Jeffrey Craig Hellinger MD, Presenter: Nothing to Disclose

Alessandro Napoli MD, Abstract Co-Author: Nothing to Disclose

Eric E. Williamson MD, Abstract Co-Author: Nothing to Disclose

Dominik Fleischmann MD, Abstract Co-Author: Nothing to Disclose

Geoffrey David Rubin MD, Abstract Co-Author: Nothing to Disclose

To examine the utility of CT angiography (CTA) for diagnosis and management of UE vascular disease.

100 consecutive UECTA exams were performed over 36 months. Indications included arterial (n=28) or venous (n=2) occlusive disease, vasculitis (n=8), traumatic injury (n=11), vascular mass (n=8), failing hemodialysis fistula or graft (n=8), vascular mapping (n=33), and assessment of graft patency (n=2). Studies were acquired on 4 (n=11), 8 (n=19), or 16 (n=70) channel MDCT. Slice thickness (0.5-2.0mm), pitch (0.875-1.75), rotation speed (0.5-0.6sec), and scan coverage were individualized to optimize spatial resolution and scan duration. Contrast medium was injected at 3-5ml/sec. 3D post-processing was performed in all studies with VR, MIP, and CPR techniques. The success of clinical management based upon UECTA findings was assessed by clinical follow-up of at least 6 months (mean 15 months).

All studies were technically adequate. 31% were normal. Vascular findings (seen in 60%) included stenosis (18), occlusion (19), small vessel disease (7), aneurysm (5), pseudoaneurysm (4), AVM (4), dissection (1), transection (1), and vasospasm (1). Extravascular findings provided alternative diagnoses in 9%: ganglion cyst, nerve sheath tumor, lymphocele, intramuscular hematoma, torn biceps tendon, pulmonary metastasis, and perivascular fibrosis. Management was based upon CTA in 90 cases – observation (17), medical (14), endovascular (8), or surgical (51) therapy. In the remaining 10, ongoing or planned management was supported – observation (2) or medical (8) therapy. In the 59 cases where surgical or endovascular management was prescribed, there were no immediate or delayed procedural complications. For the 41 cases where observation or medical management was the treatment of choice, no endovascular or surgical therapies were ultimately required.

MDCTA is a robust modality for UE vascular evaluation which can be applied in a broad spectrum of clinical presentations. CTA can provide reliable vascular and nonvascular diagnoses for UE management decision making.

Hellinger, J, Napoli, A, Williamson, E, Fleischmann, D, Rubin, G, Upper Extremity (UE) Multi-Detector Row CT (MDCT) Angiography: Clinical Experience in 100 Examinations.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4405336.html