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document
Peripheral arterial disease : therapeutic confidence of CT versus digital subtraction angiography and effects on additional imaging recommendations . PURPOSE To compare multi-detector row computed tomographic ( CT ) angiography and digital subtraction angiography ( DSA ) prior to revascularization in patients with symptomatic peripheral arterial disease for the purpose of assessing recommendations for additional imaging and physician confidence ratings for chosen therapy . MATERIALS AND METHODS In a randomized controlled trial , 73 patients were assigned to CT angiography , and 72 were assigned to DSA . Physician confidence in the treatment decision was measured as a continuous outcome on a scale of 0-10 ( uncertain to certain ) and as a dichotomous outcome ( further imaging recommended , yes or no ) . Mean confidence scores and additional imaging recommendations were compared between CT and DSA groups in an intention-to-diagnose-and-treat analysis . To detect trends in confidence , confidence scores were plotted over time , and multiple linear regression analysis was performed . To detect trends in additional imaging recommendations , logistic regression analysis was used . Data from eligible nonrandomized patients were analyzed separately . RESULTS No statistically significant difference in baseline characteristics between randomized groups was found . CT had a lower confidence score than did DSA ( 7.2 vs 8.2 , P < .001 ) . Further imaging was recommended more often after CT ( 25 of 71 patients , 35 % ) than after DSA ( nine of 66 patients , 14 % ; P = .003 ) . Analysis of trends demonstrated increasing ( but not statistically significant ) confidence in CT and stable confidence in DSA . No significant difference was found in baseline characteristics between randomized and nonrandomized patients . Among nonrandomized patients , no significant difference in mean confidence score ( 8.2 vs 8.3 , P = .26 ) was found between CT ( n = 24 ) and DSA ( n = 26 ) . CONCLUSION With CT angiography , physician confidence decreases with an associated increase in additional imaging prior to revascularization in patients with symptomatic peripheral arterial disease . Given that CT is less invasive than DSA , results suggest that CT may replace DSA in selected cases .
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Intervention_Other
CT
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Intervention_Other
digital subtraction angiography
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Intervention_Other
multi-detector row computed tomographic ( CT ) angiography
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Intervention_Other
digital subtraction angiography ( DSA )
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Intervention_Surgical
revascularization
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Intervention_Other
CT angiography
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Intervention_Other
DSA
18618
Intervention_Other
CT
18619
Intervention_Other
DSA
18620
Intervention_Other
CT
18621
Intervention_Other
DSA
18622
Intervention_Other
CT
18623
Intervention_Other
DSA
18624
Intervention_Other
CT
18625
Intervention_Other
DSA
18626
Intervention_Other
CT
18627
Intervention_Other
DSA
18628
Intervention_Other
CT angiography
18629
Intervention_Other
CT
18630
Intervention_Other
DSA
18631
Intervention_Other
CT
18632
Intervention_Other
DSA
18633
Outcome_Mental
Physician confidence in the treatment decision
18634
Outcome_Mental
Mean confidence scores
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Outcome_Other
additional imaging recommendations
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Outcome_Other
additional imaging recommendations
18637
Outcome_Mental
lower confidence score
18638
Outcome_Mental
confidence
18639
Outcome_Mental
confidence
18640
Outcome_Other
No significant difference
18641
Outcome_Mental
mean confidence score
18642
Participant_Condition
patients with symptomatic peripheral arterial disease
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Participant_Sample-size
73 patients
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Participant_Condition
were assigned to CT angiography , and
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Participant_Sample-size
72
18646
Participant_Condition
were assigned to DSA