Changing trends in a decade of vascular radiology—the impact of technical developments of non-invasive techniques on vascular imaging

OBJECTIVES: This review aims to establish the impact on conventional angiography and endovascular intervention of contrast-enhanced magnetic resonance angiography (CE-MRA) and contrast-enhanced computed tomography angiography (CE-CTA) on a background of evolving technology, changing clinical requirements and resulting clinical repercussions. METHODS: The angiographic and interventional caseload was prospectively recorded between 1997 and 2010, along with the CE-MRA and CE-CTA caseload. Waiting times and the marginal cost analyses for 2001 and 2009 were also prospectively established. RESULTS: Conventional diagnostic angiographies declined from a peak of 847 to 121 per year while endovascular interventions continue in similar numbers. CE-MRA increased from effectively none initially to 620 per year while CE-CTA has currently risen to 396 per year. Total diagnostic study numbers have increased but at reduced cost. Various influences are clear, including on-site modality availability, capability and accuracy along with impact of new therapies, research studies and adverse events. CONCLUSIONS: Vascular imaging has undergone a metamorphosis in little over a decade because of CE-MRA and CE-CTA. With waiting times significantly reduced since the start of the study and the cost-effectiveness of both CE-MRA and CE-CTA as primary diagnostic investigations established, further development of these services is inevitable. MAIN MESSAGES: • The availability of CE-MRA and CE-CTA has reduced the need for conventional angiography. • Both waiting times and the marginal cost analyses for CE-MRA and CE-CTA have reduced. • The impact of new therapies, research studies (e.g. ASTRAL) and adverse events is illustrated.