Skip to main content
SpringerLink
Log in
Book cover

Noninvasive Vascular Diagnosis pp 813–821Cite as

Computed Tomographic Angiography in the Diagnosis of Peripheral Arterial Disease

  • Chapter
  • First Online:

  • 2179 Accesses

Abstract

Advanced CT scanners produce high-resolution datasets. With the use of image post-processing tools, reconstructions are made in any direction, and three-dimensional models are generated for time-effective image analysis. Because of the non-invasive character of CTA and high resolution images, CTA has become the diagnostic method of choice in peripheral artery disease. Overall this results in an increased exposure to radiation and a higher incidence of allergic and contrast-induced nephrotoxic reactions. By adjusting the acquisition parameters on a patient-to-patient basis, specific protocols can be created reducing radiation and contrast exposure without compromising image quality.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Kau T, Eicher W, Reiterer C, Niedermayer M, Rabitsch E, Senft B, et al. Dual-energy CT angiography in peripheral arterial occlusive disease-accuracy of maximum intensity projections in clinical routine and subgroup analysis. Eur Radiol. 2011;21(8):1677–86.

    Article  PubMed  Google Scholar 

  2. Broeders IA, Blankensteijn JD, Olree M, Mali W, Eikelboom BC. Preoperative sizing of grafts for transfemoral endovascular aneurysm management: a prospective comparative study of spiral CT angiography, arteriography, and conventional CT imaging. J Endovasc Surg. 1997;4(3):252–61.

    Article  CAS  PubMed  Google Scholar 

  3. Blankensteijn JD, Schultze Kool LJ. Computed tomography. Rutherford’s vascular surgery 7th ed. Chapter 21. Edited by Cronenwett J, Johnston. 2010.

    Google Scholar 

  4. Iezzi R, Santoro M, Marano R, Di SC, Dattesi R, Kirchin M, et al. Low-dose multidetector CT angiography in the evaluation of infrarenal aorta and peripheral arterial occlusive disease. Radiology. 2012;263(1):287–98.

    Article  PubMed  Google Scholar 

  5. Utsunomiya D, Oda S, Funama Y, Awai K, Nakaura T, Yanaga Y, et al. Comparison of standard- and low-tube voltage MDCT angiography in patients with peripheral arterial disease. Eur Radiol. 2010;20(11):2758–65.

    Article  PubMed  Google Scholar 

  6. Rose TA Jr, Choi JW. Intravenous imaging contrast media complications: the basics that every clinician needs to know. Am J Med. 2015;128(9):943–9.

    Article  PubMed  Google Scholar 

  7. Mammarappallil JG, Hiatt KD, Vincent W, Bettmann MA. How accurate is the label “allergic to iodinated contrast agents”? Acta Radiol. 2016;57(1):47–50.

    Article  PubMed  Google Scholar 

  8. McCullough PA, Sandberg KR. Epidemiology of contrast-induced nephropathy. Rev Cardiovasc Med. 2003;4(Suppl 5):S3–9.

    Google Scholar 

  9. American College of Radiology. ACR manual on contrast media. 2015.

    Google Scholar 

  10. Briguori C, Donnarumma E, Quintavalle C, Fiore D, Condorelli G. Contrast-induced acute kidney injury: potential new strategies. Curr Opin Nephrol Hypertens. 2015;24(2):145–53.

    Article  CAS  PubMed  Google Scholar 

  11. Zhang B, Liang L, Chen W, Liang C, Zhang S. The efficacy of sodium bicarbonate in preventing contrast-induced nephropathy in patients with pre-existing renal insufficiency: a meta-analysis. BMJ Open. 2015;5(3):e006989.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Baxa J, Vendis T, Molacek J, Stepankova L, Flohr T, Schmidt B, et al. Low contrast volume run-off CT angiography with optimized scan time based on double-level test bolus technique – feasibility study. Eur J Radiol. 2014;83(3):e147–55.

    Article  PubMed  Google Scholar 

  13. Swanberg J, Nyman R, Magnusson A, Wanhainen A. Selective intra-arterial dual-energy CT angiography (s-CTA) in lower extremity arterial occlusive disease. Eur J Vasc Endovasc Surg. 2014;48(3):325–9.

    Article  CAS  PubMed  Google Scholar 

  14. Akyuz A, Akkoyun DC, Degirmenci H, Oran M. Rosuvastatin decreases mean platelet volume in patients with diabetes mellitus. Angiology. 2016;67(2):116–20.

    Article  PubMed  Google Scholar 

  15. Singh H, Cardella JF, Cole PE, Grassi CJ, McCowan TC, Swan TL, et al. Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 2003;14(9 Pt 2):S283–8.

    PubMed  Google Scholar 

  16. Iglesias J, Pena C. Computed tomography angiography and magnetic resonance angiography imaging in critical limb ischemia: an overview. Tech Vasc Interv Radiol. 2014;17(3):147–54.

    Article  PubMed  Google Scholar 

  17. Jens S, Koelemay MJ, Reekers JA, Bipat S. Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: systematic review and meta-analysis. Eur Radiol. 2013;23(11):3104–14.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. VUmc Amsterdam, The Netherlands, Vascular Surgery, De Boelelaan 1118, Amsterdam, The Netherlands, 1081HZ

    Maarten Truijers MD, PhD & Jan D. Blankensteijn MD, PhD

Authors
  1. Maarten Truijers MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan D. Blankensteijn MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Maarten Truijers MD, PhD or Jan D. Blankensteijn MD, PhD .

Editor information

Editors and Affiliations

  1. Charleston, West Virginia, USA

    Ali F. AbuRahma

Review Questions

Review Questions

  1. 1.

    In modern CT scanners, spatial resolution is determined by scan range.

    1. a.

      True

    2. b.

      False

  2. 2.

    The theoretical advantage of a dual energy CT scanner is the ability to discriminate between calcium and contrast based upon differences in x-ray attenuation.

    1. a.

      True

    2. b.

      False

  3. 3.

    MIP (maximum intensity projection) reconstructions rely on the difference in attenuation factor between calcium, iodine and remaining soft tissue to identify voxels containing blood (lumen), thrombus or calcium, a technique called segmentation. This results in three-dimensional models of the peripheral artery lumen and wall.

    1. a.

      True

    2. b.

      False

  4. 4.

    A clear trade-off exists between radiation exposure and image quality. Traditional peripheral CTA uses a tube voltage of 120 kVp. By reducing the tube voltage to 80 kVp, radiation exposure in patients with peripheral artery disease is decreased; this however compromises image quality and diagnostic performance.

    1. a.

      True

    2. b.

      False

  5. 5.

    Contrast-induced nephropathy (CIN) is rare (0.02–0.04%) but potentially life-threatening.

    1. a.

      True

    2. b.

      False

  6. 6.

    Hydration increases urine flow rate resulting in faster contrast media excretion and shorter contrast exposure. Today, hydration with standard saline is the most common preventive measure. Hydration with sodium bicarbonate however results in a significant decrease in the incidence of CIN.

    1. a.

      True

    2. b.

      False

  7. 7.

    In patients with peripheral artery disease, the diagnostic performance of CTA exceeds the specificity and sensitivity of MRA.

    1. a.

      True

    2. b.

      False

Answer Key

  1. 1.

    b

  2. 2.

    a

  3. 3.

    b

  4. 4.

    b

  5. 5.

    b

  6. 6.

    a

  7. 7.

    a

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Truijers, M., Blankensteijn, J.D. (2017). Computed Tomographic Angiography in the Diagnosis of Peripheral Arterial Disease. In: AbuRahma, A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-54760-2_61

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-54760-2_61

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54758-9

  • Online ISBN: 978-3-319-54760-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation