The Clinical Application Of MSCTA In The Traumatic In Injuries Of Lower Extremities And Thromboangiitis Obliterans

Objective:Comparing the MSCTA findings with intraoperation findings to retrospectively evaluate the clinical application of MSCTA as the one-stop diagnostic modality in the traumatic injuries of lower extremities.Material and Methods:The MSCTA date and clinical date of38patients were reviewed. All the38patients had underwent MSCTA for lower extremities injuries before the operation between2009.11-2011.10.28patients were male,10patients were female. The average age was40years old. MSCTA was performed with128-slice (Somaton Definition AS+, Germany) and the axial images were reconstructed by Siemens post-processing workstation (MMWP, Siemens) to display and analyse the injury situation of vascular, bone and soft tissue of the lower limb. Bolus-tracking technology was used. The Scanning Parameters were as follow:0.6mm collimation,0.4pitch. Parameters investigated include age, type of injury, interval time between the injury and the CTA, CTA findings, surgical approach, intraoperative findings, intra-op and post-op complications, and clinical outcomes. Taking the interoperation findings as the standard, evaluate the accuracy of assessment for the morphological changes in injury situation of vascular, and calculate the accuracy, sensitivity and specificity of MSCTA.Result:Mechanism of injury included crush injury (n=15), stab wound injury(n=7), weight caused by blunt force trauma cases(n=5), machine cut ground injury(n=3), unclean injection(n=3), impact injury(n=2), falling injury(n=2), high altitude falling injury (n=1). Interval time between the injury and the CTA was defined as acute (<24 h after injury), subacute (1-7days after injury), or late (>7days after injury), the cases were2,18,18.38cases included26fractures cases,34soft tissue defects cases and31vascular injury cases. There were18arterial occlusion or stenosis cases caused by thrombogenesis,1arterial occlusion or stenosis combine with pseudoaneurysm case,3arterial occlusion or stenosis combine with arteriovenous fistula case,5pseudoaneurysm cases,3arteriovenous fistula cases,1pseudoaneurysm combined with rteriovenous fistula case.4of38cases who experienced amputation did not detect the vessel, and the results were unable to compare with the MSCTA findings. Of the rest34cases, taking the intraoperation findings as the standard, the accuracy, sensitivity and specificity in detecting the lesions of vascular were respectively94.1%,100%and77.8%, in detecting thrombogenesis were respectively97.1%,94.7%and77.8%, in detecting the pseudoaneurysm and arterial occlusion were all100%, in detecting arteriovenous fistula were respectively94.1%、100%and93.1%.2arterial fragmentation were not detected in MSCTA.Conclusion:Taking MSCTA as one-stop diagnostic modality in the traumatic injuries of lower extremities, it can detect the injury situation of vascular, bone and soft tissue rapidly, efficiently and accurately. MSCTA findings can guide clinical doctors make effective Surgical planning. MSCTA can be used as the primary diagnostic modality in the traumatic injuries of lower extremities. Objective:To analyze the MSCTA manifestations of Thromboangiitis obliterans(TAO) and its diagnostic value.Material and Methods:The imaging data and clinical data of38cases of patients with TAO were reviewed. All of the patients were male. The average age was34. The scan parameters and post-processing methods were same as part1. MSCTA imagings were reviewed by two practiced radiologists and the number of vascular lesion segments on each lower extremity was recorded. Imaging evaluation includes: the arterial stenosis or occlusion, thrombogenesis, calcification, plaque of vascular wall and the establishment of collateral vessels. Taking the interoperation findings and DSA as the standard, evaluate the accuracy of MSCTA.Result:①There were26bilateral TAO patients in38patients, the rest was unilateral. MSCTA showed lesions of vessels in160segments, mainly involving crus artery group (the popliteal artery, tibioperoneal trunk, anterior tibial artery, posterior tibial artery and peroneal artery). The rate is90.0%(144/160).②The manifestation of TAO in MSCTA included arterial stenosis or occlusion with establishment of collateral vessels in unilateral or bilateral lower extremities. Arterial occlusion (113), arterial stenosis(4) and arterial stenosis combine with occlusion(43) were found in160lesion vascular segments. There were18cases included22segments of stenosis or occlusion with establishment of collateral vessels in unilateral or bilateral lower extremities were shown in MSCTA.③The findings of16patients who underwent DSA (2cases) and surgical interventions(14cases) were consistent with MSCTA findings. The clinical symptoms of the rest22patients who had conservative treatment were released more or less. Conclusion:The site of lesion vascular and it’s surrounding changes can be accurately detected by MSCTA as a noninvasive method. MSCTA has a high diagnostic accuracy in TAO, and can guide clinical treatment effectively.