Changing trends in a decade of vascular radiology—the impact of technical developments of non-invasive techniques on vascular imaging

Abstract

ObjectivesThis review aims to establish the impact on conventional angiography and endovascular intervention of contrast-enhanced magnetic resonance angiography (CE-MRA) and contrast-enhanced computed tomography angiography (CE-CTA) on a background of evolving technology, changing clinical requirements and resulting clinical repercussions.MethodsThe angiographic and interventional caseload was prospectively recorded between 1997 and 2010, along with the CE-MRA and CE-CTA caseload. Waiting times and the marginal cost analyses for 2001 and 2009 were also prospectively established.ResultsConventional diagnostic angiographies declined from a peak of 847 to 121 per year while endovascular interventions continue in similar numbers. CE-MRA increased from effectively none initially to 620 per year while CE-CTA has currently risen to 396 per year. Total diagnostic study numbers have increased but at reduced cost. Various influences are clear, including on-site modality availability, capability and accuracy along with impact of new therapies, research studies and adverse events.ConclusionsVascular imaging has undergone a metamorphosis in little over a decade because of CE-MRA and CE-CTA. With waiting times significantly reduced since the start of the study and the cost-effectiveness of both CE-MRA and CE-CTA as primary diagnostic investigations established, further development of these services is inevitable.Main Messages• The availability of CE-MRA and CE-CTA has reduced the need for conventional angiography.• Both waiting times and the marginal cost analyses for CE-MRA and CE-CTA have reduced.• The impact of new therapies, research studies (e.g. ASTRAL) and adverse events is illustrated.

National variation in the utilization of alternative imaging in peripheral arterial disease

“…3,[5][6][7][8][9][10] Particularly in Europe, the evolving role of AI is well described because these noninvasive techniques have come to replace conventional angiography in many institutions. [11][12][13][14] DUS is a safe modality because it allows for hemodynamic PAD evaluation, is safe and inexpensive, and is reliable and useful for clinical decision making. 2,[14][15][16][17] The operator-dependency and lack of a true road-map image are disadvantages described for DUS; therefore, a skilled technician is required, and mapping the results on an arterial map is recommended.…”

Diagnostic imaging trends in the emergency department: an extensive single-center experience

“…(14). CT angiography for systemic vascular imaging has also been validated for various clinical uses and has seen an expanded role leading to dramatic decreases in the use of conventional diagnostic catheter angiography (15–18).…”

Valg av modalitet ved karundersøkelser: CTA vs. MRA

“…To studier fant at CTA var mer tilgjengelig enn MRA 17,18 . I 3 av de 4 studiene som så på kostnad var CTA billigst 17,19,20 men i den ene studien var 3D Time-of-flight magnetisk resonans angiografi (TOF MRA) billigst 21 . Syv studier fant at CTA er raskest 17,19,[22][23][24][25][26] men 1 studie med 3D TOF MRA fant at denne sekvensen hadde kortere skannetid enn CTA 21 .…”

“…Flere av respondentene kommenterte at kvalitet på undersøkelse hadde innvirkning på valg av modalitet. 7 studier fant at CTA hadde bedre fremstilling og bildekvalitet 17,19,22,24,[26][27][28] , mens 4 studier fant ingen stor forskjell 21,[29][30][31] . Ved 6 studier var den romlige oppløsningen best hos CTA 17,23,[25][26][27]31 , mens hos 1 studie med 3D TOF-MRA var den romlige oppløsningen bedre enn ved CTA 21 .En respondent uttrykte at CT ofte har den beste romlige oppløsningen som visualiserer mye detaljer.…”