Predicting complications and morbidities in PAD patients through lower extremity compositions with dual-energy CT and material decomposition: a 2-year follow-up observational study

• Published in: BMC cardiovascular disorders Vol. 25; no. 1; pp. 268 - 12
• Main Authors: Lin, Dao-Chen, Tsai, Pei-Shan, Lin, Tzu-Lin, Huang, Wen-Hui, Liu, Yu-Peng, Wu, Tung-Hsin, Shih, Cheng‑Ting
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.04.2025; BioMed Central; BMC
• Subjects: Abdomen; Adiposity; Aged; Amputation; Amputation, Surgical; Analysis; Body Composition; Bone composition; Bone mass; Bones; Cardiovascular disease; Care and treatment; Comorbidity; Complications and side effects; Computed tomography; Contrast agents; Cortical bone; Cortical bone mass volume; CT imaging; Decomposition; Density; Diagnosis; Diagnostic imaging; Dual energy CT; Energy; Falls (Accidents); Female; Follow-Up Studies; Fractures; Humans; Inflammation; Iodine; Ischemia; Lower Extremity - blood supply; Lower Extremity - diagnostic imaging; Male; Material decomposition; Medical imaging; Medical imaging equipment; Medical research; Medicine, Experimental; Middle Aged; Morbidity; Muscle, Skeletal - diagnostic imaging; Muscle, Skeletal - physiopathology; Observational studies; Patients; Peripheral Arterial Disease - complications; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - physiopathology; Peripheral Arterial Disease - therapy; Peripheral vascular diseases; Predictive Value of Tests; Prevention; Prognosis; Risk Assessment; Risk Factors; Severity of Illness Index; Stenosis; Time Factors; Tomography, X-Ray Computed; Vascular diseases; Vein & artery diseases; Taiwan; Material decomposition; Dual energy CT; Cortical bone mass volume
• DOI: 10.1186/s12872-025-04695-8
• ISSN: 1471-2261

Peripheral artery disease (PAD) is associated with various morbidities. This study aims to investigate the correlation between different lower extremity compositions and development of morbidities in PAD patients. Between January 2018 and December 2020, 108 subjects diagnosed of PAD were enrolled (mean age of 64.1 ± 13.5 years) and utilized dual-energy computed tomography (DECT) with material decomposition to measure the vessel volume, muscle volume, fat volume, and cortical-bone volume in lower extremity respectively. The association between each leg composition and developing complications or morbidities in PAD patients was analyzed over a two-year follow-up. Fontaine stage 3 and 4 had lower muscle mass compared to stages 1 and 2. More severe vascular stenosis was associated with lower muscle, fat, and cortical-bone volume. Patients with severe Fontaine stages (3 and 4) and lower-leg vascular stenosis had a higher risk of developing infection or inflammation (OR 45.5, 95% CI: 13.5-166.7, and OR 11.7, 95% CI: 2.8-50, P < 0.05) and amputation (OR 18.2, 95% CI: 2.2-142.8, and OR 10.7, 95% CI: 1.11-100, P < 0.05). Lower thigh cortical-bone volume was associated with an increased risk of falls resulting in fractures (OR: 1.39, 95% CI: 1.13-2.19, P < 0.01). Thigh cortical-bone volume below 64.5 cm was identified as the cut-off value to predict fall-related fractures, with a sensitivity of 100% and specificity of 92%. This study demonstrates the potential of DECT with material decomposition to assess lower extremity composition and its relevance in predicting complications and morbidities in PAD patients. Severe vascular stenosis may contribute to muscle wasting and subsequent complications, while lower thigh cortical-bone mass may serve as a predictor of fall-related fractures.