背景:2型糖尿病(T2DM)患者发生糖尿病足溃疡(DFU)的风险增加,并经历与潜在微血管疾病相关的伤口愈合受损。
目的:评估体素内不相干运动(IVIM)和血氧水平依赖性(BOLD)MRI对DFU患者微血管变化的敏感性。
方法:病例对照。
方法:20名年龄和体重指数相匹配的志愿者,包括有DFU的T2DM患者(N=10,平均年龄=57.5岁),血糖控制且无DFU的T2DM患者(DC,N=5,平均年龄=57.4岁)和健康对照(HC,N=5,平均年龄=52.8岁)。
■3T/多b值IVIM和动态BOLD。
结果:使用多b值扩散加权成像序列获得静息IVIM参数,并拟合两个IVIM模型以获得扩散系数(D),伪扩散系数(D*),灌注分数(f)和微血管体积分数(MVF)参数。通过在动态BOLD成像期间用血压袖带诱导足部缺血状态来评估微血管反应性。在足的两个区域评估灌注指数:足底内侧(MP)和足底外侧(LP)区域。
方法:使用针对小样本量调整的Hedgeg评估组平均差异的效应大小。
结果:DFU参与者表现出D*升高,f,与DC参与者相比,两个地区的MVF值(g≥1.10)和MP地区的D值增加(g=1.07)。与MP区域的HC参与者相比,DC参与者显示f和MVF降低(g≥1.06)。最后,与DC组相比,DFU组对LP区缺血的耐受性降低(g=-1.51),且两个区的再灌注反应减弱(g<-2.32).
结论:IVIM和BOLDMRI的联合使用显示出在区分糖尿病患者足部灌注异常方面的前景,并提示DFU患者存在过度灌注。
方法:1技术效果:第一阶段。
BACKGROUND: Patients with type-2 diabetes (T2DM) are at increased risk of developing diabetic foot ulcers (DFU) and experiencing impaired wound healing related to underlying microvascular disease.
OBJECTIVE: To evaluate the sensitivity of intra-voxel incoherent motion (IVIM) and blood oxygen level dependent (BOLD) MRI to microvascular changes in patients with DFUs.
METHODS: Case-control.
METHODS: 20 volunteers who were age and body mass index matched, including T2DM patients with DFUs (N = 10, mean age = 57.5 years), T2DM patients with controlled glycemia and without DFUs (DC, N = 5, mean age = 57.4 years) and healthy controls (HC, N = 5, mean age = 52.8 years).
UNASSIGNED: 3T/multi-b-value IVIM and dynamic BOLD.
RESULTS: Resting IVIM parameters were obtained using a multi-b-value diffusion-weighted imaging sequence and two IVIM models were fit to obtain diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) and microvascular volume fraction (MVF) parameters. Microvascular reactivity was evaluated by inducing an ischemic state in the foot with a blood pressure cuff during dynamic BOLD imaging. Perfusion indices were assessed in two regions of the foot: the medial plantar (MP) and lateral plantar (LP) regions.
METHODS: Effect sizes of group mean differences were assessed using Hedge\'s g adjusted for small sample sizes.
RESULTS: DFU participants exhibited elevated D*, f, and MVF values in both regions (g ≥ 1.10) and increased D (g = 1.07) in the MP region compared to DC participants. DC participants showed reduced f and MVF compared to HC participants in the MP region (g ≥ 1.06). Finally, the DFU group showed reduced tolerance for ischemia in the LP region (g = -1.51) and blunted reperfusion response in both regions (g < -2.32) compared to the DC group during the cuff-occlusion challenge.
CONCLUSIONS: The combined use of IVIM and BOLD MRI shows promise in differentiating perfusion abnormalities in the feet of diabetic patients and suggests hyperperfusion in DFU patients.
METHODS: 1 TECHNICAL EFFICACY: Stage 1.