Multipath Curved Planar Reformations of Peripheral CT Angiography: Diagnostic Accuracy and Time Efficiency

OBJECTIVES: To compare diagnostic performance and time efficiency between 3D multipath curved planar reformations (mpCPRs) and axial images of CT angiography for the pre-interventional assessment of peripheral arterial disease (PAD), with digital subtraction angiography as the standard of reference. METHODS: Forty patients (10 females, mean age 72 years), referred to CTA prior to endovascular treatment of PAD, were prospectively included and underwent peripheral CT angiography. A semiautomated toolbox was used to render mpCPRs. Twenty-one arterial segments were defined in each leg; for each segment, the presence of stenosis > 70% was assessed on mpCPRs and axial images by two readers, independently, with digital subtraction angiography as gold standard. RESULTS: Both readers reached lower sensitivity (Reader 1: 91 vs. 94%, p = 0.08; Reader 2: 89 vs. 93%, p = 0.03) but significantly higher specificity (Reader 1: 94 vs. 89%, p < 0.01; Reader 2: 96 vs. 95%, p = 0.01) with mpCPRs than with axial images. Reader 1 achieved significantly higher accuracy with mpCPRs (93 vs. 91%, p = 0.02), and Reader 2 had similar overall accuracy in both evaluations (94 vs. 94%, p = 0.96). Both readers read mpCPRs significantly faster than axial images (Reader 1: 5′45″ based on mpCPRs vs. 7′40″ based on axial images; Reader 2: 4′41″ based on mpCPRs vs. 6′57″ based on axial images; p < 0.01). CONCLUSIONS: mpCPRs are a promising 3D reformation technique that facilitates a fast assessment of PAD with high diagnostic accuracy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00270-017-1846-3) contains supplementary material, which is available to authorized users.