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1、THEINFRAREDIMAGINGOFTHEDIABETICFOOT1PPT课件ALITTLEHISTORYInfraredThermographyinDiabetesMellitusP.I.Branemark,S.E.Fagerberg,L.LangerandSaveSoderbergh,Diabetologia3,196716diabetics,12womenand4man,meanage28,averagediseaselength13years2PPT课件The emission over toes and metatarso-phalangeal regions wasdistin
2、ctlydecreasedandgaveasharptransverseboundary.Littleornoreductionoftheemissionwasshownoverthedorsumofthefootandtibia.Asymmetricpatternswererecordedfromtheonlydiabeticwithlocalgangrene.3PPT课件4PPT课件5PPT课件DisturbancesinthearterialcirculationDetectionofareasathighriskforulcerationorre-ulcerationAssessmen
3、t of tissues viability, amputation level, and the intra-operativeskinflapviabilityDiagnosisofosteomyelitisEvaluationofthemedicaltreatmenteffectivenessAssessment of microangiopathy and others vascular changescausedbytheneuropathy6PPT课件TheexaminationofthediabeticfootRoomtemperature:24CAcclimatizationt
4、ime:20minutesUndressedlegsPosition : Orthostatism or seated with the lowers extremitieshangingfreely7PPT课件Theimagesaretakenatfixedcamera/objectdistancesfromthebothlegsintheanteriorview,thefootfromatopviewandthesolesHot spot is defined as an area at least 0,5 C warmer thansurroundingsThe thermal grad
5、ient represents the difference between the skintemperatureatthekneeandatthedorsumofthefoot.ThermalimagingofskinchangesonthefeetoftypeIIdiabeticsK.Ammer,P. Melnizky,O.Rathkolb,E.F. Ring-200123rdAnnualEMBSInternationalConference8PPT课件ChangesinthearterialcirculationEco-DopplerAngiographyThermography9PP
6、T课件The “macro-circulation” pathology localizes more often below thepoplitealfossa,thanattheleveloftheaortaoriliacvesselsTheinjuriesrespectthedistal(pedal)arteriesThechangesareusuallyasymmetric,thetibialperonealtrianglebeingthemostcommonlyaffected.10PPT课件Thermographyisespeciallyusefultodifferentiateb
7、etween“ischemicfoot”(cold)andthe“neuropathicfoot(warm).Detectingareasofcriticalischemia11PPT课件12PPT课件13PPT课件14PPT课件ARTERYOGRAPHYSevere atheromatosis affecting theentire length of the tibial-peronealtrunk15PPT课件16PPT课件Neuropathic(40%)Neuro-ischemicIschemic(10%)ULCERATION17PPT课件18PPT课件19PPT课件Itwas sug
8、gestedthatexamining thermographicpatterns,patientswithdiabetiscouldbescreenedforriskofulcerationandthathightemperaturewerepredictiveofulceration.Inpatientswithdiabetesperipheralneuropathies,andnoadditionalpathology,thetemperatureoftherightandtheleftlowerextremitieswerenotdifferent.20PPT课件Infraredder
9、malthermometryfortheHigh-RiskdiabeticfootD.Armstrong, L.Lavery, P.Liswood, W.Todd, J.Tredweell-PhysicalTherapy,77,2,february1997Allpatientswhoexperiencedulcerationorre-ulceration during the follow-up period showed elevated skintemperaturegradients.21PPT课件The patients can be monitored to prevent ulce
10、rations, highertemperatureshavingapredictiveroleforulcerationorre-ulceration(20-58%ofpatientsdevelopanotherulcerwithinoneyear)Wehavetokeepinmindthattheincreasedtemperatureindicatesthereisaproblemandwhereitis,NOTWHATITIS!22PPT课件ThetemperaturemonitoringisalsorecommendedinpatientswithCharcotsfractures,
11、inthepost-acutephase,aftertheinflammationhadsubsided.Thermography is also useful in detecting subtle temperaturechanges that may persist in the post acute phase; a prematurereactivationindicatingreoccurrence.23PPT课件24PPT课件Infrared imaging is a sensitive indicator ofthe presence or absence of osteomy
12、elitiscomplicating the diabetic foot ulcerationwhencomparedwithotherimagingmodalitiesImaging in diabetic foot ulceration: a blindedcomparison of infrared imaging with a plain filmradiology,MRI,clinicalassessment,andhaematologicalandbiochemicalinvestigation-R.Harding, J.Jones, A. Griffiths, H. Morris
13、 RoyalGwent&STWoolosHospital,Newport,Gwent,UKOSTEOMYELITIS25PPT课件Thetemperatureoninfraredimagingissignificantlyincreasednotonlyaroundtheulcerbutalsointheentiresoleofthefootinpatientswithradiologicallyconfirmedosteomyelitis.Quantitative infrared imaging can point out the osteomyelitisinstallation, re
14、ducing morbidity and mortality by selecting thosepatients who will benefit from appropriate aggressive antibiotictherapy.26PPT课件THERMOGRAPHYINTHEASSESSMENTOFTHEAMPUTATIONLEVELVIABILITYDiabeticfootamputation:theneedforanobjectiveassessmenttool (Wounds 15(7):241-245,2003,Healthmanagementpublication)Th
15、ermography and later the clearance of theradioisotope were successfully used to determinethe viability of skin flaps for below the kneeamputation. The combination of these techniquesyielded a success rate of 93% for transifibialamputation.(NinewellsHospital,Dundee,Scotland)27PPT课件Amputation oftheisc
16、hemiclimb:selectionof the optimum site by thermography V.A.Spence,W.F.Walker,I.M.TroupVascularLaboratory,NinewellesHospitalandMedicalSchool,Dundee,ScotlandResults from 104 patients demonstrate that the thermographicmethod is a reliable indicator for the level of a major limbamputation.28PPT课件IR lack
17、s information about the local anatomy and only indirectlyestimate the changes in the cutaneous microcirculatory bloodsupply.Theobtaineddatabymergingbothimagingtechniques(IR&MRI)allowsthedeterminationoftheextentofanatomicandphysiologicalcompromise,thusleadingtoabetterandmoreadequatesurgicalinterventi
18、on29PPT课件MICROANGIOPATHYANDNEUROPATHYThesetwotopicscanbediscussedtogether,sincethemicroangiopathyofthevasanervorumcontributestotheneuropathypathogenesis,whichinturninduceschangesin the capillary circulation, thus partially compensatingforthereductioninflowcausedbythemicroangiopathy.Intheinitialstage
19、sofneuropathy,whenthemicroangiopathic changes are dominant, there is asymmetric hypothermia in the toes and the distal onethird of the foot. Severe hypothermia may appear as“thermic amputation” , generated by a combination ofobstructivemicroangiopathyandsympathetichyperactivitycausedbypartialnerveda
20、mage.30PPT课件MICROANGIOPATHYANDNEUROPATHY31PPT课件After the onset of the neuropathic process, the skin temperatureincreasesThediabeticneuropathyaffectsthemicrocirculationbyincreasingthebloodflowthrougharteriovenousshunts,whicharenormallyunderthecontrolofsympatheticsystem.32PPT课件E.Boyko(Skintemperaturei
21、ntheneuropathicdiabeticfoot-2001)quotesastudyinwhichthemeanskintemperatureontheplantarfootisbetween33,2and33,5Camongdiabeticsubjectswitheitherpainful or sensory neuropathy compared to a mean of 27,8 indiabeticsubjectwithoutneuropathy.33PPT课件Thedynamicmeasurementsoftheplantarmeantemperaturecanbeusefu
22、lindetectingtheperfusionanomaliesduetoneuropathy.The plantar temperature modifications are the result of thecirculatoryinsufficiency,neuropathdisorders,skeletonmodifications,infectionsoranycombinationsofthesefactors.34PPT课件35PPT课件ComplicationsDetermination of infection complicated because of superim
23、posedneuropathicosteoarthropathyandperipheralvasculardiseaseNeuropathicdiseasecanleadtof/x,deformity,boneproduction,andhyperemiawhichcanmimicinfectiononMRIandscanningincreasingthefalsepositivesPeripheral vascular disease can prevent contrast material or tracerfromreachingsiteofconcernandleadtofalsenegatives36PPT课件
