A Useful Method for Assessing the Position of Perforating Veins and Stasis Ulcers with MDCT: A Case Report

Abstract

Evaluation by multidetector-row CT (MDCT) was carried out in a case of severe varicose veins (CEAP class 6) accompanied by stasis ulcers where ultrasonography had not allowed adequate evaluation. The contrast material, diluted 1 : 8, was injected with an injector via the dorsal venous arch. The images taken by 64-row MDCT were processed using volume rendering (VR). We obtained three-dimensional images of ulcer-affected epidermal tissue, depicting the superficial veins (deleting the cutaneous fat layer), the perforating branches and even the deep veins. Serial presentation of these images, delineating the anatomical relationship of the lesions and structures, enabled adequate evaluation. Generally, morphological evaluation of ordinary varices can be performed with CT using VR without contrast material. However, the technique described above allowed clear visualization of the arrangement of deep veins and saphenous vein as well as the presence of perforating branches using only a small amount of contrast material even in cases of severe varices complicated by changes in the skin or cases where ultrasonography was difficult due to physical characteristics. Furthermore, this technique enables clear visualization of the relationship of ulcer bottom to varices or to perforating branches although this was difficult with conventional leg venography. If needed, manipulation on the perforating branches can also be performed easily with this technique. Thus, MDCT seems to be highly useful as a means of preoperative mapping and is expected to provide a valid means of evaluating and diagnosing ulcers for the treatment.