Met R, Bipat S, Legemate DA, Reekers JA, Koelemay MJ, et al.
JAMA. Date of publication 2009 Jan 28;volume 301(4):415-24.
1. JAMA. 2009 Jan 28;301(4):415-24. doi: 10.1001/jama.301.4.415.
Diagnostic performance of computed tomography angiography in peripheral arterial
disease: a systematic review and meta-analysis.
Met R(1), Bipat S, Legemate DA, Reekers JA, Koelemay MJ.
Author information:
(1)Department of Radiology, Academic Medical Center, PO Box 22660, 1100 DD
Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. r.met@amc.uva.nl
Comment in
Ann Intern Med. 2009 May 19;150(10):JC5-12.
CONTEXT: Computed tomography angiography (CTA) is an increasingly attractive
imaging modality for assessing lower extremity peripheral arterial disease (PAD).
OBJECTIVE: To determine the accuracy of CTA compared with intra-arterial digital
subtraction angiography (DSA) in differentiating extent of disease in patients
with PAD.
DATA SOURCES AND STUDY SELECTION: Search of MEDLINE (January 1966-August 2008),
EMBASE (January 1980-August 2008), and the Database of Abstracts of Reviews of
Effectiveness for studies comparing CTA with intra-arterial DSA for PAD. Eligible
studies compared multidetector CTA with intra-arterial DSA, included at least 10
patients with intermittent claudication or critical limb ischemia, aimed to
detect more than 50% stenosis or arterial occlusion, and presented either 2 x 2
or 3 x 3 contingency tables (< or = 50% stenosis vs > 50% stenosis or occlusion),
or provided data allowing their construction.
DATA EXTRACTION: Two reviewers screened potential studies for inclusion and
independently extracted study data. Methodological quality was assessed by using
the QUADAS instrument.
DATA SYNTHESIS: Of 909 studies identified, 20 (2.2%) met the inclusion criteria.
These 20 studies had a median sample size of 33 (range, 16-279) and included 957
patients, predominantly with intermittent claudication (68%). Methodological
quality was moderate. Overall, the sensitivity of CTA for detecting more than 50%
stenosis or occlusion was 95% (95% confidence interval [CI], 92%-97%) and
specificity was 96% (95% CI, 93%-97%). Computed tomography angiography correctly
identified occlusions in 94% of segments, the presence of more than 50% stenosis
in 87% of segments, and absence of significant stenosis in 96% of segments.
Overstaging occurred in 8% of segments and understaging in 15%.
CONCLUSION: Computed tomography angiography is an accurate modality to assess
presence and extent of PAD in patients with intermittent claudication; however,
methodological weaknesses of examined studies prevent definitive conclusions from
these data.
DOI: 10.1001/jama.301.4.415
PMID: 19176443 [Indexed for MEDLINE]
