Hiroyuki Niinuma, MD, PhD
Is computed tomography angiography (CTA) an accurate test for diagnosing significant stenosis in patients with peripheral arterial disease (PAD)?
Included studies compared multidetector CTA with intraarterial digital subtraction angiography (DSA) or conventional angiography in patients with intermittent claudication or critical limb ischemia. Outcomes were sensitivity and specificity for detecting > 50% stenosis or occlusion on a per-segment basis.
MEDLINE and EMBASE/Excerpta Medica (to Aug 2008); Database of Abstracts of Reviews of Effectiveness; and references were searched for cohort studies that included ≥ 10 patients and reported the number of arterial segments with and without > 50% stenosis or occlusion. Studies done after lower extremity revascularization were excluded. 20 studies (n = 957, mean age 53 to 69 y, 54% to 96% men, mean 24 segments/patient) met the selection criteria. 12 studies reported mutually blinded interpretation of both tests, and 8 studies were considered to be high quality. 7 studies reported interobserver agreement (kappa) ranging from 0.61 to 1.0. Intraarterial DSA was the reference standard in all studies.
The Table shows the diagnostic test characteristics of CTA; statistical heterogeneity across studies was present. CT scanner slice number affected the pooled estimates of sensitivity and specificity (Table), but patient population, anatomical region, study design, and study quality did not. Mean prevalence of diseased segments was 29%. CTA accurately diagnosed 87% of arteries with significant stenosis (51% to 99%), 94% of occluded arteries, and 96% of arteries without significant stenosis (≤ 50%).
Computed tomography angiography (CTA) is highly accurate for diagnosing significant stenosis in patients with intermittent claudication. Higher-slice CTA yields better results.
Computed tomography (CT) angiography compared with intraarterial digital subtraction angiography for diagnosing > 50% stenosis or occlusion in patients with peripheral arterial disease*
*Abbreviations and diagnostic terms defined in Glossary. +LR and −LR calculated from sensitivity and specificity.
Niinuma H. Review: Computed tomography angiography is highly accurate for diagnosing significant stenosis in peripheral arterial disease. Ann Intern Med. 2009;150:JC5–12. doi: 10.7326/0003-4819-150-10-200905190-02012
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Published: Ann Intern Med. 2009;150(10):JC5-12.
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