Lower limb tissue muscle 99m-MIBI perfusion scintigraphy in diabetic and non-diabetic patients

Abstract

Introduction: Peripheral artery disease in patients with diabe- tes mellitus (DM) is insufficiently explored. The aim of our study was to correlate the Doppler ultrasonography, pedo-brachi- al index and CT-angiography with perfusion reserve of lower limbs in diabetic patients (pts). Materials and Methods: 60 pts with DM, age 30 to 70 years, average age of 61.8 ± 10.5 years, with a duration of diabetes over 5 years. Doppler ulstrasonog- raphy and pedo-brachial index (PBI) measurement were per- formed and afterwards tissue-muscle perfusion scintigraphy with 99m Tc-MIBI. CT-angiography was performed in 20 diabetic pts. Results: Significantly lower average value of the perfusion reserve (PR) was registered in diabetic group, where the Dop- pler finding demonstrated obstruction of aa. tibialis posterior bill. or obstruction of aa. dorsalis pedis. PR of left calf (LC): 33.1 ± 14.6% vs. 46.93 ± 11.3%, p = 0.0001, while for the right calf (RC): 33.62% ± 9.5 vs. 46.0 ± 9.3%, p = 0.000004 in pts with ob- struction of aa.tibialis post. bill. PR for LC was 31.85% ± 16.2 vs. 47.12 ± 8.7, p = 0.000018, while for the RC: 32.93 ± 9.5 vs. 45.82± 8.9, p = 0.000001 (pts with obstruction of aa.dorsalis pedis). Lower values of PR was obtained in pts with reduced PBI, as well as Meckenberg sclerosis compared to subjects with nor- mal PBI. CT-angiography positively correlated with perfusion scintigraphy - 71.43% of pts with pathological findings on CTA had lower PR, while perfusion scintigraphy detected microcircu- latory changes in 28.57% of pts (showing lower PR) when CTA finding was normal. Conclusion: The scintigraphic method can earlier estimate microcirculatory disorders than Doppler ultra- sonographic findings and CTA and may help in evaluating the perfusion status in individuals with Meckenberg sclerosis. Key words: muscle perfusion, diabetes, perfusion reserve, Doppler, pedo-brachial index, CT-angiography