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Diagnostische Genauigkeit der Dual-energy-CT-Angiographie bei Patienten mit Diabetes mellitus

Diagnostic accuracy of dual energy CT angiography in patients with diabetes mellitus

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Zusammenfassung

Zielsetzung

Die periphere arterielle Verschlusskrankheit (PAVK) ist eine wesentliche Komplikation des Diabetes mellitus und stellt aufgrund ausgeprägter Gefäßverkalkungen eine diagnostische Herausforderung dar. Ziel dieser Arbeit war die Ermittlung der diagnostischen Genauigkeit der Dual-energy-CT-Angiographie (DE-CTA) im Vergleich zum Goldstandard, der invasiven digitalen Subtraktionsangiographie (DSA) bei der Stenoseerkennung, da die DE-CTA potenziell eine Differenzierung von Verkalkungen und jodhaltigem Kontrastmittel ermöglicht.

Material und Methoden

Dreißig Patienten mit dem Verdacht auf das Vorliegen oder bekannter PAVK und zusätzlich bestehendem Diabetes mellitus wurden retrospektiv in die Studie eingeschlossen. Bei allen Teilnehmern wurde eine DE-CTA (Somatom Definition Flash, Siemens Healthcare, Germany), gefolgt von einer invasiven Angiographie durchgeführt. Das Vorhandensein von Stenosen in gekrümmten multiplanaren Reformationen (MPR) und Projektionen maximaler Intensität (MIP) wurde verblindet evaluiert. Die diagnostische Genauigkeit wurde mit der Angiographie als Goldstandard errechnet.

Ergebnisse

Bei den 30 in die Analyse eingeschlossenen diabetischen Patienten (83 % männlich, 70,0 ± 10,5 Jahre alt, 83 % Diabetes mellitus Typ 2) war die Prävalenz behandlungsbedürftiger Stenosen in 331 evaluierten Gefäßsegmenten hoch (30 %). Die DE-CTA detektierte kritische Stenosen mit einer hohen Sensitivität und guten Spezifität anhand gekrümmter MPR (100 und 93,1 %) und MIP (99 und 91,8 %). In einer Subanalyse war die diagnostische Genauigkeit am höchsten für Stenosen im Bereich der Beckenstrombahn (gekrümmte MPR 97,1 % vs. MIP 100 %) und im Oberschenkelbereich (99,2 vs. 96,6 %) verglichen mit dem Unterschenkelkompartiment (90,9 vs. 88 %).

Schlussfolgerungen

Die DE-CTA weist eine hohe diagnostische Genauigkeit bei der Stenosenerkennung und -charakterisierung im Rahmen der PAVK bei Patienten mit Diabetes mellitus auf, hat jedoch eine eingeschränkte Genauigkeit im Bereich des Unterschenkelkompartiments.

Abstract

Objectives

Peripheral arterial disease (PAD) represents a major and highly prevalent complication in patients with diabetes mellitus. The diagnostic, non-invasive work-up by computed tomography angiography (CTA) is limited in the presence of extensive calcification. The aim of the study was to determine the diagnostic accuracy of dual energy CTA (DE-CTA) for the detection and characterization of PAD in patients with diabetes mellitus.

Material and methods

In this study 30 diabetic patients with suspected or known PAD were retrospectively included in the analysis. All subjects underwent DE-CTA (Somatom Definition Flash, Siemens Healthcare, Erlangen, Germany) prior to invasive angiography, which served as the reference standard. Blinded analysis included assessment of the presence and degree of peripheral stenosis on curved multiplanar reformatting (MPR) and maximum intensity projections (MIP). Conventional measures of diagnostic accuracy were derived.

Results

Among the 30 subjects included in the analysis (83 % male, mean age 70.0 ± 10.5 years, 83 % diabetes type 2), the prevalence of critical stenosis in 331 evaluated vessel segments was high (30 %). Dual energy CT identified critical stenoses with a high sensitivity and good specificity using curved MPR (100 % and 93.1 %, respectively) and MIP images (99 % and 91.8 %, respectively). In stratified analysis, the diagnostic accuracy was higher for stenosis pertaining to the pelvic and thigh vessels as compared with the lower extremities (curved MPR accuracy 97.1 % vs. 99.2 vs. 90.9 %; respectively, p < 0.001).

Conclusion

The use of DE-CTA allows reliable detection and characterization of peripheral arterial stenosis in patients with diabetes mellitus with higher accuracy in vessels in the pelvic and thigh regions compared with the vessels in the lower legs.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Schabel weist auf folgende Beziehung hin: Speaker Siemens Health Care. M.N. Bongers, D. Ketelsen. R. Syha, C. Thomas, G. Homann, M. Notohamiprodjo, K. Nikolaou, F. Bamberg geben an, dass kein Interessenkonflikt besteht. Alle angewandten Verfahren stehen im Einklang mit den ethischen Normen der verantwortlichen Kommission für Forschung am Menschen (institutionell und national) und mit der Deklaration von Helsinki von 1975 in der revidierten Fassung von 2008. Alle Patienten wurden erst nach erfolgter Aufklärung und Einwilligung in die Studie eingeschlossen.

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Authors and Affiliations

  1. Abteilung für Diagnostische und Interventionelle Radiologie, Klinikum der Eberhard-Karls-Universität, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland

    C. Schabel M.D., M.N. Bongers, D. Ketelsen, R. Syha, G. Homann, M. Notohamiprodjo, K. Nikolaou & F. Bamberg

  2. Sektion für Experimentelle Radiologie der Abteilung für Diagnostische und Interventionelle Radiologie, Klinikum der Eberhard-Karls-Universität, Tübingen, Deutschland

    C. Schabel M.D., M.N. Bongers & R. Syha

  3. Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    C. Thomas

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  1. C. Schabel M.D.
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  2. M.N. Bongers
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  3. D. Ketelsen
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  5. C. Thomas
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  7. M. Notohamiprodjo
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  8. K. Nikolaou
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  9. F. Bamberg
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Correspondence to C. Schabel M.D..

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Dieser Beitrag ist als eine Originalarbeit anzusehen und aus formalen Gründen im Leitthema dieser Ausgabe eingeordnet.

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Schabel, C., Bongers, M., Ketelsen, D. et al. Diagnostische Genauigkeit der Dual-energy-CT-Angiographie bei Patienten mit Diabetes mellitus. Radiologe 55, 314–322 (2015). https://doi.org/10.1007/s00117-014-2721-8

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