Academic Surgery Unit, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Independent Vascular Services Ltd, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Independent Vascular Services Ltd, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Eur J Vasc Endovasc Surg. 2021 Mar;61(3):440-446. doi: 10.1016/j.ejvs.2020.10.007. Epub 2020 Nov 20.
Clear imaging of below knee and foot arteries is essential to plan distal reconstructions. Contrast enhanced tomographic 3D ultrasound (CEtUS) is novel and entirely safe with no exposure to ionising radiation or nephrotoxic contrast. In the present study, inter- and intra-observer agreement of CEtUS was calculated, and compared with below knee angiography.
In the same week as computed tomography, magnetic resonance or catheter angiography, CEtUS was performed using intravenous 1.2 mL bolus injections of Sonovue with a maximum of 5 mL administered per patient. CEtUS was reported by a vascular scientist blinded to the angiograms reported by a consultant radiologist. Images were compared using a modified Society of Vascular Surgery (SVS) runoff score.
Of the 181 patients recruited with peripheral arterial disease, 20 were excluded from analysis as they withdrew consent, could not be cannulated, or their images were non-diagnostic. In the remaining 161 patients, there were 175 comparative patient images split into two groups: 81 had calf imaging and 94 had pedal imaging representing 405 and 198 imaged arteries, respectively. Weighted quadratic kappa/ICC values for intra- and inter-observer agreement were excellent (κ/ICC = 0.83 to 0.95) and had narrow confidence intervals in both groups. When comparing angiography and CEtUS, weighted quadratic κ/ICC agreement was moderate with acceptable confidence intervals in both groups (Calf κ/ICC = 0.54; Pedal κ/ICC = 0.53). Agreement decreased from popliteal to pedal vessels as diameter decreased. Agreement between CEtUS and digital subtraction angiography was best, and computed tomography angiography the weakest.
CEtUS is a novel imaging modality with strong observer agreement that achieves clear peripheral and foot images without ionising radiation exposure or nephrotoxic X-ray contrast media. CEtUS enhances visualisation of runoff vessels, which may play a role in planning of limb salvage or targeted assessment.
清晰显示膝下和足部动脉对于计划远端重建至关重要。对比增强断层超声（CEtUS）是一种新颖的方法，完全安全，没有电离辐射或肾毒性造影剂的暴露。在本研究中，计算了 CEtUS 的观察者内和观察者间一致性，并与膝下血管造影进行了比较。
在与计算机断层扫描、磁共振成像或导管血管造影相同的一周内，使用静脉内 1.2 毫升 SonoVue 推注进行 CEtUS，每位患者最多给药 5 毫升。CEtUS 由一位对顾问放射科医生报告的血管造影结果不知情的血管科学家进行报告。使用改良的血管外科学会（SVS）流出评分比较图像。
在患有外周动脉疾病的 181 名患者中，有 20 名因撤回同意、无法进行插管或其图像无法诊断而被排除在分析之外。在其余的 161 名患者中，有 175 个比较患者图像分为两组：81 个有小腿成像，94 个有足成像，分别代表 405 个和 198 个成像动脉。两组观察者内和观察者间一致性的加权二次 Kappa/ICC 值均为优秀（κ/ICC=0.83 至 0.95），置信区间较窄。当比较血管造影和 CEtUS 时，两组的加权二次 Kappa/ICC 一致性为中度，置信区间可接受（小腿 Kappa/ICC=0.54；足 Kappa/ICC=0.53）。一致性随着直径的减小从腘动脉到足动脉而降低。CEtUS 与数字减影血管造影的一致性最好，与计算机断层血管造影的一致性最差。
CEtUS 是一种新颖的成像方式，具有很强的观察者一致性，可在不暴露于电离辐射或肾毒性 X 射线造影剂的情况下清晰显示外周和足部图像。CEtUS 增强了流出血管的可视化，这可能在肢体挽救或靶向评估的计划中发挥作用。
