Lower extremity: nonstepping digital angiography with photostimulable imaging plates versus conventional angiography.

Abstract

To compare nonstepping digital subtraction angiography (DSA) (ie, storage phosphor radiography adapted to a stationary imaging plate changer) with conventional screen-film angiography in the evaluation of the lower extremities. Fifty-one patients with peripheral vascular disease underwent both nonstepping DSA and screen-film angiography. The angiographic and radiologic techniques of both systems were kept identical for each patient. Three radiologists independently rated the overall quality of each angiogram. In their evaluations for each of 12 arterial segments on all 102 angiograms, they also rated the degree of opacification, the diameter reduction of the most severe stenosis, and their level of confidence. Mean overall quality scores and levels of confidence were better for nonstepping DSA than for screen-film angiography (P < .001). Full opacification was reported in 95.6% and 89.2% of all 1,836 segments with nonstepping DSA and screen-film angiography, respectively (P < .0001). The difference between the mean stenosis grades obtained with screen-film angiography and nonstepping DSA was not statistically significant. Intertechnique agreements were good (kappa = 0.77, 0.81, and 0.81), whereas interobserver agreements were influenced by the observer's experience with the imaging techniques. Nonstepping DSA images of the lower extremity were of better diagnostic quality than were screen-film angiograms. The development of dedicated nonstepping DSA equipment is warranted.