下肢动脉硬化闭塞症骨骼肌灌注异常与侧支循环相关性的超声造影观察  

Preliminary study of contrast-enhanced ultrasound in correlation between muscle perfusion deficits inlower extremity arterial disease and its collateralization

作　　者：宋烨[1] 李园[1] 陆雯[1] 高源[2] 

机构地区：[1]同济大学附属同济医院超声科,上海200065 [2]同济大学附属同济医院超声科血管外科,上海200065

出　　处：《中华医学杂志》2014年第7期507-509,共3页National Medical Journal of China

基　　金：上海市卫生局科研基金（20124201）

摘　　要：目的探讨超声造影评价下肢动脉硬化闭塞症（LEAD）致骨骼肌灌注障碍与侧支循环的相关性。方法收集同济大学附属同济医院2011年1月至2012年11月血管外科就诊LEAD患者和对照组各80例，超声造影观察小腿骨骼肌血流灌注情况，运用数学模型分析时间强度曲线，获取反映组织血流灌注参数达峰时间（1TrP）。同时CT血管造影评估LEAD组侧支循环。结果时间强度曲线显示对照组平均1TrP38．6S，LEAD组平均TTP59．1s，两组比较差异有统计学意义（P〈0．01），不同超声检查者读取1TrP平均差异是0．29S，受试者操作曲线下面积为0．92。TTP为47．5s诊断点时，阳性预测值为91％。LEAD组中侧支循环丰富组平均rrrP50．4S，侧支循环差组平均TTP为67．9s，两组比较差异有统计学意义（P〈0．01）。结论超声造影可评价小腿骨骼肌灌注障碍，它与侧支循环程度有很好的相关性。Objective To explore the value of contrast-enhanced ultrasound （CEUS）as a new method in evaluating the correlation between muscle perfusion deficits and collateralization in lower extremity arterial disease （LEAD）. Methods Ultrasound contrast agent was injected into peripheral vein of 80 control subjects and 80 LEAD patients. Its appearance in calf muscle was detected by contrast-enhanced ultrasound. Time intensity curves （TIC） and time to peak intensity （TTP） were analyzed. And collateral formation was evaluated by computed tomography angiography （CTA）. Results TIP in LEAD group was statistically higher than that in control group （59.1 vs 38.6 s, P 〈0. 01 ）. The TYP difference between two investigators who evaluate the row data in a blinded way was 0. 29 s and the area under receiver operating characteristic （ROC） curve 0. 92. A TIP cutoff at 47.5 s was associated with 91% positive predictive value statistically. TIP in LEAD with bad collateralization was statistically higher than that in LEAD with good collateralization （67.9 vs 50. 4 s, P 〈 0. 01 ）. Conclusion As a consistent method of evaluating muscle perfusion deficits, CEUS shows a good correlation with the extent of collateral formation in LEAD.

关 键 词：超声检查 动脉闭塞性疾病 侧支循环 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.5[医药卫生—诊断学]