Duplex Sonography versus Angiography for Assessment of Femoropopliteal Arterial Disease in a “Real-World” Setting

2007 ◽  
Vol 14 (4) ◽  
pp. 452-459 ◽  
Author(s):  
Oliver Schlager ◽  
Marcel Francesconi ◽  
Markus Haumer ◽  
Petra Dick ◽  
Schila Sabeti ◽  
...  
Keyword(s):  
Real World ◽  
Predictive Value ◽  
Velocity Ratio ◽  
Peak Systolic Velocity ◽  
Duplex Ultrasound ◽  
Weighted Kappa ◽  
Arterial Disease ◽  
Duplex Sonography ◽  
Kappa Statistics ◽  
Sensitivity Specificity

Purpose: To evaluate the agreement of duplex ultrasound (DUS) versus digital subtraction angiography (DSA) for assessment of femoropopliteal arterial disease in a real-world clinical setting. Methods: Consecutive patients with peripheral artery disease who were scheduled for a percutaneous intervention were included in this retrospective study. During an 18-month period, 491 patients (276 men; median age 73 years, interquartile range 64–81) were enrolled. A peak systolic velocity ratio (PSVR) >2.4 was the optimal cutoff for detecting a >50% stenosis by DSA. Findings of preprocedural DUS in the proximal, middle, and distal ipsilateral superficial femoral artery and in the popliteal segment were analyzed for agreement with preprocedural femoropopliteal DSA using kappa statistics. Only the target limb in each patient was analyzed, for a total of 1964 vascular segments. Results: Agreement for the degree of stenosis in 10% increments was only moderate (weighted kappa 0.67, 95% CI 0.65 to 0.69). Using the PSVR >2.4 cutoff, agreement between DUS and DSA for a >50% stenosis was good (kappa 0.79, 95% CI 0.77 to 0.81). Sensitivity, specificity, positive predictive value, and negative predictive value for correctly detecting a >50% stenosis by DUS were 0.81 (0.78 to 0.84), 0.93 (0.91 to 0.94), 0.84 (0.81 to 0.87), and 0.91 (0.87 to 0.95), respectively. Comparable findings were observed within different patient subgroups. Conclusion: Agreement between DUS and DSA in the femoropopliteal segment is only moderate with respect to the absolute degree of stenosis. However, detection of a >50% stenosis can be done with acceptable precision in routine clinical practice using PSVR >2.4 as a threshold.

scholarly journals The Reliability of Ultrasound Measurements of Carotid Stenosis Compared to MRA and DSA

2005 ◽  
Vol 32 (4) ◽  
pp. 465-471 ◽  
Author(s):  
Colin Honish ◽  
Venkatraman Sadanand ◽  
Derek Fladeland ◽  
Vance Chow ◽  
Fahrad Pirouzmand
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Carotid Stenosis ◽  
Predictive Value ◽  
Velocity Ratio ◽  
Peak Systolic Velocity ◽  
Roc Curves ◽  
Weighted Kappa ◽  
Internal Carotid Artery Stenosis ◽  
Diastolic Velocity

ABSTRACT:Objective:Carotid ultrasound (US) is a screening test for patients with transient ischemic attacks (TIAs) or stroke who then undergo Digital Subtraction Angiogram (DSA) or Magnetic Resonance Angiography (MRA). Gold standard DSA is invasive with inherent risks and costs. MRA is an evolving technology. This study compares reliability of MRA and US modes with DSA in determining degree of internal carotid artery stenosis.Methods:A five year retrospective analysis of 140 carotid arteries from patients who had carotid US and DSA, and possibly Magnetic Resonance Angiography was undertaken. Recorded US parameters were peak systolic velocity (PSV), end diastolic velocity (EDV), and ICA/CCA peak systolic velocity ratio. The MRA and DSA parameters used NASCET technique for measuring stenosis. Statistical analysis included ROC curves and Kappa computation.Results:US grading of carotid stenosis can be made more reliable by choosing appropriate parameters. The best combination of sensitivity and specificity for stenosis > 70% in our hospital was seen at PSV > 173cm/s (sensitivity 0.87, specificity 0.8, Positive Predictive Value (PPV) 0.70, Negative Predictive Value (NPV) 0.93, kappa 0.64 and weighted kappa 0.71). MRA kappa was 0.78, (sensitivity 0.75, specificity 1.0, PPV 1.0, NPV 0.85).Conclusions:US parameters should be validated in each centre. At best, US can only approximate the accuracy of DSA, probably due to inherent limitations of this modality. Magnetic Resonance Angiography has a perfect specificity and PPV but this technique needs to be standardized. Simultaneous use of MRA and US for screening increases sensitivity to over 0.9 without compromising specificity in > 70% stenosis.

Frequency and anatomic distribution of arterial obstructions in patients with vasculogenic erectile dysfunction not responding to intracavernous prostaglandin

VASA ◽  
2021 ◽  
pp. 1-6
Author(s):  
Vignes Mohan ◽  
Giuseppe Sangiorgi ◽  
Jonas Knöchel ◽  
Hak-Hong Keo ◽  
Jan Schönhofen ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Peak Systolic Velocity ◽  
Duplex Ultrasound ◽  
Arterial Disease ◽  
Duplex Sonography ◽  
Intracavernosal Injection ◽  
Specific Patient ◽  
Published Evidence ◽  
Diastolic Velocity ◽  
Penile Artery

Summary: Background: The extent of arterial disease in patients with erectile dysfunction (ED) non-responsive to intracavernosal injection of Alprostadil is of importance for therapeutic options. However, published evidence, in particular angiographically validated is scarce. Here we investigated arterial lesion patterns in this specific patient cohort by selective angiography. Patients and methods: A cohort of 239 patients received a clinical and duplex-sonographic workup for ED of suspected vascular origin. Duplex ultrasound of the cavernosal arteries was performed after intracavernosal injection of 10 μg Alprostadil. Consequently, standardized workup included grading of the erectile and determination of peak systolic velocity (PSV) and end-diastolic velocity (EDV) in both cavernosal arteries. PSV-values below 30 cm/sec indicated reduced arterial flow, whereas EDV-values above 15 cm/sec indicated a venous leak of the pudendal veins. All patients with suspected arterial ED based on duplex sonography underwent contrast-enhanced computed tomography. Endovascular therapy was carried out in ED patients not responsive or with significant side effects to PDE-5-inhibitors or Alprostadil by selective angiographic depiction of erection-related arteries. Results: 54 patients with a mean age of 61.2 (±9.8) years underwent angioplasty of erectionr elated arteries. Out of these 48/54 (89%) patients presented with an erection considered insufficient for penetration (E0-E3) subsequent to intracavernous application of 10 μg Alprostadil. 14/48 (29%) patients had bilateral arterial obstructions and 34/48 (71%) had unilateral disease. Commonly affected was the internal pudendal artery (n = 31, 65%), followed closely by the common penile artery (n = 30, 64%). The least affected arteries were the dorsal penile (n = 6, 13%), hypogastric (n = 4, 8%), common iliac (n = 4, 8%), cavernosal (n = 4, 8%), and inferior gluteal (n = 1, 2%) arteries. Conclusions: Arterial obstructions amenable to endovascular revascularization are frequent in patients non-responsive to intracavernosal prostaglandin administration. Therapeutic strategies in ED patients non-responsive to conservative measures should therefore consider endovascular treatment opportunities.

Elevated Peak Systolic Velocity and Velocity Ratio from Duplex Ultrasound are Associated with Hemodynamically Significant Lesions in Arteriovenous Access

2016 ◽  
Vol 35 ◽  
pp. 68-74 ◽  
Author(s):  
Steven A. Plato ◽  
Elizabeth A. Kudlaty ◽  
Matthew T. Allemang ◽  
Daniel E. Kendrick ◽  
Virginia L. Wong ◽  
...  
Keyword(s):  
Velocity Ratio ◽  
Peak Systolic Velocity ◽  
Duplex Ultrasound ◽  
Arteriovenous Access

scholarly journals Comparison of Mammography and Ultrasonography in Evaluation of Breast Masses

2019 ◽  
Vol 13 (2) ◽  
pp. 22-24
Author(s):  
Zebun Nahar ◽  
Md Enamul Kabir ◽  
Taharul Alam ◽  
Shamoli Yasmin ◽  
Maisha Naowar
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Breast Tumour ◽  
Military Hospital ◽  
Kappa Statistics ◽  
K Value ◽  
Breast Masses ◽  
Malignant Breast ◽  
Diagnostic Modalities ◽  
Sensitivity Specificity

Introduction: Breast cancer is the most common cancer and second leading cause of cancer deaths in women. Early detection, efficient and accurate diagnosis can reduce the mortality rate. Objectives: To compare the screening accuracy of mammography (MMG) and ultrasonography (USG) in suspected cases of breast masses. Material and Methods: This cross-sectional analytical study was carried out in the Department of Radiology and Imaging, Combined Military Hospital, Dhaka from June 2016 to July 2017. A total of 100 clinically suspected case of breast masses aged from 20 to 75 years referred for MMG and USG was selected. Each patient underwent USG and MMG followed by a histopathological examination of the biopsy material taken from the lump lesion. Two cases histopathological report was not found. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of USG and MMG were compared with histopathology as the gold standard. In order to determine the agreement of diagnoses between USG and MMG, consistency analysis was performed using Kappa-statistics. Results: Sensitivity, specificity, PPV, NPV and diagnostic accuracy of USG was 58.8%, 98.4%, 77.8%, 85.0% and 83.6% and for MMG 92.0%, 84.5%, 67.6%, 96.8% and 84.7% respectively. Kappa-statistics shows that the two diagnostic modalities had a test agreement in 39.8% cases to differentiate malignant breast tumour from the benign one (k-value = 0.398, p > 0.05). Conclusion: Two diagnostic modalities USG and MMG had a fair agreement in the differentiation of malignant breast tumour from the benign. Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 22-24

Duplex Evaluation Following Femoropopliteal Angioplasty and Stenting: Criteria and Utility of Surveillance

2012 ◽  
Vol 46 (5) ◽  
pp. 353-357 ◽  
Author(s):  
Donald T. Baril ◽  
Luke K. Marone
Keyword(s):  
Lower Extremity ◽  
Velocity Ratio ◽  
Peak Systolic Velocity ◽  
Duplex Ultrasound ◽  
Standard Of Care ◽  
Endovascular Interventions ◽  
Routine Surveillance ◽  
Angioplasty And Stenting ◽  
Aneurysm Repair ◽  
Stent Stenosis

Surveillance following lower extremity bypass, carotid endarterectomy, and endovascular aortic aneurysm repair has become the standard of care at most institutions. Conversely, surveillance following lower extremity endovascular interventions is performed somewhat sporadically in part because the duplex criteria for recurrent stenoses have been ill defined. It appears that duplex surveillance after peripheral endovascular interventions, as with conventional bypass, is beneficial in identifying recurrent lesions which may preclude failure and occlusion. In-stent stenosis following superficial femoral artery angioplasty and stenting can be predicted by both peak systolic velocity and velocity ratio data as measured by duplex ultrasound. Duplex criteria have been defined to determine both ≥50% in-stent stenosis and ≥80% in-stent stenosis. Although not yet well studied, it appears that applying these criteria during routine surveillance may assist in preventing failure of endovascular interventions.

Angiography and Colour Flow Duplex Ultrasonography in the Evaluation of Peripheral Ischaemic Occlusive Arterial Disease

1994 ◽  
Vol 35 (3) ◽  
pp. 270-274 ◽  
Author(s):  
J. Zeuchner ◽  
J. T. Geitung ◽  
P. Lukes ◽  
J. H. Göthlin
Keyword(s):  
Sensitivity And Specificity ◽  
Velocity Ratio ◽  
Peak Systolic Velocity ◽  
Arterial Disease ◽  
Posterior Tibial Artery ◽  
Duplex Ultrasonography ◽  
Wave Form ◽  
Conventional Angiography ◽  
Colour Flow ◽  
Run Off

Colour flow duplex ultrasonography (CFDUS) was performed in 50 patients with advanced peripheral ischaemic disease scheduled for conventional angiography. Atherosclerosis was diagnosed by the appearance of plaque and spectral broadening. Haemodynamically significant stenosis was represented as a doubling of peak systolic velocity expressed as peak velocity ratio. Occlusion was diagnosed by the lack of colour saturation and absence of Doppler wave form. In the pelvis and thigh/knee region the sensitivity and specificity exceeded 90% except for stenoses, where the sensitivity was lower. The run-off was evaluated by examination of the tibial and peroneal arteries to at least midcalf. If 2 open arteries were identified, or, if only the posterior tibial artery was patent, the run-off was considered good. Compared to angiography the sensitivity and specificity exceeded 90%. We conclude that CFDUS is an accurate non-invasive method for preoperative screening of patients with peripheral ischaemic disease.

scholarly journals Performance of a three-level triage scale in live triage encounters in an emergency department in Hong Kong.

2020 ◽  
Author(s):  
Rex Pui Kin Lam ◽  
Shing Lam Kwok ◽  
Vi Ka Chaang ◽  
Lujie Chen ◽  
Eric Ho Yin Lau ◽  
...  
Keyword(s):  
Predictive Value ◽  
Weighted Kappa ◽  
Cross Sectional Study ◽  
Medical Attention ◽  
Kappa Statistics ◽  
Triage Nurse ◽  
Real Patient ◽  
Cross Sectional ◽  
Continued Use ◽  
Low Volume

Abstract Background Despite its continued use in many low-volume emergency departments (EDs), 3-level triage systems have not been extensively studied, especially on live triage cases. We have modified from the Australasian Triage Scale and developed a 3-level triage scale, and sought to evaluate its validity, reliability, over- and under-triage rates in real patient encounters in our setting. Method This was a cross-sectional study in a single ED with 24,000 attendances per year. At triage, each patient was simultaneously assessed by a triage nurse, an adjudicator (the “criterion standard”), and a study nurse independently. Predictive validity was determined by comparing clinical outcomes, such as hospitalization, across triage levels. The discriminating performance of the triage tool in identifying patients requiring earlier medical attention was determined. Inter-observer reliability between the triage nurse and criterion standard, and across providers were determined using kappa statistics. Results In total, 453 triage ratings of 151 triage cases, involving 17 ED triage nurses and 57 nurse pairs, were analysed. The proportion of hospital admission significantly increased with a higher triage rating. The performance of the scale in identifying patients requiring earlier medical attention was: sensitivity, 68.2% (95% CI 45.1-86.1%); specificity, 99.2% (95% CI 95.8-100%); positive predictive value, 93.8% (95% CI 67.6-99.1%); negative predictive value, 94.8% (95% CI 90.8-97.1%). The over-triage and under-triage rates were 0.7% and 4.6%, respectively. Agreement between the triage nurse and criterion standard was substantial (quadratic-weighted kappa = 0.76, 95% CI, 0.60-0.92, p<0.001), so was the agreement across nurses (quadratic-weighted kappa=0.81, 95% CI 0.65-0.97, p<0.001). Conclusions The 3-level triage system appears to have good validity and reasonable reliability in a low-volume ED setting. Further studies comparing 3-level and prevailing 5-level triage scales in live triage encounters and different ED settings are warranted.

scholarly journals Correlation between ultrasonographic and histopathological findings of hysterectomy specimen in patients with abnormal uterine bleeding

2020 ◽  
Vol 9 (10) ◽  
pp. 4123
Author(s):  
Kaushik Mahajan ◽  
R. K. Praneshwari Devi ◽  
Ajitkumar Singh ◽  
Dipenty Lairenjam ◽  
Leimapokpam Roshan Singh ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Abnormal Uterine Bleeding ◽  
Clinical History ◽  
Uterine Bleeding ◽  
Kappa Statistics ◽  
Cross Sectional ◽  
Common Diagnosis ◽  
Sensitivity Specificity

Background: AUB is a common and debilitating condition and it is one of the main gynaecological reasons for hysterectomy. Ultrasonography can be as good as histopathology (HPE) in the diagnosis of abnormal uterine bleeding. Hence, our study was conducted to validate the ultrasonographic findings with HPE findings in diagnosis of AUB.Methods: A hospital based cross-sectional analytical study was conducted among 86 patients with abnormal uterine bleeding in the department of Obstetrics and Gynaecology in collaboration with department of Pathology, RIMS, Imphal from September 2017 to March 2019. The clinical history and socio demographic profile were collected using a pre-designed proforma. General physical examination, pelvic examination and ultrasonagraphy was carried out and the hysterectomy specimens were subjected to histopathological examination.Results: Fibromyoma was diagnosed by ultrasound in 62.8% of the patients and it was the common diagnosis in this study. The sensitivity, specificity, positive predictive value, negative predictive value and kappa statistics of USG for diagnosing leiomyoma was 92.9%, 93.3%, 96.3%, 87.5% and 84.9% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and kappa statistics of USG for diagnosing adenomyosis was 53.8%, 98.6%, 87.5%, 92.3% and 62.3% respectively.Conclusions: The study provides an evidence that ultrasonography has good diagnostic accuracy as histopathology in the diagnosis of fibroid in patients with abnormal uterine bleeding. However, as with all the diagnostic procedures, the utility of ultrasound in the diagnosis of adenomyosis is questionable, since it has a low sensitivity amidst good specificity.

scholarly journals Balanced Steady-State Free Precision and Time of Flight Noncontrast Magnetic Resonance Angiography in Peripheral Arterial Disease

2021 ◽  
Author(s):  
Soumya Susan Regi ◽  
Aparna Irodi ◽  
Shyamkumar N. Keshava ◽  
Sunil Agarwal
Keyword(s):  
Steady State ◽  
Magnetic Resonance ◽  
Image Quality ◽  
Magnetic Resonance Angiography ◽  
Peripheral Arterial Disease ◽  
Predictive Value ◽  
Weighted Kappa ◽  
Arterial Disease ◽  
Peripheral Arterial

Abstract Purpose To determine the diagnostic efficacy of balanced steady-state free precession (bSSFP) and time-of-flight (TOF)-based noncontrast magnetic resonance angiography (NC-MRA) in lower limb peripheral arterial disease (PAD). Material and Methods 10 patients with suspected PAD underwent both NC-MRA (bSSFP and 2D TOF) and contrast-enhanced MR angiography (CE-MRA)/CT angiography (CTA). A total of 170 arterial segments (17 segments in each patient) were analyzed on NC-MRA and compared with CE-MRA/CTA for quality of images and for estimating the degree of stenoses. Image quality was graded as 1—poor, 2—fair, 3—good, and 4—excellent. The degree of stenoses was graded as 0—normal, 1— ≤ 50% narrowing, 2— > 50% narrowing, 3—near complete/100% occlusion. Sensitivity, specificity, positive predictive value, and negative predictive value of NC-MRA in identifying significant stenosis, as compared with CE-MRA/CTA, were estimated. Results a) Mean grade of the image quality of NC-MRA was 3.10 and the CE-MRA/CTA was 3.64. b) The agreement in the estimation of the degree of stenosis on NC-MRA as compared with CE-MRA/CTA was substantial in aortoiliac segments (weighted kappa 0.646 [95% CI] [0.361–0.931] [p < 0.001]), almost perfect in femoropopliteal segments (weighted kappa 0.911 [95% CI] [0.79–1.032] [p < 0.001]), and poor in infrapopliteal segments (weighted kappa 0.052 [95% CI] [0.189–0.293] [p < 0.33587]). Conclusion TOF and bSSFP-based NC-MRA was found to be comparable to the CE-MRA/CTA in the evaluation of PAD in lower limbs in the aortoiliac and femoropopliteal regions. NC-MRA was especially helpful in assessing the aortoiliac vessels and femoropopliteal vessels, with the imaging of infrapopliteal arteries being suboptimal.

Sign in / Sign up

Export Citation Format

Share Document