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Sixteen–Detector Row CT Angiography for Lower-Leg Arterial Occlusive Disease: Analysis of Section Width¹

¹ From the Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland (T.S., S.W., H.A., M.K., B.M., T.B.); and Institute of Radiology, Kantonsspital Chur, Spitäler Chur, Loestrasse 170, CH-7000 Chur, Switzerland (T.B.). Received November 2, 2004; revision requested January 1, 2005; revision received January 27; accepted February 25. Supported by the National Center of Competence and Research, Computer Aided and Image Guided Medical Interventions, of the Swiss National Science Foundation. Address correspondence to T.B. (e-mail: thomas_boehm{at}gmx.net).

View larger version (101K): [in a new window]   Figure 1. DSA image and CT angiograms in 65-year-old man with Fontaine stage IIb PAD. Left: DSA image in anteroposterior projection reveals a high-grade stenosis (arrow) in the distal popliteal artery and luminal narrowing of less than 50% (arrowhead) in the tibioperoneal trunk. Top row: Corresponding volume-rendered reconstructions in anteroposterior projection from CT data sets 1 (left), 2 (middle), and 3 (right) show good concordance with the DSA image in depicting the noncalcified stenosis (arrow) in the distal popliteal artery and a calcified stenosis (arrowhead) in the tibioperoneal trunk. Note the sharper demarcation of the calcified part of the partially calcified stenosis in the distal popliteal artery in the thinnest CT section (upper right). Bottom row: In corresponding transverse CT images from CT data sets 1 (left), 2 (middle), and 3 (right), a luminal narrowing of more than 50% (resulting in a false-positive rating) is seen in the images from CT data sets 1 and 2. This narrowing represents a "blooming" artifact caused by calcium that occurs with larger section widths. The stenosis was graded correctly with the 0.75-mm section width and 0.4-mm reconstruction interval of CT data set 3 (lower right). "Calcium blooming" caused the majority of the false-positive ratings in our study.

View larger version (72K): [in a new window]   Figure 2. DSA image and CT angiograms in 59-year-old man with Fontaine stage IIa PAD. Left: DSA image in anteroposterior projection shows a normal tibioperoneal trunk without luminal narrowing (arrow); this segment was rated as grade 0 at DSA. Top row: Corresponding volume-rendered reconstructions in anteroposterior projection from CT data sets 1 (left), 2 (middle), and 3 (right) show a calcified plaque (arrow) proximal to the bifurcation in all three reconstructions but do not give sufficient diagnostic information about the luminal narrowing. Bottom row: Corresponding transverse CT images from CT data sets 1 (left), 2 (middle), and 3 (right) show the position of the plaque (arrow) as orthogonal to the anteroposterior x-ray beam at DSA. A grade 2 stenosis (50%–99%) is seen in all three CT reconstructions. Projectional errors of DSA were the second major source of inaccuracy resulting in false-positive ratings of stenoses in this study.