International Circulation: Multidetector CT scan (MDCT) has renovated the diagnosis of peripheral arterial disease (PAD). What are the basic principles of MDCT and its application in vascular diseases based on?
Dr Lindsay S. Machan: I think the major difference with using MDCT is the speed at which we can image a patient from their diaphragm to their toes in one quick sweep in less than 20 seconds. This along with the very powerful computers we have at our disposal allows us to do very active reconstructions and provide accurate information similar to the way of angiographies in a non invasive way.
《国际循环》：多层螺旋CT扫描（MDCT）使外周动脉疾病（PAD）的诊断得到了革新。请您谈一谈多层螺旋CT扫描的基本原则以及其在血管疾病上的应用如何？
Lindsay S. Machan医生：我认为采用多层螺旋CT扫描的主要优势在于速度，我们可以快速扫描一个患者，在不到20秒的时间内从横隔膜到脚趾迅速成像。当其与我们所现行的功能强大的计算机协作时，能非常灵活的重建并提供准确的信息，这与非侵入性的血管造影术的方式是类似的。

International Circulation: Duplex ultrasonography can identify the degree of vascular stenosis or occlusion and assess the vessel wall and plaque morphology. What are its roles on early diagnosis of PAD or initial evaluation of patients with suspected PAD?
Dr Lindsay S. Machan: I think it has a limited role; we use it to assess intima-thickness， which is a non specific measurement to determine whether or not the patient has atherosclerosis.  In addition we can use as a monitoring modality to see if they are responding to treatments such as lipid lowering agents. However， in terms of detecting whether or not the patient has PAD， in North America we would not really use this option， it is much more commonly used in Europe as a research tool.  In America CTA and MRA would be the two workhorse tools and we would tend to use ultrasound for graphical surveillance from graft bypass surgery or if we want to look at a very focal lesion.
《国际循环》：超声多普勒能够辨认血管狭窄或阻塞的程度，并对血管壁和斑块形态进行评估。早期诊断PAD或对疑似PAD患者初期评估的作用如何？
Lindsay S. Machan：我认为它的作用有限；我们用它来评估内膜的厚度，这对于确诊患者是否存在动脉粥样硬化来说是一种非特异性测试。此外，我们可以将其用作一种监控方法，来观察患者对于降脂药物之类的治疗的反应是否良好。然而，对于检测患者是否患有PAD，在北美我们并不会采用这一方式，在欧洲则经常作为一种研究工具应用。在美国，CTA和MRA为两种主力工具，我们倾向于在心脏搭桥手术时使用超声进行图形监控或者在我们想看某一具体病变的时候使用。
International Circulation: With the development of advanced 3D visualization image and vessel wall imaging， Diagnostic angiography is being replaced. Do you think CTA or MRA examinations are now used to guide endovascular therapy in patients with PAD?
Dr Lindsay S. Machan: Unquestionably， it has transformed our practice， because when we are performing an angiogram and putting a catheter in a patient we use it in a very direct fashion. It allows us to plan our procedures ahead of time and discuss it with our patients， so that the patient knows the expectation on what we can achieve. Previously， we had to rely on physical examination and do angiogram， usually at the same sitting when the catheter is in the patient and from all this information decide what we want to the patient there and then. Now that we have so many new tools and therapies we can certainly make better choices for the patient.  
《国际循环》：随着先进三维可视图像和血管壁成像的发展，诊断性血管造影术正在被代替。您认为CTA或MRA检查现在被用来指导PAD患者的血管内疗法吗？
Lindsay S. Machan医生：毫无疑问的，它改变了我们的惯例，因为当我们进行血管造影在患者体内安放导管时采用的是一个非常直接的方式。先进三维可视图像和血管壁成像的发展使我们能够提前制定计划并与患者进行讨论，让患者知道我们所能达到的期望值。以前，我们不得不依赖体格检查并进行血管造影，通常导管进入患者体内和得到信息并决定当时当地患者的治疗是在同一时间。现在，我们拥有了如此多的先进工具和治疗方法，我们当然能够为患者做出更好的选择。

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