© Pol J Radiol, 2010; 75(2): 94-97 Waliszewska M et al – Application of the 64-slice computed tomography… consisted in elevating the upper limbs and placing them over the head, in one line with the body. Contrast medi- um was injected into the cubital vein of the limb reveal- ing better perfusion, with the a 18G or 20G cannula and an automatic syringe. The volume of the contrast medium was 80–120 ml, depending on the patient’s body mass. The injection rate ranged from 3.5–4.5 ml/sec. Immediately after contrast administration, an additional ‘pushing’ bolus of the physiological saline was administered, which aimed to increase the concentration of the contrast bolus in the vessels. The concentration of the contrast medium was monitored in the aortic arch with the use of a ‘smart-prep’ method; scanning was started a few seconds after obtain- ing by the contrast medium the plateau phase in the aortic arch. Scanning time of the upper limbs ranged from 5 to 15 seconds (10 sec on average). Radiation doses depended on the examination time mainly, and ranged from 700 to 2000 DLP (Dose Length Product) units (mean: 1200 u DLP). The examined area extended from the aortic arch to the wrist. The slice width was 0.67 mm, the pitch – 1.3, the tube rota- tion time – 0.5 sec. Every time, the intensity of the tube current was adjusted automatically (mA modulation). The analysis of the obtained images was carried out with a diagnostic Advantage Workstation 4.4 (GE Healthcare) and References: 1. Chin AS, Rubin GD: MDCT Angiography of Peripheral Arterial Occlusive Disease .Tech Vasc Interventional Rad, 2006; 9: 143–49 2. Norgren L, Hiatt WR, Dormandy JA et al: Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg, 2007; 33: 1–75 3. Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). Section C: acute limb ischaemia. Eur J Vasc Endovasc Surg, 2000; 19: 115–43 4. Sontheimer DL: Peripheral vascular disease: diagnosis and treatment. Am Fam Physician, 2006; 73(11): 1971–76 5. Quraishy MS, Cawthorn SJ, Giddings AEB: Critical ischaemia of the upper limb. J R Soc Med., 1992; 85(5): 269–73 Vessel Analysis software. Three types of reconstructions were performed: three-dimensional MIP (Maximum Intensity Projection), Curved Planar Reconstruction (CPR) (Figure 3) and Volume Rendering (VR) (Figures 1, 2A,B). In all three cases, owing to the application of the above presented protocol, a high-quality image of the upper limb arteries were obtained and the occlusion sites were precisely located. This allowed for successful operations, restoring normal perfusion of the upper limbs. Conclusions The presented cases show that CTA allows for rapid and precise diagnostics of arteries in patients with acute post- traumatic ischaemia of the upper limbs. Due to the low invasiveness of the examination, as well as its high effec- tiveness in the detection of stenoses and occlusions of the vessels in patients with ALI symptoms, the importance of CTA in the diagnostics and treatment monitoring in ALI is increasing. This examination mode may become a golden diagnostic standard in cases of suspected acute ischaemia of the upper limbs, especially when caused by vascular pathology within the elbow and arm. 6. Masłowski L, Frołow M: Choroby aorty i tętnic obwodowych. In: Choroby wewnętrzne. Szczeklik A (ed). Medycyna Praktyczna, Kraków 2005; 381–84 7. Diagnosing traumatic arterial injury in the extremities with CT angiography: pearls and pitfalls. Radiographics, 2005; 25(Suppl.1): S133–42 8. Jakubiak A, Waliszewska M, Guziński M et al.: The value of 64-detector computer tomography angiography as a diagnostics method during emergency service in acute lower limbs ischemia. Pol J Radiol, 2009; 74(3): 37–41 9. Hsu CS, Hellinger JC, Rubin GD, Chang J: CT angiography in pediatric extremity trauma: preoperative evaluation prior to reconstructive surgery. Hand (NY), 2008; 3(2): 139–45 97