INVESTIGATING THE CAPILLARY CIRCULATION OF THE FOOT WITH TC-99M-MACROAGGREGATED ALBUMIN - A PROSPECTIVE-STUDY IN PATIENTS WITH DIABETES ANDFOOT ULCERATION

Macroaggregated albumin has been used to assess capillary circulation for over 20 years. The aim of the present study was to use Tc-99m-macr oaggregated albumin (Tc-99m-MAA) perfusion scanning to assess capillar y circulation in feet with ischaemic ulcers in patients with diabetes, and relate the appearances to outcome. Twenty-three patients with dia betes presented with a total of 41 neuroischaemic foot ulcers. Perfusi on scanning was performed by direct femoral artery injection of approx imately 400 000 particles of Tc-99m-MAA and imaging with a gamma camer a. Patients were followed prospectively for 3 months. Scans were grade d independently by a radiologist who was unaware of the site of the ul cers. Significant associations were detected between a radiologist's a ssessment of increased tissue perfusion and complete healing after 3 m onths (p = 0.047) and poor tissue perfusion on the image and failure t o heal (p = 0.0005). This technique may be useful in deciding whether to persist with conservative treatment in patients with diabetes and f oot ulceration.