Preliminary Diagnosis: Thromboangiitis Obliterans (Beurger Disease)

I. What imaging technique is first-line for this diagnosis?

Ultrasound (Gray scale, Color Doppler, and spectral waveform) of the region of interest to evaluate the underlying vasculature.

II. Describe the advantages and disadvantages of this technique for diagnosing thromboangiitis obliterans.

Advantages

  • Highly portable and relatively inexpensive imaging modality that exposes patients to no ionizing radiation.

  • Moderately sensitive and moderately specific in evaluating the underlying vasculature.

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  • May help guide percutaneous treatment and therapy.

Disadvantages

  • Less adept in fully detailing, characterizing, and evaluating the surrounding vasculature suspicious for Beurger disease than other imaging modalities.

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 with contrast.

  • MRA imaging with and without contrast.

  • Catheter angiography with contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing thromboangiitis obliterans.

CTA imaging with contrast
Advantages

  • Highly sensitive and specific in detailing the abnormal findings within the vessel.

  • Offers exquisite visualization of the surrounding soft tissues, osseous structures, and vasculature.

Disadvantages

  • Less adept in detailing the fine mucosal abnormalities of the vasculature as compared to catheter angiography.

  • Exposes patients to ionizing radiation.

MRA imaging with and without contrast
Advantages

  • Does not expose patients to ionizing radiation.

  • Offers exquisite visualization of the surrounding soft tissues.

Disadvantages

  • Limited in sensitivity and specificity in evaluating the vascular structures.

  • Solely a diagnostic modality and does not guide or direct percutaneous intervention.

  • May be subject to motion artifact and susceptibility weighted artifact, degrading image quality.

  • Expensive.

  • Time consuming.

Catheter angiography with contrast
Advantages

  • Highly sensitive and specific in detecting, characterizing, and diagnosing any vascular abnormalities.

  • Gold standard in diagnosing Beurger disease and may help guide any endovascular intervention and therapy.

Disadvantages

  • Invasive procedure that exposes patients to the increased morbidity and mortality associated with any invasive procedure.

  • Highly operator dependent.

VI. What are the contraindications for the alternative imaging techniques?

CTA imaging with contrast

  • May be contraindicated in pregnant patients and those with renal dysfunction on an inadequate dialysis regimen.

  • May be contraindicated in patients with a contrast allergy.

MRA imaging with and without contrast

  • Contraindicated in patients with non-MR compatible hardware.

Catheter angiography with contrast

  • Catheter angiography is contraindicated in patients that are in a severe hypocoaguable state.

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