Critical limb ischemia is associated with high mortality and major amputations. Intra-arterial digital subtraction angiography (IADSA) has been the reference standard but has some shortcomings including the two-dimensional projection and the lack of tissue perfusion information. The aim of this exploratory study is to examine four-dimensional computed tomography (4DCT) angiography and perfusion imaging using low-volume intra-arterial contrast injections for an improved anatomic and hemodynamic assessment in patients with foot ulcers. Three patients underwent a low-volume (2 mL) intra-arterial contrast-enhanced 4DCT examination combined with a diagnostic IADSA. An automated assessment of blood flow and tissue perfusion from the 4DCT data was performed. Vascular structures and corresponding blood flows were successfully assessed and correlated well with the IADSA results. Perfusion values of the affected tissue were significantly higher compared to the unaffected tissue. The proposed 4DCT protocol combined with the minimal usage of contrast agent (2 mL) provides superior images compared to IADSA as three phases (arterial, perfusion, and venous) are captured. The obtained parameters could allow for an improved diagnosis of critical limb ischemia as both the proximal vasculature and the extent of the perfusion deficit in the microvasculature can be assessed.
Boonen, P, Buls, N, Vandemeulebroucke, J, Van Gompel, G, Van Den Bergh, F, Leiner, T, Aerden, D & De Mey, J 2023, 'Combined evaluation of blood flow and tissue perfusion in diabetic feet by intra-arterial dynamic 4DCT imaging', European Radiology Experimental, vol. 7, no. 1, 44. https://doi.org/10.1186/s41747-023-00352-x
Boonen, P., Buls, N., Vandemeulebroucke, J., Van Gompel, G., Van Den Bergh, F., Leiner, T., Aerden, D., & De Mey, J. (2023). Combined evaluation of blood flow and tissue perfusion in diabetic feet by intra-arterial dynamic 4DCT imaging. European Radiology Experimental, 7(1), Article 44. https://doi.org/10.1186/s41747-023-00352-x
@article{b2be83fb214a4459b2de7cf3947f2ae8,
title = "Combined evaluation of blood flow and tissue perfusion in diabetic feet by intra-arterial dynamic 4DCT imaging",
abstract = "Critical limb ischemia is associated with high mortality and major amputations. Intra-arterial digital subtraction angiography (IADSA) has been the reference standard but has some shortcomings including the two-dimensional projection and the lack of tissue perfusion information. The aim of this exploratory study is to examine four-dimensional computed tomography (4DCT) angiography and perfusion imaging using low-volume intra-arterial contrast injections for an improved anatomic and hemodynamic assessment in patients with foot ulcers. Three patients underwent a low-volume (2 mL) intra-arterial contrast-enhanced 4DCT examination combined with a diagnostic IADSA. An automated assessment of blood flow and tissue perfusion from the 4DCT data was performed. Vascular structures and corresponding blood flows were successfully assessed and correlated well with the IADSA results. Perfusion values of the affected tissue were significantly higher compared to the unaffected tissue. The proposed 4DCT protocol combined with the minimal usage of contrast agent (2 mL) provides superior images compared to IADSA as three phases (arterial, perfusion, and venous) are captured. The obtained parameters could allow for an improved diagnosis of critical limb ischemia as both the proximal vasculature and the extent of the perfusion deficit in the microvasculature can be assessed.",
author = "Pieter Boonen and Nico Buls and Jef Vandemeulebroucke and {Van Gompel}, Gert and {Van Den Bergh}, Frans and Tim Leiner and Dimitri Aerden and {De Mey}, Johan",
note = "Funding Information: PTB was funded by the Research Foundation Flanders (FWO), 1S63719N. Publisher Copyright: {\textcopyright} 2023, The Author(s). Copyright: Copyright 2023 Elsevier B.V., All rights reserved.",
year = "2023",
month = jul,
day = "26",
doi = "10.1186/s41747-023-00352-x",
language = "English",
volume = "7",
journal = "European Radiology Experimental",
issn = "2509-9280",
publisher = "SpringerOpen",
number = "1",
}