Multimodality Imaging of Lower Extremity Peripheral Arterial Disease

Pollak, Amy W.; Norton, Patrick T.; Kramer, Christopher M.

doi:10.1161/circimaging.111.970814

Cited by 109 publications

(102 citation statements)

References 63 publications

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“…Since below-knee arteries are not a treatment target in patients with intermittent claudication, this is not a significant drawback in this population (50). However, in patients with critical limb ischemia, who may also be diabetic and may have significant arterial calcification, this a greater concern, and time-resolved MR angiography techniques may be advantageous in this subgroup of patients (51). Recent data suggest, however, that CT angiography provides accurate recommendations for the management of patients with critical limb ischemia as well (52).…”

Section: Peripheral Vascular Disease: Pushing the Envelope For Ct Angmentioning

confidence: 99%

CT Angiography after 20 Years: A Transformation in Cardiovascular Disease Characterization Continues to Advance

et al. 2014

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Through a marriage of spiral computed tomography (CT) and graphical volumetric image processing, CT angiography was born 20 years ago. Fueled by a series of technical innovations in CT and image processing, over the next 5–15 years, CT angiography toppled conventional angiography, the undisputed diagnostic reference standard for vascular disease for the prior 70 years, as the preferred modality for the diagnosis and characterization of most cardiovascular abnormalities. This review recounts the evolution of CT angiography from its development and early challenges to a maturing modality that has provided unique insights into cardiovascular disease characterization and management. Selected clinical challenges, which include acute aortic syndromes, peripheral vascular disease, aortic stent-graft and transcatheter aortic valve assessment, and coronary artery disease, are presented as contrasting examples of how CT angiography is changing our approach to cardiovascular disease diagnosis and management. Finally, the recently introduced capabilities for multispectral imaging, tissue perfusion imaging, and radiation dose reduction through iterative reconstruction are explored with consideration toward the continued refinement and advancement of CT angiography.

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Section: Peripheral Vascular Disease: Pushing the Envelope For Ct Angmentioning

confidence: 99%

CT Angiography after 20 Years: A Transformation in Cardiovascular Disease Characterization Continues to Advance

et al. 2014

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“…More invasive imaging techniques such as x-ray computed tomography angiograms (CTA) and magnetic resonance angiography (MRA) are also used presurgically to determine the locations of lesions. However, these techniques require the use of contrast agents that are nephrotoxic which renders them dangerous to use for diabetic patients and patients with renal insufficiency [3][4][5]. Furthermore, these anatomical imaging methods do not provide information on the perfusion response within the foot.…”

Section: Current Diagnostic Techniquesmentioning

confidence: 99%

“…a greater ampl etic PAD patien nd [4][5] To further qu dynamic ima amount of bl total hemogl concordance 4(B), 4(C)) assertion that arterial stiffe D patient within the foot while providing cross-sectional images that correspond to the foot vasculature. We found differences between all three cases in the magnitude of the detector intensity drop during thigh cuff occlusion and the weighted average change in [HbT] signal obtained from the image reconstructions.…”

Section: Imagementioning

confidence: 99%

Imaging of vascular dynamics within the foot using dynamic diffuse optical tomography to diagnose peripheral arterial disease

et al. 2013

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Peripheral Arterial Disease (PAD) is the narrowing of the functional area of the artery generally due to atherosclerosis. It affects between 8-12 million people in the United States and if untreated this can lead to ulceration, gangrene and ultimately amputation. The current diagnostic method for PAD is the ankle-brachial index (ABI). The ABI is a ratio of the patient's systolic blood pressure in the foot to that of the brachial artery in the arm, a ratio below 0.9 is indicative of affected vasculature. However, this method is ineffective in patients with calcified arteries (diabetic and end-stage renal failure patients), which falsely elevates the ABI recording resulting in a false negative reading. In this paper we present our results in a pilot study to deduce optical tomography's ability to detect poor blood perfusion in the foot. We performed an IRB approved 30 patient study, where we imaged the feet of the enrolled patients during a five stage dynamic imaging sequence. The patients were split up into three groups: 10 healthy subjects, 10 PAD patients and 10 PAD patients with diabetes and they were imaged while applying a pressure cuff to their thigh. Differences in the magnitude of blood pooling in the foot and rate at which the blood pools in the foot are all indicative of arterial disease.

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Section: Introductionmentioning

confidence: 99%

“…However, it is invasive and carries limitations and risks (5). Computed tomography angiography (CTA), a less invasive and safer examination, is an alternative to DSA and has gained widespread clinical acceptance for diagnosing PAD (5). Although CTA of lower extremities is more sensitive, specific, and accurate for assessing the location and extent of peripheral artery stenosis than DSA (6), its spatial resolution is inferior to DSA, and the visualization of small vessels, such as the peripheral small artery and collateral vessels, is suboptimal.…”

Section: Introductionmentioning

confidence: 99%