Lin Dao-Chen, Tsai Pei-Shan, Lin Tzu-Lin, Huang Wen-Hui, Liu Yu-Peng, Wu Tung-Hsin, Shih Cheng-Ting
Department of Radiology, Taipei Veterans General Hospital, Taipei City, Taiwan.
Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan.
BMC Cardiovasc Disord. 2025 Apr 8;25(1):268. doi: 10.1186/s12872-025-04695-8.
Peripheral artery disease (PAD) is associated with various morbidities. This study aims to investigate the correlation between different lower extremity compositions and development of morbidities in PAD patients.
Between January 2018 and December 2020, 108 subjects diagnosed of PAD were enrolled (mean age of 64.1 ± 13.5 years) and utilized dual-energy computed tomography (DECT) with material decomposition to measure the vessel volume, muscle volume, fat volume, and cortical-bone volume in lower extremity respectively. The association between each leg composition and developing complications or morbidities in PAD patients was analyzed over a two-year follow-up.
Fontaine stage 3 and 4 had lower muscle mass compared to stages 1 and 2. More severe vascular stenosis was associated with lower muscle, fat, and cortical-bone volume. Patients with severe Fontaine stages (3 and 4) and lower-leg vascular stenosis had a higher risk of developing infection or inflammation (OR 45.5, 95% CI: 13.5-166.7, and OR 11.7, 95% CI: 2.8-50, P < 0.05) and amputation (OR 18.2, 95% CI: 2.2-142.8, and OR 10.7, 95% CI: 1.11-100, P < 0.05). Lower thigh cortical-bone volume was associated with an increased risk of falls resulting in fractures (OR: 1.39, 95% CI: 1.13-2.19, P < 0.01). Thigh cortical-bone volume below 64.5 cm was identified as the cut-off value to predict fall-related fractures, with a sensitivity of 100% and specificity of 92%.
This study demonstrates the potential of DECT with material decomposition to assess lower extremity composition and its relevance in predicting complications and morbidities in PAD patients. Severe vascular stenosis may contribute to muscle wasting and subsequent complications, while lower thigh cortical-bone mass may serve as a predictor of fall-related fractures.
外周动脉疾病（PAD）与多种疾病相关。本研究旨在探讨PAD患者不同下肢成分与疾病发生之间的相关性。
2018年1月至2020年12月，纳入108例诊断为PAD的受试者（平均年龄64.1±13.5岁），采用具有物质分解功能的双能计算机断层扫描（DECT）分别测量下肢的血管体积、肌肉体积、脂肪体积和皮质骨体积。在两年的随访期间，分析了PAD患者每条腿的成分与发生并发症或疾病之间的关联。
与1期和2期相比，Fontaine 3期和4期的肌肉质量较低。更严重的血管狭窄与较低的肌肉、脂肪和皮质骨体积相关。Fontaine分期严重（3期和4期）且小腿血管狭窄的患者发生感染或炎症的风险较高（比值比45.5，95%置信区间：13.5 - 166.7，以及比值比11.7，95%置信区间：2.8 - 50，P < 0.05）和截肢风险较高（比值比18.2，95%置信区间：2.2 - 142.8，以及比值比10.7，95%置信区间：1.11 - 100，P < 0.05）。大腿下部皮质骨体积与跌倒导致骨折的风险增加相关（比值比：1.39，95%置信区间：1.13 - 2.19，P < 0.01）。大腿皮质骨体积低于64.5 cm被确定为预测跌倒相关骨折的临界值，敏感性为100%，特异性为92%。
本研究证明了具有物质分解功能的DECT评估下肢成分的潜力及其在预测PAD患者并发症和疾病方面的相关性。严重的血管狭窄可能导致肌肉萎缩及随后的并发症，而大腿下部皮质骨质量可能作为跌倒相关骨折的预测指标。
