Multidetector Computed Tomography Angiography in the Treatment of Non-cardiac Peripheral Vascular Disease

Multidetector Computed Tomography Angiography in the Treatment of Non-cardiac Peripheral Vascular Disease

Allie David E, Hebert Chris J, Walker Craig M
US Cardiology 2006
Published: November 2005
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Since its original description in 1992, computed tomography angiography (CTA) has advanced from the method of using a simple single-detector to a powerful imaging multidetector system capable of acquiring 16 channels of data with rapid imaging acquisition and higher spatial resolution, while simultaneously allowing patient coverage of more than 120cm with a single scan. Computed tomography (CT) has undergone a remarkable evolution over the last two decades and now allows subsecond scan times, submillimeter scan thickness and the acquisition of more than 1,000 slices per examination with a single venous injection. Optimized contrast enhancement, improved threedimensional (3-D) volumetric data analysis, and sophisticated computer software and workstations are but several advantages of the current technology and is why several sources are predicting that multidetector CTA (MDCTA) will “replace 80% to 90% of all conventional diagnostic angiography”.1 MDCTA has already demonstrated comparability and even diagnostic superiority over conventional diagnostic angiography (CDA) in several vascular applications including the aorta, carotid, renal, iliac, and pulmonary vessels.

CDA with digital subtraction angiography (DSA) remains the clinical ‘gold standard’ for vascular imaging but has multiple limitations. Magnetic resonance angiography (MRA) has been advocated to address the limitations of DSA but MRA also possesses significant limitations. In comparing MDCTA with DSA and MRA, noteworthy MDCTA advantages include lower costs, less invasiveness (venous stick),much faster operating times, potentially less contrast use and radiation exposure, allowance for 3-D reconstruction, it does not require an angiosuite or cathode laboratory team, and has potentially fewer complications.

CDA with digital subtraction angiography (DSA) remains the clinical ‘gold standard’ for vascular imaging but has multiple limitations. Magnetic resonance angiography (MRA) has been advocated to address the limitations of DSA but MRA also possesses significant limitations. In comparing MDCTA with DSA and MRA, noteworthy MDCTA advantages include lower costs, less invasiveness (venous stick),much faster operating times, potentially less contrast use and radiation exposure, allowance for 3-D reconstruction, it does not require an angiosuite or cathode laboratory team, and has potentially fewer complications (see Box 1). MDCTA can also be utilized in evaluating coronary artery disease (CAD), chronic vascular thrombus or calcification, and non-vascular soft tissues and osseous structures. Since MDCTA does not require an arterial access, patients on anticoagulation or with hypercoagulable states need no pre- or peri-procedural preparations, and MDCTA can be utilized in patients with limited vascular access (grafts, severe peripheral vascular disease (PVD), or absent pulses). This article describes the authors’ early 16-channel and current 64-channel out-patient office experience with MDCTA, and how it has changed and influenced patient care.

Imaging Technique
The three major principles of MDCTA are:

  • to achieve an adequate level of arterial contrast enhancement during acquisition;
  • to provide cephalocaudad coverage of the targeted anatomy during an early sustainable breath-hold interval (less than 20 seconds); and
  • to time the onset of CT acquisition after contrast injection accurately, so the first circulation enhancement is obtained from the start to the end of acquisition.


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