Simultaneous CT Angiography of Lower Extremity and Coronary Arteries Using 256-Slice CT: Feasibility Study

This feasibility study evaluated whether a single-injection ECG-gated CT acquisition using a 256-slice scanner could simultaneously image both the coronary arteries and the lower extremity arterial tree in 34 patients, assessing image quality and diagnostic accuracy for significant stenosis in both vascular territories.

The combined protocol produced diagnostic-quality images in >93% of coronary segments and >95% of lower extremity arterial segments, with high sensitivity and specificity for detecting significant stenosis in both territories from a single contrast injection.

The concept of combined whole-body CT angiography is clinically appealing because CAD and PAD are manifestations of the same systemic atherosclerotic process and frequently coexist. Approximately 50–70% of PAD patients have significant concomitant CAD, and PAD is an ASCVD risk equivalent that identifies patients warranting intensive cardiovascular risk management. A single comprehensive study could characterize total atherosclerotic burden across territories.

The practical barriers to routine adoption include patient radiation exposure (combining two studies’ dose), the complexity of simultaneously optimizing coronary and peripheral timing and reconstruction parameters, and the clinical workflows for interpreting and acting on multi-territory findings. These remain active areas of investigation.

We rate the evidence limited. A small feasibility study demonstrating that simultaneous coronary and lower extremity CT angiography from a single injection is technically feasible with diagnostic image quality — an interesting concept for comprehensive atherosclerotic burden assessment, but not established for routine clinical use.