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Quantitative Assessment of Foot Blood Flow by Using Dynamic Volume Perfusion CT Technique: A Feasibility Study
Saebeom Hur1, Hwan Jun Jae1, Yeonggul Jang1
1From the Departments of Radiology (S.H., H.J.J., H.C.K., J.W.C., E.A.P., W.L.), Surgery (S.K.M., S.I.M.), and Orthopedic Surgery (D.Y.L.), Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea; Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea (Y.J.); Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea (S.G.S.); and Department of Biomedical Engineering, National Cancer Center, Gyeonggi-do, South Korea (K.G.K.).
Purpose:
To demonstrate the feasibility of foot blood flow measurement by using dynamic volume perfusion computed tomographic (CT) technique with the upslope method in an animal experiment and a human study.
Materials And Methods:
The human study was approved by the institutional review board, and written informed consent was obtained from all patients. The animal study was approved by the research animal care and use committee. A perfusion CT experiment was first performed by using rabbits. A color-coded perfusion map was reconstructed by using in-house perfusion analysis software based on the upslope method, and the measured blood flow on the map was compared with the reference standard microsphere method by using correlation analysis. A total of 17 perfusion CT sessions were then performed (a) once in five human patients and (b) twice (before and after endovascular revascularization) in six human patients. Perfusion maps of blood flow were reconstructed and analyzed. The Wilcoxon signed rank test was used to prove significant differences in blood flow before and after treatment.
Results:
The animal experiment demonstrated a strong correlation (R(2) = 0.965) in blood flow between perfusion CT and the microsphere method. Perfusion maps were obtained successfully in 16 human clinical sessions (94%) with the use of 32 mL of contrast medium and an effective radiation dose of 0.31 mSv (k factor for the ankle, 0.0002). The plantar dermis showed the highest blood flow among all anatomic structures of the foot, including muscle, subcutaneous tissue, tendon, and bone. After a successful revascularization procedure, the blood flow of the plantar dermis increased by 153% (P = .031). The interpretations of the color-coded perfusion map correlated well with the clinical and angiographic findings.
Conclusion:
Perfusion CT could be used to measure foot blood flow in both animals and humans. It can be a useful modality for the diagnosis of peripheral arterial disease by providing quantitative information on foot perfusion status.
