Imaging
Vascular Ulcers
- Preliminary Diagnosis: Vascular Ulcers
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosing vascular ulcers.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosing vascular ulcers.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Vascular Ulcers
I. What imaging technique is first-line for this diagnosis?
Ultrasound of the vessel of concern.
II. Describe the advantages and disadvantages of this technique for diagnosing vascular ulcers.
Advantages
Highly portable imaging modality.
Does not expose patients to ionizing radiation.
Highly adept in detailing the velocity and directionality of the flow of blood within vessels.
Disadvantages
Limited in sensitivity and specificity in evaluating the endothelium of the vessel of concern.
Less useful in guiding endovascular therapy in patients, compared to catheter angiography.
Highly operator dependent.
Limited in evaluating the surrounding soft tissues and osseous structures.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to ultrasound exist.
IV. What alternative imaging techniques are available?
CTA imaging
MRA imaging
Catheter angiography all utilizing IV contrast medium
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing vascular ulcers.
CTA imaging
Advantages
Highly sensitive and specific in evaluating the vasculature and detailing any endothelial abnormality.
Offers exquisite visualization of the surrounding soft tissues, osseous structures, and vasculature.
Highly specific in characterizing any secondary complications.
Disadvantages
Exposes the patients to ionizing radiation.
Less adept in guiding therapeutic intervention.
MRA imaging
Advantages
Does not expose patients to ionizing radiation.
Offers exquisite detail of the surrounding soft tissues.
Moderate in sensitivity and specificity in detecting the vasculature structures and is less sensitive and specific in detailing any endothelial abnormalities.
Disadvantages
Expensive.
Time consuming.
Subject to motion and susceptibility weighted artifact, degrading image quality.
Catheter angiography all utilizing IV contrast medium
Advantages
Gold standard in detecting, characterizing, and diagnosing vascular ulcers and any vascular endothelial abnormalities.
Offers both diagnostic capabilities and therapeutic access in diagnosing and treating vascular ulcers and any secondary complications.
Disadvantages
Exposes patients to ionizing radiation.
Exposes patients to increased morbidity and mortality secondary to the invasiveness of the procedure.
Contraindicated in patients who are in an hypocoaguable state.
VI. What are the contraindications for the alternative imaging techniques?
CTA imaging
May be contraindicated in pregnant patients and those in renal failure who are not on an adequate dialysis regimen.
May be contraindicated in patients with contrast allergy.
MRA imaging
May be contraindicated in patients with non-MR compatible hardware.
Catheter angiography all utilizing IV contrast medium
Catheter angiography may be contraindicated in patients in a hypocoaguable state.
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