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1、天津医科大学硕士研究生学位论文符 号 说 明英文简称 英 文 全 称 中文名称CT computed tomography X线计算机体层摄影SCT spiral computed tomography 螺旋CTMSCT multislice spiral computed tomography 多层螺旋CTCTA computed tomography angiography CT血管 造 影MSCTA multi slice spiral CTA 多层螺旋CT血管造影DSA digital subtraction angiography X线数字减影血管造影MRA magnetic res
2、onance angiography 磁共振血管造影VR volume rendering 容积重建术CDFI color doppler flow imaging 彩色多普勒超声CMPR curved multiplanar reformations 曲面重建MIP maximum intensity projection 最大密度投影AVA advanced vessel analysis 高级血管分析软件ASO arteriosclerosis obliterans 动脉硬化性闭塞症DM diabetes mellitus 糖尿病DF diabetic foot 糖尿病足病NDM non
3、 diabetes mellitus 非糖尿病16层螺旋CT血管造影评估糖尿病足病下肢血管病变的研究研究生: 卢山 导师： 白人驹 教授摘 要目的：利用16层螺旋CT血管成像（computed tomography angigraphy，CTA）技术评估各级糖尿病足患者下肢动脉病变程度和特点，为糖尿病足病临床诊断、治疗及预后评估提供准确的影像学依据。材料和方法：对42例临床诊为糖尿病足（Diabetic foot，DF）患者行16螺旋CT下肢动脉CTA检查, 其中男32例，女10例，年龄4479岁，平均63.409.09岁，足病病程0.526个月。根据糖尿病足病的临床分级，将02级足病患者归为
4、轻度组，共20例，其中男14例，女6例，年龄4479岁，平均58.759.38岁，足病病程0.520个月；将3、4级足病患者归为重度组，共22例，男18例，女4例，年龄5378岁，平均67.646.51岁，足病病程0.524个月。另外随机选取同龄无明显并发症的糖尿病（diabetes mellitus，DM）患者20例及同龄无糖尿病者（NDM）18例作为对照组。DM组男15例，女5例，年龄4974岁，平均60.857.58岁；NDM组，男14例，女4例，年龄4868岁，平均59.836.82岁。将所获图像数据信息传送至GE16层螺旋CT图像工作站(软件版本：ADW 4.2)进行后处理。以横断面
5、图像为基础，结合容积重建(VR)、最大密度投影（MIP）、血管分析软件（AVA）图像，对病变进行分析。然后将分析结果与彩色多普勒超声(CDFI)进行对照。结果：（1）34级DF组下肢动脉管径低于02级DF组，管壁钙化、管腔狭窄、斑块及侧枝循环范围及程度较02级DF组严重，存在统计学差异。管壁钙化、管腔狭窄、斑块和侧枝循环与糖尿病足的级别存在相关性，其中斑块的相关性最强。（2）DF组患侧下肢动脉狭窄程度与对侧比较无统计学差异，提示糖尿病足下肢动脉病变是糖尿病代谢紊乱对动脉管壁的长期弥漫损害，不仅患侧下肢动脉病变显著, 且对侧下肢动脉也存在一定程度的缺血。（3）DF组下肢动脉管径低于DM组及NDM
6、组，斑块和侧枝循环的发生率、管壁钙化、动脉狭窄严重程度均高于DM组和NDM组，差别具有统计学意义，说明糖尿病足下肢动脉病变较糖尿病患者更为严重。此外，DM组下肢动脉病变较NDM组明显, 提示糖尿病人已存在下肢动脉病变。（4）16层螺旋CT CTA对判断重度以上下肢动脉狭窄闭塞的检出率要高于彩色多普勒超声，特别是局部闭塞伴侧枝循环的动脉的显示。结论：16层螺旋CT CTA检查，为了解糖尿病足血管病变提供了一种无创、快速、准确的检查方法。对下肢动脉病变较轻的患者，可以评估动脉血管狭窄和动脉硬化的部位和程度，有助于临床确定治疗方案；对于下肢动脉病变较重的患者可以评估，足坏疽区域血供有无中断、闭塞，有
7、无侧枝循环，这对确定患肢有无保留价值及外科手术截肢平面的确定具有重要临床意义。此外，CTA检查在源图像上还可以观察病变区域骨骼、软组织受累情况，从而为糖尿病足病的整体评估提供准确的影像学信息。CTA检查应作为糖尿病足病治疗前的常规检查。关键词：糖尿病足；糖尿病；CTA；下肢动脉；彩色多普勒超声；DSAApplication of 16-slice spiral CT in lower extremity vascular disease of the diabetes patient with foot problemAbstract objective To evaluate all deg
8、rees and features in the lower extremity arterial disease of the diabetes patient with foot problem by 16-slice spiral CT angiography(CTA) . It can provide the precise imaging reference for clinical diagnosis, treatment and prognosis of the diabetes patient with foot problem.Materials and methods Th
9、e 42 diabetes patients with foot problem were examined by 16-slice spiral CT angiography. These patients were 32 male cases and 10 female cases. They were from 44-years-old to 79-years-old, average to 63.409.09-years-old. Their duration of diabetic foot was from 0.5 month to 26 months. According to
10、clinical scale of diabetic foot, the patients were divided into mild group (0-2 level) and severe group (3-4 level). There were 20 cases in mild group, including 14 male cases and 6 female cases. They were from 44-years-old to 79-years-old, average to 58.759.38-years-old. The duration of diabetic fo
11、ot was from 0.5 month to 20 months. Another 22 cases were in severe group, including 18 male cases and 4 female cases . They were from 53-years-old to 78-years-old, average to 67.646.51-years-old. The duration of diabetic foot was from 0.5 month to 24 months. And we selected the 20 patients of diabe
12、tes without obviously complications and the 18 healthy persons at the same age class as contrast group. The 20 patients of diabetes included 15 male cases and 5 female cases with the age from 49-years-old to 74-years-old, average to 60.857.58-years-old. The 18 healthy persons included 14 male cases
13、and 4 female cases with the age from 48-years-old to 68-years-old, average to 59.836.82-years-old. The information of imaging and data were postprocessed at the workstation (version: ADW4.2) of GE 16-slice spiral CT. By means of transaction, the process were analyzed by volume rendering(VR), maximum
14、 intensity projection(MIP), advanced vessel analysis(AVA). Then the results were compared with doppler sonography(DS).Result 1. With the degree of diabetic foot, the lower extremity arterial disease would aggravate gradually. The degree of the lower extremity arterial disease was mild in 0-2 lever diabetic foot. The degree of the lower extremity arterial disease was severe and the scope was wide in 3-4 lever diabetic foot.2. The main appearance of the lower extremity arterial disease about diabetic foot were the thickening of vessel wall in ar
