Imaging of the Peripheral Vasculature and Carotid Arteries

Abstract

By age 60, 3–6% of men experience intermittent claudication due to obstructive disease of the aortoiliac and lower extremities. CT angiography (CTA) has become an integral part of assessing the treatment options in these patients. Its role is typically to determine a management strategy after peripheral arterial disease (PAD) is diagnosed. Other less expensive, noninvasive, and well-validated modalities are typically recommended as first-line studies in the diagnosis of PAD. CTA then becomes the platform for mapping vascular anatomy and delineating the location and severity of the stenosis. This information is of paramount importance in selecting patients who are candidates for endovascular or surgical revascularization. Additional information, including the presence of aneurysms, popliteal entrapment, and cystic adventitial disease, are also provided by CTA. In this group of patients, multidetector CT (MDCT) is noted to have high sensitivity (96%) and specificity (97%), and excellent interobserver agreement compared with digital subtraction angiography (DSA). Overestimation of stenosis has shown to be associated with significant calcification, but this problem can be overcome to a large extent by routinely adjusting the window and leveling setting in the presence of calcium.