1、THE INFRARED IMAGING OF THE DIABETIC FOOT1PPT课件 A LITTLE HISTORYA LITTLE HISTORYInfrared Thermography in Diabetes MellitusInfrared Thermography in Diabetes MellitusP.I.Branemark, S.E.Fagerberg, L.Langer and Save Soderbergh, Diabetologia 3, P.I.Branemark, S.E.Fagerberg, L.Langer and Save Soderbergh,
2、Diabetologia 3, 1967196716 diabetics, 12 women and 4 man, mean age 28, average disease length 13 years16 diabetics, 12 women and 4 man, mean age 28, average disease length 13 years2PPT课件The emission over toes and metatarso-phalangeal regions was distinctly decreased and gave a sharp transverse bound
3、ary. Little or no reduction of the emission was shown over the dorsum of the foot and tibia. Asymmetric patterns were recorded from the only diabetic with local gangrene.3PPT课件4PPT课件5PPT课件Disturbances in the arterial circulationDetection of areas at high risk for ulceration or re-ulcerationAssessmen
4、t of tissues viability, amputation level, and the intra-operative skin flap viabilityDiagnosis of osteomyelitisEvaluation of the medical treatment effectivenessAssessment of microangiopathy and others vascular changes caused by the neuropathy6PPT课件The examination of the diabetic footRoom temperature
5、 : 24 CAcclimatization time: 20 minutesUndressed legsPosition : Orthostatism or seated with the lowers extremities hanging freely7PPT课件The images are taken at fixed camera/object distances from the both legs in the anterior view, the foot from a top view and the solesHot spot is defined as an area a
6、t least 0,5 C warmer than surroundingsThe thermal gradient represents the difference between the skin temperature at the knee and at the dorsum of the foot.Thermal imaging of skin changes on the feet of type II Thermal imaging of skin changes on the feet of type II diabetics K.Ammer, P. Melnizky, O.
7、Rathkolb, E.F. diabetics K.Ammer, P. Melnizky, O.Rathkolb, E.F. Ring- 2001 23Ring- 2001 23rdrd Annual EMBS International Conference Annual EMBS International Conference8PPT课件Changes in the arterial circulationEco-DopplerAngiographyThermography9PPT课件The “macro-circulation” pathology localizes more of
8、ten below the popliteal fossa, than at the level of the aorta or iliac vesselsThe injuries respect the distal (pedal) arteriesThe changes are usually asymmetric, the tibial peroneal triangle being the most commonly affected.10PPT课件Thermography is especially useful to differentiate between “ischemic
9、foot”(cold) and the “neuropathic foot(warm).Detecting areas of critical ischemia11PPT课件12PPT课件13PPT课件14PPT课件ARTERYOGRAPHYSevere atheromatosis affecting the entire length of the tibial-peroneal trunk 15PPT课件16PPT课件Neuropathic ( 40%)Neuro-ischemic Ischemic ( 10%)ULCERATION17PPT课件18PPT课件19PPT课件It was s
10、uggested that examining thermographic patterns, patients with diabetis could be screened for risk of ulceration and that high temperature were predictive of ulceration.In patients with diabetes peripheral neuropathies, and no additional pathology, the temperature of the right and the left lower extr
11、emities were not different.20PPT课件Infrared dermal thermometry for the High-Risk diabetic footInfrared dermal thermometry for the High-Risk diabetic footD.Armstrong, L.Lavery, P.Liswood, W.Todd, J.Tredweell-Physical Therapy, 77, 2, february 1997All patients who experienced ulceration or re -ulceratio
12、n during the follow-up period showed elevated skin temperature gradients.21PPT课件The patients can be monitored to prevent ulcerations, higher temperatures having a predictive role for ulceration or re-ulceration (20- 58% of patients develop another ulcer within one year)We have to keep in mind that t
13、he increased temperature indicates there is a problem and where it is, NOT WHAT IT IS ! 22PPT课件The temperature monitoring is also recommended in patients with Charcots fractures, in the post-acute phase, after the inflammation had subsided. Thermography is also useful in detecting subtle temperature
14、 changes that may persist in the post acute phase; a premature reactivation indicating reoccurrence.23PPT课件24PPT课件Infrared imaging is a sensitive indicator Infrared imaging is a sensitive indicator o f t h e p r e s e n c e o r a b s e n c e o f o f t h e p r e s e n c e o r a b s e n c e o f osteom
15、yelitis complicating the diabetic osteomyelitis complicating the diabetic foot ulceration when compared with other foot ulceration when compared with other imaging modalitiesimaging modalitiesImaging in diabetic foot ulceration: a blinded Imaging in diabetic foot ulceration: a blinded comparison of
16、infrared imaging with a plain film comparison of infrared imaging with a plain film radiology, MRI, clinical assessment, and radiology, MRI, clinical assessment, and haematological and biochemical investigation- haematological and biochemical investigation- R.Harding, J.Jones, A. Griffiths, H. Morri
17、s R.Harding, J.Jones, A. Griffiths, H. Morris Royal Gwent & ST Woolos Hospital, Newport, Gwent, Royal Gwent & ST Woolos Hospital, Newport, Gwent, UKUKOSTEOMYELITIS25PPT课件T h e t e m p e r a t u r e o n i n f r a r e d i m a g i n g i s significantlyincreased not only around the ulcer but also in the
18、 entire sole of the foot in patients with radiologically confirmed osteomyelitis. Quantitative infrared imaging can point out the osteomyelitis installation, reducing morbidity and mortality by selecting those patients who will benefit from appropriate aggressive antibiotic therapy.26PPT课件THERMOGRAP
19、HY IN THE ASSESSMENT OF THE AMPUTATION LEVEL VIABILITYDiabetic foot amputation: the need for an Diabetic foot amputation: the need for an objective assessment tool (Wounds 15(7):241-245, objective assessment tool (Wounds 15(7):241-245, 2003, Health management publication)2003, Health management publ
20、ication)Thermography and later the clearance of the Thermography and later the clearance of the radioisotope were successfully used to determine radioisotope were successfully used to determine the viability of skin flaps for below the knee the viability of skin flaps for below the knee amputation.
21、The combination of these techniques amputation. The combination of these techniques yielded a success rate of 93% for transifibial yielded a success rate of 93% for transifibial amputation. ( Ninewells Hospital, Dundee, Scotland)amputation. ( Ninewells Hospital, Dundee, Scotland)27PPT课件Amputation of
22、 the ischemic limb: selection Amputation of the ischemic limb: selection of the optimum site by thermography of the optimum site by thermography V.A.Spence, W.F.Walker, I.M.Troup V.A.Spence, W.F.Walker, I.M.Troup Vascular Laboratory, Ninewelles Hospital Vascular Laboratory, Ninewelles Hospital and M
23、edical School , Dundee , Scotlandand Medical School , Dundee , ScotlandResults from 104 patients demonstrate that the thermographic method is a reliable indicator for the level of a major limb amputation.28PPT课件IR lacks information about the local anatomy and only indirectly estimate the changes in
24、the cutaneous microcirculatory blood supply.The obtained data by merging both imaging techniques (IR&MRI) allows the determination of the extent of anatomic and physiological compromise, thus leading to a better and more adequate surgical intervention29PPT课件MICROANGIOPATHY AND NEUROPATHYThese two to
25、pics can be discussed together, since the microangiopathy of the vasa nervorum contributes to the neuropathy pathogenesis, which in turn induces changes in the capillary circulation, thus partially compensating for the reduction in flow caused by the microangiopathy.In the initial stages of neuropat
26、hy, when the microangiopathic changes are dominant, there is a symmetric hypothermia in the toes and the distal one third of the foot. Severe hypothermia may appear as “thermic amputation” , generated by a combination of obstructive microangiopathy and sympathetic hyperactivity caused by partial ner
27、ve damage. 30PPT课件MICROANGIOPATHY AND NEUROPATHY31PPT课件After the onset of the neuropathic process, the skin temperature increases The diabetic neuropathy affects the microcirculation by increasing the blood flow through arteriovenous shunts, which are normally under the control of sympathetic system
28、. 32PPT课件E.Boyko (Skin temperature in the neuropathic diabetic foot -2001) quotes a study in which the mean skin temperature on the plantar foot is between 33,2 and 33,5C among diabetic subjects with either painful or sensory neuropathy compared to a mean of 27,8 in diabetic subject without neuropat
29、hy.33PPT课件The dynamic measurements of the plantar mean temperature can be useful in detecting the perfusion anomalies due to neuropathy .The plantar temperature modifications are the result of the circulatory insufficiency, neuropath disorders, skeleton modifications, infections or any combinations
30、of these factors.34PPT课件35PPT课件ComplicationsDeterminationofinfectioncomplicatedbecauseofsuperimposedneuropathicosteoarthropathyandperipheralvasculardiseaseNeuropathicdiseasecanleadtof/x,deformity,boneproduction,andhyperemiawhichcanmimicinfectiononMRIandscanningincreasingthefalsepositivesPeripheralvasculardiseasecanpreventcontrastmaterialortracerfromreachingsiteofconcernandleadtofalsenegatives36PPT课件
