Comparing the Efficacy of CT Angiography and Doppler Ultrasound in Diagnosing Peripheral Arterial Disease in Diabetic Saudi Arabian Patients: A Retrospective Study
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Abstract
Peripheral arterial disease (PAD) is a major complication of diabetes that increases the risk of lower extremity amputation and cardiovascular mortality. Prompt diagnosis of PAD is critical for initiating appropriate management and preventing adverse outcomes. CT angiography (CTA) and Doppler ultrasound (DUS) are two non-invasive imaging modalities commonly used to evaluate PAD, but their comparative effectiveness in diabetic patients remains unclear.
This retrospective study aimed to compare the diagnostic performance of CTA and DUS for detecting PAD in diabetic Saudi Arabian patients, using digital subtraction angiography (DSA) as the reference standard. We reviewed the medical records and imaging studies of 325 diabetic patients (mean age 59.7 ± 10.4 years, 61% male) who underwent CTA, DUS, and DSA for suspected PAD at a tertiary care center in Riyadh between 2015-2020.
The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CTA and DUS were calculated for diagnosing ≥50% stenosis, with subgroup analyses based on lesion location (aortoiliac, femoropopliteal, infrapopliteal). CTA demonstrated higher overall sensitivity (93% vs. 81%, p<0.001), specificity (96% vs. 92%, p<0.05), PPV (93% vs. 87%, p<0.05), NPV (96% vs. 89%, p<0.01), and accuracy (95% vs. 88%, p<0.001) compared to DUS. The diagnostic superiority of CTA was most pronounced for detecting infrapopliteal disease.
In conclusion, this large retrospective study found that CTA had greater diagnostic efficacy than DUS for evaluating PAD in diabetic Saudi patients, particularly in assessing distal arterial segments. Incorporating CTA in the diagnostic algorithm for high-risk patients may improve the detection and treatment of PAD, thereby reducing limb loss and mortality in this population. However, the choice of imaging modality should be individualized based on patient factors, resource availability, and clinical expertise.