Quantitative vascular measurements in arterial occlusive disease

Accuracy in quantifying arterial occlusive disease requires an understanding of the relevant technical considerations and familiarity with the strengths and weaknesses of various imaging modalities in this setting. The degree of stenosis is evaluated in terms of diameter stenosis, which can be measured on either projection images or cross-sectional images, or area stenosis, which can be measured only on cross-sectional images. With projection images, the minimum luminal diameter should be sought on multiple images obtained at different angles. The reference site used for measurement should be noted and may be located at the level of the lesion or in a normal-looking portion of the stenotic vessel near the lesion. Multi-detector row computed tomographic (CT) angiography and magnetic resonance (MR) angiography are starting to replace digital subtraction angiography in quantifying arterial occlusive disease. CT angiography allows accurate evaluation without reducing in-plane resolution, although beam-hardening artifacts from high-attenuation structures can degrade image quality. MR angiography is useful even in cases of severe calcification but has a lower spatial resolution. Ultrasonography (US) may also be helpful in quantifying arterial occlusive disease; US analysis is almost always based on blood flow velocity measurement. Precise measurements of stenotic occlusion will help determine optimal therapy for affected patients.