Treatment planning for leg ischemia
A vascular surgeon needs a complete “map” of the arteries: the level and length of occlusion, the condition of the inflow and outflow tracts, the suitability of the arteries for a bypass or stent - CT angiography provides all this with 3D reconstruction and replaces diagnostic catheter angiography. It also detects popliteal artery aneurysms, entrapment syndrome, post-traumatic injuries, and monitors the patency of shunts and stents. With severe calcification of the tibial arteries in diabetics, the information content is reduced - then they are supplemented with duplex scanning or catheter angiography. Need creatinine; patients with renal failure - preparation with hydration.
Indications
- aneurysm and aortic dissection, chest and back pain with suspected vascular accident;
- coronary heart disease - non-invasive assessment of coronary arteries, calcium index;
- pulmonary embolism (PE) with shortness of breath and chest pain;
- stenosis of the carotid and cerebral arteries, cerebral aneurysms, stroke;
- obliterating atherosclerosis and intermittent claudication - arteries of the legs before surgery;
- planning of stenting, bypass surgery, aortic endoprosthetics, monitoring after them.
What is MSCT
Multislice computed tomography is a layer-by-layer X-ray study in which detectors receive dozens of sections up to 0.5–1 mm thick in one revolution of the tube, and a computer builds a three-dimensional image of the organ. MSCT is performed in 5-15 minutes, accurately shows bones, lungs, stones, hemorrhages, tumors and vessels (with contrast), and is often the method of choice for trauma and acute conditions when MRI is too long or contraindicated.
Preparation and contrast
Non-contrast MSCT does not require preparation. Before a study with intravenous contrast, a test for creatinine (kidney function) and the absence of an allergy to iodine are required; 4–6 hours without eating; When taking metformin, agree on a break with your doctor. Contrast (Unigexol) is administered using an automatic injector; a feeling of warmth for 1–2 minutes is normal. To examine the abdominal and pelvic organs, oral contrast is used, which is drunk 30–60 minutes before the scan. Remove metal objects from the examination area. The radiologist’s conclusion is completed within 1–2 hours, the images are issued on film and disk.
Radiation exposure and safety
Modern devices use low-dose protocols; the dose for one study is comparable to several months of natural background and does not accumulate dangerously when prescribed appropriately. MSCT is not performed on pregnant women (except for vital indications); for children - according to strict indications with a minimum dose. Iodine contrast is contraindicated in severe renal failure, iodine allergy and uncontrolled hyperthyroidism. Pacemaker and metal implants are not a contraindication, unlike MRI.
