应用体素内不相干运动和血氧水平依赖 MRI 评估糖尿病足溃疡的可行性。
Feasibility of Multiparametric Perfusion Assessment in Diabetic Foot Ulcer Using Intravoxel Incoherent Motion and Blood Oxygenation-Level Dependent MRI.
机构信息
Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA.
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
出版信息
J Magn Reson Imaging. 2024 May;59(5):1555-1566. doi: 10.1002/jmri.28955. Epub 2023 Aug 19.
BACKGROUND
Patients with type-2 diabetes (T2DM) are at increased risk of developing diabetic foot ulcers (DFU) and experiencing impaired wound healing related to underlying microvascular disease.
PURPOSE
To evaluate the sensitivity of intra-voxel incoherent motion (IVIM) and blood oxygen level dependent (BOLD) MRI to microvascular changes in patients with DFUs.
STUDY TYPE
Case-control.
POPULATION
20 volunteers who were age and body mass index matched, including T2DM patients with DFUs (N = 10, mean age = 57.5 years), T2DM patients with controlled glycemia and without DFUs (DC, N = 5, mean age = 57.4 years) and healthy controls (HC, N = 5, mean age = 52.8 years).
FIELD STRENGTH/SEQUENCE: 3T/multi-b-value IVIM and dynamic BOLD.
ASSESSMENT
Resting IVIM parameters were obtained using a multi-b-value diffusion-weighted imaging sequence and two IVIM models were fit to obtain diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) and microvascular volume fraction (MVF) parameters. Microvascular reactivity was evaluated by inducing an ischemic state in the foot with a blood pressure cuff during dynamic BOLD imaging. Perfusion indices were assessed in two regions of the foot: the medial plantar (MP) and lateral plantar (LP) regions.
STATISTICAL TESTS
Effect sizes of group mean differences were assessed using Hedge's g adjusted for small sample sizes.
RESULTS
DFU participants exhibited elevated D*, f, and MVF values in both regions (g ≥ 1.10) and increased D (g = 1.07) in the MP region compared to DC participants. DC participants showed reduced f and MVF compared to HC participants in the MP region (g ≥ 1.06). Finally, the DFU group showed reduced tolerance for ischemia in the LP region (g = -1.51) and blunted reperfusion response in both regions (g < -2.32) compared to the DC group during the cuff-occlusion challenge.
DATA CONCLUSION
The combined use of IVIM and BOLD MRI shows promise in differentiating perfusion abnormalities in the feet of diabetic patients and suggests hyperperfusion in DFU patients.
LEVEL OF EVIDENCE
1 TECHNICAL EFFICACY: Stage 1.
背景
2 型糖尿病（T2DM）患者发生糖尿病足溃疡（DFU）的风险增加，并且存在与潜在微血管疾病相关的伤口愈合受损。
目的
评估体素内不相干运动（IVIM）和血氧水平依赖（BOLD）MRI 对 DFU 患者微血管变化的敏感性。
研究类型
病例对照。
人群
20 名志愿者，年龄和体重指数匹配，包括 T2DM 合并 DFU 患者（N=10，平均年龄=57.5 岁）、T2DM 血糖控制良好且无 DFU 的患者（DC，N=5，平均年龄=57.4 岁）和健康对照组（HC，N=5，平均年龄=52.8 岁）。
磁场强度/序列：3T/多 b 值 IVIM 和动态 BOLD。
评估
使用多 b 值扩散加权成像序列获得静息 IVIM 参数，并拟合两种 IVIM 模型以获得扩散系数（D）、假性扩散系数（D*）、灌注分数（f）和微血管容积分数（MVF）参数。通过在足部放置血压袖带诱导缺血状态来评估微血管反应性，在足部的两个区域（内侧足底（MP）和外侧足底（LP）区域）评估灌注指数。
统计学检验
使用 Hedge's g 调整小样本量评估组间均值差异的效应大小。
结果
与 DC 组相比，DFU 组在两个区域（g≥1.10）的 D*、f 和 MVF 值升高，MP 区域的 D 值升高（g=1.07）。此外，与 HC 组相比，DC 组在 MP 区域的 f 和 MVF 值降低（g≥1.06）。最后，与 DC 组相比，DFU 组在 LP 区域对缺血的耐受性降低（g=-1.51），在两个区域的再灌注反应减弱（g＜-2.32）。
数据结论
IVIM 和 BOLD MRI 的联合使用有望区分糖尿病患者足部的灌注异常，并提示 DFU 患者存在高灌注。
证据水平
1 技术功效：阶段 1。
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