动态对比增强磁共振成像评价肢体冷感症患者下肢肌肉微循环状况  

Assessment of microcirculation status of lower limb muscles by using DCE-MRI in patients with limb cold sensation symptom

作　　者：丁健 王延春 王立章 张伟强 吴凡 汤文瑞 DING Jian;WANG Yanchun;WANG Lizhang;ZHANG Weiqiang;WU Fan;TANG Wenrui(Department of Radiology,the First Hospital of Jiaxing,Jiaxing,Zhejiang Province 314001,China)

机构地区：[1]嘉兴市第一医院放射科,浙江嘉兴314001

出　　处：《实用放射学杂志》2020年第12期1989-1993,共5页Journal of Practical Radiology

基　　金：嘉兴市科技计划项目(2017BY18002);嘉兴市重点学科资助项目(2019-fc-06)。

摘　　要：目的通过DCE-MRI量化分析肢体冷感症患者下肢肌肉微循环状况.方法本研究为前瞻性研究,选取20例经临床证实为自主神经功能紊乱致下肢冷痛患者共39条下肢,所有患者均行横断面DCE-MRI检测,获取胫骨前肌、胫骨后肌、比目鱼肌及腓肠肌内侧头4块肌肉的容积转运常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙容积分数(Ve)3个定量参数及对比剂到达时间(BAT),增强曲线下初始面积(IAUC),最大斜率(MaxSlope)、对比增强率(CER)等4个半定量参数.采用R(R3.6.1)统计学软件进行统计分析,采用SNK-q检验多重比较胫骨前肌、胫骨后肌、比目鱼肌和腓肠肌内侧头各肌肉组间微循环差异.结果胫骨前肌、胫骨后肌、比目鱼肌和腓肠肌内侧头在MaxSlope、CER、IAUC、Ktrans、Ve、Kep组间有差异(P<0.05),其中胫骨前肌在CER、IAUC、Ktrans参数值小于胫骨后肌及比目鱼肌,胫骨后肌在MaxSlope、CER、IAUC、Ktrans、Kep要高于腓肠肌内侧头,比目鱼肌CER、IAUC、Ktrans、Kep高于腓肠肌内侧头,胫骨前肌与腓肠肌内侧头、胫骨后肌与比目鱼肌间各参数间均无统计学差异.结论肢体冷感症患者小腿肌肉微循环存在差异,胫骨后肌、比目鱼肌在血流量及毛细血管渗透性均优于胫骨前肌及腓肠肌内侧头.DCE-MRI能从血流动力学角度很好地评价冷感症患者小腿肌肉微循环情况,可为探究冷感症病因提供病理生理依据,能为术后微循环定量指标的建立提供依据.Objective To quantitatively analyze the microcirculation of lower limb muscles in patients with limb cold sensation symptom by DCE-MRI.Methods 39 legs of 20 patients were enrolled,these patients were clinically confirmed to had cold and pain in their lower limbs due to dysfunction of autonomic nervous system.All patients underwent cross sectional DCE MRI to obtain parameters in the anterior tibialis,posterior tibialis,soleus,and medial head of the gastrocnemius muscle,which included three quantitative parameters,namely,volume transfer(Ktrans),interstitium-to plasmarate rate constant(Kep),extravascular extracellular space volume fraction(Ve)and four semi-quantitative parameters,involving bolus arrival time(BAT),initial area under the enhancement curve(IAUC),maximum slope(MaxSlope)and contrast enhancement ratio(CER).Statistical analysis was performed using R(R3.6.1)statistical software,and the SNK-q test was used to make multiple comparisons of microcirculation differences between the anterior tibialis,posterior tibialis,soleus,and medial head of the gastrocnemius muscle.Results The anterior tibialis,posterior tibialis,soleus,and medial head of the gastrocnemius muscle were significantly different in MaxSlope,CER,IAUC,Ktrans,Veand Kep groups(P<0.05).The values of CER,IAUC and Knm in the anterior tibialis were significantly lower than that in the posterior tibialis and soleus.MaxSlope,CER,IAUC,Ktrans and Kep in the posterior tibialis were significantly higher than that in the medial head of the gastrocnemius muscle.CER,IAUC,Ktrans and Kep in the soleus were higher than that in the medial head of the gastrocnemius muscle,moreover,there were no statistical differences between the parameters of the anterior tibialis and the medial head of the gastrocnemius muscle,the posterior tibialis and the soleus.Conclusion There is a difference in the calf muscle microcirculation in patients with cold sensation syrmptorm.The posterior tibialis and soleus are better than the anterior tibialis and the medial head of the gastrocnemiu

关 键 词：动态对比增强磁共振成像 下肢 冷感症 微循环 

分 类 号：R445.2[医药卫生—影像医学与核医学] R323.72[医药卫生—诊断学]