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Article

The Clinical Utility of Lower Extremity Dual-Energy CT Angiography in the Detection of Bone Marrow Edema in Diabetic Patients with Peripheral Artery Disease

by
Chiara Floridi
1,2,3,
Laura Maria Cacioppa
1,2,
Tommaso Valeri
1,
Nicolo Rossini
1,*,
Marzia Rosati
2,
Vincenzo Vento
4,
Alessandro Felicioli
2,
Marco Macchini
2,
Roberto Candelari
2,
Marina Carotti
1,3 and
Andrea Giovagnoni
1,3
1
Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
2
Division of Interventional Radiology, Department of Radiological Sciences, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
3
Division of Radiology, Department of Radiological Sciences, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
4
Vascular Surgery Unit, Aortic Team, Lancisi Cardiovascular Center, 60122 Ancona, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(6), 1536; https://doi.org/10.3390/jcm13061536
Submission received: 8 January 2024 / Revised: 24 February 2024 / Accepted: 26 February 2024 / Published: 7 March 2024
(This article belongs to the Special Issue Dual-Energy and Spectral CT in Clinical Practice)
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Abstract

(1) Background: Type 2 diabetes is a major cause of incidences and the progression of peripheral artery disease (PAD). Bone marrow edema (BME) is an important finding suggestive of underlying bone inflammation in non-traumatic diabetic patients with PAD. Our aim was to evaluate the presence, severity, and clinical implications of BME detected by virtual non-calcium application (VNCa) of dual-energy CT angiography (DE-CTA). (2) Methods: A consecutive series of 76 diabetic patients (55 men; mean age 71.6 ± 11.2 yrs) submitted to lower limb DE-CTA for PAD evaluation and revascularization planning, which were retrospectively analyzed. VNCa images were independently and blindly revised for the presence, location, and severity of BME by two radiologists with 10 years of experience. BME and non-BME groups were evaluated in terms of PAD clinical severity and 6-month secondary major amputation rate. (3) Results: BME was present in 17 (22%) cases, while 59 (78%) patients were non-BME. The BME group showed a significantly higher incidence of major amputation (p < 0.001) and a significantly higher number of patients with advanced clinical stages of PAD compared to the non-BME group (p = 0.024). (4) Conclusions: Lower limb DE-CTA with VNCa application is a useful tool in the detection of BME in diabetic patients with PAD, simultaneously enabling the evaluation of the severity and location of the arterial disease for revascularization planning. BME presence could be a marker of clinically severe PAD and a possible risk factor for revascularization failure.
Keywords: computed tomography angiography; peripheral arterial disease; dual-energy computed tomography; digital subtraction angiography; bone marrow edema; diabetes computed tomography angiography; peripheral arterial disease; dual-energy computed tomography; digital subtraction angiography; bone marrow edema; diabetes

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MDPI and ACS Style

Floridi, C.; Cacioppa, L.M.; Valeri, T.; Rossini, N.; Rosati, M.; Vento, V.; Felicioli, A.; Macchini, M.; Candelari, R.; Carotti, M.; et al. The Clinical Utility of Lower Extremity Dual-Energy CT Angiography in the Detection of Bone Marrow Edema in Diabetic Patients with Peripheral Artery Disease. J. Clin. Med. 2024, 13, 1536. https://doi.org/10.3390/jcm13061536

AMA Style

Floridi C, Cacioppa LM, Valeri T, Rossini N, Rosati M, Vento V, Felicioli A, Macchini M, Candelari R, Carotti M, et al. The Clinical Utility of Lower Extremity Dual-Energy CT Angiography in the Detection of Bone Marrow Edema in Diabetic Patients with Peripheral Artery Disease. Journal of Clinical Medicine. 2024; 13(6):1536. https://doi.org/10.3390/jcm13061536

Chicago/Turabian Style

Floridi, Chiara, Laura Maria Cacioppa, Tommaso Valeri, Nicolo Rossini, Marzia Rosati, Vincenzo Vento, Alessandro Felicioli, Marco Macchini, Roberto Candelari, Marina Carotti, and et al. 2024. "The Clinical Utility of Lower Extremity Dual-Energy CT Angiography in the Detection of Bone Marrow Edema in Diabetic Patients with Peripheral Artery Disease" Journal of Clinical Medicine 13, no. 6: 1536. https://doi.org/10.3390/jcm13061536

APA Style

Floridi, C., Cacioppa, L. M., Valeri, T., Rossini, N., Rosati, M., Vento, V., Felicioli, A., Macchini, M., Candelari, R., Carotti, M., & Giovagnoni, A. (2024). The Clinical Utility of Lower Extremity Dual-Energy CT Angiography in the Detection of Bone Marrow Edema in Diabetic Patients with Peripheral Artery Disease. Journal of Clinical Medicine, 13(6), 1536. https://doi.org/10.3390/jcm13061536

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