title: Selective intra-arterial dual-energy CT angiography (s-CTA) in lower extremity arterial occlusive disease.
abstract: OBJECTIVE
  In patients with peripheral arterial occlusive disease, renal impairment is a common contraindication to iodine and gadolinium contrast media, which limits the utility of conventional computed tomography angiography (CTA) and magnetic resonance angiography (MRA). It is proposed that selective intra-arterial dual-energy CT-angiography (s-CTA), that is CTA with intra-arterial injection of an ultra-low dose iodine contrast media, is a feasible, safe and accurate alternative imaging method to conventional non-invasive contrast enhanced vascular imaging in this patient group. The aim of this study was to report a preliminary experience of s-CTA in patients with critical limb ischemia and renal insufficiency with respect to safety, feasibility, and diagnostic accuracy.
  
  
  METHODS
  Ten non-consecutive patients with ischemic foot ulcers underwent s-CTA of one leg. Procedure related complications were recorded and imaging results were compared with conventional digital subtraction angiography (DSA).
  
  
  RESULTS
  A median 17 mL (range 10-19 mL) contrast media (400 mg I/mL) was used. The median baseline plasma creatinine was 163 μmol/L (range 105-569) pre s-CTA versus 153 μmol/L (range 105-562) post s-CTA (p = .24). There was no puncture site complication. Among the patients selected for intervention (n = 6 with 30 arterial segments) the s-CTA findings correlated well with the DSA findings; the diagnostic sensitivity was 100%, the specificity 89%, and the accuracy 93%.
  
  
  CONCLUSIONS
  In this pilot study, a novel imaging method (s-CTA) is presented that provides high-quality arterial phase images with ultra-low dose iodine contrast media useful also for patients unsuitable for conventional contrast enhanced imaging methods because of renal insufficiency.
authors: Department of Radiology, Oncology and Radiation Sciences, Section of Radiology, Uppsala University Hospital, Uppsala, Sweden.
authors: J
authors: J
authors: Swanberg
authors: Department of Radiology, Oncology and Radiation Sciences, Section of Radiology, Uppsala University Hospital, Uppsala, Sweden.
authors: R
authors: R
authors: Nyman
authors: Department of Radiology, Oncology and Radiation Sciences, Section of Radiology, Uppsala University Hospital, Uppsala, Sweden.
authors: A
authors: A
authors: Magnusson
authors: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden. Electronic address: anders.wanhainen@surgsci.uu.se.
authors: A
authors: A
authors: Wanhainen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D016523:Foot Ulcer / Q000000981:diagnostic imaging*; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011857:Radiographic Image Interpretation, Computer-Assisted; D051437:Renal Insufficiency / Q000150:complications; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol
keywords: CT-angiography; Computed tomography; Contrast media; Intra-arterial; Iodine; Ischemia; Lower extremity; Renal insufficiency