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• W3142525916 abstract "The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from the private and academic sectors of medicine. Generally, Standards of Practice Committee member dedicate the vast majority of their professional time to performing interventional procedures; as such, they represent a valid, broad expert constituency of the subject matter under consideration for standards production.SIR DisclaimerThe clinical practice guidelines of the Society of Interventional Radiology attempt to define practice principles that generally should assist in producing high quality medical care. These guidelines are voluntary and are not rules. A physician may deviate from these guidelines, as necessitated by the individual patient and available resources. These practice guidelines should not be deemed inclusive of all proper methods of care or exclusive of other methods of care that are reasonably directed towards the same result. Other sources of information may be used in conjunction with these principles to produce a process leading to high quality medical care. The ultimate judgment regarding the conduct of any specific procedure or course of management must be made by the physician, who should consider all circumstances relevant to the individual clinical situation. Adherence to the SIR Quality Improvement Program will not assure a successful outcome in every situation. It is prudent to document the rationale for any deviation from the suggested practice guidelines in the department policies and procedure manual or in the patient’s medical record. The clinical practice guidelines of the Society of Interventional Radiology attempt to define practice principles that generally should assist in producing high quality medical care. These guidelines are voluntary and are not rules. A physician may deviate from these guidelines, as necessitated by the individual patient and available resources. These practice guidelines should not be deemed inclusive of all proper methods of care or exclusive of other methods of care that are reasonably directed towards the same result. Other sources of information may be used in conjunction with these principles to produce a process leading to high quality medical care. The ultimate judgment regarding the conduct of any specific procedure or course of management must be made by the physician, who should consider all circumstances relevant to the individual clinical situation. Adherence to the SIR Quality Improvement Program will not assure a successful outcome in every situation. It is prudent to document the rationale for any deviation from the suggested practice guidelines in the department policies and procedure manual or in the patient’s medical record. SIR produces its Standards of Practice documents with the use of the following process: Standards documents of relevance and timeliness are conceptualized by the Standards of Practice Committee members. A recognized expert is identified to serve as the principal author for the document. Additional authors may be assigned depending on the magnitude of the project. An in-depth literature search is performed with use of electronic medical literature databases. Then, a critical review of peer-reviewed articles is performed with regard to the study methodology, results, and conclusions. The qualitative weight of these articles is assembled into an evidence table, which is used to write the document such that it contains evidence-based data with respect to content, rates, and thresholds. When the evidence of literature is weak, conflicting, or contradictory, consensus for the parameter is reached by a minimum of 12 Standards of Practice Committee members with use of a modified Delphi consensus method (Appendix A). For the purpose of these documents, consensus is defined as 80% Delphi participant agreement on a value or parameter. The draft document is critically reviewed by the Standards of Practice Committee members in a telephone conference call or face-to-face meeting. The finalized draft from the Committee is sent to the SIR membership for further input/criticism during a 30-day comment period. These comments are discussed by the Standards of Practice Committee, and appropriate revisions are made to create the finished standards document. Before its publications, the document is endorsed by the Executive Council. A considerable amount of work in this document is based on the 2003 Quality Improvement Guidelines for Diagnostic Arteriography (1Singh H. Cardella J.F. Cole P.E. et al.Quality improvement guidelines for diagnostic arteriography.J Vasc Interv Radiol. 2003; 14: S283-S288PubMed Google Scholar). However, a paradigm shift has occurred in the interim since publication of these original guidelines. Numerous improvements and technologic advances of multidetector computed tomographic (CT) angiography and magnetic resonance (MR) angiography have transformed the diagnostic capabilities of these modalities, and they have become complementary to, or reduced the need for, catheter-based diagnostic angiography, or catheter angiography (CA). The diagnostic sensitivity and specificity of these and other less invasive imaging modalities continue to improve. In many instances, CA remains the gold standard as a result of its superior resolution and ability to isolate small caliber vascular anomalies as well as provide therapeutic options. Therefore, this document updates previous references and emphasizes the current literature of the foregoing points. CA remains an established, safe, and accurate method of evaluating vascular disease. Advantages include better spatial resolution, the ability to adjust contrast agent delivery to optimize imaging and to evaluate blood flow rate and directionality, the option of using alternative contrast agents such as CO2 or gadolinium when appropriate, the capacity of intravascular manometry, and the ability to use CA to direct transcatheter/endovascular therapies. Disadvantages of CA include its invasive nature with the attendant potential for procedure-related complications, the more limited area of evaluation compared with other imaging modalities, increased radiation exposure, and the somewhat lengthy procedure times. Arteriography remains the diagnostic standard in instances in which noninvasive imaging is inconclusive or not able to be performed, or before treatment. Because of the varying skill levels and training of physicians performing arteriography procedures, the potential exists for variation in success rates, complication rates, and diagnostic study quality. The indications for arteriography have evolved over time, and there may be considerable variation in practice. Interventional radiologists must consider the potential risks and benefits of CA and its impact on patient management. CA is no longer a generalized procedure, and it should be performed with a specific goal in mind that cannot be achieved with a less invasive test or procedure. The present standard was developed as a guide for practicing interventional radiologists to ensure that patients undergo arteriography for appropriate reasons, that the methods used and the periprocedural care provided minimize the potential for complications, and that the studies obtained are of adequate diagnostic quality to answer the clinical questions that prompted them. The qualifications for physicians performing arteriography have been previously published (2Spies J.B. Bakal C.W. Burke D.R. et al.Standards for interventional radiology. Standards of Practice Committee of the Society of Cardiovascular and Interventional Radiology.J Vasc Interv Radiol. 1991; 2: 59-65Abstract Full Text PDF PubMed Google Scholar). This standard is intended to define a minimal standard of care and the indications for arteriography in vessels other than the coronary or cervicocerebral circulation. Similar documents have been published for the coronary arteries (3Bashore T.M. Balter S. Barac A. et al.2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine.J Am Coll Cardiol. 2012; 59: 2221-2305Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar) and for diagnostic neuroangiography (4Citron S.J. Wallace R.C. Lewis C.A. et al.Quality improvement guidelines for adult diagnostic neuroangiography. Cooperative study between ASITN.ASNR, and SIR. J Vasc Interv Radiol. 2003; 14: S257-S262Google Scholar). Some of the indications, techniques, and complications of CA may be found in a document specific to pediatric patients (5Heran M.K. Marshalleck F. Temple M. et al.Joint quality improvement guidelines for pediatric arterial access and arteriography: from the Societies of Interventional Radiology and Pediatric Radiology.J Vasc Interv Radiol. 2010; 21: 32-43Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar). Patients will likely benefit when appropriate selection criteria, pre- and postprocedural care, and monitoring are used. In all cases, the type of care provided should be directed by the operating physician, and treatment decisions should be made after individual consideration of each case. Variation from this standard may be necessary and appropriate depending on the specific clinical circumstances. Diagnostic Arteriogram: For the purposes of this standard, diagnostic arteriography is defined as a procedure involving percutaneous passage of a needle and/or catheter into an artery under imaging guidance, followed by injection of contrast media and imaging of the vascular distribution in question. Several projections, eg, orthogonal obliquities, may be required to best demonstrate the targeted area. Patient positioning, magnification of image intensifier, and frame rates must be optimized. Additionally, radiation dosage to the patient (eg, fluoroscopy time, reference air kerma, dose area product, and peak skin dose [if available]) must be recorded (6Miller D.L. Balter S. Dixon R.G. et al.Quality improvement guidelines for recording patient radiation dose in the medical record for fluoroscopically guided procedures.J Vasc Interv Radiol. 2012; 23: 11-18Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar). Success: For the purposes of this document, success is defined as the successful completion of arteriography, including gaining access to the artery, choosing the appropriate catheter, obtaining a complete set of images, and the timely and accurate interpretation of the findings. A complete set of images in the lower extremity, for example, is defined to include the vessels down to the level of the foot. In the upper extremity, the entire extremity from the origin of the great vessels from the thoracic aorta should be imaged. In the kidney, it is defined as imaging from the abdominal aorta to the renal parenchyma. These guidelines were developed for use in institution-wide quality improvement programs to assess the practice of diagnostic arteriography. The most important processes of care are (i) patient selection; (ii) performance of the procedure; and (iii) monitoring the patient. The major outcome measures for diagnostic arteriography include complete imaging of the pathologic process, success rates, and complication rates. Outcome measures are assigned threshold values. While practicing physicians should strive to achieve perfect outcomes (eg, 100% success, 0% complications), in practice, all physicians will fall short of this ideal to a variable extent. Therefore, in addition to quality-improvement case reviews customarily conducted after individual procedural failures or complications, outcome measure thresholds should be used to assess diagnostic arteriography in ongoing quality improvement programs. For the purpose of these guidelines, a threshold is specific level of an indicator which, when reached or crossed, should prompt a review of departmental policies and procedures. “Procedure thresholds” or “overall thresholds” reference a group of outcome measures for a procedure; for example, major complications for diagnostic arteriography. Individual complications may also be associated with complication-specific thresholds, such as fever or hemorrhage. When outcome measures such as success rates or indications fall below a (minimum) threshold, or when complications rates exceed a (maximum) threshold, a departmental review should be performed to determine causes and to implement changes if necessary. For example, if the incidence of contrast agent–induced nephropathy (CIN) is one measure of the quality (indicator) of arteriography, exceeding a defined threshold, in this case 5%, should trigger a review of policies and procedures within the department to determine the causes and implement changes to lower the incidence of the complication. Thresholds may vary from those listed here; for example, patient referral patterns may dictate a different threshold value for a particular indicator at a particular institution. Therefore, setting universal thresholds is very difficult, and each department is urged to alter the thresholds as needed to higher or lower values to meet its own quality improvement program needs. Complications can be stratified on the basis of outcome. Major complications may result in admission to a hospital for therapy (for outpatient procedures), an unplanned increase in the level of care, prolonged hospitalization, permanent adverse sequelae, or death. Minor complications result in no sequelae; they may require nominal therapy or a short hospital stay for observation, generally overnight (Appendix B). The complication rates and thresholds in this document refer to major complications unless otherwise noted. Noninvasive imaging techniques such as multidetector CT angiography and MR angiography have replaced diagnostic arteriography for many indications. However, indications for CA still exist. A summary of the indications for CA is provided. The threshold for the department and for each individual is 95% (ie, 95% of procedures should be performed for one of the indications listed). When fewer than 95% of procedures are for these indications, the department will review the process of patient selection. Indications in which noninvasive imaging may be better used (in lieu of CA) will also be discussed. •Assessment of vascular anatomy/disease not characterized by other imaging tests;•Assessment of small-vessel disease (eg, vasculitis, vascular malformations) in cases in which the spatial and temporal resolution of other noninvasive imaging is insufficient;•Assessment of direct arterial supply to neoplasms. •Suspected acute pulmonary embolism in which CT angiography is nondiagnostic;•Suspected chronic pulmonary embolus;•Other suspected pulmonary vascular abnormalities, such as vasculitis, congenital and acquired anomalies, and tumor encasement;•Before pulmonary artery interventions. The evolution of multidetector CT has allowed for highly sensitive and specific detection of acute pulmonary embolism, and it provides quick acquisition time, less exposure to ionizing radiation, as well as additional diagnostic considerations (eg, airspace disease, pleural effusion, cardiac causes of chest pain) (13Russo V. Piva T. Lovato L. Fattori R. Gavelli G. Multidetector C.T. a new gold standard in the diagnosis of pulmonary embolism? State of the art and diagnostic algorithms.Radiol Med. 2005; 109: 49-61PubMed Google Scholar). Multidetector CT angiography more easily detects pulmonary arteriovenous malformations compared with pulmonary arteriography, but at the expense of specificity (multidetector CT has a sensitivity of 83% and specificity of 78%; pulmonary arteriography has a sensitivity of 70% and specificity of 100%). Therefore, multidetector CT angiography has become the preferred imaging modality to detect pulmonary arteriovenous malformations, but pulmonary angiography continues to play an integral role in treating these lesions (14Nawaz A. Litt H.I. Stavropoulos S.W. et al.Digital subtraction pulmonary arteriography versus multidetector CT in the detection of pulmonary arteriovenous malformations.J Vasc Interv Radiol. 2008; 19 (1582–1528)Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar). •Spine and spinal cord tumors;•Vascular malformations;•Spinal trauma;•Preoperative evaluation before aortic or spinal surgery;•Before interventional procedures. •Suspected congenital cardiopulmonary anomalies;•Assessment of distal pulmonary artery circulation (through collateral vessels) in patients who are potential candidates for pulmonary thromboendarterectomy;•Before interventional procedures. Multidetector CT angiography can provide important information in determining the cause of hemoptysis related to bronchial artery pathologic conditions (20Noe G.D. Jaffe S.M. Molan M.P. CTand CT angiography in massive haemoptysis with emphasis on pre-embolization assessment.Clin Radiol. 2011; 66: 869-875Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 21Chun J.Y. Morgan R. Belli A.M. Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization.Cardiovasc Intervent Radiol. 2010; 33: 240-250Crossref PubMed Scopus (44) Google Scholar). •Evaluation of aorta and its branches before selective angiographic studies;•Before interventional procedures. Multidetector CT angiography is accurate in diagnosing aortic injury and has become the first line of diagnosis in patients suspected of having acute traumatic aortic injury (24Dyer D.S. Moore E.E. Ilke D.N. et al.Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients.J Trauma. 2000; 48: 673-682Crossref PubMed Google Scholar, 25Melton S.M. Kerby J.D. McGiffin D. et al.The evolution of chest computed tomography for the definitive diagnosis of blunt aortic injury: a single-center experience.J Trauma. 2004; 56: 243-250Crossref PubMed Google Scholar). •Acute or chronic gastrointestinal hemorrhage;•Intraabdominal tumors;•Preoperative evaluation;•Pre- and postoperative evaluation of organ transplantation;•Before interventional procedures. Multidetector CT angiography has replaced CA as a first-line diagnostic test with a specificity of 94% and sensitivity of 96% for acute or chronic mesenteric ischemia. Although MR angiography demonstrates a high sensitivity and specificity for high-grade proximal celiac and superior mesenteric stenoses, it has proven to be less sensitive and specific for distal occlusions and inferior mesenteric occlusions. Therefore, multidetector CT angiography has emerged as a first-line diagnostic screening test whereas angiography remains the gold standard with a potential therapeutic role (35Oliva I.B. Davarpanah A.H. Rybicki F.J. et al.ACR appropriateness criteria((R)) imaging of mesenteric ischemia.Abdom Imaging. 2013; 38: 714-719Crossref PubMed Scopus (6) Google Scholar). In trauma centers, multidetector CT angiography is often the primary diagnostic imaging tool in the evaluation of visceral organ injuries, especially in patients who are in hemodynamically stable condition (36Hamilton J.D. Kumaravel M. Censullo M.L. Cohen A.M. Kievlan D.S. West O.C. Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients.Radiographics. 2008; 28: 1603-1616Crossref PubMed Scopus (24) Google Scholar, 37Maturen K.E. Adusumilli S. Blane C.E. et al.Contrast-enhanced CT accurately detects hemorrhage in torso trauma: direct comparison with angiography.J Trauma. 2007; 62: 740-745Crossref PubMed Scopus (12) Google Scholar, 38Stassen N.A. Bhullar I. Cheng J.D. et al.Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline.J Trauma Acute Care Surg. 2012; 73: S288-S293Crossref PubMed Scopus (18) Google Scholar, 39Stassen N.A. Bhullar I. Cheng J.D. et al.Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline.J Trauma Acute Care Surg. 2012; 73: S294-S300Crossref PubMed Scopus (21) Google Scholar). Evaluation of abdominal vascular abnormalities, including aneurysms, vascular malformations, and vasculitis are primarily performed by multidetector CT angiography or MR angiography (40Smith C.L. Horton K.M. Fishman E.K. Mesenteric CT angiography: a discussion of techniques and selected applications.Tech Vasc Interv Radiol. 2006; 9: 150-155Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 41Ha H.K. Lee S.H. Rha S.E. et al.Radiologic features of vasculitis involving the gastrointestinal tract.Radiographics. 2000; 20: 779-794Crossref PubMed Google Scholar). •Vasculitis or connective tissue disorders;•Before interventional procedures. Multidetector CT angiography and contrast-enhanced MR angiography in the diagnosis of renovascular occlusive disease demonstrate near-equivalent sensitivity and specificity to CA (44Fraioli F. Catalano C. Bertoletti L. et al.Multidetector-row CT angiography of renal artery stenosis in 50 consecutive patients: prospective interobserver comparison with DSA.Radiol Med. 2006; 111: 459-468Crossref PubMed Scopus (28) Google Scholar, 45Steinwender C. Schutzenberger W. Fellner F. et al.64-Detector CT angiography in renal artery stent evaluation: prospective comparison with selective catheter angiography.Radiology. 2009; 252: 299-305Crossref PubMed Scopus (5) Google Scholar, 46Soulez G. Pasowicz M. Benea G. et al.Renal artery stenosis evaluation: diagnostic performance of gadobenate dimeglumine-enhanced MR angiography--comparison with DSA.Radiology. 2008; 247: 273-285Crossref PubMed Scopus (21) Google Scholar). An advantage of MR angiography is its nonionizing radiation. However, multidetector CT angiography may be superior to MR angiography for surveillance of patients after renal artery stent placement (47Mallouhi A. Rieger M. Czermak B. Freund M.C. Waldenberger P. Jaschke W.R. Volume-rendered multidetector CT angiography: noninvasive follow-up of patients treated with renal artery stents.AJR Am J Roentgenol. 2003; 180: 233-239Crossref PubMed Google Scholar). Multidetector CT angiography can be a primary means of diagnosis for renal artery aneurysms (48Sabharwal R. Vladica P. Coleman P. Multidetector spiral CT renal angiography in the diagnosis of renal artery fibromuscular dysplasia.Eur J Radiol. 2007; 61: 520-527Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 49Kawashima A. Sandler C.M. Ernst R.D. Tamm E.P. Goldman S.M. Fishman E.K. CT evaluation of renovascular disease.Radiographics. 2000; 20: 1321-1340Crossref PubMed Google Scholar). Multidetector CT angiography can play a role in assessing aneurysms and thrombi associated with vasculitides, although conventional arteriography may better delineate microaneurysms (49Kawashima A. Sandler C.M. Ernst R.D. Tamm E.P. Goldman S.M. Fishman E.K. CT evaluation of renovascular disease.Radiographics. 2000; 20: 1321-1340Crossref PubMed Google Scholar). Multidetector CT angiography can reliably diagnose renal artery neoplasms, define their blood supply, as well as depict extrarenal extension of tumor (50Sheth S. Scatarige J.C. Horton K.M. Corl F.M. Fishman E.K. Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector ct and three-dimensional CT.Radiographics. 2001; 21: S237-S254Crossref PubMed Google Scholar, 51Ferda J. Hora M. Hes O. Ferdova E. Kreuzberg B. Assessment of the kidney tumor vascular supply by two-phase MDCT-angiography.Eur J Radiol. 2007; 62: 295-301Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar). CT evaluation of the renal arteries has long been a replacement for CA in the pre- and postoperative evaluation for renal transplantation (52Platt J.F. Ellis J.H. Korobkin M. Reige K. Helical CT evaluation of potential kidney donors: findings in 154 subjects.AJR Am J Roentgenol. 1997; 169: 1325-1330Crossref PubMed Google Scholar). In trauma centers, multidetector CT angiography is often the primary diagnostic imaging tool for the evaluation of renal injuries (53Hagiwara A. Sakaki S. Goto H. et al.The role of interventional radiology in the management of blunt renal injury: a practical protocol.J Trauma. 2001; 51: 526-531Crossref PubMed Google Scholar). •Gastrointestinal or genitourinary bleeding;•Male impotence caused by arterial occlusive disease;•Before interventional procedures. Multidetector CT angiography can depict aortoiliac disease with near-equivalent sensitivity and specificity to CA (57Albrecht T. Foert E. Holtkamp R. et al.16-MDCT angiography of aortoiliac and lower extremity arteries: comparison with digital subtraction angiography.AJR Am J Roentgenol. 2007; 189: 702-711Crossref PubMed Scopus (42) Google Scholar). Evaluation of abdominal/pelvic vascular abnormalities, including aneurysms, vascular malformations, and vasculitis are primarily performed by CT angiography or MR angiography (40Smith C.L. Horton K.M. Fishman E.K. Mesenteric CT angiography: a discussion of techniques and selected applications.Tech Vasc Interv Radiol. 2006; 9: 150-155Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 41Ha H.K. Lee S.H. Rha S.E. et al.Radiologic features of vasculitis involving the gastrointestinal tract.Radiographics. 2000; 20: 779-794Crossref PubMed Google Scholar). Although ultrasound (US) is widely available in the workup of female pelvic tumors, CT and MR imaging have become the preferred imaging modality for characterizing and staging tumors before surgery. MR imaging has additional advantages because of its multiplanar capabilities, superior contrast depiction, and lack of ionizing radiation (58Balan P. Ultrasonography, computed tomography and magnetic resonance imaging in the assessment of pelvic pathology.Eur J Radiol. 2006; 58: 147-155Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar, 59Devine C. Szklaruk J. Tamm E.P. Magnetic resonance imaging in the characterization of pelvic masses.Semin Ultrasound CT MR. 2005; 26: 172-204Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar). In trauma centers, contrast-enhanced CT has become the first line of diagnosis in patients with pelvic injuries (36Hamilton J.D. Kumaravel M. Censullo M.L. Cohen A.M. Kievlan D.S. West O.C. Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients.Radiographics. 2008; 28: 1603-1616Crossref PubMed Scopus (24) Google Scholar, 37Maturen K.E. Adusumilli S. Blane C.E. et al.Contrast-enhanced CT accurately detects hemorrhage in torso trauma: direct comparison with angiography.J Trauma. 2007; 62: 740-745Crossref PubMed Scopus (12) Google Scholar, 60Sheridan M.K. Blackmore C.C. Linnau K.F. Hoffer E.K. Lomoschitz F. Jurkovich G.J. Can CT predict the source of arterial hemorrhage in patients with pelvic fractures?.Emerg Radiol. 2002; 9: 188-194PubMed Google Scholar, 61Brasel K.J. Pham K. Yang H. Christensen R. Weigelt J.A. Significance of contrast extravasation in patients with pelvic fracture.J Trauma. 2007; 62: 1149-1152Crossref PubMed Scopus (25) Google Scholar). •Atherosclerotic vascular disease, including aneurysms, emboli, occlusive disease, and thrombosis;•Preoperative planning and postoperative evaluation for reconstructive surgery;•Evaluation of surgical bypass grafts and dialysis grafts and fistulas;•Other primary vascular abnormalities, including vascular malformations, vasculitis, entrapment syndrome, thoracic outlet syndrome, subclavian steal syndrome;•Tumors;•Before interventional procedures. Multidetector CT angiography has a high sensitivity and specificity when evaluating peripheral artery disease, measured at 95% and 96%, respectively (69Huang S.Y. Nelson R.C. Miller M.J. et al.Assessment of vascular contrast and depiction of stenoses in abdominopelvic and lower extremity vasculature: comparison of dual-energy MDCT with digital subtraction angiography.Acad Radiol. 2012; 19: 1149-1157Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar). One of the greatest benefits of using multidetector CT angiography has been multiplanar evaluation of stenotic areas, as well as the ability to visualize vessels distal to the level of occlusion (70Sun Z. Diagnostic accuracy of multislice CT angiography in peripheral arterial disease.J Vasc Interv Radiol. 2006; 17: 1915-1921Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar). An increased number of detectors increases sensitivity, specificity, and accuracy because spatial resolution is improved while images are less susceptible to partial volume effects (71Fotiadis N. Kyriakides C. Bent C. Vorvolakos T. Matson M. 64-section CT angiography in patients with critical limb ischaemia and severe claudication: comparison with digital subtractive angiography.Clin Radiol. 2011; 66: 945-952Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar). The disadvantages and limitations of the use of CT angiography in the extremities include beam-hardening artifact from calcium deposits, decreased diagnostic value below the femoral–popliteal level, and potential for increased exposure to ionizing radiation (69Huang S.Y. Nelson R.C. Miller M.J. et al.Assessment of vascular contrast and depiction of stenoses in abdominopelvic and lower extremity vasculature: comparison of dual-energy MDCT with digital subtraction angiography.Acad Radiol. 2012; 19: 1149-1157Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 70Sun Z. Diagnostic accuracy of multi" @default.
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• W3142525916 title "Quality Improvement Guidelines for Diagnostic Arteriography" @default.
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