Segmental Comparison of Peripheral Arteries by Doppler Ultrasound and CT Angiography

Abstract

Diseases of peripheral arterial system are one of the common causes of limb pain, especially in elderly patients. Here we analyse non invasive imaging of peripheral arterial segments. Aim of the study was to compare arterial diseases of extremities using Doppler ultrasound and CT angiography, and to find the better non-invasive modality of choice. Fifty patients {14 patients with upper limb complaints (15 upper limbs) and 36 patients with lower limb complaints (72 lower limbs)} of peripheral arterial disease underwent Doppler ultrasound (USG) and CT Angiogram (CTA). Arterial systems divided into anatomic segments and luminal narrowing were compared using gray scale Doppler ultrasound and axial images of arterial phase of CT angiogram. Using statistical methods, sensitivity, specificity and accuracy of Doppler ultrasound and CT angiography were determined. Six hundred and nineteen arterial segments were studied with CT angiography and Doppler ultrasound. Of which 226 diseased segments were identified in CT angiography. Doppler overestimated narrowing by one grade in 47 segments, by two grade in 11 segments, by three grades in 30 segments and by four grades in 22 segments; underestimated by one grade in 28 segments, by two grades in 9 segments, by three grades in 5 segments and by four grades in 3 segments. Significant statistical difference exists between Doppler USG and CT angiography. Doppler showed good correlation with CT angiography in 74%, but, Doppler overestimated stenosis grade in a significant percentage. The sensitivity, specificity and accuracy of Doppler USG compared with CT angiography was 93.36%, 82.44%, and 86.42%. Duplex Doppler can be the first investigation in excluding peripheral arterial disease, especially for evaluation of infra inguinal region of lower limbs and from second part of the subclavian artery in upper limbs.