Utility of Toe-brachial Index for Diagnosis of Peripheral Artery Disease

Park, Seong Chul; Choi, Chang Yong; Ha, Young In; Yang, Hyung Eun

doi:10.5999/aps.2012.39.3.227

Cited by 64 publications

(61 citation statements)

References 7 publications

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“…The lowest sensitivity was reported by Okamoto et al 20 16% to 100% ( Table 3). The highest reported specificity (100%) was also by Park et al 30 and the lowest specificity (16%) was demonstrated by Bunte et al 33…”

Section: Eligibility Identificationmentioning

confidence: 86%

A systematic review of the sensitivity and specificity of the toe–brachial index for detecting peripheral artery disease

2016

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The toe-brachial index (TBI) is used as an adjunct to the ankle-brachial index (ABI) for non-invasive lower limb vascular screening. With increasing evidence suggesting limitations of the ABI for diagnosis of vascular complications, particularly in specific populations including diabetes cohorts, the TBI is being used more widely. The aim of this review was to determine the sensitivity and specificity of the TBI for detecting peripheral artery disease (PAD) in populations at risk of this disease. A database search was conducted to identify current work relating to the sensitivity and specificity of toe-brachial indices up to July 2015. Only studies using valid diagnostic imaging as a reference standard were included. The QUADAS-2 tool was used to critically appraise included articles. Seven studies met the inclusion criteria. Sensitivity of the TBI for PAD was reported in all seven studies and ranged from 45% to 100%; specificity was reported by five studies only and ranged from 16% to 100%. In conclusion, this review suggests that the TBI has variable diagnostic accuracy for the presence of PAD in specific populations at risk of developing the disease. There was a notable lack of large-scale diagnostic accuracy studies determining the diagnostic accuracy of the TBI in detecting PAD in different at-risk cohorts. However, standardised normal values need to be established for the TBI to conclusively determine the diagnostic accuracy of this test.

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Section: Eligibility Identificationmentioning

confidence: 86%

A systematic review of the sensitivity and specificity of the toe–brachial index for detecting peripheral artery disease

2016

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“…A number of studies have included the TBI as well as angiographic findings, but the primary end points in most of these studies were not to assess the diagnostic accuracy of the TBI, which can lead to heterogeneous data. 29,48,[56][57][58] The extracted studies are reported in Table II. Most of the studies used highly selected populations, which does not allow generalization due to the different prevalence of PAD in the varying groups.…”

Section: Correlation Of Tbi To Angiographic Findingsmentioning

confidence: 99%

The toe-brachial index in the diagnosis of peripheral arterial disease

Høyer

Sandermann

Petersen

2013

Journal of Vascular Surgery

202

149

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In contrast to the well-defined and evidence-based limits of the ABI, the diagnostic criteria for a pathologic TBI remain ambiguous. Although several guidelines and reviews of PAD diagnostics recommend a TBI <0.70 as cutoff, it is not strictly evidence-based. The current literature is not sufficient to conclude a specific cutoff as diagnostic for PAD. The current studies in normal populations and the correlation with angiography are sparse, and additional trials are needed to further validate the limits. Large-scale trials are needed to establish the risk of morbidity and mortality for the various diagnostic limits of the TBI.

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“…All DM participants (age: 58 years ± 8, BMI: 32.8 kg/m 2 ± 4.9, four female) had at least one current plantar ulcer. To ensure that participants did not have any peripheral arterial disease, inclusion criterion included: ABI >0.9, toe brachial index (TBI) >0.6, and no clinical history of peripheral arterial disease . We excluded participants who were hemodynamically unstable, pregnant, claustrophobic, or had rest pain or other contraindications to MR scanning.…”

Section: Methodsmentioning

confidence: 99%

Intravenous contrast‐free standardized exercise perfusion imaging in diabetic feet with ulcers

Edalati

Hastings

Muccigrosso

et al. 2018

Magnetic Resonance Imaging

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Background: Impaired foot perfusion is a primary contributor to foot ulcer formation. There is no existing device nor method that can be used to measure local foot perfusion during standardized foot muscle exercise in an MRI environment. Purpose: To develop a new MRI-compatible foot dynamometer and MRI methods to characterize local perfusion in diabetic feet with ulcers. Study Type: Prospective. Population/Subjects: Seven participants without diabetes and 10 participants with diabetic foot ulcers. Field Strength/Sequence: 3.0T, arterial spin labeling (ASL). Assessments: Using a new MRI-compatible foot dynamometer, all participants underwent MRI ASL perfusion assessment at rest and during a standardized toe-flexion exercise. The participants without diabetes were scanned twice to assess the reproducibility of perfusion measurements. The absolute perfusion and perfusion reserve values were compared between two groups and between regions near ulcers (peri-ulcer) and away from ulcers (away-ulcer). Statistical Tests: Bland–Altman methods for the calculation of coefficient of repeatability (CR) and two-sided and unpaired Student’s t-test to compare multiple differences. Results: The perfusion reserves measured had the best reproducibility (CR in medial region: 1.6, lateral region: 0.9). The foot perfusion reserve was significantly lower in the participants with diabetes compared with the participants without diabetes (1.34 ± 0.32, 95% confidence interval [CI]: 1.1, 1.58 vs. 1.76 ± 0.31, 95% CI: 1.53, 1.98, P = 0.02). Both peri-ulcer exercise perfusion (8.7 ± 3.9 ml/min/100g) and perfusion reserve (1.07 ± 0.39, 95% CI: 0.78, 1.35) were significantly lower than away-ulcer exercise perfusion (12.7 ± 3.8 ml/min/100g, P = 0.02) and perfusion reserve (1.39 ± 0.37, 95% CI: 1.11, 1.66, P = 0.03), respectively. Data Conclusion: This study demonstrates intravenous contrast-free methods for local perfusion in feet with ulcers by standardized exercise-based MRI. Ischemia regions around foot ulcers can be quantitatively distinguished from normal perfused muscle regions. Level of Evidence: 2 Technical Efficacy: Stage: 2

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Utility of Toe-brachial Index for Diagnosis of Peripheral Artery Disease

Cited by 64 publications

References 7 publications

A systematic review of the sensitivity and specificity of the toe–brachial index for detecting peripheral artery disease

A systematic review of the sensitivity and specificity of the toe–brachial index for detecting peripheral artery disease

The toe-brachial index in the diagnosis of peripheral arterial disease

Intravenous contrast‐free standardized exercise perfusion imaging in diabetic feet with ulcers

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