Role of multidetector computed tomography angiography in evaluation of peripheral arterial disease

Abstract

Background: Diagnostic imaging plays an important role in the evaluation of peripheral arterial disease. Many imaging modalities are available ranging from conventional modalities to the cross-sectional modalities like Doppler ultrasound, DSA, CT and MRI. The main principles of imaging are to characterize the all lesions detected including type of plaques, no. of lesions, length of stenosis, diameter of vessel in pre-stenotic and post-stenotic segments, degree of wall calcification, assisting in pretreatment planning with respect to route of access, selection of balloon and demonstrates size, extent, neck dimention, and presence of thrombosis in cases with aneurysm.Methods: A Cross-sectional observational study was done in 30 patients. Clinically suspected patients of peripheral arterial disease based on history, sign and symptoms and patients diagnosed with peripheral arterial disease on color doppler were included in our study. Both modalities were compared for detecting the occlusion and stenotic segments.Results: A total of 476 vessel segments were imaged by both modalities. When all arterial segments were considered, MDCTA detected stenosis or occlusion lesions in 30% of arterial segments, versus 18.8% compared to DUS. MDCTA showed 9.8% (95% CI:[4.3%, 15.3%]) more lesions than DUS when all arterial segments were considered together, 11.2% (95% CI: [2.7%, 22.1%]) more lesions when only the iliac arteries were compared, 9.1% (95% CI: [3.2%, 17.2%]) more lesions when only the femoropopliteal arteries were compared, 8.9% (95% CI: [1.5%, 16.3%]) more lesions when only infrapopliteal arteries were compared and 13% (95% CI: [2.6%, 25.4%]) more lesions when only the upper limb arterial segments were compared, (p <0.05 for all comparisons).Conclusions: MDCTA may be used as a screening tool in patients with peripheral arterial disease as it is a non-invasive and more accurate modality when compared to DUS and plays important role in management.

Role of Doppler Ultrasound in Comparison With MDCT Angiography in the Assessment of Lower Limb PAD

“…In our study, Diabetes mellitus was the major risk factor leading to PAD. Out of 42 patients, 30 patients (86%) were presented with diabetes mellitus that was in accordance with the finding of the study by Kumar R et al 5 while other risk factors noted in our study are hypertension (71%), hyperlipidemia (63%), smoking (57%), cardiac problem (14%) and previous surgery (11%). According to the Kondeti K et al 6 smoking was a major risk factor in the development of PAD.…”

“…So, the results showed that the MDCT was able to detect 9% more diseased segments as compared to doppler USG. Similar finding were noted by Kumar R et al 5 , in which MDCTA showed 11.2% more diseased segments as compared to Doppler.…”