Terasaki Hiroaki, Inoue Yoshinori, Sugano Norihide, Jibiki Masatoshi, Kudo Toshihumi, Lepäntalo Mauri, Venermo Maarit
Department of Vascular and Applied Surgery, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan.
Ann Vasc Surg. 2013 Nov;27(8):1154-61. doi: 10.1016/j.avsg.2013.02.011. Epub 2013 Aug 20.
The purpose of this study is to introduce a new method, indocyanine green fluorescence imaging (ICG-FI), as an adjunct to distal pressure measurements in patients with peripheral arterial disease and symptomatic lower limb ischemia.
A total of 34 patients with peripheral arterial disease, including 11 with claudication (Fontaine II), 7 with rest pain (FIII), and 16 with an ulcer or gangrene (FIV), were enrolled. After an intravenous injection of ICG (0.1 mg/kg), foot perfusion was recorded by an infrared light camera. Fluorescence intensity was plotted on a time-intensity curve using recorded images, allowing the calculation of new parameters. Severity of ischemia was assessed as the duration between the rising point and half value of maximum brightness (T½). The difference in the fluorescence intensity between 10 seconds after the rising point and baseline (PDE10) was compared with the transcutaneous oxygen pressure (tcPO2) at the same site (n=51).
Median T½ was 23 seconds in FII, 41 seconds in FIII (P<0.05), and 17 seconds in FIV patients. PDE10 correlated moderately with tcpO2 (r2=0.5). A cut-off value (PDE10=28) predicted a critically ischemic limb (FIII and FIV), defined as tcpO2<30 mm Hg with a sensitivity of 100% and specificity of 86.6%.
Local tissue perfusion can be quantitatively evaluated by using ICG fluorescence imaging. It is a safe, fast, noncontact method of imaging, which may be useful even at the ulcer itself and in the circumferential area.
本研究的目的是引入一种新方法，即吲哚菁绿荧光成像（ICG-FI），作为外周动脉疾病和有症状下肢缺血患者远端压力测量的辅助手段。
共纳入34例外周动脉疾病患者，其中11例有间歇性跛行（Fontaine II级），7例有静息痛（FIII级），16例有溃疡或坏疽（FIV级）。静脉注射ICG（0.1 mg/kg）后，用红外光相机记录足部灌注情况。利用记录的图像绘制荧光强度随时间变化的曲线，从而计算新的参数。将缺血严重程度评估为最大亮度上升点与半值之间的持续时间（T½）。比较上升点后10秒与基线之间的荧光强度差异（PDE10）与同一部位的经皮氧分压（tcPO2）（n = 51）。
FII级患者的T½中位数为23秒，FIII级患者为41秒（P < 0.05），FIV级患者为17秒。PDE10与tcpO2中度相关（r2 = 0.5）。临界值（PDE10 = 28）可预测严重缺血肢体（FIII级和FIV级），定义为tcpO2 < 30 mmHg，敏感性为100%，特异性为86.6%。
利用ICG荧光成像可定量评估局部组织灌注。它是一种安全、快速、非接触的成像方法，即使在溃疡本身及其周围区域也可能有用。
