Diyabetik Ayak Komplikasyonlarının Farklı Görüntüleme Yöntemlerinin Kan Akımı Bulguları ile İlişkisinin Karşılaştırılması
Abstract
Amaç: Bu çalışmanın amacı diyabetik ayak hastalarında farklı görüntüleme yöntemlerine göre yumuşak doku ve kemik lezyonlarının vasküler akım ile ilişkisini belirlemektir.
Materyal ve Metod: Bu retrospektif, kesitsel, tanımlayıcı çalışma bir üniversite hastanesinin Radyodiag-nostik bölümünde yapıldı.
Bulgular: En sık görülen bulgu selülit (n:57, %72.2) ve en az görülen bulgu subkondral kist (n:14, %17.7) idi. RDUS bulgularına göre %24,1'inde arteriyel kan akımı yoktu, %27,8'inde monofazik idi. 41 (%51,9) hastada RDUS'ta vasküler kan akımı yetersiz olarak kabul edildi. BTA görüntülerinde hastaların %21.5'inde tam tıkanıklık, %20.3'ünde >%70 daralma saptandı. BTA bulgularına göre 46 (%58,2) hastada vasküler kan akımı yetersiz kabul edildi. RDUS bulgularının yorumlanmasında osteomiyelit saptanan hastaların %63'ünde, selülit saptananların %61'inde, apse saptananların %34'ünde, tenosinovit sapta-nanların %34'ünde, eklem efüzyonu saptananların %29'unda ve subkondral kist saptanan hastaların %29'unda yetersiz kan akımı saptandı. Sadece selülit saptanan hastalarda RDUS ile belirlenen kan akı-mında istatistiksel olarak anlamlı fark saptandı (p=0.021).
Sonuç: Diyabete bağlı gelişen komplikasyonların tanısında ve ampütasyon kararında hem RDUS hem de BTA görüntüleme yöntemleri değerlidir.
Keywords
Renkli Doppler Ultrasonografi Bilgisayarlı Tomografi Anjiografi Diyabetik Ayak Manyetik Rezonans Görüntüleme
Supporting Institution
yok
Project Number
yok
Thanks
Değerli editör ve editör yardımcılarına çok teşekkür ediyoruz.
References
- 1. Öztürk H, Kalpakçı P, Sezer RE, Yılmaz S, Erturhan S. Cumhuriyet üniversitesi hastanesinde 2007-2012 döneminde diyabetik ayağa bağlı operasyon olan hastaların özellikleri ile yaş ve cinsiyetin diyabetik ayak operasyonlarını tahmin ettirici etkisi. Türk Aile Hek Derg 2014;18(2):54-57.
- 2. Sezer RE, Yılmaz S, Sezer H, Erturhan S. Sivas’ta diyabet ve diyabetik ayak prevalansı, 2008. Türk Aile Hek Derg 2012;16(SB-22):149.
- 3. Frykberg RG, Zgonis T, Armstrong DG, et al. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg 2006;45(5 Suppl):1-66.
- 4. Gregg EW, Sorlie P, Paulose-Ram R, et al. Prevalence of lowerextremity disease in the US adult population ≥40 years of age with and without diabetes: 1999-2000 national health and nutrition examination survey. Diabetes Care 2004;27:1591-1597.
- 5. Wu SC, Driver VR, Wrobel JS, Armstrong DG. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag 2007;3(1):65-76.
- 6. Parameswaran GI, Brand K, et al. 2005. Pulse oximetry as a potential screening tool for lower extremity arterial disease in asymptomatic patients with diabetes mellitus. Arch Intern Med, 165:442–6.)
- 7. Kılıçoğlu ZG, Kılıçoğlu Öİ. Diyabetik ayakta görüntüleme. TOTBİD Dergisi 2015; 14:363-376.
- 8. Schweitzer ME, Daffner RH, Weissman BN, Bennett DL,Blebea JS, Jacobson JA, et al. ACR Appropriateness Criteria on suspected osteomyelitisin patients with diabetes mellitus. J Am Coll Radiol 2008;5(8):881–886. CrossRef)
- 9. Kerimoğlu Ü, Diyabetik ayak. Trd Sem 2016; 4: 505-515
- 10. Pourbagher A. El Bileği ve Elin Patolojik Değişiklikleri Trd Sem 2014; 2: 90-102
- 11. Yıldız B, Caymaz İ. Comparison of the Doppler ultrasonography and the multidetector computed tomography findings in the lower extremity peripheric artery disease. Cumhuriyet Med J 2013; 35: 503-509
- 12. Cossman DV, Ellison JE, Wagner WH, Carroll RM, Treiman RL, Foran RF, et al. Comparisonof contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities. J Vasc Surg 1989;10(5):522–528.
- 13. Cook TS. Computed tomography Angiography of the lower extremities. Radiologic Clinics of North America 2016;54(1):115-130.
- 14. Kapoor A, Page S, Lavalley M, Gale DR, Felson DT. Magnetic resonance imaging for diagnosing foot osteomyelitis: A metaanalysis. Arch Intern Med 2007;167(2):125-132.
- 15. Mayank Mahendra, Rahul Singh Diagnostic Accuracy and Surgical Utility of MRI in Complicated Diabetic Foot. J Clin Diagn Res 2017 Jul;11(7):RC01-RC04. DOI: 10.7860/JCDR/2017/25902.10154
- 16. Aragon-Sánchez J, Lazaro-Martínez JL, Hernandez-Herrero C, Campillo-Vilorio N, Quintana-Marrero Y, Garcia-Morales E et al. Does osteomyelitis in the feet of patients with diabetes really recur after surgical treatment? Natural history of a surgical series. Diabet Med. 2012;29(6):813-818.
- 17. Liao D, Xie L, Han Y, et al. Dynamic contrast-enhanced magnetic resonance imaging for differentiating osteomyelitis from acute neuropathic arthropathy in the complicated diabetic foot. Skeletal Radiol.2018;47(10):1337-1347. doi:10.1007/s00256-018-2942-4
A Comparison of the Association of Different Imaging Methods of Diabetic Foot Complications with Blood Flow Findings
Abstract
Background: The aim of this study was to determine the relationship of soft tissue and bone lesions with vascular flow according to different imaging methods in patients with diabetic foot.
Materials and Methods: This retrospective, cross-sectional, descriptive study was conducted in the Radiodiagnostic Department of a university hospital.
Results: The most commonly seen finding was cellulitis (n:57, 72.2%) and the least seen was subchond-ral cyst (n:14, 17.7%). According to the CDUS findings, arterial blood flow was absent in 24.1%, and was monophasic in 27.8%. Vascular blood flow on CDUS was accepted as insufficient in 41 (51.9%) patients. On the CTA images, complete obstruction was determined in 21.5% of patients and >70% narrowing in 20.3%. Vascular blood flow was accepted as insufficient in 46 (58.2%) patients according to the CTA findings. In the interpretation of the CDUS findings, insufficient blood flow was determined in 63% of the patients determined with osteomyelitis, in 61% with cellulitis, in 34% with abscess, in 34% with tenosy-novitis, in 29% with joint effusion, and in 17%with subchondral cyst. A statistically significant difference was determined in the blood flow determined with CDUS only in the patients determined with cellulitis (p=0.021).
Conclusions: In the diagnosis of complications developing secondary to diabetes, and in the decision for amputation, both CDUS and CTA imaging methods are of value.
Keywords
Colour Doppler Ultrasonography Computed Tomography Angiography Diabetic Foot Magnetic Resonance Imaging
Project Number
yok
References
- 1. Öztürk H, Kalpakçı P, Sezer RE, Yılmaz S, Erturhan S. Cumhuriyet üniversitesi hastanesinde 2007-2012 döneminde diyabetik ayağa bağlı operasyon olan hastaların özellikleri ile yaş ve cinsiyetin diyabetik ayak operasyonlarını tahmin ettirici etkisi. Türk Aile Hek Derg 2014;18(2):54-57.
- 2. Sezer RE, Yılmaz S, Sezer H, Erturhan S. Sivas’ta diyabet ve diyabetik ayak prevalansı, 2008. Türk Aile Hek Derg 2012;16(SB-22):149.
- 3. Frykberg RG, Zgonis T, Armstrong DG, et al. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg 2006;45(5 Suppl):1-66.
- 4. Gregg EW, Sorlie P, Paulose-Ram R, et al. Prevalence of lowerextremity disease in the US adult population ≥40 years of age with and without diabetes: 1999-2000 national health and nutrition examination survey. Diabetes Care 2004;27:1591-1597.
- 5. Wu SC, Driver VR, Wrobel JS, Armstrong DG. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag 2007;3(1):65-76.
- 6. Parameswaran GI, Brand K, et al. 2005. Pulse oximetry as a potential screening tool for lower extremity arterial disease in asymptomatic patients with diabetes mellitus. Arch Intern Med, 165:442–6.)
- 7. Kılıçoğlu ZG, Kılıçoğlu Öİ. Diyabetik ayakta görüntüleme. TOTBİD Dergisi 2015; 14:363-376.
- 8. Schweitzer ME, Daffner RH, Weissman BN, Bennett DL,Blebea JS, Jacobson JA, et al. ACR Appropriateness Criteria on suspected osteomyelitisin patients with diabetes mellitus. J Am Coll Radiol 2008;5(8):881–886. CrossRef)
- 9. Kerimoğlu Ü, Diyabetik ayak. Trd Sem 2016; 4: 505-515
- 10. Pourbagher A. El Bileği ve Elin Patolojik Değişiklikleri Trd Sem 2014; 2: 90-102
- 11. Yıldız B, Caymaz İ. Comparison of the Doppler ultrasonography and the multidetector computed tomography findings in the lower extremity peripheric artery disease. Cumhuriyet Med J 2013; 35: 503-509
- 12. Cossman DV, Ellison JE, Wagner WH, Carroll RM, Treiman RL, Foran RF, et al. Comparisonof contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities. J Vasc Surg 1989;10(5):522–528.
- 13. Cook TS. Computed tomography Angiography of the lower extremities. Radiologic Clinics of North America 2016;54(1):115-130.
- 14. Kapoor A, Page S, Lavalley M, Gale DR, Felson DT. Magnetic resonance imaging for diagnosing foot osteomyelitis: A metaanalysis. Arch Intern Med 2007;167(2):125-132.
- 15. Mayank Mahendra, Rahul Singh Diagnostic Accuracy and Surgical Utility of MRI in Complicated Diabetic Foot. J Clin Diagn Res 2017 Jul;11(7):RC01-RC04. DOI: 10.7860/JCDR/2017/25902.10154
- 16. Aragon-Sánchez J, Lazaro-Martínez JL, Hernandez-Herrero C, Campillo-Vilorio N, Quintana-Marrero Y, Garcia-Morales E et al. Does osteomyelitis in the feet of patients with diabetes really recur after surgical treatment? Natural history of a surgical series. Diabet Med. 2012;29(6):813-818.
- 17. Liao D, Xie L, Han Y, et al. Dynamic contrast-enhanced magnetic resonance imaging for differentiating osteomyelitis from acute neuropathic arthropathy in the complicated diabetic foot. Skeletal Radiol.2018;47(10):1337-1347. doi:10.1007/s00256-018-2942-4
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Project Number | yok |
| Publication Date | August 28, 2022 |
| Submission Date | July 21, 2022 |
| Acceptance Date | August 8, 2022 |
| Published in Issue | Year 2022 Volume: 19 Issue: 2 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty