CT Findings And Perfusion Imaging Features Of Achilles Tendon In Diabetic Foot Patients

Objective:To analyze the CT finding and perfusion imaging characteristics of Achilles tendon in patients with diabetic foot,and to explore the morphological changes and microcirculation status of Achilles tendon in diabetic foot patients.Materials and Methods:33 diabetic foot patients that were diagnosed from February 2017 to May 2018 in the first affiliated hospital of guangxi medical university were collected as the research object.According to the foot ulcer,all diabetic foots were divided into ulcer group and non-ulcer group.According to the Wagner classification,there were five groups including 0,?,?,?and?level group.10 patients with normal blood glucose were selected as the control group in the same period.All diabetic foot patients received CT plain scan of both lower limbs and CT perfusion imaging scan of lower leg and foot.All patients in the control group received CT plain scan of both lower limbs.The images of Achilles tendon were observed on the picture archiving and communication systems(PACS)of the radiology department,and the CT morphological manifestations(including thickness,density,margin,calcification and surrounding soft tissue)of the Achilles tendon were measured and recorded.Multiphase dynamic images were imported CT post-processing software(CT Perfusion,ADW4.7).The posterior tibial artery was selected as input artery in7cm from the bifurcation of the medial and lateral plantar arteries,and then time density curve(TDC)and pseudo-color imagines of lower leg and foot tissues on both sides were obtained.In order to obtain various perfusion parameters(BF?BV?MTT?TTP and PS),areas of interest(ROI)were drawn at the level of the starting,middle and ending points of the Achilles tendon.SPSS17.0 software was used for statistical analysis.We use single sample kolmogor-smirnov test to test the date whether follow the normal distribution.The data conforming to the normal distribution was analyzed by independent sample t test and expressed by X±s.The date follow the normal distribution and homogeneity test of variance was compared by one-way ANOVA,the non-conforming data was compared by non-parametric test,and LSD test was used for pairwise comparison.The counting date was analyzed by?~2 test.P<0.05 was considered statistically significant.Results:1.The thickness of Achilles tendon presented a gradually increase trend in control group,non-ulcer group and ulcer group,the difference was statistically significant(all P<0.05).The density of Achilles tendon showed a decrease trend in control group,non-ulcer group and ulcer group,but only the difference at the Achilles tendon ending point was statistically significant(P=0.015).The differences of mean thickness of Achilles tendon in ulcer group and non-ulcer group,ulcer group and control group,non-ulcer group and control group,and mean density of Achilles tendon between ulcer group and control group were statistically significant(all P<0.05).The remaining pairwise comparisons were not statistically significant.2.The incidences of blurred boundary,intra-tendinous calcification and swelling surrounding soft tissue increased gradually in control group,non-ulcer group and ulcer group.Comparison of pairs in three groups,there were statistically significant differences of boundary and surrounding soft tissue in ulcer group and non-ulcer group,ulcer group and control group(all P<0.05).There were no statistically significant differences in remaining pairwise comparisons(all P>0.05).3.BF values of ulcer group and non-ulcer group were(9.964±7.963)?(6.173±3.938)ml/100ml/min,respectively.BV values of ulcer group and non-ulcer group were(0.697±0.520)?(0.464±0.248)ml/100ml,respectively.The differences of BF and BV values between ulcer group and non-ulcer group were statistically significant(t=2.528?2.401,both P<0.05).However,there were no significant differences in MTT,TTP,and PS between ulcer group and non-ulcer group(all P were>0.05).4.With the increase of Wagner classification of diabetic foot,the thickness of Achilles tendon gradually increased,and the density increased first and then decreased.In addition to Wagner?level group,the BF and BV values of Achilles tendon perfusion parameters increased with Wagner classification.Only the difference of thickness of Achilles tendon was statistically significant(P=0.048),there were no statistically significant differences of Achilles tendon density,BF and BV in difference Wagner classification(all P>0.05).Conclusion:1.CT morphology of Achilles tendon has certain characteristics in diabetic foot patients.2.CT perfusion imaging can quantitatively analyze the change of microcirculation of Achilles tendon in diabetic patients with or without foot ulcers.This can provide some help for the early diagnosis and treatment of Achilles tendon diseases.3.The thickness of diabetic Achilles tendon can reflect the course of diabetic foot to some extent.It has certain significance for clinical to control diabetic foot in time.