Dual-energy CT angiography in peripheral arterial occlusive disease—accuracy of maximum intensity projections in clinical routine and subgroup analysis
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To evaluate the accuracy of dual-energy CT angiography (DE-CTA) maximum intensity projections (MIPs) in symptomatic peripheral arterial occlusive disease (PAOD).
In 58 patients, DE-CTA of the lower extremities was performed on dual-source CT. In a maximum of 35 arterial segments, severity of the most stenotic lesion was graded (<10%, 10–49% and 50–99% luminal narrowing or occlusion) independently by two radiologists, with DSA serving as the reference standard.
In DSA, 52.3% of segments were significantly stenosed or occluded. Agreement of DE-CTA MIPs with DSA was good in the aorto-iliac and femoro-popliteal regions (κ = 0.72; κ = 0.66), moderate in the crural region (κ = 0.55), slight in pedal arteries (κ = 0.10) and very good in bypass segments (κ = 0.81). Accuracy was 88%, 78%, 74%, 55% and 82% for the respective territories and moderate (75%) overall, with good sensitivity (84%) and moderate specificity (67%). Sensitivity and specificity was 82% and 76% in claudicants and 84% and 61% in patients with critical limb ischaemia.
While correlating well with DSA above the knee, accuracy of DE-CTA MIPs appeared to be moderate in the calf and largely insufficient in calcified pedal arteries, especially in patients with critical limb ischaemia.
KeywordsComputed tomography and angiography Dual energy CT Peripheral arterial occlusive disease Critical limb ischemia Lower extremities