| Objectives:Explore the application value of256-slice spiral CT perfusion imaging to save the limb injury by high-voltage.Materials and methods:select72patients injured by high-voltage, which accepts limb perfusion in67cases, conventional limbs CTA in5cases. According to the post-operative amputation or not, the67patients who underwent the examination of limbs perfusion divided into amputation group of22cases and45cases of non-amputation group. The result of MSCTP test compare with (the information of muscle microcirculation and the corresponding parts of the vascular the CTA image) surgery and pathology, as well as their own, bilateral control. Perfusion resulting image pass to Phillips exclusive EBW workstation line with Functional CT-General mode.(1)choosing the optimum time phrase when extracting CTA image from the perfusion scan results, use MPR,CPR,VR, MIP and Advanced Vessel Analysis (advantage vessel analysis, AVA) software for the analysis, and get the corresponding parts of the vascular image.(2)selecting the region of interest from the amputations and not amputation group, then get the pseudo-color image that contains blood perfusion (BF),peak enhancement(PEI), time to peak(TTP),blood volume(BV), specific quantitative values and time density curve(TDC).The patients of all72cases were underwent vascular morphological analysis,67cases of amputation and not amputation group were analyzed by T test, the amputation group were additionally analyzed use discriminant analysis, to compare the variation of various parts of the limb perfusion parameter in each group.Results:1.Muscles, skin and bone CT imaging findings in the high-voltage injury: patients with muscle damage usually performed as low density shadow in the CT scan and the enhanced image; skin damage manifested as local defect and skin folds; bone destruction performed as the cortex bone discontinuity and dislocation.2.The CTA performance of high-voltage injury:CTA show the vascular more clear, blood vessels damage showed segmental narrow, leaping development or occlusion, interrupt like rat caudate of distal vessel.3. CT perfusion performance of high-voltage injury:high perfusion, low perfusion and no blood perfusion. Each set of parameters is analyzed as follows:1) amputation group:a. The comparison of perfusion parameters between the affected side and the healthy side. The comparison between the level below the limb-amputation plane of the affected side and the corresponding level of the healthy side, BF value:the former<the latter, the difference was statistically significant; PEI value:the former<the latter, the difference was statistically significant; BV value:the former<the latter, the difference was no statistically significant; TTP:the former>the latter, the difference was no statistically significant. The comparison between the level above the limb-amputation plane of the affected side and the corresponding level of the healthy side. BF, PEI, BV. TTP value:the former>the latter, the difference were no statistically significant; The comparison between the amputation level of the affected side and the corresponding level of the healthy side, TTP:the former>the latter, the difference was statistically significant; BF. PEI, BV value:the former>the latter, the difference were no statistically significant, b. The comparison between the limb-amputation level and the level above of the affected side, BF PEI, TTP value:the former<the latter, the differences were no statistically significant.BV value:the former>the latter the differences were no statistically significant.c. The comparison between the limb-amputation level and the level below of the affected side, BF, PEI,TTPvalue:the former<the latter, the difference was no statistically significant; BV value:the former<the latter, the difference was statistically significant. Through discriminant analysis, group a kappa value<0.4, the consistency is poor. Therefore, the use of BF, PEI, TTP, BV value for whether the prediction of each level of the affected side and the corresponding level of the healthy side, has no particularly meaningful. Group b kappa value0.39<0.4, the consistency is poor. Therefore, the use of BF, PEI, TTP, BV value for whether the prediction of the above level of the affected side and the amputation level of the affected side, has no particularly meaningful. Group c kappa value0.42>0.4, the consistency is good. Therefore, the use of BF, PEI, TTP, BV value for whether the prediction of the low level of the affected side and the amputation level of the affected side, has practical meaningful.(2). Not amputation group:BF, PEI, BV value of the upper limb:affected side> healthy side, the difference were no statistically significant; TTP value:affected side<healthy side, the difference were no statistically significant.Conclusion:To use256slice spiral CT perfusion can diagnosis high voltage injury of limb, and obtain clear images of CTA vascular and perfusion parameter values of different sites of injury limbs, and these perfusion parameters have judging values on the prognosis of skin flap to repair; MSCTP has a certain help on making a distinguish after high voltage electrical injury whether it need to be amputated or not. MSCTP is a convenience, safety, qualitative, quantitative check method of clinical diagnosis, treatment for the high voltage electrical injury. |
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