Diagnostic Confidence Of Run-Off CT-Angiography As The Primary ...

Image quality

At the abdominopelvic level, image quality was non-diagnostic in none of the patients regardless of the clinical manifestation of PAD. At the thigh artery level, IQ was non-diagnostic in 0% of the patients with chronic PAD, and in 6% (6/93) of the patients with acute PAD. In patients with non-diagnostic IQ arteries of at least one side were unenhanced due to an acute occlusion.

At the calf level (Fig. 2), the portion of patients with non-diagnostic IQ increased and was significantly higher in patients presenting with acute PAD as compared to patients presenting with chronic PAD (acute: 28%; chronic: 17%, P = 0.02).

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Fig 2. Proportion of patients with non-diagnostic image quality (IQ-) dependent on peripheral arterial disease (PAD) manifestation and arterial level.

The total number of patients (black numbers) as well as the subset of patients with insufficient diagnostic confidence (DC−, white numbers) is given for each subgroup. DC− = insufficient, DC+ = sufficient diagnostic confidence of run-off CTA. * = P<0.05, *** = P<0.001, n.s. = no significance, P-Value of χ2-test.

https://doi.org/10.1371/journal.pone.0119900.g002

At the foot level, IQ deteriorated significantly as compared to the calf artery level in patients with acute PAD (foot level: 52%, P < 0.001), but not in patients with chronic PAD (foot level: 20%, P = 0.32).

With regards to artery levels with non-diagnostic IQ (Fig. 3), insufficient vessel enhancement was significantly more frequently observed at the calf (acute: 24% vs. chronic: 5%, P<0.001) and foot level (acute: 49% vs. chronic: 11%, P<0.001) in patients with acute PAD as compared to patients with chronic PAD. Severe vessel wall calcifications were not significantly more frequently observed at the calf level compared between patients with acute and chronic PAD. At the foot level severe calcifications were significantly more often the reason for insufficient vessel delineation (acute: 3% vs. chronic: 11%, P = 0.03) in patients with chronic PAD compared to patients with acute PAD. The risk that the diagnostic confidence of a run-off CTA in patients with chronic PAD was insufficient, if the image quality was non-diagnostic, was approximately 16% (6/37).

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Fig 3. Proportion of patients with non-diagnostic image quality (IQ-) due to severe vessel calcifications (A) or insufficient vessel contrast (B) dependent on peripheral arterial disease (PAD) manifestation and arterial level.

The total number of patients (black numbers) as well as the subset of patients with insufficient diagnostic confidence of run-off CTA (DC−, white numbers) is given for each subgroup. DC− = insufficient, DC+ = sufficient diagnostic confidence. * = P <0.05, *** = P<0.001, n.s. = no significance, P-Value of χ2-test.

https://doi.org/10.1371/journal.pone.0119900.g003