OBJECTIVE: Lower limb peripheral arterial disease in the symptomatic stage has a significant effect on patients ́ functional disability. Before an intervention, an imaging diagnostic examination is necessary to determine the extent of the disability. This study evaluates cost-effectiveness of duplex ultrasonography (DUS), digital subtraction angiography (DSA), computed tomography angiography (CTA) and magnetic resonance angiography (MRA) in the diagnostics of symptomatic patients with lower limb peripheral arterial disease indicated for endovascular or surgical intervention. METHODS: Discrete event simulation was used to capture lifetime costs and effects. Costs were calculated from the perspective of the health care payer, and the effects were calculated as quality-adjusted life year's (QALY's). The cost-effectiveness analysis was performed to pairwise compare CTA, MRA and DSA with DUS as the baseline diagnostic modality. A scenario analysis and probabilistic sensitivity analysis were carried out to evaluate the robustness of the results. RESULTS: In the basic case, the DUS diagnostic was the least expensive modality, at a cost of EUR 10,778, compared with EUR 10,804 for CTA, EUR 11,184 for MRA, and EUR 11,460 for DSA. The effects of DUS were estimated at 5.542 QALYs compared with 5.554 QALYs for both CTA and MRA, and 5.562 QALYs for DSA. The final incremental cost-effectiveness ratio (ICER) value of all evaluated modalities was below the cost-effectiveness threshold whereas CTA has the lowest ICER of EUR 2,167 per QALY. However, the results were associated with a large degree of uncertainty, because iterations were spread across all cost-effectiveness quadrants in the probabilistic sensitivity analysis. CONCLUSION: For imaging diagnosis of symptomatic patients with lower limb peripheral arterial disease, CTA examination appears to be the most cost-effective strategy with the best ICER value. Baseline diagnostics of the DUS modality has the lowest costs, but also the lowest effects. DSA achieves the highest QALYs, but it is associated with the highest costs.

• MeSH
• Cost-Benefit Analysis * MeSH
• Computed Tomography Angiography economics   statistics & numerical data   MeSH
• Diagnostic Imaging economics   statistics & numerical data   MeSH
• Angiography, Digital Subtraction * economics   MeSH
• Lower Extremity * diagnostic imaging   MeSH
• Ultrasonography, Doppler, Duplex economics   MeSH
• Quality-Adjusted Life Years * MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Angiography economics   MeSH
• Peripheral Arterial Disease * diagnostic imaging   economics   MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Cíl: Analyzovat korelaci mezi hodnotami D-dimerů a pozitivním nálezem plicní embolie na CT-angiografii. Stanovení cut-off hodnoty D-dimerů, která by vedla ke snížení počtu vyšetření na CT-angiografii. Materiály a metody: Do analýzy byli zařazeni pacienti, kteří měli v krevních testech prokázány pozitivní hodnoty D-dimerů a byly vyšetřeni na CT-angiografii z období prosinec 2019 až leden 2020. Analyzován byl vztah mezi hodnotou D-dimerů a nálezem plicní embolie na CT-angiografii. Do analýzy bylo zařazeno 91 konsekutivních pacientů (46 žen, 64,4 ± 18,8 let) vyšetřených od prosince 2019 do ledna 2020. Výsledky: Průměrná hodnota D-dimerů u pacientů s prokázanou embolií na CT byla statisticky významně vyšší než u pacientů bez embolie (7,46 vs. 2,93mg/l; p <0,001). Z celkového počtu pacientů vyšetřených na CT byla plicní embolie potvrzena u 21 (23%). Neprokázali jsme statisticky významný rozdíl ve výskytu plicní embolie u jednoho z pohlaví (52% ženy vs. 48% muži; p = 1,000), ani vztah věku a výskytu plicní embolie (64,2 vs. 64,5 let; p = 0,981). Na základě ROC analýzy jsme stanovili vysokou pravděpodobnost negativní CT-angiografie při hodnotě D-dimerů do 1,7 mg/l (negativní prediktivní hodnota 95,7%). Dále jsme stanovili hodnotu D-dimerů 3,5mg/l, od níž je pravděpodobnost plicní embolie na CT vysoká (specificita 81,4%). Závěr: Na základě retrospektivní analýzy pacientů s naměřenými hodnotami D-dimerů a objektivizací nálezu plicní embolie na CT-angiografii jsme prokázali velmi nízkou pravděpodobnost plicní embolie při hodnotách D-dimerů do 1,7mg/l. Zároveň jsme prokázali, že při hodnotách nad 3,5mg/l je pravděpodobnost plicní embolie vysoká.

Aim: The analysis of the correlation between D-dimer and positive finding of pulmonary embolism on CT-angiography. Determination of the cut-off value of D-dimers, which would lead to a reduction in the number of examinations on CT-angiography. Materials and methods: Patients who had positive D-dimer values in their blood tests and were examined using CT-angiography were included in the analysis. The relationship between the D-dimer value and the finding of pulmonary embolism on CT-angiography was analyzed. The analysis included 91 consecutive patients (46 women, 64,5 ± 18,8 years) examined from December 2019 to January 2020. Results: The mean value of D-dimers in patients with proven pulmonary embolism on CT was statistically significantly higher than in patients without embolism (7,46 vs 2,93mg/l; p <0,001). Of the total number of patients examined on CT, pulmonary embolism was confirmed in 21 (23%). We did not show a statistically significant difference in the incidence of pulmonary embolism in one sex (52% female vs 48% male; p = 1,000), nor the relationship between age and the incidence of pulmonary embolism (64,2 vs 64,5 years; p = 0,981). Based on ROC analysis, we determined a high probability of negative CT-angiography at the value of D-dimers up to 1,7mg/l (negative predictive value 95,7%). We also determined the value of D-dimers 3,5mg/l, from which the probability of pulmonary embolism on CT is high (specificity 81,4%). Conclusion: Based on a retrospective analysis of patients with measured values of D-dimers and objectification of the finding of pulmonary embolism on CT-angiography, we demonstrated a very low probability of pulmonary embolism at D-dimer values up to 1,7mg/l. We also showed that at values above 3,5mg/l, the probability of pulmonary embolism is high.

• Keywords
• pulmonary embolism, D-dimer, CT-angiography, plicní embolie, D-dimery, CT-angiografie,
• MeSH
• Computed Tomography Angiography * statistics & numerical data   MeSH
• Fibrin Fibrinogen Degradation Products MeSH
• Middle Aged MeSH
• Humans MeSH
• Pulmonary Embolism * diagnostic imaging   diagnosis   MeSH
• Predictive Value of Tests MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Publication type
• Observational Study MeSH

PURPOSE: There is no standard for measuring maximal diameter (Dmax) of abdominal aortic aneurysm (AAA) from computer tomography (CT) images although differences between Dmax evaluated from transversal (axialDmax) or orthogonal (orthoDmax) planes can be large especially for angulated AAAs. Therefore we investigated their correlations with alternative rupture risk indicators as peak wall stress (PWS) and peak wall rupture risk (PWRR) to decide which Dmax is more relevant in AAA rupture risk assessment. MATERIAL AND METHODS: The Dmax values were measured by a trained radiologist from 70 collected CT scans, and the corresponding PWS and PWRR were evaluated using Finite Element Analysis (FEA). The cohort was ordered according to the difference between axialDmax and orthoDmax (Da-o) quantifying the aneurysm angulation, and Spearman's correlation coefficients between PWS/PWRR - orthoDmax/axialDmax were calculated. RESULTS: The calculated correlations PWS/PWRR vs. orthoDmax were substantially higher for angulated AAAs (with Da-o≥3mm). Under this limit, the correlations were almost the same for both Dmax values. Analysis of AAAs divided into two groups of angulated (n=38) and straight (n=32) cases revealed that both groups are similar in all parameters (orthoDmax, PWS, PWRR) with the exception of axialDmax (p=0.024). CONCLUSIONS: It was confirmed that orthoDmax is better correlated with the alternative rupture risk predictors PWS and PWRR for angulated AAAs (DA-O≥3mm) while there is no difference between orthoDmax and axialDmax for straight AAAs (DA-O<3mm). As angulated AAAs represent a significant portion of cases it can be recommended to use orthoDmax as the only Dmax parameter for AAA rupture risk assessment.

• MeSH
• Aortic Aneurysm, Abdominal diagnostic imaging   epidemiology   physiopathology   MeSH
• Aorta, Abdominal diagnostic imaging   MeSH
• Computed Tomography Angiography methods   statistics & numerical data   MeSH
• Risk Assessment methods   MeSH
• Humans MeSH
• Models, Cardiovascular MeSH
• Computer Simulation MeSH
• Aneurysm, Ruptured diagnostic imaging   epidemiology   physiopathology   MeSH
• Prevalence MeSH
• Radiographic Image Interpretation, Computer-Assisted methods   MeSH
• Reproducibility of Results MeSH
• Sensitivity and Specificity MeSH
• Statistics as Topic MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic epidemiology   MeSH

OBJECTIVE: The diagnosis of arterial occlusion has a considerable impact on the indication of mechanical thrombectomy, and CT angiography (CTA) is recommended in the management of acute stroke. The goal of the present study is to assess the interrater agreement in the diagnosis of occlusion of intracranial arteries on CTA between a neuroradiologist and neurologists. METHODS: CTA images of 75 acute stroke patients were evaluated for occlusion of intracranial arteries by an experienced interventional neuroradiologist, and stroke and general neurologists. RESULTS: 75 patients who were treated by intravenous thrombolysis were enrolled in the study. CTA images were available for all 75 patients (34 females; mean age ± SD, 72 ± 14 years; National Institutes of Health Stroke Scale 10; median 8-14; and Alberta Stroke Program Early CT mean 9.7). The agreement between the neuroradiologist and neurologists in evaluation of intracranial artery occlusion was as follows: occlusion of the middle cerebral artery segment M1: observer agreement 77%, kappa (κ) = 0.61 and middle cerebral artery M2: observer agreement 77%, κ 0.48; internal carotid artery: observer agreement 92%, κ 0.84; T occlusion: observer agreement 90.0%, κ 0.33; posterior cerebral artery segments P1 and P2: observer agreement 98%, κ 0.97; basilar artery: observer agreement 96%, κ 0.92; and vertebral artery segment V4: observer agreement 88%, κ 0.48. CONCLUSION: Interrater agreement of CTA evaluation of occlusion between the neurologists and the neuroradiologist was very strong. The ability of the trained neurologists to read an intracranial large vessel occlusion correctly may improve the door-to-needle times in acute stroke. Advances in knowledge: In this study, the neurologists were able to recognize occlusion of intracranial arteries. This could accelerate the management of acute stroke care.

• MeSH
• Stroke diagnostic imaging   MeSH
• Computed Tomography Angiography methods   statistics & numerical data   MeSH
• Humans MeSH
• Brain diagnostic imaging   MeSH
• Cerebral Angiography methods   statistics & numerical data   MeSH
• Neurologists statistics & numerical data   MeSH
• Neuroradiography statistics & numerical data   MeSH
• Observer Variation MeSH
• Reproducibility of Results MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH