Influence of diabetes on diagnostic performance of computed tomography angiography of the calf arteries in acute limb ischemia

Abstract

Background Patients with diabetes mellitus (DM) have a more extensive distal arterial occlusive disease compared to non-diabetic patients. Diagnostic imaging is a necessity to identify the location and extent of the arterial occlusion in acute limb ischemia (ALI). Computed tomography angiography (CTA) is the most commonly used modality and the diagnostic performance with CTA of calf arteries may be questioned. Purpose To evaluate diagnostic performance of CTA of calf arteries in ALI and to compare patients with and without DM. Material and Methods All thrombolytic treatments performed during 2001–2008 in patients with ALI were included. Initial digital subtraction angiography (DSA) and CTA of all patients were classified according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) below-the-knee arteries and compared to CTA. Two raters assessed the CTA images independently. Inter-rater reliability was expressed as intraclass correlation (ICC) with 95% confidence intervals (CI). Results Patients with (n = 23) and without (n = 85) DM had lower ( P = 0.006) glomerular filtration rate. ICC between CTA and DSA was 0.33 (95% CI –0.22 to 0.56) and 0.71 (95% CI 0.38–0.68) in patients with and without DM, respectively. Sensitivity with CTA for TASC D lesions in patients with and without DM was 0.14 (95% CI –0.12 to 0.40) and 0.64 (95% CI 0.48–0.80), respectively. Conclusion The sensitivity of CTA for assessment of infra-popliteal TASC D lesions in patients with ALI was not acceptable in patients with DM in contrast to those without DM. Another imaging option at present times should be considered for patients with DM.

Computed Tomographic Angiography as the First Diagnostic Tool in the Evaluation of Patients with Acute Limb Ischaemia: A Narrative Review

“…As it was mentioned before, one of the main disadvantages is an impression of more prominent stenosis due to severe vessel calcification. Patients with ALI are commonly seen with diabetes and diabetes is associated with heavy calcified peripheral vessels [20]. Calcium-induced artefacts limit the vision of the stenosis-free lumen of the vessel.…”

“…Dual-energy CTA can provide enhanced diagnostic features to differentiate between calcium deposits on the vessels and iodinated contrast. Studies showed that dual-energy CTA is more precise in imaging heavily calcified vessels [7] [20].…”