A prospective comparison of lower limb colour-coded Duplex scanning with arteriography.
ABSTRACT To compare the diagnostic value of colour Duplex scanning with arteriography for the detection of arterial disease of the aortoiliac arteries, femoropopliteal arteries and the origins of the tibial vessels.
Prospective, semi-blind study.
Vascular laboratory and radiology department, University Hospital.
A total of 1658 arterial segments in 148 limbs were studied both by colour Duplex scanning and digital subtraction arteriography. Individual arterial segments were classified on the basis of peak systolic velocity ratios < 2.0, > or = 2.0 or an absent Doppler signal, as 0-49%, 50-99% diameter reduced, or occluded. The same arterial segments were similarly classified on the basis of arteriography and the two modalities were compared using a Kappa (k) analysis.
The overall agreement between arteriography and colour-coded Duplex was kappa = 0.74 (95% CI, 0.70-0.78), this indicates substantial agreement. Kappa values (95% CI) from the aortoiliac, femoropopliteal and the origins of the infrapopliteal arteries were kappa = 0.59 (0.49-0.73; moderate agreement), kappa = 0.80 (0.76-0.84; substantial agreement) and kappa = 0.48 (0.35-0.61; moderate agreement) respectively.
We conclude that there is substantial agreement between colour-coded Duplex and arteriography of the lower limbs, and that the ability of colour-coded Duplex to plan and guide lower limb vascular interventions requires investigation.
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ABSTRACT: Objectives The aim of this study is investigate the agreement between a portable duplex scanner (PDS and angiography in the diagnosis of peripheral arterial disease (PAD) and analyse the influence of the type of lesion on the result.Material and methodsA prospective study was conducted on 60 limbs (45 patients) with a mean age of 68 years, 33 males/12 females, 30% diabetes mellitus, 37% dyslipidaemias, 58% arterial hypertension, and 27% heart diseases.A PDS was made following the guidelines for the non-invasive diagnosis of femoral-popliteal sector (8 segments) and comparing it with the angiography. The stenosis were classified as <50%, and thrombosis as >50%. The sensitivity (Se), specificity (Sp), Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Kappa (K) index of agreement was calculated.The arterial lesions were classified in singles or multiples, and were compared with the level of accuracy of the PDS (chi-squared test).ResultsIn the above-knee segment, the level of agreement was good for the diagnosis of thrombosis (K = 0.779, Sp = 86%, Se = 95%, PPV = 79%, NPV = 96%) and stenosis >50% (K = 0.651, Se = 82%, Se = 85%, PPV = 70% and NPV = 92%).In the below-knee segment, the index of agreement was good for the diagnosis of thrombosis (K = 0.610, Sp = 72%, Se = 87%, PPV = 77%, PNV = 84%), and moderate in stenosis >50% (K = 0.472, Sp = 68%, Se = 78%, PPV = 70% and NPV = 76%).The PDS correctly identified 94% of thrombosis in single lesions compared to 85% in the multiple lesions (P = .008) and 86% in stenosis >50% in single lesions compared to 79% in multiple lesions (P = .070).Conclusions The sensitivity, specificity, PPV, NPV and Kappa index are good in the diagnosis of PAD, being more sensitive for the diagnosis of thrombosis than for the diagnosis of stenosis.-The was more reliable for the diagnosis of PAD in above-knee segments than below-knee segments.-Multiple arterial lesions decrease the reliability of PDS in the diagnosis of thrombosis.Angiología 09/2012; 64(5):193–198. DOI:10.1016/j.angio.2012.04.005