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16-MDCT Angiography of Aortoiliac and Lower Extremity Arteries: Comparison with Digital Subtraction Angiography

Thomas Albrecht1, Ellen Foert1, Robin Holtkamp1, Miles A. Kirchin2, Constanze Ribbe1, Frank K. Wacker1, Martin Kruschewski3 and Bernhard C. Meyer1

1 Department of Radiology and Nuclear Medicine, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Freie Universität Berlin, and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12200 Berlin, Germany.
2 Bracco Imaging SpA, Milan, Italy.
3 Department of Surgery, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany.


Figure 1
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  		Fig. 1A —69-year-old man with chronic right-sided claudication. Digital subtraction angiography (DSA) image of pelvic arteries (30° right anterior oblique projection) shows grade 3 stenosis of right common iliac artery (short arrow) and grade 1 stenosis of left common iliac artery (long arrow). Several collaterals (arrowheads) arising from lumbar artery (asterisks) are depicted.

 

Figure 2
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  		Fig. 1B —69-year-old man with chronic right-sided claudication. Corresponding CT angiography (CTA) image (maximum-intensity-projection reconstruction) confirms grade 3 stenosis of right common iliac artery (short arrow) and grade 1 stenosis of left common iliac artery (long arrow) as judged by both observers. Fewer collateral vessels (arrowheads) are seen on CTA than on DSA (A). Asterisk = lumbar artery.

 

Figure 3
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  		Fig. 2A —Digital subtraction angiography (DSA) and CT angiography (CTA) performed 5 days after stent placement in right distal superficial femoral artery in 59-year-old man with recurring claudication. DSA image (posteroanterior projection) of thigh shows 5-cm occlusion of stented segment (arrow) with grade 1 collaterals (arrowheads).

 

Figure 4
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  		Fig. 2B —Digital subtraction angiography (DSA) and CT angiography (CTA) performed 5 days after stent placement in right distal superficial femoral artery in 59-year-old man with recurring claudication. Corresponding CTA image (maximum-intensity-projection reconstruction) also shows occlusion (arrow) proximal to stent (asterisk) and similar number of collateral vessels (arrowheads) judged as grade 1 by both observers.

 

Figure 5
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  		Fig. 3A —Digital subtraction angiography (DSA) and CT angiography (CTA) of below-knee arteries of right leg in 54-year-old man with chronic claudication and two proximal high-grade stenoses (not shown). DSA image (posteroanterior projection) shows grade 2 stenosis of tibiofibular trunk (long arrow) and grade 3 stenosis of posterior tibial artery (short arrow). Most distal part of posterior tibial artery is not visualized.

 

Figure 6
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  		Fig. 3B —Digital subtraction angiography (DSA) and CT angiography (CTA) of below-knee arteries of right leg in 54-year-old man with chronic claudication and two proximal high-grade stenoses (not shown). Corresponding CTA image underestimates stenosis of tibiofibular trunk (long arrow) as grade 1 (both observers) but correctly shows grade 3 stenosis (as judged by both observers) of posterior tibial artery (short arrow). Posterior tibial artery (arrowhead) is visualized down to ankle and thus is shown more completely on CTA than on DSA.

 

Figure 7
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  		Fig. 4A —Digital subtraction angiography (DSA) and CT angiography (CTA) of right leg in 51-year-old woman with critical lower leg ischemia. DSA image (posteroanterior projection) shows grade 3 stenosis of common femoral artery (short arrow) and grade 3 stenosis of popliteal artery (long arrow) with grade 1 collaterals at thigh (arrowheads). Below-knee arteries are not visualized.

 

Figure 8
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  		Fig. 4B —Digital subtraction angiography (DSA) and CT angiography (CTA) of right leg in 51-year-old woman with critical lower leg ischemia. Corresponding CTA maximum-intensity-projection (MIP) reconstruction image shows extensive calcification of common femoral artery (short arrows) and area of calcification of popliteal artery (long arrow). Based on MIP reconstruction, it is unclear whether these calcifications cause stenoses. Grade 1 collaterals (arrowheads) are shown, but they are less extensive on CTA than on DSA. CTA depicts all three arteries of proximal lower leg that cannot be seen on DSA and shows them to be patent.

 

Figure 9
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  		Fig. 4C —Digital subtraction angiography (DSA) and CT angiography (CTA) of right leg in 51-year-old woman with critical lower leg ischemia. Curved CTA multiplanar reformation (MPR) image of common femoral artery reveals agreement with DSA regarding presence of distal grade 3 stenosis (arrow) as judged by both observers, whereas more proximal calcifications (arrowheads) are not stenosing.

 

Figure 10
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  		Fig. 4D —Digital subtraction angiography (DSA) and CT angiography (CTA) of right leg in 51-year-old woman with critical lower leg ischemia. Curved CTA MPR image of popliteal artery similarly reveals agreement with DSA regarding presence of calcified plaque causing grade 3 stenosis (arrow) as judged by both observers.

 

Figure 11
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  		Fig. 5 —Bar graph shows number of arterial levels of collaterals visualized by observer 1 (gray bars) and observer 2 (black bars) on CT angiography (CTA) in comparison with digital subtraction angiography (DSA) at total of 150 arterial levels.

 

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