Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

Comparison Between Computed Tomography Angiography and Digital Subtraction Angiography in Critical Lower Limb Ischemia

Author(s): Hesham Ebrahim Ahmed Al-rudaini, Ping Han* and Huimin Liang

Volume 15, Issue 5, 2019

Page: [496 - 503] Pages: 8

DOI: 10.2174/1573405614666181026112532

Abstract

Background: CT Angiography (CTA) of aortoiliac and lower extremity arteries is a relatively recent innovation of CT imaging that has changed after the introduction of multi-detector row scanners.

Objective: The study aimed to evaluate the diagnostic accuracy of Multidetector Computed Tomographic Angiography (MDCTA) in the assessment of arterial tree in patients with Peripheral Arterial Occlusive Disease (PAOD), as compared to Digital Subtraction Angiography (DSA).

Methods: A single-center nonrandomized prospective study was conducted on 50 patients complaining of peripheral arterial disease (chronic stage) from February 2017 to October 2017. All the patients were exposed to DSA and CTA prior to definitive treatment. The images were then analyzed using maximum intensity projection, volume-rendered, and curved multiplane reformation techniques.

Results: All the patients involved in this study were susceptible according to their clinical presentation. The statistical analysis exposed a highly significant difference between CTA and DSA in the assessment of stenosis at the level of Femoropopliteal segment (P<0.01), while for infrapopliteal segment, there was no statistically significant difference between CTA and DSA having 8% versus 14% insignificant stenosis and 62% versus 47% significant stenosis in CTA and DSA, respectively. The overall accuracy of CT angiography in the femoropopliteal segments was 95.20% while in the infrapopliteal segment it was 94.5%.

Conclusion: Multidetector CT angiography was found to be a reliable alternative mean for pathoanatomical description of the arterial lesions in critical lower limb ischemia and its subsequent management in comparison to digital subtraction angiography.

Keywords: Multi-detector computer tomography, lower extremity arteries, peripheral arterial disease, digital subtraction angiography, critical lower limb ischemia, atherosclerosis.

Graphical Abstract

[1]
Heuschmid M, Krieger A, Beierlein W, et al. Assessment of peripheral arterial occlusive disease: Comparison of Multislice-CT Angiography (MS-CTA) and Intraarterial Digital Subtraction Angiography (IA-DSA). Eur J Med Res 2003; 8(9): 389-96.
[2]
Sun Z. Diagnostic accuracy of multislice CT angiography in peripheral arterial disease. J Vasc Interv Radiol 2006; 17(12): 1915-21.
[3]
Oztekin PS, Sonmez A, Kucukay F, Oztuna D, Sanlıdilek U, Kosar U. An evaluation of the arterial occlusions in peripheral arterial disease by 64-detector multi-slice CT angiography: DSA correlation. World J Cardiovasc Dis 2013; 3(02): 250.
[4]
Qenawy OK, Tantawy WH, Karem A, Abdalla AKH, Sayed AAA. Comparative study between multi-detector CT angiography and digital subtraction angiography in evaluation of peripheral arterial occlusive disease. Egypt J Radiol Nucl Med 2015; 46(4): 1003-10.
[5]
Met R, Bipat S, Legemate DA, et al. Diagnostic performance of computed tomography angiography in peripheral arterial disease: A systematic review and meta-analysis. JAMA 2009; 301(4): 415-24.
[6]
Cernic S, Pozzi MF, Pellegrin A, Pizzolato R, Cova MA. Comparison between 64-row CT angiography and digital subtraction angiography in the study of lower extremities: Personal experience. Radiol Med 2009; 114(7): 1115-29.
[7]
Shareghi S, Gopal A, Gul K, et al. Diagnostic accuracy of 64 multidetector computed tomographic angiography in peripheral vascular disease. Catheter Cardiovasc Interv 2010; 75(1): 23-31.
[8]
Peach G, Sinha S, Hinchliffe RJ. Arterial pathologies in athletes. J Cardiovasc Surg 2017; 58(2): 360-8.
[9]
Fraioli F, Catalano C, Napoli A, et al. Low-dose multidetector-row CT angiography of the infra-renal aorta and lower extremity vessels: image quality and diagnostic accuracy in comparison with standard DSA. Eur Radiol 2006; 16(1): 137-46.
[10]
Hamburg NM, Creager MA. Pathophysiology of intermittent claudication in peripheral artery disease. Circ J 2017; 81(3): 281-9.
[11]
Zhao Z, Yang J, Wang B, et al. Clinical application of preoperative imaging evaluation in the anterolateral thigh flap transplantation: Comparison of computed tomography angiography, digital subtract angiography and magnetic resonance angiography. Chin J Plast Surg 2015; 31(3): 172-5.
[12]
Iezzi R, Cotroneo AR, Filippone A, Giancristofaro D, Storto ML. Four-detector row computed tomographic angiography in the evaluation of infrarenal aorta and peripheral arterial occlusive disease: Influence of contrast medium concentration. J Comput Assist Tomogr 2008; 32(5): 690-6.
[13]
Romano MAB, Markabaoui K, Tamburrini O, Salvatore M. Multidetector row computed tomographic angiography of the abdominal aorta and lower limbs arteries. A new diagnostic tool in patients with peripheral arterial occlusive disease. Minerva Cardioangiol 2004; 52(1): 9-17.
[14]
Albrecht T, Meyer BC. MDCT angiography of peripheral arteries: Technical considerations and impact on patient management. Eur Radiol 2007; 17(6): 5-15.
[15]
Schertler T, Wildermuth S, Alkadhi H, Kruppa M, Marincek B, Boehm T. Sixteen-detector row CT angiography for lower-leg arterial occlusive disease: Analysis of section width. Radiology 2005; 237(2): 649-56.
[16]
Iezzi R, Santoro M, Dattesi R. Diagnostic accuracy of CT angiography in the evaluation of stenosis in lower limbs: Comparison between visual score and quantitative analysis using a semiautomated 3D software. J Comput Assist Tomogr 2013; 37(3): 419-25.
[17]
Huang Q, Zhai R, Wang J, Zhang Y. Diagnostic value of non-invasive imaging modalities to evaluate lower limb arterial disease associated with diabetes. Clin Radiol 2015; 49(1): 20-4.
[18]
Meissner OA, Rieger J, Weber C, et al. Critical limb ischemia: Hybrid MR angiography compared with DSA. Radiology 2005; 235(1): 308-18.
[19]
Fritz J, Efron DT, Fishman EK. State-of-the-art 3DCT angiography assessment of lower extremity trauma: Typical findings, pearls, and pitfalls. Emerg Radiol 2013; 20(3): 175-84.
[20]
Antoniou GA, Chalmers N, Kanesalingham K, et al. Meta-analysis of outcomes of endovascular treatment of infrapopliteal occlusive disease with drug-eluting stents. J Endovasc Ther 2013; 20(2): 131-44.
[21]
Leibecke T, Kagel C, Lubienski A, Peters SO, Jungbluth T, Thomas H. CTA und MRA bei PAVK–ist die DSA out? Der Radiol 2006; 46(11): 941-7.
[22]
Walter F, Leyder B, Fays J, et al. Value of arteriography scanning in lower limb artery evaluation: a preliminary study. J Radiol 2001; 82(4): 473-9.
[23]
Fotiadis N, Kyriakides C, Bent C, Vorvolakos T, Matson M. 64-section CT angiography in patients with critical limb ischaemia and severe claudication: Comparison with digital subtractive angiography. Clin Radiol 2011; 66(10): 945-52.
[24]
Edwards AJ, Wells IP, Roobottom CA. Multidetector row CT angiography of the lower limb arteries: A prospective comparison of volume-rendered techniques and intra-arterial digital subtraction angiography. Clin Radiol 2005; 60(1): 85-95.
[25]
Abd-ElGawada EA, Ibraheema MA, Samya LAM, Atyia AM, Ragab M. Assessment of the distal runoff in patients with long standing diabetes mellitus and lower limb ischemia: MDCTA versus DSA. Egypt J Radiol Nucl Med 2013; 44(2): 231-6.
[26]
Kock MCJM, Dijkshoorn ML, Pattynama PMT, Hunink MGM. Multi-detector row computed tomography angiography of peripheral arterial disease. Eur Radiol 2007; 17(12): 3208-22.
[27]
Jiang L-F, Li H, Xin Z-F, Wu L-D. Computed tomography angiography and magnetic resonance imaging performance of acute segmental single compartment syndrome following an Achilles tendon repair: A case report and literature review. Chin J Traumatol 2016; 19(5): 290-4.
[28]
Cook TS. Computed tomography angiography of the lower extremities. Radiol Clin 2016; 54(1): 115-30.
[29]
Yao J, Xia J, Maslov K, et al. Noninvasive photoacoustic computed tomography of mouse brain metabolism in vivo. Neuroimage 2013; 64: 257-66.
[30]
Pomposelli F. Arterial imaging in patients with lower extremity ischemia and diabetes mellitus. J Vasc Surg 2010; 52(3): 81S-91S.
[31]
Kim JW, Choo KS, Jeon UB, et al. Diagnostic performance and radiation dose of lower extremity CT angiography using a 128-slice dual source CT at 80 kVp and high pitch. Acta Radiol 2016; 57(7): 822-8.
[32]
Swanberg J, Nyman R, Magnusson A, Wanhainen A. Selective intra-arterial dual-energy CT angiography (s-CTA) in lower extremity arterial occlusive disease. Eur J Vasc Endovasc Surg 2014; 48(3): 325-9.
[33]
Fleischmann D, Hallett RL. Contrast medium injection technique. In: Schoepf U, Meinel F Eds. Multidetector-row CT of the thorax. Springer 2016; pp. 37-57.
[34]
Kau T, Eicher W, Reiterer C, et al. Dual-energy CT angiography in peripheral arterial occlusive disease-accuracy of maximum intensity projections in clinical routine and subgroup analysis. Eur Radiol 2011; 21(8): 1677-86.

© 2024 Bentham Science Publishers | Privacy Policy