Journal
EUROPEAN RADIOLOGY
Volume 21, Issue 8, Pages 1677-1686Publisher
SPRINGER
DOI: 10.1007/s00330-011-2099-1
Keywords
Computed tomography and angiography; Dual energy CT; Peripheral arterial occlusive disease; Critical limb ischemia; Lower extremities
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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 (kappa = 0.72; kappa = 0.66), moderate in the crural region (kappa = 0.55), slight in pedal arteries (kappa = 0.10) and very good in bypass segments (kappa = 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.
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