Abstract
ObjectivesThe 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.MethodsTwenty-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.ResultsThe 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).ConclusionsCTP 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.
Highlights
Peripheral arterial disease (PAD) is a common vascular disease, which affects approximately 237 million people worldwide, with a rising global prevalence [1, 2]
CT perfusion (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
Recapitulating our results, we have shown that CTP values obtained in calf musculature, which represents the anatomic substrate for the clinical hallmark of critical limb ischemia, i.e. claudication, might represent an appropriate overview of local PAD [10]
Summary
Peripheral arterial disease (PAD) is a common vascular disease, which affects approximately 237 million people worldwide, with a rising global prevalence [1, 2]. Computed tomography angiography and magnetic resonance angiography recently saw huge technical improvement and were introduced into current guidelines [5,6,7,8]
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