Analysis of agreement between Duplex ultrasound scanning and arteriography in patients with lower limb artery disease
Analysis of agreement between Duplex ultrasound scanning and arteriography in patients with lower limb artery disease
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DOI：
10.2459/01.jcm.0000268124.51543.b2
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发表时间：
2007-05-01
影响因子：
3
通讯作者：
Palareti, Gualtiero
中科院分区：
文献类型：
--
作者：
Favaretto, Elisabetta;Pili, Caterina;Palareti, Gualtiero
背景血管造影是下肢动脉疾病治疗决策的金标准。然而，双功超声扫描的潜力和安全性都表明它可能成为主要的诊断工具。方法对49例下肢动脉病变患者（跛行24例，严重缺血12例，皮肤病变13例）行下肢动脉造影及双功超声检查，并与血管造影进行对照分析。将下肢动脉轴分为15段，并根据狭窄程度（0- 49%，50- 69%，70-99%和闭塞）进行分级。通过Cohen kappa统计（K）评估血管造影和Duplex扫描之间的一致性。结果Duplex对血管造影显示的明显狭窄（>= 70%）的诊断符合率高（kappa = 0.70，95% CI为0.588-0.825）。髂腰动脉区（kappa=0.63）的一致性良好，灵敏度为63%，特异性为96%，股腘动脉区（kappa = 0.70）的灵敏度为74%，特异性为83%。结论双功超声对下肢动脉病变的诊断与血管造影基本一致，但对膝下动脉病变的诊断与血管造影一致性较差，诊断下肢动脉狭窄或闭塞的敏感性低，特异性高。
Background Angiography is the gold standard for therapeutic decision-making in lower limb artery disease. However, both the potentiality and safety of Duplex ultrasound scanning suggest that it may become the main diagnostic tool. The present study aimed to investigate the agreement between Duplex scanning and angiography in the diagnosis of stenosis in lower limb artery disease.Methods Forty-nine patients with lower limb artery disease (24 claudication, 12 critical ischemia, 13 skin lesions) underwent angiography and Duplex scanning. The lower limb arterial axis was divided into 15 segments and graded on the basis of the degree of stenosis (0-49%, 50-69%, 70-99% and occlusion). Agreement between angiography and Duplex scanning was assessed by Cohen's kappa statistics (K). The sensitivity and specificity of Duplex scanning in detecting significant stenosis at angiography (>= 70%) were also calculated.Results Good diagnostic agreement (kappa = 0.70; 95% CI 0.588-0.825) was achieved in the whole arterial axis. Agreement was good for the aorto-iliac district (kappa=0.63) with a sensitivity of 63% and a specificity of 96%, and for the femoro-popliteal district (kappa = 0.70) with a sensitivity of 74% and a specificity of 83%. In infrapopliteal arteries, kappa showed a poor agreement, but Duplex scanning detected 28 patent tibial arteries in limbs that were not opacified on arteriography.Conclusions Duplex scanning shows good agreement with angiography in lower limb artery disease on the whole, but poor agreement in infrapopliteal districts, with a low sensitivity and high specificity in detecting significant stenoses or occlusions.