Vascular Surgery Department, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
Radiology Department, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
J Ultrasound. 2021 Dec;24(4):471-479. doi: 10.1007/s40477-020-00534-y. Epub 2020 Nov 9.
This study aimed to assess the diagnostic accuracy of duplex sonography (DUS) compared with that of computed tomography angiography (CTA) in detecting occlusion and stenosis in peripheral arterial disease (PAD) in candidate patients for endovascular revascularization with intraprocedural digital subtraction angiography (DSA).
The study involved 94 patients suffering from PAD who were candidates for endovascular procedures requiring DSA. They were all submitted preoperatively to DUS and CTA. Based on image analysis, five segments of the arterial tree were assessed: iliac, common femoral, superficial femoral, popliteal, and infrageniculate. According to the stenosis or occlusion degree, the arteries were rated as nonstenotic, stenotic, and occluded.
The agreement between DUS and CTA findings using DSA as a reference modality was expressed as a Cohen's kappa (κ) statistic agreement. Our results show that DUS has been less accurate than CTA in evaluating iliac arterial diseases (Cohen's κ agreement of 0.91 and 1.0, respectively) when measured against DSA. We found good diagnostic concordance between DUS and DSA in detecting hemodynamic stenosis and occlusion of the femoro-popliteal axis (Cohen's κ agreement between 0.96 and 0.93). Below the knee, CTA showed even less concordance with DSA (Cohen's κ 0.75).
Because of its accuracy, high-quality DUS performed by well-trained operators may therefore represent a good alternative to CTA in patients undergoing endovascular revascularization to minimize the use of contrast-enhanced radiological imaging. Nevertheless, preoperative CTA imaging is required in cases of nondiagnostic DUS or when a more complete overview of the vascular tree is needed for complex invasive interventions.
本研究旨在评估在拟行血管内再通术的患者中，与数字减影血管造影术（DSA）比较，双功能超声（DUS）检测周围动脉疾病（PAD）的闭塞和狭窄的诊断准确性。
本研究纳入了 94 名拟行血管内介入治疗的 PAD 患者，所有患者术前均行 DUS 和 CTA 检查。基于图像分析，评估了动脉树的 5 个节段：髂动脉、股总动脉、股浅动脉、腘动脉和膝下动脉。根据狭窄或闭塞程度，将动脉分为非狭窄、狭窄和闭塞。
以 DSA 为参考方法，DUS 与 CTA 检查结果的一致性用 Cohen's κ 统计量表示。我们的结果显示，在评估髂动脉疾病时，DUS 的准确性低于 CTA（Cohen's κ 一致性分别为 0.91 和 1.0）。我们发现 DUS 与 DSA 在检测股腘动脉段的血流动力学狭窄和闭塞方面具有良好的诊断一致性（Cohen's κ 一致性在 0.96 至 0.93 之间）。在膝下动脉段，CTA 与 DSA 的一致性更低（Cohen's κ 为 0.75）。
由于 DUS 具有准确性高的优点，因此经过良好培训的操作人员进行的高质量 DUS 检查可能是血管内再通术患者的一种替代 CTA 的良好选择，以尽量减少对比增强放射影像学的使用。然而，在 DUS 检查结果不可诊断或需要更全面的血管树图像以便进行复杂的有创性介入治疗时，仍需要术前 CTA 成像。
