Imaging of aortoiliac arterial disease. Duplex ultrasound and MR angiography versus digital subtraction angiography.

PURPOSE: To evaluate and compare the diagnostic accuracy of duplex ultrasound (US) and MR angiography (MRA) at 1.0 T in aortoiliac arterial disease using digital subtraction angiography (DSA) as the reference standard. In addition, a comparison of the 2D time-of-flight (TOF) and 3D contrast-enhanced MRA (CE MRA) techniques was performed. MATERIAL AND METHODS: Prospectively, 39 patients with symptoms of lower-extremity arterial occlusive disease were examined using US, TOF MRA, CE MRA and DSA. Significant lesions (stenosis > or =50%) and occlusions were evaluated blindly for each method. RESULTS: For all segments, the sensitivity for US, TOF MRA and CE MRA with regard to significant lesions was 0.72, 0.81 and 0.81, respectively, and the specificity for each was 0.97, 0.91 and 0.92, respectively. For significant lesions above the inguinal ligament the corresponding sensitivity was 0.84, 0.89 and 0.94 and the specificity 0.93, 0.82 and 0.73, respectively. The specificity was higher when the two MRA methods were combined. TOF MRA overgraded 7 segments as occluded. In most cases, the length of the occlusions was correctly determined on CE MRA, overestimated on TOF MRA and uncertain on US. CONCLUSION: Neither US nor MRA were sufficiently accurate to fully replace angiography. MRA was preferable to US as a non-invasive test when vascular intervention was contemplated. Although CE MRA was superior to TOF MRA, the most accurate results were achieved when the two methods were combined.

Quality of life after knee arthroplasty. A randomized study of 3 designs in 42 patients, compared after 4 years.

We assessed different yardsticks for outcome 4 (3-5) years after surgery in a prospective, randomized study of 42 patients, where 3 designs of cemmentless knee prostheses were used. The prognosis with regard to loosening, previously obtained by radiostereometry after 2 years of follow-up, was utilized. Patients with a prognosis of stable implant fixation (two thirds) were compared with those where loosening was predicted (one third). Hospital for Special Surgery score and Visual Analogue Scales regarding pain at rest, "first step" pain, pain during activity and global function, showed consistent postoperative improvements, but no differences between the design and prognosis groups were found. Radiolucent lines were registered both as yes/no and number of zones. Lines and prognosis were associated, but not lines and design groups. Quality of life assessment by the Nottingham Health Profile questionnaire showed that the poor prognosis group had increased pain and significant disturbances of sleep and emotions, as well as difficulty in enjoying hobbies and holiday activities. No differences were found between the design groups. Altogether, the patients showed profiles comparable to a healthy reference group. We conclude that the Nottingham Health Profile is a sensitive, relevant and simple measure of outcome after knee arthroplasty.

Validation of a non-invasive method for localization of atherosclerotic occlusive disease in the legs.

The accuracy in determining the level of haemodynamically significant occlusive arterial disease (stenosis of greater than or equal to 50%) in the leg by a combination of segmental blood pressure measurements and evaluation of pulses with the Doppler shift technique was assessed in 50 patients (100 legs), using angiography as the reference method. For aorto-iliac disease the sensitivity was 72%, the specificity 97% and the diagnostic accuracy 87%. For femoro-popliteal disease the corresponding figures were 87%, 78% and 85%, respectively. The accuracy of a positive diagnosis was 93% for both levels. Similar results were obtained for combined aorto-iliac and femoro-popliteal disease. The accuracy in detecting calf disease was poor.