scholarly journals Improved detectability of thromboses of the lower limb using low kilovoltage computed tomography

Medicine ◽  
2018 ◽  
Vol 97 (6) ◽  
pp. e9775 ◽  
Author(s):  
Tomoaki Sasaki ◽  
Yasuomi Fujimoto ◽  
Shunta Ishitoya ◽  
Basim Nabaa ◽  
Naofumi Watanabe ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lower Limb ◽  
Low Kilovoltage

Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

2021 ◽  
pp. 1-9
Author(s):  
Lucas Sousa Macedo ◽  
Renato Polese Rusig ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Upper Limb ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
High Energy ◽  
Lower Limbs ◽  
Added Value ◽  
Vascular Lesions ◽  
Limb Injuries ◽  
Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

Multiphase vascular lower limb computed tomography: Assessment of patients doses and radiogenic risk

2021 ◽  
pp. 109675
Author(s):  
Rasha Jaafar ◽  
Abdelmoneim Sulieman ◽  
Nissren Tamam ◽  
Hiba Omer ◽  
Abdelrahman Elnour ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lower Limb

Ionizing radiation doses during lower limb torsion and anteversion measurements by EOS stereoradiography and computed tomography

2014 ◽  
Vol 83 (2) ◽  
pp. 371-377 ◽  
Author(s):  
Cyrille Delin ◽  
Stéphane Silvera ◽  
Céline Bassinet ◽  
Philippe Thelen ◽  
Jean-Luc Rehel ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ionizing Radiation ◽  
Lower Limb ◽  
Radiation Doses

Reliability of the assessment of lower limb torsion using computed tomography: analysis of five different techniques

2011 ◽  
Vol 41 (3) ◽  
pp. 305-311 ◽  
Author(s):  
Emmanouil Liodakis ◽  
Iosifina Doxastaki ◽  
Kongfai Chu ◽  
Christian Krettek ◽  
Ralph Gaulke ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lower Limb ◽  
Tomography Analysis

Defining the Role of Duplex Ultrasound Assessment to Determine Severity of Arterial Calcification: An Analysis of the Superficial Femoral Artery

2020 ◽  
Vol 44 (2) ◽  
pp. 74-78
Author(s):  
Charlotte Taylor ◽  
Lukasz P. Zielinski ◽  
Mohammed M. Chowdhury ◽  
Patrick A. Coughlin
Keyword(s):  
Computed Tomography ◽  
Correlation Coefficient ◽  
Lower Limb ◽  
Imaging Modality ◽  
Objective Assessment ◽  
Duplex Ultrasound ◽  
Arterial Calcification ◽  
Gold Standard Method ◽  
Calcification Score

Lower limb arterial calcification associates with poor cardiovascular outcomes. The gold standard method of assessment is via computed tomography, yet duplex is our primary imaging modality. Currently, there is no standardized objective assessment of lower limb arterial calcification using duplex. We aimed to define the role of duplex in the assessment of lower limb arterial calcification. Initial consensus was achieved between a cohort of vascular scientists on objective imaging specific markers of lower limb arterial calcification severity using duplex. This resulted in objective descriptions to grade calcification from 0 to 3 (no calcification through to severe calcification) which formed the duplex lower limb arterial calcification score. Reproducibility of the duplex lower limb arterial calcification score was assessed and further validation was undertaken by comparing the duplex lower limb arterial calcification with computed tomography–based assessment in a separate cohort of 44 patients investigated with both modalities. The intra- and inter-class correlation coefficient were > 0.87 . The Spearman rank correlation coefficient between the duplex and CT based arterial calcium measurements was (ρ = 0.644, P < .001). The duplex lower limb arterial calcification score provides a standardized and reproducible modality for assessment of lower limb arterial calcification and may aid with risk stratification in patients with peripheral arterial disease.

Diagnostic management of pulmonary embolism using clinical assessment, plasma D-dimer assay, complete lower limb venous ultrasound and helical computed tomography of pulmonary arteries

2005 ◽  
Vol 93 (05) ◽  
pp. 982-988 ◽  
Author(s):  
Alain Cazanave ◽  
Marie Elias ◽  
Valérie Chabbert ◽  
Henri Juchet ◽  
Hélène Paradis ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Clinical Assessment ◽  
Lower Limb ◽  
Pulmonary Arteries ◽  
Ct Scans ◽  
Helical Computed Tomography ◽  
Diagnostic Strategy ◽  
Clinical Probability ◽  
D Dimer

SummaryThe objective of the study was to assess the clinical validity of a non-invasive diagnostic strategy for acute pulmonary embolism using clinical assessment combined with both ELISA D-dimer and complete lower limb ultrasound (US) examination of proximal and distal veins, before single-detector helical computed tomography (CT) of pulmonary arteries. We expected the strategy to have a high diagnostic exclusion power and to safely decrease the number of CT scans. This prospective, multicenter outcome study included 274 consecutive outpatients. All underwent a priori clinical probability, D-dimer and bilateral complete lower limb US assessments. Only patients with a high clinical probability and both tests negative, or positive D-dimer and negative US assessments, underwent CT. This was deemed necessary in 114 patients (42%). At baseline, venous thromboembolism (VTE) was detected in 110 patients (40%), either by US showing proximal (n=65) or distal (n=36) thrombosis, or by CT (n=9). Anticoagulant was withheld in the remaining patients with negative results in both D-dimer and US but a non-high clinical probability (n=59), or in both US and CT (n=90), or with negative US (n=6) and inadequate CT (n=9). All patients underwent a three-month clinical follow-up. VTE occurred in one patient with inadequate CT, yielding an incidence of 0.6% [95% confidence interval: 0.1–3.4]. No patient died from VTE or had major bleeding. Using clinical probability, ELISA D-dimer and complete US before helical CT is a safe strategy resulting in a substantial reduction in CT scans.

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