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Wang X, Nai YH, Gan J, Lian CPL, Ryan FK, Tan FSL, Chan DYS, Ng JJ, Lo ZJ, Chong TT, Hausenloy DJ. Multi-Modality Imaging of Atheromatous Plaques in Peripheral Arterial Disease: Integrating Molecular and Imaging Markers. Int J Mol Sci 2023; 24:11123. [PMID: 37446302 DOI: 10.3390/ijms241311123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral artery disease (PAD) is a common and debilitating condition characterized by the narrowing of the limb arteries, primarily due to atherosclerosis. Non-invasive multi-modality imaging approaches using computed tomography (CT), magnetic resonance imaging (MRI), and nuclear imaging have emerged as valuable tools for assessing PAD atheromatous plaques and vessel walls. This review provides an overview of these different imaging techniques, their advantages, limitations, and recent advancements. In addition, this review highlights the importance of molecular markers, including those related to inflammation, endothelial dysfunction, and oxidative stress, in PAD pathophysiology. The potential of integrating molecular and imaging markers for an improved understanding of PAD is also discussed. Despite the promise of this integrative approach, there remain several challenges, including technical limitations in imaging modalities and the need for novel molecular marker discovery and validation. Addressing these challenges and embracing future directions in the field will be essential for maximizing the potential of molecular and imaging markers for improving PAD patient outcomes.
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Affiliation(s)
- Xiaomeng Wang
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Ying-Hwey Nai
- Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
| | - Julian Gan
- Siemens Healthineers, Singapore 348615, Singapore
| | - Cheryl Pei Ling Lian
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Fraser Kirwan Ryan
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Forest Su Lim Tan
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Dexter Yak Seng Chan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Jun Jie Ng
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore 258499, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore 168752, Singapore
- Surgical Academic Clinical Programme, Singapore General Hospital, Singapore 169608, Singapore
- Vascular SingHealth Duke-NUS Disease Centre, Singapore 168752, Singapore
| | - Derek John Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore 117597, Singapore
- The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
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Xing B, He Z, Zhou F, Zhao Y, Shan T. Automatic force-controlled 3D photoacoustic system for human peripheral vascular imaging. BIOMEDICAL OPTICS EXPRESS 2023; 14:987-1002. [PMID: 36874482 PMCID: PMC9979678 DOI: 10.1364/boe.481163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 06/18/2023]
Abstract
Photoacoustic (PA) imaging provides unique advantages in peripheral vascular imaging due to its high sensitivity to hemoglobin. Nevertheless, limitations associated with handheld or mechanical scanning by stepping motor techniques have precluded photoacoustic vascular imaging from advancing to clinical applications. As clinical applications require flexibility, affordability, and portability of imaging equipment, current photoacoustic imaging systems developed for clinical applications usually use dry coupling. However, it inevitably induces uncontrolled contact force between the probe and the skin. Through 2D and 3D experiments, this study proved that contact forces during the scanning could significantly affect the vascular shape, size, and contrast in PA images, due to the morphology and perfusion alterations of the peripheral blood vessels. However, there is no available PA system that can control forces accurately. This study presented an automatic force-controlled 3D PA imaging system based on a six-degree-of-freedom collaborative robot and a six-dimensional force sensor. It is the first PA system that achieves real-time automatic force monitoring and control. This paper's results, for the first time, demonstrated the ability of an automatic force-controlled system to acquire reliable 3D PA images of peripheral blood vessels. This study provides a powerful tool that will advance PA peripheral vascular imaging to clinical applications in the future.
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Affiliation(s)
- Baicheng Xing
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Zhengyan He
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Fang Zhou
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Yuan Zhao
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
- These authors contributed equally to this work
| | - Tianqi Shan
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
- These authors contributed equally to this work
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Chen T, Liu L, Ma X, Zhang Y, Liu H, Zheng R, Ren J, Zhou H, Ren Y, Gao R, Chen N, Zheng H, Song L, Liu C. Dedicated photoacoustic imaging instrument for human periphery blood vessels: A new paradigm for understanding the vascular health. IEEE Trans Biomed Eng 2021; 69:1093-1100. [PMID: 34543187 DOI: 10.1109/tbme.2021.3113764] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A novel photoacoustic imaging system based on a semi-ring transducer array is proposed to imageperipheralbloodvessels. The system's penetration depth is deep (~15 mm) with high spatial (~200 m) and temporal resolution. In a clinical study, volumetric photoacoustic data of limbs were obtained within the 50s (for a FOV of 15 cm4 cm) with the volunteers in the standing and sitting posture. Compared to the previous studies, our system has many advantages, including (1) Larger field of view; (2) Finer elevational and in-plane resolutions; (3) Enhanced 3D visualization of peripheralvascular networks; (4) Compact size and better portability. The 3D visualization and cross-sectional images of five healthy volunteers clearly show the vascular network and the system's ability to image submillimeter blood vessels. This high-resolution PA system has great potential for imaging human periphery vasculatures noninvasively in clinical research.
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Kazemtash M, Harth M, Derwich W, Thalhammer A, Schmitz-Rixen T, Keese M. Quiescent-Interval Slice Selective Magnetic Resonance Angiography for Abdominal Aortic Aneurysm Treatment Planning. J Endovasc Ther 2021; 28:393-398. [PMID: 33478349 DOI: 10.1177/1526602821989341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Diagnostic imaging of Abdominal aortic aneurysm (AAA) almost exclusively employs CT angiography (CTA) involving X-ray exposure and contrast medium that may harm some patients. Quiescent-Interval Slice Selective MR (QISS-MR) depicts vascular anatomy without radiation or contrast medium. The diagnostic quality of QISS-MRA and CTA were compared in regard to length and diameter measurements in AAA patients. Suitability of QISS-MRA for AAA treatment planning was evaluated. MATERIALS AND METHODS The details of 30 patients with AAA who received both a QISS-MR and CTA for a known infrarenal AAA were obtained retrospectively that was approved by the local research ethics board. Two observers analyzed each dataset in terms of image quality and determined lumen diameter and length of 15 vessel segments. RESULTS Highly accurate agreement between the diagnostic scores from the two observers was achieved. There was no significant difference between CTA and QISS-MRA for all 15 measured vessels. Although information on calcification was lacking and intraluminal thrombus was visualized in only 25 patients out of 30 patients, a founded decision to carry out OR or EVAR was possible with both imaging modalities. CONCLUSION QISS-MRA presents a radiation and contrast free method for preoperative diagnostic AAA imaging. While QISS-MRA does not deliver exact information regarding calcification and thrombus formation, it does accurately allow measurement of vessel diameter and length. Therefore, it is potentially useful for EVAR planning in selected patients with impaired renal function.
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Affiliation(s)
- Majid Kazemtash
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt/Main, Germany
| | - Marc Harth
- Department of Diagnostic and Interventional Radiology, J.W. Goethe University Hospital, Frankfurt/Main, Germany
| | - Wojciech Derwich
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt/Main, Germany
| | - Axel Thalhammer
- Department of Diagnostic and Interventional Radiology, J.W. Goethe University Hospital, Frankfurt/Main, Germany
| | - Thomas Schmitz-Rixen
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt/Main, Germany
| | - Michael Keese
- Department of Vascular and Endovascular Surgery, University Hospital Mannheim, Germany
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Conti M, Ferrarini A, Finotello A, Salsano G, Auricchio F, Palombo D, Spinella G, Pane B. Patient-specific computational fluid dynamics of femoro-popliteal stent-graft thrombosis. Med Eng Phys 2020; 86:57-64. [PMID: 33261734 DOI: 10.1016/j.medengphy.2020.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/18/2020] [Accepted: 10/14/2020] [Indexed: 01/07/2023]
Abstract
Intra-stent thrombosis is one of the major failure modes of popliteal aneurysm endovascular repair, especially when the diseased arterial segment is long and requires overlapping stent-grafts having different nominal diameters in order to accommodate the native arterial tapering. However, the interplay between stent sizing, post-operative arterial tortuosity, luminal diameter, local hemodynamics, and thrombosis onset is not elucidated, yet. In the present study, a popliteal aneurysm was treated with endovascular deployment of two overlapped stent-grafts, showing intra-stent thrombosis at one-year follow-up examination. Patient-specific computational fluid-dynamics analyses including straight- and bent-leg position were performed. The computational fluid-dynamics analysis showed that the overlapping of the stent-grafts induces a severe discontinuity of lumen, dividing the stented artery in two regions: the proximal part, affected by thrombosis, is characterized by larger diameter, low tortuosity, low flow velocity, low helicity, and low wall shear stress; the distal part presents higher tortuosity and smaller lumen diameter promoting higher flow velocity, higher helicity, and higher wall shear stress. Moreover, leg bending induces an overall increase of arterial tortuosity and reduces flow velocity promoting furtherly the luminal area exposed to low wall shear stress.
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Affiliation(s)
- Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Via Ferrata 3, 27100 Pavia, Italy.
| | - Anna Ferrarini
- Department of Civil Engineering and Architecture, University of Pavia, Via Ferrata 3, 27100 Pavia, Italy
| | - Alice Finotello
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Italy
| | - Giancarlo Salsano
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Via Ferrata 3, 27100 Pavia, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni Spinella
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bianca Pane
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Wang G, Zhao D, Ling Z, Wang H, Yu S, Zhang J. Evaluation of the best single-energy scanning in energy spectrum CT in lower extremity arteriography. Exp Ther Med 2019; 18:1433-1439. [PMID: 31316630 DOI: 10.3892/etm.2019.7666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/26/2019] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to apply the best single-energy (SE) scanning in energy spectrum computed tomography (CT) to evaluate the usefulness of lower extremity arterial angiography imaging in patients with lower extremity arterial occlusive disease. A total of 64 patients diagnosed with lower extremity arterial occlusive disease were randomly selected and divided into either the experimental group (n=32) or the control group (n=32). The two treatment groups were scanned for lower extremity arteriography using the best SE scanning mode of energy spectrum CT Gemstone imaging (GSI) and mixed energy scanning mode of multi-slice helical CT (MSCT). The CT images, image noise, contrast-to-noise ratio (CNR) and quality scores of the images of lower extremity arteries between the two groups were compared. Image quality of the two experimental groups were independently evaluated by two imaging diagnostic physicians. The CT scores and CNR of the lower extremity arteries were significantly higher in the experimental group compared with the control group (P<0.01). No statistically significant differences in the background noise between the two groups were observed (P<0.05). The image quality scores of two groups, with the differences between the two diagnosticians, were found to be statistically significant (P<0.01). In the lower extremity arterial angiography, the image quality of the best SE in the CT GSI scanning mode was observed to be superior to that taken using MSCT mixed energy scanning mode.
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Affiliation(s)
- Guokun Wang
- Department of Computed Tomography, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Deli Zhao
- Department of Computed Tomography, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Zaisheng Ling
- Department of Computed Tomography, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Haibo Wang
- Department of Computed Tomography, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Shanshan Yu
- Department of Computed Tomography, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Jinling Zhang
- Department of Computed Tomography, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
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Al-rudaini HEA, Han P, Liang H. Comparison Between Computed Tomography Angiography and Digital Subtraction Angiography in Critical Lower Limb Ischemia. Curr Med Imaging 2019; 15:496-503. [PMID: 32008557 DOI: 10.2174/1573405614666181026112532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/06/2018] [Accepted: 10/19/2018] [Indexed: 11/22/2022]
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.
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Affiliation(s)
- Hesham Ebrahim Ahmed Al-rudaini
- Department of Radiology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, 430030, China
| | - Ping Han
- Department of Radiology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, 430030, China
| | - Huimin Liang
- Department of Radiology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, 430030, China
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Wray P, Lin L, Hu P, Wang LV. Photoacoustic computed tomography of human extremities. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-8. [PMID: 30784244 PMCID: PMC6380242 DOI: 10.1117/1.jbo.24.2.026003] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/29/2019] [Indexed: 05/04/2023]
Abstract
We present a method of imaging angiographic structures in human extremities, including hands, arms, legs, and feet, using a newly developed photoacoustic computed tomography (PACT) system. The system features deep penetration (1.8 cm in muscular tissues) with high spatial and temporal resolutions. A volumetric image is acquired within 5 to 15 s while each cross sectional image is acquired within 100 μs. Therefore, we see no blurring from motion in the imaging plane. Longitudinal and latitudinal cross-sectional images of a healthy volunteer clearly show the vascular network of each appendage and highlight the system's ability to image major and minor vasculatures, without the use of an external contrast or ionizing radiation. We also track heartbeat-induced arterial movement at a two-dimensional frame rate of 10 Hz. This work substantiates the idea that PACT could be used as a noninvasive method for imaging human vasculatures.
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Affiliation(s)
- Parker Wray
- California Institute of Technology, Caltech Optical Imaging Laboratory, Department of Electrical Engineering, Pasadena, California, United States
| | - Li Lin
- California Institute of Technology, Caltech Optical Imaging Laboratory, Andrew and Peggy Cheng Department of Medical Engineering, Pasadena, California, United States
| | - Peng Hu
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Lihong V. Wang
- California Institute of Technology, Caltech Optical Imaging Laboratory, Department of Electrical Engineering, Pasadena, California, United States
- California Institute of Technology, Caltech Optical Imaging Laboratory, Andrew and Peggy Cheng Department of Medical Engineering, Pasadena, California, United States
- Address all correspondence to Lihong V. Wang, E-mail:
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Riffel P, Haubenreisser H, Higashigaito K, Alkadhi H, Morelli JN, Alber B, Schoenberg SO, Henzler T. Combined Static and Dynamic Computed Tomography Angiography of Peripheral Artery Occlusive Disease: Comparison with Magnetic Resonance Angiography. Cardiovasc Intervent Radiol 2018; 41:1205-1213. [PMID: 29484465 DOI: 10.1007/s00270-018-1911-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/17/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare in patients with known peripheral artery occlusive disease (PAOD), image quality of a combined CTA to a combined MRA protocol, including both static and dynamic acquisitions. MATERIALS AND METHODS Twenty-two patients with PAOD were examined with a combined CTA and MRA protocol consisting of static acquisitions (s-CTA, s-MRA) of the entire runoff and dynamic acquisitions (d-CTA, d-MRA) of the calves. Two radiologists compared image quality of the s-MRA versus s-CTA as well as d-MRA versus d-CTA. Image quality was assessed on a segmental basis using a 4-point Likert scale. RESULTS For s-CTA, 76% of segments were rated as excellent or good. For s-MRA, 50% of segments were rated as excellent or good (p < 0.0001). For d-CTA, median image quality score for all segments was rated as excellent for both readers. For d-MRA, median image quality for the different segments ranged from moderate to good. For both d-CTA and d-MRA, the median image quality scores were significantly higher for all segments of the lower limb compared with the static examinations of the lower limb segments (all p values < 0.0001). In patients with PAOD category 4-6, 80% of segments were rated as excellent or good for d-CTA, while 45% of segments were rated as poor or non-diagnostic for d-MRA. CONCLUSION In patients with known PAOD, a combined static and dynamic CTA examination improves image quality relative to static and dynamic MRA and should be considered as an alternative to MRA, particularly in patients with advanced stage PAOD.
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Affiliation(s)
- Philipp Riffel
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Holger Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kai Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Bettina Alber
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Ahmed O, Hanley M, Bennett SJ, Chandra A, Desjardins B, Gage KL, Gerhard-Herman MD, Ginsburg M, Gornik HL, Oliva IB, Steigner ML, Strax R, Verma N, Rybicki FJ, Dill KE. ACR Appropriateness Criteria® Vascular Claudication—Assessment for Revascularization. J Am Coll Radiol 2017; 14:S372-S379. [DOI: 10.1016/j.jacr.2017.02.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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11
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Morris DR, Singh TP, Moxon JV, Smith A, Stewart F, Jones RE, Golledge J. Assessment and validation of a novel angiographic scoring system for peripheral artery disease. Br J Surg 2017; 104:544-554. [PMID: 28140457 DOI: 10.1002/bjs.10460] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 10/30/2016] [Accepted: 11/16/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Angiography is used routinely in the assessment of lower-limb arteries, but there are few well validated angiographic scoring systems. The aim of this study was to develop and validate a novel angiographic scoring system for peripheral artery disease. METHODS An angiographic scoring system (the ANGIO score) was developed and applied to a sample of patients from a single vascular surgical department who underwent CT angiography of the lower limbs. The reproducibility of the ANGIO score was compared with those of the Bollinger and Trans-Atlantic inter-Society Consensus (TASC) IIb systems in a series of randomly selected patients. Associations between the ANGIO score and lower-limb ischaemia, as measured by the ankle : brachial pressure index (ABPI), and outcome events (major lower-limb amputations and cardiovascular events - myocardial infarction, stroke and cardiovascular death) were assessed. RESULTS Some 256 patients undergoing CT angiography were included. The interobserver reproducibility of the ANGIO score was better than that of the other scoring systems examined (κ = 0·90, P = 0·002). There was a negative correlation between the ANGIO score and ABPI (ρ = -0·33, P = 0·008). A higher ANGIO score was associated with an increased risk of major lower-limb amputation (hazard ratio (HR) for highest versus lowest tertile 9·30, 95 per cent c.i. 1·95 to 44·38; P = 0·005) and cardiovascular events (HR 2·73, 1·31 to 5·70; P = 0·007) following adjustment for established risk factors. CONCLUSION The ANGIO score provided a reproducible and valid assessment of the severity of lower-limb ischaemia and risk of major amputation and cardiovascular events in these patients with peripheral artery disease.
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Affiliation(s)
- D R Morris
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Queensland, Australia
| | - T P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Queensland, Australia
| | - J V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Queensland, Australia
| | - A Smith
- Department of Anatomy, School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - F Stewart
- Department of Anatomy, School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - R E Jones
- Division of Tropical Health and Medicine, James Cook University, Queensland, Australia
| | - J Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Queensland, Australia.,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
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Rehman A, Antonietti A, Burnside G, Torella F. Categorisation of tibial artery disease on computer tomography angiography according to the TASC II classification. Vascular 2017; 25:402-405. [PMID: 28121278 DOI: 10.1177/1708538116689176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Computer tomography angiography is used to assess peripheral arterial disease. Its preference over other imaging modalities is based upon its rapid acquisition and high spatial resolution, along with ease of access. TASC II have recently updated their vascular lesion classification to include infrapopliteal lesions, and our aim is to assess the reproducibility of TASC II on infrapopliteal disease when using computer tomography angiography. Methods A retrospective analysis of a series of consecutive computer tomography angiographies was performed by seven assessors (three consultant radiologists, two consultant vascular surgeons and two vascular specialty trainees). Each assessor was asked to classify the target vessel based on the TASC II classification. Statistical analysis was performed using Cohen's weighted kappa. Results Seven assessors analysed 48 target vessels in 25 patients (20 men), with a mean age of 72.9 years. Twenty posterior tibial, 27 anterior tibial and one peroneal artery were analysed. Poor agreement was demonstrated between the two vascular consultants, with a kappa of 0.094. Weak agreement was demonstrated among the radiologists, with a kappa of 0.547. The total group of assessors had a kappa of 0.176. Conclusion This study showed poor agreement between assessors when applying the TASC II classification to infrapopliteal lesions on computer tomography angiography. TASC II should not be used to classify lesions, for clinical or research purposes, with this image modality.
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Affiliation(s)
- Adeeb Rehman
- 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | - Alberto Antonietti
- 2 Department of Radiology, Royal Liverpool University Hospital, Liverpool, UK
| | - Girvan Burnside
- 3 Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Francesco Torella
- 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
- 4 Department of Mathematical Sciences, University of Liverpool, Liverpool, UK
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Multidetector (64+) Computed Tomography Angiography of the Lower Limb in Symptomatic Peripheral Arterial Disease. J Comput Assist Tomogr 2017; 41:327-333. [DOI: 10.1097/rct.0000000000000494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reducing Variability in Orthogonal Reformatted Image Quality Associated With Axial Long-z-Axis CT Angiography. AJR Am J Roentgenol 2016; 207:1360-1365. [PMID: 27610698 DOI: 10.2214/ajr.16.16233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to reduce variation in image quality of orthogonal reformatted images generated from long-z-axis CT angiography (CTA) studies of the upper and lower extremities. SUBJECTS AND METHODS Upper and lower extremity CTA studies were targeted at a single health care system. A correctly performed CTA examination was defined as one that met the following three criteria: Sagittal and coronal reformats were obtained, a high-resolution matrix greater than 512 × 512 was used, and reformatted images were available in a distance-measurable format. Baseline data were collected from February 1, 2014, through September 30, 2014. Corrective actions were implemented during three consecutive plan-do-check-act (PDCA) cycles from October 1, 2014, through July 31, 2015, that addressed human, technical, and systematic variations. A 3-month maintenance period followed in which no intervention was performed. Longitudinal data were analyzed monthly using a statistical process control chart (p-chart). RESULTS The total number of long-z-axis extremity CTA studies analyzed was as follows: 351 CTA studies were analyzed at baseline, 94 at the first PDCA cycle, 92 at the second PDCA cycle, 114 at the third PDCA cycle, and 138 during the maintenance period. The monthly rate of correctly performed studies ranged from 7% to 51% (mean, 38% ± 13% [SD]) during the baseline period, 32-59% (mean, 46% ± 14%) during the first PDCA cycle, 40-81% (mean, 61% ± 21%) during the second PDCA cycle, and 80-82% (mean, 81% ± 0.9%) during the third PDCA cycle. The monthly rate improved to 90-91% (mean, 91% ± 0.5%) during the maintenance period. The upper and lower control limits of the p-chart were upshifted after the second and third PDCA cycles. Correcting systematic and technical variations led to the greatest improvements in reformat accuracy. CONCLUSION Obtaining consistently and correctly reformatted images from long-z-axis CTA studies is achievable using iterative PDCA cycles.
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Abstract
Peripheral artery disease (PAD) has become increasingly common in the US patient population and can be a highly symptomatic and significant source of morbidity. When PAD is suspected, the first-line screening study that is obtained is typically a noninvasive evaluation that includes the ankle brachial index (ABI). Following a positive screening study, invasive catheter digital subtraction angiography (DSA) has been historically used to image the peripheral artery system and still remains the gold standard. However, newer developments in axial imaging including computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have in large part supplanted DSA for imaging the peripheral artery system in clinical practice. Benefits of CTA include rapid noninvasive acquisition, wide availability, high spatial resolution, and the ability to generate isotropic datasets on 64-detector row and higher CT scanners, thereby allowing for multiplanar 3D reformatting. Drawbacks of CTA include the exposure to both iodinated contrast and ionizing radiation, although the radiation dose exposure is lower than for DSA, and newer techniques such as using low tube voltage and rapid acquisition times allow for lower contrast doses. The presence of vascular calcification also limits the evaluation of small distal arteries using CTA, although the development of dual-energy CT techniques has significantly addressed this issue. Benefits of MRA include the avoidance of exposure to ionizing radiation and high diagnostic accuracy, while drawbacks include limited availability and increased cost along with the risk of nephrogenic systemic fibrosis that is associated with gadolinium-based contrast agents, although the latter can be mitigated by using newer non-contrast MR angiography techniques. Future technical advances in CT and MR hardware and software and MR pulse sequences will likely lead to the broader applicability and increased accuracy of noninvasive axial imaging in the evaluation of patients with peripheral artery disease.
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Affiliation(s)
- Nandini M Meyersohn
- Division of Cardiovascular Imaging, Massachusetts General Hospital, Boston, MA, USA,
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Xie D, Na J, Zhang M, Dong S, Xiao X. CT angiography of the lower extremity and coronary arteries using 256-section CT: a preliminary study. Clin Radiol 2015; 70:1281-8. [PMID: 26275584 DOI: 10.1016/j.crad.2015.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 05/18/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
AIM To investigate the possible use of a 256-section computed tomography (CT) prospective electrocardiography (ECG)-gated wide volume scanning protocol for combined angiography of the lower extremity and coronary arteries, after a single injection of contrast medium, in patients with lower extremity peripheral arterial disease (PAD). MATERIALS AND METHODS Thirty-four patients with suspected PAD underwent CT angiography (CTA) with a prospective ECG-gated protocol that covered the level of the tracheal bifurcation to the foot sole. Digital subtraction angiography (DSA) of the lower extremity arteries was performed on patients requiring therapeutic intervention. Image quality and stenosis of the coronary and lower extremity arteries were assessed. RESULTS A total of 93.1% of the coronary segments were adequate for diagnosis. 17 (50%) patients showed coronary artery stenosis ≥50%. A total of 95.8% of the lower extremity arterial segments were adequate for diagnosis. Twenty-eight patients with severe lower extremity arterial stenosis or occlusion underwent DSA. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CTA for the detection of significant lower arterial stenosis (≥50%) was 94.8%, 97.2%, 95.3%, 96.9%, and 96.3%, respectively. CONCLUSION Using the prospective ECG-gated wide volume CTA protocol, images of the coronary and lower extremity arteries suitable for diagnosis can be acquired simultaneously after a single injection of contrast agent. In addition to accurately diagnosing PAD, combined angiography may be used to screen for coronary heart disease in patients with PAD.
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Affiliation(s)
- D Xie
- Department of Computer Tomography, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - J Na
- Department of MRI, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - M Zhang
- Department of Computer Tomography, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - S Dong
- Department of Computer Tomography, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - X Xiao
- Department of Computer Tomography, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China.
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Delivering the Saline Chaser Via a Spiral Flow-Generating Tube Improves Arterial Enhancement for Computed Tomography Angiography of the Lower Extremities. J Comput Assist Tomogr 2015; 39:962-8. [PMID: 26248150 DOI: 10.1097/rct.0000000000000292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Christie A, Roditi G. Vascular imaging: the evolving role of the multidisciplinary team meeting in peripheral vascular disease. Semin Intervent Radiol 2014; 31:320-9. [PMID: 25435657 DOI: 10.1055/s-0034-1393968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This article reviews the importance of preinterventional cross-sectional imaging in the evaluation of peripheral arterial disease, as well as discussing the pros and cons of each imaging modality. The importance of a multidisciplinary team approach is emphasized.
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Affiliation(s)
- Andrew Christie
- Department of Radiology, Southern General Hospital, Scotland, United Kingdom
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Scotland, United Kingdom
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Variations in the popliteal artery branching in 342 patients studied with peripheral CT angiography using 64-MDCT. Jpn J Radiol 2014; 33:13-20. [DOI: 10.1007/s11604-014-0373-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
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Molinari GJDP, Dalbem AMDO, Guillaumon AT. Avoiding pitfalls of intraoperative peripheral endovascular surgery with the aid of OsiriX: expanding the use of virtual fluoroscopy. Braz J Cardiovasc Surg 2014; 29:455-8. [PMID: 25372922 PMCID: PMC4412337 DOI: 10.5935/1678-9741.20140094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 07/21/2014] [Indexed: 11/20/2022] Open
Abstract
We have shown how the analysis of the angiotomography reconstruction through OsiriX program has assisted in endovascular perioperative programming. We presented its application in situations when an unexpected existence of metallic overlapping artifact (orthopedic osteosynthesis) compromised the adequate visualization of the arterial lesion during the procedure. Through manipulation upon OsiriX software, with assistance of preview under virtual fluoroscopy, it was possible to obtain the angles that would avoid this juxtaposition. These angles were reproduced in the C-arm, allowing visualization of the occluded segment, reducing the need for repeated image acquisitions and contrast overload, allowing the continuation of the procedure.
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Oca Pernas R, Delgado Sánchez-Gracián C, Tardáguila de la Fuente G, Fernández del Valle A, Silva Priegue N, González Vázquez M, Trinidad López C. Comparison of image quality and radiation dose in computed tomography angiography of the peripheral arteries using tube voltage of 80kV versus 100kV. RADIOLOGIA 2014. [DOI: 10.1016/j.rxeng.2012.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Zemedkun M, LaBounty TM, Bergman G, Wong SC, Lin FY, Reynolds D, Gomez M, Dunning AM, Leipsic J, Min JK. Effectiveness of a low contrast load CT angiography protocol in octogenarians and nonagenarians being evaluated for transcatheter aortic valve replacement. Clin Imaging 2014; 39:815-9. [PMID: 25982494 DOI: 10.1016/j.clinimag.2014.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/29/2014] [Accepted: 08/08/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) typically requires computed tomographic angiography (CTA) for aortoiliofemoral assessment to determine feasibility of a transfemoral approach, although many candidates being considered for TAVR are at increased risk of contrast-induced nephropathy (CIN). OBJECTIVE To determine the feasibility and safety of a load contrast load CTA protocol in octogenarians and nonagenarians at risk of CIN. APPROACH We evaluated 54 consecutive octogenarians and nonagenarians considered for TAVR who underwent CTA using a standard contrast protocol (n=21) versus a protocol incorporating low-dose contrast in patients at risk of CIN (n=33). We compared clinical characteristics, CTA image quality (score 1-4) and interpretability, and clinical outcomes, including CIN and vascular complications. RESULTS The mean age was 88.5±4.0 years, 37% were male, and chronic renal insufficiency was common in both the standard and low-dose contrast cohorts (57% vs. 70%, P=.39). The low-dose contrast protocol was associated with a significantly less contrast volume compared to standard contrast protocol (127±18 ml vs 76±55 ml, P<.001). Individuals imaged using low-dose (n=16) versus standard (n=17) contrast protocols received 80% less contrast volume (23±10 vs. 125±23 ml, P<.001). There was similar graded image quality (3.8±0.4 vs. 3.9±0.3, P=.76) and interpretability (100% for each, P=1.0) between standard and low-dose contrast protocol groups. There was no significant difference in rates of CIN after CTA between standard and low-dose contrast protocol groups (10% vs. 3%, P=.55), with no CIN events in those imaged by low-dose CTA. There were no major vascular injuries associated with TAVR or pigtail insertion, no major bleeding for CTA, and no noninterpretable studies in all patients. CONCLUSION In this proof-of-principle study, a low-dose contrast protocol appears feasible and safe in octogenarians and nonagenarians undergoing screening for TAVR, and results in significant reduction in contrast load as compared to a standard contrast protocol without observed differences in image quality or safety.
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Affiliation(s)
- Micheas Zemedkun
- Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Troy M LaBounty
- Departments of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Geoffrey Bergman
- Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Shing-Chiu Wong
- Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Fay Y Lin
- Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Dolores Reynolds
- Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Millie Gomez
- Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Allison M Dunning
- Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Jonathon Leipsic
- Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - James K Min
- Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
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He C, Yang JG, Li YM, Rong J, Du FZ, Yang ZG, Gu M. Comparison of lower extremity atherosclerosis in diabetic and non-diabetic patients using multidetector computed tomography. BMC Cardiovasc Disord 2014; 14:125. [PMID: 25252783 PMCID: PMC4182836 DOI: 10.1186/1471-2261-14-125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 09/22/2014] [Indexed: 11/18/2022] Open
Abstract
Background Lower extremity atherosclerosis (LEA) is among the most serious diabetic complications and leads to non-traumatic amputations. The recently developed dual-source CT (DSCT) and 320- multidetector computed tomography (MDCT) may help to detect plaques more precisely. The aim of our study was to evaluate the differences in LEA between diabetic and non-diabetic patients using MDCT angiography. Methods DSCT and 320-MDCT angiographies of the lower extremities were performed in 161 patients (60 diabetic and 101 non-diabetic). The plaque type, distribution, shape and obstructive natures were compared. Results Compared with non-diabetic patients, diabetic patients had higher peripheral neuropathy, history of cerebrovasuclar infarction and hypertension rates. A total of 2898 vascular segments were included in the analysis. Plaque and stenosis were detected in 681 segments in 60 diabetic patients (63.1%) and 854 segments in 101 non-diabetic patients (46.9%; p <0.05). Regarding these plaques, diabetic patients had a higher incidence of mixed plaques (34.2% vs. 27.1% for non-diabetic patients). An increased moderate stenosis rate and decreased occlusion rate were observed in diabetic patients relative to non-diabetic patients (35.8% vs. 28.3%; and 6.6% vs. 11.4%; respectively). In diabetic patients, 362 (53.2%) plaques were detected in the distal lower leg segments, whereas in non-diabetic patients, 551 (64.5%) plaques were found in the proximal upper leg segments. The type IV plaque shape, in which the full lumen was involved, was detected more frequently in diabetic patients than in non-diabetic patients (13.1% vs. 8.2%). Conclusion Diabetes is associated with a higher incidence of plaque, increased incidence of mixed plaques, moderate stenosis and localisation primarily in the distal lower leg segments. The advanced and non-invasive MDCT could be used for routine preoperative evaluations of LEA.
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Affiliation(s)
| | | | | | | | | | | | - Ming Gu
- Department of Radiology, Chengdu Military General Hospital, Chengdu, Sichuan 610083, China.
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Gupta P, Sinha A, Khandelwal N. Automatic scan triggering software "confused": Computed tomography angiography in foot arteriovenous malformation! Indian J Radiol Imaging 2014; 24:125-8. [PMID: 25024519 PMCID: PMC4094961 DOI: 10.4103/0971-3026.134387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Multidetector computed tomography angiography (MDCTA) has become a well-established modality for limb angiography for a variety of indications. The technique of MDCTA depends on the scanner features including the number of detector rows, rotation speeds and single or dual source energy. Integral to a diagnostic quality CTA is the acquisition timing. Various techniques are available for determining the appropriate timing of scan acquisition which includes fixed delay, test bolus and the bolus tracking technique. The transit times of contrast from the aorta to the peripheral arteries shows a wide variability and is dependent upon the inter individual hemodynamic states. The bolus tracking technique is the most preferred one which allows reliable scan timing with acceptable contrast volume and radiation dose. Pitfalls with all these techniques are well described and we report one such technical pitfall in a case of left foot arteriovenous malformation (AVM) where the bolus tracking technique employed for scan triggering failed to initiate acquisition.
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Affiliation(s)
- Pankaj Gupta
- Department of Radio-diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anindita Sinha
- Department of Radio-diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radio-diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Diagnostic efficiency of low-dose CT angiography compared with conventional angiography in peripheral arterial occlusions. AJR Am J Roentgenol 2014; 201:W906-14. [PMID: 24261398 DOI: 10.2214/ajr.12.10209] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the diagnostic efficiency and radiation dose of peripheral arterial CT angiography (CTA) performed at a low tube voltage of 70 kV in comparison with conventional angiography. SUBJECTS AND METHODS Thirty consecutive patients (body mass index ≤ 25 kg/m(2)) with known or suspected peripheral arterial occlusion diseases underwent both CTA at a low tube voltage of 70 kV and conventional angiography. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of peripheral arterial CTA were evaluated. The radiation dose was recorded. RESULTS Diagnostic CTA images were obtained in all patients. CTA allowed accurate identification, characterization, and measurement of all peripheral arterial occlusive diseases. In conventional angiography, 360 diseased segments were found among the 810 segments evaluated. The sensitivity, specificity, PPV, NPV, and accuracy of CTA were 100% (95% CI, 98.81-100%), 93.5% (90.96-95.36%), 90.86% (87.38-93.45%), 100% (99.17-100%), and 96.05% (94.48-97.19%), respectively, with a kappa value of 0.92 (excellent agreement). The mean CT dose index was 3.71 ± 0.8 mGy, and the dose-length product was 446.6 ± 35.7 mGy × cm. The effective dose was 1.94 ± 0.21 mSv for CTA and 4.41 ± 0.64 mSv for conventional angiography. CONCLUSION CTA of peripheral arteries with a low tube voltage of 70 kV provides reliable information and serves as a rapidly performed and easily available "one-stop-shop" imaging modality in the diagnosis of peripheral arterial occlusion diseases.
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CT angiography of the upper extremity arterial system: Part 2- Clinical applications beyond trauma patients. AJR Am J Roentgenol 2013; 201:753-63. [PMID: 24059364 DOI: 10.2214/ajr.13.11208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE CT angiography using modern MDCT scanners has evolved into a highly accurate noninvasive diagnostic tool for the evaluation of patients with pathologic abnormalities of the upper extremity arterial system. CONCLUSION Here we focus on the use of this modality in patients with nontraumatic vascular pathologic abnormalities.
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Pollak AW, Norton PT, Kramer CM. Multimodality imaging of lower extremity peripheral arterial disease: current role and future directions. Circ Cardiovasc Imaging 2013; 5:797-807. [PMID: 23169982 DOI: 10.1161/circimaging.111.970814] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Amy W Pollak
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
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Oca Pernas R, Delgado Sánchez-Gracián C, Tardáguila de la Fuente G, Fernández Del Valle A, Silva Priegue N, González Vázquez M, Trinidad López C. Comparison of image quality and radiation dose in computed tomography angiography of the peripheral arteries using tube voltage of 80 kV versus 100 kV. RADIOLOGIA 2012; 56:541-7. [PMID: 23276715 DOI: 10.1016/j.rx.2012.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 06/18/2012] [Accepted: 06/28/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the image quality and dose of radiation in two groups of patients undergoing CT angiography of the lower limbs, one with tube voltage of 80 kV and the other with tube voltage of 100 kV. MATERIAL AND METHODS We performed CT angiography of the lower limbs in 60 patients with suspected peripheral arterial disease. Patients were randomly assigned to one of two groups; in one group, CT angiography was performed using a tube voltage of 80kV, whereas in the other it was performed using 100 kV. The remaining acquisition parameters were the same in both groups. The images were analyzed by quantifying vascular density (VD) and noise (N) and by calculating the quotients density/noise (QVDN) and contrast/noise (QCN). Two radiologists working independently evaluated the subjective quality of the images. We calculated the estimated effective dose (EED) based on the dose-length product (DLP). RESULTS In the group studied at 80 kV, VD was significantly higher (462.5 UH ± 95.6 vs. 372 UH ± 100.9; P<.001), QVDN was significantly higher (241.9 ± 48.1 vs. 194.3 ± 49.6; P<.001), and there were trends toward higher N (21.3 UH ± 13 vs. 16.3 UH ± 3.5; P=.098) and toward higher QCN (21.4 ± 12.1 vs. 22.9 ± 9.1; P=.15). No significant differences were found in the subjective quality of the images. The EED was significantly lower in the group studied at 80 kV (4.73 mSv ± 1.1 vs. 9.6 mSv ± 2.2; P<.001). CONCLUSION Using 80 kV instead of 100 kV for CT angiography of the lower limbs reduces the dose of radiation without affecting the diagnostic efficacy of the study.
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Affiliation(s)
- R Oca Pernas
- Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, España.
| | | | | | | | - N Silva Priegue
- Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, España
| | | | - C Trinidad López
- Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, España
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Diagnostic accuracy of dynamic computed tomographic angiographic of the lower leg in patients with critical limb ischemia. Invest Radiol 2012; 47:325-31. [PMID: 22543967 DOI: 10.1097/rli.0b013e3182479c77] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the diagnostic accuracy of dynamic computed tomographic angiography (dyn-CTA) in patients with critical lower leg ischemia. MATERIALS AND METHODS A population of 29 patients with known peripheral arterial occlusive disease (Fontaine stage III or IV) was examined with a combined CTA protocol consisting of a standard CTA (s-CTA) of the lower leg runoff from the diaphragm to the toes and dyn-CTA of the calves (scan range, 48 cm; 8 phases; 3.5 seconds per phase, 100 kV; 120 mAs; contrast volume, 50 mL; flow rate, 5.0 mL/s). Digital subtraction angiography was performed on all patients and served as a reference standard. For each of seven lower leg artery segments, arterial contrast and diagnostic confidence for stenosis assessment (3-point scale) were tested for s-CTA and dyn-CTA. Similarly, stenoses of calf-segments were classified on a 3-point scale separately for s-CTA and dyn-CTA and were compared with digital subtraction angiography to assess diagnostic accuracy. RESULTS Compared with s-CTA, dyn-CTA resulted in significantly higher arterial contrast enhancement (68% vs 46% optimal contrast; P < 0.01) and higher diagnostic confidence (64% vs 48% fully confident, respectively, P < 0.05). Dyn-CTA had a slightly higher sensitivity for the detection of significant stenosis (98.0% vs 96.6%), and for the detection of occlusion (95.4% vs 94.4%). Specificity for dyn-CTA was higher than for s-CTA, both for detection of stenosis (97.1% vs 92.2%) and especially for the detection of vessel occlusions (99.3% vs 94.4%; P < 0.05). CONCLUSIONS Compared with s-CTA, dyn-CTA provides improved arterial contrast enhancement, higher diagnostic confidence, and increased diagnostic accuracy for the detection of stenoses and occlusions in peripheral arterial occlusive disease patients.
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Abstract
Non-invasive vascular studies can provide crucial information on the presence, location, and severity of critical limb ischaemia (CLI), as well as the initial assessment or treatment planning. Ankle-brachial index with Doppler ultrasound, despite limitations in diabetic and end-stage renal failure patients, is the first-line evaluation of CLI. In this group of patients, toe-brachial index measurement may better establish the diagnosis. Other non-invasive measurements, such as segmental limb pressure, continuous-wave Doppler analysis and pulse volume recording, are of limited accuracy. Transcutaneous oxygen pressure (TcPO(2)) measurement may be of value when rest pain and ulcerations of the foot are present. Duplex ultrasound is the most important non-invasive tool in CLI patients combining haemodynamic evaluation with imaging modality. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the next imaging studies in the algorithm for CLI. Both CTA and MRA have been proven effective in aiding the decision-making of clinicians and accurate planning of intervention. The data acquired with CTA and MRA can be manipulated in a multiplanar and 3D fashion and can offer exquisite detail. CTA results are generally equivalent to MRA, and both compare favourably with contrast angiography. The individual use of different imaging modalities depends on local availability, experience, and costs. Contrast angiography represents the gold standard, provides detailed information about arterial anatomy, and is recommended when revascularisation is needed.
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Shah DJ, Lim TH. Evaluation of meglumine gadoterate-enhanced MR angiography (MRA) compared with time-of-flight MRA in the diagnosis of clinically significant non-coronary arterial disease: a pooled analysis of data from two clinical trials. Br J Radiol 2011; 85:596-605. [PMID: 22167518 DOI: 10.1259/bjr/16406056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We analysed pooled data from two clinical trials to assess the diagnostic accuracy and safety of meglumine gadoterate (Gd-DOTA)-enhanced MR angiography (MRA) relative to those of non-enhanced time-of-flight (TOF) MRA for non-coronary arterial disease. Both techniques were compared with X-ray angiography as the gold standard. METHODS Patients were of both sexes, were aged at least 18 years and had suspected non-coronary arterial disease. Each patient was his/her own control and underwent TOF MRA followed by Gd-DOTA-enhanced MRA, and then X-ray angiography. MRA was performed at 1.5 T (USA study) or 3 T (Republic of Korea study). The primary criterion used to evaluate efficacy was the degree to which the MRA examination agreed with X-ray angiography in assessing non-coronary arterial lesions. The performance of Gd-DOTA over TOF was assessed using a one-sided paired t-test. We also evaluated the specificity, sensitivity, image quality, examination duration and clinical safety of both MRA procedures. RESULTS In total, 192 patients were enrolled and received Gd-DOTA. In the intent-to-treat population (n=162), within-patient accuracy was significantly greater for Gd-DOTA than for TOF (85.8 ± 19.8% agreement between Gd-DOTA and X-ray angiography compared with 78.3 ± 24.9% agreement between TOF and X-ray angiography; p=0.0001). The sensitivity, specificity, image quality and examination duration were also better for Gd-DOTA than for TOF. There were no serious drug-related adverse events. CONCLUSION We conclude that Gd-DOTA-enhanced MRA is a safe and accurate procedure for detecting arterial stenosis at both 1.5 T and 3 T.
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Affiliation(s)
- D J Shah
- Cardiac Magnetic Resonance Imaging, Weill Cornell Medical College, The Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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Csébi P, Németh T, Jakab C, Patonai A, Garamvölgyi R, Manczur F, Spitzner Á, Arany-Tóth A, Kóbori L. Experimental results of using autologous rectus fascia sheath for venous patch grafts in dogs. Acta Vet Hung 2011; 59:373-84. [PMID: 21727069 DOI: 10.1556/avet.2011.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Autologous vascular patch grafts developed from the internal rectus sheath were implanted onto the bilateral common iliac vein and jugular vein of 4 experimental beagle dogs. During the development and implanting of the grafts no technical difficulties or perioperative complications were encountered. The follow-up lasted 6 months and 3 months in the case of the common iliac vein grafts and the jugular grafts, respectively. In the postoperative period, the morphological and functional characteristics of the implanted venous sections were examined by Doppler ultrasonography and CT angiography. Normal patency was detected, and none of these check-ups showed obturation or stenosis. The histological survey showed no mesothelial cell layer, but the insides of the grafts showed total restructuring and were covered by a normal endothelial layer. No difference could be detected between samples harvested 3 and 6 months after implanting. The immunohistochemical examinations using anti-claudin-5 and anti-CD31 antibodies confirmed the preliminary results of the histological examinations that the luminal surfaces of the implanted grafts developed a differentiated monolayer endothelium which was free of degenerative and inflammatory signs. The control examinations show the suitability of the internal rectus sheath as a venous wall donor.
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Affiliation(s)
- Péter Csébi
- 1 Szent István University Department and Clinic of Surgery and Ophthalmology István u. 2 H-1078 Budapest Hungary
| | - Tibor Németh
- 1 Szent István University Department and Clinic of Surgery and Ophthalmology István u. 2 H-1078 Budapest Hungary
| | - Csaba Jakab
- 2 Szent István University Department of Pathology and Forensic Veterinary Medicine István u. 2 H-1078 Budapest Hungary
| | - Attila Patonai
- 5 Semmelweis University Medical School 2nd Department of Pathology Budapest Hungary
| | - Rita Garamvölgyi
- 4 University of Kaposvár Institute of Diagnostic Imaging and Radiation Oncology Kaposvár Hungary
| | - Ferenc Manczur
- 3 Szent István University Department and Clinic of Internal Medicine, Faculty of Veterinary Science István u. 2 H-1078 Budapest Hungary
| | - Ádám Spitzner
- 1 Szent István University Department and Clinic of Surgery and Ophthalmology István u. 2 H-1078 Budapest Hungary
| | - Attila Arany-Tóth
- 1 Szent István University Department and Clinic of Surgery and Ophthalmology István u. 2 H-1078 Budapest Hungary
| | - László Kóbori
- 6 Semmelweis University Medical School Transplantation and Surgical Department Budapest Hungary
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Lee IJ, Chung JW, Hong H, Yin YH, Kim S, Park EA, Lee W. Subtraction CT angiography of the lower extremities: single volume subtraction versus multi-segmented volume subtraction. Acad Radiol 2011; 18:902-9. [PMID: 21420330 DOI: 10.1016/j.acra.2011.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 01/26/2011] [Accepted: 01/27/2011] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES To validate the hypothesis that a multisegmented approach during subtraction computed tomography (CT) angiography of the lower extremities can improve bone removal efficiency by suppressing regional motion. MATERIALS AND METHODS The institutional review board of our hospital approved this retrospective study. One hundred and one consecutive patients that had undergone the lower extremity CT angiography were included in this study. Subtraction CT angiography was performed using two different methods, namely, by single volume subtraction and by multisegmented volume subtraction. Multisegmented volume subtraction was conducted by dividing the whole volume of the CT data into three segments along the z axis of the lower extremities, performing a subtraction process for each segment, and combining segments to form as single subtracted volume. The bone removal efficiencies of the two methods was assessed by analyzing bone subtraction scores on maximum intensity projection (MIP) images for each bone segment in a blinded fashion. In addition, overall MIP image qualities were compared by displaying MIP images produced using the two methods side by side. Differences between bone subtraction scores were tested using Wilcoxon's signed rank test. RESULTS Multisegmented volume subtraction MIP images demonstrated significantly better bone removal for the following bone segments: pelvis (P < .0001), hip (P = .0002), thigh (P = .0258), knee (P = .0004), ankle (P = .0008), metatarsal bone (P < .0001), and toes (P < .0001). Overall bone subtraction score and subjective image qualities determined by performing side-by-side comparisons were better for the multisegmented volume subtraction method. CONCLUSION Bone removal performance and overall MIP image quality can be increased by adopting multisegmented volume subtraction during subtraction CT angiography of the lower extremities.
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Affiliation(s)
- In Joon Lee
- Department of Radiology, Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul National University Medical Research Center, Clinical Research Institute, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744
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Kau T, Eicher W, Reiterer C, Niedermayer M, Rabitsch E, Senft B, Hausegger KA. Dual-energy CT angiography in peripheral arterial occlusive disease—accuracy of maximum intensity projections in clinical routine and subgroup analysis. Eur Radiol 2011; 21:1677-86. [DOI: 10.1007/s00330-011-2099-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 01/29/2011] [Indexed: 11/30/2022]
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Thévenin FS, Drapé JL, Biau D, Campagna R, Richarme D, Guerini H, Chevrot A, Larousserie F, Babinet A, Anract P, Feydy A. Assessment of vascular invasion by bone and soft tissue tumours of the limbs: usefulness of MDCT angiography. Eur Radiol 2009; 20:1524-31. [DOI: 10.1007/s00330-009-1678-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 09/18/2009] [Accepted: 09/18/2009] [Indexed: 11/28/2022]
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Schwab SA, Kuefner MA, Anders K, Adamietz B, Heinrich MC, Baigger JF, Janka R, Uder M, Kramer M. Peripheral intravenous power injection of iodinated contrast media: the impact of temperature on maximum injection pressures at different cannula sizes. Acad Radiol 2009; 16:1502-8. [PMID: 19896067 DOI: 10.1016/j.acra.2009.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 07/22/2009] [Accepted: 07/24/2009] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES Modern computed tomographic scanners and examination protocols often require high injection rates of iodinated contrast media (CM). The purpose of this study was to investigate the maximum injection pressures (MIPs) with different CM at different temperatures in the most common intravenous cannula (IVC) sizes. MATERIALS AND METHODS Three IVC sizes, 22, 20, and 18 gauge, were evaluated. All examinations were performed with a pressure-limited (300 psi) power injector. The MIPs of three different CM (Solutrast 300, Imeron 350, and Imeron 400) were measured at room temperature (20 degrees C) and at 37 degrees C using increasing flow rates (1-9 mL/s). The intactness of the IVCs was checked after injection. RESULTS Heating the CM led to reductions in injection pressures (P < .001). Using constant flow rates, the difference in MIP between 20-gauge and 22-gauge IVCs was higher than that between 20-gauge and 18-gauge IVCs. By heating the CM, the manufacturer's suggested operating pressure limit was exceeded at higher flow rates, such as with an 18-gauge cannula at 8 mL/s instead of 6 mL/s using warmed iomeprol 400. Even with pressures of up to 159.7 psi, none of the IVCs ruptured. CONCLUSIONS Heating of CM effectively reduces MIPs using power injection in common IVCs. Although the manufacturer's suggested MIP was exceeded at higher flow rates, safe CM injection seems to be possible even in small cannulas using power injection. The compilation of the obtained data is meant to serve as guidance for future decisions on parameters of the power injection of iodinated CM.
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Affiliation(s)
- Siegfried A Schwab
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, D-91054 Erlangen, Germany.
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Dual-energy CT angiography of pelvic and lower extremity arteries: dual-energy bone subtraction versus manual bone subtraction. Clin Radiol 2009; 64:1088-96. [DOI: 10.1016/j.crad.2009.07.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 07/08/2009] [Accepted: 07/13/2009] [Indexed: 11/19/2022]
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Stecker MS, Balter S, Towbin RB, Miller DL, Vañó E, Bartal G, Angle JF, Chao CP, Cohen AM, Dixon RG, Gross K, Hartnell GG, Schueler B, Statler JD, de Baère T, Cardella JF. Guidelines for patient radiation dose management. J Vasc Interv Radiol 2009; 20:S263-73. [PMID: 19560006 DOI: 10.1016/j.jvir.2009.04.037] [Citation(s) in RCA: 315] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 04/01/2009] [Accepted: 04/02/2009] [Indexed: 12/13/2022] Open
Affiliation(s)
- Michael S Stecker
- Department of Angiography & Interventional Radiology, Brigham & Women's Hospital, Boston, Massachusetts, USA.
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Ultra-fast carotid CT-angiography: low versus standard volume contrast material protocol for a 128-slice CT-system. Invest Radiol 2009; 44:257-64. [PMID: 19550377 DOI: 10.1097/rli.0b013e31819b08a0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Noninvasive imaging is increasingly accepted for the evaluation of atherosclerotic disease of the carotid arteries. We sought to evaluate the feasibility of a low-contrast media volume protocol for carotid computed tomography angiography (CTA) using a 128-slice-spiral-computed tomography scanner with a gantry rotation time of 300 milliseconds. METHODS AND MATERIALS Thirty consecutive patients underwent CTA for the evaluation of the carotid vessels, with a 128-section scanner. Fifteen patients were examined with a standard volume contrast injection protocol (group A): 80 mL of contrast material (CM) were injected at 5 mL/s using the test bolus method to assess individual transit time. Another 15 patients were examined with a low-volume contrast media protocol (group B): 30 mL CM were injected at 4 mL/s using bolus tracking to trigger the CTA acquisition. In both groups, contrast administration was followed by a saline flush. Image quality and segmental vascular enhancement as well as the presence and degree of arterial stenosis were independently evaluated by 2 radiologists. Venous enhancement and streak artifacts at the thoracic inlet because of highly concentrated CM in the subclavian veins were evaluated in both groups. Kappa statistic and Pearson correlation coefficient were used to quantify interobserver variability. Qualitative data were compared using the Wilcoxon signed rank test and student t test was used to investigate differences in segmental vessel attenuation. RESULTS All studies were of diagnostic quality in both groups. Interobserver agreement was high (kappa = 0.82, group A; kappa = 0.78, group B). Attenuation measurement showed excellent interobserver correlation in both groups (r > 0.9). Mean enhancement values were slightly higher in group A, but without statistical significance when averaged for all segments (P = 0.06). Streak artifacts impaired evaluation of 13 adjacent arterial segments in 8 patients at the level of the thoracic inlet in group A. In group B, only 1 segment was rated insufficient by both radiologists. Venous enhancement was significantly lower in group B (P = 0.04). The low-contrast protocol proved to be the more robust method with constant high arterial enhancement, less streak artifacts at the thoracic inlet, and less venous overlay. CONCLUSION Using the latest CT technology, optimal depiction of the craniocervical arteries can be archived with a low-volume (30 mL) CM protocol.
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Halász S, Puskás T. The importance of multidetector computed tomography in the vascular imaging. Orv Hetil 2009; 150:1351-60. [DOI: 10.1556/oh.2009.28664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A több detektorsoros spirál-CT-berendezések és a hozzájuk tartozó speciális rekonstrukciós szoftverek bevezetése lehetővé tette az erek jó minőségű CT-vizsgálatát.
Cél és módszerek:
A szerzők ismertetik a CT-angiográfiai vizsgálatok elvét, technikáját, amelyet az elmúlt három évben közel 700 saját betegükön végzett vizsgálataik eredményeivel, tapasztalataival egészítenek ki. Bemutatják a CT-angiográfia jelentőségét, valamint annak más vascularis képalkotó eljárások helyett vagy melletti alkalmazhatóságát.
Következtetések:
A CT-angiográfia gyors, noninvazív vizsgálati módszer, amellyel – önmagában vagy más vizsgálattal kiegészítve – pontos diagnózis állítható fel.
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Affiliation(s)
- Szabolcs Halász
- 1 Vas Megyei Markusovszky Kórház Nonprofit Zrt. Radiológiai Osztály, Diagnosztikai Részleg Szombathely Szent Flórián krt. 39. 9700
| | - Tamás Puskás
- 1 Vas Megyei Markusovszky Kórház Nonprofit Zrt. Radiológiai Osztály, Diagnosztikai Részleg Szombathely Szent Flórián krt. 39. 9700
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RODITI G, KUSUMAWIDJAJA D. Magnetic resonance angiography and computed tomography angiography for peripheral arterial disease. IMAGING 2009. [DOI: 10.1259/imaging/55671114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Türkvatan A, Altınsoy D, Küçüker Ş, Cumhur T. Multidetector CT angiography in spontaneous popliteal artery dissection. J Cardiovasc Comput Tomogr 2009; 3:180-1. [DOI: 10.1016/j.jcct.2009.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2008] [Revised: 02/05/2009] [Accepted: 03/05/2009] [Indexed: 10/21/2022]
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The Value of Dual-Energy Bone Removal in Maximum Intensity Projections of Lower Extremity Computed Tomography Angiography. Invest Radiol 2009; 44:285-92. [DOI: 10.1097/rli.0b013e31819b70ba] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shah N, Anderson SW, Vu M, Pieroni S, Rhea JT, Soto JA. Extremity CT angiography: application to trauma using 64-MDCT. Emerg Radiol 2009; 16:425-32. [DOI: 10.1007/s10140-009-0805-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 02/27/2009] [Indexed: 10/21/2022]
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Lin PH, Bechara C, Kougias P, Huynh TT, LeMaire SA, Coselli JS. Assessment of aortic pathology and peripheral arterial disease using multidetector computed tomographic angiography. Vasc Endovascular Surg 2008; 42:583-98. [PMID: 18621886 DOI: 10.1177/1538574408320029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The development of multidetector computed tomography represents a remarkable diagnostic advancement because this imaging modality has been widely used in the evaluation of the cardiovascular system. With scanner-adjusted image acquisition and contrast medium administration, multidetector computed tomographic angiography provides a cost-effective and accurate imaging assessment in patients with aortic pathologies or peripheral arterial occlusive disease. Multidetector computed tomographic angiography is associated with several advantages, including high image spatial resolution and rapid imaging acquisition speed. This diagnostic methodology allows accurate detection of a variety of intravascular lesions in the carotid artery, thoracic and abdominal aorta, renal arteries, and peripheral arterial systems. This article provides an overview of multidetector computed tomographic angiography in the assessment of arterial disease and reviews current literature about this diagnostic technology in the evaluation of aortic and peripheral arterial pathologies.
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Affiliation(s)
- Peter H Lin
- Division of Vascular Surgery and Endovascular Therapy, Houston, Texas, USA.
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