Digital subtraction vs conventional angiography for preoperative evaluation of pancreaticobiliary and hepatic disease: An efficacy and cost appraisal

S. J. Savader, C. Lugo-Olivieri, F. C. Lynch, C. Prescott, A. C. Venbrux

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Abstract

We compared digital subtraction (DSA) and conventional angiography (CA) of the visceral vessels in the evaluation of pancreaticobiliary and hepatic disease to determine if either is superior at depicting vessel involvement, predicting patient respectability status or cost-effectiveness. One hundred and ninety-five patients with pancreaticobiliary and hepatic disease were evaluated with either DSA (n = 64) or CA (n = 131) at the operator's discretion as part of their work-up. The angiographic results were compared to surgical reports in 117 cases to determine the relative sensitivities and specificities of DSA vs CA in depicting vessel involvement and predicting patient respectability/unresectability. The arteriograms were also evaluated to compare catheter, guidewire and contrast usage; conscious sedation requirements; fluoroscopy and room usage time; film requirements; and complication rates. DSA and CA had an equal sensitivity (54%) and similar specificity (95%, 98%, respectively) in depicting vessel involvement by pancreaticobiliary and hepatic processes. DSA and CA also had a similar sensitivity (46%, 58%, respectively; P > 0.10) and specificity (92%, 96%, respectively) for determining patient respectability. Of the nine procedure-related parameters evaluated, only film costs varied significantly. DSA required a mean of $21.30 to hard copy archive vs $65.70 for CA (P < 0.001). Both DSA and CA had relatively poor sensitivities in determining vessel involvement and predicting respectability; however, specificity for both these parameters was high. The value of angiography thus lies in its ability to predict unresectability. Neither exam proved to be clinically superior to the other; however, DSA was less costly to perform because of film expenditures one-third that of CA. Therefore, DSA is recommended as a cost-saving alternative to CA for patients requiring visceral angiography as part of their work-up.

Original languageEnglish (US)
Pages (from-to)44-51
Number of pages8
JournalJournal of Interventional Radiology
Volume14
Issue number1
StatePublished - May 11 1999

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All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

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