Interventional Radiology Unit and Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece.
Department of Medical Physics, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece.
J Vasc Interv Radiol. 2019 Apr;30(4):560-568. doi: 10.1016/j.jvir.2018.10.018.
To evaluate foot perfusion in patients with critical limb ischemia (CLI) using quantitative perfusion multi-detector-row CT and estimate perfusion parameter changes before and after percutaneous transluminal angioplasty (PTA).
This prospective study investigated 13 patients (10 men; median age, 72 y; range, 51-84 y) with CLI who underwent CT foot perfusion examinations with a 128-slice dual-energy CT scanner 1 day before and 1 week after PTA. Key parameters such as permeability surface (PS), blood volume (BV), and blood flow (BF) were analyzed and compared statistically. The studies were also examined by a second observer to determine interobserver reproducibility.
Revascularization was technically successful in all patients, and mean ankle-brachial index increased from 0.36 ± 0.16 to 0.75 ± 0.22. After revascularization, mean BV increased from 1.55 mL/100 g ± 0.83 to 4.51 mL/100 g ± 1.53, BF increased from 16.28 mL/100 g/min ± 4.97 to 31.49 mL/100 g/min ± 6.86, and PS increased from 3.1 mL/min/100 g ± 1.95 to 8.67 mL/min/100 g ± 3.85 (P < .05). Patients with poor response to revascularization who finally underwent amputation presented lower post-PTA perfusion parameters values than patients with significant clinical improvement (P < .05). All measurements demonstrated very good interobserver reproducibility, and intraclass correlation coefficients were 0.91 for BV, 0.94 for BF, and 0.95 for PS. The mean effective dose of the examination was estimated at 0.29 mSv.
CT foot perfusion is a reproducible technique that may be a useful modality for the estimation of PTA outcome. Significant restitution of perfusion parameters was observed after successful revascularization.
使用定量灌注多层 CT 评估临界肢体缺血 (CLI) 患者的足部灌注，并估计经皮腔内血管成形术 (PTA) 前后的灌注参数变化。
这项前瞻性研究纳入了 13 例 CLI 患者（10 例男性；中位年龄 72 岁；范围：51-84 岁），他们在 PTA 前 1 天和后 1 周均接受了 128 层双能 CT 扫描仪的 CT 足部灌注检查。分析并比较了通透性表面（PS）、血容量（BV）和血流（BF）等关键参数。研究还由第二位观察者进行检查，以确定观察者间的可重复性。
所有患者的血管再通均在技术上获得成功，踝肱指数从 0.36 ± 0.16 增加至 0.75 ± 0.22。血管再通后，BV 从 1.55 ± 0.83 mL/100 g 增加至 4.51 ± 1.53 mL/100 g，BF 从 16.28 ± 4.97 mL/100 g/min 增加至 31.49 ± 6.86 mL/100 g/min，PS 从 3.1 ± 1.95 mL/min/100 g 增加至 8.67 ± 3.85 mL/min/100 g（P <.05）。最终接受截肢的血管再通反应不良患者的 PTA 后灌注参数值低于临床显著改善的患者（P <.05）。所有测量均具有非常好的观察者间可重复性，BV 的组内相关系数为 0.91，BF 为 0.94，PS 为 0.95。检查的平均有效剂量估计为 0.29 mSv。
CT 足部灌注是一种可重复的技术，可能是评估 PTA 结果的有用方法。成功血管再通后观察到灌注参数的显著恢复。
