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Multidetector CT Angiography of Peripheral Vascular Disease: A Prospective Comparison with Intraarterial Digital Subtraction Angiography

¹ Department of Diagnostic Radiology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel.
² Department of Vascular Surgery, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel.
³ Unit of Clinical Epidemiology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel.

View larger version (66K): [in a new window]   Fig. 1A. —52-year-old man with severe right intermittent claudication. Maximum-intensity-projection reformations of CT angiograms of complete vascular tree show occlusion of right iliac arteries and bilateral occlusion of superficial femoral arteries. Note right midtibialis anterior point on B where segmentation of vessel (arrow, B) was impossible to see with our software. Distal course of artery was revealed with axial CT only. Left tibialis anterior artery is severely diseased and occluded distally (B).

View larger version (61K): [in a new window]   Fig. 1B. —52-year-old man with severe right intermittent claudication. Maximum-intensity-projection reformations of CT angiograms of complete vascular tree show occlusion of right iliac arteries and bilateral occlusion of superficial femoral arteries. Note right midtibialis anterior point on B where segmentation of vessel (arrow, B) was impossible to see with our software. Distal course of artery was revealed with axial CT only. Left tibialis anterior artery is severely diseased and occluded distally (B).

View larger version (127K): [in a new window]   Fig. 1C. —52-year-old man with severe right intermittent claudication. Axial CT scan obtained at level of distal aorta shows small aneurysm with large thrombus.

View larger version (113K): [in a new window]   Fig. 1D. —52-year-old man with severe right intermittent claudication. Digital subtraction angiogram fails to reveal aneurysm seen in C.

View larger version (70K): [in a new window]   Fig. 2A. —68-year-old man with intermittent claudication 1 year after bilateral femoropopliteal bypass graft (with saphenous vein). Maximum-intensity-projection reformations of CT angiograms (A and B) and digital subtraction angiograms (C and D) show bilateral occlusion of superficial femoral arteries, severe stenosis (arrows, A and C) of right proximal graft, and occlusion (arrows, B and D) of left popliteal artery below distal graft anastomosis. There is single vessel outflow bilaterally: tibialis posterior artery on right and tibialis anterior artery on left.

View larger version (62K): [in a new window]   Fig. 2B. —68-year-old man with intermittent claudication 1 year after bilateral femoropopliteal bypass graft (with saphenous vein). Maximum-intensity-projection reformations of CT angiograms (A and B) and digital subtraction angiograms (C and D) show bilateral occlusion of superficial femoral arteries, severe stenosis (arrows, A and C) of right proximal graft, and occlusion (arrows, B and D) of left popliteal artery below distal graft anastomosis. There is single vessel outflow bilaterally: tibialis posterior artery on right and tibialis anterior artery on left.

View larger version (158K): [in a new window]   Fig. 2C. —68-year-old man with intermittent claudication 1 year after bilateral femoropopliteal bypass graft (with saphenous vein). Maximum-intensity-projection reformations of CT angiograms (A and B) and digital subtraction angiograms (C and D) show bilateral occlusion of superficial femoral arteries, severe stenosis (arrows, A and C) of right proximal graft, and occlusion (arrows, B and D) of left popliteal artery below distal graft anastomosis. There is single vessel outflow bilaterally: tibialis posterior artery on right and tibialis anterior artery on left.

View larger version (102K): [in a new window]   Fig. 2D. —68-year-old man with intermittent claudication 1 year after bilateral femoropopliteal bypass graft (with saphenous vein). Maximum-intensity-projection reformations of CT angiograms (A and B) and digital subtraction angiograms (C and D) show bilateral occlusion of superficial femoral arteries, severe stenosis (arrows, A and C) of right proximal graft, and occlusion (arrows, B and D) of left popliteal artery below distal graft anastomosis. There is single vessel outflow bilaterally: tibialis posterior artery on right and tibialis anterior artery on left.

View larger version (15K): [in a new window]   Fig. 3. —Bar chart shows agreement between digital subtraction angiography and CT angiography for significant stenosis in each artery. CIA = common iliac artery, EIA = external iliac artery, IIA = internal iliac artery, CFA = common femoral artery, SFA = superficial femoral artery, PRF = profunda (deep femoral artery), POP = popliteal artery, TA = tibialis anterior, TPT = tibioperoneal trunk, TP = tibialis posterior, PER = peroneal, DP = dorsalis pedis.

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