Characterization of internal pudendal artery atherosclerosis using aortography and multi-detector computed angiography

Objective To compare multi-detector computed tomography (MDCT) and aortography in the assessment of the internal pudendal artery (IPA) anatomy and degree of atherosclerosis. Methods Eighty-three patients underwent MDCT and aortography of the pelvic vasculature prior to consideration for transcatheter aortic valve replacement. These modalities were used to localize the IPA origin, degree of stenosis (normal: 50% stenosis or occlusion), normal= and extent of calcification, quantified using a nominal scale (0 = no calcification, 1 = 50% of the IPA length). These studies were read independently and were blinded. Results Mean patient age was 78 ± 8 years with a high prevalence of atherosclerotic disease (70% coronary artery disease (CAD) and 30% peripheral artery disease (PAD)). The prevalence of having IPA stenosis or occlusion was 54%, 18% had an accessory arterial origin. In a patient-based analysis, the sensitivity of MDCT for detecting significant proximal IPA disease was 100% and, specificity 74%, positive predictive valve was 66%, and negative predictive value was 100%. In assessing the distal IPA and cavernosal arteries, the sensitivity was 100%, specificity was 64%, positive predictive value 89%, and negative predictive value of 100%. MDCT used significantly more contrast and more radiation than aortography. Conclusion MDCT had a high false-positive rate and low false-negative rate in evaluating the proximal IPA. For the distal IPA or cavernosal arteries, MDCT showed a high sensitivity and low specificity. These modalities have complementary roles in the assessment of IPA patency.