Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2025; 16(7): 107187
Published online Jul 15, 2025. doi: 10.4239/wjd.v16.i7.107187
Comparison of three diagnostic imaging modalities for use in diabetic inferior arterial lesions
Ying Bo, Jia Xie, Fan Xu, Guo Yang, Dong-Ling Li, Xiao-Hang Yan
Ying Bo, Department of Radiology, Chongqing Kang Hua Zhong Lian Cardiovascular Hospital, Chongqing 400025, China
Jia Xie, Guo Yang, Dong-Ling Li, Central Laboratory of Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing 400014, China
Fan Xu, Neurocritical Care Unit, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Xiao-Hang Yan, Department of Radiology, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing 400010, China
Author contributions: Bo Y, Xie J, Xu F, Yang G, Li DL, and Yan XH designed the study and were involved in the data acquisition and writing of this article; Bo Y and Yan XH contributed to the analysis of the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Chongqing Kang Hua Zhong Lian Cardiovascular Hospital, approval No. 2023. 5.
Informed consent statement: The written informed consent was waived due to the retrospective and deidentified nature of this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Hang Yan, Department of Radiology, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, No. 489 Xinhua Road, Yuzhong District, Chongqing 400010, China. yanxiaohang198@163.com
Received: March 26, 2025
Revised: May 6, 2025
Accepted: June 5, 2025
Published online: July 15, 2025
Processing time: 111 Days and 0.5 Hours
Abstract
BACKGROUND

Underdiagnosis of peripheral arterial disease results in inadequate treatment and more serious consequences. Hence, clinicians have focused on early diagnosis and treatment.

AIM

To investigate the effectiveness of the combination of doppler ultrasonography (DUS), three-dimensional dynamic contrast-enhanced magnetic resonance angiography (CE-MRA), and CT angiography (CTA) in assessing lower extremity arterial disease in diabetes mellitus (DM).

METHODS

This study retrospectively analyzed the imaging and clinical data of 116 patients diagnosed with DM complicated with lower extremity vascular diseases from January 2021 to June 2023. All patients underwent unilateral or bilateral DUS, CTA, and CE-MRA as well as invasive digital subtraction angiography (DSA). The application values of DUS, CE-MRA, and CTA were compared.

RESULTS

A total of 152 lower extremity arteries in the 116 patients were graded following the classification of vascular branches. The Kappa values between DUS and DSA were 0.780, 0.755, and 0.806 for diagnosing moderate stenosis and 0.484, 0.699, and 0.449 for severe stenosis of grade 1 arteries, grade 2 arteries, and grade 3 arteries, respectively. The Kappa values between CE-MRA and DSA were 0.784, 0.814, and 0.835 for diagnosing moderate stenosis and 0.694, 0.748, and 0.606 for severe stenosis of grade 1 arteries, grade 2 arteries, and grade 3 arteries, respectively. The Kappa values between CTA and DSA were 0.900, 0.858, and 0.878 for diagnosing moderate stenosis and 0.882, 0.823, and 0.756 for severe stenosis of grade 1 arteries, grade 2 arteries, and grade 3 arteries, respectively.

CONCLUSION

DUS, CE-MRA, and CTA demonstrated comparable accuracy in diagnosing lower extremity arterial disease in DM, and the consistency between CTA and DSA diagnoses was higher than the other two imaging methods.

Keywords: Doppler ultrasonography; Three-dimensional dynamic contrast-enhanced magnetic resonance angiography; Computerized tomography angiography; Diabetes; Lower-extremity arterial disease

Core Tip: Diabetes mellitus is a major risk factor for lower extremity peripheral arterial disease, and lower extremity complications are prevalent and increasing globally. However, peripheral arterial disease underdiagnosis results in undertreatment and subsequent complications with more serious consequences. Therefore, in this study we analyzed the diagnostic value of color doppler ultrasonography, magnetic resonance multimodal imaging, and CT angiography in diabetes mellitus complicated with lower limb arterial disease using digital subtraction angiography as the gold standard for diagnosing this disease.