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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