应用 CT 灌注成像定量评估外周动脉疾病患者介入治疗后的足部血供。
Quantitative evaluation of postintervention foot blood supply in patients with peripheral artery disease by computed tomography perfusion.
机构信息
Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China; Diagnosis and Treatment Center of Small Lung Nodules, Huadong Hospital Affiliated to Fudan University, Shanghai, China; Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
Department of Vascular Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
出版信息
J Vasc Surg. 2020 Sep;72(3):1035-1042. doi: 10.1016/j.jvs.2019.11.030. Epub 2020 Jan 19.
OBJECTIVE
The aim of this study was to quantitatively evaluate the changes of the foot's blood supply after endovascular treatment in patients with peripheral artery disease (PAD) using foot computed tomography (CT) perfusion.
METHODS
Nineteen patients who underwent endovascular treatment for PAD between January 2018 and November 2018 were included in the study. Perfusion CT scanning was performed before and after intervention with the measurement of ankle-brachial index. Regions of interest were selected from two arteries and four different tissues per foot. Perfusion maps of blood volume, blood flow, permeability surface area product, time to peak (TTP), mean transit time (MTT), mean slope of increase (MSI), Tmax, and impulse response function (IRFt) were constructed and calculated by the perfusion analysis software. Wilcoxon signed rank test was performed on the eight parameter pairs of the limbs on the treated and untreated sides before and after intervention in the 19 patients.
RESULTS
Differences in blood flow, MTT, TTP, Tmax, MSI, and IRFt on the treated side of the tissue perfusion group and statistical difference in blood flow, MTT, and MSI on the treated side of the arterial perfusion group were observed (all P < .05). Ankle-brachial index improved from 0.41 ± 0.11 to 0.76 ± 0.10 (P < .001). For the untreated side, TTP of the tissue perfusion group was significantly shortened (by 7.71 seconds) after surgery (P = .006), whereas there were no differences in the other parameters. In addition, no significant differences in parameters were observed on the untreated side of the arterial perfusion group. The average radiation dose per phase of perfusion scan was 0.00097 mSv. Moreover, the hyperperfusion zone in the plantar dermis and periosteum reappeared after revascularization.
CONCLUSIONS
Perfusion CT is a feasible and repeatable approach for quantifying blood supply in patients with PAD. The increase of blood flow, MSI, and MTT shortening suggest blood supply improvement after revascularization in both arterial perfusion and tissue perfusion. In addition, TTP may be a sensitive indicator of blood supply changes in tissue perfusion.
目的
本研究旨在通过足部 CT 灌注定量评估外周动脉疾病（PAD）患者血管内治疗后足部血液供应的变化。
方法
本研究纳入了 2018 年 1 月至 2018 年 11 月期间接受 PAD 血管内治疗的 19 名患者。在干预前后进行灌注 CT 扫描，测量踝肱指数。从每只脚的两条动脉和四个不同组织中选择感兴趣区域。通过灌注分析软件构建并计算血容量、血流量、通透性表面积产物、达峰时间（TTP）、平均通过时间（MTT）、平均斜率增加（MSI）、Tmax 和脉冲响应函数（IRFt）的灌注图。对 19 名患者干预前后患侧和健侧的 8 对肢体参数进行 Wilcoxon 符号秩检验。
结果
组织灌注组患侧血流量、MTT、TTP、Tmax、MSI 和 IRFt 差异有统计学意义（均 P<0.05），动脉灌注组患侧血流量、MTT 和 MSI 差异有统计学意义（均 P<0.05）。踝肱指数从 0.41±0.11 改善至 0.76±0.10（P<0.001）。对于健侧，组织灌注组 TTP 术后明显缩短（缩短 7.71 秒）（P=0.006），而其他参数无差异。此外，动脉灌注组健侧各参数无差异。每个灌注扫描相位的平均辐射剂量为 0.00097mSv。此外，再血管化后足底真皮和骨膜的高灌注区再次出现。
结论
灌注 CT 是一种可行且可重复的方法，可定量评估 PAD 患者的血液供应。血流量增加、MSI 和 MTT 缩短提示再血管化后动脉灌注和组织灌注的血液供应改善。此外，TTP 可能是组织灌注中血液供应变化的敏感指标。
Zotero 插件