Aortoiliac and Lower Extremity Arteries Assessed with 16-Detector Row CT Angiography vs Digital Subtraction Angiography

This prospective comparative study enrolled 39 patients with suspected peripheral artery disease and performed 16-detector row CT angiography (CTA) of the aortoiliac and lower extremity arterial tree, using digital subtraction angiography (DSA) as the reference standard for stenosis grading.

16-detector row CTA demonstrated sensitivity and specificity of 96% and 97%, respectively, for detecting significant peripheral arterial stenosis (≥50% luminal reduction) compared with DSA. Interobserver agreement was excellent. Radiation dose was lower for CTA than for DSA.

This study was published at a technological inflection point: 16-detector CT represented the state of the art in 2005, enabling whole-leg arterial coverage in a single breath-hold with clinically useful resolution. The core finding — that noninvasive CTA can replace the diagnostic phase of DSA in most peripheral artery disease evaluations — has been confirmed in subsequent studies with higher-detector-count CT systems.

The peripheral arterial disease context is relevant to CAD assessment because PAD and coronary atherosclerosis are manifestations of the same systemic atherosclerotic process. Patients with established PAD have substantially elevated CAD risk, and vice versa. The availability of accurate noninvasive peripheral arterial imaging complements coronary CTA for comprehensive atherosclerotic burden assessment.

We rate the evidence moderate. A prospective study establishing 16-detector CTA’s high diagnostic accuracy for peripheral artery disease — foundational validation for noninvasive CT imaging in peripheral vascular assessment, with implications for comprehensive systemic atherosclerosis evaluation.