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Ghirardini F, Martini R. Current Opinion on Diagnosis of Peripheral Artery Disease in Diabetic Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1179. [PMID: 39064610 PMCID: PMC11279131 DOI: 10.3390/medicina60071179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Peripheral arterial disease (PAD) prevalence and diabetes mellitus (DM) prevalence are continuously increasing worldwide. The strong relationship between DM and PAD is highlighted by recent evidence. PAD diagnosis in diabetic patients is very important, particularly in patients with diabetic foot disease (DFD); however, it is often made difficult by the characteristics of such diseases. Diagnosing PAD makes it possible to identify patients at a very high cardiovascular risk who require intensive treatment in terms of risk factor modification and medical therapy. The purpose of this review is to discuss the diagnostic methods that allow for a diagnosis of PAD in diabetic patients. Non-invasive tests that address PAD diagnosis will be discussed, such as the ankle-brachial index (ABI), toe pressure (TP), and transcutaneous oxygen pressure (TcPO2). Furthermore, imaging methods, such as duplex ultrasound (DUS), computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA), are described because they allow for diagnosing the anatomical localization and severity of artery stenosis or occlusion in PAD. Non-invasive tests will also be discussed in terms of their ability to assess foot perfusion. Foot perfusion assessment is crucial in the diagnosis of critical limb ischemia (CLI), the most advanced PAD stage, particularly in DFD patients. The impacts of PAD diagnosis and CLI identification in diabetic patients are clinically relevant to prevent amputation and mortality.
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Affiliation(s)
| | - Romeo Martini
- Department of Angiology, San Martino Hospital, 32100 Belluno, Italy;
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2
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Scheschenja M, König A, Viniol S, Bastian MB, Wessendorf J, Mahnken AH. CT angiography of the lower limbs: combining small field of view with large matrix size and iterative reconstruction further improves image quality of below-the-knee arteries. Acta Radiol 2024; 65:774-783. [PMID: 38841768 DOI: 10.1177/02841851241258655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Image quality and diagnostic accuracy in computed tomography angiography (CTA) reach their limits in imaging of below-the-knee vessels. PURPOSE To evaluate whether image quality in CTA of lower limbs is further improvable by combining side-separate reconstruction with a larger matrix size and whether resulting noise can be compromised with iterative reconstruction (IR). MATERIAL AND METHODS From CTA of the lower extremities of 26 patients (5 women, 21 men; mean age = 68.5 ± 10.3 years), the lower legs were reconstructed side-separately with different reconstruction algorithms and matrix sizes including filtered back projection (FBP) with a 512 × 512 matrix, FBP with a 1024 × 1024 matrix, IR (SAFIRE) with a 512 × 512 matrix, and IR (SAFIRE) with a 1024 × 1024 matrix. A total of 208 CT series were evaluated. Subjective image quality was assessed by two readers using a 5-point Likert scale. Image noise was assessed by measuring signal-to-noise and contrast-to-noise ratios. RESULTS Subjective image quality was rated significantly higher when using a 1024 × 1024 matrix (P < 0.001) and could further be increased with IR. Vessel sharpness was rated significantly better with a larger matrix (P < 0.001). Visible and measured image noise was significantly higher with a 1024 × 1024 matrix but could be reduced by using IR (P < 0.001), even to a level below FBP with a 512 × 512 matrix while reconstructing with a larger matrix (P < 0.001). CONCLUSION Image quality, image noise, and vessel sharpness can be further improved in CTA of the lower extremities with side-separate reconstruction using a 1024 × 1024 matrix size and IR.
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Affiliation(s)
- Michael Scheschenja
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, Marburg, Germany
| | - Alexander König
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, Marburg, Germany
| | - Simon Viniol
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, Marburg, Germany
| | - Moritz B Bastian
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, Marburg, Germany
| | - Joel Wessendorf
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, Marburg, Germany
| | - Andreas H Mahnken
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, Marburg, Germany
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3
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Cheng TW, Doros G, Jones DW, Vazirani A, Malikova MA. Evaluation of Computerized Tomography Utilization in Comparison to Digital Subtraction Angiography in Patients with Peripheral Arterial Disease. Ann Vasc Surg 2024:S0890-5096(24)00165-1. [PMID: 38582215 DOI: 10.1016/j.avsg.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 02/28/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Perform literature review to analyze current practices in imaging patient with peripheral arterial disease (PAD) and examine patterns in our practice in order to assess whether a lower extremity computed tomography angiography (CTA) in addition to digital subtraction angiography enhanced the assessment of vessel calcification, percentage of stenosis, and affected outcomes in patients with PAD. METHODS The study included patients who underwent lower extremity imaging and were followed up to 12 months. This population was divided into cases who had both an angiogram and CTA performed within 30 days (n = 20), and controls who underwent angiography only (n = 19). Baseline characteristics, imaging results, and clinical outcomes were analyzed. RESULTS Thirty-nine patients met study criteria (mean age was 58.4 years, 69.2% were males, and 33.3% had diabetes). Patients mostly presented with tissue loss/rest pain (10.3%), claudication (15.4%), acute limb (10.3%), and trauma (15.4%). We have not observed any statistically significant differences in various examined blood vessels when their features (e.g., vessel diameter, stenosis, calcifications) were assessed by CTA combined with angiography versus angiography alone. The exceptions were external iliac artery, superficial femoral artery and dorsalis pedis vessels. In external iliac artery percentage of stenosis was 1.11% as determined by computed tomography (CT) scan versus 30% by angiography (P = 0.009). For superficial femoral artery stenosis, the percentage determined by CT was 48.68% vs. 81.41% by angiography, and observed difference between 2 modalities was statistically significant (P = 0.025). For dorsalis pedis percentage of stenosis detected by CT scan was 60.63% vs. 22.73% by angiography, and the differences in findings by these modalities were statistically significant (P = 0.039). The most frequent perioperative complication was cardiac-related (35.5%). Nineteen patients were readmitted and 8 had reinterventions within 12 months. CONCLUSIONS Both imaging modalities yielded similar results for assessing vessel calcification and percentage of stenosis regardless of anatomic vessel location. Overall, utilization of CTA in addition to angiography for large vessels above the knee (e.g., iliac artery, superficial femoral artery) and below the knee for dorsalis pedis provided more detailed information on the properties of these vessels. Therefore, during preoperative assessments, CTA may be helpful in addition to angiography for planning surgical and endovascular interventions for symptomatic PAD treatment in larger vessels.
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Affiliation(s)
- Thomas Wei Cheng
- Vascular Surgery Residency Program, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Gheorghe Doros
- Department of Biostatistics, Boston University, Boston, MA
| | | | - Aniket Vazirani
- General Surgery Residency Program, Jefferson Abington Hospital, Philadelphia, PA
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Shu G, Zhao L, Li F, Jiang Y, Zhang X, Yu C, Pan J, Sun SK. Metallic artifacts-free spectral computed tomography angiography based on renal clearable bismuth chelate. Biomaterials 2024; 305:122422. [PMID: 38128318 DOI: 10.1016/j.biomaterials.2023.122422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
Computed tomography angiography (CTA) is one of the most important diagnosis techniques for various vascular diseases in clinic. However, metallic artifacts caused by metal implants and calcified plaques in more and more patients severely hinder its wide applications. Herein, we propose an improved metallic artifacts-free spectral CTA technique based on renal clearable bismuth chelate (Bi-DTPA dimeglumine) for the first time. Bi-DTPA dimeglumine owns the merits of ultra-simple synthetic process, approximately 100% of yield, large-scale production capability, good biocompatibility, and favorable renal clearable ability. More importantly, Bi-DTPA dimeglumine shows superior contrast-enhanced effect in CTA compared with clinical iohexol at a wide range of X-ray energies especially in higher X-ray energy. In rabbits' model with metallic transplants, Bi-DTPA dimeglumine assisted-spectral CTA can not only effectively mitigate metallic artifacts by reducing beam hardening effect under high X-ray energy, but also enables accurate delineation of vascular structure. Our proposed strategy opens a revolutionary way to solve the bottleneck problem of metallic artifacts in CTA examinations.
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Affiliation(s)
- Gang Shu
- School of Medical Imaging, Tianjin Medical University, Tianjin, 300203, China; Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Lu Zhao
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Fengtan Li
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yingjian Jiang
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xuening Zhang
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Chunshui Yu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jinbin Pan
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| | - Shao-Kai Sun
- School of Medical Imaging, Tianjin Medical University, Tianjin, 300203, China.
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5
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Boonen PT, Buls N, van Gompel G, Devos H, de Brucker Y, Leiner T, Aerden D, de Mey J, Vandemeulebroucke J. Quantitative hemodynamic assessment of stenotic below-the-knee arteries using spatio-temporal bolus tracking on 4D-CT angiography. Med Phys 2023; 50:6844-6856. [PMID: 37750537 DOI: 10.1002/mp.16755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) is a chronic occlusive disease that restricts blood flow in the lower limbs, causing partial or complete blockages of the blood flow. While digital subtraction angiography (DSA) has traditionally been the preferred method for assessing blood flow in the lower limbs, advancements in wide beam Computed Tomography (CT), allowing successive acquisition at high frame rate, might enable hemodynamic measurements. PURPOSE To quantify the arterial blood flow in stenotic below-the-knee (BTK) arteries. To this end, we propose a novel method for contrast bolus tracking and assessment of quantitative hemodynamic parameters in stenotic arteries using 4D-CT. METHODS Fifty patients with suspected PAD underwent 4D-CT angiography in addition to the clinical run-off computed tomography angiography (CTA). From these dynamic acquisitions, the BTK arteries were segmented and the region of maximum blood flow was extracted. Time attenuation curves (TAC) were estimated using 2D spatio-temporal B-spline regression, enforcing both spatial and temporal smoothness. From these curves, quantitative hemodynamic parameters, describing the shape of the propagating contrast bolus were automatically extracted. We evaluated the robustness of the proposed TAC fitting method with respect to interphase delay and imaging noise and compared it to commonly used approaches. Finally, to illustrate the potential value of 4D-CT, we assessed the correlation between the obtained hemodynamic parameters and the presence of PAD. RESULTS 280 out of 292 arteries were successfully segmented, with failures mainly due to a delayed contrast arrival. The proposed method led to physiologically plausible hemodynamic parameters and was significantly more robust compared to 1D temporal regression. A significant correlation between the presence of proximal stenoses and several hemodynamic parameters was found. CONCLUSIONS The proposed method based on spatio-temporal bolus tracking was shown to lead to stable and physiologically plausible estimation of quantitative hemodynamic parameters, even in the case of stenotic arteries. These parameters may provide valuable information in the evaluation of PAD and contribute to its diagnosis.
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Affiliation(s)
- Pieter Thomas Boonen
- Department of Radiology, Vrije Universiteit Brussel (VUB), Jette, Brussels, Belgium
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Elsene, Brussels, Belgium
- imec, Leuven, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Jette, Brussels, Belgium
| | - Gert van Gompel
- Department of Radiology, Vrije Universiteit Brussel (VUB), Jette, Brussels, Belgium
| | - Hannes Devos
- Department of Radiology, Vrije Universiteit Brussel (VUB), Jette, Brussels, Belgium
| | - Yannick de Brucker
- Department of Radiology, Vrije Universiteit Brussel (VUB), Jette, Brussels, Belgium
| | - Tim Leiner
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dimitri Aerden
- Department of Vascular Surgery, Vrije Universiteit Brussel (VUB), Jette, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Jette, Brussels, Belgium
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Elsene, Brussels, Belgium
- imec, Leuven, Belgium
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Azene EM, Steigner ML, Aghayev A, Ahmad S, Clough RE, Ferencik M, Hedgire SS, Hicks CW, Kirsch DS, Lee YJ, Myers LA, Nagpal P, Osborne N, Pillai AK, Ripley B, Singh N, Thomas R, Kalva SP. ACR Appropriateness Criteria® Lower Extremity Arterial Claudication-Imaging Assessment for Revascularization: 2022 Update. J Am Coll Radiol 2022; 19:S364-S373. [PMID: 36436963 PMCID: PMC9876734 DOI: 10.1016/j.jacr.2022.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Arterial claudication is a common manifestation of peripheral artery disease. This document focuses on necessary imaging before revascularization for claudication. Appropriate use of ultrasound, invasive arteriography, MR angiography, and CT angiography are discussed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Ezana M Azene
- Director of PERT, Chair Cancer Advisory Council, Medical Governor, Gundersen Health System, La Crosse, Wisconsin.
| | - Michael L Steigner
- Panel Chair; Director, Vascular CT/MR, Medical Director 3D Lab, Brigham & Women's Hospital, Boston, Massachusetts
| | - Ayaz Aghayev
- Panel Vice-Chair, Brigham & Women's Hospital, Boston, Massachusetts
| | - Sarah Ahmad
- University of Toronto, Toronto, Ontario, Canada; American College of Physicians
| | - Rachel E Clough
- St. Thomas' Hospital, King's College, School of Biomedical Engineering and Imaging Science, London, United Kingdom; Society for Cardiovascular Magnetic Resonance
| | - Maros Ferencik
- Section Head of Cardiovascular Imaging, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Society of Cardiovascular Computed Tomography
| | - Sandeep S Hedgire
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Caitlin W Hicks
- Director of Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland; Editor-in-Chief, Seminars in Vascular Surgery; Society for Vascular Surgery
| | | | - Yoo Jin Lee
- University of California, San Francisco, San Francisco, California
| | - Lee A Myers
- Keck School of Medicine of USC, Los Angeles, California; Committee on Emergency Radiology-GSER
| | - Prashant Nagpal
- Head, Cardiovascular Imaging, University of Wisconsin, Madison, Wisconsin
| | - Nicholas Osborne
- University of Michigan, Ann Arbor, Michigan; Society for Vascular Surgery
| | - Anil K Pillai
- Section Chief, Interventional Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Beth Ripley
- VA Puget Sound Health Care System and University of Washington, Seattle, Washington
| | | | - Richard Thomas
- Section Chief of Thoracic Imaging and Cardiac CT and Associate Magnetic Resonance Medical Director, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Sanjeeva P Kalva
- Specialty Chair; Chief of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
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7
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Zheng J, Li R, Zayed MA, Yan Y, An H, Hastings MK. Pilot study of contrast-free MRI reveals significantly impaired calf skeletal muscle perfusion in diabetes with incompressible peripheral arteries. Vasc Med 2021; 26:367-373. [PMID: 33749394 DOI: 10.1177/1358863x21996465] [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: 01/30/2023]
Abstract
Patients with diabetes mellitus (DM) are more likely to have densely calcified lesions in the below-the-knee tibial arteries. However, the relationship between peripheral arterial calcification and local skeletal muscle perfusion has not been explored. Thirty subjects were prospectively recruited into three groups in this pilot study: (1) Non-DM: 10 people without DM; (2) DM, ABI < 1.3: 10 people with DM and normal ankle-brachial index (ABI) (0.9-1.3); and (3) DM, ABI ⩾ 1.3: 10 people with DM and ABI ⩾ 1.3. All subjects underwent calf perfusion measurements at rest and during an isometric plantarflexion contraction exercise within the magnetic resonance imaging (MRI) system. The noncontrast MRI techniques were applied to quantitatively assess skeletal muscle blood flow (SMBF) and oxygen extraction fraction (SMOEF) in medial gastrocnemius and soleus muscles. Both SMBF and SMOEF reserves were calculated as the ratio of the exercise value to the resting value. Exercise SMBF and SMOEF values in the medial gastrocnemius muscle were lower in the two DM groups than in the non-DM group (p < 0.05). The SMBF reserve in medial gastrocnemius was significantly lower in the DM, ABI ⩾ 1.3 group compared to the DM, ABI < 1.3 group (p < 0.05). This study demonstrates that people with DM and calcified arteries had lower perfusion in gastrocnemius muscle compared to those without DM and those with DM and a normal ABI.
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Affiliation(s)
- Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Ran Li
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Mohamed A Zayed
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Yan Yan
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Mary K Hastings
- Physical Therapy Program, Washington University School of Medicine, St Louis, MO, USA
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Aly GSG, Kassem HH, Hashad A, Salem MA, Labib D, Baligh E. Lower extremity arterial calcifications assessed by multislice CT as a correlate to coronary artery disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patients with peripheral artery disease (PAD) frequently have concomitant coronary artery disease (CAD) and display a higher risk for myocardial infarction, stroke, and death due to cardiovascular events. In order to prevent cardiovascular events, there is an increasing interest in new markers of atherosclerosis. Vascular calcifications (VC) are often present in the early stages of atherogenesis and could be considered an early marker. The aim of this study is to correlate the extent of lower limbs, aortic, and coronary arterial calcification diagnosed by non-contrast multislice CT with the severity of coronary artery disease diagnosed by conventional coronary angiography.
Results
There is borderline significant association between CAD (Gensini score) and each of total lower limb and aorto-iliac calcifications. There is significant association between the number of diseased coronaries and lower limb calcifications. Also, there is significant association between the coronary artery calcifications and lower limb arterial calcifications (total and segmental).
Diabetes mellitus and hypertension are significantly associated with lower limb calcification (total, aorto-iliac, and infra-popliteal). Moreover, lower limb arterial calcifications (total and segmental) are positively correlated with increasing age.
Conclusion
Lower limb arterial calcifications, as diagnosed by non-contrast MSCT, is a noninvasive measure for evaluation of the atherosclerotic burden that correlate to the CAD; it can aid to refine risk stratification and the need for more aggressive preventive strategies.
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Varga-Szemes A, Penmetsa M, Emrich T, Todoran TM, Suranyi P, Fuller SR, Edelman RR, Koktzoglou I, Schoepf UJ. Diagnostic accuracy of non-contrast quiescent-interval slice-selective (QISS) MRA combined with MRI-based vascular calcification visualization for the assessment of arterial stenosis in patients with lower extremity peripheral artery disease. Eur Radiol 2020; 31:2778-2787. [PMID: 33068186 DOI: 10.1007/s00330-020-07386-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/04/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The proton density-weighted, in-phase stack-of-stars (PDIP-SOS) MRI technique provides calcification visualization in peripheral artery disease (PAD). This study sought to investigate the diagnostic accuracy of a combined non-contrast quiescent-interval slice-selective (QISS) MRA and PDIP-SOS MRI protocol for the detection of PAD, in comparison with CTA and digital subtraction angiography (DSA). METHODS Twenty-six prospectively enrolled PAD patients (70 ± 8 years) underwent lower extremity CTA and 1.5-T or 3-T PDIP-SOS/QISS MRI prior to DSA. Two readers rated image quality and graded stenosis (≥ 50%) on QISS MRA without/with calcification visualization. Sensitivity, specificity, and area under the curve (AUC) were calculated against DSA. Calcification was quantified and compared between MRI and non-contrast CT (NCCT) using paired t test, Pearson's correlation, and Bland-Altman analysis. RESULTS Image quality ratings were significantly higher for CTA compared to those for MRA (4.0 [3.0-4.0] and 3.0 [3.0-4.0]; p = 0.0369). The sensitivity and specificity of QISS MRA, QISS MRA with PDIP-SOS, and CTA for ≥ 50% stenosis detection were 85.4%, 92.2%, and 90.2%, and 90.3%, 93.2%, and 94.2%, respectively, while AUCs were 0.879, 0.928, and 0.923, respectively. A significant increase in AUC was observed when PDIP-SOS was added to the MRA protocol (p = 0.0266). Quantification of calcification showed significant differences between PDIP-SOS and NCCT (80.6 ± 31.2 mm3 vs. 88.0 ± 29.8 mm3; p = 0.0002) with high correlation (r = 0.77, p < 0.0001) and moderate mean of differences (- 7.4 mm3). CONCLUSION QISS MRA combined with PDIP-SOS MRI provides improved, CTA equivalent, accuracy for the detection of PAD, although its image quality remains inferior to CTA. KEY POINTS • Agreement in stenosis detection rate using non-contrast quiescent-interval slice-selective MRA compared to DSA improved when calcification visualization was provided to the readers. • An increase was observed in both sensitivity and specificity for the detection of ≥ 50% stenosis when MRI-based calcification assessment was added to the protocol, resulting in a diagnostic accuracy more comparable to CTA. • Quantification of calcification showed statistical difference between MRI and non-contrast CT; however, a high correlation was observed between the techniques.
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Affiliation(s)
- Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Megha Penmetsa
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
| | - Thomas M Todoran
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Stephen R Fuller
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Robert R Edelman
- Department of Radiology, NorthShore University, Evanston, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ioannis Koktzoglou
- Department of Radiology, NorthShore University, Evanston, IL, USA.,University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.
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Abstract
Computed tomography angiography (CTA) has become a mainstay for the imaging of vascular diseases, because of high accuracy, availability, and rapid turnaround time. High-quality CTA images can now be routinely obtained with high isotropic spatial resolution and temporal resolution. Advances in CTA have focused on improving the image quality, increasing the acquisition speed, eliminating artifacts, and reducing the doses of radiation and iodinated contrast media. Dual-energy computed tomography provides material composition capabilities that can be used for characterizing lesions, optimizing contrast, decreasing artifact, and reducing radiation dose. Deep learning techniques can be used for classification, segmentation, quantification, and image enhancement.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55904, USA.
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11
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Free-Breathing Fast Low-Angle Shot Quiescent-Interval Slice-Selective Magnetic Resonance Angiography for Improved Detection of Vascular Stenoses in the Pelvis and Abdomen: Technical Development. Invest Radiol 2020; 54:752-756. [PMID: 31299678 DOI: 10.1097/rli.0000000000000592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Balanced steady-state free precession-based quiescent-interval slice-selective (bSSFP QISS) magnetic resonance angiography (MRA) is accurate for the noncontrast evaluation of peripheral arterial disease (PAD); however, drawbacks include the need for breath-holding when imaging the abdomen and pelvis, and sensitivity to off-resonance artifacts. The purpose of this study was to evaluate the image quality and diagnostic accuracy in the pelvis and abdomen of free-breathing fast low-angle shot-based QISS (FLASH QISS) techniques in comparison to bSSFP QISS in patients with PAD, using computed tomographic angiography as the reference. MATERIALS AND METHODS Twenty-seven patients (69 ± 10 years, 17 men) with PAD were enrolled in this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant prospective study between April and December 2018. Patients underwent noncontrast MRA using standard bSSFP QISS and prototype free-breathing radial-FLASH and Cartesian-FLASH QISS at 3 T. A subset of patients (n = 22) also underwent computed tomographic angiography as the reference standard. Nine arterial segments per patient were evaluated spanning the abdomen, pelvis, and upper thigh regions. Objective (signal intensity ratio and relative standard deviation) and subjective image quality (4-point scale) and stenosis (>50%) were evaluated by 2 readers and compared using one-way analysis of variance, Wilcoxon, and McNemar tests, respectively. RESULTS A total of 179 vascular segments were available for analysis by all QISS techniques. No significant difference was observed among bSSFP, radial-FLASH, and Cartesian-FLASH QISS techniques in signal intensity ratio (P = 0.428) and relative standard deviation (P = 0.220). Radial-FLASH QISS demonstrated the best image quality (P < 0.0001) and the highest interreader agreement (κ = 0.721). The sensitivity values of bSSFP, radial-FLASH, and Cartesian-FLASH QISS for the detection of greater than 50% stenosis were 76.0%, 84.0%, and 80.0%, respectively, whereas specificity values were 97.6%, 94.0%, and 92.8%, respectively. Moreover, FLASH QISS consistently reduced off-resonance artifacts compared with bSSFP QISS. CONCLUSIONS Free-breathing FLASH QISS MRA techniques provide improved image quality and sensitivity, high specificity, and reduced off-resonance artifacts for vascular stenosis detection in the abdomen and pelvis.
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Frank U, Nikol S, Belch J, Boc V, Brodmann M, Carpentier PH, Chraim A, Canning C, Dimakakos E, Gottsäter A, Heiss C, Mazzolai L, Madaric J, Olinic DM, Pécsvárady Z, Poredoš P, Quéré I, Roztocil K, Stanek A, Vasic D, Visonà A, Wautrecht JC, Bulvas M, Colgan MP, Dorigo W, Houston G, Kahan T, Lawall H, Lindstedt I, Mahe G, Martini R, Pernod G, Przywara S, Righini M, Schlager O, Terlecki P. ESVM Guideline on peripheral arterial disease. VASA 2019; 48:1-79. [DOI: 10.1024/0301-1526/a000834] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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13
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Oh LCW, Lau KKP, Devapalasundaram A, Buchan K, Kuganesan A, Huynh M. Efficacy of fine focal spot technique in CT angiography of neck. Br J Radiol 2019; 92:20190083. [PMID: 31112401 DOI: 10.1259/bjr.20190083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Focal spot size partially defines spatial resolution of a CT system. Many CT tubes have two focal spot sizes, with the finer one allowing more detailed imaging at the cost of photon intensity and increased heat production. Improved X-ray technology and advancement of various generations of iterative reconstruction allow the use of fine focal spot technique in CT angiography. CT neck angiography (CTNA) has been commonly performed as part of stroke imaging or in the trauma setting. This prospective study aimed to assess the efficacy of fine focal spot scanning in vessel clarity improvement, vessel calcification and arterial pulsation artefact reduction on CTNA. METHODS AND MATERIALS Consecutive adult patients of all ages and genders who presented for CTNA were included. All CTNA were scanned with standard focal spot size (SFSS) of 1 × 1 mm in first 4 months while the CTNA in the following 4 months with fine focal spot size (FFSS) of 0.5 × 1 mm. Vessel clarity, calcification and arterial pulsation artefact of arch of aorta, brachiocephalic, subclavian, common carotid, carotid bifurcation, internal carotid, external carotid and vertebral arteries were assessed randomly using a 5-point scale by two blinded radiologists. Results were compared. RESULTS There were 43 patients (mean age 60) with 97 calcified arterial segments in SFSS and 48 patients (mean age 62) with 113 calcified arterial segments in FFSS. 30 % of patients had > 50% carotid artery stenosis. No occlusion or dissection was found in the remaining arteries. Mann-Whitney test showed FFSS performed significantly better for vessel clarity (U: 48238.50, p < .001,r: 0.556) and calcification artefact reduction (U: 2040.50, p < .001,r: 0.564). There was no significant reduction for arterial pulsation artefact. CONCLUSION Fine focal spot technique improves vessel clarity and reduces calcification blooming artefact in CTNA. These benefits may potentially improve the assessment of arterial luminal stenosis and vessel wall pathology, including plaque morphology. ADVANCES IN KNOWLEDGE Beam hardening artefact from calcification particularly in the vessel wall can often reduce the clarity of vessel lumen thus affect accurate assessment of luminal stenosis. Fine focal spot technique has the advantages of reducing beam-hardening artefact of vessel wall calcifications and improving vessel wall clarity, thus it may potentially improve the assessment of arterial luminal stenosis and vessel wall pathology, including plaque morphology. It may become an important CT imaging technique in near future.
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Affiliation(s)
| | - Kenneth Kwok-Pan Lau
- 2 Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia.,3 Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | | | - Kevin Buchan
- 5 Clinical Science, Philips Healthcare, Mont Albert, Victoria, Australia
| | - Ahilan Kuganesan
- 6 Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia
| | - Minh Huynh
- 7 Department of Statistics Data Science and Epidemiology, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Cooper K, Majdalany BS, Kalva SP, Chandra A, Collins JD, Francois CJ, Ganguli S, Gornik HL, Kendi AT, Khaja MS, Minocha J, Norton PT, Obara P, Reis SP, Sutphin PD, Rybicki FJ. ACR Appropriateness Criteria ® Lower Extremity Arterial Revascularization-Post-Therapy Imaging. J Am Coll Radiol 2019; 15:S104-S115. [PMID: 29724414 DOI: 10.1016/j.jacr.2018.03.011] [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: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 02/07/2023]
Abstract
Peripheral arterial disease (PAD) affects millions across the world and in the United States between 9% to 23% of all patients older than 55 years. The refinement of surgical techniques and evolution of endovascular approaches have improved the success rates of revascularization in patients afflicted by lower extremity PAD. However, restenosis or occlusion of previously treated vessels remains a pervasive issue in the postoperative setting. A variety of different imaging options are available to evaluate patients and are reviewed within the context of asymptomatic and symptomatic patients with PAD who have previously undergone endovascular or surgical revascularization. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Kyle Cooper
- Research Author, University of Michigan Health System, Ann Arbor, Michigan
| | - Bill S Majdalany
- Principal Author and Panel Vice-Chair, University of Michigan Health System, Ann Arbor, Michigan.
| | | | - Ankur Chandra
- Scripps Green Hospital, La Jolla, California; Society for Vascular Surgery
| | | | | | | | - Heather L Gornik
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; American College of Cardiology
| | | | | | - Jeet Minocha
- University of California, San Diego, San Diego, California
| | | | - Piotr Obara
- Loyola University Medical Center, Maywood, Illinois
| | | | | | - Frank J Rybicki
- Specialty Chair, Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada
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15
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Feasibility of Image Fusion for Concurrent MRI Evaluation of Vessel Lumen and Vascular Calcifications in Peripheral Arterial Disease. AJR Am J Roentgenol 2019; 212:914-918. [PMID: 30714829 DOI: 10.2214/ajr.18.20000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE With MR angiography of peripheral arterial disease, calcifications are unapparent, so a separate calcification-sensitive pulse sequence (proton density-weighted in-phase 3D stack-of-stars [PDIP-SOS]) is needed for complete assessment. We hypothesized that, despite being acquired separately, MR angiography and PDIP-SOS images could be coregistered and fused without loss of significant diagnostic information. CONCLUSION In a prospective study of 15 patients, MR image fusion enabled the simultaneous display of vessel lumen and vascular calcifications similarly to CT angiography.
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Edelman RR, Koktzoglou I. Noncontrast MR angiography: An update. J Magn Reson Imaging 2019; 49:355-373. [PMID: 30566270 PMCID: PMC6330154 DOI: 10.1002/jmri.26288] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 12/12/2022] Open
Abstract
Both computed tomography (CT) angiography (CTA) and contrast-enhanced MR angiography (CEMRA) have proven to be useful and accurate cross-sectional imaging modalities over a wide range of vascular territories and vascular disorders. A key advantage of MRA is that, unlike CTA, it can be performed without the administration of a contrast agent. In this review article we consider the motivations for using noncontrast MRA, potential contrast mechanisms, imaging techniques, advantages, and drawbacks with respect to CTA and CEMRA, and the level of evidence for using the various MRA techniques. In addition, we explore new developments that promise to expand the reliability and range of clinical applications for noncontrast MRA, along with functional MRA capabilities not available with CTA or CEMRA. Level of Evidence: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:355-373.
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Affiliation(s)
- Robert R. Edelman
- Radiology, Northshore University HealthSystem, Evanston, IL
- Radiology, Northwestern Memorial Hospital, Chicago, IL
| | - Ioannis Koktzoglou
- Radiology, Northshore University HealthSystem, Evanston, IL
- Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL
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17
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Serhal A, Koktzoglou I, Aouad P, Carr JC, Giri S, Morcos O, Edelman RR. Cardiovascular magnetic resonance imaging of aorto-iliac and ilio-femoral vascular calcifications using proton density-weighted in-phase stack of stars. J Cardiovasc Magn Reson 2018; 20:51. [PMID: 30078377 PMCID: PMC6091148 DOI: 10.1186/s12968-018-0479-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 07/19/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Comparing cardiovascular magnetic resonance (CMR) angiography with computed tomography angiography (CTA), a major deficiency has been its inability to reliably image peripheral vascular calcifications that may impact the choice of interventional strategy and influence patient prognosis. Recently, MRI using a proton density-weighted, in-phase stack of stars (PDIP-SOS) technique has proved capable of detecting these calcifications. The goal of the present study was two-fold: (1) to determine whether magnetic field strength impacts the apparent size and conspicuity of ilio-femoral arterial calcifications; and (2) to determine whether the technique can be accurately applied to image aorto-iliac arterial calcifications. MAIN BODY Two patient cohorts were studied. For the first cohort, ilio-femoral arterial calcifications were imaged at 1.5 Tesla in 20 patients and at 3 Tesla in 12 patients. For the second cohort, aorto-iliac arterial calcifications were imaged in 10 patients at 3 Tesla and one patient at 1.5 Tesla. Qualitative image analysis as well as quantitative analysis using a semi-automated technique were performed using CTA as the reference standard. Qualitatively, most PDIP-SOS CMR images showed good-to-excellent confidence to detect vascular calcifications, with good-to-excellent inter-reader agreement (κ = 0.67 for ilio-femoral region, P < 0.001; κ = 0.80 for aorto-iliac region, P < 0.01). There was an overall excellent correlation (r = 0.98, P < 0.001) and agreement (intraclass correlation coefficient = 0.97, P < 0.001) between PDIP-SOS CMR and CTA measures of calcification volume in both regions, with no overt difference in performance at 1.5 Tesla vs. 3 Tesla for ilio-femoral calcifications. CMR lesion volumes were slightly lower than those measured for CTA. CONCLUSION Using PDIP-SOS CMR, aorto-iliac and ilio-femoral calcifications could be simultaneously evaluated at 3 Tesla in less than six minutes with excellent correlation and agreement to CTA. Our results suggest that PDIP-SOS CMR provides a reliable alternative to CT for pre-interventional evaluation of peripheral vascular calcium burden.
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Affiliation(s)
- Ali Serhal
- Radiology, Northwestern Memorial Hospital, Chicago, IL USA
- Radiology, Northshore University HealthSystem, Walgreen Building, G534, 2650 Ridge Avenue, Evanston, IL 60201 USA
| | - Ioannis Koktzoglou
- Radiology, Northshore University HealthSystem, Walgreen Building, G534, 2650 Ridge Avenue, Evanston, IL 60201 USA
- Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL USA
| | - Pascale Aouad
- Radiology, Northwestern Memorial Hospital, Chicago, IL USA
| | - James C. Carr
- Radiology, Northwestern Memorial Hospital, Chicago, IL USA
| | | | - Omar Morcos
- Surgery, Northshore University HealthSystem, Evanston, IL USA
| | - Robert R. Edelman
- Radiology, Northwestern Memorial Hospital, Chicago, IL USA
- Radiology, Northshore University HealthSystem, Walgreen Building, G534, 2650 Ridge Avenue, Evanston, IL 60201 USA
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18
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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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19
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Edelman RR, Carr M, Koktzoglou I. Advances in non-contrast quiescent-interval slice-selective (QISS) magnetic resonance angiography. Clin Radiol 2018; 74:29-36. [PMID: 29336780 DOI: 10.1016/j.crad.2017.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is a pressing clinical need to develop accurate, efficient non-contrast magnetic resonance angiography (NC-MRA) techniques. Our efforts in the field have focused on a novel non-subtractive technique called quiescent-interval slice-selective (QISS) MRA. Compared with other NC-MRA techniques, QISS has the advantage of being more accurate while enabling a simpler and more efficient workflow. The original implementation, which uses electrocardiogram (ECG) gating and a Cartesian k-space trajectory, is a reliable technique for the evaluation of peripheral arterial disease (PAD). Recent advances in QISS technology include the use of a radial k-space trajectory, which facilitates rapid imaging of the coronary, renal, and pulmonary arteries as well as other vascular beds, and ungated ("UnQISS") acquisitions for PAD.
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Affiliation(s)
- R R Edelman
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL, USA; Department of Radiology, Northshore University Health System, Evanston, IL, USA.
| | - M Carr
- Department of Radiology, Northshore University Health System, Evanston, IL, USA
| | - I Koktzoglou
- Department of Radiology, Northshore University Health System, Evanston, IL, USA; Department of Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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20
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Schreiner MM, Platzgummer H, Unterhumer S, Weber M, Mistelbauer G, Loewe C, Schernthaner RE. A BMI-adjusted ultra-low-dose CT angiography protocol for the peripheral arteries—Image quality, diagnostic accuracy and radiation exposure. Eur J Radiol 2017; 93:149-156. [DOI: 10.1016/j.ejrad.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 05/13/2017] [Accepted: 06/01/2017] [Indexed: 11/30/2022]
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21
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Jin KN, Chung JW, Park EA, Lee W. Dual-energy computed tomography angiography: virtual calcified plaque subtraction in a vascular phantom. Acta Radiol Open 2017; 6:2058460117717765. [PMID: 28811929 PMCID: PMC5528944 DOI: 10.1177/2058460117717765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 06/05/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Material decomposition of dual-energy computed tomography (DECT) enables subtraction of calcified plaque. PURPOSE To evaluate the accuracy of lumen area measurement in calcified plaque by subtraction of DECT and to determine the effect of contrast material concentration, lumen diameter, density, and thickness of calcified plaque for the measurement. MATERIAL AND METHODS Vessel phantoms were made with six lumen diameters (5.7, 4.9, 3.9, 3.0, 1.9, and 1.3 mm) and six types of calcified plaques with three densities and two thicknesses were attached. CT scans were performed with three contrast material concentrations (62, 111, and 170 mg iodine/mL). Lumen area discrepancy (AD) was calculated by subtracting the measured lumen area from a reference value. The lumen area underestimation percentage (AU), defined as (AD/reference value) × 100, was calculated. General linear model analysis was used to test the effect of variables for log-transformed AU (ln_AU). RESULTS The AD and AU was calculated to be 6.1 ± 4.8 mm2 and 69.8 ± 29.4%, respectively. Ln_AU was significantly affected by contrast material concentration (P < 0.001), calcium density (P = 0.001), plaque thickness (P = 0.010), and lumen diameter (P < 0.001). Ln_AU was significantly higher in 62 mg iodine/mL than in 111 or 170 mg iodine/mL (P < 0.001 for both). Ln_AU was significantly lower at a lumen diameter of 5.7 mm than 3.9 mm (P = 0.001) or 3.0 (P < 0.001). CONCLUSION Calcified plaque subtraction in DECT substantially underestimates measurements of lumen area. Higher enhancement in larger vessels ensures more accurate subtraction of calcified plaque.
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Affiliation(s)
- Kwang Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
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22
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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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23
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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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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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Tsukada J, Yamada M, Yamada Y, Yamazaki S, Imanishi N, Tamura K, Hashimoto M, Nakatsuka S, Jinzaki M. Comparison of the diagnostic accuracy of FBP, ASiR, and MBIR reconstruction during CT angiography in the evaluation of a vessel phantom with calcified stenosis in a distal superficial femoral artery in a cadaver extremity. Medicine (Baltimore) 2016; 95:e4127. [PMID: 27399123 PMCID: PMC5058852 DOI: 10.1097/md.0000000000004127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To investigate whether adaptive statistical iterative reconstruction (ASiR) or model-based iterative reconstruction (MBIR) improves the diagnostic performance of computed tomography angiography (CTA) for small-vessel calcified lesions relative to filtered back projection (FBP) using cadaver extremities and a calcified stenosis phantom. METHODS A cadaver was used in accordance with our institutional regulations, and a calcified stenosis phantom simulating 4 grades of stenosis was prepared. The phantom was inserted within the distal superficial femoral artery of the cadaver leg. Ten CT images per reconstruction type and stenosis grade were acquired using a 64-slice multidetector-row CTA.As an objective measurement, the first and second derivatives of the CT value function profiles were calculated. As a subjective measurement, 2 blinded reviewers measured the stenosis ratio using a quantitative scale. The Wilcoxon rank-sum test was used to evaluate the data. RESULTS Objective measurements of both 25% and 50% stenosis differed significantly (P < 0.01) between MBIR (25/50%: 25.80/50.30 ± 3.88/3.86%) and FBP (25/50%: 35.60/83.80 ± 3.44/26.10%), whereas significant differences were not observed between ASiR and FBP.Reviewer 2's subjective measurements of 25% stenosis differed significantly (P < 0.01) between MBIR (35.13 ± 3.25%) and ASiR (40.89 ± 3.14%), and the measurements of 50% stenosis differed significantly (P < 0.01) between MBIR (reviewers 1/2, 62.36/54.78 ± 2.78/4.96%) and FBP (reviewers 1/2, 62.36/74.84 ± 2.78/18.10%). Significant differences in the subjective measurements were not observed between ASiR and FBP. CONCLUSION MBIR improves the diagnostic performance of CTA for small-vessel calcified lesions relative to FBP.
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Affiliation(s)
- Jitsuro Tsukada
- Department of Diagnostic Radiology, Keio University School of Medicine
| | - Minoru Yamada
- Multi-Dimension Biomedical Imaging and Information Laboratory in Research Park, Keio University School of Medicine
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine
| | - Shun Yamazaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine
| | - Nobuaki Imanishi
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Tamura
- Department of Diagnostic Radiology, Keio University School of Medicine
| | | | - Seishi Nakatsuka
- Department of Diagnostic Radiology, Keio University School of Medicine
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine
- Correspondence: Masahiro Jinzaki, Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan (e-mail: )
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Cooper KJ, Peña C, Benenati J. Determining End Points for Critical Limb Ischemia Interventions. Tech Vasc Interv Radiol 2016; 19:104-12. [PMID: 27423992 DOI: 10.1053/j.tvir.2016.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Critical limb ischemia is a condition that has increased in prevalence and carries a high degree of morbidity. Although endovascular therapy for treatment of patients with critical limb ischemia has undergone significant advances with improved outcomes over the past decade, these patients often have multilevel disease, and it may take weeks or months for ulceration healing. For this reason, the acceptable therapeutic end points during and immediately following revascularization remain somewhat obscure. There are multiple tools available to guide the treating vascular specialist in this regard. Establishment of in-line flow to the foot and the angiosome containing the ulceration, appearance of a "wound blush," restoration of pulses, and bleeding at the ulcer site are basic tenets intraprocedurally. Postprocedural noninvasive testing including the ankle-brachial and toe-brachial indices, segmental pressure measurements, pulse volume recordings, transcutaneous oxygen tension, skin perfusion pressures (SPPs), and toe pressures all play a role in determining the likelihood of clinical improvement. Newer technologies such as two-dimensional (2D) perfusion angiography, fluorescence angiography, and tissue oxygen saturation mapping may allow better real-time assessment of flow restoration. In combination with close clinical follow-up and wound care, these tools provide treating physicians with a better grasp of the necessary end points to optimize patients for clinical improvement.
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Shin HS, Jung Park M, Nyeo Jeon K, Min Cho J, Soo Bae K, Seob Choi D, Boem Na J, Cheol Choi H, Young Choi H, Eun Kim J, Bueum Cho S, Eun Park S. Lower Extremity Arterial Calcification as a Predictor of Coronary Atherosclerosis in Patients with Peripheral Arterial Disease. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e33179. [PMID: 27703657 PMCID: PMC5037928 DOI: 10.5812/iranjradiol.33179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/29/2015] [Accepted: 11/07/2015] [Indexed: 01/07/2023]
Abstract
Background Until now, there has been no study on the relationship between the calcification of the lower extremity arteries and significant coronary arterial disease (CAD). Objectives To evaluate whether lower extremity calcium scores (LECS) are associated with CAD and whether this can predict multivessel-CAD in patients with peripheral arterial disease (PAD). Patients and Methods We retrospectively enrolled 103 PAD patients without cardiac symptoms or known CAD. All patients underwent cardiac computed tomography (CT) and lower extremity CT within 1 month and were categorized as nonsignificant CAD, single-CAD, or multivessel-CAD. The coronary calcium scores (CCS) were quantitatively measured according to the Agatston method and LECS were semi-quantitatively measured according to the presence of lower extremity calcification in the segment. The extent of CAD was evaluated according to the presence of ≥ 50% luminal diameter stenosis in the segment of CAD. Results LECS in multivessel-CAD were significantly higher than those in nonsignificant CAD (10.0 ± 5.8 versus 4.0 ± 3.1, P < 0.001). LECS significantly correlated with CCS (r = 0.831, P < 0.001) and the extent of CAD (r = 0.631, P < 0.001). Multivariate regression analysis demonstrated LECS and log-transformed CCS were independent predictors for multivessel-CAD. In receiver operating characteristic curve analysis, the diagnostic performance of LECS was 0.807 (95% confidence interval = 0.724-0.891, P < 0.001) for predicting multivessel-CAD. Conclusion Peripheral arterial calcification is significantly correlated with CAD extent in patients with PAD. Peripheral arterial calcification can be a useful marker for predicting multivessel-CAD.
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Affiliation(s)
- Hwa Seon Shin
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Mi Jung Park
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Corresponding author: Mi Jung Park, Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea. Tel: +82-557508814, Fax: +82-557581568, E-mail:
| | - Kyung Nyeo Jeon
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jae Min Cho
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Kyung Soo Bae
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jae Boem Na
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Ho Cheol Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Hye Young Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Ji Eun Kim
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Soo Bueum Cho
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Suzuki M, Tanaka R, Yoshioka K, Abiko A, Ehara S. Subtraction CT angiography for the diagnosis of iliac arterial steno-occlusive disease. Jpn J Radiol 2015; 34:194-202. [DOI: 10.1007/s11604-015-0508-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/24/2015] [Indexed: 11/28/2022]
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Haubenreisser H, Bigdeli A, Meyer M, Kremer T, Riester T, Kneser U, Schoenberg SO, Henzler T. From 3D to 4D: Integration of temporal information into CT angiography studies. Eur J Radiol 2015; 84:2421-4. [DOI: 10.1016/j.ejrad.2015.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/15/2015] [Indexed: 12/15/2022]
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Oh LCW, Lau KK, Devapalasundaram A, Buchan K, Ardley N, Huynh M. Efficacy of 'fine' focal spot imaging in CT abdominal angiography. Eur Radiol 2014; 24:3010-6. [PMID: 25097134 DOI: 10.1007/s00330-014-3368-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/26/2014] [Accepted: 07/21/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the efficacy of fine focal spot imaging in calcification beam-hardening artefact reduction and vessel clarity on CT abdominal angiography (CTAA). METHODS Adult patients of any age and gender who presented for CTAA were included. Thirty-nine patients were examined with a standard focal spot size (SFSS) of 1 × 1 mm in the first 3 months while 31 consecutive patients were examined with a fine focal spot size (FFSS) of 1 × 0.5 mm in the following 3 months. Vessel clarity and calcification beam-hardening artefacts of the abdominal aorta, celiac axis, superior mesenteric artery, inferior mesenteric artery, renal arteries, and iliac arteries were assessed using a 5-point grading scale by two blinded radiologists randomly. RESULTS Cohen's Kappa test indicated that on average, there was substantial agreement among reviewers for vessel wall clarity and calcification artefact grading. Mann-Whitney test showed that there was a significant difference between the two groups, with FFSS performing significantly better for vessel clarity (U, 6481.50; p < 0.001; r, 0.73) and calcification artefact reduction (U, 1916; p < 0.001; r, 0.77). CONCLUSION Fine focus CT angiography produces images with better vessel wall clarity and less vessel calcification beam-hardening artefact. KEY POINTS Focal spot size affects the spatial resolution of a CT system. Fine focus CTAA produces images with improved vessel wall clarity. Fine focus CTAA is associated with fewer calcification beam-hardening artefacts. Fine focus CTAA may improve accuracy in assessment of luminal stenosis.
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Affiliation(s)
- Lawrence Chia Wei Oh
- Department of Diagnostic Imaging, Monash Health, 246 Clayton Road, Clayton, 3168, Victoria, Australia,
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Rubin GD, Leipsic J, Joseph Schoepf U, Fleischmann D, Napel S. CT angiography after 20 years: a transformation in cardiovascular disease characterization continues to advance. Radiology 2014; 271:633-52. [PMID: 24848958 DOI: 10.1148/radiol.14132232] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Through a marriage of spiral computed tomography (CT) and graphical volumetric image processing, CT angiography was born 20 years ago. Fueled by a series of technical innovations in CT and image processing, over the next 5-15 years, CT angiography toppled conventional angiography, the undisputed diagnostic reference standard for vascular disease for the prior 70 years, as the preferred modality for the diagnosis and characterization of most cardiovascular abnormalities. This review recounts the evolution of CT angiography from its development and early challenges to a maturing modality that has provided unique insights into cardiovascular disease characterization and management. Selected clinical challenges, which include acute aortic syndromes, peripheral vascular disease, aortic stent-graft and transcatheter aortic valve assessment, and coronary artery disease, are presented as contrasting examples of how CT angiography is changing our approach to cardiovascular disease diagnosis and management. Finally, the recently introduced capabilities for multispectral imaging, tissue perfusion imaging, and radiation dose reduction through iterative reconstruction are explored with consideration toward the continued refinement and advancement of CT angiography.
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Affiliation(s)
- Geoffrey D Rubin
- From the Duke Clinical Research Institute, 2400 Pratt St, Box 17969, Durham, NC 27715 (G.D.R.); Department of Medical Imaging and Division of Cardiology, University of British Columbia, Vancouver, BC, Canada (J.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.F., S.N.)
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Ong MM, Hausotter K, Pilz LR, Schoenberg SO, Michaely HJ. Steady state vascular imaging with extracellular gadobutrol: evaluation of the additional diagnostic benefit in patients who have undergone a peripheral magnetic resonance angiography protocol. J Cardiovasc Magn Reson 2013; 15:97. [PMID: 24156379 PMCID: PMC4015531 DOI: 10.1186/1532-429x-15-97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 09/18/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To evaluate the feasibility and additional diagnostic benefit of a high-resolution steady state 3D-volume interpolated breath-hold exam (VIBE) sequence between a continuous table movement (CTM) MR angiography of the entire runoff vasculature and a time-resolved (TWIST) MRA of the calves. METHODS In this retrospective IRB approved study 224 patients (72 women, 152 men, mean age 67.29 ± 13.9) were included who had undergone a low-dose MR angiographic protocol at 3T (Siemens TimTrio) after injection of 0.1 mmol/kg gadobutrol including a CTM MRA, a time-resolved MRA of the calf station and a steady state 3D VIBE sequence prior to the time-resolved MRA. One board-certified radiologist rated the image quality of the steady state VIBE sequences on an ordinal three point scale (excellent, good, poor) and analyzed the images for additional diagnostic findings of and beyond the vascular system in comparison to the CTM MRA and the time-resolved MRA. Descriptive statistics and demographic patient data were used for further evaluation. RESULTS The image quality of the steady state imaging of the pelvis, upper and lower leg was excellent in up to 88%, 84% and 47%, respectively, while poor image quality was only detected in the upper (2%) and lower leg (6%). An additional diagnostic benefit was found in 44% of the patients overall. The most common relevant pathologies included inflammatory processes of the soft tissues (26%), thrombi (14%), abscesses (13%) and tumors (11%). In subgroups of patients above the age of 60, 65, 70, 75 and 80 years an additional pathology was found in 50% 33%, 44%, 65% and 58%, respectively. There was no significant difference in terms of additional findings between men and women (46% and 39%, p > 0.05) and inpatients and outpatients (42% and 45%, p > 0.05). CONCLUSION Steady state imaging is also feasible with extracellular contrast agents with good image quality yielding additional diagnostic findings in up to 44% and above in patients older than 60 years of age irrespective of gender or patient status. Given the short acquisition time of 4 minutes this sequence could be added to all peripheral MRA exams.
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Affiliation(s)
- Melissa M Ong
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Katharina Hausotter
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Lothar R Pilz
- Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Henrik J Michaely
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Inada S, Masuda T, Maruyama N, Matsumoto Y, Kusunoki T, Ishibashi T, Onishi H, Takigawa A, Sato T, Imada N. [Usefulness of subtraction computed tomography angiography employing orbital synchronized helical scanning for diagnosis of lower extremity arteries with vessel wall calcification]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2013; 69:1119-1129. [PMID: 24140900 DOI: 10.6009/jjrt.2013_jsrt_69.10.1119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Massive calcification complicates the diagnosis of the blood vessel lumen in computed tomography angiography (CTA) of the arteries of the lower extremities. The purpose of this study was to evaluate subtraction CTA with the use of orbital synchronized helical scanning (OS-SCTA). METHOD Phantom study: We performed OS-SCTA and non-OSCTA of a calcified vessel phantom (ψ2.5 mm), and compared them with a non-calcified vessel phantom as the reference by full width at half maximum (FWHM) and full width at tenth maximum (FWTM) of maximum intensity projection (MIP) images. Clinical study: 58 patients with peripheral artery disease who were referred for angiography also underwent OS-SCTA. OS-SCTA was produced using MIP images. Findings were graded according to three categories: (1) stenosis greater than 50% or occluded; (2) stenosis less than 50%; (3) not detected due to insufficient image quality. OS-SCTA findings were compared with the angiographic findings for each arterial segment. RESULTS In the phantom study, FWHM showed no significant difference between OS-SCTA and the reference (P=0.135), whereas FWTM showed a significant difference (P<0.001). FWHM and FWTM showed a significant difference between non-OS-SCTA and the reference (P<0.001), due to misregistration with helical artifacts. In a clinical study comparing OS-SCTA with angiography, the sensitivity and specificity were 93.3% and 95.1% in calcified segments, 91.8% and 93.9% in non-calcified segments, and 92.2% and 94.6% in all segments. There was no significant difference between calcified segments and non-calcified segments (sensitivity: P=0.568, specificity: P=0.549). CONCLUSION OS-SCTA is beneficial for the diagnosis of lower extremity arteries with vessel wall calcification, since it shows detection accuracy comparable to that of angiography.
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Affiliation(s)
- Satoshi Inada
- Department of Medical Technology, Tsuchiya General Hospital
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Lim RP, Fan Z, Chatterji M, Baadh A, Atanasova IP, Storey P, Kim DC, Kim S, Hodnett PA, Ahmad A, Stoffel DR, Babb JS, Adelman MA, Xu J, Li D, Lee VS. Comparison of nonenhanced MR angiographic subtraction techniques for infragenual arteries at 1.5 T: a preliminary study. Radiology 2013; 267:293-304. [PMID: 23297320 DOI: 10.1148/radiol.12120859] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate diagnostic performance of three nonenhanced methods: variable-refocusing-flip angle (FA) fast spin-echo (SE)-based magnetic resonance (MR) angiography (variable FA MR) and constant-refocusing-FA fast SE-based MR angiography (constant-FA MR) and flow-sensitive dephasing (FSD)-prepared steady-state free precession MR angiography (FSD MR) for calf arteries, with dual-injection three-station contrast material-enhanced MR angiography (gadolinium-enhanced MR) as reference. MATERIALS AND METHODS This prospective study was institutional review board approved and HIPAA compliant, with informed consent. Twenty-one patients (13 men, eight women; mean age, 62.6 years) underwent calf-station variable-FA MR, constant-FA MR, and FSD MR at 1.5 T, with gadolinium-enhanced MR as reference. Image quality and stenosis severity were assessed in 13 segments per leg by two radiologists blinded to clinical data. Combined constant-FA MR and FSD MR reading was also performed. Methods were compared (logistic regression for correlated data) for diagnostic accuracy. RESULTS Of 546 arterial segments, 148 (27.1%) had a hemodynamically significant (≥ 50%) stenosis. Image quality was satisfactory for all nonenhanced MR sequences. FSD MR was significantly superior to both other sequences (P < .0001), with 5-cm smaller field of view; 9.6% variable-FA MR, 9.6% constant-FA MR, and 0% FSD MR segmental evaluations had nondiagnostic image quality scores, mainly from high diastolic flow (variable-FA MR) and motion artifact (constant-FA MR). Stenosis sensitivity and specificity were highest for FSD MR (80.3% and 81.7%, respectively), compared with those for constant-FA MR (72.3%, P = .086; and 81.8%, P = .96) and variable-FA MR (75.9%, P = .54; and 75.6%, P = .22). Combined constant-FA MR and FSD MR had superior sensitivity (81.8%) and specificity (88.3%) compared with constant-FA MR (P = .0076), variable-FA MR (P = .0044), and FSD MR (P = .0013). All sequences had an excellent negative predictive value (NPV): 93.2%, constant-FA MR; 94.7%, variable-FA MR; 91.7%, FSD MR; and 92.9%, combined constant-FA MR and FSD MR. CONCLUSION At 1.5 T, all evaluated nonenhanced MR angiographic methods demonstrated satisfactory image quality and excellent NPV for hemodynamically significant stenosis. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120859/-/DC1.
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Affiliation(s)
- Ruth P Lim
- Department of Radiology, New York University Medical Center, New York, NY, USA.
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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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Elsharawy MA, Moghazy KM, Shawarby MA. Atherosclerosis in sickle cell disease - a review. Int J Angiol 2012; 18:62-6. [PMID: 22477494 DOI: 10.1055/s-0031-1278326] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Acute, vaso-occlusive crises are the most common and earliest clinical manifestations of sickle cell disease. Recent thoughts about development of atherosclerosis as a result of this disease are presented. Current insights into the pathogenesis of atherosclerosis in sickle cell disease are reviewed, in particular the role of endothelial dysfunction, homocysteine and platelets. Common and uncommon sites of atherosclerosis are described. Radiological assessment and potential therapeutic agents to slow the progression of atherosclerosis are discussed. Finally, treatment of atherosclerosis in certain sites is evaluated and reviewed.
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Kasapis C, Gurm HS. Current approach to the diagnosis and treatment of femoral-popliteal arterial disease. A systematic review. Curr Cardiol Rev 2011; 5:296-311. [PMID: 21037847 PMCID: PMC2842962 DOI: 10.2174/157340309789317823] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 02/01/2009] [Accepted: 02/01/2009] [Indexed: 02/08/2023] Open
Abstract
Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis affecting 5 million adults in the United States, with an age-adjusted prevalence of 4% to 15% and increasing up to 30% with age and the presence of cardiovascular risk factors. In this article we focus on lower extremity PAD and specifically on the superficial femoral and proximal popliteal artery (SFPA), which are the most common anatomic locations of lower extremity atherosclerosis. We summarize current evidence and perform a systematic review on the diagnostic evaluation as well as the medical, endovascular and surgical management of SFPA disease.
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Affiliation(s)
- Christos Kasapis
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
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Fotiadis N, Kyriakides C, Bent C, Vorvolakos T, Matson M. 64-section CT angiography in patients with critical limb ischaemia and severe claudication: comparison with digital subtractive angiography. Clin Radiol 2011; 66:945-52. [PMID: 21658691 DOI: 10.1016/j.crad.2011.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 04/13/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
Abstract
AIM To assess the utility of 64 section multidetector computed tomography (MDCT) lower-limb angiography in the evaluation of patients with critical limb ischaemia (CLI) or severe intermittent claudication (IC) in grading disease before endovascular treatment. MATERIALS AND METHODS Forty-one consecutive patients with CLI or severe IC were assessed using 64 section MDCT angiography. The MDCT examinations were compared with subsequent intra-arterial digital subtraction angiography (IADSA) examinations performed at the time of endovascular intervention. The MDCT and IADSA examinations were independently scrutinized by readers blinded to the results of the other imaging method. RESULTS For arterial segments with haemodynamically significant disease (stenosis ≥50%), the overall sensitivity, specificity, and accuracy of MDCT in patients with severe claudication and CLI was 99% (95% CI: 98-100%), 98% (95% CI: 97-100%) and 98% (95% CI: 97-99%), respectively. The positive predictive value (PPV) was 97% and the negative predictive value (NPV) was 99%. CONCLUSIONS MDCT angiography is a useful tool in the assessment of patients with severe claudication and CLI and can be reliably used to grade disease severity and plan treatment.
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Affiliation(s)
- N Fotiadis
- Department of Diagnostic Imaging, Barts and The London NHS Trust, London, UK.
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Hodnett PA, Koktzoglou I, Davarpanah AH, Scanlon TG, Collins JD, Sheehan JJ, Dunkle EE, Gupta N, Carr JC, Edelman RR. Evaluation of peripheral arterial disease with nonenhanced quiescent-interval single-shot MR angiography. Radiology 2011; 260:282-93. [PMID: 21502384 DOI: 10.1148/radiol.11101336] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the diagnostic performance of quiescent-interval single-shot (QISS) magnetic resonance (MR) angiography, a nonenhanced two-dimensional electrocardiographically gated single-shot balanced steady-state free precession examination for the evaluation of symptomatic chronic lower limb ischemia. MATERIALS AND METHODS For this prospective institutional review board-approved, HIPAA-compliant study, the institutional review board waived the requirement for informed patient consent. The QISS nonenhanced MR angiography technique was evaluated in a two-center trial involving 53 patients referred for lower extremity MR angiography for suspected or known chronic peripheral arterial disease (PAD), with contrast material-enhanced MR angiography serving as the noninvasive reference standard. The accuracy of stenosis assessments performed with the nonenhanced MR angiography sequence was evaluated relative to the reference standard. Per-segment, per-region, and per-limb sensitivities and specificities were calculated, and assessments were considered correct only if they were in exact agreement with the reference standard-derived assessments. Generalized estimating equation (GEE) modeling with use of an unstructured binomial logit analysis was used to account for clustering of multiple measurements per case. The sensitivity and specificity of QISS MR angiography for the determination of nonsignificant (<50%) versus significant (50%-100%) stenosis were compared with the sensitivity and specificity of the reference standard. RESULTS The diagnostic performance of nonenhanced MR angiography was found to be nearly equivalent to the diagnostic performances of contrast-enhanced MR angiography and digital subtraction angiography. Non-GEE segment-based analysis revealed that for the two reviewers, nonenhanced MR angiography had sensitivities of 89.7% (436 of 486 segments) and 87.0% (423 of 486 segments) and specificities of 96.5% (994 of 1030 segments) and 94.6% (973 of 1028 segments). CONCLUSION QISS nonenhanced MR angiography offers an alternative to currently used imaging tests for symptomatic chronic lower limb ischemia, for which the administration of iodinated or gadolinium-based contrast agents is contraindicated.
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Affiliation(s)
- Philip A Hodnett
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL 60201, USA
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Abstract
OBJECTIVE The purpose of this article is to review the role of diagnostic imaging in the evaluation of women with diabetes. CONCLUSION Diabetic patients present a challenging population for the performance of various imaging studies and special considerations need to be made to obtain adequate studies. Imaging plays a significant role in assessing the multisystem morbidity of diabetes. Furthermore, diabetes in women may have some unique features and consequences and imaging studies can aid in the correct management of these patients.
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Nakamura K, Miyazaki M, Kuroki K, Yamamoto A, Hiramine A, Admiraal-Behloul F. Noncontrast-enhanced peripheral MRA: Technical optimization of flow-spoiled fresh blood imaging for screening peripheral arterial diseases. Magn Reson Med 2010; 65:595-602. [DOI: 10.1002/mrm.22614] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 07/27/2010] [Accepted: 08/04/2010] [Indexed: 11/06/2022]
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Menke J, Lüthje L, Kastrup A, Larsen J. Thromboembolism in atrial fibrillation. Am J Cardiol 2010; 105:502-10. [PMID: 20152245 DOI: 10.1016/j.amjcard.2009.10.018] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 10/11/2009] [Accepted: 10/11/2009] [Indexed: 11/25/2022]
Abstract
Thromboembolism is a severe complication in atrial fibrillation. This overview presents thromboembolic disease as a single entity, ranging from stroke through mesenteric ischemia to acute limb ischemia. The PubMed, Embase, and Cochrane databases were systematically searched for the terms "atrial fibrillation" and "thromboembolism" in reports published from January 1986 to September 2009. The information of 10 evidence-based practice guideline documents and 61 further sources was systematically extracted. In atrial fibrillation, the average annual stroke risk is increased by 2.3% (lethality 30%). The annual incidence of acute mesenteric ischemia is 0.14% (lethality 70%), and that of acute limb ischemia is 0.4% (lethality 16%). In total, approximately 80% of embolism-related deaths are from stroke and 20% from other systemic thromboembolism. The ischemic symptoms generally have an acute onset but may mimic other diseases, particularly in mesenteric ischemia. Early diagnosis and treatment can limit or even prevent tissue infarction. Guideline-recommended therapy with aspirin or warfarin reduces the thromboembolic risk. Suitable patients may optimize their warfarin therapy by self-monitoring of the international normalized ratio (INR). New oral and parenteral anticoagulants with more stable pharmacokinetics are being developed. In conclusion, atrial fibrillation predisposes to thromboembolism. If ischemic stroke or systemic thromboembolism occurs, early diagnosis and treatment can improve outcomes. The thromboembolic risks are reduced by guideline-adherent antithrombotic therapy with warfarin or aspirin. Future directions may include self-monitoring of the international normalized ratio and novel anticoagulants.
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Do the cardiovascular risk profile and the degree of arterial wall calcification influence the performance of MDCT angiography of lower extremity arteries? Eur Radiol 2009; 20:497-505. [DOI: 10.1007/s00330-009-1555-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 07/05/2009] [Indexed: 10/20/2022]
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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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Yim PJ, Nosher JL, Burgos A, Haddadin I. Subtraction computed tomographic angiography of calcified arteries: preliminary phantom and clinical studies. Acad Radiol 2009; 16:257-65. [PMID: 19201354 DOI: 10.1016/j.acra.2008.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 06/18/2008] [Accepted: 07/10/2008] [Indexed: 10/21/2022]
Abstract
RATIONALE AND OBJECTIVES The technique of subtraction computed tomographic angiography (sCTA) has been proposed for the evaluation of atherosclerotic disease to address limitations in CTA in highly calcified arteries. However, sCTA has not gained acceptance in clinical practice, in part, due to image artifacts caused by patient motion that occur between the acquisition of the two component images. The purpose of this study was to evaluate the effectiveness of computational image co-registration to obtain sCTA. MATERIALS AND METHODS The study was conducted using a semi-automated implementation of the mutual information (MI) registration algorithm. The results of sCTA were evaluated quantitatively in a phantom representing a calcified artery. Technical success of sCTA was evaluated in 14 calcified arterial segments in two patients. An observer study was carried out to determine interobserver agreement in the interpretation of sCTA. Qualitative observations were made between sCTA and CTA. RESULTS Computation time for performing the co-registration for each 2-cm calcification is less than 1 second. The necessary user interaction required minimal expertise. Measurements of the degree of stenosis in the calcified artery phantom agreed to within 8 +/- 4% of gold-standard measurements. Technical success was demonstrated in all calcifications. Strong interobserver agreement was obtained for the detection of hemodynamically significant stenoses (kappa = 0.86). Several apparent pitfalls in the interpretation of CTA in calcified arteries were noted that could potentially be obviated by sCTA. CONCLUSIONS The study supports the use of a straight-forward implementation of the MI algorithm and provides preliminary evidence validating the use of sCTA in the setting of atherosclerotic disease of the lower extremities.
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Tran DN, Straka M, Roos JE, Napel S, Fleischmann D. Dual-energy CT discrimination of iodine and calcium: experimental results and implications for lower extremity CT angiography. Acad Radiol 2009; 16:160-71. [PMID: 19124101 DOI: 10.1016/j.acra.2008.09.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 08/02/2008] [Accepted: 09/06/2008] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this work was to measure the accuracy of dual-energy computed tomography for identifying iodine and calcium and to determine the effects of calcium suppression in phantoms and lower-extremity computed tomographic (CT) angiographic data sets. MATERIALS AND METHODS Using a three-material basis decomposition method for 80- and 140-kVp data, the accuracy of correctly identified contrast medium and calcium voxels and the mean attenuation before and after calcium suppression were computed. Experiments were first performed on a phantom of homogenous contrast medium and hydroxyapatite samples with mean attenuation of 57.2, 126, and 274 Hounsfield units (HU) and 50.0, 122, and 265 HU, respectively. Experiments were repeated in corresponding attenuation groups of voxels from manually segmented bones and contrast medium-enhanced arteries in a lower-extremity CT angiographic data set with mean attenuation of 293 and 434 HU, respectively. Calcium suppression in atherosclerotic plaques of a cadaveric specimen was also studied, using micro-computed tomography as a reference, and in a lower-extremity CT angiographic data set with substantial below-knee calcified plaques. RESULTS Higher concentrations showed increased accuracy of iodine and hydroxyapatite identification of 87.4%, 99.7%, and 99.9% and 88.0%, 95.0%, and 99.9%, respectively. Calcium suppression was also more accurate with higher concentrations of iodine and hydroxyapatite, with mean attenuation after suppression of 47.1, 122, and 263 HU and 7.14, 11.6, and 12.6 HU, respectively. Similar patterns were seen in the corresponding attenuation groups of the contrast medium-enhanced arteries and bone in the clinical data set, which had overall accuracy of 81.3% and 78.9%, respectively, and mean attenuation after calcium suppression of 254 and 73.7 HU, respectively. The suppression of calcified atherosclerotic plaque was accurate compared with the micro-CT reference; however, the suppression in the clinical data set showed probable inappropriate suppression of the small vessels. CONCLUSION Dual-energy computed tomography can detect and differentiate between contrast medium and calcified tissues, but its accuracy is dependent on the CT density of tissues and limited when CT attenuation is low.
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Affiliation(s)
- David N Tran
- School of Medicine, Stanford University Medical Center, Stanford, CA 94305-5105, USA
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Rybicki FJ, Nallamshetty L, Yucel EK, Holtzman SR, Baum RA, Foley WD, Ho VB, Mammen L, Narra VR, Stein B, Moneta GL. ACR Appropriateness Criteria® on Recurrent Symptoms Following Lower-Extremity Angioplasty. J Am Coll Radiol 2008; 5:1176-80. [DOI: 10.1016/j.jacr.2008.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Indexed: 11/24/2022]
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Role of magnetic resonance imaging in the evaluation of diabetic foot with suspected osteomyelitis. Radiol Med 2008; 114:121-32. [DOI: 10.1007/s11547-008-0337-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 01/25/2008] [Indexed: 11/25/2022]
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Quantitative and qualitative evaluation of the influence of different table feeds on visualization of peripheral arteries in CT angiography of aortoiliac and lower extremity arteries. Eur Radiol 2008; 18:1546-55. [DOI: 10.1007/s00330-008-0914-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 01/22/2008] [Accepted: 01/31/2008] [Indexed: 10/22/2022]
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