Diagnostic performance and radiation dose of lower extremity CT angiography with 128 slice dual source CT using 80 kvp plus high pitch

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1 Diagnostic performance and radiation dose of lower extremity CT angiography with 128 slice dual source CT using 80 kvp plus high pitch Poster No.: C-1372 Congress: ECR 2014 Type: Scientific Exhibit Authors: K. S. Choo, J. Roh, J. W. Kim; Busan/KR Keywords: Cardiac, Breast, CT-Angiography, Biopsy DOI: /ecr2014/C-1372 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 7

2 Aims and objectives MDCT angiography has proven highly accurate in the diagnostic evaluation of stenoocclusive disease in patients with critical limb ischemia. However, MDCT angiography has a limitation due to it's high radiation dose. The common utilization of CT is accompanied by a steady increase in the population's cumulative exposure to ionizing radiation. As MDCT angiography develops, techniques should be refined to minimize patient dose without compromising image quality. To our knowledge, no research has been published that confirms the accuracy and radiation dose of lower extremity MDCT angiography using 80 kvp plus high pitch. The purpose of our study was to evaluate the diagnostic performance and radiation dose of lower extremity CT angiography (CTA) with 128 slice dual source CT using 80 kvp plus high pitch for patients with critical limb ischemia (CLI). Methods and materials We included 36 consecutive patients with CLI for whom CT angiography (CTA) with 128 slice dual source CT using 80 kvp plus high pitch and subsequent intra-arterial digital subtraction angiography (DSA) were performed at the Yangsan Pusan National University Hospital from March 2008 to June All patients received 120ml of a nonionic, iso-osmolar contrast agent ioversol (320mg iodine/ml; Iversense 320, Accuzen, Seoul, Korea) at a flow rate of 4ml/s followed by 30ml of normal saline at the same rate through a 20 G canula placed at the patient's antecubital fossa. There were 27 men and 9 women with a mean age of 66.9 years (range : years) and a body mass index (BMI) of The intra-arterial digital subtraction angiography (DSA) was as standard reference for assessing diagnostic performance and radiation dose of lower extremity CTA was reported. The arterial tree of lower extremity was divided into following 14 segments : common femoral arteries, superficial femorals (upper, middle and lower), popliteal arteries, tibioperoneal trunk, anterior tibial arteries (3 segments), posterior tibial arteries (3 segments) and peroneal arteries (upper and lower). The arterial segments were divided Page 2 of 7

3 in two subgroups, which included the above the knee segments (common femoral artery ~ popliteal artery) and the below the knee segments. In every segment, the most severe lesion was graded visually using a five-point scale: grade 1 = no stenosis, grade 2 = # 50% stenosis, grade 3 = 50-75% stenosis, grade 4 = 75-99% stenosis and grade 5 = occlusion. Lesions that scored grade 3 or higher were considered hemodynamically significant. The DSA images were evaluated by same five-point scale. All segments that were adequately evaluated with both techniques were included in the comparative analysis. Images for this section: Page 3 of 7

4 Fig. 1: A 64-year-old female diabetic patient. (a) CT angiography image demonstrates grade 3 (50-75%) stenosis of the right popliteal artery. (b) Corresponding DSA image showing a large calcification plaque of the popliteal causing grade 3 (50-75%) stenosis. Page 4 of 7

5 Fig. 2: A 78-year-old female patient. (a) CT angiography image demonstrates grade 3 (50-75%) stenosis of the right popliteal artery. (b) Corresponding DSA image showing non-significant <50% stenosis of the right popliteal artery, which was clearly overestimated with the CTA. Page 5 of 7

6 Results Overall 546 segments of 36 patients were included in the statistical analysis. Stenosis grading was better in the above the knee segments (common femoral artery ~ popliteal artery) where 90.3% of the lesions were correctly graded at CTA. In the below the knee segments, 80.1% of the segments were correctly graded with the CTA with 128 slice dual source CT using 80 kvp plus high pitch in comparison with the DSA. For arterial segments with hemodynamically significant disease (more than 50% in stenosis), the overall sensitivity, specificity, and accuracy of lower extremity CTA was 86.1%, 81.6% and 83.7%, respectively. The positive predictive value (PPV) was 80.1% and the negative predictive value(npv) was 87.3%. In addition, radiation dose of lower extremity CTA was (mgy.cm). Images for this section: Table 1: Cross table of hematodynamically significant stenosis(>50%) as measured using CT angiography and digital subtraction angiography(dsa). Page 6 of 7

7 Conclusion Lower extremity CTA with 128 slice dual source CT using 80 kvp plus high pitch presented good diagnostic performance for the assessment of patients with CLI as well as extremely low radiation dose. Personal information References References : section CT angiography in patients with critical limb ischemia and severe claudication : Comparison with digital subtractive angiography --Clinical Radiology 66(2011) Multidetector CT Angiography of the Aortoiliac System and Lower Extremities : A Prospective Comparison with Digital Subtraction Angiography --AJR:180, April The image Quality and Radiation Dose of 100-kVp versus 120 kvp ECG-Gated 16- Slice CT Coronary Angiography --Korean J Radiol May-Jun; 10(3): Dianostic performance of computed tomography angiography in peripheral arterial disease : a systematic review and meta-analysis --JAMA 2009;301: Low-dose multidetector-row CT angiography of the infra-renal aorta and lower extremity vessels: image quality and diagnostic accuracy in comparison with standard DSA --Eur Radiol 2006;16: Page 7 of 7