CT, MR edge ultrasound in PVD utility, but CT wins on cost

CT and MR angiography both provided more clinically useful information than duplex ultrasound in screening peripheral vascular disease. But when costs are factored in, CT emerged as the clear leader, according to a four-hospital study conducted in the Netherlands and described Saturday.

The study considered results from 514 patients randomized to the three modalities (255 MR, 177 ultrasound, and 79 CT, with six patients excluded). Outcome measures included clinical utility, functional patient outcomes, quality of life, and costs during six-month follow-up.

The diagnostic cost included the initial imaging test and all additional vascular imaging and associated hospital costs. The therapeutic cost included vascular interventions and vascular surgery and associated hospital costs.

Hospitals covered in the study were Rotterdam, Maastricht, Eindhoven, and Nijmegen.

The modalities were given scores for therapeutic confidence:

• 8.1 for MRA

• 8.0 for CTA

• 7.5 for duplex ultrasound

MRA required 8% additional imaging, compared with 6% for CTA and 23% for duplex ultrasound.

Differences in quality of life were not significant, but total costs were significantly higher, by about €2500, for MRA and ultrasound than for CTA, the presenters said.