Quantitative evaluation of postintervention foot blood supply in patients with peripheral artery disease by computed tomography perfusion

Ming Li; Zheng Li; Pan Gao; Liang Jin; Li Li; Wei Zhao; Wan Zhang; Yingli Sun; Yun Zhao; Jiasen Cui

doi:10.1016/j.jvs.2019.11.030

Quantitative evaluation of postintervention foot blood supply in patients with peripheral artery disease by computed tomography perfusion

J Vasc Surg. 2020 Sep;72(3):1035-1042. doi: 10.1016/j.jvs.2019.11.030. Epub 2020 Jan 19.

Authors

Ming Li¹, Zheng Li², Pan Gao³, Liang Jin³, Li Li², Wei Zhao⁴, Wan Zhang², Yingli Sun³, Yun Zhao², Jiasen Cui⁵

Affiliations

¹ Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China; Diagnosis and Treatment Center of Small Lung Nodules, Huadong Hospital Affiliated to Fudan University, Shanghai, China; Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
² Department of Vascular Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
³ Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
⁴ Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China; Diagnosis and Treatment Center of Small Lung Nodules, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
⁵ Department of Vascular Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China. Electronic address: cuijiasen@163.com.

PMID: 31964575
DOI: 10.1016/j.jvs.2019.11.030

Abstract

Objective: The aim of this study was to quantitatively evaluate the changes of the foot's blood supply after endovascular treatment in patients with peripheral artery disease (PAD) using foot computed tomography (CT) perfusion.

Methods: Nineteen patients who underwent endovascular treatment for PAD between January 2018 and November 2018 were included in the study. Perfusion CT scanning was performed before and after intervention with the measurement of ankle-brachial index. Regions of interest were selected from two arteries and four different tissues per foot. Perfusion maps of blood volume, blood flow, permeability surface area product, time to peak (TTP), mean transit time (MTT), mean slope of increase (MSI), Tmax, and impulse response function (IRFt₀) were constructed and calculated by the perfusion analysis software. Wilcoxon signed rank test was performed on the eight parameter pairs of the limbs on the treated and untreated sides before and after intervention in the 19 patients.

Results: Differences in blood flow, MTT, TTP, Tmax, MSI, and IRFt₀ on the treated side of the tissue perfusion group and statistical difference in blood flow, MTT, and MSI on the treated side of the arterial perfusion group were observed (all P < .05). Ankle-brachial index improved from 0.41 ± 0.11 to 0.76 ± 0.10 (P < .001). For the untreated side, TTP of the tissue perfusion group was significantly shortened (by 7.71 seconds) after surgery (P = .006), whereas there were no differences in the other parameters. In addition, no significant differences in parameters were observed on the untreated side of the arterial perfusion group. The average radiation dose per phase of perfusion scan was 0.00097 mSv. Moreover, the hyperperfusion zone in the plantar dermis and periosteum reappeared after revascularization.

Conclusions: Perfusion CT is a feasible and repeatable approach for quantifying blood supply in patients with PAD. The increase of blood flow, MSI, and MTT shortening suggest blood supply improvement after revascularization in both arterial perfusion and tissue perfusion. In addition, TTP may be a sensitive indicator of blood supply changes in tissue perfusion.

Keywords: Blood supply; Perfusion; Peripheral artery disease; Quantitative assessment; Tomography; X-ray computed.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Blood Flow Velocity
Computed Tomography Angiography*
Endovascular Procedures*
Feasibility Studies
Female
Foot / blood supply*
Humans
Male
Middle Aged
Multidetector Computed Tomography*
Perfusion Imaging*
Peripheral Arterial Disease / diagnostic imaging
Peripheral Arterial Disease / physiopathology
Peripheral Arterial Disease / therapy*
Predictive Value of Tests
Prospective Studies
Recovery of Function
Regional Blood Flow
Treatment Outcome