Peripheral arterial disease: Therapeutic confidence of CT versus digital subtraction angiography and effects on additional imaging recommendations
Peripheral arterial disease: Therapeutic confidence of CT versus digital subtraction angiography and effects on additional imaging recommendations
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DOI：
10.1148/radiol.2331031595
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发表时间：
2004-11-01
期刊：
影响因子：
19.7
通讯作者：
Hunink, MGM
中科院分区：
文献类型：
--
作者：
Adriaensen, MEAPM;Kock, MCJM;Hunink, MGM
目得：比较多探测器行计算机断层扫描（CT）血管造影和数字减影血管造影（DSA）在有症状的外周动脉疾病患者血运重建术的目的，评估建议额外的成像和医生的信心评级为选定therapy.MATERIALS和METHODS：在一项随机对照试验中，73例患者被分配到CT血管造影，72被分配到DSA。医生对治疗决策的信心被测量为0-10分（不确定到确定）的连续结局和二分结局（建议进一步成像，是或否）。在意向性诊断和治疗分析中，比较了CT组和DSA组的平均置信度评分和额外的成像建议。为了检测置信度的趋势，绘制了置信度评分随时间的变化曲线，并进行了多元线性回归分析。为了检测其他影像学建议的趋势，使用逻辑回归分析。结果：两组患者的基线特征无统计学显著差异，CT的可信度评分低于DSA（7.2比8.2，P <0.001）。CT检查后推荐进一步影像学检查的比例（25/71，35%）高于DSA检查后（9/66，14%; P = 0.003）。趋势分析表明CT的置信度增加（但无统计学显著性），DSA的置信度稳定。随机化和非随机化患者的基线特征无显著差异。在非随机化患者中，CT（n = 24）和DSA（n = 26）之间的平均置信度评分（8.2 vs 8.3，P = 0.26）无显著差异。结论：在有症状的外周动脉疾病患者中，CT血管造影，医生的置信度随着血运重建前额外成像的增加而降低。鉴于CT比DSA侵入性小，结果表明，在某些情况下，CT可以取代DSA。(C)RSNA，2004年。
PURPOSE: To compare multi-detector row computed tomographic (CT) angiography and digital subtraction angiography (DSA) prior to revascularization in patients with symptomatic peripheral arterial disease for the purpose of assessing recommendations for additional imaging and physician confidence ratings for chosen therapy.MATERIALS AND METHODS: In a randomized controlled trial, 73 patients were assigned to CT angiography, and 72 were assigned to DSA. Physician confidence in the treatment decision was measured as a continuous outcome on a scale of 0-10 (uncertain to certain) and as a dichotomous outcome (further imaging recommended, yes or no). Mean confidence scores and additional imaging recommendations were compared between CT and DSA groups in an intention-to-diagnose-and-treat analysis. To detect trends in confidence, confidence scores were plotted over time, and multiple linear regression analysis was performed. To detect trends in additional imaging recommendations, logistic regression analysis was used. Data from eligible nonrandomized patients were analyzed separately.RESULTS: No statistically significant difference in baseline characteristics between randomized groups was found. CT had a lower confidence score than did DSA (7.2 vs 8.2, P < .001). Further imaging was recommended more often after CT (25 of 71 patients, 35%) than after DSA (nine of 66 patients, 14%; P = .003). Analysis of trends demonstrated increasing (but not statistically significant) confidence in CT and stable confidence in DSA. No significant difference was found in baseline characteristics between randomized and nonrandomized patients. Among nonrandomized patients, no significant difference in mean confidence score (8.2 vs 8.3, P = .26) was found between CT (n = 24) and DSA (n = 26).CONCLUSION: With CT angiography, physician confidence decreases with an associated increase in additional imaging prior to revascularization in patients with symptomatic peripheral arterial disease. Given that CT is less invasive than DSA, results suggest that CT may replace DSA in selected cases. (C) RSNA, 2004.