A novel computer-aided diagnostic approach for detecting peripheral arterial disease in patients with diabetes

• Published in: PloS one Vol. 13; no. 6; p. e0199374
• Main Authors: Buschmann, Eva Elina, Li, Lulu, Brix, Michèle, Zietzer, Andreas, Hillmeister, Philipp, Busjahn, Andreas, Bramlage, Peter, Buschmann, Ivo
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21.06.2018; Public Library of Science (PLoS)
• Subjects: Acceleration; Aged; Algorithms; Angiography; Ankle; Ankle Brachial Index; Area Under Curve; Arteries; Arteriosclerosis; Atherosclerosis; Biology and Life Sciences; Calcification; Calcification (ectopic); Cardiology; Cardiovascular disease; Care and treatment; Diabetes; Diabetes mellitus; Diabetic Angiopathies - diagnosis; Diabetic Angiopathies - diagnostic imaging; Diabetic Angiopathies - physiopathology; Diabetics; Diagnosis; Diagnosis, Computer-Assisted; Diagnostic systems; Female; Flow alteration; Franklin, Benjamin (1706-1790); Health aspects; Hemodynamics; Humans; Internal medicine; Laboratories; Male; Medical diagnosis; Medical equipment; Medical imaging; Medicine and Health Sciences; Middle Aged; Patients; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - physiopathology; Peripheral vascular diseases; Physiology; Preventive medicine; Pulse; Research and Analysis Methods; Risk analysis; Risk factors; ROC Curve; Sensitivity; Sensitivity and Specificity; Stenosis; Systole; Tibial Arteries - diagnostic imaging; Tibial Arteries - pathology; Tibial Arteries - physiopathology; Ultrasonic imaging; Wavelet Analysis; Austria; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0199374

Peripheral arterial disease (PAD) is an important manifestation of systemic atherosclerosis, with diabetes being one of its most significant risk factors. Owing to medial arterial calcification (MAC), the ankle-brachial index (ABI) is not always a reliable tool for detecting PAD. Arterial Doppler flow parameters, such as systolic maximal acceleration (ACCmax) and relative pulse slope index (RPSI), may serve as effective surrogates to detect stenosis-induced flow alteration. In the present study, ACCmax and RPSI were prospectively evaluated in 166 patients (304 arteries) with clinical suspicion of PAD, including 76 patients with and 90 patients without diabetes. In the overall sample, the sensitivity of ACCmax (69%) was superior to that of ABI (58%) and RPSI (56%). In patients with diabetes, the sensitivity of ACCmax (57%), ABI (56%) and RPSI (57%) were similar, though a parallel test taking both ACCmax and RPSI into account further increased sensitivity to 68%. The specificity (98%) and accuracy (78%) of ACCmax were superior to those of ABI (83% and 70%, respectively), as were the specificity (95%) and accuracy (77%) of RPSI in patients with diabetes. The diagnostic properties of ACCmax and RPSI were superior to those of ABI for detecting PAD in patients with diabetes. Our acceleration algorithm (Gefäßtachometer®) provides a rapid, safe, noninvasive tool for identifying PAD in patients with diabetes.