ABSTRACT
PURPOSE: CT angiography (CTA) is established as a standard method for the evaluation of patients with peripheral arterial disease. However, there are some drawbacks including overestimation of stenotic lesions as well as dye toxicity and allergic reactions and renal function impairment. Arterial waveform analysis (AWA) is widely accepted as a diagnostic as well as a screening tool in the vascular laboratory. The purpose of this study was to determine the diagnostic accuracy of the AWA compared to the CTA. METHOD: One hundred thirty-eight AWA procedures were performed among symptomatic patients in our laboratory between October 2004 and February 2007. Sixty patients were entered into the study; they were eligible to have AWA and CTA synchronously. There were 5 women and 55 men with an average age of 64 years. The disease entities were atherosclerosis in 53, Burger's disease in three, popliteal entrapment in 2, arterial embolism in 1 and vascular trauma in one. Continuous-wave Doppler velocity waveforms were recorded at the common femoral, popliteal and dorsal pedal and posterior tibial arterial levels with compression cuffs. Four hundred and eighty segmental interpretations were analyzed and compared with the CTA findings. RESULT: The sensitivity of the AWA to detect iliac, femoropopliteal and tibial lesions were 93.8%, 64.4% and 88.4% respectively. The specificity of the AWA for the iliac, femoropopliteal and tibial lesions were 87.3%, 93.4% and 95.6% respectively. Overall, the accuracy of the AWA was 88.9% compared to the CT findings. Additional exercise AWA improved the results from 82.8 % to 88.6% for the overall sensitivity of the AWA. The 20 false positives included technical problems in 14 and reference errors (CTA) in six that were due to calcifications. There were 33 false negatives mostly from cases with stenosis and good collaterals. CONCLUSION: The results of this study showed that the AWA was a valuable method for the prediction of hemodynamically significant arterial lesions. The addition of highly skilled operators and a protocol including a high thigh cuff application might improve the accuracy of this diagnostic method.
Subject(s)
Female , Humans , Male , Angiography , Atherosclerosis , Constriction, Pathologic , Embolism , Hypersensitivity , Mass Screening , Peripheral Arterial Disease , Sensitivity and Specificity , ThighABSTRACT
BACKGROUND/AIMS: To reduce the rate of recurrence and to prevent postoperative liver failure, it is necessary to determine the extent of hepatic resection preoperatively in primary liver cancer patients. The aim of this study was to examine the clinical significance and correlation among several preoperative liver function tests. METHODS: Twenty-nine patients who underwent hepatic resection for hepatocellular carcinoma from November 1994 to March 1995 at the Department of Surgery, Seoul National University Hospital were analyzed. Fifteen patients had gross cirrhosis. Major resections were performed in two patients, segmentectomy in 6 patients, subsegmentectomy and limited resection in 21 patients. Maximal removal rate of indocyanine green (ICG Rmax), ICG retention rate at 15 min(ICG R15), oral glucose tolerance test(oral GTT), arterial ketone body ratio(AKBR) and computed tomographic volumetry, as well as conventional liver function test and prothrombin time were done preoperatively. RESULTS: There were significant correlations among Child's class, prothrombin time and ICG R15. AKBR, oral GTT, ICG Rmax, liver volume had no correlations with any other tests. Liver failure occurred in 2 patients(6.9%). No tests, except ICG R15, could predict the patients with liver failure. ICG R15 value of these two patients were 27% and 29%, respectively while those of the remaining 27 patients ranged from 1 to 22% (mean 11.9%). CONCLUSION: Neither standard liver function tests nor hepatic function studies such as AKBR, oral GTT, CT volumetry were useful as preoperative prognostic indicators in hepatic resection. ICG R15 test is a simple test and good predictor of liver failure after hepatic resection.