CT perfusion in peripheral arterial disease—hemodynamic differences before and after revascularisation

Abstract

Objectives The purpose of this study was the assessment of volumetric CT perfusion (CTP) of the lower leg musculature in patients with symptomatic peripheral arterial disease (PAD) before and after interventional revascularisation. Methods Twenty-nine consecutive patients with symptomatic PAD of the lower extremities requiring interventional revascularisation were assessed prospectively. All patients underwent a CTP scan of the lower leg, and hemodynamic and angiographic assessment, before and after intervention. Ankle-brachial pressure index (ABI) was determined. CTP parameters were calculated with a perfusion software, acting on a no outflow assumption. A sequential two-compartment model was used. Differences in CTP parameters were assessed with non-parametric tests. Results The cohort consisted of 24 subjects with an occlusion, and five with a high-grade stenosis. The mean blood flow before/after (BFpre and BFpost, respectively) was 7.42 ± 2.66 and 10.95 ± 6.64 ml/100 ml*min−1. The mean blood volume before/after (BVpre and BVpost, respectively) was 0.71 ± 0.35 and 1.25 ± 1.07 ml/100 ml. BFpost and BVpost were significantly higher than BFpre and BVpre in the treated limb (p = 0.003 and 0.02, respectively), but not in the untreated limb (p = 0.641 and 0.719, respectively). Conclusions CTP seems feasible for assessing hemodynamic differences in calf muscles before and after revascularisation in patients with symptomatic PAD. We could show that CTP parameters BF and BV are significantly increased after revascularisation of the symptomatic limb. In the future, this quantitative method might serve as a non-invasive method for surveillance and therapy control of patients with peripheral arterial disease. Key Points • CTP imaging of the lower limb in patients with symptomatic PAD seems feasible for assessing hemodynamic differences before and after revascularisation in PAD patients. • This quantitative method might serve as a non-invasive method, for surveillance and therapy control of patients with PAD.

Acute and Long-Term Consequences of COVID-19 on Arterial Stiffness—A Narrative Review

“…Meanwhile, CT is broadly available, rather cheap and frequently used in the assessment of COVID-19 patients. CT perfusion imaging has recorded significant technical improvement [ 49 , 50 ], and several new indications in vascular imaging are in clinical investigation. The CT aortic stiffness index (CTASI) proved to be a robust measure of arterial stiffness [ 51 ].…”

Clinical Outcomes after Endovascular Revascularisation of the Femoropopliteal Arterial Segment in Patients with Anticoagulant versus Antiplatelet Therapy: A Single-Centre Retrospective Cohort Study

“…In addition to the abovementioned points, when drafting potential future (prospective) research, the use of modern imaging techniques such as CT perfusion imaging of the lower limb should be considered to assess treatment outcomes. In our study, outcomes were only assessed clinically, while recent research shows non-invasive imaging to be a viable alternative [ 38 ].…”

A Reperfusion BOLD-MRI Tissue Perfusion Protocol Reliably Differentiate Patients with Peripheral Arterial Occlusive Disease from Healthy Controls

“…Other functional MRI techniques have also been suggested in PAOD applications, including arterial spin labeling techniques [4]. Furthermore, CT perfusion techniques are under development and may provide reasonable alternatives to quantify PAOD tissue perfusion [26][27][28]. To the best of our knowledge, no functional MRI technique has been broadly introduced in clinical practice or included in pathoanatomical PAOD imaging protocols, perhaps due to logistical and technical issues including limited availability of MRI scanners, problems with signal strengths in smaller muscles, risk for motion artifacts and the added time for image acquisition.…”