Abstract

Background: With the improvements in design and techniques of advanced computed tomography techniques like multiple- row detector CT (MDCT), CT angiography of peripheral vasculature have become an easy, fast and feasible tool for imaging of peripheral vascular diseases. In addition to peripheral vascular disease CT angiography can also be used in patients with trauma or bone tumors. Peripheral vascular diseases in most instances develop gradually and there is ample time for development of collaterals, for this reason the patient may be unaware of the condition until there is critical stenosis. In some other patients the occlusion may be acute and may present with severe symptoms due to absence of collateral pathways. The signs and symptoms of peripheral vascular diseases depend upon site, distribution and severity of involvement of the vessels. The crucial role of CT angiography is to locate and characterize the involvement and to find out presence or absence of adequate collaterals. Reduced slice thickness and increased spatial resolution of modern CT machines have made it possible to non-invasively image the peripheral vessels. The advantage of quick and non-invasively imaging the peripheral vasculature cannot be overemphasized. We undertook this study as there was scarcity of centers undertaking comprehensive studies of Peripheral Arterial Disease (PAD) using advanced MDCTA in our area.

Aims and Objectives: (1) To discuss spectrum of imaging findings and define the role of Multiple-row Detector CT Angiography (MDCTA) in diagnosis and management Of Peripheral Arterial Occlusive Diseases. (2) To determine efficacy and accuracy of Multiple-row Detector CT Angiography (MDCTA) in cases of trauma and peripheral arterial occlusive disease [PAOD] in comparison to intra-operative surgical findings. (3) To discuss the merits, pitfalls and futuristic of MDCTA for Peripheral Vascular Applications.
Materials and Methods: The study was approved by institutional ethical committee. 64 patients meeting the criteria of the study were enrolled in the study. All these patients have undergone CT angiography on upper or lower limbs. All patients were scanned in the supine position with a Collimation of 0.6 mm, pitch 1 , tube voltage (kV) 120, tube current (effective mAs) 160, acquisition 2x32x0.6 mm , resolution <0.4mm, double z-sampling position (64 slices per rotation) with specific - scan range, specific coverage length and position. The R.O.I marker was placed just beyond aortic arch in descending thoracic aorta .Reconstructions performed in smooth kernel (B20f), Abdomen window, with overlapping axial image reconstruction (minimizes aliasing and stair step artefacts) on Multi Planar Reconstructions (MPR) that permits true 3 Dimensional renderings, and then transferring data to [Leonardo-CT, Siemens] workstation for 3D reconstruction and analysis. In all 64 patients, the spectrum of imaging findings was studied in cases of trauma with suspected arterial injuries and PAOD; while in cases where follow-up was possible, a comparison with intra operative surgical findings was done.

Results: Study comprised of 64 patients. There was a male preponderance with 40 (62.5%) males and 24 (37.5%) females with a male to female ratio of urban population (53%) was more commonly affected than the rural population (47%). Various risk factors found in studied cases were dyslipedimia (50%), systemic illnesses (43.75%) and smoking (40.63%). The most common age group was 41-60 years (36%) followed by 21-40 years (33%) and 61-80 years (20%). Lower limb (73.43%) was more commonly affected than the upper limb (26.56%). Analysis of diseases spectrum revealed that the most common form of the disease was thrombotic occlusion (31.25%) followed by traumatic occlusion (15.63%) and Takayasu’s arteritis (7.81%).

Conclusion: Our study concludes that CT angiography using 64 slice-multi detector row CT is effective, quick, reliable, accurate and safe imaging modality for diagnosis and knowing severity of peripheral arterial disease. 

Keywords: 64 Slice computerized tomography, Peripheral vascular diseases, Traumatic vascular injuries, Safe and Non invasive Imaging.