Improving the diagnosis of peripheral arterial disease in below-the-knee arteries by adding time-resolved CT scan series to conventional run-off CT angiography. First experience with a 256-slice CT scanner

Buls, Nico; Brucker, Yannick De; Aerden, Dimitri; Devos, Hannes; Gompel, Gert Van; Boonen, Pieter Thomas; Nieboer, Koenraad; Leiner, Tim; Mey, Johan De

doi:10.1016/j.ejrad.2018.11.030

Cited by 23 publications

(21 citation statements)

References 18 publications

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“…In this study, The CT attenuation of anterior tibial artery, posterior tibial artery and bular artery at proximal 1/3 of the lower legs in t-MIP images was 21.5 to 28.3 HU higher than that in best enhancement phase of dyn-CTA, and was 50.5 to 56.1 HU higher than that in s-CTA images. It was reasonable for t-MIP retrieved the highest vascular attenuation from the whole time-phase of dyn-CTA images, and the previous study found that t-MIP [17] and dyn-CTA [10] showed higher vascular attenuation than s-CTA. In our study, t-MIP was correlated with s-CTA, which was consistent with the results of the previous study and a follow up [16] showing that t-MIP images had a strong positive correlation with NCCT images.…”

Section: Discussionmentioning

confidence: 53%

“…Studies on dyn-CTA have shown that compared with s-CTA, dyn-CTA can improve arterial enhancement and diagnostic con dence [9,10], which may compensate for the limitation of unsatisfactory arterial enhancement of lower extremity runoff CTA. In addition to the advantage of tracking the best time of the bolus, large image data of multiphase dyn-CTA consume more time than those of s-CTA and inhibit its clinical application.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with s-CTA, dyn-CTA shows better performance on arterial contrast enhancement, diagnostic con dence, and diagnostic accuracy for detecting vessel stenoses and occlusions in PAD patients [9]. Buls et al evaluated the mean CT values (HU) of all arteries below the knees, and gave conclusion that dyn-CTA showed higher image quality and diagnostic con dence for assessing the occurrence and degree of arterial stenosis [10].…”

Section: Introductionmentioning

confidence: 99%

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Quick Evaluation of Lower Leg Ischemia in Patients with Peripheral Arterial Disease by Time Maximum Intensity Projection CT Angiography: A Pilot Study

Zhou

Zhang

Fan

et al. 2020

Preprint

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Background: The purpose of this study is to evaluate the new method of time maximum intensity projection (t-MIP) which was postprocessed from dynamic computed tomographic angiography (dyn-CTA) in diagnosing peripheral arterial disease (PAD). Methods: A population of 34 patients with known PAD was examined with a combined CTA protocol consisting of an s-CTA of the lower extremity and a dyn-CTA scan of the calves. For each lower leg, t-MIP images consisting of the MIP0 (sagittal MIP), and MIP+θ (45degree lateral MIP), MIP-θ (-45degree lateral MIP) were automatically generated from dyn-CTA. An objective evaluation of vascular CT attenuation of the best enhancement phase of dyn-CTA and t-MIP was measured; subjective evaluation of vessel stenosis and occlusion with a score was assigned for t-MIP and s-CTA. A comparison between the CT attenuation of t-MIP and dyn-CTA was made, so was the runoff score of t-MIP and s-CTA.Results: The CT attenuation of t-MIP CTA of three vascular segments from 68 lower extremities was higher than that of the best enhancement phase of dyn-CTA and s-CTA, with statistical significant difference at posterior tibial artery and fibular artery (all p＜0.05) . There were strong correlations (r ≥0.75, p < 0.05) of runoff scores between t-MIP and s-CTA. Conclusions: There is potential clinical application of t-MIP for assisting with the diagnosis of lower leg vascular stenosis in dyn-CTA with reliable diagnostic accuracy and convenient immediacy.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quick Evaluation of Lower Leg Ischemia in Patients with Peripheral Arterial Disease by Time Maximum Intensity Projection CT Angiography: A Pilot Study

Zhou

Zhang

Fan

et al. 2020

Preprint

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“…Amacker et al reported that the mean radiation dose decreased by 20% and 42% when the pitch was increased from 1 to 3.2 for routine chest and abdominal CT scans, respectively [15], but it in our case there was no decrease in the amount of the dose due to the care dose option being selected during the image scan; this option increases the mAs during image scanning to reduce image noise, which led to increased image quality. On other hand, a decrease in the kVp during CTA scan will increased the attenuation of each unit of low iodine concentration because the low voltage helps improve blood vessels and elasticity while minimising the absorption of radiation at the same time, as long as there is no significant scattering of the beam or degradation of the image due to large tissue or bone along the X-ray path [6]. The reduction of the amount of contrast media also leads to the reduction of the cost and risk of side effects resulting from giving iodine in large quantities.…”

Section: Discussionmentioning

confidence: 99%

“…Early diagnosis and appropriate medical interventions can mitigate limb-specific symptoms, improve quality of life, and decrease systemic cardiovascular risk [4]. Computed tomography angiography (CTA), as a non-invasive and safe examination, has been widely used in clinical practice to diagnose PAD and acute lower-extremity vascular injury with high accuracy [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Image quality and radiation exposure with low-contrast-dose computed tomography angiography of the lower extremities

Assi

2020

Pol J Radiol

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IntroductionMultidetector computed tomography is the reference standard for the diagnosis of peripheral arterial disease (PAD). The aim of this study is to optimise the image quality of computed tomography (CT) scanning for the diagnosis of PAD with the lowest possible radiation and contrast volume.Material and methodsSeventy-two patients were referred for evaluation of suspected PAD with CT angiography. Patients were randomly assigned to an optimise care dose of kVp – group A, n = 36; 18 men, 18 women; mean age, 63 years with standard deviation 15; range, 20-88 years (contrast volume 80-85 ml was injected automatically with bolus tracking, and group B, n = 36; 18 men, 18 women; mean age, 61 years with standard deviation 16; range, 26-88 years (contrast volume 120-140 ml was injected automatically with bolus tracking). Other scanning parameters were kept constant. Lower extremities vessel enhancement and image noise were quantified, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective vessel contrast was assessed by two radiologists in consensus.ResultA total of 16 cases of PAD (22.2%) were found in the evaluated of subjects (10 in group A, and six in group B). All PAD cases were detected by the two readers. There was no significant difference in the size or location of the PAD between the two groups; the average image noise was 19 HU for group A and 16 HU for group B. The difference was not statistically significant (p = 0.183). Overall, the SNR and CNR were slightly higher in group B (25.5 and 24.1, respectively) compared with group A (20 and 17.4, respectively), but those differences were not statistically significant (p = 061 and p = 0.38, respectively).ConclusionsAll patients were evaluated by lower extremities CTA protocol allowing similar image quality to be achieved in both groups, with optimised care dose for both protocols, and contrast volume was reduced by 40% in the new protocol group compared to the conventional protocol group.

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Quantitative hemodynamic assessment of stenotic below‐the‐knee arteries using spatio‐temporal bolus tracking on 4D‐CT angiography

Boonen,

Buls,

van Gompel

et al. 2023

Medical Physics

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BackgroundPeripheral 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.PurposeTo 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.MethodsFifty 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.Results280 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.ConclusionsThe 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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Improving the diagnosis of peripheral arterial disease in below-the-knee arteries by adding time-resolved CT scan series to conventional run-off CT angiography. First experience with a 256-slice CT scanner

Cited by 23 publications

References 18 publications

Quick Evaluation of Lower Leg Ischemia in Patients with Peripheral Arterial Disease by Time Maximum Intensity Projection CT Angiography: A Pilot Study

Quick Evaluation of Lower Leg Ischemia in Patients with Peripheral Arterial Disease by Time Maximum Intensity Projection CT Angiography: A Pilot Study

Image quality and radiation exposure with low-contrast-dose computed tomography angiography of the lower extremities

Quantitative hemodynamic assessment of stenotic below‐the‐knee arteries using spatio‐temporal bolus tracking on 4D‐CT angiography

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