Multidetector row CT angiography of the lower limb arteries: a prospective comparison of volume-rendered techniques and intra-arterial digital subtraction angiography

AIM: To assess whether multi-detector CT angiograms (MDCTA) of the lower limb arteries, compared with conventional digital subtraction angiograms (DSA), could replace invasive arteriography in patients with symptomatic peripheral arterial disease. MATERIALS AND METHODS: In a prospective comparative analysis of MDCTA and DSA in 44 patients, MDCTA was analyzed using volume-rendered images acquired at a disease workstation and viewed in tandem with the original axial data. Designated arterial segments were graded according to their degree of stenosis. RESULTS: We found agreement for the degree of stenosis in 88.8% and 85.4% of 1024 segments analysed for two observers. The sensitivity for treatable lesions (> 50% stenosis) was 79.1% and 72% with a specificity of 93.3% and 92.6%. DSA failed to visualize 7.3% of segments that were visible with MDCTA. These segments were exclusively downstream to long segment occlusions. CONCLUSION: MDCTA using 4-slice machines is insensitive to detecting significant arterial stenoses in the lower limb arteries. MDCTA is superior to DSA in its visualization of arterial territories downstream to significant occlusive disease. (C) 2005 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.