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VASCULAR IMAGING Table of Contents   
Year : 2004  |  Volume : 14  |  Issue : 3  |  Page : 309-315
Role of CT angiography in the evaluation of peripheral vasculature using MSCT - our initial experience


Department of Radiology, Lokmanya Tilak Municipal Medical College and Lokmanya Municipal General Hospital, Sion, Mumbai, India

Correspondence Address:
V Nimbkar
Department of Radiology, Lokmanya Tilak Municipal Medical College and Lokmanya Municipal General Hospital, Sion, Mumbai
India
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Source of Support: None, Conflict of Interest: None


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Purpose : To evaluate the efficacy of multislice computerized tomography (MSCT) in imaging the upper and lower limb arterial tree in trauma, peripheral vascular disease and bone tumors. Materials and methods: Since the installation of multidetector CT (4 detectors) in our institution, 35 patients have undergone CT angiography of the upper or the lower limb. Of these, 23 were of suspected arterial injury, 10 were with symptoms of peripheral vascular disease and 2 patients had a bone tumor. All patients were scanned in the supine position with a slice thickness of 3 mm and a collimation of 2.5 mm in a single sitting, with 150-180 cc of water based iodinated contrast medium injected at a rate of 3 cc/sec, via a pressure injector. Axial images were then reconstructed with 50 percent overlap and then transferred to a dedicated workstation for 3-D reconstruction and analysis; in maximum intensity projection (MIP), volume rendered (VR) and surface shaded display (SSD) images. The findings were then retrospectively compared with the surgical outcome in cases of trauma with suspected arterial injuries; or Colour Doppler correlation was obtained, for patients of peripheral vascular disease. Results : All the patients withstood the procedure well, with diagnostically adequate vascular enhancement. No image degradation due to respiration or motion artifacts and no serious post procedure complications due to the amount of contrast or the radiation dosage used were noted. CT angiography allowed a comprehensive diagnostic workup in all trauma cases with suspected arterial injuries, showing spasm in 7 patients (30.43 percent), compression in 9 patients (39.13 percent), contusion in 4 patients (17.39 percent) while any vascular injury was positively ruled out in 3 patients (13.04 percent), thus aiding in their management in a critically significant short time. The bony skeleton, soft tissues and the other visceral organs were simultaneously evaluated for the presence of any injury. In the 10 cases of peripheral vascular diseases, CT angiography adequately demonstrated the presence of any stenosis or occlusion, its degree and extent, the presence of collaterals and distal reformation if any; the presence of plaques, soft or calcified and the probable usefulness and the type of treatment, which should be employed. The role of CT angiography in the evaluation of bone and soft tissue tumours could not be fully explored due to inadequate number of cases. Conclusion : Our initial experience of CT angiography with multislice CT has clearly demonstrated its efficacy as a promising new, fast, accurate, safe and non-invasive imaging modality of choice in cases of trauma with suspected arterial injuries; and as a useful screening modality in cases of peripheral vascular diseases for diagnosis, for grading, for potential usefulness and type of treatment and also in the follow-up of patients, post treatment.


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