糖尿病足合并骨髓炎的X线、MR及CTA影像分析  

作　　者：王秀 钱琦[1] 李阳[2] 

机构地区：[1]浙江中医药大学附属第三医院,310005 [2]浙江省瑞安市人民医院,325200

出　　处：《浙江临床医学》2023年第11期1694-1696,1699,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2020PY014)。

摘　　要：目的分析糖尿病足合并骨髓炎(DFO)患者常规X线、MR及CTA的影像特征。方法收集2019年7月至2021年12月收治的糖尿病足患者70例,男50例,女20例;年龄40~85岁;70例患者均接受足部X线及MR检查,其中26例患者行CTA检查;根据患者有无骨髓炎分为2组,分析X线、MRI、CTA影像特征,为确定独立的预测性MR影像特征,采用二元Logistic回归分析进行多变量分析。结果X线各影像学特征的敏感度明显不如MR;在MR检查中T_(2)WI信号增高、T_(1)WI信号减低、骨质破坏、溃疡四种影像学特征在骨髓炎患者中更常见,其敏感度分别为93.9%、78.8%、48.5%、81.8%。二元Logistic回归分析显示,T_(1)WI信号减低为诊断骨髓炎的主要因素(P<0.05)。糖尿病下肢动脉病变以膝下动脉为主,狭窄的严重程度在有无骨髓炎患者中差异无统计学意义(P>0.05)。结论T_(1)WI信号减低是诊断糖尿病骨髓炎有力的证据,结合MR影像特征可以帮助临床医师判断是否合并骨髓炎;下肢CTA检查可以充分显示病变血管、狭窄程度及钙化程度,有利于影像医师对狭窄程度进行准确分级,但其狭窄程度并不能判断是否合并骨髓炎。Objective To analyze the routine X-ray,MR And CTA signs of diabetic foot with osteomyelitis(DFO).Methods Seventy patients with diabetic foot admitted from July 2019 to December 2021 were collected,including 50 males and 20 females,aged 40~85 years.All the 70 patients underwent foot X-ray and MR examination,and 26 patients underwent CTA examination.The patients were divided into the osteomyelitis group and the non-osteomyelitis group.The X-ray,MRI and CTA signs were retrospectively analyzed.In order to determine independent predictive MR signs,binary Logistic regression analysis was used for multivariate analysis.Results The sensitivity of X-ray signs was significantly lower than that of MR.The four imaging signs of increased T_(2)WI signal,decreased T_(1)WI signal,bone destruction and ulcer were more common in patients with osteomyelitis,and their sensitivities were 93.9%,78.8%,48.5%and 81.8%,respectively.Binary Logistic regression analysis showed that decreased T_(1)WI signal was the most important factor in determining osteomyelitis(P<0.05).Diabetic lower extremity artery lesions were mainly inferior knee artery,and the severity of stenosis was not statistically significant between patients with and without osteomyelitis(P>0.05).Conclusion Decreased T_(1)WI signal is the most powerful evidence for the diagnosis of diabetic osteomyelitis.Combined with multiple MR signs,it can better help clinical diagnosis of osteomyelitis.Lower extremity CTA examination can fully show the diseased blood vessels,the degree of stenosis and the degree of calcification,which is helpful for radiologists to accurately grade the degree of stenosis,but the degree of stenosis can not judge whether there is osteomyelitis.

关 键 词：糖尿病足 骨髓炎 影像诊断 MRI CTA 

分 类 号：R681.2[医药卫生—骨科学] R587.2[医药卫生—外科学]