Sixteen-Detector Row CT Angiography Evaluation Of Lower Extremity Vascular Disease In Diabetic Foot

Objective: To evaluate all degrees and features of lower extremity arterial disease in diabetic foot patients by 16-slice spiral computed tomography angiography(CTA). It can provide the precise imaging reference for clinical diagnosis, treatment and prognosis of the diabetic foot patients.Materials and methods: The 42 diabetic foot (DF)patients 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 63.40±9.09-years-old. Their duration of diabetic foot was from 0.5 month to 26 months. According to 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 58.75±9.38-years-old. The duration of diabetic foot 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 67.64±6.51-years-old. The duration of diabetic foot was from 0.5 month to 24 months. And we selected the 20 patients of diabetes mellitus(DM)without obviously complications and the 18 non-diabetic mellitus(NDM)at the same age class by random 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 60.85±7.58-years-old. The 18 healthy persons included 14 male cases and 4 female cases with the age from 48-years-old to 68-years-old, average to 59.83±6.82-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 intensity projection(MIP), advanced vessel analysis(AVA). Then the results were compared with Color Doppler Flow Imaging(CDFI).Result:1. The caliber of the artery of lower extremity in 3～4 lever group was lower than that in 0～2 lever group. And the calcification of vessel wall, the stenosis of lumens and the scope and the degree of plaque and collateral circulation in 3～4 lever group were severer than those in 0～2 lever group. Those had statistics difference. The calcification of vessel wall, the stenosis of lumens and the scope and the degree of plaque and collateral circulation had correlation with the lever of diabetic foot and the correlation was strongest in plaque.2. In DF group, the degree of the lower extremity arterial stenosis in the side of the trouble had no significant difference to the opposite side. It showed that the lower extremity arterial disease in DF was the long-term and widespread damage of arterial wall by metabolic disorder. The lower extremity arterial disease in the side of trouble was obviously, the lower extremity arterial in the opposite side had ischemic in some extent as well.3. The caliber of the artery of lower extremity in DF group was lower than that in DM and NDM group. The incidence rate of plaque and collateral circulation, the calcification of vessel wall and arterial stenosis in the DF group were higher than those in the DM and NDM group. It had statistical significance. It showed the lower extremity arterial disease in DF was severer than that in DM. The lower extremity arterial disease in DM was more obviously than that in NDM. It showed. The lower extremity arterial disease in DM had existed.4. The detection rate of the lower extremity arterial stenosis and occlusion in 16-slice spiral CTA was higher than CDFI, especial to the display of the local occlusion artery with collateral circulation.Conclusion The application of 16-slice spiral computed tomography angiography in the lower extremity provides a untraumatic, quick and precise examination for vascular lesion of diabetic foot. It can evaluate the degree of arterial stenosis and arteriosclerosis and help the clinic to determine the treatment plan for the mild patient. For the severe patient, it can evaluate whether the blood supply has broken or stopped and whether the collateral circulation has formed. It can decide whether the affected extremity has reserving value. And it can provide important clinical significance for the determination of the level of amputation in the surgery. Meanwhile the skeleton and the soft tissue to be involved in are observed in CTA. It provides the precise imaging information for the evaluation of diabetic foot. CTA should be routine examination in the diabetic foot before treatment.