Role of multidetector computed tomography angiography in evaluation of peripheral arterial disease
Keywords:Diagnostic imaging, Doppler ultrasound, Multidetector computed tomography angiography, Peripheral arterial disease
Background: Diagnostic imaging plays an important role in the evaluation of peripheral arterial disease. Many imaging modalities are available ranging from conventional modalities to the cross-sectional modalities like Doppler ultrasound, DSA, CT and MRI. The main principles of imaging are to characterize the all lesions detected including type of plaques, no. of lesions, length of stenosis, diameter of vessel in pre-stenotic and post-stenotic segments, degree of wall calcification, assisting in pretreatment planning with respect to route of access, selection of balloon and demonstrates size, extent, neck dimention, and presence of thrombosis in cases with aneurysm.
Methods: A Cross-sectional observational study was done in 30 patients. Clinically suspected patients of peripheral arterial disease based on history, sign and symptoms and patients diagnosed with peripheral arterial disease on color doppler were included in our study. Both modalities were compared for detecting the occlusion and stenotic segments.
Results: A total of 476 vessel segments were imaged by both modalities. When all arterial segments were considered, MDCTA detected stenosis or occlusion lesions in 30% of arterial segments, versus 18.8% compared to DUS. MDCTA showed 9.8% (95% CI:[4.3%, 15.3%]) more lesions than DUS when all arterial segments were considered together, 11.2% (95% CI: [2.7%, 22.1%]) more lesions when only the iliac arteries were compared, 9.1% (95% CI: [3.2%, 17.2%]) more lesions when only the femoropopliteal arteries were compared, 8.9% (95% CI: [1.5%, 16.3%]) more lesions when only infrapopliteal arteries were compared and 13% (95% CI: [2.6%, 25.4%]) more lesions when only the upper limb arterial segments were compared, (p <0.05 for all comparisons).
Conclusions: MDCTA may be used as a screening tool in patients with peripheral arterial disease as it is a non-invasive and more accurate modality when compared to DUS and plays important role in management.
Creager MA, White CJ, Hiatt WR, Criqui MH, Josephs SC, Alberts MJ, et al. Atherosclerotic Peripheral Vascular Disease Symposium II: Executive Summary. Circulation. 2008 Dec 16;118(25):2811-25.
Peripheral Arterial Disease Fact Sheet|Data & Statistics. Available at: https://www.nhlbi.nih.gov/health/educational/pad/docs/pad_extfctsht_general_508.pdf
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrisons Manual of Medicine, 19th Edition. McGraw Hill Professional; 2016:1244.
Hofer M. Teaching Manual of Color Duplex Sonography. 2001.
Khanna NN. Overview of peripheral vascular disease. Med Update. 2005;89-99.
Zwiebel WJ. Introduction to Vascular Ultrasonography. Saunders; 2005. 758 p. Shirol1 RJ, Shetty2 A, K3 CT. "Role MDCT in evaluation of Peripheral Vascular Disease of the Lower Limb Arteries and Comparision with Colour Doppler". J Evalua Med Dent Sci. 2015;4(54):9336-46.
Shirol RJ, Shetty A, Chethan TK. Role of MDCT in evaluation of peripheral vascular disease of the lower limb arteries and comparison with colour doppler. J Evalua Med Dent Sci. 2015 Jul 6;4(54):9336-47.
Collins R, Cranny G, Burch J, Aguiar-Ibanez R, Craig D, Wright K, et al. A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease. Health technology assessment (Winchester, England). 2007;11(20):iii-v.
Polak JF, Karmel MI, Mannick JA, O'Leary DH, Donaldson MC, Whittemore AD. Determination of the extent of lower-extremity peripheral arterial disease with color-assisted duplex sonography: comparison with angiography. AJR. Am J Roentgenol. 1990 Nov;155(5):1085-9.
Ubbink DT, Fidler M, Legemate DA. Interobserver variability in aortoiliac and femoropopliteal duplex scanning. J Vasc Surg. 2001 Mar 1;33(3):540-5.
Algazzar MAA, Elzawawi MSE, Alhawary KES, Mousa WA. Role of multi-detector computed tomography angiography in the evaluation of lower limb ischemia. Int J Med Imag. 2014;2(5):125-30.
Catalano C, Fraioli F, Laghi A, Napoli A, Bezzi M, Pediconi F, et al. Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi–detector row CT angiography. Radiol. 2004 May;231(2):555-63.
Willmann JK, Baumert B, Schertler T, Wildermuth S, Pfammatter T, Verdun FR, et al. Aortoiliac and lower extremity arteries assessed with 16–detector row CT angiography: prospective comparison with digital subtraction angiography. Radiol. 2005 Sep;236(3):1083-93.
Schernthaner R, Stadler A, Lomoschitz F, Weber M, Fleischmann D, Lammer J, et al. Multidetector CT angiography in the assessment of peripheral arterial occlusive disease: accuracy in detecting the severity, number, and length of stenoses. Eur Radiol. 18:665-71.
Wintersperger B, Jakobs T, Herzog P, Schaller S, Nikolaou K, Suess C, et al. Aorto-iliac multidetector-row CT angiography with low kV settings: improved vessel enhancement and simultaneous reduction of radiation dose. Eur Radiol. 2005 Feb;15(2):334-41.
Bergamini TM, Tatum Jr CM, Marshall C, Hall-Disselkamp B, Richardson JD. Effect of multilevel sequential stenosis on lower extremity arterial duplex scanning. Am J Surg. 1995;169:564-6.
Schlager O, Francesconi M, Haumer M, Dick P, Sabeti S, Amighi J, Mlekusch W, Koppensteiner R, Minar E, Schillinger M. Duplex sonography versus angiography for assessment of femoropopliteal arterial disease in a “real-world” setting. J Endovasc Ther. 2007 Aug;14(4):452-9.
Portugaller HR, Schoellnast H, Hausegger KA, Tiesenhausen K, Amann W, Berghold A. Multislice spiral CT angiography in peripheral arterial occlusive disease: a valuable tool in detecting significant arterial lumen narrowing. Eur Radiol. 2004;14:1681-7.
Laswed T, Rizzo E, Guntern D, Doenz F, Denys A, Schnyder P, et al. Assessment of occlusive arterial disease of abdominal aorta and lower extremities arteries: value of multidetector CT angiography using an adaptive acquisition method. Europ Radiol. 2008 Feb 1;18(2):263-72.
Premalatha G, Shanthirani S, Deepa R, Markovitz J, Mohan V. Prevalence and risk factors of peripheral vascular disease in a selected South Indian population: the Chennai Urban Population Study. Diabetes Care. 2000 Sep;23(9):1295-300.
Joshi A, Nimbkar V, Merchant S, Mhashelkar Y, Talekar K. Role of CT angiography in the evaluation of peripheral vasculature using MSCT - our initial experience. Indian J Radiol Imaging. 2004 Aug 1;14(3):309.
Chidambaram PK, Swaminathan RK, Ganesan P, Mayavan M. Segmental Comparison of Peripheral Arteries by Doppler Ultrasound and CT Angiography. J Clin Diagn Res JCDR. 2016 Feb;10(2):TC12-6.
Klingenbeck-Regn K, Schaller S, Flohr T, Ohnesorge B, Kopp AF, Baum U. Subsecond multi-slice computed tomography: basics and applications. Eur J Radiol. 1999 Aug;31(2):110-24.
Peedikayil RU, Rajendran VR, Monthampally S, Puthiyakam J. Multidetector CT. angiography v/s colour Doppler ultrasonography in the diagnosis of peripheral arterial diseases of lower extremities. J Evol Med Dent Sci-JEMDS. 2016;5(63):4457-61.
Kayhan A, Palabıyık F, Serinsöz S, Kırış A, Bayramoğlu S, Williams JTB, et al. Multidetector CT angiography versus arterial duplex USG in diagnosis of mild lower extremity peripheral arterial disease: is multidetector CT a valuable screening tool? Eur J Radiol. 2012 Mar;81(3):542-6.
Singh Netam S, Singh R, Kumar S, Singhal A, Jain V. CT angiography evaluation of peripheral vascular disease and comparison with color doppler ultrasound. J Evol Med Dent Sci. 2015 Oct 14;4:14504-14.
Met R, Bipat S, Legemate DA, Reekers JA, Koelemay MJW. Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis. JAMA. 2009 Jan 28;301(4):415-24.