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Infrarenal Aortic and Lower-Extremity Arterial Disease: Diagnostic Performance of Multi–Detector Row CT Angiography¹

¹ From the Departments of Radiology (C.C., F.F., A.L., A.N., M.B., F.P., M.D., R.P.) and Experimental Medicine and Pathology (I.N.), University of Rome "La Sapienza," Viale Regina Elena 324, 00161 Rome, Italy. From the 2001 RSNA scientific assembly. Received July 26, 2002; revision requested September 10; final revision received September 8, 2003; accepted October 14. Address correspondence to C.C. (e-mail: carlo.catalano@uniroma1.it).

View larger version (145K): [in a new window]   Figure 1a. Rutherford and Becker grade III (category 5) disease and cutaneous trophic lesions in a 57-year-old man. (a-c) Left transfemoral DSA images show (a) obstruction of the right popliteal artery with enhancement of collateral vessels (arrowheads), (b) reconstitution of the right peroneal artery (thick arrow) and patency of the left peroneal (thin arrow) and anterior tibial (arrowheads) arteries, and (c) distal reconstitution of the anterior tibial artery and patency of the dorsal pedal artery in the right side (thin arrow), and, in the left side, obstruction of the posterior tibial artery and patency of the anterior tibial (thick arrow) and peroneal (arrowheads) arteries. (d) Coronal MIP image from multi-detector row CT angiography with bone segmentation depicts occlusion of the right superficial femoral artery (thick arrow), reconstitution of the peroneal artery via collateral vessels, and patency of the distal anterior tibial (thin arrow) and dorsal pedal (arrowheads) arteries. In the left leg, below the knee, the patency of the anterior tibial artery and peroneal artery and occlusion of the posterior tibial artery also are depicted.

View larger version (159K): [in a new window]   Figure 1b. Rutherford and Becker grade III (category 5) disease and cutaneous trophic lesions in a 57-year-old man. (a-c) Left transfemoral DSA images show (a) obstruction of the right popliteal artery with enhancement of collateral vessels (arrowheads), (b) reconstitution of the right peroneal artery (thick arrow) and patency of the left peroneal (thin arrow) and anterior tibial (arrowheads) arteries, and (c) distal reconstitution of the anterior tibial artery and patency of the dorsal pedal artery in the right side (thin arrow), and, in the left side, obstruction of the posterior tibial artery and patency of the anterior tibial (thick arrow) and peroneal (arrowheads) arteries. (d) Coronal MIP image from multi-detector row CT angiography with bone segmentation depicts occlusion of the right superficial femoral artery (thick arrow), reconstitution of the peroneal artery via collateral vessels, and patency of the distal anterior tibial (thin arrow) and dorsal pedal (arrowheads) arteries. In the left leg, below the knee, the patency of the anterior tibial artery and peroneal artery and occlusion of the posterior tibial artery also are depicted.

View larger version (159K): [in a new window]   Figure 1c. Rutherford and Becker grade III (category 5) disease and cutaneous trophic lesions in a 57-year-old man. (a-c) Left transfemoral DSA images show (a) obstruction of the right popliteal artery with enhancement of collateral vessels (arrowheads), (b) reconstitution of the right peroneal artery (thick arrow) and patency of the left peroneal (thin arrow) and anterior tibial (arrowheads) arteries, and (c) distal reconstitution of the anterior tibial artery and patency of the dorsal pedal artery in the right side (thin arrow), and, in the left side, obstruction of the posterior tibial artery and patency of the anterior tibial (thick arrow) and peroneal (arrowheads) arteries. (d) Coronal MIP image from multi-detector row CT angiography with bone segmentation depicts occlusion of the right superficial femoral artery (thick arrow), reconstitution of the peroneal artery via collateral vessels, and patency of the distal anterior tibial (thin arrow) and dorsal pedal (arrowheads) arteries. In the left leg, below the knee, the patency of the anterior tibial artery and peroneal artery and occlusion of the posterior tibial artery also are depicted.

View larger version (49K): [in a new window]   Figure 1d. Rutherford and Becker grade III (category 5) disease and cutaneous trophic lesions in a 57-year-old man. (a-c) Left transfemoral DSA images show (a) obstruction of the right popliteal artery with enhancement of collateral vessels (arrowheads), (b) reconstitution of the right peroneal artery (thick arrow) and patency of the left peroneal (thin arrow) and anterior tibial (arrowheads) arteries, and (c) distal reconstitution of the anterior tibial artery and patency of the dorsal pedal artery in the right side (thin arrow), and, in the left side, obstruction of the posterior tibial artery and patency of the anterior tibial (thick arrow) and peroneal (arrowheads) arteries. (d) Coronal MIP image from multi-detector row CT angiography with bone segmentation depicts occlusion of the right superficial femoral artery (thick arrow), reconstitution of the peroneal artery via collateral vessels, and patency of the distal anterior tibial (thin arrow) and dorsal pedal (arrowheads) arteries. In the left leg, below the knee, the patency of the anterior tibial artery and peroneal artery and occlusion of the posterior tibial artery also are depicted.

View larger version (146K): [in a new window]   Figure 2a. Rutherford and Becker grade II (category 3) disease in a 63-year-old man. (a) Right transfemoral DSA image shows severe stenosis (arrow) of the left common iliac artery and dilatation (arrowheads) of the right common iliac artery. (b) Coronal MIP image from multi-detector row CT angiography with bone segmentation correlates well with the DSA image. (c) Transverse CT image shows dilatation of the right common iliac artery and soft plaque (arrow) of the proximal left common iliac artery.

View larger version (96K): [in a new window]   Figure 2b. Rutherford and Becker grade II (category 3) disease in a 63-year-old man. (a) Right transfemoral DSA image shows severe stenosis (arrow) of the left common iliac artery and dilatation (arrowheads) of the right common iliac artery. (b) Coronal MIP image from multi-detector row CT angiography with bone segmentation correlates well with the DSA image. (c) Transverse CT image shows dilatation of the right common iliac artery and soft plaque (arrow) of the proximal left common iliac artery.

View larger version (100K): [in a new window]   Figure 2c. Rutherford and Becker grade II (category 3) disease in a 63-year-old man. (a) Right transfemoral DSA image shows severe stenosis (arrow) of the left common iliac artery and dilatation (arrowheads) of the right common iliac artery. (b) Coronal MIP image from multi-detector row CT angiography with bone segmentation correlates well with the DSA image. (c) Transverse CT image shows dilatation of the right common iliac artery and soft plaque (arrow) of the proximal left common iliac artery.

View larger version (137K): [in a new window]   Figure 3a. Rutherford and Becker grade II (category 2) disease with segmental occlusion of the left superficial femoral artery in a 43-year-old man. (a) DSA image depicts 1.5-cm-long occlusion of the left superficial femoral artery (arrow). (b) Coronal MIP image from multi-detector row CT angiography with bone segmentation correlates well with the DSA image and provides clearer depiction of the collateral vessels (arrowheads).

View larger version (107K): [in a new window]   Figure 3b. Rutherford and Becker grade II (category 2) disease with segmental occlusion of the left superficial femoral artery in a 43-year-old man. (a) DSA image depicts 1.5-cm-long occlusion of the left superficial femoral artery (arrow). (b) Coronal MIP image from multi-detector row CT angiography with bone segmentation correlates well with the DSA image and provides clearer depiction of the collateral vessels (arrowheads).

View larger version (56K): [in a new window]   Figure 4a. Rutherford and Becker grade II (category 3) disease in a 48-year-old man. (a) Composite DSA image obtained with multiple injections of contrast agent depicts a focal severe (>50%) stenosis in the proximal right common femoral artery (thick arrow) and bilateral occlusion of the popliteal artery. In the right calf, the patency of the peroneal (thin arrow) and posterior tibial (black arrowheads) arteries is evident; in the left calf, although arterial enhancement is poor, the patency of the anterior tibial artery (white arrowhead) is demonstrated. (b) Coronal MIP image from multi-detector row CT angiography with bone segmentation correlates well with the DSA image and depicts the right femoral stenosis (arrow) and bilateral popliteal occlusion with excellent distal enhancement. (c) Transverse multi-detector row CT angiogram at the level of the knees confirms bilateral popliteal occlusion and right popliteal aneurysm (arrow).

View larger version (46K): [in a new window]   Figure 4b. Rutherford and Becker grade II (category 3) disease in a 48-year-old man. (a) Composite DSA image obtained with multiple injections of contrast agent depicts a focal severe (>50%) stenosis in the proximal right common femoral artery (thick arrow) and bilateral occlusion of the popliteal artery. In the right calf, the patency of the peroneal (thin arrow) and posterior tibial (black arrowheads) arteries is evident; in the left calf, although arterial enhancement is poor, the patency of the anterior tibial artery (white arrowhead) is demonstrated. (b) Coronal MIP image from multi-detector row CT angiography with bone segmentation correlates well with the DSA image and depicts the right femoral stenosis (arrow) and bilateral popliteal occlusion with excellent distal enhancement. (c) Transverse multi-detector row CT angiogram at the level of the knees confirms bilateral popliteal occlusion and right popliteal aneurysm (arrow).

View larger version (81K): [in a new window]   Figure 4c. Rutherford and Becker grade II (category 3) disease in a 48-year-old man. (a) Composite DSA image obtained with multiple injections of contrast agent depicts a focal severe (>50%) stenosis in the proximal right common femoral artery (thick arrow) and bilateral occlusion of the popliteal artery. In the right calf, the patency of the peroneal (thin arrow) and posterior tibial (black arrowheads) arteries is evident; in the left calf, although arterial enhancement is poor, the patency of the anterior tibial artery (white arrowhead) is demonstrated. (b) Coronal MIP image from multi-detector row CT angiography with bone segmentation correlates well with the DSA image and depicts the right femoral stenosis (arrow) and bilateral popliteal occlusion with excellent distal enhancement. (c) Transverse multi-detector row CT angiogram at the level of the knees confirms bilateral popliteal occlusion and right popliteal aneurysm (arrow).