Dr. Richard Hallett's refresher course on peripheral arterial disease (PAD) and CT angiography of the lower extremities.

1.
@CTterrific
DSA

2. DSA
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3. @CTterrific@
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Optional Scanning Range 2
above the kneesabove the knees toestoes
Always pre-programmed, but only initiated
by RT if no contrast in pedal vessels
Scanning Range 1
celiac artery (~T12)celiac artery ( T toes
(105 – 130 cm)
Recons:
Thin, overlapped
FOV = ggggggrererererereatatatatataterererererer trtrtrtrtrtrocococococochahahahahahantntntntntntererererererssssss
~35~35~35~35~35 mmmmmmmmm/////sssss
slslsllslowowowowow
slslsllslowowowowowslslslowowoowol
fafafastststfafafastststtf t
fafafastststt
Anatomic coverage:
105 – 130cm
fafafafafafaafastststststsststfafafafaaststststff t
vevevev ryryryryyyyyyyyyyyyyyyyyy
~~~~85858585 mm/mm/mm/mm/ssss
~~~656565 mm/mm/mm/sss
FLASH Modes
BBBBBLLLLLLAAAAAAZZZZZZIIIINNNNNNGGGGG

4. preprogrammed,
optional 2nd acquisition
Arteriomegaly
1st acquisition
0
0.2
0.4
0.6
0.8
1
0 30 60 90 120 150 180
p
0
0.2
0.4
0.6
0.8
1
Cumulative
percentageoflimbs
Table speed (mm/s)
Relativeriskto
outrunbolus
Aorto-popliteal
transit speed (mm/s)
0 30 60 90 120 150 180
0
< .01
~.33
> .50
Fleischmann D and Rubin GD.
Radiology 2005, 1076-1082
Fleischmann et al. JVIR 2006, 17(1) 3-26.

5. 0
100
200
300
400
0 8 16 24 32 40 48 56 64 72 80
0
2
4
6
8
1 9 17 25 33
INPUT
intravenous
injection rate
(mL/s)
OUTPUT
arterial
enhancement
(ΔHU)
Phase I
(surge phase)
Phase II
(continuing phase)
Biphasic Injection for Peripheral CTA
0
100
200
300
400
0 8 16 24 32 40 48 56 64 72 80
0
2
4
6
8
1 9 17 25 33
Biphasic
Injection
Fleischmann D. Eur. J. Radiol. 2003 Mar 1;45 Suppl 1:S88–93.
1) Hittmair & Fleischmann, JCAT 2001
usually
unknown
weight Biphasic Injection
<55kg 20 mL (4.0mL/s) + 96 mL (3.2mL/s)
<65kg 23 mL (4.5mL/s) + 108 mL (3.6mL/s)
75kg 25 mL (5.0mL/s) + 120 mL (4.0mL/s)
>85kg 28 mL (5.5mL/s) + 132 mL (4.4mL/s)
>95kg 30 mL (6.0mL/s) + 144 mL (4.8mL/s)
5 sec FAST + 30 sec SLOWER

6.
weight Biphasic Injection
<55 kg 20 mL (4.0mL/s) + 96 mL (3.2mL/s)
555-95 kg 25 mL (5.0mL/s) + 120 mL (4.0mL/s)
>95 kg 30 mL (6.0mL/s) + 144 mL (4.8mL/s)
Gurm HS, et al. J Am Coll Cardiol 2011; 58:907-14

7.
** Low concentration CM (300 mgI-/mL)
Courtesy:D.Fleischmann,MD
Chapter 3: Contrast Medium Injection Technique. In: Schoepf and
Meinel, eds. Multidetector-Row CT of the Thorax (2016)

8. @CTterrific@
** Fleischmann D, Hallett RL, Rubin GR. JVIR 2006, 17: 3-26.

9. 1 Meyer BC Eur Radiol (2010) 20:497-505
2 Ouwendijk R. Radiology (2006) 241, 603-608
Itoga NK et al. J Vasc Surg 2017, 835-43.
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Sommer Eur. Radiol (2010) 20: 2876-2881
@CTterrific@

10. Detection of >50%
Stenosis or Occlusion
By Anatomical Region
Performance
Met R et al. JAMA 2009;301:415-424
Napoli A. Radiology. 2011 Dec 1;261(3):976–86.
Schernthaner R, et al. AJR 2007; 189:1215-1222

11.
Fotiadis N, et al. Clinical Radiology 2011; 66: 945-52
Napoli A. Radiology. 2011 Dec 1;261(3):976–86.

12. Willmann JK, et al. Radiology 2003; 229: 465-474.
1 Li X, et al. Eur J Radiol 2010; 98-103
2 Strotzer, Invest. Radiol. 2001:36(11)

13.
1DeFreitas DJ, et al. J Vasc Surg 2013; 57(1): 5-55.
2Johnston WF, et al. J Vasc Surg 2012: 56(5) 1331-37.
@CTterrific@