CT angiography of the lower extremity and coronary arteries using 256-section CT: a preliminary study

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To investigate the possible use of a 256-section computed tomography (CT) prospective electrocardiography (ECG)-gated wide volume scanning protocol for combined angiography of the lower extremity and coronary arteries, after a single injection of contrast medium, in patients with lower extremity peripheral arterial disease (PAD). Thirty-four patients with suspected PAD underwent CT angiography (CTA) with a prospective ECG-gated protocol that covered the level of the tracheal bifurcation to the foot sole. Digital subtraction angiography (DSA) of the lower extremity arteries was performed on patients requiring therapeutic intervention. Image quality and stenosis of the coronary and lower extremity arteries were assessed. A total of 93.1% of the coronary segments were adequate for diagnosis. 17 (50%) patients showed coronary artery stenosis ≥50%. A total of 95.8% of the lower extremity arterial segments were adequate for diagnosis. Twenty-eight patients with severe lower extremity arterial stenosis or occlusion underwent DSA. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CTA for the detection of significant lower arterial stenosis (≥50%) was 94.8%, 97.2%, 95.3%, 96.9%, and 96.3%, respectively. Using the prospective ECG-gated wide volume CTA protocol, images of the coronary and lower extremity arteries suitable for diagnosis can be acquired simultaneously after a single injection of contrast agent. In addition to accurately diagnosing PAD, combined angiography may be used to screen for coronary heart disease in patients with PAD.