Ugur Bozlar MD, Abstract Co-Author: Nothing to Disclose

Patrick T. Norton MD, Presenter: Nothing to Disclose

Ahmed Mohamed Housseini MD, Abstract Co-Author: Nothing to Disclose

Ismaeel Mohammad Maged MD, Abstract Co-Author: Nothing to Disclose

Klaus D. Hagspiel MD, Abstract Co-Author: Grant, Siemens AG, Malvern, PA

To describe the technique and performance characteristics of multidetector CT angiography (MDCTA) of the upper extremity (UE) arterial system.

32 patients underwent 40 UE examinations on 16 channel MDCT scanners. 100 cc of nonionic iodinated contrast media was administered intravenously in the contralateral anticubital vein or a central line at 5 cc/s using a power injector and automated bolus timing. Scan parameters: collimation 0.625 mm, pitch 1.75, mAs 440, kV 120, reconstruction interval 0.625 mm, scan range mid aortic arch to fingertips, field of view 25 cm to 50 cm. Images were analyzed on a 3D workstation. Qualitative assessment for confidence in diagnosis was graded on a 4 point Likert scale for thoracic, upper arm, forearm arteries, arches of the hand, common and proper digital arteries for all cases (1= Ability to grade stenosis and detect occlusion high; 2= Limited ability to grade stenosis, occlusions easily identifiable; 3=Unable to quantify stenosis, limited ability to identify occlusion; 4=Non diagnostic). For cases with angiographic correlation, sensitivities and specificities for presence of stenosis > 50% were calculated.  

44 UEs were available for analysis. Confidence in diagnosis was ranked as follows: thoracic aa. 1.2±0.4, brachial a. 1.2±0.6, forearm aa. 1.2±0.6, palmar arches 2.2±1.3, common digital aa. 2.3±1.3, proximal proper digital aa. 2.8±1.2, distal proper digital aa. 3.6±0.7. 141 arterial segments were available for correlation on digital subtraction angiography. 84 of these segments were not evaluable on CTA, with 82 of these distal to the palmar arches. Sensitivity and specificity (%) by segment were: thoracic aa. NA/100, brachial a. 100/100, forearm aa. 100/100, palmar arches 100/80.  

MDCTA of the upper extremities is an accurate diagnostic tool allowing quantification of stenosis and detection of occlusions to the level of the wrist, and in the palmar arches is sufficient to detect occlusions. The digital arteries cannot be confidently assessed with MDCTA.

MDCTA is a suitable modality for the noninvasive evaluation of the UE arterial system proximal to the digital arteries.

Bozlar, U, Norton, P, Housseini, A, Maged, I, Hagspiel, K, MDCT Angiography of the Upper Extremity: Technique and Performance.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6012853.html