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lüll Peripheral arterial disease: comparison of color duplex US and contrast-enhanced MR angiography for diagnosis Leiner T; Kessels AG; Nelemans PJ; Vasbinder GB; de Haan MW; Kitslaar PE; Ho KY; Tordoir JH; van Engelshoven JMRadiology 2005[May]; 235 (2): 699-708PURPOSE: To prospectively compare the diagnostic accuracies of color duplex ultrasonography (US) and contrast material-enhanced magnetic resonance (MR) angiography and to assess interobserver agreement regarding contrast-enhanced MR angiographic findings in patients suspected of having peripheral arterial disease (PAD). MATERIALS AND METHODS: The institutional review board approved the study, and all patients provided signed informed consent. Two hundred ninety-five patients referred for diagnostic and preinterventional work-up of PAD with duplex US also underwent gadolinium-enhanced MR angiography. Data sets were reviewed for presence or absence of 50% or greater luminal reduction, which indicated hemodynamically significant stenosis, and to determine interobserver agreement. At duplex US, a peak systolic velocity ratio of 2.5 or greater indicated significant stenosis. Primary outcome measures were differences between duplex US and contrast-enhanced MR angiography in sensitivity and specificity for detection of significant stenosis, as assessed with the McNemar test, and interobserver agreement between the two contrast-enhanced MR angiogram readings, expressed as quadratic weighted kappa values. Intraarterial digital subtraction angiography (DSA) was the reference standard. RESULTS: Two hundred forty-nine patients had at least one hemodynamically significant stenotic lesion at contrast-enhanced MR angiography, duplex US, or both examinations. One hundred fifty-two patients underwent intraarterial DSA. The quadratic weighted kappa for agreement regarding the presence of 50% or greater stenosis at contrast-enhanced MR angiography was 0.89 (95% confidence interval [CI]: 0.87, 0.91). Sensitivity of duplex US was 76% (95% CI: 69%, 82%); specificity, 93% (95% CI: 91%, 95%); and accuracy, 89%. Sensitivity and specificity of contrast-enhanced MR angiography were 84% (95% CI: 78%, 89%) and 97% (95% CI: 95%, 98%), respectively; accuracy was 94%. Sensitivity (P = .002) and specificity (P = .03) of contrast-enhanced MR angiography were significantly higher. CONCLUSION: Results of this prospective comparison between contrast-enhanced MR angiography and duplex US provide evidence that contrast-enhanced MR angiography is more sensitive and specific for diagnosis and preinterventional work-up of PAD.|*Image Processing, Computer-Assisted[MESH]|*Magnetic Resonance Angiography[MESH]|*Ultrasonography, Doppler, Color[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Angiography, Digital Subtraction[MESH]|Arterial Occlusive Diseases/*diagnosis[MESH]|Contrast Media/administration & dosage[MESH]|Humans[MESH]|Intermittent Claudication/*diagnosis[MESH]|Middle Aged[MESH]|Prospective Studies[MESH]|Reference Values[MESH]|Sensitivity and Specificity[MESH] |