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Intelligent Algorithm-Based Analysis on Ultrasound Image Characteristics of Patients with Lower Extremity Arteriosclerosis Occlusion and Its Correlation with Diabetic Mellitus Foot

Intelligent Algorithm-Based Analysis on Ultrasound Image Characteristics of Patients with Lower... Hindawi Journal of Healthcare Engineering Volume 2021, Article ID 7758206, 13 pages https://doi.org/10.1155/2021/7758206 Research Article Intelligent Algorithm-Based Analysis on Ultrasound Image Characteristics of Patients with Lower Extremity Arteriosclerosis Occlusion and Its Correlation with Diabetic Mellitus Foot 1 2 3 YunShuang Wu , Yan Shen , and Hailing Sun Department of Ultrasound, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Affiliated with Nanjing University of Chinese Medicine, Nanjing 210014, Jiangsu, China Department of Ultrasound, Lianshui County People’s Hospital, Lianshui, Huai’an 223400, Jiangsu, China Department of Ultrasound, Hongze District People’s Hospital, Huai’an 223100, Jiangsu, China Correspondence should be addressed to Hailing Sun; fsyy00102@njucm.edu.cn Received 28 June 2021; Revised 5 September 2021; Accepted 9 September 2021; Published 26 September 2021 Academic Editor: Enas Abdulhay Copyright © 2021 YunShuang Wu et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. *e study focused on the correlation between lower extremity arteriosclerosis and diabetic mellitus (DM) foot, and it was explored by virtue of ultrasound images processed by an intelligent algorithm. Methods. A total of 60 DM foot patients admitted to our hospital in the past three years were selected and divided into two groups according to their condition. Patients with DM foot alone were in group B (30 cases), and patients with DM foot combined with lower extremity arteriosclerosis occlusion were in group C (30 cases). 30 healthy people were in group A as a control. Color Doppler ultrasound was used to examine the arteries of the lower extremities of all subjects. It the intramedia thickness (IMT) from the femoral artery to the dorsal foot artery was recorded, whether there was plaque in the artery or knowing the size of the plaque, its echo, and distribution, and whether the artery had stenosis. Next, the stenosis percentage was calculated. Additionally, the general information of patients was analyzed. At the same time, an intelligent algorithm was used to process ultrasound images, and its effects on image quality were evaluated. Results. Doppler ultrasound images processed by Artificial Bee Colony (ABC) had less noise and better quality, and key information about the lesion was clearly displayed. *ere was no statistical difference between the general data of the three groups of patients; group B and group C had higher IMT value, plaque incidence, arterial stenosis incidence, and degree of stenosis versus group A, and there were statistically significant differences between groups B and C. In particular, the incidence of femoral artery stenosis and the degree of stenosis were significantly higher in group C than in group B. *e rate of stenosis above grade I in group C was as high as 71%, while that in group B was only 19%; in Group C, the incidence of stenosis above grade II was 30%, and that in group B was 13.1%. Compared with group A, group B and group C had decreased peak arterial blood velocity (PSV), resistance index (RI), and pulse index (PI), and there were statistically significant differences between groups B and C.Conclusion. DM foot is a risk factor for arteriosclerosis occlusion; color Doppler ultrasound demonstrates good diagnostic effects on arteriosclerosis occlusion; the algorithm proposed in this study can improve the quality of Doppler ultrasound images and has a high application value. tumors and cardiovascular diseases. DM foot is a common 1.Introduction complication of DM patients. Statistics show that 15% of In recent years, with the continuous improvement of peo- DM patients worldwide have foot ulcers and gangrene [2]. ple’s living standards and changes in dietary structure, the 50% of patients with amputation each year are DM patients, incidence of diabetes mellitus (DM) foot has been increasing and more than 85% of these patients are amputated because year by year [1]. It is the third most common disease after of worsening foot ulcers leading to deep infection or 2 Journal of Healthcare Engineering image processing technologies have also been developed, such gangrene. Domestic clinical data show that DM foot patients account for 2% of outpatients and 8% to 12% of inpatients. as the arterial detection and tracking algorithm developed on the basis of ultrasound imaging, various ultrasonic 3D re- *e per capita treatment cost for DM foot is more than 10,000 yuan. Worldwide, the incidence of DM foot is high, construction algorithms, and computer-aided diagnostic and the prognosis is poor [3]. systems. At present, the most widely used feature extraction As for why DM patients develop DM foot, it may be and classification method in the field of medical image related to the influence of DM on the cardiac and cerebral processing is the support vector machine. However, a large vessels. To some extent, DM can be regarded as a cardio- number of studies have shown that support vector machines vascular and cerebrovascular disease and affects almost every are susceptible to extreme values in data classification and training. *erefore, in this article, the Artificial Bee Colony blood vessel. *e abnormal metabolism caused by DM can lead to changes in the structure and functions of arteries. (ABC) was used to perform noise reduction and feature extraction on the ultrasound images of diabetes and arte- *ese changes occur even before DM is diagnosed [4]. Peripheral arterial disease (PAD) is common in DM pa- riosclerosis occlusion [10], aiming to provide a scientific basis for the diagnosis and treatment of related diseases. tients. It is a lower extremity occlusive disease, and its clinical symptoms are not obvious. PAD is an important indicator of thrombotic diseases of arteriosclerosis [5]. 2. Materials and Methods Statistics reveal that more than 40% of PAD patients suffer from DM, and DM is the strongest threat factor for PAD. 2.1. Research Subjects. 60 patients with DM foot and DM foot combined with lower extremity arteriosclerosis occlu- Unlike PAD caused by other factors, DM is closely related to femoral-popliteal PAD and tibial artery PAD (below the sion who were hospitalized in the hospital from March 2019 to June 2019 were selected as the research subjects. 30 knee). *e DM foot arises from lower limb ischemia caused by arteriosclerosis occlusion [6]. Above, there is a huge healthy subjects were selected into group A as a control. *e 30 subjects in group B were patients with DM foot alone. *e correlation between DM foot and lower extremity arterio- sclerosis occlusion. *ere are many commonalities but are diagnostic criteria of DM foot were based on the standards drawn up by the first DM foot academic conference of the different. Research has found that patients with both PAD and DM foot have a more complicated condition than Chinese Medical Association Diabetes Mellitus Society. *e patients with one of them alone, and the probability of 30 subjects in group C were patients with DM foot and lower extremity arteriosclerosis occlusion. *e diagnostic criteria cardiovascular diseases is greatly increased [7]. At present, the relationship between the two remains unclear. In the for lower extremity arteriosclerosis occlusion were as fol- lows. (1) *ose with intermittent claudication; resting pain; study, the correlation between the two was explored, in order to provide reference and basis for clinical research. soreness, swelling, numbness, and numbness (patients with one or more of them was included); dystrophic changes in At present, the methods to diagnose lower extremity arteriosclerosis occlusion mainly include digital subtraction skin, hair, muscles, and nails; and ulcers or gangrene were included. (2) *e affected swelled and the pulsation of the angiography (DSA), magnetic resonance angiography (MRA), CT angiography (CTA), and Doppler ultrasound. middle artery was weakened or disappeared. (3) *ose with Among them, DSA is the recognized gold standard for sclerosis changes on fundus examination; electrocardiogram peripheral vascular examination, but it is often not easily showing coronary artery ischemia, left ventricular hyper- accepted by patients because it is invasive and expensive. As trophy, or old myocardial infarction; and Doppler or an- giography showing limb arteriosclerosis were also included. ultrasound technology marches forward continuously, it has been widely used in the detection of vascular diseases, es- *e subjects were 62 × 6.5 years old on average, including 44 males and 46 females. All subjects need to be free of coronary pecially in the research of atherosclerosis, because of its advantages, such as noninvasive, fast, efficient, safe, and heart disease, hyperlipidemia, and other cardiovascular and cerebrovascular diseases, with no long-term smoking his- accurate [8]. Statistics show that the accuracy of ultrasound examination for intraplaque hemorrhage is 90% and the tory. *e study met the requirements of medical ethics and the patients had signed an inform consent form. sensitivity is 96%. B-mode ultrasound can display the an- atomical images of the artery at longitudinal axis and at the transverse axis, providing rich information, such as artery 2.2. Examination Methods thickness, plaque shape, size, range, and lumen stenosis and occlusion. Color blood flow imaging can reflect the blood 2.2.1. Inspection Instrument. Philips iu22 color Doppler filling and distribution state, which is of great significance ultrasonic diagnostic instrument, with a linear array probe, for the evaluation of hemodynamic changes. In the early the probe frequency is 2–9 MHz. During the inspection stage of atherosclerosis, it mainly manifests as expansion of process, conditions, such as emission energy, total gain, the arterial wall or the thickening of MIT, which can be contrast, time gain compensation, and lateral gain com- observed by ultrasound scan [9]. *us, ultrasound has great pensation, need to be kept basically unchanged. advantages in the diagnosis of vascular diseases. Nevertheless, its imaging effects are poor thanks to the reflection and random scattering. As a result, it is difficult to 2.2.2. Inspection Content. *e patient stayed in the supine recognize the edges and details of the organs. Recently, In- and prone positions, and two-dimensional ultrasound scan ternet technology has developed rapidly, and some medical was performed on the femoral artery, popliteal artery, Journal of Healthcare Engineering 3 L L anterior tibial artery, posterior tibial artery, dorsal foot artery σ y � 􏽘 􏽘 y (i, j) − y . lumen, and inner membrane of both lower limbs. *e lumen 􏼁 􏼂 􏼃 (6) k k k L2 i�1 j�1 inner diameter and intramedia thickness (IMT) were measured. It was observed that there were plaques on the ′ ′ *e probability that the pixels (i , j ) with distance d, tube wall, the position of plaques, and that there was stenosis angle θ, and gray value g appear at the same time is as in the lumen. *e stenosis percentage was then calculated. follows: Color Doppler was used to observe the blood vessel filling, ′ ′ ′ ′ and spectrum Doppler was used to detect blood flow P g , g � # (i, j), i , j ∈ M × N ∣ f(i, j) � g , f i , j � g , 􏼐 􏼑 􏼈 􏼁 􏼁 􏼉 θ,d 1 2 1 2 spectrum. After a clear spectrum appeared, the blood flow (7) parameters PSV, RI, and PI were measured. During the inspection, it should be noted not to compress the artery too where #{·} represents the number of elements in the set. For much, and the angle between the sound beam and the blood the sake of simplicity, θ and d are ignored, and the matrix is flow direction should be less than 60 ; each index is mea- normalized as follows: sured 3 times, and the average value is taken. P g , g 􏼁 θ,d 1 2 (8) ⟶ P g , g 􏼁 , 1 2 2.3. Image Processing. A total of 220 ultrasound images are where R is the normalization constant and its value is the collected as research data. *en, the NL algorithm is used to total number of point pairs in the gray-level cooccurrence reduce the noise of the image. *e original noise image is matrix. CON is the contrast, and it can reflect the clarity and M×N Y ∈ R , and the image NL(Y) after noise reduction was texture of the image. A greater grayscale difference of the M×N pixel pair value leads to a greater value of CON: NL(Y(p)) � 􏽘 w(p, q) � 1, (1) N −1 N −1 g g 􏼌 􏼌 q�1 􏼌 􏼌2 􏼌 􏼌 CON � 􏽘 􏽘 􏼌g − g 􏼌 p g − g 􏼁 . (9) 1 2 1 2 g �0 g �0 1 2 where p are the pixels to be denoised and q are the other pixels. w(p, q) is the weight, 0≤ w(p, q)≤ 1, and Entropy ENT can be a measure of the complexity of the M×N 􏽐 w(p, q) � 1. *e calculation of w(p, q) is as follows: q�1 image texture, and it is calculated as follows: N −1 N −1 g g 1 d(p, q) w(p, q) � exp − . (2) 􏼠 􏼡 ENT � − 􏽘 􏽘 P g , g 􏼁 log􏼂 P g , g 􏼁􏼃 . (10) Z(p) 1 2 1 2 g �0 g �0 1 2 *en, the weighted Gaussian distance is used to judge the *e linear dependence of the image gray level depends similarity: on COR: � 2 � � N −1 N −1 � � (3) g g d(p, q) � G g􏼐N 􏼑 − g􏼐N 􏼑 , p� p q � 􏽐 􏽐 g g P g , g 􏼁 − μ μ g �0 g �0 1 2 1 2 g g 1 2 1 2 (11) COR � . σ σ g g where G is the Gaussian weighting function and Z(p) is the 1 2 normalization parameter: Energy ENG can reflect the uniformity of the image gray M×N distribution and the thickness of the texture: d(p, q) Z(p) � 􏽘 exp􏼠− 􏼡, (4) 2 N −1 N −1 g g q�1 ENG � − 􏽘 􏽘 p g , g . (12) 1 2 g �0 g �0 1 2 where h are the attenuation control parameters. *is al- gorithm has good noise reduction effects but long calcula- tion time. In order to reduce the amount of calculation and shorten the calculation time, the search range is controlled in 2.4.ObservationIndicators. *e measurement of intramedia the large search box of (2 × R + 1) × (2 × R + 1). thickness (IMT) takes the average value of the left and right search search sides, and the thickest part of the arterial wall is measured in the diastolic phase of each segment of the lower limbs. It 2.3.1. Feature Extraction. *e ultrasonic image features are should be noted to be away from the plaque position during divided into basic texture features and gray-level cooccur- the measurement. IMT ≤ 0.9 mm is the normal value, and rence matrix features. *e gray mean value of the k subblock IMT> 0.9 mm is the thickened IMT. Plaque is defined as: is defined as localized thickening of blood vessel wall greater than 1.2 mm or diffuse thickening of blood vessel greater than 1.2 mm. L L *e calculation of vascular stenosis rate depends on the y � 􏽘 􏽘 􏼂y (i, j) − y 􏼃 . (5) k k k L2 i�1 j�1 percentage reduction of inner diameter: vascular stenosis rate � ((d −d )/d ) × 100% (d is the inner diameter of the 2 1 2 1 *e gray-level variance σ (y ) of the k subblock is lumen at the stenosis and d is the original inner diameter of defined as follows: the lumen). *e grades of stenosis were as follows: grade 0, 4 Journal of Healthcare Engineering Table 1: *e basic information of subjects. no stenosis; grade I, stenosis rate 1%∼19%; grade II, stenosis 20%∼49%; grade III, stenosis 50%∼99%; grade IV, occlusion, Item A (30 cases) B (30 cases) C (30 cases) Case 30 30 30 no blood flow information. If there are multiple plaques or Age (year) 65.1± 6.8 66.2± 5.4 64.2± 5.9 stenosis in the same segment of blood vessel, the most severe Male 16 18 17 part of the stenosis shall prevail. Gender Female 14 12 13 Proportion of 16 15.1 15.3 smokers (%) 2.5.Statistics. *e data was processed by SPSS 17.0 software. TC (mol/L) 4.66± 1.08 4.55± 1.13 4.61± 1.14 *e measurement data were expressed as (x ± s). *e TG (mol/L) 2.06± 1.16 2.08± 1.12 4.07± 1.19 comparison of data between groups adopted analysis of variance, and the x test was used to test the count data. P< 0.05 was the threshold for significance. and C decreased, and the difference was statistically sig- nificant, P< 0.05, and the decrease in group B was more 3.Results obvious versus group C, and the difference was statistically significant, P< 0.05. 3.1.8eBasicInformationofSubjects. *e basic information of the subjects was shown in Table 1. *e average ages of A, B, and C groups were 65.1± 6.8, 66.2± 5.4, and 64.2± 5.9, 3.4.Occurrence andDistributionof AtheroscleroticPlaquesin respectively. *e number of male subjects in the three the Lower Extremities of Each Group. Two-dimensional groups was 16, 18, and 17, respectively, and the number of ultrasound results showed that the intima surface of the female subjects was 14, 12, and 13, respectively; the pro- lower extremity arteries in groups B and C were not portions of smokers in each group were 16%, 15.1%, and smooth, and there were patches or dots with localized or 15.3%. It was noted that there was no significant difference diffuse distribution and uneven echo. *e plaques at the between the general data of the three groups of subjects and femoral artery were mostly single and large in volume. *e it was comparable. plaques were often found at the bifurcation. *e plaques of the popliteal artery, anterior tibial, posterior tibial, and dorsal foot artery were mostly diffusely distributed dots 3.2. Ultrasound Images and Processing Results. *e original echoes and small in volume. Figure 4 showed the plaque ultrasound image and the processed image were shown in incidence in each group, where (a) was the total number of Figure 1. From column A in Figure 1, it was noted that arteries, (b) was the number of plaque arteries in each although Doppler color ultrasound can reflect the arterial arterial segment, and (c) was the probability of plaque in thickness, plaque shape, size, range, luminal stenosis and each arterial segment. Compared with A, the incidence of occlusion, blood flow filling, and other information in a plaque in the lower limb femoral artery, popliteal artery, comprehensive and detailed manner, the figure had much anterior tibial artery, posterior tibial artery, and dorsal foot noise, with poor clarity and quality. It failed to show the artery in the groups B and C was higher, P< 0.05, and the edge and detailed information of diseased parts and tissue. difference was statistically significant. *e incidence of As for column B in Figure 1, the clarity of the image was arterial plaque in each segment of the C group was higher improved a lot, and the noise has also been reduced. At the than that of the B group, and the difference was statistically same time, the key information of the disease was extracted, significant, P< 0.05. and the redundant information was removed that had nothing to do with the disease, to highlight the focus of the disease. 3.5. Occurrence of Arteriosclerosis and Stenosis of the Lower Extremities. Two-dimensional ultrasound results showed 3.3.8eIntramedia8icknessandHemodynamicTestResults that the arterial intima of the lower extremities of the two groups B and C showed varying degrees of thickening and of the Lower Extremity Arteries of Each Group. *e IMT measurement results of both lower limbs in the three groups plaques of different sizes and irregular shapes protruding into the lumen, resulting in varying degrees of stenosis of the were shown in Figure 2. Compared with group A, subjects in groups B and C had thicker IMT in the lower limb femoral vascular lumen. Figures 5–9 showed the occurrence and artery, popliteal artery, anterior tibial artery, posterior tibial distribution of stenosis in each group. Compared with group artery, and dorsal foot artery, and the difference was sta- A, the lower extremity arterial stenosis rate of groups B and tistically significant, P< 0.05. *e thickening of IMT in C was higher, and the difference was statistically significant, group C was more obvious versus group B, and the dif- P< 0.05. *e incidence of stenosis in of group C was higher ference was statistically significant, P< 0.05. than that of group B, and the difference was statistically *e hemodynamic results of each group were shown in significant, P< 0.05. In particular, the incidence of femoral Figure 3. *e test indicators included peak systolic velocity artery stenosis and the degree of stenosis was higher in group C than in group B. *e stenosis rate of grade I and above in (PSV), resistance index (RI), and pulse index (PI), and the detection was located in femoral artery, popliteal artery, group C was as high as 71%, while that in group B was only 19%; in group C, the stenosis rate of grade II and above was anterior tibial artery, posterior tibial artery, and dorsal foot artery. Compared with group A, PSV, RI, and PI of groups B 30%, and that in group B was 13.1%. Journal of Healthcare Engineering 5 (a) (b) Figure 1: Comparison of the original ultrasound image and the processed image. Note. (a) *e original image and (b) the processed image. 1.5 1.2 ∗# ∗# ∗# ∗# ∗# 0.9 0.6 0.3 A BC Group Femoral artery Popliteal artery Tibial artery before Posterior tibial artery Dorsalis pedisartery Figure 2: Comparison of intramedia thickness results of each group. Note. Compared with group A, P< 0.05; compared with group B, P< 0.05. incidence of diabetes continues to rise [11]. DM foot is one 4.Discussion of the most common complications of diabetes [12]. Studies In China, diabetes is a common disease that threatens the have shown that 15 out of every 100 diabetic patients will lives and health of people. With the development of suffer from DM foot. Clinical data show that diabetes is the economy and the gradual westernization of lifestyle, the culprit of 50% of amputation patients every year. In general, IMT (mm) 6 Journal of Healthcare Engineering 120 100 ∗# ∗# ∗# ∗# ∗ ∗# ∗ ∗# A BC A BC Group Group PSV (CM/S) PSV (CM/S) RI RI PI PI (a) (b) 80 80 ∗# 60 60 ∗# ∗# ∗# ∗ ∗# ∗ ∗# A BC A BC Group Group PSV (CM/S) PSV (CM/S) RI RI PI PI (c) (d) ∗# ∗# ∗ ∗# A BC Group PSV (CM/S) RI PI (e) ∗ # Figure 3: Hemodynamic examination results of each group. Note. Compared with group A, P< 0.05; compared with group B, P< 0.05. (a) Femoral artery. (b) Popliteal artery. (c) Tibial artery before. (d) Posterior tibial artery. (e) Dorsalis pedis artery. Value Value Value Value Value Journal of Healthcare Engineering 7 80 80 ∗# ∗# ∗# ∗# ∗# A BC A BC Group Group Femoral artery Dorsalis pedisartery Posterior tibial artery Tibial artery before Popliteal artery (a) (b) ∗# ∗# ∗# ∗# ∗ ∗# A BC Group Femoral artery Dorsalis pedisartery Posterior tibial artery Tibial artery before Popliteal artery (c) Figure 4: *e occurrence and distribution of atherosclerotic plaques in the lower extremities of each group. Note. Compared with group A, ∗ # P< 0.05; compared with group B, P< 0.05. DM foot can be divided into two types. One is DM foot we have different definitions of the two diseases, which has combined with lower extremity arteriosclerosis occlusion, caused ambiguity. *e international definitions of DM with the lower extremity arteriosclerosis being the main foot and fine arteriosclerosis occlusion are as follows. DM pathological change. It manifests as the coldness of the foot refers to the foot ischemia, infection, or neuropathy lower extremities, numbness, poor skin nutrition, and in diabetic patients; lower extremity arteriosclerosis oc- weakened or disappeared artery pulsation in distant end clusion is a systemic arterial disease, and it manifests as of lower extremities, that is, ischemic diabetes [13]. *e the appearance of atherosclerotic plaque, degeneration or other is DM foot with no obvious arteriosclerosis of the calcification of the middle layer of the tissue, and the lower extremities, that is, nonischemic diabetes. Such formation of secondary thrombosis in the lumen, which patients have no obvious symptoms of lower limb is- will eventually narrow or even completely occlude the chemia, and the pulsation of dorsal foot artery and lumen. In severe cases, ischemia in lower extremities may posterior tibial artery is also good. Clinical statistics show cause acronecrosis [15]. As per the definition, both DM that the proportion of DM foot combined with lower foot and lower extremity arterial occlusion are related to extremity arteriosclerosis occlusion is different among ischemia. When a diabetic person has lower extremity countries, regions, and races [14]. *e reason may be that arterial bleeding, whether it should be diagnosed as e arteries Proportion (%) Proportion (%) 8 Journal of Healthcare Engineering 100 100 A BC 20 Group A BC Group Class 0 Class III Class I Class IV Class II (a) (b) A BC Group Class 0 Class III Class I Class IV Class II (c) Figure 5: *e occurrence of femoral artery stenosis in each group. (a) Total number of arteries in each group. (b) *e number of arteries with stenosis in each group. (c) *e occurrence probability of arterial stenosis in each group. diabetic foot or lower extremity arteriosclerosis occlusion used mathematical sets to express it; that is, those with DM is a common problem that currently plagues clinicians foot alone and those with lower extremity arteriosclerosis [16]. If diagnosed as DM foot, it will enlarge the influence occlusion alone are in mutually independent subsets, and of DM foot and reduce the detection rate of arteriosclerosis those in the intersection have DM foot combined with occlusion; if diagnosed as lower extremity arteriosclerosis arteriosclerosis occlusion. Hence, it is important to explore occlusion, it will reduce the detection rate of DM foot the difference and connection between the two [18]. combined with lower extremity arteriosclerosis occlusion Currently, except for the diagnosis method based on the [17]. For the relationship between the two, scholars have clinical systems, the main methods to diagnose DM foot and Number of arterial Proportion (%) Proportion (%) Journal of Healthcare Engineering 9 100 100 A BC Group A BC Group Class 0 Class III Class I Class IV Class II (a) (b) A BC Group Class 0 Class III Class I Class IV Class II (c) Figure 6: *e occurrence of popliteal artery stenosis in each group. (a) Total number of arteries in each group. (b) *e number of arteries with stenosis in each group. (c) *e occurrence probability of arterial stenosis in each group. lower extremity arteriosclerosis occlusion include DSA, atherosclerosis and the location of small nonstenotic ath- MRA, CTA, and Doppler ultrasound. Among them, DSA is erosclerotic plaques. Despite many advantages, the ultra- the gold standard for peripheral blood vessel examination, sound examination is affected by reflection and random but it is invasive and expensive and thus poorly accepted by scattering, the image has large noise, and the edge of the patients. Ultrasound examination has been widely used in lesion is often blurred. To further improve the quality of clinical vascular examinations, especially the diagnosis of ultrasound images to more accurately grasp the patient’s atherosclerosis, because of its fast speed, noninvasiveness, disease information, researchers have applied various image accuracy, and simple operation. It can detect early processing techniques to ultrasound image processing, such Number of arterial Proportion (%) Proportion (%) 10 Journal of Healthcare Engineering 100 100 A BC Group A BC Group Class 0 Class III Class I Class IV Class II (a) (b) A BC Group Class 0 Class III Class I Class IV Class II (c) Figure 7: *e occurrence of anterior tibial artery stenosis in each group. (a) Total number of arteries in each group. (b) *e number of arteries with stenosis in each group. (c) *e occurrence probability of arterial stenosis in each group. as the arterial detection and tracking algorithm developed on images of all subjects. *e study found that compared with the basis of ultrasound images [19]. In this study, the ABC the original image, the processed image was clearer, and the algorithm was used to process the Doppler ultrasound lesion features were more prominent. *en, the relationship Number of arterial Proportion (%) Proportion (%) Journal of Healthcare Engineering 11 100 100 A BC Group A BC Group Class 0 Class III Class I Class IV Class II (a) (b) A BC Group Class 0 Class III Class I Class IV Class II (c) Figure 8: Occurrence of posterior tibial artery stenosis in each group. (a) Total number of arteries in each group. (b) *e number of arteries with stenosis in each group. (c) *e occurrence probability of arterial stenosis in each group. between DM foot and lower extremity arteriosclerosis extremity plaque and severe vascular stenosis compared occlusion was analyzed on the basis. *e study found that with patients with DM foot alone. *is suggested that DM patients with DM foot combined with lower extremity foot is a risk factor for lower extremity arteriosclerosis arteriosclerosis occlusion had a higher incidence of lower occlusion. Number of arterial Proportion (%) Proportion (%) 12 Journal of Healthcare Engineering 100 100 A BC Group A BC Group Class 0 Class III Class I Class IV Class II (a) (b) A BC Group Class 0 Class III Class I Class IV Class II (c) Figure 9: Occurrence of dorsal artery stenosis in each group. (a) Total number of arteries in each group. (b) *e number of arteries with stenosis in each group. (c) *e occurrence probability of arterial stenosis in each group. the prognosis of extremity arteriosclerosis occlusion. 5.Conclusion Meanwhile, an intelligent algorithm was used to process In this study, patients with DM foot combined with PDA Doppler ultrasound images. It was found that the algorithm can highlight lesion information and improve image quality, were selected, and they were analyzed for lower extremity arterial stenosis and plaque occurrence, as well as MIT with high application value and prospects. However, some thickness. *en, the correlation between DM foot and lower limitations in the study should be noted. *e sample size is extremity arteriosclerosis occlusion was explored. It was small, which will reduce the power of the study. In the found that DM foot was one of the risk factors for lower follow-up, an expanded sample size is necessary to strengthen the findings of the study. extremity arteriosclerosis occlusion, which negatively affect Number of arterial Proportion (%) Proportion (%) Journal of Healthcare Engineering 13 Chong Jian Wai Ke Za Zhi, vol. 32, no. 12, pp. 1576–1580, Data Availability [14] D. V. Kosaev, “Early outcomes of therapy and indirect re- *e data used to support the findings of this study are vascularization surgery in patients with critical ischemia of available from the corresponding author upon request. lower extremities,” Khirurgiya. Zhurnal im. N.I. Pirogova, vol. 14, no. 8, pp. 55–60, 2020. Conflicts of Interest [15] S. H. Lai, J. Fenlon, B. B. 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Price, “Epigenetic regulators of the revascularization response to chronic arterial occlusion,” Cardiovascular Research, vol. 115, no. 4, pp. 701–712, 2019. [10] Z. Lv, X. Li, and W. Li, “Virtual reality geographical interactive scene semantics research for immersive geography learning,” Neurocomputing, vol. 254, pp. 71–78, 2017. [11] J. A. Barnes, M. A. Eid, M. A. Creager, and P. P. Goodney, “Epidemiology and risk of amputation in patients with dia- betes mellitus and peripheral artery disease,” Arteriosclerosis, 8rombosis, and Vascular Biology, vol. 40, no. 8, pp. 1808– 1817, 2020. [12] Y. Shimada, N. Kino, D. Tonomura et al., “Efficacy of cutting balloon angioplasty for chronic total occlusion of femo- ropopliteal arteries,” Annals of Vascular Surgery, vol. 58, pp. 91–100, 2019. [13] B. Wang, W. Liu, Y. Huo et al., “Application of femoral- femoral artery bypass grafting combined with transverse tibial bone transporting for lower extremity arteriosclerosis oblit- erans or combined with diabetic foot,” Zhongguo Xiu Fu http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Healthcare Engineering Hindawi Publishing Corporation

Intelligent Algorithm-Based Analysis on Ultrasound Image Characteristics of Patients with Lower Extremity Arteriosclerosis Occlusion and Its Correlation with Diabetic Mellitus Foot

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Hindawi Publishing Corporation
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Copyright © 2021 YunShuang Wu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Journal of Healthcare Engineering Volume 2021, Article ID 7758206, 13 pages https://doi.org/10.1155/2021/7758206 Research Article Intelligent Algorithm-Based Analysis on Ultrasound Image Characteristics of Patients with Lower Extremity Arteriosclerosis Occlusion and Its Correlation with Diabetic Mellitus Foot 1 2 3 YunShuang Wu , Yan Shen , and Hailing Sun Department of Ultrasound, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Affiliated with Nanjing University of Chinese Medicine, Nanjing 210014, Jiangsu, China Department of Ultrasound, Lianshui County People’s Hospital, Lianshui, Huai’an 223400, Jiangsu, China Department of Ultrasound, Hongze District People’s Hospital, Huai’an 223100, Jiangsu, China Correspondence should be addressed to Hailing Sun; fsyy00102@njucm.edu.cn Received 28 June 2021; Revised 5 September 2021; Accepted 9 September 2021; Published 26 September 2021 Academic Editor: Enas Abdulhay Copyright © 2021 YunShuang Wu et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. *e study focused on the correlation between lower extremity arteriosclerosis and diabetic mellitus (DM) foot, and it was explored by virtue of ultrasound images processed by an intelligent algorithm. Methods. A total of 60 DM foot patients admitted to our hospital in the past three years were selected and divided into two groups according to their condition. Patients with DM foot alone were in group B (30 cases), and patients with DM foot combined with lower extremity arteriosclerosis occlusion were in group C (30 cases). 30 healthy people were in group A as a control. Color Doppler ultrasound was used to examine the arteries of the lower extremities of all subjects. It the intramedia thickness (IMT) from the femoral artery to the dorsal foot artery was recorded, whether there was plaque in the artery or knowing the size of the plaque, its echo, and distribution, and whether the artery had stenosis. Next, the stenosis percentage was calculated. Additionally, the general information of patients was analyzed. At the same time, an intelligent algorithm was used to process ultrasound images, and its effects on image quality were evaluated. Results. Doppler ultrasound images processed by Artificial Bee Colony (ABC) had less noise and better quality, and key information about the lesion was clearly displayed. *ere was no statistical difference between the general data of the three groups of patients; group B and group C had higher IMT value, plaque incidence, arterial stenosis incidence, and degree of stenosis versus group A, and there were statistically significant differences between groups B and C. In particular, the incidence of femoral artery stenosis and the degree of stenosis were significantly higher in group C than in group B. *e rate of stenosis above grade I in group C was as high as 71%, while that in group B was only 19%; in Group C, the incidence of stenosis above grade II was 30%, and that in group B was 13.1%. Compared with group A, group B and group C had decreased peak arterial blood velocity (PSV), resistance index (RI), and pulse index (PI), and there were statistically significant differences between groups B and C.Conclusion. DM foot is a risk factor for arteriosclerosis occlusion; color Doppler ultrasound demonstrates good diagnostic effects on arteriosclerosis occlusion; the algorithm proposed in this study can improve the quality of Doppler ultrasound images and has a high application value. tumors and cardiovascular diseases. DM foot is a common 1.Introduction complication of DM patients. Statistics show that 15% of In recent years, with the continuous improvement of peo- DM patients worldwide have foot ulcers and gangrene [2]. ple’s living standards and changes in dietary structure, the 50% of patients with amputation each year are DM patients, incidence of diabetes mellitus (DM) foot has been increasing and more than 85% of these patients are amputated because year by year [1]. It is the third most common disease after of worsening foot ulcers leading to deep infection or 2 Journal of Healthcare Engineering image processing technologies have also been developed, such gangrene. Domestic clinical data show that DM foot patients account for 2% of outpatients and 8% to 12% of inpatients. as the arterial detection and tracking algorithm developed on the basis of ultrasound imaging, various ultrasonic 3D re- *e per capita treatment cost for DM foot is more than 10,000 yuan. Worldwide, the incidence of DM foot is high, construction algorithms, and computer-aided diagnostic and the prognosis is poor [3]. systems. At present, the most widely used feature extraction As for why DM patients develop DM foot, it may be and classification method in the field of medical image related to the influence of DM on the cardiac and cerebral processing is the support vector machine. However, a large vessels. To some extent, DM can be regarded as a cardio- number of studies have shown that support vector machines vascular and cerebrovascular disease and affects almost every are susceptible to extreme values in data classification and training. *erefore, in this article, the Artificial Bee Colony blood vessel. *e abnormal metabolism caused by DM can lead to changes in the structure and functions of arteries. (ABC) was used to perform noise reduction and feature extraction on the ultrasound images of diabetes and arte- *ese changes occur even before DM is diagnosed [4]. Peripheral arterial disease (PAD) is common in DM pa- riosclerosis occlusion [10], aiming to provide a scientific basis for the diagnosis and treatment of related diseases. tients. It is a lower extremity occlusive disease, and its clinical symptoms are not obvious. PAD is an important indicator of thrombotic diseases of arteriosclerosis [5]. 2. Materials and Methods Statistics reveal that more than 40% of PAD patients suffer from DM, and DM is the strongest threat factor for PAD. 2.1. Research Subjects. 60 patients with DM foot and DM foot combined with lower extremity arteriosclerosis occlu- Unlike PAD caused by other factors, DM is closely related to femoral-popliteal PAD and tibial artery PAD (below the sion who were hospitalized in the hospital from March 2019 to June 2019 were selected as the research subjects. 30 knee). *e DM foot arises from lower limb ischemia caused by arteriosclerosis occlusion [6]. Above, there is a huge healthy subjects were selected into group A as a control. *e 30 subjects in group B were patients with DM foot alone. *e correlation between DM foot and lower extremity arterio- sclerosis occlusion. *ere are many commonalities but are diagnostic criteria of DM foot were based on the standards drawn up by the first DM foot academic conference of the different. Research has found that patients with both PAD and DM foot have a more complicated condition than Chinese Medical Association Diabetes Mellitus Society. *e patients with one of them alone, and the probability of 30 subjects in group C were patients with DM foot and lower extremity arteriosclerosis occlusion. *e diagnostic criteria cardiovascular diseases is greatly increased [7]. At present, the relationship between the two remains unclear. In the for lower extremity arteriosclerosis occlusion were as fol- lows. (1) *ose with intermittent claudication; resting pain; study, the correlation between the two was explored, in order to provide reference and basis for clinical research. soreness, swelling, numbness, and numbness (patients with one or more of them was included); dystrophic changes in At present, the methods to diagnose lower extremity arteriosclerosis occlusion mainly include digital subtraction skin, hair, muscles, and nails; and ulcers or gangrene were included. (2) *e affected swelled and the pulsation of the angiography (DSA), magnetic resonance angiography (MRA), CT angiography (CTA), and Doppler ultrasound. middle artery was weakened or disappeared. (3) *ose with Among them, DSA is the recognized gold standard for sclerosis changes on fundus examination; electrocardiogram peripheral vascular examination, but it is often not easily showing coronary artery ischemia, left ventricular hyper- accepted by patients because it is invasive and expensive. As trophy, or old myocardial infarction; and Doppler or an- giography showing limb arteriosclerosis were also included. ultrasound technology marches forward continuously, it has been widely used in the detection of vascular diseases, es- *e subjects were 62 × 6.5 years old on average, including 44 males and 46 females. All subjects need to be free of coronary pecially in the research of atherosclerosis, because of its advantages, such as noninvasive, fast, efficient, safe, and heart disease, hyperlipidemia, and other cardiovascular and cerebrovascular diseases, with no long-term smoking his- accurate [8]. Statistics show that the accuracy of ultrasound examination for intraplaque hemorrhage is 90% and the tory. *e study met the requirements of medical ethics and the patients had signed an inform consent form. sensitivity is 96%. B-mode ultrasound can display the an- atomical images of the artery at longitudinal axis and at the transverse axis, providing rich information, such as artery 2.2. Examination Methods thickness, plaque shape, size, range, and lumen stenosis and occlusion. Color blood flow imaging can reflect the blood 2.2.1. Inspection Instrument. Philips iu22 color Doppler filling and distribution state, which is of great significance ultrasonic diagnostic instrument, with a linear array probe, for the evaluation of hemodynamic changes. In the early the probe frequency is 2–9 MHz. During the inspection stage of atherosclerosis, it mainly manifests as expansion of process, conditions, such as emission energy, total gain, the arterial wall or the thickening of MIT, which can be contrast, time gain compensation, and lateral gain com- observed by ultrasound scan [9]. *us, ultrasound has great pensation, need to be kept basically unchanged. advantages in the diagnosis of vascular diseases. Nevertheless, its imaging effects are poor thanks to the reflection and random scattering. As a result, it is difficult to 2.2.2. Inspection Content. *e patient stayed in the supine recognize the edges and details of the organs. Recently, In- and prone positions, and two-dimensional ultrasound scan ternet technology has developed rapidly, and some medical was performed on the femoral artery, popliteal artery, Journal of Healthcare Engineering 3 L L anterior tibial artery, posterior tibial artery, dorsal foot artery σ y � 􏽘 􏽘 y (i, j) − y . lumen, and inner membrane of both lower limbs. *e lumen 􏼁 􏼂 􏼃 (6) k k k L2 i�1 j�1 inner diameter and intramedia thickness (IMT) were measured. It was observed that there were plaques on the ′ ′ *e probability that the pixels (i , j ) with distance d, tube wall, the position of plaques, and that there was stenosis angle θ, and gray value g appear at the same time is as in the lumen. *e stenosis percentage was then calculated. follows: Color Doppler was used to observe the blood vessel filling, ′ ′ ′ ′ and spectrum Doppler was used to detect blood flow P g , g � # (i, j), i , j ∈ M × N ∣ f(i, j) � g , f i , j � g , 􏼐 􏼑 􏼈 􏼁 􏼁 􏼉 θ,d 1 2 1 2 spectrum. After a clear spectrum appeared, the blood flow (7) parameters PSV, RI, and PI were measured. During the inspection, it should be noted not to compress the artery too where #{·} represents the number of elements in the set. For much, and the angle between the sound beam and the blood the sake of simplicity, θ and d are ignored, and the matrix is flow direction should be less than 60 ; each index is mea- normalized as follows: sured 3 times, and the average value is taken. P g , g 􏼁 θ,d 1 2 (8) ⟶ P g , g 􏼁 , 1 2 2.3. Image Processing. A total of 220 ultrasound images are where R is the normalization constant and its value is the collected as research data. *en, the NL algorithm is used to total number of point pairs in the gray-level cooccurrence reduce the noise of the image. *e original noise image is matrix. CON is the contrast, and it can reflect the clarity and M×N Y ∈ R , and the image NL(Y) after noise reduction was texture of the image. A greater grayscale difference of the M×N pixel pair value leads to a greater value of CON: NL(Y(p)) � 􏽘 w(p, q) � 1, (1) N −1 N −1 g g 􏼌 􏼌 q�1 􏼌 􏼌2 􏼌 􏼌 CON � 􏽘 􏽘 􏼌g − g 􏼌 p g − g 􏼁 . (9) 1 2 1 2 g �0 g �0 1 2 where p are the pixels to be denoised and q are the other pixels. w(p, q) is the weight, 0≤ w(p, q)≤ 1, and Entropy ENT can be a measure of the complexity of the M×N 􏽐 w(p, q) � 1. *e calculation of w(p, q) is as follows: q�1 image texture, and it is calculated as follows: N −1 N −1 g g 1 d(p, q) w(p, q) � exp − . (2) 􏼠 􏼡 ENT � − 􏽘 􏽘 P g , g 􏼁 log􏼂 P g , g 􏼁􏼃 . (10) Z(p) 1 2 1 2 g �0 g �0 1 2 *en, the weighted Gaussian distance is used to judge the *e linear dependence of the image gray level depends similarity: on COR: � 2 � � N −1 N −1 � � (3) g g d(p, q) � G g􏼐N 􏼑 − g􏼐N 􏼑 , p� p q � 􏽐 􏽐 g g P g , g 􏼁 − μ μ g �0 g �0 1 2 1 2 g g 1 2 1 2 (11) COR � . σ σ g g where G is the Gaussian weighting function and Z(p) is the 1 2 normalization parameter: Energy ENG can reflect the uniformity of the image gray M×N distribution and the thickness of the texture: d(p, q) Z(p) � 􏽘 exp􏼠− 􏼡, (4) 2 N −1 N −1 g g q�1 ENG � − 􏽘 􏽘 p g , g . (12) 1 2 g �0 g �0 1 2 where h are the attenuation control parameters. *is al- gorithm has good noise reduction effects but long calcula- tion time. In order to reduce the amount of calculation and shorten the calculation time, the search range is controlled in 2.4.ObservationIndicators. *e measurement of intramedia the large search box of (2 × R + 1) × (2 × R + 1). thickness (IMT) takes the average value of the left and right search search sides, and the thickest part of the arterial wall is measured in the diastolic phase of each segment of the lower limbs. It 2.3.1. Feature Extraction. *e ultrasonic image features are should be noted to be away from the plaque position during divided into basic texture features and gray-level cooccur- the measurement. IMT ≤ 0.9 mm is the normal value, and rence matrix features. *e gray mean value of the k subblock IMT> 0.9 mm is the thickened IMT. Plaque is defined as: is defined as localized thickening of blood vessel wall greater than 1.2 mm or diffuse thickening of blood vessel greater than 1.2 mm. L L *e calculation of vascular stenosis rate depends on the y � 􏽘 􏽘 􏼂y (i, j) − y 􏼃 . (5) k k k L2 i�1 j�1 percentage reduction of inner diameter: vascular stenosis rate � ((d −d )/d ) × 100% (d is the inner diameter of the 2 1 2 1 *e gray-level variance σ (y ) of the k subblock is lumen at the stenosis and d is the original inner diameter of defined as follows: the lumen). *e grades of stenosis were as follows: grade 0, 4 Journal of Healthcare Engineering Table 1: *e basic information of subjects. no stenosis; grade I, stenosis rate 1%∼19%; grade II, stenosis 20%∼49%; grade III, stenosis 50%∼99%; grade IV, occlusion, Item A (30 cases) B (30 cases) C (30 cases) Case 30 30 30 no blood flow information. If there are multiple plaques or Age (year) 65.1± 6.8 66.2± 5.4 64.2± 5.9 stenosis in the same segment of blood vessel, the most severe Male 16 18 17 part of the stenosis shall prevail. Gender Female 14 12 13 Proportion of 16 15.1 15.3 smokers (%) 2.5.Statistics. *e data was processed by SPSS 17.0 software. TC (mol/L) 4.66± 1.08 4.55± 1.13 4.61± 1.14 *e measurement data were expressed as (x ± s). *e TG (mol/L) 2.06± 1.16 2.08± 1.12 4.07± 1.19 comparison of data between groups adopted analysis of variance, and the x test was used to test the count data. P< 0.05 was the threshold for significance. and C decreased, and the difference was statistically sig- nificant, P< 0.05, and the decrease in group B was more 3.Results obvious versus group C, and the difference was statistically significant, P< 0.05. 3.1.8eBasicInformationofSubjects. *e basic information of the subjects was shown in Table 1. *e average ages of A, B, and C groups were 65.1± 6.8, 66.2± 5.4, and 64.2± 5.9, 3.4.Occurrence andDistributionof AtheroscleroticPlaquesin respectively. *e number of male subjects in the three the Lower Extremities of Each Group. Two-dimensional groups was 16, 18, and 17, respectively, and the number of ultrasound results showed that the intima surface of the female subjects was 14, 12, and 13, respectively; the pro- lower extremity arteries in groups B and C were not portions of smokers in each group were 16%, 15.1%, and smooth, and there were patches or dots with localized or 15.3%. It was noted that there was no significant difference diffuse distribution and uneven echo. *e plaques at the between the general data of the three groups of subjects and femoral artery were mostly single and large in volume. *e it was comparable. plaques were often found at the bifurcation. *e plaques of the popliteal artery, anterior tibial, posterior tibial, and dorsal foot artery were mostly diffusely distributed dots 3.2. Ultrasound Images and Processing Results. *e original echoes and small in volume. Figure 4 showed the plaque ultrasound image and the processed image were shown in incidence in each group, where (a) was the total number of Figure 1. From column A in Figure 1, it was noted that arteries, (b) was the number of plaque arteries in each although Doppler color ultrasound can reflect the arterial arterial segment, and (c) was the probability of plaque in thickness, plaque shape, size, range, luminal stenosis and each arterial segment. Compared with A, the incidence of occlusion, blood flow filling, and other information in a plaque in the lower limb femoral artery, popliteal artery, comprehensive and detailed manner, the figure had much anterior tibial artery, posterior tibial artery, and dorsal foot noise, with poor clarity and quality. It failed to show the artery in the groups B and C was higher, P< 0.05, and the edge and detailed information of diseased parts and tissue. difference was statistically significant. *e incidence of As for column B in Figure 1, the clarity of the image was arterial plaque in each segment of the C group was higher improved a lot, and the noise has also been reduced. At the than that of the B group, and the difference was statistically same time, the key information of the disease was extracted, significant, P< 0.05. and the redundant information was removed that had nothing to do with the disease, to highlight the focus of the disease. 3.5. Occurrence of Arteriosclerosis and Stenosis of the Lower Extremities. Two-dimensional ultrasound results showed 3.3.8eIntramedia8icknessandHemodynamicTestResults that the arterial intima of the lower extremities of the two groups B and C showed varying degrees of thickening and of the Lower Extremity Arteries of Each Group. *e IMT measurement results of both lower limbs in the three groups plaques of different sizes and irregular shapes protruding into the lumen, resulting in varying degrees of stenosis of the were shown in Figure 2. Compared with group A, subjects in groups B and C had thicker IMT in the lower limb femoral vascular lumen. Figures 5–9 showed the occurrence and artery, popliteal artery, anterior tibial artery, posterior tibial distribution of stenosis in each group. Compared with group artery, and dorsal foot artery, and the difference was sta- A, the lower extremity arterial stenosis rate of groups B and tistically significant, P< 0.05. *e thickening of IMT in C was higher, and the difference was statistically significant, group C was more obvious versus group B, and the dif- P< 0.05. *e incidence of stenosis in of group C was higher ference was statistically significant, P< 0.05. than that of group B, and the difference was statistically *e hemodynamic results of each group were shown in significant, P< 0.05. In particular, the incidence of femoral Figure 3. *e test indicators included peak systolic velocity artery stenosis and the degree of stenosis was higher in group C than in group B. *e stenosis rate of grade I and above in (PSV), resistance index (RI), and pulse index (PI), and the detection was located in femoral artery, popliteal artery, group C was as high as 71%, while that in group B was only 19%; in group C, the stenosis rate of grade II and above was anterior tibial artery, posterior tibial artery, and dorsal foot artery. Compared with group A, PSV, RI, and PI of groups B 30%, and that in group B was 13.1%. Journal of Healthcare Engineering 5 (a) (b) Figure 1: Comparison of the original ultrasound image and the processed image. Note. (a) *e original image and (b) the processed image. 1.5 1.2 ∗# ∗# ∗# ∗# ∗# 0.9 0.6 0.3 A BC Group Femoral artery Popliteal artery Tibial artery before Posterior tibial artery Dorsalis pedisartery Figure 2: Comparison of intramedia thickness results of each group. Note. Compared with group A, P< 0.05; compared with group B, P< 0.05. incidence of diabetes continues to rise [11]. DM foot is one 4.Discussion of the most common complications of diabetes [12]. Studies In China, diabetes is a common disease that threatens the have shown that 15 out of every 100 diabetic patients will lives and health of people. With the development of suffer from DM foot. Clinical data show that diabetes is the economy and the gradual westernization of lifestyle, the culprit of 50% of amputation patients every year. In general, IMT (mm) 6 Journal of Healthcare Engineering 120 100 ∗# ∗# ∗# ∗# ∗ ∗# ∗ ∗# A BC A BC Group Group PSV (CM/S) PSV (CM/S) RI RI PI PI (a) (b) 80 80 ∗# 60 60 ∗# ∗# ∗# ∗ ∗# ∗ ∗# A BC A BC Group Group PSV (CM/S) PSV (CM/S) RI RI PI PI (c) (d) ∗# ∗# ∗ ∗# A BC Group PSV (CM/S) RI PI (e) ∗ # Figure 3: Hemodynamic examination results of each group. Note. Compared with group A, P< 0.05; compared with group B, P< 0.05. (a) Femoral artery. (b) Popliteal artery. (c) Tibial artery before. (d) Posterior tibial artery. (e) Dorsalis pedis artery. Value Value Value Value Value Journal of Healthcare Engineering 7 80 80 ∗# ∗# ∗# ∗# ∗# A BC A BC Group Group Femoral artery Dorsalis pedisartery Posterior tibial artery Tibial artery before Popliteal artery (a) (b) ∗# ∗# ∗# ∗# ∗ ∗# A BC Group Femoral artery Dorsalis pedisartery Posterior tibial artery Tibial artery before Popliteal artery (c) Figure 4: *e occurrence and distribution of atherosclerotic plaques in the lower extremities of each group. Note. Compared with group A, ∗ # P< 0.05; compared with group B, P< 0.05. DM foot can be divided into two types. One is DM foot we have different definitions of the two diseases, which has combined with lower extremity arteriosclerosis occlusion, caused ambiguity. *e international definitions of DM with the lower extremity arteriosclerosis being the main foot and fine arteriosclerosis occlusion are as follows. DM pathological change. It manifests as the coldness of the foot refers to the foot ischemia, infection, or neuropathy lower extremities, numbness, poor skin nutrition, and in diabetic patients; lower extremity arteriosclerosis oc- weakened or disappeared artery pulsation in distant end clusion is a systemic arterial disease, and it manifests as of lower extremities, that is, ischemic diabetes [13]. *e the appearance of atherosclerotic plaque, degeneration or other is DM foot with no obvious arteriosclerosis of the calcification of the middle layer of the tissue, and the lower extremities, that is, nonischemic diabetes. Such formation of secondary thrombosis in the lumen, which patients have no obvious symptoms of lower limb is- will eventually narrow or even completely occlude the chemia, and the pulsation of dorsal foot artery and lumen. In severe cases, ischemia in lower extremities may posterior tibial artery is also good. Clinical statistics show cause acronecrosis [15]. As per the definition, both DM that the proportion of DM foot combined with lower foot and lower extremity arterial occlusion are related to extremity arteriosclerosis occlusion is different among ischemia. When a diabetic person has lower extremity countries, regions, and races [14]. *e reason may be that arterial bleeding, whether it should be diagnosed as e arteries Proportion (%) Proportion (%) 8 Journal of Healthcare Engineering 100 100 A BC 20 Group A BC Group Class 0 Class III Class I Class IV Class II (a) (b) A BC Group Class 0 Class III Class I Class IV Class II (c) Figure 5: *e occurrence of femoral artery stenosis in each group. (a) Total number of arteries in each group. (b) *e number of arteries with stenosis in each group. (c) *e occurrence probability of arterial stenosis in each group. diabetic foot or lower extremity arteriosclerosis occlusion used mathematical sets to express it; that is, those with DM is a common problem that currently plagues clinicians foot alone and those with lower extremity arteriosclerosis [16]. If diagnosed as DM foot, it will enlarge the influence occlusion alone are in mutually independent subsets, and of DM foot and reduce the detection rate of arteriosclerosis those in the intersection have DM foot combined with occlusion; if diagnosed as lower extremity arteriosclerosis arteriosclerosis occlusion. Hence, it is important to explore occlusion, it will reduce the detection rate of DM foot the difference and connection between the two [18]. combined with lower extremity arteriosclerosis occlusion Currently, except for the diagnosis method based on the [17]. For the relationship between the two, scholars have clinical systems, the main methods to diagnose DM foot and Number of arterial Proportion (%) Proportion (%) Journal of Healthcare Engineering 9 100 100 A BC Group A BC Group Class 0 Class III Class I Class IV Class II (a) (b) A BC Group Class 0 Class III Class I Class IV Class II (c) Figure 6: *e occurrence of popliteal artery stenosis in each group. (a) Total number of arteries in each group. (b) *e number of arteries with stenosis in each group. (c) *e occurrence probability of arterial stenosis in each group. lower extremity arteriosclerosis occlusion include DSA, atherosclerosis and the location of small nonstenotic ath- MRA, CTA, and Doppler ultrasound. Among them, DSA is erosclerotic plaques. Despite many advantages, the ultra- the gold standard for peripheral blood vessel examination, sound examination is affected by reflection and random but it is invasive and expensive and thus poorly accepted by scattering, the image has large noise, and the edge of the patients. Ultrasound examination has been widely used in lesion is often blurred. To further improve the quality of clinical vascular examinations, especially the diagnosis of ultrasound images to more accurately grasp the patient’s atherosclerosis, because of its fast speed, noninvasiveness, disease information, researchers have applied various image accuracy, and simple operation. It can detect early processing techniques to ultrasound image processing, such Number of arterial Proportion (%) Proportion (%) 10 Journal of Healthcare Engineering 100 100 A BC Group A BC Group Class 0 Class III Class I Class IV Class II (a) (b) A BC Group Class 0 Class III Class I Class IV Class II (c) Figure 7: *e occurrence of anterior tibial artery stenosis in each group. (a) Total number of arteries in each group. (b) *e number of arteries with stenosis in each group. (c) *e occurrence probability of arterial stenosis in each group. as the arterial detection and tracking algorithm developed on images of all subjects. *e study found that compared with the basis of ultrasound images [19]. In this study, the ABC the original image, the processed image was clearer, and the algorithm was used to process the Doppler ultrasound lesion features were more prominent. *en, the relationship Number of arterial Proportion (%) Proportion (%) Journal of Healthcare Engineering 11 100 100 A BC Group A BC Group Class 0 Class III Class I Class IV Class II (a) (b) A BC Group Class 0 Class III Class I Class IV Class II (c) Figure 8: Occurrence of posterior tibial artery stenosis in each group. (a) Total number of arteries in each group. (b) *e number of arteries with stenosis in each group. (c) *e occurrence probability of arterial stenosis in each group. between DM foot and lower extremity arteriosclerosis extremity plaque and severe vascular stenosis compared occlusion was analyzed on the basis. *e study found that with patients with DM foot alone. *is suggested that DM patients with DM foot combined with lower extremity foot is a risk factor for lower extremity arteriosclerosis arteriosclerosis occlusion had a higher incidence of lower occlusion. Number of arterial Proportion (%) Proportion (%) 12 Journal of Healthcare Engineering 100 100 A BC Group A BC Group Class 0 Class III Class I Class IV Class II (a) (b) A BC Group Class 0 Class III Class I Class IV Class II (c) Figure 9: Occurrence of dorsal artery stenosis in each group. (a) Total number of arteries in each group. (b) *e number of arteries with stenosis in each group. (c) *e occurrence probability of arterial stenosis in each group. the prognosis of extremity arteriosclerosis occlusion. 5.Conclusion Meanwhile, an intelligent algorithm was used to process In this study, patients with DM foot combined with PDA Doppler ultrasound images. It was found that the algorithm can highlight lesion information and improve image quality, were selected, and they were analyzed for lower extremity arterial stenosis and plaque occurrence, as well as MIT with high application value and prospects. However, some thickness. *en, the correlation between DM foot and lower limitations in the study should be noted. *e sample size is extremity arteriosclerosis occlusion was explored. It was small, which will reduce the power of the study. In the found that DM foot was one of the risk factors for lower follow-up, an expanded sample size is necessary to strengthen the findings of the study. extremity arteriosclerosis occlusion, which negatively affect Number of arterial Proportion (%) Proportion (%) Journal of Healthcare Engineering 13 Chong Jian Wai Ke Za Zhi, vol. 32, no. 12, pp. 1576–1580, Data Availability [14] D. V. Kosaev, “Early outcomes of therapy and indirect re- *e data used to support the findings of this study are vascularization surgery in patients with critical ischemia of available from the corresponding author upon request. lower extremities,” Khirurgiya. Zhurnal im. N.I. Pirogova, vol. 14, no. 8, pp. 55–60, 2020. Conflicts of Interest [15] S. H. Lai, J. Fenlon, B. B. 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Journal of Healthcare EngineeringHindawi Publishing Corporation

Published: Sep 26, 2021

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