超声造影评价糖尿病足下肢动脉病变的临床价值  

Contrast-enhanced Ultrasonography in the Evaluation of Lower Extremity Artery Disease in Patients with Diabetic Foot

作　　者：王锦惠[1] 于子芳 张莹 张琼[1] 李繁强 闫芳[1] 刘英[1] Wang Jinhui;Yu Zifang;Zhang Ying;Zhang Qiong;Li Fanqiang;Yan Fang;Liu Ying(Department of Ultrasound,TaiYuan Munnicipal No.2 Peoples Hospital,Taiyuan,Shanxi 030002,China;Diabetic Foot Center,TaiYuan Munnicipal No.2 Peoples Hospital,Taiyuan,Shanxi 030002,China)

机构地区：[1]太原市第二人民医院超声科,太原市030002 [2]太原市第二人民医院糖尿病足中心,太原市030002

出　　处：《中国超声医学杂志》2021年第10期1165-1168,共4页Chinese Journal of Ultrasound in Medicine

基　　金：山西省科学技术发展计划项目(社会发展)(No.201503130087)。

摘　　要：目的探讨超声造影(CEUS)评价糖尿病足(DF)患者下肢动脉病变的临床价值。方法对213例DF患者,共426条下肢,行彩色多普勒超声(CD-US)检查,观察其血管内径、内-中膜厚度、有无粥样硬化斑块形成、管腔狭窄或闭塞及血流动力学特征,分析股动脉、腘动脉、胫前动脉、胫后动脉、腓动脉、足背动脉各段病变分布特点;213例DF患者中,102例患者进行了CEUS检查,选取CD-US发现有重度狭窄或闭塞的88个动脉节段的CEUS结果与数字剪影血管造影(DSA)结果进行对照。结果 DF下肢动脉病变为弥漫性或多节段性,下肢动脉管腔狭窄、闭塞病变以腘动脉以下的远端动脉多见,胫前动脉、胫后动脉受累明显。88个动脉节段CEUS结果显示,重度狭窄50个节段,闭塞38个节段。CEUS诊断动脉闭塞的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为100%(31/31),87.72%(50/57),81.58%(31/38)、100%(50/50)、8.13、0.0。一致性分析显示,CEUS与DSA两种方法高度一致,Kappa值为0.834、P<0.001。CEUS与DSA诊断的一致率为92.05%。CEUS诊断的特异度、准确率均高于CD-US。结论 CEUS对下肢动脉重度狭窄及闭塞病变的诊断与DSA高度一致。CEUS可增强下肢动脉的血流信号强度,提高CD-US对重度狭窄、闭塞病变的诊断能力,是对DF患者下肢动脉重度狭窄、闭塞病变更可靠的无创评估方法之一。Objective To investigate the clinical value of contrast-enhanced ultrasonography in evaluation on lower extremity artery disease in patients with diabetic foot. Methods A total of 426 lower limbs in 213 patients with diabetic foot underwent color doppler ultrasonography. The related indicators were observed including vascular diameter, arterial intimal thickness, plaques, arteriostenosis or occlusion and hemodynamic parameters. The lesion characteristics of common femoral artery, popliteal artcry, pretibial artery, posterior tibial artery, peroneal artery and dorsalis pedis artery were analyzed. The CEUS results from 88 arterial segments with severe stenoses or occlusios were selected to compare with digital subtraction angiography. Results Lower extremity artery disease in patients with diabetic foot was common, multiple segments of arteries were involved, severe stenosis and occlusion were more common in anterior and posterial tibial artery. Among 88 arterial segments, there were 50 arterial segments with severe stenosis, 38 arterial segments with occlusion by Contrast-enhanced ultrasonography. The sensitivity, specificity, positive predictive value and negative predictive value of Contrast-enhanced ultrasonography for evaluation of artery occlusion was 100%(31/31),87.72%(50/57),81.58%(31/38),100%(50/50)respectively, and the positive likelihood ratio was 8.13, the negative likelihood ratio was 0.0. The agreement between CEUS and DSA were high, Kappa value was 0.834. The specificity and accuracy of CEUS were higher than that of CD-US. Conclusions There were high agreement between CEUS and DSA. CEUS can enhance blood flow signal and color Doppler signals intensity in lower extremity artery and improve the diagnostic ability of CD-US when scanning difficult artery segments in patients suffering from DF.

关 键 词：超声检查 造影剂 糖尿病足 下肢动脉病变 

分 类 号：R587.2[医药卫生—内分泌] R543.5[医药卫生—内科学]