CT-perfusion in peripheral arterial disease - Correlation with angiographic and hemodynamic parameters.

Bert-Ram Sah,Martin Banyai,Patrick Veit-Haibach,Martin W Huellner,Klaus Strobel,Salvatore De Rosa

doi:10.1371/journal.pone.0223066

Abstract

ObjectiveThe 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) of the lower extremities, comparing it with established angiographic and hemodynamic parameters.Materials and methodsThirty-five consecutive patients with symptomatic PAD of the lower extremities requiring interventional revascularization were assessed prospectively. All patients underwent a CTP scan of the lower leg, and hemodynamic and angiographic assessment. Hemodynamic parameters, specifically ankle-brachial pressure index (ABI), ankle blood pressure (ABP), peak systolic velocity (PSV), and segmental pulse oscillography (SPO) level, were determined. Lesion length and degree of collateralization were assessed by interventional angiography. 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 and correlations between CTP, hemodynamic and angiographic parameters were assessed with non-parametric tests.ResultsThe cohort consisted of 27 subjects with an occlusion, and eight with a high-grade stenosis. The mean blood flow (BF) was 7.71 ± 2.96 ml/100ml*min-1, mean blood volume (BV) 0.71 ± 0.33 ml/100ml, and mean mean transit time (MTT) 7.22 ± 2.66 s. BF and BV were higher in subjects with longer lesions, and BV was higher in subjects with lower ABI. Significant correlations were found between lesion length and BV (r = 0.65) and BF (r = 0.52). Significant inverse correlations were found between BV and ABI and between BV and ABP (r = -0.56, for both correlations).ConclusionsIn our study, we have shown the feasibility of CTP for the assessment of PAD. In the future, this quantitative method might serve as a non-invasive method, possibly complementing the diagnostic workup of patients with peripheral arterial disease.

Highlights

Peripheral arterial disease (PAD) is one of the major cost-driving factors in public healthcare [1]
We have shown the feasibility of CTP for the assessment of PAD
This quantitative method might serve as a non-invasive method, possibly complementing the diagnostic workup of patients with peripheral arterial disease

Summary

Introduction

Peripheral arterial disease (PAD) is one of the major cost-driving factors in public healthcare [1]. One of its predominant clinical substrates and early indicators is pain in the lower extremities, which is caused by ischemia due to insufficient blood flow to the dependent musculature [3]. The radiation exposure from perfusion imaging is lower in the extremities compared to chest or abdominal imaging This is reflected by considerably different tissue weighting factors in ICRP publication 103 (skin and bone: 0.01, compared to chest or stomach: 0.12) [19]. In contrast to the myocardium and lungs, perfusion imaging of the limbs is less prone to organ motion during scan [20]. Involuntary movement may degrade data acquisition [21] This is especially true for symptomatic PAD patients suffering from pain. The venous outflow from skeletal muscles is difficult to assess

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Conclusion