Predicting complications and morbidities in PAD patients through lower extremity compositions with dual-energy CT and material decomposition: a 2-year follow-up observational study

Abstract Background Peripheral artery disease (PAD) is associated with various morbidities. This study aims to investigate the correlation between different lower extremity compositions and development of morbidities in PAD patients. Methods Between January 2018 and December 2020, 108 subjects diagn...

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Main Authors: Dao-Chen Lin, Pei-Shan Tsai, Tzu-Lin Lin, Wen-Hui Huang, Yu-Peng Liu, Tung-Hsin Wu, Cheng‑Ting Shih
Format: Article
Language:English
Published: BMC 2025-04-01
Series:BMC Cardiovascular Disorders
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Online Access:https://doi.org/10.1186/s12872-025-04695-8
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author Dao-Chen Lin
Pei-Shan Tsai
Tzu-Lin Lin
Wen-Hui Huang
Yu-Peng Liu
Tung-Hsin Wu
Cheng‑Ting Shih
author_facet Dao-Chen Lin
Pei-Shan Tsai
Tzu-Lin Lin
Wen-Hui Huang
Yu-Peng Liu
Tung-Hsin Wu
Cheng‑Ting Shih
author_sort Dao-Chen Lin
collection DOAJ
description Abstract Background Peripheral artery disease (PAD) is associated with various morbidities. This study aims to investigate the correlation between different lower extremity compositions and development of morbidities in PAD patients. Methods Between January 2018 and December 2020, 108 subjects diagnosed of PAD were enrolled (mean age of 64.1 ± 13.5 years) and utilized dual-energy computed tomography (DECT) with material decomposition to measure the vessel volume, muscle volume, fat volume, and cortical-bone volume in lower extremity respectively. The association between each leg composition and developing complications or morbidities in PAD patients was analyzed over a two-year follow-up. Results Fontaine stage 3 and 4 had lower muscle mass compared to stages 1 and 2. More severe vascular stenosis was associated with lower muscle, fat, and cortical-bone volume. Patients with severe Fontaine stages (3 and 4) and lower-leg vascular stenosis had a higher risk of developing infection or inflammation (OR 45.5, 95% CI: 13.5–166.7, and OR 11.7, 95% CI: 2.8–50, P < 0.05) and amputation (OR 18.2, 95% CI: 2.2–142.8, and OR 10.7, 95% CI: 1.11–100, P < 0.05). Lower thigh cortical-bone volume was associated with an increased risk of falls resulting in fractures (OR: 1.39, 95% CI: 1.13–2.19, P < 0.01). Thigh cortical-bone volume below 64.5 cm3 was identified as the cut-off value to predict fall-related fractures, with a sensitivity of 100% and specificity of 92%. Conclusions This study demonstrates the potential of DECT with material decomposition to assess lower extremity composition and its relevance in predicting complications and morbidities in PAD patients. Severe vascular stenosis may contribute to muscle wasting and subsequent complications, while lower thigh cortical-bone mass may serve as a predictor of fall-related fractures.
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spelling doaj-art-fea50400a8a24b3597ab5fa6fa542d5d2025-08-20T02:11:51ZengBMCBMC Cardiovascular Disorders1471-22612025-04-0125111210.1186/s12872-025-04695-8Predicting complications and morbidities in PAD patients through lower extremity compositions with dual-energy CT and material decomposition: a 2-year follow-up observational studyDao-Chen Lin0Pei-Shan Tsai1Tzu-Lin Lin2Wen-Hui Huang3Yu-Peng Liu4Tung-Hsin Wu5Cheng‑Ting Shih6Department of Radiology, Taipei Veterans General HospitalDepartment of Radiology, MacKay Memorial HospitalDepartment of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung UniversityDepartment of Radiology, MacKay Memorial HospitalNursing and Management, Mackay Junior College of MedicineDepartment of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung UniversityDepartment of Biomedical Imaging and Radiological Science, China Medical UniversityAbstract Background Peripheral artery disease (PAD) is associated with various morbidities. This study aims to investigate the correlation between different lower extremity compositions and development of morbidities in PAD patients. Methods Between January 2018 and December 2020, 108 subjects diagnosed of PAD were enrolled (mean age of 64.1 ± 13.5 years) and utilized dual-energy computed tomography (DECT) with material decomposition to measure the vessel volume, muscle volume, fat volume, and cortical-bone volume in lower extremity respectively. The association between each leg composition and developing complications or morbidities in PAD patients was analyzed over a two-year follow-up. Results Fontaine stage 3 and 4 had lower muscle mass compared to stages 1 and 2. More severe vascular stenosis was associated with lower muscle, fat, and cortical-bone volume. Patients with severe Fontaine stages (3 and 4) and lower-leg vascular stenosis had a higher risk of developing infection or inflammation (OR 45.5, 95% CI: 13.5–166.7, and OR 11.7, 95% CI: 2.8–50, P < 0.05) and amputation (OR 18.2, 95% CI: 2.2–142.8, and OR 10.7, 95% CI: 1.11–100, P < 0.05). Lower thigh cortical-bone volume was associated with an increased risk of falls resulting in fractures (OR: 1.39, 95% CI: 1.13–2.19, P < 0.01). Thigh cortical-bone volume below 64.5 cm3 was identified as the cut-off value to predict fall-related fractures, with a sensitivity of 100% and specificity of 92%. Conclusions This study demonstrates the potential of DECT with material decomposition to assess lower extremity composition and its relevance in predicting complications and morbidities in PAD patients. Severe vascular stenosis may contribute to muscle wasting and subsequent complications, while lower thigh cortical-bone mass may serve as a predictor of fall-related fractures.https://doi.org/10.1186/s12872-025-04695-8Dual energy CTMaterial decompositionCortical bone mass volume
spellingShingle Dao-Chen Lin
Pei-Shan Tsai
Tzu-Lin Lin
Wen-Hui Huang
Yu-Peng Liu
Tung-Hsin Wu
Cheng‑Ting Shih
Predicting complications and morbidities in PAD patients through lower extremity compositions with dual-energy CT and material decomposition: a 2-year follow-up observational study
BMC Cardiovascular Disorders
Dual energy CT
Material decomposition
Cortical bone mass volume
title Predicting complications and morbidities in PAD patients through lower extremity compositions with dual-energy CT and material decomposition: a 2-year follow-up observational study
title_full Predicting complications and morbidities in PAD patients through lower extremity compositions with dual-energy CT and material decomposition: a 2-year follow-up observational study
title_fullStr Predicting complications and morbidities in PAD patients through lower extremity compositions with dual-energy CT and material decomposition: a 2-year follow-up observational study
title_full_unstemmed Predicting complications and morbidities in PAD patients through lower extremity compositions with dual-energy CT and material decomposition: a 2-year follow-up observational study
title_short Predicting complications and morbidities in PAD patients through lower extremity compositions with dual-energy CT and material decomposition: a 2-year follow-up observational study
title_sort predicting complications and morbidities in pad patients through lower extremity compositions with dual energy ct and material decomposition a 2 year follow up observational study
topic Dual energy CT
Material decomposition
Cortical bone mass volume
url https://doi.org/10.1186/s12872-025-04695-8
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