A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease

Collins R, Cranny G, Burch J, Aguiar-Ibanez R, Craig D, Wright K, et al
Record ID 32007000520
English
Authors' objectives:

"The objectives of this review were:

to determine the diagnostic accuracy of DUS, MRA and CTA, alone or in combination, for the assessment of lower limb PAD

to evaluate the impact of these assessment methods on patient management/outcome

to evaluate the evidence regarding patient attitudes to these technologies

to summarise available adverse event data associated with these technologies

to analyse the cost-effectiveness of these technologies using a review of existing cost-effectiveness literature, and decision analysis."

(from executive summary)

Authors' recommendations: The results of the review suggest that CE MRA has a better overall diagnostic accuracy than CTA or DUS, and that CE MRA is generally preferred by patients over CA. Where available, CE MRA may be a viable alternative to CA. The only controlled trial of the effectiveness of imaging procedures suggested that the results of DUS were comparable to those of CA, in terms of surgical planning and outcome. This finding conflicts with the results of diagnostic accuracy studies, which reported poor estimates of accuracy for DUS in comparison with CA. There was insufficient evidence to evaluate the usefulness of CTA for the assessment of PAD, particularly newer techniques. The results of the economic modelling suggest that for PAD patients for whom the whole leg is evaluated by a preoperative diagnostic test DUS dominates the other alternatives by presenting higher effectiveness at a lower cost per QALY. However, when the analysis of stenosis is limited to a section of the leg, either above the knee or below the knee, 2D TOF MRA appears to be the most cost-effective preoperative diagnostic strategy.
Authors' methods: Review
Details
Project Status: Completed
URL for project: http://www.hta.ac.uk/1394
Year Published: 2007
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Magnetic Resonance Imaging
  • Tomography, X-Ray Computed
  • Ultrasonography, Doppler, Duplex
  • Peripheral Vascular Diseases
Contact
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name: journals.library@nihr.ac.uk
Contact Email: journals.library@nihr.ac.uk
Copyright: 2009 Queen's Printer and Controller of HMSO
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.