超声造影联合超微血管成像对下肢穿支皮瓣移植术前穿支血管评估的临床价值

Clinical value of contrast-enhanced ultrasound and superb microvascular imaging in preoperative assessment of lower extremity perforator flaps

目的评估超声造影(CEUS)联合超微血管成像(SMI)在下肢穿支皮瓣移植术前穿支血管定位中的价值。方法对2018年1月至2019年12月在宁波市第一医院就诊的69例患者共85条下肢皮瓣穿支,分别行彩色多普勒血流显像(CDFI)、SMI、CEUS及超声造影模式下的超微血管成像(CEUS+SMI)检测。采用Kappa一致性检验分析4种检查方法的一致性;以术中定位为金标准,采用χ^(2)检验比较4种模式显示穿支血管能力(显示率和准确率)的差异。结果CDFI、SMI、CEUS和CEUS+SMI对下肢皮瓣穿支血管的显示率分别为74.11%、85.88%、88.23%、95.29%;以术中所核实的穿支显示和定位作为参考标准,CDFI、SMI、CEUS和CEUS+SMI对下肢皮瓣穿支血管探查的准确率分别为60.00%、76.47%、78.82%、92.94%,CEUS+SMI与CDFI、SMI、CEUS比较均表现出更高的准确率(χ^(2)=25.631、8.900、6.986,P<0.001、=0.003、=0.008)。同时CEUS+SMI的检查时间明显短于CDFI的检查时间[(26.5±8.4)min vs(43.4±11.1)min],两者比较差异具有统计学意义(t=5.136,P=0.001)。结论CEUS+SMI定位下肢穿支血管的能力明显优于CDFI、SMI和CEUS,同时可大大缩短检查时间。

Objective To evaluate the value of contrast-enhanced ultrasonography(CEUS)combined with superb microvascular imaging(SMI)in the localization of lower limb flap perforator vessel.Methods A total of 85 lower extremity skin flap perforators from 69 patients treated at the Ningbo First Hospital from January 2018 to December 2019 were subjected to color Doppler flow imaging(CDFI),SMI,CEUS,and CEUS+SMI in ultrasound contrast mode.The Kappa consistency test was used to analyze the consistency of the four methods.Using intraoperative positioning as the golden standard,the chi-square test was used to compare the differences in the ability(display rate and accuracy)of the four modes to display perforators.Results The display rates of CDFI,SMI,CEUS,and CEUS+SMI for the lower limb flap perforators were 74.11%,85.88%,88.23%,and 95.29%,respectively.Taking intraoperative perforator display and location as the golden standard,the accuracy rates of CDFI,SMI,CEUS,and CEUS+SMI for perforator exploration in lower extremity flaps were 60.00%,76.47%,78.82%,and 92.94%,respectively;CEUS+SMI showed higher accuracy compared with CDFI,SMI,and CEUS(χ^(2)=25.631,8.900,and 6.986;P<0.001,=0.003,and=0.008,respectively).The examination time of CEUS+SMI was significantly shorter than that of CDFI[(26.5±8.4)min vs(43.4±11.1 min),t=5.136,P=0.001].Conclusion CEUS+SMI has significantly better ability to locate the lower limb perforator than CDFI,SMI,and CEUS,and can greatly reduce the examination time.