摘要目的：前瞻性探讨定量足部多排螺旋计算机断层扫描（MDCT）技术在糖尿病患者评估足底软组织血流灌注中应用的可行性和可重复性，并初步分析糖尿病足软组织微循环的灌注特征。材料与方法：获得了机构审查委员会的批准和患者书面知情同意书。前瞻性纳入了13例糖尿病患者，男9例，女4例；年龄40~77岁，平均（63.5±11）岁，均行过CTA作出明确诊断，并按照CTA有无大血管病变分为病变足（12条）和正常足（14条）。运用东芝320排螺旋CT（Aquilion ONE）行双侧足部容积动态增强。对比分析动态增强的时间-密度曲线（TDC）及相关参数，包括血流量（BF）、血容量（BV）、平均通过时间（MTT）和峰值时间（TTP）。结果：13例患者均顺利完成检查，测量患者双侧足部TDC参数（BF、BV、MTT、TTP）值，病变足与正常足分别为（21.1±12.3） mL/（100 mg·min） vs （34.8±20.2） mL/（100 mg·min），（1.7±0.6） mL/100 g vs （1.8±0.7） mL/100 g，（5.9±1.9） s vs （3.8±1.9） s，（55.5±16.6） s vs （38.9±15.6） s。所有患者均获得良好的观察者间和观察者内的一致性。通过比较正常足的灌注参数，获得显著较长的MTT和TTP。结论：足部CT灌注是一种能够评估糖尿病患者足底软组织血流灌注水平的可行性和可重复性的技术，并且能够早期提示糖尿病足微血管病变，具有一定价值。
Abstract：Objective: To prospectively investigate the feasibility and repeatability of multi-slice spiral computed tomography(MDCT) in the quantitative evaluation of perfusion of plantar soft tissue in patients with diabetic and to analyze the microcirculation perfusion characteristics of diabetic foot soft tissue. Methods: Institutional review board approval and informed patient consent were obtained. Thirteen patients with diabetes mellitus(9 males and 4 females; mean age 63.5±11 years, range 40~77) were prospectively included. All patients underwent CTA to make a definite diagnosis and were classified into abnormal group(12) and normal group(14) as having major vascular lesions according to CTA. A Toshiba 320-row spiral CT(Aquilion ONE) was used with acquisition of dynamic volume perfusion of double-sided foot. Time density curve(TDC), blood flow(BF), blood volume(BV), mean transit time(MTT) and time to peak(TTP) of skeletal muscle in normal or abnormal foot were obtained with perfusion software． Results: CT perfusion scans of lower extremities were performed in all patients. Thirteen patients completed the examination successfully. The TDC parameters(BF, BV, MTT and TTP) of the diabetic foot were measured. The abnormal group and normal group respectively were (21.1±12.3) mL/(100 mg·min) vs (34.8±20.2) mL/(100 mg·min), (1.7±0.6) mL/100 g vs (1.8±0.7) mL/100 g, (5.9±1.9) s vs (3.8±1.9) s, (55.5±16.6) s vs (38.9±15.6) s. Good inter-observer and intra-observer agreement was obtained in all patients. By comparing perfusion parameters for normal foot, a significantly longer MTT and TTP was obtained. Conclusion: CT perfusion of the foot is a feasible and reproducible technique that can assess the level of microcirculation in the plantar soft tissue and can prompt the existence of early skeletal muscle ischemia for patients with diabetic foot． The method can be valuable for clinical early diagnosis．
杜 梅，倪建明，徐慧婷，华冬英，张追阳. 动态增强CT评估糖尿病患者足底软组织血流灌注的可行性[J]. 中国临床医学影像杂志, 2019, 30(3): 208-211.
DU Mei, NI Jian-ming, XU Hui-ting, HUA Dong-ying, ZHANG Zhui-yang. Feasibility of dynamic contrast-enhanced CT in evaluating perfusion of diabetic patients’ plantar soft tissue . JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(3): 208-211.
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