糖尿病足的红外线诊断课件

THEINFRAREDIMAGING

OFTHEDIABETICFOOTZhi-jieXi,M.D.DepartmentofOrthopaedicsShanghaiGuanghuaHospitalofIntegratedTraditionalChineseandWesternMedicineTHEINFRAREDIMAGING

OFTH

ALITTLEHISTORYInfraredThermographyinDiabetesMellitusP.I.Branemark,S.E.Fagerberg,L.LangerandSave–Soderbergh,Diabetologia3,1967

16diabetics,12womenand4man,meanage28,averagediseaselength13years糖尿病足的红外线诊断课件Theemissionovertoesandmetatarso-phalangealregionswasdistinctlydecreasedandgaveasharptransverseboundary.Littleornoreductionoftheemissionwasshownoverthedorsumofthefootandtibia.Asymmetricpatternswererecordedfromtheonlydiabeticwithlocalgangrene.Theemissionovertoesandmet糖尿病足的红外线诊断课件糖尿病足的红外线诊断课件DisturbancesinthearterialcirculationDetectionofareasathighriskforulcerationorre-ulcerationAssessmentoftissuesviability,amputationlevel,andtheintra-operativeskinflapviabilityDiagnosisofosteomyelitisEvaluationofthemedicaltreatmenteffectivenessAssessmentofmicroangiopathyandothersvascularchangescausedbytheneuropathyDisturbancesinthearterialcTheexaminationofthediabeticfootRoomtemperature:24CAcclimatizationtime:20minutesUndressedlegsPosition:OrthostatismorseatedwiththelowersextremitieshangingfreelyTheexaminationofthediabetiTheimagesaretakenatfixedcamera/objectdistancesfromthebothlegsintheanteriorview,thefootfromatopviewandthesolesHotspotisdefinedasanareaatleast0,5CwarmerthansurroundingsThethermalgradientrepresentsthedifferencebetweentheskintemperatureatthekneeandatthedorsumofthefoot.ThermalimagingofskinchangesonthefeetoftypeIIdiabetics–K.Ammer,P.Melnizky,O.Rathkolb,E.F.Ring-2001–23rdAnnualEMBSInternationalConferenceTheimagesaretakenatfixedChangesinthearterialcirculationEco-DopplerAngiographyThermographyChangesinthearterialcirculThe“macro-circulation”pathologylocalizesmoreoftenbelowthepoplitealfossa,thanattheleveloftheaortaoriliacvesselsTheinjuriesrespectthedistal(pedal)arteriesThechangesareusuallyasymmetric,thetibial–peronealtrianglebeingthemostcommonlyaffected.The“macro-circulation”patholThermographyisespeciallyusefultodifferentiatebetween“ischemicfoot”(cold)andthe“neuropathicfoot(warm).Detectingareasofcriticalischemia糖尿病足的红外线诊断课件糖尿病足的红外线诊断课件糖尿病足的红外线诊断课件糖尿病足的红外线诊断课件ARTERYOGRAPHYSevereatheromatosisaffectingtheentirelengthofthetibial-peronealtrunkARTERYOGRAPHY糖尿病足的红外线诊断课件Neuropathic(40%)Neuro-ischemicIschemic(10%)ULCERATIONULCERATION糖尿病足的红外线诊断课件糖尿病足的红外线诊断课件Itwassuggestedthatexaminingthermographicpatterns,patientswithdiabetiscouldbescreenedforriskofulcerationandthathightemperaturewerepredictiveofulceration.Inpatientswithdiabetesperipheralneuropathies,andnoadditionalpathology,thetemperatureoftherightandtheleftlowerextremitieswerenotdifferent.ItwassuggestedthatexamininInfrareddermalthermometryfortheHigh-RiskdiabeticfootD.Armstrong,L.Lavery,P.Liswood,W.Todd,J.Tredweell-PhysicalTherapy,77,2,february1997Allpatientswhoexperiencedulcerationorre-ulcerationduringthefollow-upperiodshowedelevatedskintemperaturegradients.InfrareddermalthermometryfoThepatientscanbemonitoredtopreventulcerations,highertemperatureshavingapredictiveroleforulcerationorre-ulceration(20-58%ofpatientsdevelopanotherulcerwithinoneyear)Wehavetokeepinmindthattheincreasedtemperatureindicatesthereisaproblemandwhereitis,NOTWHATITIS!ThepatientscanbemonitoredThetemperaturemonitoringisalsorecommendedinpatientswithCharcot’sfractures,inthepost-acutephase,aftertheinflammationhadsubsided.Thermographyisalsousefulindetectingsubtletemperaturechangesthatmaypersistinthepostacutephase;aprematurereactivationindicatingreoccurrence.

Thetemperaturemonitoringis糖尿病足的红外线诊断课件InfraredimagingisasensitiveindicatorofthepresenceorabsenceofosteomyelitiscomplicatingthediabeticfootulcerationwhencomparedwithotherimagingmodalitiesImagingindiabeticfootulceration:ablindedcomparisonofinfraredimagingwithaplainfilmradiology,MRI,clinicalassessment,andhaematologicalandbiochemicalinvestigation-R.Harding,J.Jones,A.Griffiths,H.Morris–RoyalGwent&STWoolosHospital,Newport,Gwent,UKOSTEOMYELITISInfraredimagingisasensitivThetemperatureoninfraredimagingissignificantly

increasednotonlyaroundtheulcerbutalsointheentiresoleofthefootinpatientswithradiologicallyconfirmedosteomyelitis.Quantitativeinfraredimagingcanpointouttheosteomyelitisinstallation,reducingmorbidityandmortalitybyselectingthosepatientswhowillbenefitfromappropriateaggressiveantibiotictherapy.ThetemperatureoninfraredimTHERMOGRAPHYINTHEASSESSMENTOFTHEAMPUTATIONLEVELVIABILITYDiabeticfootamputation:theneedforanobjectiveassessmenttool(Wounds15(7):241-245,2003,Healthmanagementpublication)Thermographyandlatertheclearanceoftheradioisotopeweresuccessfullyusedtodeterminetheviabilityofskinflapsforbelowthekneeamputation.Thecombinationofthesetechniquesyieldedasuccessrateof93%fortransifibialamputation.(NinewellsHospital,Dundee,Scotland)THERMOGRAPHYINTHEASSESSMENTAmputationoftheischemiclimb:selectionoftheoptimumsitebythermography–V.A.Spence,W.F.Walker,I.M.Troup–VascularLaboratory,NinewellesHospitalandMedicalSchool,Dundee,Scotland

Resultsfrom104patientsdemonstratethatthethermographicmethodisareliableindicatorforthelevelofamajorlimbamputation.AmputationoftheischemiclimIRlacksinformationaboutthelocalanatomyandonlyindirectlyestimatethechangesinthecutaneousmicrocirculatorybloodsupply.Theobtaineddatabymergingbothimagingtechniques(IR&MRI)allowsthedeterminationoftheextentofanatomicandphysiologicalcompromise,thusleadingtoabetterandmoreadequatesurgicalinterventionIRlacksinformationabouttheMICROANGIOPATHYANDNEUROPATHYThesetwotopicscanbediscussedtogether,sincethemicroangiopathyofthevasanervorumcontributestotheneuropathypathogenesis,whichinturninduceschangesinthecapillarycirculation,thuspartiallycompensatingforthereductioninflowcausedbythemicroangiopathy.Intheinitialstagesofneuropathy,whenthemicroangiopathicchangesaredominant,thereisasymmetrichypothermiainthetoesandthedistalonethirdofthefoot.Severehypothermiamayappearas“thermicamputation”,generatedbyacombinationofobstructivemicroangiopathyandsympathetichyperactivitycausedbypartialnervedamage.

MICROANGIOPATHYANDNEUROPATHYMICROANGIOPATHYANDNEUROPATHYMICROANGIOPATHYANDNEUROPATHYAftertheonsetoftheneuropathicprocess,theskintemperatureincreasesThediabeticneuropathyaffectsthemicrocirculationbyincreasingthebloodflowthrougharteriovenousshunts,whicharenormallyunderthecontrolofsympatheticsystem.AftertheonsetoftheneuropaE.Boyko(Skintemperatureintheneuropathicdiabeticfoot-2001)quotesastudyinwhichthemeanskintemperatureontheplantarfootisbetween33,2and33,5Camongdiabeticsubjectswitheitherpainfulorsensoryneuropathycomparedtoameanof27,8indiabeticsubjectwithoutneuropathy.E.Boyko(SkintemperatureintThedynamicmeasurementsoftheplantarmeantemperaturecanbeusefulindetectingtheperfusionanomaliesduetoneuropathy.Theplantartemperaturemodificationsaretheresultofthecirculatoryinsufficiency,neuropathdisorders,skeletonmodifications,infectionsoranycombinationsofthesefactors.Thedynamicmeasurementsofth糖尿病足的红外线诊断课件ComplicationsDeterminationofinfectioncomplicatedbecauseofsuperimposedneuropathicosteoarthropathyandperipheralvasculardiseaseNeuropathicdiseasecanleadtof/x,deformity,boneproduction,andhyperemiawhichcanmimicinfectiononMRIandscanningincreasingthefalsepositivesPeripheralvasculardiseasecanpreventcontrastmaterialortracerfromreachingsiteofconcernandleadtofalsenegativesComplicationsDeterminationofTHEINFRAREDIMAGING

OFTHEDIABETICFOOTZhi-jieXi,M.D.DepartmentofOrthopaedicsShanghaiGuanghuaHospitalofIntegratedTraditionalChineseandWesternMedicineTHEINFRAREDIMAGING

OFTH

ALITTLEHISTORYInfraredThermographyinDiabetesMellitusP.I.Branemark,S.E.Fagerberg,L.LangerandSave–Soderbergh,Diabetologia3,1967

16diabetics,12womenand4man,meanage28,averagediseaselength13years糖尿病足的红外线诊断课件Theemissionovertoesandmetatarso-phalangealregionswasdistinctlydecreasedandgaveasharptransverseboundary.Littleornoreductionoftheemissionwasshownoverthedorsumofthefootandtibia.Asymmetricpatternswererecordedfromtheonlydiabeticwithlocalgangrene.Theemissionovertoesandmet糖尿病足的红外线诊断课件糖尿病足的红外线诊断课件DisturbancesinthearterialcirculationDetectionofareasathighriskforulcerationorre-ulcerationAssessmentoftissuesviability,amputationlevel,andtheintra-operativeskinflapviabilityDiagnosisofosteomyelitisEvaluationofthemedicaltreatmenteffectivenessAssessmentofmicroangiopathyandothersvascularchangescausedbytheneuropathyDisturbancesinthearterialcTheexaminationofthediabeticfootRoomtemperature:24CAcclimatizationtime:20minutesUndressedlegsPosition:OrthostatismorseatedwiththelowersextremitieshangingfreelyTheexaminationofthediabetiTheimagesaretakenatfixedcamera/objectdistancesfromthebothlegsintheanteriorview,thefootfromatopviewandthesolesHotspotisdefinedasanareaatleast0,5CwarmerthansurroundingsThethermalgradientrepresentsthedifferencebetweentheskintemperatureatthekneeandatthedorsumofthefoot.ThermalimagingofskinchangesonthefeetoftypeIIdiabetics–K.Ammer,P.Melnizky,O.Rathkolb,E.F.Ring-2001–23rdAnnualEMBSInternationalConferenceTheimagesaretakenatfixedChangesinthearterialcirculationEco-DopplerAngiographyThermographyChangesinthearterialcirculThe“macro-circulation”pathologylocalizesmoreoftenbelowthepoplitealfossa,thanattheleveloftheaortaoriliacvesselsTheinjuriesrespectthedistal(pedal)arteriesThechangesareusuallyasymmetric,thetibial–peronealtrianglebeingthemostcommonlyaffected.The“macro-circulation”patholThermographyisespeciallyusefultodifferentiatebetween“ischemicfoot”(cold)andthe“neuropathicfoot(warm).Detectingareasofcriticalischemia糖尿病足的红外线诊断课件糖尿病足的红外线诊断课件糖尿病足的红外线诊断课件糖尿病足的红外线诊断课件ARTERYOGRAPHYSevereatheromatosisaffectingtheentirelengthofthetibial-peronealtrunkARTERYOGRAPHY糖尿病足的红外线诊断课件Neuropathic(40%)Neuro-ischemicIschemic(10%)ULCERATIONULCERATION糖尿病足的红外线诊断课件糖尿病足的红外线诊断课件Itwassuggestedthatexaminingthermographicpatterns,patientswithdiabetiscouldbescreenedforriskofulcerationandthathightemperaturewerepredictiveofulceration.Inpatientswithdiabetesperipheralneuropathies,andnoadditionalpathology,thetemperatureoftherightandtheleftlowerextremitieswerenotdifferent.ItwassuggestedthatexamininInfrareddermalthermometryfortheHigh-RiskdiabeticfootD.Armstrong,L.Lavery,P.Liswood,W.Todd,J.Tredweell-PhysicalTherapy,77,2,february1997Allpatientswhoexperiencedulcerationorre-ulcerationduringthefollow-upperiodshowedelevatedskintemperaturegradients.InfrareddermalthermometryfoThepatientscanbemonitoredtopreventulcerations,highertemperatureshavingapredictiveroleforulcerationorre-ulceration(20-58%ofpatientsdevelopanotherulcerwithinoneyear)Wehavetokeepinmindthattheincreasedtemperatureindicatesthereisaproblemandwhereitis,NOTWHATITIS!ThepatientscanbemonitoredThetemperaturemonitoringisalsorecommendedinpatientswithCharcot’sfractures,inthepost-acutephase,aftertheinflammationhadsubsided.Thermographyisalsousefulindetectingsubtletemperaturechangesthatmaypersistinthepostacutephase;aprematurereactivationindicatingreoccurrence.

Thetemperaturemonitoringis糖尿病足的红外线诊断课件InfraredimagingisasensitiveindicatorofthepresenceorabsenceofosteomyelitiscomplicatingthediabeticfootulcerationwhencomparedwithotherimagingmodalitiesImagingindiabeticfootulceration:ablindedcomparisonofinfraredimagingwithaplainfilmradiology,MRI,clinicalassessment,andhaematologicalandbiochemicalinvestigation-R.Harding,J.Jones,A.Griffiths,H.Morris–RoyalGwent&STWoolosHospital,Newport,Gwent,UKOSTEOMYELITISInfraredimagingisasensitivThetemperatureoninfraredimagingissignificantly

increasednotonlyaroundtheulcerbutalsointheentiresoleofthefootinpatientswithradiologicallyconfirmedosteomyelitis.Quantitativeinfraredimagingcanpointouttheosteomyelitisinstallation,reducingmorbidityandmortalitybyselectingthosepatientswhowillbenefitfromappropriateaggressiveantibiotictherapy.ThetemperatureoninfraredimTHERMOGRAPHYINTHEASSESSMENTOFTHEAMPUTATIONLEVELVIABILITYDiabeticfootamputation:theneedforanobjectiveassessmenttool(Wounds15(7):241-245,2003,Healthmanagementpublication)Thermographyandlatertheclearanceoftheradioisotopeweresuccessfullyusedtodeterminetheviabilityofskinflapsforbelowthekneeamputation.Thecombinationofthesetechniquesyieldedasuccessrateof93%fortransifibialamputation.(NinewellsHospital,Dundee,Scotland)THERMOGRAPHYINTHEASSESSMENTAmputationoftheischemiclimb:selectionoftheoptimumsitebythermography–V.A.Spence,W.F.Walker,I.M.Troup–VascularLaboratory,NinewellesHospitalandMedicalSchool,Dundee,Scotland

Resultsfrom104patientsdemonstratethatthethermographicmethodisareliableindicatorforthelevelofamajorlimbamputation.AmputationoftheischemiclimIRlacksinformationaboutthelocalanatomyandonlyindirectlyestimatethechangesinthecutaneousmicrocirculatorybloodsupply.Theobtaineddatabymergingbothimagingtechniques(IR&MRI)allowsthedeterminationoftheextentofanatomicandphysiologicalcompromise,thusleadingtoabetterandmoreadequatesurgicalinterventionIRlacksinformationabouttheMICROANGIOPATHYANDNEUROPATHYThesetwotopicscanbediscussedtogether,sincethemicroangiopathyofthevasanervorumcontributestotheneuropathypathogenesis,whichinturninduceschangesinthecapillarycirculation,thuspartiallycompensatingforthereductioninflowcausedbythemicroangiopathy.Intheinitialstagesofneuropathy,whenthemicroangiopathicchangesaredominant,thereisasymmetrichypothermiainthetoesandthedistalonethirdofthe