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Peripheral Arterial Disease: Comparison of Color Duplex US and Contrast-enhanced MR Angiography for Diagnosis¹

¹ From the Departments of Radiology (T.L., G.B.C.V., M.W.d.H., K.Y.J.A.M.H., J.M.A.v.E.), Clinical Epidemiology and Medical Technology Assessment (A.G.H.K.), Epidemiology (P.J.N.), and Vascular Surgery (P.E.J.H.M.K., J.H.M.T.), Maastricht University Hospital, Peter Debijelaan 25, NL-6229 HX Maastricht, the Netherlands; and Department of Epidemiology, Maastricht University Medical School, Maastricht, the Netherlands (P.J.N.). From the 2002 RSNA Annual Meeting. Received January 17, 2004; revision requested March 31; revision received May 25; accepted July 1. Supported in part by the Dutch Heart Foundation, grant 98–150. Address correspondence to T.L. (e-mail: leiner@rad.unimaas.nl).

PURPOSE: To prospectively compare the diagnostic accuracies of color duplex ultrasonography (US) and contrast material–enhanced magnetic resonance (MR) angiography and to assess interobserver agreement regarding contrast-enhanced MR angiographic findings in patients suspected of having peripheral arterial disease (PAD).

MATERIALS AND METHODS: The institutional review board approved the study, and all patients provided signed informed consent. Two hundred ninety-five patients referred for diagnostic and preinterventional work-up of PAD with duplex US also underwent gadolinium-enhanced MR angiography. Data sets were reviewed for presence or absence of 50% or greater luminal reduction, which indicated hemodynamically significant stenosis, and to determine interobserver agreement. At duplex US, a peak systolic velocity ratio of 2.5 or greater indicated significant stenosis. Primary outcome measures were differences between duplex US and contrast-enhanced MR angiography in sensitivity and specificity for detection of significant stenosis, as assessed with the McNemar test, and interobserver agreement between the two contrast-enhanced MR angiogram readings, expressed as quadratic weighted values. Intraarterial digital subtraction angiography (DSA) was the reference standard.

RESULTS: Two hundred forty-nine patients had at least one hemodynamically significant stenotic lesion at contrast-enhanced MR angiography, duplex US, or both examinations. One hundred fifty-two patients underwent intraarterial DSA. The quadratic weighted for agreement regarding the presence of 50% or greater stenosis at contrast-enhanced MR angiography was 0.89 (95% confidence interval [CI]: 0.87, 0.91). Sensitivity of duplex US was 76% (95% CI: 69%, 82%); specificity, 93% (95% CI: 91%, 95%); and accuracy, 89%. Sensitivity and specificity of contrast-enhanced MR angiography were 84% (95% CI: 78%, 89%) and 97% (95% CI: 95%, 98%), respectively; accuracy was 94%. Sensitivity (P = .002) and specificity (P = .03) of contrast-enhanced MR angiography were significantly higher.

CONCLUSION: Results of this prospective comparison between contrast-enhanced MR angiography and duplex US provide evidence that contrast-enhanced MR angiography is more sensitive and specific for diagnosis and preinterventional work-up of PAD.

© RSNA, 2005

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