ROLE OF DOPPLER ULTRASOUND AND CT-ANGIOGRAPHY IN EVALUATION OF PERIPHERAL ARTERIAL DISEASE

Abstract

Background: Peripheral arterial disease (PAD) is a progressive atherosclerotic condition that compromises arterial blood flow, particularly to the lower limbs, leading to significant morbidity. Early and accurate diagnosis is essential for timely intervention and prevention of complications such as ulcers, claudication, and limb loss. Non-invasive imaging techniques like Doppler ultrasonography (DS) and computed tomography angiography (CTA) are critical in evaluating the extent and severity of PAD.

Objective: To evaluate and compare the diagnostic accuracy, strengths, and limitations of Doppler ultrasonography and CT angiography in assessing peripheral arterial disease, and to determine their combined utility in patient management.

Methods: A prospective cross-sectional study was conducted at the Department of Radiology, PAF Hospital Islamabad, between July and December 2024. A total of 255 patients (175 males, 80 females) with suspected PAD were enrolled using a non-probability consecutive sampling technique. Each participant underwent both DS and CTA as part of their diagnostic workup. Data including demographics, imaging findings, and stenosis grading were recorded. Kappa statistics were applied to assess inter-modality agreement, while diagnostic performance metrics—sensitivity, specificity, PPV, NPV, and accuracy—were calculated using SPSS version 25.

Results: Of 255 individuals, 84 were found positive on DS and 171 on CTA. CTA identified wall thickness in 28.7% of cases, wall calcification in 26.3%, occlusion in 24.0%, and thrombus in 21.1%. In comparison, DS detected 59.5% wall thickness, 15.5% wall calcification, 13.1% occlusion, and 11.9% thrombus. Sensitivity and specificity of DS were 49.1% and 100%, respectively, with an overall diagnostic accuracy of 65.9%. CTA demonstrated superior detection in moderate-to-severe stenosis grades.

Conclusion: Doppler ultrasound remains valuable for initial PAD screening, particularly in early disease stages. However, CTA is essential for detailed vascular mapping and treatment planning in advanced cases. A combined diagnostic approach enhances accuracy and optimizes patient care.