Aim: To assess the role of duplex ultrasonography (DUS) in peripheral arterial disease and compare the accuracy, sensitivity and specificity of duplex ultrasonography (DUS) and multidetector computed tomography angiography (MDCTA) to diagnose peripheral arterial disease (PAD).

Materials and Methods: It is descriptive type of observational study done on 40 patients with clinical suspicious of PAD (37 patients with lower limb complaints and 3 patients with upper limb complaints) underwent Doppler ultrasonography and CT angiography. Atheromatous wall changes, steno-occlusive lesions and collaterals (if present) were identified and localized these according to arterial segments.

Results: On grey scale, diffuse atheromatous wall changes were noted in 72.5% (i.e. 29) patients with suspected peripheral arterial disease on evaluation by Doppler USG.

27.5% (11) cases had attenuated calibre of the affected arterial segment. On CTA, diffuse atheromatous wall changes were identified in 82.5% (33) cases and attenuated lumen of the affected arterial segment(s) was identified in 57.5% (23) cases.

Doppler USG identified 47.5% (19) cases as grade 4, 10% (4) cases as grade 2, 12.5% (5) cases as grade 1 and 10% (4) cases as grade 0 stenosis. 20% (8) cases were labelled non-specifically as grade 3 or grade 4 stenosis in proximal segment based on analysis of distal dampened monophasic waveform. MDCTA identified 42.5% (17) cases as grade 4, 32.5% (13) cases as grade 3, 5% (2) cases as grade 2, 7.5% (3) cases as grade 1 and 12.5% (5) cases as grade 0 stenosis.Identification of collaterals was better on CTA as compared to DUS. While on CTA, collaterals were identified in 24 cases, on DUS they were identified in 6 cases. A statistically significant difference (p<0.05) between Doppler USG and CTA was found in grades of stenosis (p<0.05) in aortoiliac and infrapopliteal region of lower limb in our study.In the present study, the sensitivity, specificity, and accuracy of Doppler USG compared with CTA was 97%, 60%, and 92.2%, respectively.

Conclusion: Doppler USG can be used as the first investigation for peripheral arterial diseases. In distal arterial disease as Doppler USG overestimates the stenosis, therefore CTA has to be preferred.

Keywords: Peripheral arterial disease, Non invasive imaging modalities, Doppler ultrasonography, MDCTA, Stenosis grading.

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Dr Vipin Kumar Choudhary

PG Resident, Department of Radiodiagnosis, Dr. S.N. Medical College, Jodhpur, Rajasthan, India