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Sah BR, Veit-Haibach P, Strobel K, Banyai M, Huellner MW. CT-perfusion in peripheral arterial disease - Correlation with angiographic and hemodynamic parameters. PLoS One 2019; 14:e0223066. [PMID: 31560706 PMCID: PMC6764684 DOI: 10.1371/journal.pone.0223066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 09/12/2019] [Indexed: 12/14/2022] Open
Abstract
Objective The purpose of this study was the assessment of volumetric CT-perfusion (CTP) of the lower leg musculature in patients with symptomatic peripheral arterial disease (PAD) of the lower extremities, comparing it with established angiographic and hemodynamic parameters. Materials and methods Thirty-five consecutive patients with symptomatic PAD of the lower extremities requiring interventional revascularization were assessed prospectively. All patients underwent a CTP scan of the lower leg, and hemodynamic and angiographic assessment. Hemodynamic parameters, specifically ankle-brachial pressure index (ABI), ankle blood pressure (ABP), peak systolic velocity (PSV), and segmental pulse oscillography (SPO) level, were determined. Lesion length and degree of collateralization were assessed by interventional angiography. CTP parameters were calculated with a perfusion software, acting on a no outflow assumption. A sequential two-compartment model was used. Differences in CTP parameters and correlations between CTP, hemodynamic and angiographic parameters were assessed with non-parametric tests. Results The cohort consisted of 27 subjects with an occlusion, and eight with a high-grade stenosis. The mean blood flow (BF) was 7.71 ± 2.96 ml/100ml*min-1, mean blood volume (BV) 0.71 ± 0.33 ml/100ml, and mean mean transit time (MTT) 7.22 ± 2.66 s. BF and BV were higher in subjects with longer lesions, and BV was higher in subjects with lower ABI. Significant correlations were found between lesion length and BV (r = 0.65) and BF (r = 0.52). Significant inverse correlations were found between BV and ABI and between BV and ABP (r = -0.56, for both correlations). Conclusions In our study, we have shown the feasibility of CTP for the assessment of PAD. In the future, this quantitative method might serve as a non-invasive method, possibly complementing the diagnostic workup of patients with peripheral arterial disease.
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Affiliation(s)
- Bert-Ram Sah
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
- Department of Cancer Imaging, King’s College London, London, England, United Kingdom
- * E-mail:
| | - Patrick Veit-Haibach
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Klaus Strobel
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Martin Banyai
- Department of Internal Medicine, Subdivision of Angiology, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Martin W. Huellner
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
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Hur S, Jae HJ, Jang Y, Min SK, Min SI, Lee DY, Seo SG, Kim HC, Chung JW, Kim KG, Park EA, Lee W. Quantitative Assessment of Foot Blood Flow by Using Dynamic Volume Perfusion CT Technique: A Feasibility Study. Radiology 2015; 279:195-206. [PMID: 26444663 DOI: 10.1148/radiol.2015150560] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To demonstrate the feasibility of foot blood flow measurement by using dynamic volume perfusion computed tomographic (CT) technique with the upslope method in an animal experiment and a human study. MATERIALS AND METHODS The human study was approved by the institutional review board, and written informed consent was obtained from all patients. The animal study was approved by the research animal care and use committee. A perfusion CT experiment was first performed by using rabbits. A color-coded perfusion map was reconstructed by using in-house perfusion analysis software based on the upslope method, and the measured blood flow on the map was compared with the reference standard microsphere method by using correlation analysis. A total of 17 perfusion CT sessions were then performed (a) once in five human patients and (b) twice (before and after endovascular revascularization) in six human patients. Perfusion maps of blood flow were reconstructed and analyzed. The Wilcoxon signed rank test was used to prove significant differences in blood flow before and after treatment. RESULTS The animal experiment demonstrated a strong correlation (R(2) = 0.965) in blood flow between perfusion CT and the microsphere method. Perfusion maps were obtained successfully in 16 human clinical sessions (94%) with the use of 32 mL of contrast medium and an effective radiation dose of 0.31 mSv (k factor for the ankle, 0.0002). The plantar dermis showed the highest blood flow among all anatomic structures of the foot, including muscle, subcutaneous tissue, tendon, and bone. After a successful revascularization procedure, the blood flow of the plantar dermis increased by 153% (P = .031). The interpretations of the color-coded perfusion map correlated well with the clinical and angiographic findings. CONCLUSION Perfusion CT could be used to measure foot blood flow in both animals and humans. It can be a useful modality for the diagnosis of peripheral arterial disease by providing quantitative information on foot perfusion status.
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Affiliation(s)
- Saebeom Hur
- From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.)
| | - Hwan Jun Jae
- From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.)
| | - Yeonggul Jang
- From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.)
| | - Seung-Kee Min
- From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.)
| | - Sang-Il Min
- From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.)
| | - Dong Yeon Lee
- From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.)
| | - Sang Gyo Seo
- From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.)
| | - Hyo-Cheol Kim
- From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.)
| | - Jin Wook Chung
- From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.)
| | - Kwang Gi Kim
- From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.)
| | - Eun-Ah Park
- From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.)
| | - Whal Lee
- From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.)
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