Supplementary Table 1. Search Syntax Medline
Supplementary table 1. Search syntax Medline
Date search: 3rd of August 2012
Component of search / Search terms1. Intermittent claudication or critical limb ischemia / (arterial occlusive disease OR arterial obstructive disease* OR ((critical OR chronic) AND (lower extremit* OR limb* OR limb OR legs) AND (ischemias OR ischaemia*)) OR intermittent claudication OR aortoiliac occlusive disease OR peripheral arterial diseases OR peripheral artery disease* OR peripheral vascular disease OR peripheral angiopath* OR pad OR paod OR poad OR fontaine)
AND
2. Computed tomography angiography or contrast-enhance magnetic resonance angiography / (cta OR ct angiography[tw] OR MDCT angiography[tw] OR computed tomograph* angiography[tw] OR mra OR mr angiography[tw] OR mri angiographies)
AND
3. Digital subtraction angiography / (dsa OR digital subtraction angiography OR contrast arteriography OR contrast arteriographies OR catheter arteriography OR catheter angiography OR transcatheter arteriography OR transcatheter angiography OR conventional angiogram* OR conventional arteriography OR conventional angiography)
Supplementary table 2. Search syntax Embase 1980 – present
Date search: 3rd of August 2012
Component of search / Search terms1. Intermittent claudication or critical limb ischemia / 1. ((critical or chronic) adj1 (lower extremit$ or limb? or leg?) adj1 ischemia?).mp.
2. ("critical isch?emia" and (leg? or limb? or lower extremit$)).ab,ti.
3. intermittent claudication.ab,sh,ti.
4. aortoiliac occlusive disease.ab,ti.
5. peripheral occlusive artery disease.ab,sh,ti.
6. exp artery occlusion/
7. (arterial adj1 occlusive adj1 disease).mp.
8. (arterial adj1 obstructive adj1 disease*).ab,ti.
9. peripheral vascular disease.ab,sh,ti.
10. limb ischemia.ab,sh,ti.
11. leg ischemia.ab,sh,ti.
12. peripheral arterial disease?.mp.
13. peripheral artery disease?.mp.
14. peripheral angiopath*.mp.
15. (paod or poad).ab,ti.
16. fontaine.ab,ti.
Combining component 1 / 17. or/1-16
2. Computed tomography angiography or contrast-enhance magnetic resonance angiography / 18. computed tomographic angiography.ab,sh,ti.
19. cta.ab,ti.
20. mdct angiography.ab,ti.
21. multidetector computed angiography.ab,sh,ti.
22. mri angiograph*.ab,ti.
23. magnetic resonance angiography.ab,sh,ti.
24. (mra or mr angiography).ab,ti.
25. computer assisted tomography.ab,sh,ti.
26. (computed tomography or cat or ct).ab,ti.
Combining component 2 / 27. or/18-26
3. Digital subtraction angiography / 28. contrast radiography.ab,sh,ti.
29. arteriography.ab,sh,ti.
30. contrast arteriography.ab,sh,ti.
31. digital subtraction angiography.ab,sh,ti.
32. dsa.ab,ti.
33. contrast angiography.ab,ti.
34. conventional angiography.ab,sh,ti.
35. conventional arteriography.ab,ti.
36. conventional angiogram?.ab,ti.
37. (catheter adj1 (arteriography or angiography)).ab,ti.
38. (transcatheter adj1 (arteriography or angiography)).ab,ti.
Combining component 3 / 39. or/28-38
Combining component 1, 2 and 3 / 40. 17 and 27 and 39
41. limit 40 to yr="1995 -Current"
Supplementary figure 1. Individual QUADAS scores of CTA studies
Abbreviations: CTA, computed tomography angiography; DSA, digital subtraction angiography.
Supplementary figure 2. Individual QUADAS scores of CE-MRA studies
Abbreviations: CE-MRA, contrast-enhanced magnetic resonance angiography; DSA, digital subtraction angiography.
Supplementary table 3. Outcomes of aortotibial segments of CTA studies
STUDIES / Comment / Nondiagnostic / TP / FP / FN / TN / Sensitivity % / Specificity %Fotiadis [20] / - / 32 / 303 / 10 / 4 / 424 / 99 / 98
Kau [21] / - / 27 / 298 / 99 / 59 / 226 / 83 / 70
Li GC [22] / - / 0 / 110 / 4 / 2 / 100 / 98 / 96
Cia [23] / - / 0 / 1152 / 67 / 29 / 3495 / 98 / 98
Li XM [24] / RA included / 0 / 336 / 3 / 5 / 376 / 99 / 99
Bui [25] / - / 7 / 159 / 75 / 18 / 466 / 90 / 86
Willmann [26] / - / 0 / 352 / 38 / 12 / 965 / 97 / 96
Catalano [27] / - / 13 / 251 / 23 / 3 / 860 / 99 / 97
Martin [28] / - / 22 / 327 / 61 / 38 / 886 / 90 / 94
Ofer [29] / RA/DPA included / 16 / 110 / 22 / 11 / 267 / 91 / 92
Puls [30] / - / NA / 56 / 17 / 7 / 106 / 89 / 86
Rieker [31]* / Axial images / 0 / 19 / 1 / 0 / 40 / 100 / 98
MIP images / 5 / 16 / 1 / 0 / 38 / 100 / 97
Abbreviations: DPA, dorsal pedal artery; FN, false negative; FP, false positive; MIP, maximum intensity projection; NA, not available; RA, renal arteries; TN, true negative; TP, true positive.
* For this study two techniques were compared within the same patients. The mean of these data were used in the meta-analysis.
Supplementary table 4. Outcomes of aortopopliteal segments of CTA studies
STUDIES / Comment / Nondiagnostic / TP / FP / FN / TN / Sensitivity % / Specificity %Fotiadis [20] / - / NA / 181 / 6 / 0 / 260 / 100 / 98
Kau [21] / - / 9 / 91 / 20 / 39 / 145 / 70 / 88
Willmann [26] / - / 0 / 174 / 16 / 5 / 468 / 97 / 97
Puls [30] / - / NA / 56 / 17 / 7 / 106 / 89 / 86
Rieker [31]* / Axial images / 0 / 19 / 1 / 0 / 40 / 100 / 98
MIP Images / 5 / 16 / 1 / 0 / 38 / 100 / 97
Abbreviations: FN, false negative; FP, false positive; MIP, maximum intensity projection; NA, not available; TN, true negative; TP, true positive.
* For this study two techniques were compared within the same patients. The mean of these data were used in the meta-analysis.
Supplementary table 5. Outcomes of tibial segments of CTA studies
STUDIES / Comment / Nondiagnostic / TP / FP / FN / TN / Sensitivity % / Specificity %Fotiadis [20] / - / NA / 122 / 4 / 4 / 164 / 97 / 98
Kau [21] / - / 18 / 207 / 79 / 20 / 81 / 91 / 51
Willmann [26] / - / 0 / 178 / 22 / 7 / 497 / 96 / 96
Abbreviations: FN, false negative; FP, false positive; NA, not available; TN, true negative; TP, true positive.
Supplementary table 6. Three-by-three contingency table and summary estimates of CTA and CE-MRA studies.
DSA Normal / DSA stenosis / DSA occlusionCTA STUDIES / Comment / Normal / Stenosis / Occlusion / Normal / Stenosis / Occlusion / Normal / Stenosis / Occlusion
Fotiadis [20] / 424 / 10 / 0 / 4 / 136 / 0 / 0 / 5 / 162
Li GC [22] / 100 / 4 / 0 / 2 / 58 / 4 / 0 / 1 / 47
Cia [23] / 3495 / 67 / 0 / 29 / 857 / 53 / 0 / 12 / 230
Li XM [24] / RA included / 376 / 3 / 0 / 5 / 233 / 5 / 0 / 4 / 94
Bui [25] / 466 / 65 / 10 / 6 / 41 / 5 / 12 / 7 / 106
Catalano [27] / 860 / 23 / 0 / 2 / 72 / 5 / 1 / 4 / 170
Martin [28] / 886 / 61 / 0 / 31 / 104 / 2 / 7 / 19 / 202
Ofer [29] / RA/DPA included / 267 / 19 / 3 / 10 / 34 / 3 / 1 / 6 / 67
Puls [30] / 106 / 17 / 0 / 7 / 43 / 0 / 0 / 0 / 13
Rieker [31]* / Axial images / 40 / 1 / 0 / 0 / 7 / 0 / 0 / 0 / 12
MIP images / 38 / 1 / 0 / 0 / 6 / 0 / 0 / 0 / 10
Summary estimates (%) / 96
(95%CI: 94-97) / 4
(95%CI:3-5) / 0.1
(95%CI: 0-0.3) / 7
(95%CI:4-10) / 89
(95%:86-92) / 4
(95%CI:3-6) / 1
(95%CI:0.4-2) / 5
(95%CI:3-6) / 94
(95%CI:92-96)
DSA normal / DSA stenosis / DSA occlusion
MRA STUDIES / Comment / Normal / Stenosis / Occlusion / Normal / Stenosis / Occlusion / Normal / Stenosis / Occlusion
Anzidei [32]* / First-pass imaging / 390 / 26 / 0 / 3 / 113 / 2 / 0 / 8 / 18
First-pass + SS imaging / 400 / 16 / 0 / 1 / 117 / 0 / 0 / 0 / 26
Janka [43] / 344 / 33 / 0 / 6 / 71 / 1 / 5 / 3 / 81
Lapeyre [44] / 2 pedal arteries included / 139 / 3 / 1 / 2 / 54 / 1 / 7 / 3 / 102
Bezooijen [48]* / Non-SENSE MRA / 267 / 17 / 7 / 11 / 21 / 2 / 3 / 10 / 43
SENSE MRA / 282 / 9 / 0 / 8 / 25 / 1 / 3 / 7 / 46
Steffens [51] / 706 / 8 / 0 / 1 / 89 / 7 / 0 / 4 / 85
Lenhart [53] / 279 / 12 / 1 / 3 / 31 / 1 / 2 / 2 / 63
Lundin [54] / 204 / 18 / 0 / 7 / 21 / 0 / 1 / 1 / 13
Lenhart [56] / 155 / 25 / 3 / 4 / 45 / 3 / 2 / 10 / 54
Sueyoshi [57] / 9 bypasses included / 351 / 2 / 1 / 2 / 28 / 0 / 0 / 0 / 39
Winterer [58] / 1361 / 42 / 1 / 6 / 92 / 10 / 8 / 5 / 255
Laissy [59] / 393 / 9 / 5 / 0 / 40 / 6 / 0 / 3 / 64
Summary estimates (%) / 96
(95%CI:94-97) / 4
(95%CI: 3-6) / 0.4
(95%CI:0.2-0.6) / 6
(95%CI:4-9) / 89
(95%CI:86-92) / 4
(95%CI:3-6) / 3
(95%CI:2-5) / 5
(95%CI:3-7) / 92
(95%CI:89-94)
Abbreviations: DPA, dorsal pedal artery; DSA, digital subtraction angiography; MIP, maximum intensity projection; MRA, magnetic resonance angiography; NA, not available; RA, renal arteries; SENSE, sensitivity encoding; SS, steady state.
* For these studies two techniques were compared within the same patients. The mean of these data were used in the meta-analysis.
Supplementary table 7. Outcomes of aortotibial segments of CE-MRA studies
STUDIES / Comment / Nondiagnostic / TP / FP / FN / TN / Sensitivity % / Specificity %Anzidei [30] / First-pass imaging / 0 / 141 / 26 / 3 / 390 / 98 / 94
First-pass + SS imaging / 0 / 143 / 16 / 1 / 400 / 99 / 96
Bui [33] / - / NA / 355 / 132 / 130 / 1605 / 73 / 92
Gerretsen [34] / Gd-BOPTA / NA / 101 / 11 / 26 / 259 / 80 / 96
Gd-DTPA / NA / 82 / 29 / 45 / 241 / 65 / 89
Wang [35] / 2 pedal arteries included / NA / 310 / 27 / 31 / 461 / 91 / 94
Poschenrieder [36] / - / 0 / 53 / 7 / 9 / 51 / 85 / 88
Owen [37] / - / 0 / 148 / 21 / 11 / 211 / 93 / 91
Berg [38] / 2 pedal arteries included / 11 / 163 / 14 / 8 / 705 / 95 / 98
Andreisek [39]* / Standard MRA Fem-tibial / 44 / 88 / 13 / 21 / 177 / 81 / 93
TRICKS MRA tibial / 30 / 78 / 8 / 15 / 87 / 84 / 92
Diehm [40]* / 1.5 Tesla MRA / 0 / 26 / 9 / 7 / 78 / 79 / 90
3.0 Tesla MRA / 0 / 27 / 11 / 6 / 76 / 82 / 87
Deutschmann [41] / - / 2 / 84 / 8 / 3 / 131 / 97 / 94
Gjonnaess [42] / - / 0 / 115 / 37 / 7 / 711 / 94 / 95
Janka [43] / - / NA / 155 / 33 / 11 / 344 / 93 / 91
Lapeyre [44] / 2 pedal arteries included / 0 / 160 / 4 / 8 / 139 / 95 / 97
Leiner [45] / - / NA / 164 / 21 / 30 / 453 / 85 / 96
Schmitt [46] / - / 0 / 92 / 0 / 3 / 112 / 97 / 100
de Vries [47] / Non-SENSE MRA / NA / 66 / 14 / 18 / 321 / 79 / 96
SENSE MRA / NA / 38 / 15 / 9 / 301 / 81 / 95
Bezooijen [48]* / Non-SENSE MRA / NA / 76 / 24 / 14 / 267 / 84 / 92
SENSE MRA / NA / 79 / 9 / 11 / 282 / 88 / 97
Leiner [5] / 3 pedal arteries included / NA / 68 / 35 / 10 / 112 / 87 / 76
Cronberg [49] / 3 pedal arteries included / NA / 227 / 62 / 20 / 109 / 92 / 64
Huber [50] / Body coil / 0 / 119 / 19 / 10 / 233 / 92 / 92
Phased array coil / 0 / 125 / 14 / 4 / 238 / 97 / 94
Steffens 51] / - / NA / 185 / 8 / 1 / 706 / 99 / 99
Wyttenbach [52] / Gd-BOPTA / 10 / 116 / 56 / 8 / 581 / 94 / 91
Gd-DOTA / 29 / 161 / 63 / 6 / 515 / 96 / 89
STUDIES / Comment / Nondiagnostic / TP / FP / FN / TN / Sensitivity % / Specificity %
Lenhart [53] / - / 10 / 97 / 13 / 5 / 279 / 95 / 96
Lundin [54] / - / 2 / 35 / 18 / 8 / 204 / 81 / 92
Sueyoshi [55]* / Standard MRA, 3 bypasses included / 0 / 22 / 5 / 0 / 80 / 100 / 94
Subtraction MRA, 3 bypasses included / 0 / 22 / 3 / 0 / 82 / 100 / 96
Lenhart [56] / - / NA / 112 / 28 / 5 / 155 / 96 / 85
Sueyoshi [57] / - / 0 / 65 / 3 / 2 / 344 / 97 / 99
Winterer [58] / - / NA / 362 / 43 / 14 / 1361 / 96 / 97
Laissy [59] / - / 0 / 113 / 14 / 0 / 393 / 100 / 97
Rofsky [60] / - / NA / 37 / 4 / 1 / 108 / 97 / 96
Abbreviations: Fem, femoral; FN, false negative; FP, false positive; Gd-BOPTA, gadobenate dimeglumine, Gd-DOTA, gadoterate meglumine; Gd-DTPA, gadopentetate dimeglumine ; MRA, magnetic resonance angiography; NA, not available; SENSE, sensitivity encoding; SS, steady state; TN, true negative; TP, true positive; TRICKS, time-resolved imaging of contrast kinetics.
* For these studies two techniques were compared within the same patients. The mean of these data were used in the meta-analysis.
Supplementary table 8. Outcomes of aortopopliteal segments of CE-MRA studies
STUDIES / Comment / Nondiagnostic / TP / FP / FN / TN / Sensitivity % / Specificity %Anzidei [32]* / First-pass imaging / 0 / 63 / 14 / 2 / 201 / 97 / 93
First-pass + SS imaging / 0 / 64 / 7 / 1 / 208 / 98 / 97
Bui [33] / NA / 355 / 132 / 130 / 1605 / 73 / 92
Wang [35] / NA / 68 / 9 / 19 / 265 / 78 / 97
Poschenrieder [36] / 0 / 25 / 1 / 5 / 9 / 83 / 90
Owen [37] / 0 / 48 / 11 / 7 / 116 / 87 / 91
Berg [38] / 3 / 49 / 10 / 7 / 292 / 88 / 97
Andreisek [39] / 1 / 20 / 3 / 4 / 97 / 83 / 97
Diehm [40]* / 1.5 Tesla MRA / 0 / 0 / 0 / 0 / 15 / NA / 100
3.0 Tesla MRA / 0 / 0 / 1 / 0 / 14 / NA / 93
Deutschmann [41] / NA / 52 / 4 / 2 / 34 / 96 / 89
Gjonnaess [42] / 0 / 115 / 37 / 7 / 711 / 94 / 95
Janka [43] / NA / 87 / 25 / 4 / 230 / 96 / 90
Lapeyre [44] / 0 / 36 / 1 / 1 / 55 / 97 / 98
Leiner [45] / NA / 164 / 21 / 30 / 453 / 85 / 96
de Vries [47] / Non-SENSE MRA / NA / 41 / 10 / 11 / 185 / 79 / 95
SENSE MRA / NA / 25 / 7 / 7 / 155 / 78 / 96
Bezooijen [48]* / Non-SENSE MRA / NA / 22 / 6 / 6 / 173 / 79 / 97
SENSE MRA / NA / 25 / 2 / 3 / 177 / 89 / 99
Wyttenbach [52] / Gd-BOPTA / NA / 62 / 26 / 6 / 377 / 91 / 94
Gd-DOTA / NA / 66 / 30 / 3 / 358 / 96 / 92
Lenhart [53] / NA / 42 / 11 / 3 / 233 / 93 / 95
Lundin [54] / 2 / 35 / 18 / 8 / 204 / 81 / 92
Sueyoshi [55]* / Standard MRA, 3 bypasses included / 0 / 22 / 5 / 0 / 80 / 100 / 94
Subtraction MRA, 3 bypasses included / 0 / 22 / 3 / 0 / 82 / 100 / 96
Lenhart [56] / NA / 52 / 18 / 2 / 118 / 96 / 87
Winterer [58] / NA / 189 / 21 / 0 / 879 / 100 / 98
Laissy [59] / 0 / 66 / 7 / 0 / 167 / 100 / 96
Abbreviations: FN, false negative; FP, false positive; Gd-BOPTA, gadobenate dimeglumine, Gd-DOTA, gadoterate meglumine; MRA, magnetic resonance angiography; NA, not available; SENSE, sensitivity encoding; SS, steady state; TN, true negative; TP, true positive.
* For these studies two techniques were compared within the same patients. The mean of these data were used in the meta-analysis.
Supplementary table 9. Outcomes of tibial segments of CE-MRA studies
STUDIES / Comment / Nondiagnostic / TP / FP / FN / TN / Sensitivity % / Specificity %Bolus-chase
Poschenrieder [36] / 0 / 28 / 6 / 4 / 42 / 88 / 88
Andreisek [39] / Standard MRA / 43 / 68 / 10 / 17 / 80 / 80 / 89
Deutschmann [41] / NA / 32 / 4 / 1 / 97 / 97 / 96
de Vries [47] / Non-SENSE MRA / NA / 25 / 4 / 7 / 136 / 78 / 97
SENSE MRA / NA / 13 / 8 / 2 / 146 / 87 / 95
Bezooijen [48]* / Non-SENSE MRA / NA / 54 / 18 / 8 / 94 / 87 / 84
SENSE MRA / NA / 54 / 7 / 8 / 105 / 87 / 94
Wyttenbach [52] / Gd-BOPTA / NA / 54 / 30 / 3 / 204 / 95 / 87
Gd-DOTA / NA / 95 / 33 / 3 / 157 / 97 / 83
Lenhart [53] / NA / 55 / 2 / 2 / 46 / 96 / 96
Lenhart [56] / NA / 60 / 11 / 4 / 38 / 94 / 78
Winterer [58] / NA / 173 / 22 / 14 / 482 / 93 / 96
Laissy [59] / 0 / 47 / 7 / 0 / 226 / 100 / 97
Separate imaging / Comment / Nondiagnostic / TP / FP / FN / TN / Sensitivity % / Specificity %
Anzidei [32]* / First-pass imaging / 0 / 78 / 12 / 1 / 189 / 99 / 94
First-pass + SS imaging / 0 / 79 / 9 / 0 / 192 / 100 / 96
Wang [35] / 2 pedal arteries included / NA / 242 / 19 / 12 / 197 / 95 / 91
Owen [37] / 0 / 101 / 10 / 4 / 96 / 96 / 91
Berg [38] / 2 pedal arteries included / 8 / 115 / 4 / 2 / 413 / 98 / 99
Andreisek [39] / TRICKS MRA / 30 / 78 / 8 / 15 / 87 / 84 / 92
Diehm [40]* / 1.5 Tesla MRA / 0 / 26 / 9 / 7 / 63 / 79 / 88
3.0 Tesla MRA / 0 / 27 / 10 / 6 / 62 / 82 / 86
Janka [43] / NA / 68 / 8 / 7 / 114 / 91 / 93
Lapeyre [44] / 2 pedal arteries included / 0 / 124 / 4 / 7 / 84 / 95 / 95
Schmitt [46] / 0 / 92 / 0 / 3 / 112 / 97 / 100
Cronberg [49] / 3 pedal arteries included / NA / 227 / 62 / 20 / 109 / 92 / 64
Abbreviations: FN, false negative; FP, false positive; Gd-BOPTA, gadobenate dimeglumine, Gd-DOTA, gadoterate meglumine; MRA, magnetic resonance angiography; NA, not available; SENSE, sensitivity encoding; SS, steady state; TN, true negative; TP, true positive; TRICKS, time-resolved imaging of contrast kinetics.
* For these studies two techniques were compared within the same patients. The mean of these data were used in the meta-analysis
Supplementary figure 3. Funnel plot of CTA studies: sample size versus natural logarithm of the diagnostic odds ratio.
Abbreviations: CTA, computed tomography angiography; Ln(DOR), natural logarithm of the diagnostic odds ratio.
Supplementary figure 4. Funnel plot of CE-MRA studies: sample size versus natural logarithm of the diagnostic odds ratio.
Abbreviations: CE-MRA, contrast-enhanced magnetic resonance angiography; Ln(DOR), natural logarithm of the diagnostic odds ratio.
1