间接下肢CT静脉成像对下肢深静脉血栓的诊断价值  

The diagnostic value of indirect lower limb CT venography in the lower extremity deep venous thrombosis

作　　者：朱力[1] 郭佑民[1] 王建国[2] 郭晓娟[3] 刘敏[3] 郭玉林[4] 

机构地区：[1]西安交通大学医学院第二医院影像中心,710004 [2]深圳市第五人民医院放射科 [3]首都医科大学附属北京朝阳医院放射科 [4]宁夏医科大学附属医院放射科

出　　处：《中华放射学杂志》2009年第9期948-952,共5页Chinese Journal of Radiology

基　　金：国家“十一五”科技攻关项目资助（2006BA101A06）

摘　　要：目的评价间接下肢CT静脉成像（CTV）对下肢深静脉血栓（DVT）的诊断价值。方法回顾性分析516例经影像学方法诊断为急性肺栓塞（PTE）患者的CT肺动脉成像（CTPA）资料，结合间接下肢CTV和下肢静脉加压超声检查，以下肢静脉加压超声检查结果为参照标准，计算间接下肢CaW诊断DVT的敏感性、特异性、阳性预测值和阴性预测值；评价两种方法对DVT显示的一致性，采用Kappa检验对数据进行分析。结果516例急性VIE患者中同时行CTPA联合CTV和下肢静脉超声检查者共110例，CTV和下肢超声检查均发现下肢静脉内栓子48例，两者结果均为阴性39例，CTV结果阳性而下肢超声结果阴性13例，下肢超声结果阳性而CTV结果阴性10例。CTV诊断下肢DVT的敏感性为82．8％（48／58）、特异性为75．O％（39／52）、阳性预测值为78．7％（48／61）、阴性预测值为79．6％（39／49）；下肢CaW和下肢静脉加压超声检查对显示股胴静脉内血栓的一致性较好（CTV分别显示了62和52个血栓，超声分别显示了67和51个血栓；Kappa=0．874～0．914，P值均为0．000），对小腿静脉内血栓的一致性降低（CTV分别显示了6、25和13个血栓，超声分别显示了13、38和19个血栓；Kappa=0．464～0．584，P值均为0．000），对髂外静脉内血栓的一致性较差（CTV显示了33个血栓，超声显示了17个血栓；Kappa=0．230～0．262，P值分别为0．067和0．004）。结论CTV对诊断下肢深静脉血栓具有较高的准确性。CTPA联合CTV可以1次同时完成肺动脉和下肢静脉检查，CTV可以更准确、方便地检出盆腔静脉内血栓。Objective To evaluate indirect CT venography （CTV） in the diagnosis of deep venous thrombosis （DVT）. Methods A total of 516 acute pulmonary embolism patients proved by objective test were analyzed retrospectively. Using the results of lower limb compression sonography as reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of indirect CTV were calculated. The agreement between lower extremity venous sonography and indirect CTV were assessed by Kappa analysis. Results Among 516 patients with acute pulmonary thromboembolism （PTE）, 110 patients underwent both CTV and CTPA and lower extremity sonography. DVT were detected by CTV and sonography simultaneously in 48 patients, while no DVT was detected in 39 patients by both examinations. Thirteen patients were diagnosed to have DVT by CTV without sonography detection, and DVT was detected in other 10 patients only by sonography. The sensitivity, specificity, positive predictive value and negative predictive value of indirect CTV was 82. 8% （48/58）, 75.0% （39/52）, 78.7% （48/61） and 79.6% （39/49）. The agreement between lower extremity venous sonography and indirect CTV was good for femoropopliteal vein （Kappa value range from 0. 874 to 0.914, P = 0.000）. Thrombi detected by CTV were 62 and 52 respectively, and for sonography were 67 and 51 respectively. For calf veins, the agreement decreased （Kappa value range from 0. 464 to 0. 584, P = 0. 000 ） . Thrombi detected by CTV were 6, 25 and 13 respectively, and for sonography were 13, 38 and 19 respectively. The agreement for external iliac vein was poor（Kappa value range from 0. 230 to 0. 262 ,P =0. 067 and 0. 004 ,respectively）. Thrombi detected by CTV were 33, and for sonography were 17. Conclusions The indirect CTV has high accuracy in the diagnosis of DVT. Combined CTPA and CTV can image pulmonary arteries and lower extremity veins in one examination. Indirect CTV can reveal thrombus in large pelvic veins, which has an advantage

关 键 词：下肢 静脉血栓形成 静脉造影术 体层摄影术 X线计算机 超声检查 

分 类 号：R686[医药卫生—骨科学]