Comparison of CT and MR angiography in evaluation of peripheral arterial disease before endovascular intervention

Cina, Alessandro; Stasi, Carmine Di; Semeraro, Vittorio; Marano, Riccardo; Savino, Giancarlo; Iezzi, Roberto; Bonomo, Lorenzo

doi:10.1177/0284185115595657

Cited by 16 publications

(8 citation statements)

References 31 publications

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“…38,41,51 Magnetic resonance angiography does not require radiation but is technically more labor intensive and, on rare occasions, can also be affected by calcific shadowing, specifically in the tibial arteries. 52 The choice of Doppler ultrasound, CTA, or MRA will likely depend on local expertise, availability, and cost, and their use should be tailored to each individual patient's needs. Invasive angiography remains the gold standard for the diagnosis of CLI.…”

Section: Anatomic Imagingmentioning

confidence: 99%

Critical Limb Ischemia: A Practical Up-To-Date Review

et al. 2017

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Critical limb ischemia (CLI) is the most advanced form of peripheral artery disease. It is associated with significant morbidity and mortality and high management costs. It carries a high risk of amputation and local infection. Moreover, cardiovascular complications remain a major concern. Although it is a well-known entity and new technological and therapeutic advances have been made, this condition remains poorly addressed, with significantly heterogeneous management, especially in nonexperienced centers. This review, from a third-level dedicated inpatient and outpatient cardioangiology structure, aims to provide an updated summary on the topic of CLI of its complexity, encompassing epidemiological, social, economical and, in particular, diagnostic/imaging issues, together with potential therapeutic strategies (medical, endovascular, and surgical), including the evaluation of cardiovascular risk factors, the diagnosis, and treatment together with prognostic stratification.

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Section: Anatomic Imagingmentioning

confidence: 99%

Critical Limb Ischemia: A Practical Up-To-Date Review

et al. 2017

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“… 2 , 65 This may arise in the selection of more expensive and less frequently used imaging modalities that have higher diagnostic accuracy only for select patients, such as catheter angiography vs CT or MRI for investigation of vascular pathologies. 66 Thus, while publication bias is likely a key cause of small study effects, it is difficult to ascertain the relative influence of other factors in our study.…”

Section: Discussionmentioning

confidence: 93%

Small Study Effects in Diagnostic Imaging Accuracy

et al. 2022

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Key Points Question What are the prevalence and extent of small study effects in the diagnostic imaging literature? Findings This meta-analysis of diagnostic performance data pooled from 31 diagnostic imaging accuracy meta-analyses including 668 primary studies found significant evidence for small study effects. Subgroup analysis by imaging modality revealed similar trends throughout all examined modalities (computed tomography, magnetic resonance imaging, positron emission tomography, ultrasonography). Meaning These findings suggest small study effects are widely underestimated at the level of individual meta-analyses when using conventional methods, including visual assessment of funnel plots and Egger test.

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“…Occlusion of a lower limb artery is most commonly seen in the FPA, which may be related to the anatomical and blood flow characteristics of these arteries. 5 At the distal end of FPA occlusion lesions, a retrograde flow sign (decreasing CT values from the distal to proximal direction on CTA axial images) is due to retrograde filling with contrast medium in the lumen of the artery. Retrograde collateral circulation causes the vessels distal to the occlusion site to be the first filled with contrast agent, and then the flow is reversed to the proximal side, causing a higher CT value in the distal than the proximal lumen at a distance below the occlusion.…”

Section: Discussionmentioning

confidence: 97%

Differentiation of chronic total occlusion and subtotal occlusion of the femoropopliteal artery—role of retrograde flow sign and collateral circulation on CT angiography images

Zhang

Chen

2017

The British Journal of Radiology

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Objective:To study the value of a retrograde flow sign and the collateral circulation on CT angiography (CTA) for the differential diagnosis of chronic total occlusion from subtotal occlusion of the femoropopliteal artery (FPA).Abstract50 patients with obstruction of the FPA underwent CTA and digital subtraction angiography examinations of the lower limbs. The frequency of a retrograde flow sign and collateral circulation on CTA in chronic total and subtotal occlusion was noted and analyzed, with the results of digital subtraction angiography as a standard to judge total or subtotal occlusion. The decreasing CT value from the distal to proximal direction on CTA suggests the existence of retrograde flow.Results:There were significant differences in the occurrence rates of a retrograde flow sign on CTA in the chronic total and subtotal obstruction groups (X2 = 13.1, p < 0.05), as well as a collateral circulation sign (X2 = 13.5, p < 0.05). Employing both the retrograde flow sign and the collateral circulation sign to diagnose chronic total obstruction of the FPA had a sensitivity of 92.3% and specificity of 89.8%.Conclusion:The retrograde flow sign combined with a collateral circulation sign is of great clinical value for differentiation of chronic total stenosis from severe stenosis (subtotal occlusion) of the FPA.Advances in knowledge:A retrograde flow sign combined with a collateral circulation sign is of great clinical value to differentiate between chronic total stenosis and severe stenosis (subtotal occlusion) of the FPA.

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Comparison of CT and MR angiography in evaluation of peripheral arterial disease before endovascular intervention

Abstract: Our results suggest that MDCTA can be considered as a first-line investigation in patients being candidates for endovascular procedures when clinical history or duplex sonographic evaluation are indicative of severe impairment of the infrapopliteal segment.

Cited by 16 publications

References 31 publications

Critical Limb Ischemia: A Practical Up-To-Date Review

Critical Limb Ischemia: A Practical Up-To-Date Review

Small Study Effects in Diagnostic Imaging Accuracy

Differentiation of chronic total occlusion and subtotal occlusion of the femoropopliteal artery—role of retrograde flow sign and collateral circulation on CT angiography images

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