title: Run-Off Computed Tomography Angiography (CTA) for Discriminating the Underlying Causes of Intermittent Claudication.
abstract: OBJECTIVE
  To evaluate run-off computed tomography angiography (CTA) of abdominal aorta and lower extremities for detecting musculoskeletal pathologies and clinically relevant extravascular incidental findings in patients with intermittent claudication (IC) and suspected peripheral arterial disease (PAD). Does run-off CTA allow image-based therapeutic decision making by discriminating the causes of intermittent claudication in patients with suspected peripheral arterial disease PAD?
  
  
  METHODS
  Retrospective re-evaluation of CTAs performed in patients with acute or chronic intermittent claudication (i.e., Fontaine stages I to IIB) between January 2005 and October 2013. Allocation to one of three categories of underlying causes of IC symptoms: vascular, musculoskeletal (MSK) or both. Clinically relevant extravascular incidental findings were evaluated. Medical records were reviewed to verify specific therapies as well as main and incidental findings.
  
  
  RESULTS
  While focused on vascular imaging, CTA image quality was sufficient for evaluation of the MSK system in all cases. The underlying cause of IC was diagnosed in run-off CTA as vascular, MSK and a combination in n = 138 (65%), n = 10 (4%), and n = 66 (31%) cases, respectively. Specific vascular or MSK therapy was recorded in n = 123 and n = 9 cases. In n = 82, no follow-up was possible. Clinically relevant extravascular incidental findings were detected in n = 65 patients (30%) with neoplasia, ascites and pleural effusion being the most common findings.
  
  
  CONCLUSIONS
  Run-off CTA allows identification of vascular, MSK, and combined causes of IC in patients with suspected PAD and can guide specific therapy. CTA also allowed confident detection of crEVIF although detection did not necessarily trigger workup or treatment.
authors.affiliation: Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Preuß
authors.affiliation: Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Lars-Arne
authors.initials: LA
authors.lastname: Schaafs
authors.affiliation: Institute for Radiology, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Werncke
authors.affiliation: Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Ingo G
authors.initials: IG
authors.lastname: Steffen
authors.affiliation: Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.affiliation: Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Elgeti
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007383:Intermittent Claudication / Q000175:diagnosis*; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*