CTA、CE-MRA、DUS三种影像学方法对糖尿病下肢动脉病变的诊断价值对比
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摘要
目的探讨彩色多普勒超声(DUS)、三维动态增强磁共振血管成像(CE-MRA)、CT血管造影(CTA)三种影像学方法对糖尿病下肢动脉病变的诊断价值。方法将本院115例诊断为糖尿病引起的下肢动脉病变(下肢动脉狭窄或闭塞病变)的患者作为研究对象,均行单侧或双侧的CTA、CE-MRA、DUS影像学检查。结果 115例患者149条下肢动脉中,按照血管分支分级,其中1级:轻度狭窄79条,中度狭窄41例,重度狭窄或闭塞29条;2级:轻度狭窄51条,中度狭窄48例,重度狭窄或闭塞50条;3级:轻度狭窄98条,中度狭窄37例,重度狭窄或闭塞14条。在98条行DUS检查的下肢动脉病变中,1、2、3级动脉中度狭窄的灵敏度分别为91.18%、87.23%、78.57%,特异度分别为93.75%、96.08%、98.57%;1、2、3级动脉重度狭窄的灵敏度分别为75.00%、81.82%、55.56%,特异度分别为93.02%、90.91%、97.75%。结论三种不同影像学方法(DUS、CE-MRA、CTA)在诊断糖尿病下肢动脉病变方面均具有较高的准确性,其中CTA对评估患者下肢动脉重度狭窄的诊断效能高于其它两种影像学方法。
引文
[1] Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the american college of cardiology/american heart association task force on clinical practice guidelines [J]. J Am Coll Cardiol, 2017, 69(11): 1465-1508.
[2] D'Abate F, Ramachandran V, Young MA, et al. B-flow imaging in lower limb peripheral arterial disease and bypass graft ultrasonography [J]. Ultrasound Medi Biol, 2016, 42(9): 2345-2351.
[3] Hinchliffe RJ, Brownrigg JR, Apelqvist J, et al. IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes [J]. Diabetes/Metabolism Research And Reviews, 2016, 32(Suppl): 37-44.
[4] Conte MS, Pomposelli FB, Clair DG, et al. Society for vascular surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication [J]. J Vasc Surg, 2015, 61(3): 2-41.
[5] 李鹏飞, 龚金山. 256层螺旋CT间接法静脉造影在下肢静脉疾病中的价值[J]. 医学影像学杂志, 2015,25(8):1413-1415.
[6] Langham MC, Desjardins B, Englund EK, et al. Rapid high-resolution, self-registered, dual lumen-contrast MRI method for vessel-wall assessment in peripheral artery disease: a preliminary investigation [J]. Acad Radiol, 2016, 23(4): 457-467.
[7] Eleftheriadou I, Grigoropoulou P, Kokkinos A, et al. Association of plasma fetuin-a levels with peripheral arterial disease and lower extremity arterial calcification in subjects with type 2 diabetes mellitus [J]. J Diabetes Complications, 2017, 31(3): 599-604.
[8] Saponjski J, Stojanovich L, Petrovic J, et al. The role of MSCT angiography in early detection of lower limb arterial lesions in patients with antiphospholipid syndrome[J]. Immunol Res, 2017, 65(2): 482-486.
[9] Masuda T, Funama Y, Nakaura T, et al. CT angiography of suspected peripheral artery disease: comparison of contrast enhancement in the lower extremities of patients undergoing and those not undergoing hemodialysis[J]. Am J Roentgenol, 2017, 208(5): 1127-1133.
[10] Alavi A, Sibbald RG, Nabavizadeh R, et al. Audible handheld Doppler ultrasound determines reliable and inexpensive exclusion of significant peripheral arterial disease [J]. Vascular, 2015, 23(6): 622-629.
[11] 刘晓蓉, 朱德发. 糖尿病下肢动脉病变的诊断与治疗[J]. 国际内分泌代谢杂志, 2015, 35(5):327-331.
[12] Mathew RC, Kramer CM. Recent advances in magnetic resonance imaging for peripheral artery disease[J]. Vasc Med, 2018, 23(2): 143-152.
[13] Walker JP, Nosova E, Sigovan M, et al. Ferumoxytol-enhanced magnetic resonance angiography is a feasible method for the clinical evaluation of lower extremity arterial disease[J]. Ann Vasc Surg, 2015, 29(1): 63-68.
[14] Muhlestein JB, Lappé DL, Lima JAC, et al. Effect of screening for coronary artery disease using CT angiography on mortality and cardiac events in high-risk patients with diabetes: the FACTOR-64 randomized clinical trial[J]. Jama, 2014, 312(21): 2234-2243.
[15] Jiang L, Zhao Y. The value of color Doppler ultrasound in the diagnosis of lower extremity vascular disease in type 2 diabetes and an analysis of related factors[J]. Minerva Endocrinol, 2017, 42(3): 223-227.
[16] 陈松宽, 杨光钊, 茅国群,等. 双源CT 诊断下肢动脉阻塞性疾病的临床价值[J]. 医学影像学杂志, 2014,24(11):2051-2054.
[2] D'Abate F, Ramachandran V, Young MA, et al. B-flow imaging in lower limb peripheral arterial disease and bypass graft ultrasonography [J]. Ultrasound Medi Biol, 2016, 42(9): 2345-2351.
[3] Hinchliffe RJ, Brownrigg JR, Apelqvist J, et al. IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes [J]. Diabetes/Metabolism Research And Reviews, 2016, 32(Suppl): 37-44.
[4] Conte MS, Pomposelli FB, Clair DG, et al. Society for vascular surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication [J]. J Vasc Surg, 2015, 61(3): 2-41.
[5] 李鹏飞, 龚金山. 256层螺旋CT间接法静脉造影在下肢静脉疾病中的价值[J]. 医学影像学杂志, 2015,25(8):1413-1415.
[6] Langham MC, Desjardins B, Englund EK, et al. Rapid high-resolution, self-registered, dual lumen-contrast MRI method for vessel-wall assessment in peripheral artery disease: a preliminary investigation [J]. Acad Radiol, 2016, 23(4): 457-467.
[7] Eleftheriadou I, Grigoropoulou P, Kokkinos A, et al. Association of plasma fetuin-a levels with peripheral arterial disease and lower extremity arterial calcification in subjects with type 2 diabetes mellitus [J]. J Diabetes Complications, 2017, 31(3): 599-604.
[8] Saponjski J, Stojanovich L, Petrovic J, et al. The role of MSCT angiography in early detection of lower limb arterial lesions in patients with antiphospholipid syndrome[J]. Immunol Res, 2017, 65(2): 482-486.
[9] Masuda T, Funama Y, Nakaura T, et al. CT angiography of suspected peripheral artery disease: comparison of contrast enhancement in the lower extremities of patients undergoing and those not undergoing hemodialysis[J]. Am J Roentgenol, 2017, 208(5): 1127-1133.
[10] Alavi A, Sibbald RG, Nabavizadeh R, et al. Audible handheld Doppler ultrasound determines reliable and inexpensive exclusion of significant peripheral arterial disease [J]. Vascular, 2015, 23(6): 622-629.
[11] 刘晓蓉, 朱德发. 糖尿病下肢动脉病变的诊断与治疗[J]. 国际内分泌代谢杂志, 2015, 35(5):327-331.
[12] Mathew RC, Kramer CM. Recent advances in magnetic resonance imaging for peripheral artery disease[J]. Vasc Med, 2018, 23(2): 143-152.
[13] Walker JP, Nosova E, Sigovan M, et al. Ferumoxytol-enhanced magnetic resonance angiography is a feasible method for the clinical evaluation of lower extremity arterial disease[J]. Ann Vasc Surg, 2015, 29(1): 63-68.
[14] Muhlestein JB, Lappé DL, Lima JAC, et al. Effect of screening for coronary artery disease using CT angiography on mortality and cardiac events in high-risk patients with diabetes: the FACTOR-64 randomized clinical trial[J]. Jama, 2014, 312(21): 2234-2243.
[15] Jiang L, Zhao Y. The value of color Doppler ultrasound in the diagnosis of lower extremity vascular disease in type 2 diabetes and an analysis of related factors[J]. Minerva Endocrinol, 2017, 42(3): 223-227.
[16] 陈松宽, 杨光钊, 茅国群,等. 双源CT 诊断下肢动脉阻塞性疾病的临床价值[J]. 医学影像学杂志, 2014,24(11):2051-2054.