{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T18:11:07Z","timestamp":1773425467618,"version":"3.50.1"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,6,18]],"date-time":"2020-06-18T00:00:00Z","timestamp":1592438400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,6,18]],"date-time":"2020-06-18T00:00:00Z","timestamp":1592438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Imaging"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Percutaneous transluminal angioplasty (PTA) is increasingly requested in the therapy of peripheral arterial occlusive disease. The evaluation of the technical result after balloon angioplasty with regard to bailout stenting is highly dependent on the operators\u00b4 subjective assessment and mainly based on the monochromatic digital subtraction angiography (DSA) images. The aim of this study was to compare color-coded single image as a novel diagnostic tool with monochromatic DSA for the analysis of flow limitation and need for stent implantation after PTA of superficial femoral artery (SFA) stenoses.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>During a period of 18\u2009months, 213 SFA lesions were treated by PTA with a standard balloon in 170 patients, resulting in a total of 193 endovascular procedures. The median age of the patients was 77\u2009years (range, 35\u201396\u2009years). Median length of the treated lesions was 10.5\u2009cm (range, 1.0\u201350\u2009cm). Three interventional radiologists retrospectively evaluated the results of balloon angioplasty with monochromatic as well as post-processed color-coded DSA images for flow limitations to decide if subsequent stent implantation was necessary. Consensus reading of two experienced interventional radiologists 2\u00a0months after the initial review served as reference standard to perform a receiver operating characteristics (ROC) analysis.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>ROC analysis for readers A, B and C showed area under the curve (AUC) values of 0.797, 0.865 and 0.804 for color-coded DSA and AUC values of 0.792, 0.843 and 0.872 for monochromatic DSA: a significant advantage of color-coded over conventional monochromatic DSA was not found for readers A and B (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). Results of reader C were significantly better in the assessment of monochromatic images (<jats:italic>p<\/jats:italic>\u2009=\u20090.023). Diagnostic confidence using color-coded images was slightly higher than in monochromatic images (\u03ba\u2009=\u20090.486 vs. \u03ba\u2009=\u20090.459).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In this study, color coded DSA did not reveal to be superior to conventional monochromatic DSA when evaluating results of PTA and when deciding whether stent implantation is necessary or not. This technology, however, requires further experiences with special regard to homogeneously trained radiologists and to the time requirement.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12880-020-00468-1","type":"journal-article","created":{"date-parts":[[2020,6,18]],"date-time":"2020-06-18T11:02:59Z","timestamp":1592478179000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluation of superficial femoral artery-lesions after percutaneous transluminal angioplasty: color-coded summation images vs. monochromatic digital subtraction angiography"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3541-5287","authenticated-orcid":false,"given":"Anne Marie","family":"Augustin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irina","family":"Thein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Rickert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thorsten","family":"Klink","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thorsten Alexander","family":"Bley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralph","family":"Kickuth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,6,18]]},"reference":[{"issue":"9901","key":"468_CR1","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1016\/S0140-6736(13)61249-0","volume":"382","author":"FG Fowkes","year":"2013","unstructured":"Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329\u201340.","journal-title":"Lancet."},{"issue":"15","key":"468_CR2","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1093\/eurheartj\/ehv006","volume":"36","author":"H Reinecke","year":"2015","unstructured":"Reinecke H, Unrath M, Freisinger E, Bunzemeier H, Meyborg M, Luders F, et al. Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. Eur Heart J. 2015;36(15):932\u20138.","journal-title":"Eur Heart J"},{"issue":"1","key":"468_CR3","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.ejrad.2010.04.016","volume":"75","author":"JO Balzer","year":"2010","unstructured":"Balzer JO, Thalhammer A, Khan V, Zangos S, Vogl TJ, Lehnert T. Angioplasty of the pelvic and femoral arteries in PAOD: results and review of the literature. Eur J Radiol. 2010;75(1):48\u201356.","journal-title":"Eur J Radiol"},{"issue":"3","key":"468_CR4","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1067\/mva.2003.155","volume":"37","author":"JP Becquemin","year":"2003","unstructured":"Becquemin JP, Favre JP, Marzelle J, Nemoz C, Corsin C, Leizorovicz A. Systematic versus selective stent placement after superficial femoral artery balloon angioplasty: a multicenter prospective randomized study. J Vasc Surg. 2003;37(3):487\u201394.","journal-title":"J Vasc Surg"},{"issue":"2","key":"468_CR5","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/s00062-012-0184-8","volume":"23","author":"P Golitz","year":"2013","unstructured":"Golitz P, Struffert T, Lucking H, Rosch J, Knossalla F, Ganslandt O, et al. Parametric color coding of digital subtraction angiography in the evaluation of carotid cavernous fistulas. Clin Neuroradiol. 2013;23(2):113\u201320.","journal-title":"Clin Neuroradiol"},{"issue":"3","key":"468_CR6","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1016\/j.jvs.2012.02.041","volume":"56","author":"TC Huang","year":"2012","unstructured":"Huang TC, Wu TH, Lin CJ, Mok GS, Guo WY. Peritherapeutic quantitative flow analysis of arteriovenous malformation on digital subtraction angiography. J Vasc Surg. 2012;56(3):812\u20135.","journal-title":"J Vasc Surg"},{"issue":"4","key":"468_CR7","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/j.jcma.2012.12.009","volume":"76","author":"CJ Lin","year":"2013","unstructured":"Lin CJ, Luo CB, Hung SC, Guo WY, Chang FC, Beilner J, et al. Application of color-coded digital subtraction angiography in treatment of indirect carotid-cavernous fistulas: initial experience. J Chin Med Assoc. 2013;76(4):218\u201324.","journal-title":"J Chin Med Assoc"},{"issue":"5","key":"468_CR8","doi-asserted-by":"publisher","first-page":"919","DOI":"10.3174\/ajnr.A2020","volume":"31","author":"CM Strother","year":"2010","unstructured":"Strother CM, Bender F, Deuerling-Zheng Y, Royalty K, Pulfer KA, Baumgart J, et al. Parametric color coding of digital subtraction angiography. AJNR Am J Neuroradiol. 2010;31(5):919\u201324.","journal-title":"AJNR Am J Neuroradiol"},{"issue":"6","key":"468_CR9","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1016\/j.jvir.2016.02.011","volume":"27","author":"WS Lou","year":"2016","unstructured":"Lou WS, Su HB, Huang KY, He X, Chen L, Chen GP, et al. Evaluation of distal hemodynamic changes of lower extremity after endovascular treatment: correlation between measurements of color-coded quantitative digital subtraction angiography and ankle-brachial index. J Vasc Interv Radiol. 2016;27(6):852\u20138.","journal-title":"J Vasc Interv Radiol"},{"issue":"8","key":"468_CR10","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1007\/s00270-017-1670-9","volume":"40","author":"M Kostrzewa","year":"2017","unstructured":"Kostrzewa M, Kara K, Pilz L, Mueller-Muertz H, Rathmann N, Schoenberg SO, et al. Treatment evaluation of flow-limiting Stenoses of the superficial femoral and popliteal artery by parametric color-coding analysis of digital subtraction angiography series. Cardiovasc Intervent Radiol. 2017;40(8):1147\u201354.","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"2","key":"468_CR11","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s00270-015-1253-6","volume":"39","author":"JA Reekers","year":"2016","unstructured":"Reekers JA, Koelemay MJ, Marquering HA, van Bavel ET. Functional imaging of the foot with perfusion angiography in critical limb ischemia. Cardiovasc Intervent Radiol. 2016;39(2):183\u20139.","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"5\u20136","key":"468_CR12","first-page":"499","volume":"21","author":"R Fontaine","year":"1954","unstructured":"Fontaine R, Kim M, Kieny R. Surgical treatment of peripheral circulation disorders. Helv Chir Acta. 1954;21(5\u20136):499\u2013533.","journal-title":"Helv Chir Acta"},{"issue":"6","key":"468_CR13","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1016\/j.jvir.2015.02.018","volume":"26","author":"MR Rajebi","year":"2015","unstructured":"Rajebi MR, Benenati MJ, Schernthaner MB, Walker G, Gandhi RT, Pena CS, et al. Reliability and accuracy of simple visual estimation in assessment of peripheral arterial stenosis. J Vasc Interv Radiol. 2015;26(6):890\u20136.","journal-title":"J Vasc Interv Radiol"},{"issue":"4","key":"468_CR14","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/s00062-013-0208-z","volume":"23","author":"T Struffert","year":"2013","unstructured":"Struffert T, Deuerling-Zheng Y, Engelhorn T, Kloska S, Golitz P, Bozzato A, et al. Monitoring of balloon test occlusion of the internal carotid artery by parametric color coding and perfusion imaging within the angio suite: first results. Clin Neuroradiol. 2013;23(4):285\u201392.","journal-title":"Clin Neuroradiol"},{"key":"468_CR15","first-page":"90380L","volume":"9038","author":"CN Ionita","year":"2014","unstructured":"Ionita CN, Garcia VL, Bednarek DR, Snyder KV, Siddiqui AH, Levy EI, et al. Effect of injection technique on temporal parametric imaging derived from digital subtraction angiography in patient specific phantoms. Proc SPIE Int Soc Opt Eng. 2014;9038:90380L.","journal-title":"Proc SPIE Int Soc Opt Eng"}],"container-title":["BMC Medical Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12880-020-00468-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12880-020-00468-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12880-020-00468-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T23:15:48Z","timestamp":1623971748000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedimaging.biomedcentral.com\/articles\/10.1186\/s12880-020-00468-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,18]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["468"],"URL":"https:\/\/doi.org\/10.1186\/s12880-020-00468-1","relation":{},"ISSN":["1471-2342"],"issn-type":[{"value":"1471-2342","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,18]]},"assertion":[{"value":"8 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 June 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 June 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The local institutional review board of University Hospital W\u00fcrzburg waived its approval before conducting the study (Waiver No. 20160514 01) and the need for informed consent was waived due to the retrospective design of the study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"67"}}