Download Diagnosis of critical limb ischemia

TITLE
Imaging of critical limb ischemia.
BACKGROUND
This project will focus on the best way to image patients with critical limb ischemia (CLI).
Current there are several diagnostic imaging modalities available. All of them have been
evaluated, but mostly in a mixed group of patient, including claudicants and some CLI
patients. Imaging in CLI patients has several problems, calcification, low-flow, collateral flow
but also problems related to the techniques. Angiography is the reference standard imaging
before and during treatment. During the angiographic procedure, 50-100 ml of contrast is
administrated. This might/can have implications for renal function in patients with general
atherosclerosis. Dilution of contrast might help to reduce decline in renal function.
PURPOSE
The purpose of this study is to evaluate CTA and MRA and Angiography in a prospective
manner, considering angiography as reference standard. In addition we will study to which
extent contrast dilution during intervention for CLI is affecting the imaging quality and the
renal function.
OUTCOME MEASURES
Evaluation of the intra and inter observer variability in CTA.
Evaluation of the intra and inter observer variability in MRA
Direct comparison between CTA and Angiography
Direct comparison between MRA and Angiography.
Evaluate how and to which extend contrast dilution during intervention for CLI is
affecting the imaging quality and the renal function.
FUTURE PERSPECTIVE
Critical ischemia is poor perfusion of the effected limb/foot. With the new flat panel
technology it would be possible to image the local perfusion. This is already done with CT in
the brain. In the AMC we have experience with this technique in the brain and this technique
could be explored in the limb. Philips wants to invest also in this project.
- Developing a technology for the imaging of perfusion in lower limb ischemia.
- Imaging of lower limb perfusion after intervention ( maybe in relation to the
angiosome theory)
PARTICIPATING CENTERS
Academic Medical Center Amsterdam
TIME SCHEDULE
Start of project: 15-Mar-2011
End of project: 15-Mar-2014
LOCAL INVESTIGATORS
S.Jensh, MD, study coordinator
Dept. of Radiology/Surgery
H.A.Marquering, PhD
Department of Department of Biomedical Engineering and Physics
Dr S Bipat, PhD
Dept. of Radiology
J.A. Reekers, MD, PhD, project leader, Principal Investigator
Dept. of Radiology
M.J.W. Koelemay, MD, PhD, project leader,
Dept. of Surgery