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Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: systematic review and meta-analysis

  • Magnetic Resonance
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Abstract

Objective

To evaluate the diagnostic performance of computed tomography angiography (CTA) and contrast-enhanced magnetic resonance angiography (CE-MRA) in detecting haemodynamically significant arterial stenosis or occlusion in patients with critical limb ischaemia (CLI) or intermittent claudication (IC).

Methods

Medline and Embase were searched for studies comparing CTA or CE-MRA with digital subtraction angiography as a reference standard, including patients with CLI or IC. Outcome measures were aortotibial arterial stenosis of more than 50 % or occlusion. Methodological quality of studies was assessed using QUADAS.

Results

Out of 5,693 articles, 12 CTA and 30 CE-MRA studies were included, respectively evaluating 673 and 1,404 participants. Summary estimates of sensitivity and specificity were respectively 96 % (95 % CI, 93–98 %) and 95 % (95 % CI, 92–97 %) for CTA, and 93 % (95 % CI, 91–95 %) and 94 % (95 % CI, 93–96 %) for CE-MRA. Regression analysis showed that the prevalence of CLI in individual studies was not an independent predictor of sensitivity and specificity for either technique. Methodological quality of studies was moderate to good.

Conclusion

CTA and CE-MRA are accurate techniques for evaluating disease severity of aortotibial arteries in patients with CLI or IC. No significant differences in the diagnostic performance of the two techniques between patients with CLI and IC were found.

Key Points

• Computed tomography and contrast-enhanced magnetic resonance angiography can both demonstrate arterial disease.

• CTA and CE-MRA can both accurately evaluate arteries in peripheral arterial disease.

• Diagnostic performances of critical limb ischaemia and intermittent claudication are not different.

• Separate imaging technique of tibial arteries by CE-MRA is preferred.

• CTA and CE-MRA can distinguish confidently between high-grade stenoses and occlusions.

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Abbreviations

CE-MRA:

contrast-enhanced magnetic resonance angiography

CLI:

critical limb ischaemia

CTA:

computed tomography angiography

IC:

intermittent claudication

PAD:

peripheral arterial disease

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Acknowledgements

Joost Daams, MA (clinical librarian at Academic Medical Center Amsterdam, the Netherlands), provided assistance with the study search. Mr Daams did not receive compensation for his contribution. The authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Academic Medical Center, Room G1-229, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands

    Sjoerd Jens

  2. Department of Surgery, Academic Medical Center, Room G5-153, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands

    Mark J. W. Koelemay

  3. Department of Radiology, Academic Medical Center, Room G1-206, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands

    Jim A. Reekers

  4. Department of Radiology, Academic Medical Center, Room G1-231, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands

    Shandra Bipat

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Jens, S., Koelemay, M.J.W., Reekers, J.A. et al. Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: systematic review and meta-analysis. Eur Radiol 23, 3104–3114 (2013). https://doi.org/10.1007/s00330-013-2933-8

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