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Vascular and Interventional Radiology |
1 From the Departments of Epidemiology and Biostatistics (K.V., M.G.M.H.) and Radiology (M.G.M.H.), Erasmus Medical Center Rotterdam, Rm EE21-40a, Dr Molewaterplein 50, 3015 GE Rotterdam, the Netherlands, and the Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass (M.G.M.H.). Received February 17, 1999; revision requested May 3; final revision received September 29; accepted October 25. Supported in part by the Persoongerichte Impuls voor Onderzoeksgroepen met Nieuwe Ideëen voor Excellente Research (PIONIER) award from the Netherlands Organization for Scientific Research. Address correspondence to M.G.M.H. (e-mail: hunink@epib.fgg.eur.nl).
PURPOSE: To summarize and compare the published data on gadolinium-enhanced magnetic resonance (MR) angiography and color-guided duplex ultrasonography (US) for the work-up for peripheral arterial disease.
MATERIALS AND METHODS: Studies published between January 1984 and November 1998 were included if (a) gadolinium-enhanced MR angiography and/or color-guided duplex US were performed for evaluation of arterial stenoses and occlusions in the work-up for peripheral arterial disease of the lower extremities, (b) conventional angiography was the reference standard, and (c) absolute numbers of true-positive, false-negative, true-negative, and false-positive results were available or derivable.
RESULTS: With a random effects model, pooled sensitivity for MR angiography (97.5% [95% CI: 95.7%, 99.3%]) was higher than that for duplex US (87.6% [95% CI: 84.4%, 90.8%]). Pooled specificities were similar: 96.2% (95% CI: 94.4%, 97.9%) for MR angiography and 94.7% (95% CI: 93.2%, 96.2%) for duplex US. Summary receiver operating characteristic analysis demonstrated better discriminatory power for MR angiography than for duplex US. Regression coefficients for MR angiography versus US were 1.67 (95% CI: -0.23, 3.56) with adjustment for covariates, 2.11 (95% CI: 0.12, 4.09) without such adjustment, and 1.73 (95% CI: 0.44, 3.02) with a random effects model.
CONCLUSION: Gadolinium-enhanced MR angiography has better discriminatory power than does color-guided duplex US and is a highly sensitive and specific method, as compared with conventional angiography, for the work-up for peripheral arterial disease.
Index terms: Arteries, extremities • Arteries, stenosis or obstruction, 92.72 • Arteries, MR, 92.12942, 92.12943 • Arteries, US, 92.12981, 92.12983 • Magnetic resonance (MR), comparative studies, 92.12942, 92.12943 • Ultrasound (US), comparative studies, 92.12981, 92.12983
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