Confronto tra angio-TC a 64 strati e angiografia digitale nello studio degli arti inferiori: esperienza personale

Purpose. This study was undertaken to evaluate the potential of 64-row multislice computed tomography (CT) versus digital subtraction angiography (DSA) in detecting significant lesions of lower-extremity inflow and runoff arteries. Materials and methods. Fifty-three patients underwent 64-row multislice CT and DSA over a mean of 36 days. The vascular tree was divided into 33 segments. Three readers independently reviewed the axial CT scans and multiplanar oblique and two- and three-dimensional reconstructions (maximum intensity projection and Volume rendering) images to assess degree of stenosis according to four categories: 1 (0%-49% stenosis); 2 (50%-99% stenosis); 3 (occluded); 4 (not evaluable). In all cases, DSA was performed by arterial catheterisation. Results. In 53 patients, 1,440 segments were evaluated (infrarenal aorta and 16 arterial segments for each leg; 42 bilateral studies, 11 unilateral studies). Compared with DSA, CT angiography yielded 97.2% sensitivity, 97% specificity, 92.5% positive predictive value, 98.9% negative predictive value, 97.1% diagnostic accuracy and 95.4% concordance on the degree of stenosis. Conclusions. Sixty-four-row multislice CT proved to be helpful in detecting haernodynamically significant lesions in peripheral arterial occlusive disease and improved the results obtained with 4- and 16-slice rnultidetector CT. In addition, owing to the high spatial resolution and rigorous technique, no variations in the data obtained below the knee were detected, overcoming a limitation of earlier generations of CT scanners.