Foot CT perfusion in patients with peripheral arterial occlusive disease (PAOD): a feasibility study

To prospectively assess the technical feasibility and reproducibility of quantitative foot perfusion multidetector-row computed tomography (MDCT) in patients with peripheral occlusive artery disease (PAOD) and to evaluate perfusion parameters changes after endovascular treatment.

Institutional review board approval and informed patient consent were obtained. 10 patients older than 65 years (mean 74.1 years, range 66-95 years) with PAOD and who were referred to our department for single-limb endovascular treatment were enrolled prospectively. All patients underwent foot CT perfusion examinations before and within 72 h after endovascular treatment. A 64-row CT lightspeed VCT scanner (GE Medical Systems) was used with acquisition of eight contiguous 5-mm reconstructed sections (60-s acquisition time; 40 mL Iomeprol 400 mgI/mL, @4 mL/s). Data were analyzed by two blinded readers using commercially available software to calculate perfusion parameters. Inter-observer and intra-observer agreement of perfusion CT analysis was assessed using Bland-Altman analyses and intra-class correlation coefficient (ICC). Changes in perfusion parameters after endovascular treatment were assessed using Wilcoxon's test.

Good inter-observer and intra-observer agreement was obtained in all patients. Good agreement was obtained for perfusion parameters for the untreated foot and in repeated studies. By comparing perfusion parameters in the treated foot, a significantly shorter mean transit time (MTT) was obtained.

Foot CT perfusion is a feasible and reproducible technique. A significant decrease of MTT between pre- and post-revascularization suggests improved flow in the below-the-knee arteries.