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Comparative Study
. 2014 Sep 24:14:125.
doi: 10.1186/1471-2261-14-125.

Comparison of lower extremity atherosclerosis in diabetic and non-diabetic patients using multidetector computed tomography

Affiliations
Comparative Study

Comparison of lower extremity atherosclerosis in diabetic and non-diabetic patients using multidetector computed tomography

Ci He et al. BMC Cardiovasc Disord. .

Abstract

Background: Lower extremity atherosclerosis (LEA) is among the most serious diabetic complications and leads to non-traumatic amputations. The recently developed dual-source CT (DSCT) and 320- multidetector computed tomography (MDCT) may help to detect plaques more precisely. The aim of our study was to evaluate the differences in LEA between diabetic and non-diabetic patients using MDCT angiography.

Methods: DSCT and 320-MDCT angiographies of the lower extremities were performed in 161 patients (60 diabetic and 101 non-diabetic). The plaque type, distribution, shape and obstructive natures were compared.

Results: Compared with non-diabetic patients, diabetic patients had higher peripheral neuropathy, history of cerebrovascular infarction and hypertension rates. A total of 2898 vascular segments were included in the analysis. Plaque and stenosis were detected in 681 segments in 60 diabetic patients (63.1%) and 854 segments in 101 non-diabetic patients (46.9%; p <0.05). Regarding these plaques, diabetic patients had a higher incidence of mixed plaques (34.2% vs. 27.1% for non-diabetic patients). An increased moderate stenosis rate and decreased occlusion rate were observed in diabetic patients relative to non-diabetic patients (35.8% vs. 28.3%; and 6.6% vs. 11.4%; respectively). In diabetic patients, 362 (53.2%) plaques were detected in the distal lower leg segments, whereas in non-diabetic patients, 551 (64.5%) plaques were found in the proximal upper leg segments. The type IV plaque shape, in which the full lumen was involved, was detected more frequently in diabetic patients than in non-diabetic patients (13.1% vs. 8.2%).

Conclusion: Diabetes is associated with a higher incidence of plaque, increased incidence of mixed plaques, moderate stenosis and localisation primarily in the distal lower leg segments. The advanced and non-invasive MDCT could be used for routine preoperative evaluations of LEA.

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Figures

Figure 1
Figure 1
Plaque shapes. A. Normal lumen. B. Type I, <25%; C. Type II, 25–50%; D. Type III, 50–75%; E. Type IV, 75–100%.
Figure 2
Figure 2
DSCT images of a 56 -year- old man with diabetes for 15 years , 1 year of cold feet, show diffuse plaques and stenoses in both lower extremities. A, Volume-rendered reconstruction (VRT) after dual energy bone removal displays overview of both lower extremities with a mild stenosis (white arrow), an occlusion (blue arrow) and a compensatory artery (white triangle) in the right femoral artery. B, Maximum intensity projection (MIP) depicts the overview of plaques and stenosis. C, Both the mild stenosis (white arrow) and occlusion (blue arrow) are caused by non-calcified plaque as evidenced using curved planar reformation (CPR).
Figure 3
Figure 3
320-MDCT images of a 62 -year- old man with diabetes for 10 years , intermittent claudication of both lower extremities for 6 months. A, VRT reflects overview artery tree of lower extremities with bone remaining, showing diffused stenoses in right femoral artery. B, VRT image after bone removal depicts a severe (blue arrow) and diffused mild to moderate stenosis (white arrows) in right femoral artery. C, All the stenoses are caused by non-calcified plaques as evidenced using coronal MIP. D, Sagital MIP displays the severe stenosis (blue arrow), mild to moderate stenoses (white arrows) in right femoral artery caused by non-calcified plaques.
Figure 4
Figure 4
Bar graph demonstrates the main distribution of plaques between diabetic and non-diabetic patients, showing the increased distal segment involvement in diabetic patients ( P =  0.01) . ULA = Upper Leg arteries, LLA = Lower leg arteries.

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Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2261/14/125/prepub

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