彩色多普勒超声在下肢静脉病变中的诊断效率与误诊分析  

Efficiency of color Doppler imaging in evaluating lower extremity vein diseases and analysis of misdiagnosis

作　　者：熊建群[1] 王莉[1] 余琛[1] 李应华[1] 张勤勤[1] 

机构地区：[1]广州医学院第二附属医院超声科,广东广州510260

出　　处：《中国医学影像技术》2012年第1期121-124,共4页Chinese Journal of Medical Imaging Technology

基　　金：广东省科技厅科研立项项目(2011B031800391)

摘　　要：目的评价彩色多普勒显像(CDI)对不同节段下肢静脉血栓、侧支循环形成及瓣膜功能不全的诊断效率。方法将80例患者90条静脉分为髂静脉段、股-腘静脉段、胫-腓静脉段共270个节段,并与X线静脉造影对照,分析CDI对各节段静脉血栓、侧支循环形成及瓣膜功能不全的诊断效率,分析漏、误诊原因。结果 CDI诊断髂静脉段、股-腘静脉段、胫-腓静脉段深静脉血栓、侧支循环形成、瓣膜功能不全的敏感度分别为83.33%(20/24)、94.59%(35/37)、77.78%(21/27)、66.67%(8/12)、84.09%(37/44);特异度分别为76.47%(13/17)、94.34%(50/53)、90.48%(57/63)、93.59%(73/78)、91.30%(42/46);准确率分别为80.49%(33/41)、94.44%(85/90)、77.78%(78/90)、90.00%(81/90)、87.78%(79/90);阳性预测值分别为83.33%(20/24)、92.11%(35/38)、86.67%(21/27)、61.54%(8/13)、90.24%(37/41)。髂静脉段血栓漏、误诊8条,股-腘静脉段血栓漏、误诊5条,均为急性、部分栓塞。胫-腓静脉段血栓漏、误诊12条,11例为急性、完全栓塞,1例为慢性、部分栓塞。结论 CDI诊断股-腘静脉段血栓的敏感度、特异度高于髂静脉、胫-腓静脉段。尽管CDI对侧支循环形成的敏感度和阳性预测值较低,但特异度和准确度较高。急性栓塞较易造成漏、误诊。Objective To observe the efficiency of color Doppler imaging（CDI） in the diagnosis of different parts of lower deep vein thrombus（DVT）,as well as collateral circulation formation and valve dysfunction.Methods Totally 90 veins of 80 patients underwent CDI and venography,and were divided into 270 segments of iliac,femoral and popliteal,tibial and peroneal veins segments.The diagnostic efficiency of CDI for different segments of lower DVT,venous insufficiency and collateral circulation were analyzed,and the causes for misdiagnosis were analyzed.Results The sensitivity was 83.33%（20/24）,94.59%（35/37）,77.78%（21/27）,specificity was 76.47%（13/17）,94.34%（50/53）,90.48%（57/63）,accuracy was 80.49%（33/41）,94.44%（85/90）,77.78%（78/90）,positive predictive value was 83.33%（20/24）,92.11%（35/38）,86.67%（21/27）,respectively for CDI in diagnosing thrombosis of iliac,femoral and popliteal,tibial and peroneal veins segments.For collateral circulation and venous insufficiency,the sensitivity was 66.67%（8/12） and 84.09%（37/44）,specificity was 93.59%（73/78） and 91.30%（42/46）,accuracy was 90.00%（81/90）,and 87.78%（79/90）,the positive predictive value was 61.54%（8/13） and 90.24%（37/41）,respectively.Eight iliac DVT and 5 femoral and popliteal veins segments thrombus were misdiagnosed,all were acute and partial DVT.For tibial and peroneal veins segments,12 veins with thrombus were misdiagnosed,of which 11 were acute and complete,1 was chronic and partial thrombus.Conclusion CDI is more sensitive and specific for DVT of femoral and popliteal veins than of iliac,tibial and peroneal veins. CDI has high specific and accuracy for collateral circulation,though its sensitivity and PPV is relatively low.Acute DVT trends to be misdiagnosed by CDI.

关 键 词：下肢静脉 超声检查 多普勒 彩色 静脉造影术 

分 类 号：R543.6[医药卫生—心血管疾病] R445.1[医药卫生—内科学]