Abstract
We sought to study the accuracy of dual-energy computed tomographic angiography (DE-CTA) for the assessment of symptomatic peripheral arterial occlusive disease of the lower extremity by using the dual-energy bone removal technique compared with a commercially available conventional bone removal tool. Twenty patients underwent selective digital subtraction angiography and DE-CTA of the pelvis and lower extremities. CTA data were postprocessed with two different applications: conventional bone removal and dual-energy bone removal. All data were reconstructed and evaluated as 3D maximum-intensity projections. Time requirements for reconstruction were documented. Sensitivity, specificity, accuracy, and concordance of DE-CTA regarding degree of stenosis and vessel wall calcification were calculated. A total of 359 vascular segments were analyzed. Compared with digital subtraction angiography, sensitivity, specificity, and accuracy, respectively, of CTA was 97.2%, 94.1%, and 94.7% by the dual-energy bone removal technique. The conventional bone removal tool delivered a sensitivity of 77.1%, a specificity of 70.7%, and an accuracy of 72.0%. Best results for both postprocessing methods were achieved in the vascular segments of the upper leg. In severely calcified segments, sensitivity, specificity, and accuracy stayed above 90% by the dual-energy bone removal technique, whereas the conventional bone removal technique showed a substantial decrease of sensitivity, specificity, and accuracy. DE-CTA is a feasible and accurate diagnostic method in the assessment of symptomatic peripheral arterial occlusive disease. Results obtained by DE-CTA are superior to the conventional bone removal technique and less dependent on vessel wall calcifications.
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References
Heijenbrok-Kal MH, Kock MC, Hunink MG (2007) Lower extremity arterial disease: multidetector CT angiography meta-analysis. Radiology 245:433–439
Ofer A, Nitecki SS, Linn S et al (2003) Multidetector CT angiography of peripheral vascular disease: a prospective comparison with intraarterial digital subtraction angiography. AJR Am J Roentgenol 180:719–724
Heuschmid M, Krieger A, Beierlein W et al (2003) Assessment of peripheral arterial occlusive disease: comparison of multislice-CT angiography (MS-CTA) and intraarterial digital subtraction angiography (IA-DSA). Eur J Med Res 8:389–396
Martin ML, Tay KH, Flak B et al (2003) Multidetector CT angiography of the aortoiliac system and lower extremities: a prospective comparison with digital subtraction angiography. AJR Am J Roentgenol 180:1085–1091
Catalano C, Fraioli F, Laghi A et al (2004) Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography. Radiology 231:555–563
Mesurolle B, Qanadli SD, El Hajjam M et al (2004) Occlusive arterial disease of abdominal aorta and lower extremities: comparison of helical CT angiography with transcatheter angiography. Clin Imaging 28:252–260
Ota H, Takase K, Igarashi K et al (2004) MDCT compared with digital subtraction angiography for assessment of lower extremity arterial occlusive disease: importance of reviewing cross-sectional images. AJR Am J Roentgenol 182:201–209
Portugaller HR, Schoellnast H, Hausegger KA et al (2004) Multislice spiral CT angiography in peripheral arterial occlusive disease: a valuable tool in detecting significant arterial lumen narrowing? Eur Radiol 14:1681–1687
Fraioli F, Catalano C, Napoli A et al (2006) Low-dose multidetector-row CT angiography of the infra-renal aorta and lower extremity vessels: image quality and diagnostic accuracy in comparison with standard DSA. Eur Radiol 16:137–146
Johnson TR, Krauss B, Sedlmair M et al (2007) Material differentiation by dual energy CT: initial experience. Eur Radiol 17:1510–1517
Fontaine R, Kim M, Kieny R (1954) Surgical treatment of peripheral circulation disorders. Helv Chir Acta 21:499–533
Bui TD, Gelfand D, Whipple S et al (2005) Comparison of CT and catheter arteriography for evaluation of peripheral arterial disease. Vasc Endovascular Surg 39:481–490
Willmann JK, Baumert B, Schertler T et al (2005) Aortoiliac and lower extremity arteries assessed with 16-detector row CT angiography: prospective comparison with digital subtraction angiography. Radiology 236:1083–1093
Visser K, Hunink MG (2000) Peripheral arterial disease: gadolinium-enhanced MR angiography versus color-guided duplex US—a meta-analysis. Radiology 216:67–77
Ouwendijk R, de Vries M, Pattynama PM et al (2005) Imaging peripheral arterial disease: a randomized controlled trial comparing contrast-enhanced MR angiography and multi-detector row CT angiography. Radiology 236:1094–1103
Johnson TR, Nikolaou K, Wintersperger BJ et al (2006) Dual-source CT cardiac imaging: initial experience. Eur Radiol 16:1409–1415
Fink C, Johnson TR, Michaely HJ et al (2008) Dual-energy CT angiography of the lung in patients with suspected pulmonary embolism: initial results. Rofo 180:879–883
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Brockmann, C., Jochum, S., Sadick, M. et al. Dual-Energy CT Angiography in Peripheral Arterial Occlusive Disease. Cardiovasc Intervent Radiol 32, 630–637 (2009). https://doi.org/10.1007/s00270-008-9491-5
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DOI: https://doi.org/10.1007/s00270-008-9491-5