| 1. Leng GC, Lee AJ, Fowkes FG, et al. Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population. Int J Epidemiol 1996;25:1172-81. |
Observational-Dx |
116 patients |
To determine the incidence and natural history of claudication, and the incidence of cardiovascular events in symptomatic and asymptomatic peripheral arterial disease. |
One hundred and sixteen new cases of claudication were identified (incidence density 15.5 per 1000 person-years). Of those with claudication at baseline, 28.8% and still had pain after 5 years, 8.2% underwent vascular surgery or amputation, and 1.4% developed leg ulceration. Claudicants had a significantly increased risk of developing angina compared with normals (RR: 2.31, 95% CI: 1.04-5.10), and asymptomatic subjects had a slightly increased risk of myocardial infarction and stroke. Deaths from cardiovascular disease were more likely in both claudicants (RR: 2.67, 95% CI: 1.34-5.29) and subjects with major (RR: 2.08, 95% CI: 1.13-3.83) or minor asymptomatic disease (RR: 1.74, 95% CI: 1.09-2.76). Subjects with major asymptomatic disease also had an increased risk of non-cardiovascular death (RR: 2.19, 95% CI: 1.33-3.59), and therefore had the highest overall risk of death (RR: 2.44, 95% CI: 1.59-3.74). |
3 |
| 2. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol 2006; 47(6):1239-1312. |
Review/Other-Dx |
N/A |
Practice guidelines to address the diagnosis and management of atherosclerotic, aneurysmal, and thromboembolic peripheral arterial diseases (PADs). |
N/A |
4 |
| 3. Alzamora MT, Fores R, Baena-Diez JM, et al. The peripheral arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population. BMC Public Health 2010;10:38. |
Observational-Dx |
3,786 individuals |
To know the prevalence and associated risk factors of peripheral arterial disease in the general population. |
The prevalence (95% confidence interval) of peripheral arterial disease was 7.6% (6.7-8.4), (males 10.2% (9.2-11.2), females 5.3% (4.6-6.0); p < 0.001).Multivariate analysis showed the following risk factors: male sex [odds ratio (OR) 1.62; 95% confidence interval 1.01-2.59]; age OR 2.00 per 10 years (1.64-2.44); inability to perform physical activity [OR 1.77 (1.17-2.68) for mild limitation to OR 7.08 (2.61-19.16) for breathless performing any activity]; smoking [OR 2.19 (1.34-3.58) for former smokers and OR 3.83 (2.23-6.58) for current smokers]; hypertension OR 1.85 (1.29-2.65); diabetes OR 2.01 (1.42-2.83); previous cardiovascular disease OR 2.19 (1.52-3.15); hypercholesterolemia OR 1.55 (1.11-2.18); hypertriglyceridemia OR 1.55 (1.10-2.19). Body mass index > or =25 Kg/m2 OR 0.57 (0.38-0.87) and walking >7 hours/week OR 0.67 (0.49-0.94) were found as protector factors. |
3 |
| 4. Muluk SC, Muluk VS, Kelley ME, et al. Outcome events in patients with claudication: a 15-year study in 2777 patients. Journal of vascular surgery 2001;33:251-7; discussion 57-8. |
Observational-Dx |
2777 male patients |
To delineate the natural history of claudication and determine risk factors for death. |
The mean follow-up was 47 months. The cohort exhibited a mortality rate of 12% per year, which was significantly (P <.05) more than the age-adjusted US male population. Among the deaths in which the cause was known, 66% were due to heart disease. We examined several baseline risk factors in a multivariate Cox model. Four were significant (P <.01) independent predictors of death: older age (relative risk [RR] = 1.3 per decade), lower ankle-brachial index (RR = 1.2 for 0.2 change), diabetes requiring medication (RR = 1.4), and stroke (RR = 1.4). The model can be used to estimate the mortality rate for specific patients. Surprisingly, a history of angina and myocardial infarction was not a significant predictor. Major and minor amputations had a 10-year cumulative rate less than 10%. Revascularization procedures occurred with a 10-year cumulative rate of 18%. |
3 |
| 5. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: Executive Summary. Vasc Med 2017;22:NP1-NP43. |
Review/Other-Dx |
N/A |
To provide recommendations applicable to patients with or at risk of developing cardiovascular disease. |
No abstract available. |
4 |
| 6. Sigvant B, Lundin F, Wahlberg E. The Risk of Disease Progression in Peripheral Arterial Disease is Higher than Expected: A Meta-Analysis of Mortality and Disease Progression in Peripheral Arterial Disease. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2016;51:395-403. |
Meta-analysis |
35 studies |
To improve assessment of risks associated with PAD by gathering all current reliable data on long-term risk of leg symptom deterioration and CV morbidity associated with PAD. A secondary aim was to assess if these risks differed among the sexes. |
Of 354 identified articles, 35 were eligible for systematic review. Sample size varied between 109 and 16,440 subjects. Mean age in the cohorts ranged from 56 to 81 years (SD 10.8) and mean follow up was 6.3 years (range 1-13). Most included patients with symptomatic PAD had IC (91%). Symptomatic PAD subjects had higher 5 year cumulative CV mortality than the reference population, 13% versus 5%. During follow up, approximately 7% of APAD patients progressed to IC, and 21% of IC patients were diagnosed as having critical limb ischemia, with 4-27% undergoing amputations. |
Inadequate |
| 7. Fuglestad MA, Hernandez H, Gao Y, et al. A low-cost, wireless near-infrared spectroscopy device detects the presence of lower extremity atherosclerosis as measured by computed tomographic angiography and characterizes walking impairment in peripheral artery disease. J Vasc Surg. 71(3):946-957, 2020 03. |
Observational-Dx |
50 patients (40 with PAD, 10 controls) |
To test the hypothesis that extremities affected by PAD exhibit distinct NIRS profiles that differentiate them from healthy controls as measured by a novel, cost-effective, and wireless NIRS.To evaluate and characterize the relationship between walking limitation and NIRS parameters during exercise testing. |
Patients with PAD experienced claudication onset at a median of 108 seconds with a median peak walking time of 288 seconds. The baseline StO2 was similar between PAD and control. The StO2 of PAD and control participants dropped below baseline at a median of 1 and 104 seconds of exercise, respectively (P< .0001). Patients with PAD reached minimum StO2 earlier than control participants (119 seconds vs 522 seconds, respectively; P < .001) and experienced a greater change in StO2 at 1 minute of exercise (-73.2% vs 83%; P< ,0001)and a greater decrease at minimum exercise StO2 (-83.4% vs -16.1%; P< .0001). For patients with PAD, peak walking time, and 6-minute walking distance correlated with percent change in StO2atl minute of exercise (r = -0.76 and -0.67, |
3 |
| 8. Huang CL, Wu YW, Hwang CL, et al. The application of infrared thermography in evaluation of patients at high risk for lower extremity peripheral arterial disease. J Vasc Surg. 2011;54(4):1074-1080. |
Observational-Dx |
51 patients |
To examine the usefulness of infrared thermography in evaluating patients at high risk for lower extremity peripheral arterial disease (PAD), including severity, functional capacity, and quality of life. |
28 subjects had abnormal ABI (ABI <1), while PAD was diagnosed in 20. No subjects had non-compressible artery (ABI >1.3). Demographic profiles and clinical parameters in PAD and non-PAD patients were similar, except for age, smoking history, and hyperlipidemia. PAD patients walked shorter distances (356 ± 102 m vs 218 ± 92 m; P < .001). Claudication occurred in 14 patients, while seven failed in completing the 6MWT. The rest temperatures were similar in PAD and non-PAD patients. However, the post-exercise temperature dropped in the lower extremities with arterial stenosis, but was maintained or elevated slightly in the extremities with patent arteries (temperature changes at sole in PAD vs non-PAD patients: -1.25 vs -0.15°C; P < .001). The exercise-induced temperature changes at the sole were not only positively correlated with the 6MWD (Spearman correlation coefficient = 0.31, P = .03), but was also correlated with ABI (Spearman correlation coefficient = 0.48, P < .001) and 7-day physical activity recall scores (Spearman correlation coefficient = 0.30, P = .033). By detecting cutaneous temperature changes in the lower extremities, infrared thermography offers another non-invasive, contrast-free option in PAD evaluation and functional assessment. |
4 |
| 9. Rutherford RB, Lowenstein DH, Klein MF. Combining segmental systolic pressures and plethysmography to diagnose arterial occlusive disease of the legs. Am J Surg 1979; 138(2):211-218. |
Observational-Dx |
11 volunteers and 103 patients |
To evaluate the diagnostic value of segmental pressures and pulse volume recording to diagnose arterial occlusive disease of the legs. |
Both tests 86% accurate when multilevel disease was present, 97% when used in combination with no errors observed in diagnosing either normal limbs or those with isolated occlusive disease. |
4 |
| 10. Ofer A, Nitecki SS, Linn S, et al. Multidetector CT angiography of peripheral vascular disease: a prospective comparison with intraarterial digital subtraction angiography. AJR. 2003;180(3):719-724. |
Observational-Dx |
18 patients |
To determine the accuracy of CTA using a multidetector scanner in the evaluation of patients with PVD when compared with DSA. |
Authors found agreement for the degree of stenosis in 77.7% of the arteries and discrepancy for 22.3% of the arteries when all categories were considered. Grouping the six categories according to the threshold for treatment (categories 1 and 2 as one group and categories 3, 4, and 5 as the second group) resulted in an agreement of 91.95%. Compared with DSA, CTA yielded a sensitivity of 90.9% and a specificity of 92.4%. MDCTA is an accurate, noninvasive technique for the imaging of PVD. |
2 |
| 11. Vahl AC, Geselschap J, Montauban van Swijndregt AD, et al. Contrast enhanced magnetic resonance angiography versus intra-arterial digital subtraction angiography for treatment planning in patients with peripheral arterial disease: a randomised controlled diagnostic trial. Eur J Vasc Endovasc Surg. 2008;35(5):514-521; discussion 522-513. |
Observational-Dx |
197 total patients; 97 assigned to MRA and 100 to DSA |
A randomized controlled study to compare the diagnostic and therapeutic confidence, patient outcome and costs between MRA and DSA as the initial diagnostic imaging test, in patients with symptomatic arterial disease of the leg. |
A treatment plan was determined for each included patient. Additional imaging was necessary in 11% of patients in the MRA group compared to 10% in the DSA group (p=0.5). 84% of the patients who received MRA judged the diagnostic work up as comfortable compared to 57% who had DSA (p=0.013). Within 4 months of randomization 30 patients in the MRA group compared to 34 patients in de DSA group underwent operative procedures; 39 versus 36 patients respectively underwent angioplasty. The mean total in-hospital costs during the first 4 months were euro4768,- in the MRA group compared to euro4697,- in the DSA group (95% CI of difference -1331;1472). Adequate treatment can be made with MRA which is better tolerated by the patient than DSA. Costs were equivalent. |
3 |
| 12. Thiele BL, Strandness DE, Jr. Accuracy of angiographic quantification of peripheral atherosclerosis. Prog Cardiovasc Dis. 1983;26(3):223-236. |
Review/Other-Dx |
N/A |
A critical evaluation of arteriography as a means of quantifying PVD and its effects based on extensive literature review. |
Arteriography has remained a purely morphologic study with limited usefulness in determining clinical significance of visualized lesions. The major problems are observer variability and lack of functional data. |
4 |
| 13. Kumamaru KK, Hoppel BE, Mather RT, Rybicki FJ. CT angiography: current technology and clinical use. Radiol Clin North Am. 2010;48(2):213-235, vii. |
Review/Other-Dx |
N/A |
To describe CT hardware and associated software for angiography. |
Recent advances in technology have moved CT to the front line for many vascular diseases, dramatically changing clinical evaluation pathways. Understanding CT technology is critical for optimizing protocols. |
4 |
| 14. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010;121:e266-369. |
Review/Other-Dx |
N/A |
To assist healthcare providers in clinical decision making by describing a range of generally acceptable approaches for diagnosis, management, and prevention of specific diseases or conditions. This guideline includes diseases involving any or all parts of the thoracic aorta with the exception of aortic valve diseases5 and includes the abdominal aorta when contiguous thoracic aortic diseases are present. |
No abstract available. |
4 |
| 15. Fotiadis N, Kyriakides C, Bent C, Vorvolakos T, Matson M. 64-section CT angiography in patients with critical limb ischaemia and severe claudication: comparison with digital subtractive angiography. Clin Radiol. 66(10):945-52, 2011 Oct. |
Observational-Dx |
41 consecutive patients |
To assess the utility of 64 section multidetector computed tomography (MDCT) lower-limb angiography in the evaluation of patients with critical limb ischaemia (CLI) or severe intermittent claudication (IC) in grading disease before endovascular treatment. |
For arterial segments with haemodynamically significant disease (stenosis >/=50%), the overall sensitivity, specificity, and accuracy of MDCT in patients with severe claudication and CLI was 99% (95% CI: 98-100%), 98% (95% CI: 97-100%) and 98% (95% CI: 97-99%), respectively. The PPV was 97% and the NPV was 99%. MDCT angiography is a useful tool in the assessment of patients with severe claudication and CLI and can be reliably used to grade disease severity and plan treatment. |
2 |
| 16. Schernthaner R, Stadler A, Lomoschitz F, et al. Multidetector CT angiography in the assessment of peripheral arterial occlusive disease: accuracy in detecting the severity, number, and length of stenoses. Eur Radiol. 2008;18(4):665-671. |
Observational-Dx |
50 consecutive patients |
To evaluate the accuracy of MDCTA in the morphologic assessment of PAOD compared to DSA. |
Mean sensitivity and specificity in the detection of significant stenoses (over 70%) were 100% and 99.5% in the iliac arteries, 97.4% and 99.0% in the femoro-popliteal arteries, and 98.3% and 99.8% in the infrapopliteal arteries, respectively. High kappa values for exact stenoses gradation (0.74-1), lesion length (0.74-1), and number of lesions (0.71-1) were reached by MDCTA, indicating high agreement with DSA. Non-invasive MDCTA is an accurate tool for the assessment of all treatment-relevant morphologic information of PAOD (gradation, length, and number of stenoses) compared to DSA. |
2 |
| 17. Catalano C, Fraioli F, Laghi A, et al. Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography. Radiology. 2004;231(2):555-563. |
Observational-Dx |
50 patients |
To compare MDCTA with DSA in evaluation of the infrarenal aorta and lower-extremity arterial system. |
Substantial to almost perfect interobserver agreement was achieved in all cases. At DSA, 349 diseased segments were found among the 1,137 segments evaluated. Sensitivity, specificity, and accuracy, based on a consensus reading of MDCTA, were 96%, 93%, and 94%, respectively. A statistically significant difference (P<.05) between DSA and MDCTA was present only in arteries graded 1 or 2. Interobserver agreement was almost perfect among the three readers for treatment recommendations based on findings at CTA and DSA. |
2 |
| 18. Fine JJ, Hall PA, Richardson JH, Butterfield LO. 64-slice peripheral computed tomography angiography: a clinical accuracy evaluation. J Am Coll Cardiol. 2006;47(7):1495-1496. |
Observational-Dx |
212 patients |
To determine the accuracy of 64-slice peripheral CTA to determine if improved performance metrics offer a lower risk, more efficient, non-invasive mode of peripheral angiography, which in selected clinical situations may replace the need for catheter angiography. |
Data from renal, carotid and PAD of 212 patients, 107 had PAD. Vessel to vessel analysis went from sensitivity 86%, specificity 95%, PPV 89%, and NPV 80% in iliac arteries to the popliteal arteries where sensitivity 90%, specificity 96%, PPV 82%, and NPV 98%. |
2 |
| 19. Heijenbrok-Kal MH, Kock MC, Hunink MG. Lower extremity arterial disease: multidetector CT angiography meta-analysis. Radiology. 2007;245(2):433-439. |
Meta-analysis |
436 patients from 12 studies of 9,541 arterial segments |
To obtain the best available estimates of the diagnostic performance of MDCTA compared with that of DSA in the assessment of symptomatic lower extremity arterial disease and to identify the most important sources of variation in diagnostic performance between studies. |
Of the 70 studies initially identified, 12 were included in which multidetector CT angiography was used to evaluate 9541 arterial segments in 436 patients. The pooled sensitivity and specificity for detecting a stenosis of at least 50% per segment were 92% (95% confidence interval: 89%, 95%) and 93% (95% confidence interval: 91%, 95%), respectively. Three studies provided data about the diagnostic performance of multidetector CT angiography in subdivisions of the arterial tract. The diagnostic performance of multidetector CT angiography in the infrapopliteal tract was lower than but not significantly different from that in the aortoiliac (P > .11) and femoropopliteal (P > .40) tracts. Regression analysis showed that diagnostic performance was not significantly influenced by differences in study characteristics. |
M |
| 20. Willmann JK, Wildermuth S, Pfammatter T, et al. Aortoiliac and renal arteries: prospective intraindividual comparison of contrast-enhanced three-dimensional MR angiography and multi-detector row CT angiography. Radiology. 226(3):798-811, 2003 Mar. |
Observational-Dx |
46 patients; 2 readers |
Prospective study to compare contrast material-enhanced 3D MRA with MDCT in the same patients for assessment of the aortoiliac and renal arteries. DSA is the standard of reference. |
Sensitivity of MR angiography for detection of hemodynamically significant arterial stenosis was 92% for reader 1 and 93% for reader 2, and specificity was 100% and 99%, respectively. Sensitivity of CT angiography was 91% for reader 1 and 92% for reader 2, and specificity was 99% and 99%, respectively. Differences between the two modalities were not significant. Interobserver and intermodality agreement was excellent (kappa = 0.88-0.90). The time for performance of 3D reconstruction and image analysis of CT data sets was significantly longer than that for MR data sets (P <.001). Patient acceptance was best for CT angiography (P =.016). |
1 |
| 21. Kayhan A, Palabiyik F, Serinsoz S, et al. Multidetector CT angiography versus arterial duplex USG in diagnosis of mild lower extremity peripheral arterial disease: is multidetector CT a valuable screening tool? European journal of radiology 2012;81:542-6. |
Observational-Dx |
43 patients; 774 vessel segments |
To prospectively compare the efficacy of 40-row multidetector computed tomography angiography (MDCTA) and duplex ultrasonography (DUS) to diagnose mild peripheral arterial occlusive disease (PAOD) in lower leg and to search whether MDCTA can be used as a screening tool. |
A total of 774 vessel segments were imaged by both modalities. When all arteries were considered, MDCTA detected obstructed or stenotic lesions in 16.8% of arteries, versus 11.1% compared to DUS. When suprapopliteal arteries alone were considered, MDCTA detected lesions in 15.0% of arteries, versus 11.0% with DUS. When infrapopliteal arteries only were considered, MDCTA detected lesions in 19.6% of arteries, versus 11.3% with DUS. MDCTA showed 5.7% (95% CI: [3.5%, 7.9%]) more lesions than DUS when all arteries were considered together, 8.3% (95% CI: [4.6%, 12.0%]) more lesions when only the infrapopliteal arteries were compared, and 4.0% (95% CI: [1.3%, 6.8%]) more lesions when only suprapopliteal arteries were compared (p<0.01 for all comparisons). |
2 |
| 22. Ouwendijk R, Kock MC, van Dijk LC, van Sambeek MR, Stijnen T, Hunink MG. Vessel wall calcifications at multi-detector row CT angiography in patients with peripheral arterial disease: effect on clinical utility and clinical predictors. Radiology. 2006;241(2):603-608. |
Observational-Dx |
145 patients |
To evaluate retrospectively the effect of vessel wall calcifications on the clinical utility of MDCTA performed in patients with PAD and to identify clinical predictors for the presence of vessel wall calcifications. |
The number of calcified segments was a significant predictor of the need for additional imaging (P=.001) and of the confidence scores (P<.001). The number of calcified segments discriminated between patients who required additional imaging after CTA and those who did not (area under the receiver operating characteristic curve, 0.66; 95% CI: 0.54, 0.77). Age, diabetes mellitus, and cardiac disease were significant predictors of the number of calcified segments in both the univariable and multivariable analyses (P<.05). |
4 |
| 23. Machida H, Tanaka I, Fukui R, et al. Dual-Energy Spectral CT: Various Clinical Vascular Applications. Radiographics 2016;36:1215-32. |
Review/Other-Dx |
N/A |
To describe basic principles and various techniques of SSDE CT with fast kilovolt-peak switching and offer various vascular applications of SSDE CT with fast kilovolt-peak switching with illustrative clinical data and images to overcome the limitations of SE CT. |
SSDE CT with fast kilovolt-peak switching allows projection-based reconstruction of DE CT images, which leads to substantial reduction of beam hardening, accurate reconstruction of monochromatic images obtained at 40–140 keV and MDIs that use various basis materials, and detailed analysis of material content by using the spectral Hounsfield unit curve and effective Z histogram. |
4 |
| 24. Hallett RL, Fleischmann D. Tools of the trade for CTA: MDCT scanners and contrast medium injection protocols. Techniques in vascular and interventional radiology 2006;9:134-42. |
Review/Other-Dx |
N/A |
To describe an approach tailored to the available scanner technology and to patient size aimed at providing consistently robust CTA studies across all vascular territories. |
No abstract available. |
4 |
| 25. Cambria RP, Kaufman JA, L'Italien GJ, et al. Magnetic resonance angiography in the management of lower extremity arterial occlusive disease: a prospective study. J Vasc Surg. 1997;25(2):380-389. |
Observational-Dx |
79 patients |
A prospective study to clarify the clinical utility of MRA in the treatment of patients with lower extremity arterial occlusive disease. |
Precise agreement (%) and the percent of major discrepancies (segment classified as normal/mild stenosis on one study and severe stenosis/occlusion on the other) between MRA and ANGIO for respective arterial segments was as follows: common and external iliacs (n = 256) 77/3.5; superficial femoral and above-knee popliteal (n = 255) 73/6.7; below-knee popliteal (n = 131) 84/3.8; infrapopliteal runoff vessels (n = 864) 74/12.4; pedal vessels (n = 111) 69/19.8 Kappa values indicated moderate agreement (between MRA and angiography) beyond chance for all arterial segments. Treatment plans formulated by the attending surgeon, the MRA surgeon, and the angiography surgeon agreed in more than 85% of cases. |
4 |
| 26. Jens S, Koelemay MJ, Reekers JA, Bipat S. Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: systematic review and meta-analysis. Eur Radiol 2013;23:3104-14. |
Meta-analysis |
12 CTA, 30 CE-MRA studies;, 673 and 1,404 participants, respectively |
To evaluate the diagnostic performance of computed tomography angiography (CTA) and contrast-enhanced magnetic resonance angiography (CE-MRA) in detecting haemodynamically significant arterial stenosis or occlusion in patients with critical limb ischaemia (CLI) or intermittent claudication (IC). |
Out of 5,693 articles, 12 CTA and 30 CE-MRA studies were included, respectively evaluating 673 and 1,404 participants. Summary estimates of sensitivity and specificity were respectively 96 % (95 % CI, 93-98 %) and 95 % (95 % CI, 92-97 %) for CTA, and 93 % (95 % CI, 91-95 %) and 94 % (95 % CI, 93-96 %) for CE-MRA. Regression analysis showed that the prevalence of CLI in individual studies was not an independent predictor of sensitivity and specificity for either technique. Methodological quality of studies was moderate to good. |
M |
| 27. Loewe C, Schoder M, Rand T, et al. Peripheral vascular occlusive disease: evaluation with contrast-enhanced moving-bed MR angiography versus digital subtraction angiography in 106 patients. AJR. 2002;179(4):1013-1021. |
Observational-Dx |
106 patients |
A retrospective analysis to compare contrast-enhanced moving-bed MRA and DSA in the evaluation of PAOD. |
2,378 vessel segments were evaluated. In 2,156 segments, MRA and DSA were concordant for stenosis classification; in 188 segments the two modalities differed in one category, and in 24 segments they differed in two categories. MRA sensitivity 96.7%; and specificity 95.8%, for differentiating nonsignificant from hemodynamically significant stenosis (kappa = 0.91). |
3 |
| 28. Iglesias J, Pena C. Computed tomography angiography and magnetic resonance angiography imaging in critical limb ischemia: an overview. [Review]. Tech Vasc Interv Radiol. 17(3):147-54, 2014 Sep. |
Review/Other-Dx |
N/A |
To describe the rise in noninvasive vascular imaging with CTA and MRA in patients with critical limb ischemia (CLI). |
No results in abstract |
4 |
| 29. Zhu YQ, Zhao JG, Wang J, et al. Patency of runoff detected by MR angiography at 3.0 T with cuff-compression: a predictor of successful endovascular recanalization below the knee. Eur Radiol. 24(11):2857-65, 2014 Nov. |
Observational-Dx |
63 patients with diabetes (98 limbs) |
To assess the reliability of detecting distal runoff vessels using contrast-enhanced MR angiography (CE-MRA) that were occult on digital subtraction angiography (DSA) for predicting the outcome of endovascular recanalization (ER). |
Successful ER was achieved in 85.7 % of limbs, and runoff score was significantly lower than in failure limbs (5.1 ± 1.1 vs. 6.2 ± 1.3; P < 0.05). During follow-up, sustained ankle-brachial index (ABI) improvement was found in 76.6 % claudication patients, and walking distance improvement in 86.5 %; pain was relieved in 70.6 % of critical limb ischemia (CLI) limbs, ulceration healed in 81.3 %, and limb-salvage rate was 100 %. Restenosis/occlusion rate was higher for patients with CLI at 12 months (48.8 % vs. 96.3 % in claudication; P < 0.01). Runoff score was associated with a significantly higher likelihood of ER success (odds ratio = 4.096, 95 % confidence interval: 2.056-8.158; P < 0.001). |
3 |
| 30. Hodnett PA, Ward EV, Davarpanah AH, et al. Peripheral arterial disease in a symptomatic diabetic population: prospective comparison of rapid unenhanced MR angiography (MRA) with contrast-enhanced MRA. AJR Am J Roentgenol 2011;197:1466-73. |
Observational-Dx |
25 diabetic patients |
To evaluate the accuracy of the rapid technique of quiescent-interval single-shot (QISS) unenhanced MR angiography (MRA) compared with CEMRA for the diagnosis in diabetic patients referred with symptomatic chronic PAD. |
For this study, 775 segments were analyzed. On a per-segment basis, the mean values of the diagnostic accuracy of unenhanced MRA compared with reference CEMRA for two reviewers, reviewers 1 and 2, were as follows: sensitivity, 87.4% and 92.1%; specificity, 96.8% and 96.0%; positive predictive value, 90.8% and 94.0%; and negative predictive value, 95.5% and 94.6%. Substantial agreement was found when overall DSA results were compared with QISS unenhanced MRA (kappa = 0.68) and CEMRA (kappa = 0.63) in the subgroup of patients who also underwent DSA. There was almost perfect agreement between the two readers for stenosis scores, with Cohen's kappa values being greater than 0.80 for both MRA techniques. |
2 |
| 31. Visser K, Hunink MG. Peripheral arterial disease: gadolinium-enhanced MR angiography versus color-guided duplex US--a meta-analysis. Radiology. 2000;216(1):67-77. |
Meta-analysis |
N/A |
To summarize and compare the published data on gadolinium-enhanced MRA and color-guided duplex US for the workup for PAD. |
With a random effects model, pooled sensitivity for MRA 97.5% was higher than that for duplex US 87.6%. Pooled specificities were similar: 96.2% for MRA and 94.7% for duplex US. |
M |
| 32. de Vries M, Ouwendijk R, Flobbe K, et al. Peripheral arterial disease: clinical and cost comparisons between duplex US and contrast-enhanced MR angiography--a multicenter randomized trial. Radiology. 2006;240(2):401-410. |
Experimental-Dx |
352 total patients; 178 in contrast-enhanced MRA group and 174 in duplex US group |
Multicenter prospective randomized trial to determine the clinical and economic consequences of replacing duplex US with contrast material-enhanced MRA for the initial imaging workup of patients with PAD. |
At 6 months, 352 patients (239 [68%] men, 113 [32%] women; mean age, 65 years) were analyzed. The use of contrast-enhanced MR angiography versus duplex US reduced the number of additional vascular imaging procedures by 42%; contrast-enhanced MR angiography was also associated with higher therapeutic confidence. Diagnostic costs for contrast-enhanced MR angiography were 167 euros (186 dollars) higher than those for duplex US (P < .001). No statistically significant differences were found for total cost, changes in disease severity, or changes in QOL between patients examined with duplex US and those examined with contrast-enhanced MR angiography (P > .05).Replacing duplex US with contrast-enhanced MRA for the initial imaging workup of patients with PAD reduces the need for additional imaging, although diagnostic costs are higher. |
1 |
| 33. Miyazaki M, Akahane M. Non-contrast enhanced MR angiography: Established techniques. J Magn Reson Imaging. 2012;35(1):1-19. |
Review/Other-Dx |
N/A |
This article introduces other established NC-MRA techniques, such as ECG-gated partial Fourier fast spin echo (FSE) and balanced steady-state free precession (bSSFP), both with and without arterial spin labeling. Then, the article focuses on two main applications: peripheral run-off and renal MRA. |
Recently, both applications have achieved remarkable advancements and have become a viable clinical option as an alternative to contrast-enhanced (CE)-MRA. In addition, developments on the horizon including whole body MRA applications and further advancement at 3 Tesla are discussed. |
4 |
| 34. Hanrahan CJ, Lindley MD, Mueller M, et al. Diagnostic Accuracy of Noncontrast MR Angiography Protocols at 3T for the Detection and Characterization of Lower Extremity Peripheral Arterial Disease. J Vasc Interv Radiol. 29(11):1585-1594.e2, 2018 11. |
Observational-Dx |
20 patients with PAD and intermittent claudication |
To compare the diagnostic accuracy of established non-gadolinium (Gd)-enhanced magnetic resonance (MR) angiography protocols with Gd-enhanced MR angiography at 3T for evaluating lower extremity peripheral arterial disease (PAD). |
Of 573 vascular segments imaged, 16.9% (97/573, 19/20 patients) demonstrated hemodynamically significant abnormalities. Reader confidence was sufficient for diagnosis in 98% of segments with Gd MR angiography, 93% with QIR/ECG-FSE, and 95% with QISS. Overall reader confidence was higher with QISS than QIR/ECG-FSE within all 3 stations combined (P < .05). With lowconfidence segments treated as misdiagnosis, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and k agreement for all 3 stations combined were 81.4/87.2/57.0/95.8/86.2%/0.578 for QIR/ECG-FSE and 75.0/90.6/61.6/94.7/88.0%/ 0.597 for QISS. Using TASC II criteria to assess severity, QISS and QIR/ECG-FSE had no statistical difference in agreement with Gd MR angiography |
1 |
| 35. Offerman EJ, Hodnett PA, Edelman RR, Koktzoglou I. Nonenhanced methods for lower-extremity MRA: a phantom study examining the effects of stenosis and pathologic flow waveforms at 1.5T. J Magn Reson Imaging. 33(2):401-8, 2011 Feb. |
Review/Other-Dx |
N/A |
To evaluate the signal properties of 2D time of flight, QISS, ECG-gated 3D FSE, and ungated 3D fast spin-echo ghost (Ghost) MRA over a range of flow velocities in a pulsatile flow phantom with a 50% diameter stenosis at 1.5T. |
TOF and QISS signal trends were similar, but QISS exhibited the most consistent signal across velocities. At high velocities (= 42.4 cm/s), TOF showed poststenotic signal loss that was not observed with QISS. FBI and Ghost signals peaked at low velocities (3.9-9.7 cm/s) without flow compensation and at high velocities (= 64.6 cm/s) with flow compensation. FBI and Ghost demonstrated dependence on blood flow velocity and flow compensation. TOF was sensitive to flow artifacts at high velocities. QISS proved most robust for accurately depicting the normal lumen and stenosis under a wide range of flow conditions. Monophasic and triphasic flow did not appreciably affect the signal performance of any method. |
4 |
| 36. Hoey ET, Ganeshan A, Puni R, Henderson J, Crowe PM. Fresh blood imaging of the peripheral vasculature: an emerging unenhanced MR technique. AJR Am J Roentgenol. 2010; 195(6):1444-1448. |
Review/Other-Dx |
N/A |
To describe the technical aspects of performing lower extremity MRA and illustrate some sample cases. |
Fresh blood imaging is an emerging unenhanced MRA technique that has recently become commercially available. Early clinical trials appear promising and it is anticipated that fresh blood imaging will become invaluable, particularly in patients with impaired renal function. Technical refinements are still required to perfect this novel MR application, particularly for the assessment of distal calf and pedal vessels and for the evaluation of patients with arrhythmias and those with impaired cardiac function. |
4 |
| 37. Jager KA, Phillips DJ, Martin RL, et al. Noninvasive mapping of lower limb arterial lesions. Ultrasound Med Biol. 1985;11(3):515-521. |
Observational-Dx |
30 patients |
To compare US duplex evaluation of iliac to popliteal artery to angiography. |
For lesion < or > than 50%, sensitivity 77%, specificity 98%, PPV 94%, NPV 92%. These results are not significantly different from interobserver variability for angiography. |
3 |
| 38. Fletcher JP, Kershaw LZ, Chan A, Lim J. Noninvasive imaging of the superficial femoral artery using ultrasound Duplex scanning. J Cardiovasc Surg (Torino). 1990;31(3):364-367. |
Observational-Dx |
28 total patients 56 extremities |
To compare duplex US and angiography in superficial femoral artery disease. |
Overall sensitivity for duplex scanning compared to arteriography in detecting stenotic or occlusive disease was 91%, specificity was 94%, PPV 85% and NPV 97%. Results for Duplex scanning were better in the proximal and middle segment compared to the distal third of the superficial femoral artery. The sensitivity of segmental lower extremity pressures and pulse volume recordings for predicting proximal superficial femoral artery disease compared to arteriography was 82%; specificity was 79% and accuracy 80%, all inferior to that of Duplex scanning. Duplex US is suitable for noninvasive assessment of superficial femoral artery disease. |
2 |
| 39. Leng GC, Whyman MR, Donnan PT, et al. Accuracy and reproducibility of duplex ultrasonography in grading femoropopliteal stenoses. J Vasc Surg. 1993;17(3):510-517. |
Observational-Dx |
30 patients |
To determine the accuracy of Doppler waveform characteristics in grading femoropopliteal stenoses. |
An increase in peak systolic velocity of more than 200% accurately predicted a 50% or greater reduction in luminal diameter on angiography (70% sensitivity, 96% specificity). The presence of spectral broadening and an abnormal waveform shape were found to correlate poorly with the degree of stenosis. Analysis of variance showed no significant difference between observers in velocity measurements (p = 0.78). Although stenoses of greater than 50% can be distinguished from minor stenoses, more precise definition of the degree of narrowing is unlikely. The good repeatability of the velocity ratio makes it an excellent tool for monitoring major changes in the progression of disease. |
4 |
| 40. de Vries SO, Hunink MG, Polak JF. Summary receiver operating characteristic curves as a technique for meta-analysis of the diagnostic performance of duplex ultrasonography in peripheral arterial disease. Acad Radiol. 1996;3(4):361-369. |
Meta-analysis |
14 reports |
To summarize and compare the diagnostic performance of duplex and color-guided duplex US in the evaluation of PAD. |
The summary ROC curves demonstrated a high level of diagnostic performance for both types of duplex imaging; with color-guided duplex scanning being superior. A false-positive rate of .05 (specificity .95), the analysis predicted a true-positive rate (sensitivity) of .83 for duplex alone and .93 for color guided duplex. For aortoiliac and femoropopliteal arteries, the addition of color flow imaging to duplex scanning improves diagnostic performance in evaluating PAD. |
M |
| 41. Allard L, Cloutier G, Durand LG, Roederer GO, Langlois YE. Limitations of ultrasonic duplex scanning for diagnosing lower limb arterial stenoses in the presence of adjacent segment disease. J Vasc Surg. 1994;19(4):650-657. |
Observational-Dx |
55 patients |
To provide a quantitative evaluation of the effect of adjacent segment lesions on disease classification in lower limb arteries by US duplex scanning. |
To recognize severe stenoses (50%-100% diameter reduction) in any arterial segment, duplex scanning had sensitivity and specificity rates of 74% and 96%. However, sensitivity and specificity rates increased to 80% and 98%, when there was no 50%-100% diameter-reducing lesion in adjacent segments, whereas they decreased to 66% and 94%, when there was at least one 50%-100% diameter-reducing lesion in adjacent segments. The results demonstrated that the presence of multiple stenoses was an important limitation of duplex scanning for the detection and quantification of lower limb arterial disease. |
2 |
| 42. Martinez-Rico C, Marti-Mestre X, Jimenez-Guiu X, Espinar-Garcia E, Cervellera-Perez D, Vila-Coll R. Ultrasound Surveillance in Endovascular Revascularization of Lower Limbs. Ann Vasc Surg. 56:274-279, 2019 Apr. |
Observational-Tx |
113 endovascular procedures (106 patients) |
To evaluate the initial efficacy of duplex ultrasound as a surveillance method in endovascular treatment in symptomatic peripheral arterial disease patients in our center. |
he average age was 68.3 years, with 72% being men. Twenty-two percent of treated lesions were iliac, 57% were femoropopliteal, and 21% were distal. There were 329 visits, with a mean follow-up of 13.5 months (3-31). The US detected permeability or moderate stenosis in 66 patients (58.4%) and restenosis or occlusion in 47 (41.6%). When compared with clinical status, there was a noncorrelation in 23% and a discrepancy with respect to the ABI of 27% and of 39% with plethysmography. All these differences were statistically significant (P < 0.001). Twenty-one reinterventions were performed (18.6%), six patients died (5.3%), and 11 required major amputation (9.7%). |
2 |
| 43. Chan KA, Junia A. Lower extremity peripheral artery disease: a basic approach. [Review]. Br J Hosp Med (Lond). 81(3):1-9, 2020 Mar 02. |
Review/Other-Dx |
N/A |
To provide an overview of the diagnosis and assessment of peripheral artery disease to allow appropriate earlyrisk modification and treatment. |
No results available. |
4 |
| 44. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
