多层螺旋CT肺动脉造影联合静脉造影诊断深静脉血栓的研究  

Diagnostic Value of Combined Multislice Spiral CT Venography and Pulmonary Angiography in Deep Venous Thrombosis

作　　者：张燕[1] 金征宇[1] 齐振红[1] 张竹花[1] 赵文敏[1] 王沄[1] 朱海峰[1] 梁继祥[1] 王林辉[1] 齐冰[1] 陆菁菁[1] 薛华丹[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院放射科,北京100730

出　　处：《实用放射学杂志》2006年第5期577-580,共4页Journal of Practical Radiology

摘　　要：目的应用16层螺旋CT肺动脉造影联合静脉造影(CTVPA)探讨深静脉血栓发生率及部位,并与下肢彩色超声多普勒对照评价其诊断下肢深静脉血栓(DVT)的价值。方法临床怀疑肺栓塞(PE)的147例病人行CTVPA检查,以病人为单位计算两医师诊断DVT一致性;102例患者同时行下肢超声检查,计算股静脉-腘静脉段DVT诊断敏感度、特异度、阳性预测值、阴性预测值。结果147例患者中33例(22.4%)有DVT,27例合并PE。33例DVT的患者CTV共发现156个部位的血栓,腹盆腔静脉血栓共48个(31%),股静脉-腘静脉段血栓58个(37%),小腿静脉血栓50个(32%)。DVT血栓CT值为(42±13)HU。2医师诊断DVT的一致率为90%,Kappa值为0.86。以超声作为对照,CTV诊断股静脉-腘静脉段DVT的敏感度为92.3%,特异度为100%。结论CTV对股静脉-腘静脉段DVT诊断准确率高,并能显示下腔静脉、滤器内及盆腔静脉血栓,CTV的观察者间诊断一致性非常好。Objective To study the incidence and locations of deep venous thrombosis（DVT） by using 16 - slice spiral CT venography in combination with pulmonary angiography （ CTVPA ）. The accuracy of DVT in lower extremities by CT venography （ CTV ） was compared with color Doppler ultrasound. Methods 147 patinets with clinically suspected pulmonary embolism underwent CTVPA. The interobserver agreement in two doctors were assessed based on a patient as unit in diagnosing DVT. The results of CTV were compared with the ultrasonic results of DVT in lower extremities. Results DVT were diagnosed in 33 patients, among .which 27 patients had been combined PTE and 6 patients without PTE. 156 thrombi were detected in 33 patients, among which 48 thrombi （31%） were located in abdominal and pelvic veins, 58 thrombi （ 37% ） were located in femoropopliteal veins and the other 50 thrombi （ 32% ） were located in the calf veins . The CT value of DVT was （42±13 ） HU. Agreement of diagnosis was achieved in 90% patients. The Kappa was 0.86. The sensitivity and specificity were 92.3% and 100% in diagnosis of femoropepliteal venous thrombosis by CTV. Conclusion CTV is an accurate method in the diagnosis of femoropopliteal venous thrombosis and can also reveal the thrombosis in the inferior vena cava, filter and iliac veins. The interobserver agreement is very good.

关 键 词：深静脉血栓 血管造影术 CT静脉血管成像 体层摄影术 X线计算机 

分 类 号：R543.2[医药卫生—心血管疾病] R814.43[医药卫生—内科学]