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

• Published in: PloS one Vol. 14; no. 9; p. e0223066
• Main Authors: Sah, Bert-Ram, Veit-Haibach, Patrick, Strobel, Klaus, Banyai, Martin, Huellner, Martin W.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 27.09.2019; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Algorithms; Angiography; Angioplasty; Ankle; Ankle Brachial Index; Biology and Life Sciences; Blood flow; Blood pressure; Blood Volume; Cancer; Cardiovascular disease; Care and treatment; CAT scans; Cohort analysis; Correlation; Correlation analysis; Diabetes; Diagnosis; Diagnostic imaging; Diagnostic systems; Extremities; Family medical history; Feasibility Studies; Female; Hemodynamics; Hospitals; Humans; Ischemia; Leg; Lesions; Lower Extremity - blood supply; Male; Medical research; Medicine and Health Sciences; Middle Aged; Musculoskeletal system; NMR; Nuclear magnetic resonance; Nuclear medicine; Occlusion; Pain; Parameters; Perfusion; Perfusion (Physiology); Perfusion Imaging - methods; Peripheral Arterial Disease - diagnosis; Peripheral vascular diseases; Stenosis; Tomography, X-Ray Computed - methods; Transit time; Ulcers; Ultrasonic imaging; Switzerland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0223066

The 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. Thirty-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. The 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). In 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.