Comparative study between Doppler ultrasound and computed tomography angiography in diabetic lower limb arterial insufficiency

Abstract

Objective This work aimed to highlight the role of color Doppler ultrasound in the assessment of lower limb arterial insufficiency in patients with diabetes as well as the characteristics of lower limb arterial disease in diabetic patients. Background Diabetic lower limb arterial insufficiency is a major health problem affecting the individuals and community health. Doppler ultrasound is a widespread relatively cheap examination with no health hazards of radiation. Hence, we considered studying the role of Doppler ultrasound in determining the characteristics of lower limb arterial diabetic insufficiency and its level of accuracy. Patients and methods One hundred diabetic patients with clinically suspected lower limb arterial insufficiency were examined using Doppler ultrasound and computed tomography angiography (CTA), and the characteristics of diabetic lower limb arterial disease and accuracy of Doppler results in relation to CTA were determined. Results Diabetic lower limb arterial disease was characterized by being bilateral and multisegmental in the majority of cases with more affection of the distal (below knee) arteries. There was no significant difference between Doppler and CTA results at the above knee arteries as regards detection of significant arterial stenosis (luminal narrowing ≥ 50% of artery diameter); P values were as follows: common iliac artery segment, 0.695; external iliac artery, 0.776; common femoral artery, 0.563; and superficial femoral artery, 0.599. Further, a low significant difference at below knee arteries was found; P values were as follows: popliteal artery segment, 0.033; anterior tibial artery, 0.025; posterior tibial artery, 0.019; and peroneal artery, 0.031. The overall sensitivity of Doppler in evaluating lower limb arteries was 90.46%, the specificity was 92.05%, and the accuracy was 91.81% when CTA was taken as a standard. Conclusion Duplex ultrasound provides high-resolution, precise anatomical and physiological information of the peripheral arteries. It should be first-line investigation for lower limb arterial assessment and also be combined with other arterial imaging modalities to obtain better diagnostic accuracy.