Does Dopplersignal enhancement with Levovist improve the diagnostic confidence of duplex scanning of the iliac arteries?--(A pilot study with correlation to intravascular ultrasound).

OBJECTIVE

To evaluate whether echo-enhancement with Levovist improves the diagnostic confidence of duplex scanning of the iliac arteries.

METHODS

Sixteen patients admitted for either PTA (n=7) or femoro-femoral cross-over bypass (n=9) were examined with duplex scanning before and after Levovist injection. The diagnostic confidence was noted before and after the echo-enhancement on a visual analog scale. The following day, intraoperatively, an IVUS examination of the iliac artery was performed. The agreement between duplex scanning before and after enhancement compared to IVUS was evaluated by kappa statistics, and sensitivity-specificity calculations.

RESULTS

The diagnostic confidence improved in 50% of the patients, remained unchanged in 44%, and deteriorated in one (6%) patient. The agreement with IVUS was moderate before enhancement (kappa=0.48) and good after the enhancement (kappa=0.63). Sensitivity rose from 64% (before) to 73% (after) Levovist while the specificity was unchanged (100%). These values are not as good as reported by others after fasting of the patients and comparing the results with arteriography.

CONCLUSION

Levovist improves the diagnostic confidence of duplex scanning, but marginally. In inconclusive duplex scannings echo-enhancement can supply decisive informations.