Abstract
ObjectivesTo compare diagnostic performance and time efficiency between 3D multipath curved planar reformations (mpCPRs) and axial images of CT angiography for the pre-interventional assessment of peripheral arterial disease (PAD), with digital subtraction angiography as the standard of reference.MethodsForty patients (10 females, mean age 72 years), referred to CTA prior to endovascular treatment of PAD, were prospectively included and underwent peripheral CT angiography. A semiautomated toolbox was used to render mpCPRs. Twenty-one arterial segments were defined in each leg; for each segment, the presence of stenosis > 70% was assessed on mpCPRs and axial images by two readers, independently, with digital subtraction angiography as gold standard.ResultsBoth readers reached lower sensitivity (Reader 1: 91 vs. 94%, p = 0.08; Reader 2: 89 vs. 93%, p = 0.03) but significantly higher specificity (Reader 1: 94 vs. 89%, p < 0.01; Reader 2: 96 vs. 95%, p = 0.01) with mpCPRs than with axial images. Reader 1 achieved significantly higher accuracy with mpCPRs (93 vs. 91%, p = 0.02), and Reader 2 had similar overall accuracy in both evaluations (94 vs. 94%, p = 0.96). Both readers read mpCPRs significantly faster than axial images (Reader 1: 5′45″ based on mpCPRs vs. 7′40″ based on axial images; Reader 2: 4′41″ based on mpCPRs vs. 6′57″ based on axial images; p < 0.01).ConclusionsmpCPRs are a promising 3D reformation technique that facilitates a fast assessment of PAD with high diagnostic accuracy.
Highlights
Peripheral arterial disease (PAD) and its associated morbidity place a significant burden on both patients and healthcare systems
Twenty-one arterial segments were defined in each leg; for each segment, the presence of stenosis [ 70% was assessed on multipath curved planar reformations (mpCPRs) and axial images by two readers, independently, with digital subtraction angiography as gold standard
Conclusions mpCPRs are a promising 3D reformation technique that facilitates a fast assessment of peripheral arterial disease (PAD) with high diagnostic accuracy
Summary
Peripheral arterial disease (PAD) and its associated morbidity place a significant burden on both patients and healthcare systems. While the diagnosis is made clinically, the guidelines of the Cardiovascular and Interventional Radiological Society of Europe on endovascular treatment in aortoiliac arterial disease recommend a comprehensive radiological assessment for accurate treatment planning [4]. Digital subtraction angiography (DSA) is still considered the standard of reference because it offers the highest spatial and temporal resolution. Over the last 20 years, computed tomography angiography (CTA) has evolved into an accurate and cost-effective imaging alternative [5,6,7], with high clinical impact for patient management [8, 9]. The improved spatial resolution has resulted in an increasing number of axial slices [10]. Axial image evaluation is a progressively time-consuming and cumbersome task in the clinical routine [11], which bears the
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