.Inter-observer and inter-modality preparation were dogged via global k statistics.All statistical evaluates were done via a statistical set(SPSS,version13.0;SPSS,Chicago,Ill).
Results:This study was done on fifty consecutive patients.Their mean age is62.5years old and median age was63years.Thirty-five patients were male(70%)and fifteen patients were female(30%).Most of them had one or more risk factors.Twenty-eight patients had hypertension(56%).Forty-five patients are diabetics(90%).The median duration of diabetics was19.1years.Thirty-six patients were smokers(72%).The median smoking duration was36years.
The sensitivity of CTA in the detection of insignificant(<50%)and significant(50%-70%,>70%,occlusion)stenosis in the femoropopliteal segment was100%and79%,while the specificity was80%and100%,respectively.In case of infrapopliteal segment,the sensitivity and specificity recorded were92%and86%while,100%and100%for the detection of insignificant and significant stenosis,respectively.The overall accuracy of CTA in femoropopliteal segment and infrapopliteal segment was95.20%and94.5%,respectively.The statistical analysis exposed there was a significant deference between CTA and DSA in the assessment in the level of femoropopliteal segment(P<0.05),while for infrapopliteal segment,there was no significant difference between CTA and DSA(P>0.05).
Conclusion:Multidetector CT angiography is a reliable objective mean in the anatomical description of the arterial lesions with the critical lower limb ischemia and subsequent management,but to be cautious in the infra-popliteal segment lesions when severe calcification is suspect.While,further studies are needed to compare accuracy of both multidetector CT angiography and digital subtraction angiography.
Methodology:After acquirement approval from virtuous committee,written permission was obtained from all members.A single-center nonrandomized forthcoming study was steered in Union Hospital,Tongji medical School,Wuhan,China.
From February2017to October2017,according to inclusion criteria and exclusion criteria,comparison between CTA and DSA in critical lower limb ischemia was completed on fifty patients with diabetics,smokers and hypertension.All images were processed in dedicated workstation,by means of maximum intensity projection(MIP),volume-rendering(VR),and curved multiplane reconstruction(cMPR)techniques.
To recognize and describe stenosis and plaque morphology and composition,Image investigation was accomplished by separating the arterial vascular system into divisions.Gradation of disease of each segment was graded into four scores:mild stenosis≤4(9%luminal narrowing),moderate stenosis(50%–69%luminal narrowing),severe stenosis(70%–99%luminal narrowing),occlusion(100%lumen blockage).DSA and CT angiography(CTA)images were blinded analyzed by two different consultant radiologists respectively.
The diagnostic presentation of CTA was dogged on a per-patient,per-segment,and per-region origins in terms of accurateness,sensitivity,specificity,positive and negative prophetic standards,and positive and negative likelihood proportions by means of DSA as the orientation average.The x2,McNemar,and Wilcoxon luxuriant examinations were casted-off to inspect statistical importance,as suitable.Inter-observer and inter-modality preparation were dogged via global k statistics.All statistical evaluates were done via a statistical set(SPSS,version13.0;SPSS,Chicago,Ill).
Results:This study was done on fifty consecutive patients.Their mean age is62.5years old and median age was63years.Thirty-five patients were male(70%)and fifteen patients were female(30%).Most of them had one or more risk factors.Twenty-eight patients had hypertension(56%).Forty-five patients are diabetics(90%).The median duration of diabetics was19.1years.Thirty-six patients were smokers(72%).The median smoking duration was36years.
The sensitivity of CTA in the detection of insignificant(<50%)and significant(50%-70%,>70%,occlusion)stenosis in the femoropopliteal segment was100%and79%,while the specificity was80%and100%,respectively.In case of infrapopliteal segment,the sensitivity and specificity recorded were92%and86%while,100%and100%for the detection of insignificant and significant stenosis,respectively.The overall accuracy of CTA in femoropopliteal segment and infrapopliteal segment was95.20%and94.5%,respectively.The statistical analysis exposed there was a significant deference between CTA and DSA in the assessment in the level of femoropopliteal segment(P<0.05),while for infrapopliteal segment,there was no significant difference between CTA and DSA(P>0.05).
Conclusion:Multidetector CT angiography is a reliable objective mean in the anatomical description of the arterial lesions with the critical lower limb ischemia and subsequent management,but to be cautious in the infra-popliteal segment lesions when severe calcification is suspect.While,further studies are needed to compare accuracy of both multidetector CT angiography and digital subtraction angiography.