下肢CTA及足部CT灌注对下肢动脉硬化闭塞症合并足溃疡的研究  

Study of lower extremity CTA and foot CT perfusion in the lower extremity arteriosclerotic obliteranscombined with foot ulcer

作　　者：任娇 王晓妍[1] 吴少虹 郭莉莉[1] REN Jiao;WANG Xiao-yan;WU Shao-hong(Department of Radiology,the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University,JIangsu 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院影像科,江苏223300

出　　处：《放射学实践》2024年第10期1393-1398,共6页Radiologic Practice

基　　金：江苏省医学会伦琴影像科研专项资金项目[糖尿病足的多模态CT诊断及治疗疗效评估的应用研究(SYH-3201150-0020)]。

摘　　要：目的:探讨下肢CTA及足部CT灌注对下肢动脉硬化闭塞症(ASO)合并足溃疡的诊断价值。方法:搜集29例经临床综合诊断为ASO合并足溃疡的患者,分析溃疡足下肢动脉狭窄情况,探讨下肢动脉狭窄程度预判ASO患者溃疡足的敏感度及特异性;分析溃疡足与非溃疡足的灌注值差异,包括血流量(BF)、血容量(BV)、表面通透性(PS)、平均通过时间(MTT)及达峰时间(Tmax);采用受试者工作特征曲线(ROC)分析下肢动脉狭窄程度及CT灌注值对溃疡足的诊断价值。结果:共有30只溃疡足、28只非溃疡足入组:①溃疡足胫后动脉(PTA)、胫前动脉(ATA)重度狭窄及闭塞高于腓动脉(PA)。②溃疡足的膝上动脉(股浅及腘动脉)重度狭窄/闭塞与非溃疡足比较有统计学意义(P<0.05),ROC曲线结果显示膝上动脉重度狭窄/闭塞联合预判ASO足部溃疡的AUC值为0.78,灵敏度为76.7%,特异度67.9%;膝下动脉重度狭窄/闭塞支数及分布未见明显统计学意义(P>0.05)。③足部CT灌注显示:溃疡足的BF、BV、Tmax及PS值与非溃疡足比较有统计学差异(P<0.05),ROC曲线结果显示BF、BV、Tmax及PS值四者联合诊断的AUC值为0.91,灵敏度76.7%,特异度96.4%,与下肢动脉狭窄程度比较诊断效能更高,差异有统计学意义(P<0.05)。④膝上动脉狭窄程度联合CT灌注值诊断ASO足部溃疡的AUC值为0.93,灵敏度83.3%,特异度92.9%,两者联合与CT灌注值诊断效能比较,差异未见统计学意义(P>0.05)。结论:下肢CTA联合足部CT灌注可以辅助诊断下肢动脉硬化闭塞症合并足溃疡,对临床治疗决策有指导意义。Objective:To investigate the diagnostic value of lower extremity CTA and foot CT perfusion in lower extremity arteriosclerotic obliterans(ASO)combined with foot ulcer.Methods:A total of 29 patients who were clinically diagnosed as ASO combined with foot ulcer in our hospital were collected to analyze the stenosis of lower limb artery,and to explore the sensitivity and specificity of lower extremity artery stenosis in pre-judging ulcer foot in ASO patients.The differences of perfusion values between ulcer and non-ulcer feet were analyzed,including blood flow(BF),blood volume(BV),surface permeability(PS),mean transit time(MTT)and time To max(Tmax).Receiver operating characteristic curve(ROC)was used to analyze the degree of arterial stenosis of the lower extremity and the value of perfusion values in the diagnosis of ulcerative foot.Results:A total of 30 ulcerated feet and 28 non-ulcerated feet were enrolled in the group.①Severe stenosis and occlusion of posterior tibial artery(PTA)(73.30%)and anterior tibial artery(ATA)(70.00%)were higher than those of the perinea artery(PA)(53.30%).②The severe stenosis/occlusion of superior knee arteries(superficial femoral and popliteal arteries)in ulcerated feet compared with that in non-ulcerated feet was statistically significant(P<0.05).ROC curve results showed that the AUC value for ASO foot ulcer pre-judged by joint superior knee artery severe stenosis/occlusion was 0.78,the sensitivity was 76.7%,and the specificity was 67.9%.There was no significant statistical significance in the number and distribution of infrapopliteal arterys which cause severe stenosis/occlusion(P>0.05).③Foot CT perfusion showed that the values of BF,BV,Tmax and PS in ulcerated feet were statistically different from those in non-ulcerated feet(P<0.05).ROC curve results showed that the AUC value diagnosed by combining of BF,BV,Tmax and PS was 0.91,the sensitivity was 76.7%,and the specificity was 96.4%.Compared with the degree of arterial stenosis of the lower extremities,the diagnostic performa

关 键 词：下肢 闭塞性动脉硬化 足溃疡 CT血管造影术 灌注 

分 类 号：R323.72[医药卫生—人体解剖和组织胚胎学] R543.5[医药卫生—基础医学] R658R817.4R814.4