Department of Radiological Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan; Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-City, Saitama-Pref 350-1298, Japan.
Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, Kumamoto, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
Radiography (Lond). 2021 Aug;27(3):888-896. doi: 10.1016/j.radi.2021.02.007. Epub 2021 Apr 2.
With intra-arterial digital subtraction angiography (DSA) considered as the gold standard, we compared the diagnostic value of computed tomography angiography (CTA) and computed tomography-digital subtraction angiography (CT-DSA in hemodialysis (HD) patients suspected of having lower limb peripheral artery disease (PAD).
In this retrospective study, we enrolled 220 HD patients with suspected PAD. CT-DSA images were obtained by subtracting unenhanced images from enhanced images. The research team calculated the area under the curve (AUC), sensitivity, specificity, positive and negative predictive value (PPV, NPV), and recorded the diagnostic accuracy between the CTA and CT-DSA images using the DSA as gold standard. Visual evaluation of calcifications in the peripheral arteries were also compared between CTA and CT-DSA images.
At the above-knee level, the CTA AUC [95% confidence interval (CI)] was 0.68 (CI 0.64-0.72), sensitivity and specificity were 60 and 81%, PPV and NPV were 85 and 53%, and accuracy was 67%. Below the knee, these values were 0.66 (CI 0.62-0.70), 71 and 79%, 79 and 47%, and 66%. For CT-DSA, above-knee, the AUC [95% CI] was 0.88 (CI 0.85-0.91), sensitivity and specificity were 84 and 92%, PPV and NPV were 89 and 97%, and accuracy was 93%. Below the knee, these values were 0.95 (CI 0.93-0.97), 95 and 93%, 96 and 83%, and 93%. The scores for the visualization of calcification in the peripheral arteries was significantly higher for CT-DSA than CTA (p < 0.05).
CT-DSA helps to assess stenotic PAD with high calcification in the lower extremities of HD patients.
On CT-DSA images, the severity of vascular calcification can be assessed for HD patients suspected of PAD of the lower extremities.
动脉内数字减影血管造影（DSA）被认为是金标准，我们比较了计算机断层血管造影（CTA）和计算机断层血管造影-数字减影血管造影（CT-DSA）在疑似下肢外周动脉疾病（PAD）的血液透析（HD）患者中的诊断价值。
在这项回顾性研究中，我们纳入了 220 例疑似 PAD 的 HD 患者。CT-DSA 图像通过从增强图像中减去未增强图像获得。研究团队计算了曲线下面积（AUC）、敏感性、特异性、阳性和阴性预测值（PPV、NPV），并使用 DSA 作为金标准记录 CTA 和 CT-DSA 图像之间的诊断准确性。还比较了 CTA 和 CT-DSA 图像外周动脉钙化的视觉评估。
在膝上水平，CTA AUC[95%置信区间（CI）]为 0.68（CI 0.64-0.72），敏感性和特异性分别为 60%和 81%，PPV 和 NPV 分别为 85%和 53%，准确性为 67%。在膝下，这些值分别为 0.66（CI 0.62-0.70）、71%和 79%、79%和 47%以及 66%。对于 CT-DSA，膝上水平的 AUC[95%CI]为 0.88（CI 0.85-0.91），敏感性和特异性分别为 84%和 92%，PPV 和 NPV 分别为 89%和 97%，准确性为 93%。在膝下，这些值分别为 0.95（CI 0.93-0.97）、95%和 93%、96%和 83%以及 93%。外周动脉钙化的可视化评分 CT-DSA 明显高于 CTA（p<0.05）。
CT-DSA 有助于评估 HD 患者下肢高度钙化的狭窄性 PAD。
在 CT-DSA 图像上，可以评估疑似下肢 PAD 的 HD 患者的血管钙化严重程度。
