Evaluation Of Peripheral Vascular Disease Research Articles

A prospective interventional study to assess the advantage of premedication with sublingual nitroglycerin in evaluation of peripheral vascular disease with computed tomography peripheral angiography

A prospective interventional study to assess the advantage of premedication with sublingual nitroglycerin in evaluation of peripheral vascular disease with computed tomography peripheral angiography

CT Angiography in Evaluation of Peripheral Vascular Disease and Comparison with Color Doppler Ultrasound

CT Angiography in Evaluation of Peripheral Vascular Disease and Comparison with Color Doppler Ultrasound

Abstract P329: Ankle Brachial Index Profile in a Diabetic Population With High Risk of Cardiovascular Disease

Introduction: The Ankle Brachial Index (ABI) is a noninvasive and effective measure in the evaluation of peripheral vascular disease, also being indicative of atherosclerosis. This measure is based on the ratio of ankle systolic pressure values to ipsilateral arm systolic pressure. ABI values below 0.90 are considered risk factors for coronary and cerebrovascular diseases and for the presence of high cardiovascular risk. Objective: To describe the ABI and risk factors (RF) of participants in a cross-sectional sample of diabetic and hypertensive patients at high cardiovascular risk. Method: After analyzing a group of 147 high-risk cardiovascular patients, 25.9% of hypertensive diabetic patients (n = 38) were selected for ABI and the demographic profile analysis, related to the presence of brain and/or cardiovascular events (CVD). To evaluate the project, a cross-sectional descriptive analysis of data collected through questionnaires and anthropometric evaluation was used Results: Of the 38 subjects (57.9% women), with a mean age of 63 ± 9 years, other RF history were found: physical inactivity (73.7%); dyslipidemia (63.2%); family history of cardiovascular diseases (60.5%); reports of previous cardiovascular events, myocardial infarction and / or stroke (71.1%); overweight (34.2%); obesity (36.8%) and smoking (7.9%). When comparing the ITB values found in the subgroup with CVD (n = 27) and without CVD (n = 11), we observed values of 1.00 (0.73-1.25) x 1.02 (0.68- 1.13), respectively, with significant difference between the groups by the chi-square Monte Carlo analysis (p 0.13), although with a small analysis sample. Conclusion: In a population with a high cardiovascular profile, with multiple risk factors, the assessment of ABI was a risk marker in the presence of previous CVD, and should be a method to be encouraged in daily clinical practice as a possible marker of cardiovascular risk in the diabetic population.

Abstract 124: Radiotracer Imaging of Serial Changes in Angiosome Foot Perfusion in Critical Limb Ischemia Patients Undergoing Lower Extremity Revascularization: Association With 12-month Limb Salvage Outcomes

Introduction: Single photon emission computed tomography (SPECT)/CT imaging is a standard approach for assessing myocardial perfusion, but has not been traditionally applied for evaluating peripheral vascular disease (PVD). Due to the prevalence of extremity perfusion abnormalities in PVD patients, SPECT/CT imaging may allow for sensitive physiological evaluation of regional changes in perfusion within the lower extremities following revascularization. Therefore, we assessed regional changes in angiosome foot perfusion following percutaneous revascularization in diabetic patients with critical limb ischemia (CLI) to evaluate the association between treatment-induced perfusion responses and clinical outcomes. Methods: Diabetic patients with CLI and non-healing ulcers (n=24) underwent SPECT/CT perfusion imaging of the feet before and after revascularization (Fig. 1A). CT images were segmented into angiosomes (i.e. vascular territories of the foot), and radiotracer uptake was expressed as standardized uptake values (SUVs). Post-treatment changes in perfusion within ulcerated angiosomes were quantified and limb salvage outcomes were assessed for the following 12 months. Results: Post-revascularization changes in perfusion were significantly higher in patients who experienced limb salvage compared to patients who underwent amputation in the 12-months after treatment (Fig. 1B). When patients were divided into groups (high and low perfusion responders) based on median perfusion response, patients with higher percent change in perfusion demonstrated a significantly higher incidence of amputation free survival (p=0.005; Fig. 1C). Conclusion: SPECT/CT imaging detects regional changes in foot perfusion following revascularization that are associated with limb salvage outcomes. Application of SPECT/CT perfusion imaging in the evaluation of PVD could assist with characterizing treatment success and predicting clinical outcomes.

A study on diabetic foot and its association with peripheral artery disease

Background: Diabetes mellitus is characterized by high blood sugar levels over a prolonged period due to alteration in either the insulin secretion, insulin action, or both. Worldwide, as of the recent 2016 data collected from the World Health Organization (WHO) around 422 million adults have diabetes mellitus which is estimated to almost double by 2030 which is composed of mainly type 2 diabetes (85-90% of all cases). The early detection of peripheral artery disease in asymptomatic patients goes a long way in reduction of major lower limb amputations and mortality. Hence, there is a need for evaluation of peripheral vascular disease in all diabetics, especially those with diabetic foot by formulating effective management protocols, thereby limiting the morbidity, mortality and social costs associated with the disease.Methods: Patients admitted and seen in out-patient department for diabetic foot ulcers between January 2013 and October 2013 in Department of general surgery, vascular surgery and diabetology, Kilpauk Medical College Hospital, Chennai, India were taken for study.Results: 150 cases satisfying the inclusion criteria were taken up for the study from January 2013 to October 2013. Out of 150 patients, 76 patients presented with ulcer in foot, 34 presented with gangrene of toe or foot. After clinical examination it was found that 52 patients had associated neuropathy, 17 patients had ABI less than 0.3 and 39 patients had ABI in between 0.4 and 0.9. Patients with ulcer and gangrene in foot and with ABI less than 0.9 were admitted and evaluated with doppler study of lower limbs. After getting consent, appropriate procedure was done for each patient. Wound debridement was done in 21 cases, toe disarticulation in 12, fore foot amputations in 4, Below knee amputation in 9, above knee amputation in 3. 11 patients were referred to vascular surgery and underwent revascularization procedures (BYPASS).Conclusions: The prevalence of peripheral artery disease in patients with diabetic foot is significantly high i.e. 38 % as per this study. Males have a higher predilection for developing peripheral vascular disease than females. The average age of presentation of PAD in diabetics is 40 -60 years. The most common level of arterial occlusion in PAD associated diabetic foot is femoro-popliteal segment followed by tibial segment.

Educational Exhibit Abstract No. 371 - Streamlining a vascular referral service line through the use of a portable vascular laboratory

Learning Objectives 1)The reader will learn strategies to increase efficiency in the evaluation of vascular referrals through the use of electronic medical records and a portable vascular laboratory.2)Methods and strategies utilizing a portable vascular laboratory to improve patient care, reduce healthcare costs, and increase access to care in Interventional Radiology will be discussed. Background Noninvasive vascular testing including Doppler ultrasound, segmental pressures, pulse volume recordings, and ankle brachial indices are regularly used for evaluation of peripheral vascular disease. Ultrasound is also used in evaluation of venous reflux and venous mapping. Testing can be used to screen, diagnose, and plan for vascular therapy. With the development of compact mobile noninvasive diagnostic devices, noninvasive testing has become portable. Portable vascular laboratories allow for rapid evaluation when patients are initially seen with primary care providers in office-based clinics. This technology has been utilized to increase referrals to Interventional Radiology. Clinical Findings/Procedure Details This exhibit will demonstrate how to incorporate a portable vascular laboratory into an existing vascular service line. A practical guide will be proposed which can be used to prioritize referrals based on this portable testing and the information available in the electronic medical record. Strategies to improve communication with referring clinicians and optimize treatments will be presented. Also exhibited will be the possible benefits of improving efficiency including potential cost-reduction. Methods utilizing portable devices to appropriately screen patients for referral to Interventional Radiology will be highlighted. Conclusion and/or Teaching Points Through the use of a portable noninvasive vascular laboratory and a supporting EMR, vascular referrals can be more efficiently evaluated. The potential benefits of portability and increased efficiency include cost-reduction and increased patient volume to Interventional Radiology.

Time-resolved MR angiography of the calf arteries using a phased array cardiac coil: comparison of visibility with standard three-step bolus chase MR angiography

Standard bolus chase MR angiography (MRA) is increasingly replacing digital subtraction angiography (DSA) in the diagnostic evaluation of peripheral vascular disease. However, a major limitation of bolus chase MRA is the relatively poor visibility of the calf arteries. To evaluate the feasibility of visualizing the calf arteries and the visibility quality of an 8-channel cardiac phased array coil using time-resolved imaging of contrast kinetics (TRICKS) MRA compared with standard bolus chase MRA on a 1.5 Tesla MRI scanner. MRA findings of 59 sequential patients (mean age 57.8 years, range 14-83 years; 41 men) were retrospectively evaluated. All examinations included preliminary TRICKS for the lower leg using a surface 8-channel cardiac coil, followed by a 3-step MRA of the abdominal aorta, thigh, and lower leg using a body coil. Images yielded by both methods were separately evaluated by consensus of two radiologists unaware of the patients' clinical data. Visibility of the calf arteries (popliteal, tibialis anterior, tibialis posterior, tibioperoneal trunk, and peroneal) for both sides was subjectively classified as 'diagnostic' or 'non-diagnostic'. Descriptive statistics for image diagnostic quality were assessed. A total of 575 calf arterial segments were evaluated. Visibility of all calf arteries was significantly better with TRICKS than with the standard bolus chase MRA (P < 0.001). The improvement of calf artery visibility with TRICKS was more pronounced in patients with peripheral vascular disease compared to those with arteritis, vascular malformation and popliteal entrapment syndrome. Using a cardiac coil for MRA of the lower extremities resulted in visibility comparable to that of a dedicated leg coil, with diagnostic superiority for the TRICKS method compared to the standard bolus chase method.

Agreement of duplex ultrasonography vs. computed tomography angiography for evaluation of native and in-stent SFA re-stenosis—Findings from a randomized controlled trial

BackgroundMultidetector CT angiography (CTA) is a non-invasive imaging technique for evaluation of peripheral vascular disease. CTA might be particularly useful for assessment of intermediate- and long-term morphological outcome after endovascular treatment. Validation of CTA vs. the current imaging standard, colour Doppler ultrasonography (CDUS), for quantification of native and in-stent re-stenosis in the superficial femoral artery (SFA) is required. MethodsSeventy randomized patients who underwent stent implantation (n=47) or balloon angioplasty (n=23) underwent 6-month follow-up with CDUS and CTA. CTA was compared with CDUS in both sub-groups of patients in terms of binary re-stenosis (>50% lumen narrowing) and re-occlusion. Agreement between CTA and CDUS was assessed using Kappa (κ) statistics with 95% confidence intervals, and correlation coefficients. ResultsBinary re-stenosis was detected in 16/70 (22.9%) patients by CTA and 17/70 (24.3%) patients by CDUS (κ=0.88, 95% CI: 0.80–0.96). Re-stenosis rates after balloon angioplasty were 39.1% (9/23) on CTA and CDUS (κ=0.82, 95% CI: 0.66–0.98), and after stent implantation 14.9% (7/47) on CTA and 17.0% (8/47) on CDUS (κ=0.92, 95% CI: 0.84–1.00). Re-occlusions were detected in 3/70 (4.3%) patients by both CTA and CDUS (κ=0.65; 95% CI 0.54–0.76). Significant correlations (r=0.85, p<0.001) were noted between degree of re-stenosis on CTA and peak velocity ratio on CDUS. The correlation coefficient was higher in patients after balloon angioplasty (r=0.94, p<0.001) than in patients after stent implantation (r=0.71, p<0.001). ConclusionCTA and CDUS show excellent agreement for evaluation of native and in-stent re-stenosis after endovascular treatment of SFA obstructions. CTA is an appropriate non-invasive imaging modality for follow-up after endovascular therapy.

Tc-99m sestamibi lower extremity muscle scan, is it a useful screening tool for assessment of preclinical atherosclerosis in rheumatoid arthritis patients?

Increased cardiovascular morbidity and mortality in rheumatoid arthritis (RA) patients cannot be entirely explained by traditional risk factors, suggesting that systemic inflammation characterizing this disease may accelerate atherosclerosis. Technetium 99m-Methoxyisobutyl isonitrile (Tc-99m sestamibi) is a myocardial perfusion imaging agent that has been suggested for evaluation of peripheral vascular disease. We used Tc-99m sestamibi muscle scan to investigate the prevalence of preclinical atherosclerosis in RA patients by perfusion reserve (PR) measurement. This study included 25 RA patients and 25 controls; 13/25 RA (GII) were on glucocorticoids and 12/25 (GI) were not. Database included full history, clinical examination, relevant laboratory tests, and Tc-99m sestamibi muscle scan for lower limbs. The percentage increase in the total counts (Cts) in the exercising calf termed PR was calculated according to the formula: (PR %) = (Cts in exercising calf-Cts in resting calf) ÷ (Cts in resting calf) × 100%. A significant difference was found between the means of PR in RA and controls (30.7±22.6% vs. 48.3±27.2%, P = 0.015). The mean perfusion reserve of GII correlated significantly with the steroids cumulative dose (P = 0.01). A statistically significant negative correlation was elicited between PR and disease duration (P = 0.024), while the negative correlation between PR and Disease Activity Index (DAS28) was not statistically significant (P = 0.065). Tc-99m sestamibi lower-limb muscle scan could be a useful screening tool for detection of preclinical atherosclerosis in lower limbs of RA patients, so early prophylactic measures and therapy modifications could be considered.

Cost Impact of Diagnostic Imaging for Lower Extremity Peripheral Vascular Occlusive Disease

Objective The evaluation of peripheral vascular disease in the primary care setting is routinely performed by contrast-enhanced magnetic resonance angiography (CE-MRA) and digital subtraction angiography (DSA). However, limited data are available on the relative costs and clinical outcomes following these diagnostic procedures. The objective of this study is to assess and compare costs associated with diagnostic imaging in peripheral vascular occlusive disease (PAOD). Methods US veterans (n = 19,209) with CE-MRA or DSA for the assessment of PAOD from fiscal year (FY) 1999 to FY 2004. Main outcome measure(s) using the Department of Veterans Affairs' (VA) costing algorithms, cost, and log-cost of interventions (e.g., revascularization, stent, angioplasty), amputations or mortality rates within 30/90 days and 1 year of DSA or CE-MRA were compared, and adjusted for patient characteristics and disease severity using multivariate regression. Imaging modality selection bias was evaluated with propensity score, instrumental variables, and Heckman methods using untransformed costs and log-costs with smearing retransformation. Results Initial CE-MRA imaging was significantly more likely among patients with prior renal disease or bypass surgery [odds ratio (OR) > 2; P < 0.001], and less likely among patients with prior amputation, peripheral vascular disease (PVD), claudication, or other cardiovascular disease (OR < 0.7; P < 0.001). After adjusting for endogenous choice of initial imaging modality, 30-day treatment costs were US$3500–$4300 lower ( P < 0.001) for patients with initial CE-MRA. Eighty-two percent of DSA imaging patients had no additional procedures or events within 30 days, and 65% at 90 days. Less than 3.2% (3.6%) of patients had any repeat imaging within 30 (90) days of initial imaging. Conclusions Relative to DSA, CE-MRA imaging was associated with substantial treatment episode savings, beyond the US$950 direct savings in imaging cost per procedure. Substituting CE-MRA for DSA among those not planning or requiring any follow-up procedures within 30 days, could have reduced outpatient imaging costs by up to 55%, and reduced VA system costs by US$13.2 million over the six-year period.

Near-infrared Spectroscopy for Evaluation of Peripheral Vascular Disease. A Systematic Review of Literature

Objectives: To assess near-infrared spectroscopy (NIRS) as a method for the diagnosis and evaluation of peripheral vascular disease. Search strategy: MEDLINE and CENTRAL were searched with a search protocol presented below. Handsearching through reference lists of the retrieved articles and reviews was conducted. Main results: 224 and 57 abstracts from MEDLINE and CENTRAL respectively were retrieved from which 21 studies were selected. NIRS was evaluated for the diagnosis and severity evaluation in patients with peripheral vascular disease. Its parameters were shown to reflect the clinical status of patients, with good correlation to existing methods. Conclusions: Currently NIRS technology can serve as an adjunct method for the diagnosis and evaluation of patients with peripheral vascular disease.

Whole-Body Contrast-Enhanced Magnetic Resonance Angiography

During the past decade, technical improvements and numerous advances in scanner hardware and software have significantly improved image quality, speed, and reliability of 3-dimensional (3-D) contrast-enhanced magnetic resonance angiography (CE-MRA). The accuracy of CE-MRA is now comparable with that of computed tomography angiography or even conventional catheter angiography. Peripheral vascular disease (PVD) accounts for 50,000 to 60,000 cases of percutaneous transluminal angioplasty and for about 100,000 cases of amputation annually in the United States. Proper treatment of the arterial disease requires a comprehensive assessment of the underlying vascular morphology because it is crucial to localize and gauge the severity of arterial lesions for further therapeutic decision making.Contrast-enhanced magnetic resonance angiography has been widely implemented in noninvasive evaluation of PVD with high diagnostic accuracy. The lack of ionizing radiation and the use of contrast agent with relatively small potential nephrotoxicity in population of PVD with high prevalence of renal impairment are the appealing features for broad acceptance of CE-MRA in initial diagnosis and repeated follow-up studies of patients with PVD. The minimum anatomical coverage for evaluation of PVD comprises the aortic bifurcation to the ankles; however, because of the systemic nature of atherosclerosis hypertension, renal or cerebrovascular disease frequently coexist. Thus, many clinicians regard evaluation of the whole-body arterial vasculature as desirable.

A Prospective Feasibility Study of Duplex Ultrasound Arterial Mapping, Digital-Subtraction Angiography, and Magnetic Resonance Angiography in Management of Critical Lower Limb Ischemia by Endovascular Revascularization

Duplex ultrasound arterial mapping (DUAM) allows precise evaluation of peripheral vascular disease (PVD). However, magnetic resonance angiography (MRA) and digital-subtraction angiography (DSA) are the diagnostic tools used most frequently prior to intervention. Our aim was to compare clinical pragmatism, hemodynamic outcomes, and cost-effectiveness when using DUAM alone compared to DSA or MRA as preoperative assessment tools for endovascular revascularization (EvR) in critical lower limb ischemia (CLI). From 2002 through 2005, 465 patients were referred with PVD. Of these, 199 had CLI and 137 required EvR. Preoperative diagnostic evaluation included DUAM (n = 41), DSA (n = 50), or MRA (n = 46). EvR was aortoiliac in 27% of cases and infrainguinal in 73%. Patients were assessed at day 1, 6 weeks, 3 months, and 6 months. Composite end points were relief of rest pain, ulcer/gangrene healing, and increase in perfusion pressure, as measured by ankle-brachial index (ABI) and digital pressures. Patency by DUAM, limb salvage, morbidity, mortality, length of stay, and cost-effectiveness were compared between groups using nonparametric t-test, analysis of variance, and Kaplan-Meier analysis. The three groups were comparable in terms of age, sex, comorbidity, and Society for Vascular Surgery/International Society of Cardiovascular Surgery clinical classification. Six-month mean improvement in ABI in the DUAM group was comparable to that in the DSA group (P = 0.25) and significantly better than that in the MRA group (P < 0.05). Six-month patency rates for the DUAM group were comparable to those in the DSA group (P = 0.68, relative risk [RR] = 0.74, 95% confidence interval [CI] 0.18-2.99) and superior to that in the MRA group (P = 0.022, RR = 0.255, 95% CI 0.09-0.71). Length of hospital stay was lower in the DUAM group compared with the DSA group (P < 0.0001) and the MRA group (P = 0.0003). The cost of DUAM is lower than that of both DSA and MRA. DUAM accurately identified the total number of target lesions for revascularization; however, MRA overestimated it. Our results indicate that DUAM is outstanding when compared with other available modalities as a preoperative imaging tool in a successful EvR program. DUAM is a minimally invasive preoperative evaluation for EvR and offers precise consecutive data with patency and limb salvage rates comparable to EvR based on DSA and superior to MRA. We believe that our feasibility study has established DUAM as an economically proficient primary modality for investigating patients with CLI that significantly shortens length of hospital stay.

Guidelines for the treatment of arterial insufficiency ulcers

1. Co-chaired panel 2. University of Utah, Salt Lake City, UT 3. University of Texas, San Antonio, TX 4. Sinai Hospital/Johns Hopkins Medical Institutions, Baltimore, MD 5. GKT School of Medicine, King’s College, London, UK 6. University of Texas Health Science Center at Houston, TX 7. Sequoia Hospital, Redwood City, CA 8. Maricopa Medical Center, Phoenix, AZ 9. Tufts-New England Medical Center, Boston, MA 10. Southampton University Hospitals Trust NHS, Southampton, UK 11. Penrose–St. Francis Health Services, Colorado Springs, CO 12. Beverly Surgical Associates, Beverly, MA 13. Saint Francis Memorial Hospital, San Francisco, CA 14. Northbay Center for Wound Care, Vacaville, CA, and 15. University of California, San Francisco, CA

Accuracy of Stepping-Table Lower Extremity MR Angiography with Dual-Level Bolus Timing and Separate Calf Acquisition: Hybrid Peripheral MR Angiography

To retrospectively evaluate the accuracy of hybrid peripheral magnetic resonance (MR) angiography by using conventional digital subtraction angiography (DSA) as the reference standard. This retrospective study protocol received approval from the Office of Sponsored Research at Northwestern University, which included review by the Office for the Protection of Research Subjects. Informed consent was waived for this HIPAA-compliant study. One hundred twenty-one consecutive patients (67 men: mean age, 66 years +/- 12 [standard deviation]; 54 women: mean age, 69 years +/- 14), who were referred for evaluation of peripheral vascular disease, underwent peripheral contrast material-enhanced MR angiography. By using a hybrid technique, two independent timing measurements were performed in the pelvis and calves followed by MR angiography of the calves and, subsequently, a pelvis-thigh stepping-table acquisition. Images were evaluated for extent of disease, on the basis of degree of stenosis; for venous contamination, on the basis of venous signal intensity; and for diagnostic quality, on the basis of diagnostic confidence of the observer. DSA correlation of the extent of vascular disease was available in 45 of these patients, which was used to evaluate the diagnostic power of the hybrid technique. For detection of stenosis greater than 50%, the hybrid technique had 95% sensitivity (P < .05), 95% specificity (P < .05), and 95% accuracy (P < .05). There was no significant venous contamination in any of the examinations performed with this technique. The hybrid peripheral MR angiography technique provides diagnostic-quality examinations and virtually eliminates venous contamination.

Usefulness of Abdominal Aortic Calcification for Screening of Peripheral Vascular Disease

Purpose: We wanted to evaluate the value of abdominal aortic calcification (AAC), as detected on CT, as a predictor of atherosclerotic stenotic disease of the lower extremity arteries. Materials and Methods: One hundred three patients who had CT angiography performed for the evaluation of peripheral vascular disease were enrolled in this retrospective study. The volume (mm) of the AAC was measured on CT. Each lower extremity was divided into 8 segments. The extent of stenosis of the lower extremity artery was manifested as the sum of the stenosis scores for 16 segments (total stenosis score: TSS). The significant stenosis scores (SSS-50 and SSS-75) were defined as the sum of scores for the lower extremity artery segments that had significant stenosis of more than 50% and 75%, respectively. AAC was correlated to the TSS, SSS-50 and SSS-75 with using Spearman's correlation coefficient. The diagnostic performance of AAC for stenosis of a lower extremity artery of more than 50% and 75%, respectively, was evaluated by using the receiver operating characteristic (ROC) curve Results: The Spearman's correlation coefficients were 0.728 (AAC vs. TSS), 0.662 (AAC vs. SSS-50), and 0.602 (AAC vs. SSS-75), respectively. For significant stenosis more than 50% and 75%, the areas under the ROC curve were 0.898 and 0.866, respectively. The cutoff value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 1030 mm3, 87%, 88%, 89%, 86% and 87% for stenosis more than 50% and 1030 mm, 87%, 80%, 79%, 88% and 84% for stenosis more than 75%, respectively. Conclusion: Abdominal aortic calcification detected on CT may be a useful predictor of atherosclerotic stenotic disease of lower extremity arteries.

Is Duplex Ultrasonography an Effective Single Modality for the Preoperative Evaluation of Peripheral Vascular Disease?

The purpose of this study was to determine whether duplex ultrasonography can be used as an effective modality for the preoperative evaluation of lower-extremity arterial occlusive disease. The records of all patients undergoing both color flow duplex scanning and contrast arteriography of the lower extremities during a 13-month period were reviewed. Comparisons between the two modalities were made at the femoral, popliteal, and tibial artery levels. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated for duplex scanning using angiography as the gold standard. Three hundred fifteen arterial segments were evaluated. Color flow imaging overestimated the degree of stenosis in seven vessels and underestimated the degree of stenosis in four vessels. Overall duplex ultrasonography accurately determined lower-extremity arterial anatomy as defined by contrast arteriography with a sensitivity of 96.9 per cent, a specificity of 96.2 per cent, a positive predictive value of 94.6 per cent, a negative predictive value of 97.8 per cent, and an overall accuracy of 96 per cent. The accuracy of duplex ultrasonography must be determined in each individual vascular laboratory. Once this is satisfactorily accomplished color flow scanning may be used as the single imaging modality for lower-extremity arterial occlusive disease in selected patients deemed to be at high risk for contrast angiography.

Femoral artery wall thickness and stiffness in evaluation of peripheral vascular disease in type 2 diabetes mellitus

Stiffening and thickening of arterial wall are two important components of atherosclerosis. The purpose of this study was to evaluate the effects of femoral artery wall stiffness on clinical manifestation of peripheral vascular disease (PVD) in type 2 diabetes mellitus. The subjects were 315 patients with type 2 diabetes. Presence of intermittent claudication and/or leg pain at rest and reduced ankle-brachial blood pressure index (ABI<0.9) were used as a subjective and an objective index of PVD, respectively. Femoral artery intima-media thickness (FA-IMT) and stiffness parameter β (FA-stiffness β) were measured by ultrasound methods. Symptomatic patients ( N=58) showed greater values for both FA-IMT and FA-stiffness β than those without symptom ( N=257). Similarly, patients with reduced ABI ( N=56) had greater FA-IMT and FA-stiffness β than those without ( N=259). However, correlation between FA-IMT and FA-stiffness β was not impressive, especially in the symptomatic patients. To evaluate the effect of FA-stiffness β on PVD symptoms, the subjects were divided into three subgroups according to FA-IMT, and then FA-stiffness β was compared between those with and without PVD symptoms in each subgroup. The symptomatic patients had greater FA-stiffness β values than the asymptomatic subjects in all the three subgroups. Multiple logistic regression analysis indicated that the presence of PVD symptoms was associated more closely with increased FA-stiffness β than with increased FA-IMT, whereas reduced ABI was associated more closely with FA-IMT than with FA-stiffness β. These data suggest that stiffening of arterial wall has a significant impact on PVD manifestations, particularly on the leg symptoms, in patients with type 2 diabetes.

Magnetic resonance imaging of the wrist.

Optimal magnetic resonance (MR) imaging of the wrist requires a high field strength magnet and a dedicated wrist coil to achieve high-resolution images. Using current MR sequences, detailed images of articular cartilage and the supporting ligaments and tendons can be obtained. Evaluation of the triangular fibrocartilage as well as the extrinsic and intrinsic ligaments of the wrist is possible with thin-slice three-dimensional volumetric gradient recalled sequences. Fast inversion recovery sequences, used to achieve fat suppression in peripheral joints such as the wrist, allow for detection of acute osseous trauma, which is often radiographically occult. Cartilage-sensitive imaging allows for evaluation of conditions in the skeletally immature patient, such as chronic physeal loading in the adolescent gymnast, as well as detection of the sequelae of altered biomechanics in the adult, as in the ulnolunate impaction syndrome. Moreover, contrast-enhanced magnetic resonance angiography permits a relatively noninvasive evaluation of peripheral vascular disease, obviating the need for an intraarticular injection.

Comparison of Ankle/Brachial Index with duplex colour doppler scanning in evaluation of peripheral vascular disease in type 2 diabetic patients

Comparison of Ankle/Brachial Index with duplex colour doppler scanning in evaluation of peripheral vascular disease in type 2 diabetic patients