Imaging Modalities

in Overview of Vascular Disease

Applied

Type

Modification

Confidence

90%

Created

Mar 27, 2026

Evidence

1 source

Rationale

The section was updated to integrate the 2025 ACC Scientific Statement on PAD in adults with diabetes. This new evidence emphasizes the specific roles of DUS, CTA, and MRA in managing the complex, often multi-segmental and infrapopliteal disease patterns seen in diabetic patients. Additionally, abbreviations for IVUS, OCT, and PET/CT were expanded to comply with the textbook's formatting requirements for first-use expansion.

Evidence

Das SR et al. Management of Peripheral Artery Disease in Adults With Diabetes: 2025 ACC Scientific Statement: A Report of the American College of Cardiology. J Am Coll Cardiol. 2025. PMID: 41405527.
Verified source
PubMedDOI

Content Changes

* **Duplex Ultrasound (DUS):** First-line for peripheral arterial disease (PAD), abdominal aortic aneurysm (AAA), carotid stenosis, venous reflux, and deep vein thrombosis (DVT). Operator-dependent but safe and inexpensive [@moneta2010]. In patients with diabetes, DUS is the preferred initial imaging modality for PAD [@acc2025-e].
* **computed tomography angiography (CTA):** Provides high-resolution 3D reconstructions for aneurysms and PAD; requires contrast and radiation [@sun2011]. CTA is highly effective for identifying the multi-segmental and infrapopliteal disease patterns common in diabetic patients [@acc2025-e].
* **magnetic resonance angiography (MRA):** Useful when CTA contraindicated; gadolinium-based contrast or time-of-flight techniques [@prince2016]. MRA is an alternative for detailed anatomical assessment in PAD, particularly when avoiding ionizing radiation is prioritized [@acc2025-e].
* **Catheter angiography:** Remains the gold standard; allows simultaneous diagnosis and treatment but carries procedural risk [@white2006].
* **IVUS/OCT:****intravascular ultrasound (IVUS) and optical coherence tomography (OCT):** Provide intraluminal detail; OCT superior for plaque characterization, IVUS for stent sizing [@ali2016].
* **PET/CT:****positron emission tomography/computed tomography (PET/CT):** Detects active inflammation in aneurysm walls and vulnerable plaques [@figueroa2015].
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