CT血管成像在诊断下肢深静脉血栓形成机械性阻塞原因中的作用  

Role of CT angiography in the detection of mechanical obstructive cause of deep vein thrombosis of lower extremity

作　　者：杨春霞[1] 王书智[1] 吴刚[1] 顾建平[1] 殷信道[1] 卢铃铨[1] 

机构地区：[1]南京医科大学附属南京医院南京市第一医院放射科,210006

出　　处：《中华放射学杂志》2015年第8期610-614,共5页Chinese Journal of Radiology

基　　金：南京市医学科技发展重点项目（ZKX10004）;“十二五”南京市医学科技发展重大项目（宁卫规财[2012]6号）

摘　　要：目的探讨CTA对下肢深静脉血栓形成（DVT）机械性阻塞原因的诊断价值。方法回顾性分析47例下肢DVT的CTA和DSA影像资料，患者均有下腔静脉或下肢静脉机械性阻塞。将CTA三维图像与DSA检查结果进行比较，观察血栓部位及范围、侧支循环血管、血管受压部位以及对应的血管外病变，分析静脉阻塞原因。采用Kappa检验分析CTA及DSA诊断的一致性。应用妒检验，比较CTA及DSA分别对左、右髂股静脉，下腔静脉，髂内静脉内血栓诊断的准确性。结果47例下肢DVT中左下肢28例，右下肢14例，双下肢5例。下肢DVT的机械性阻塞原因：髂静脉受压静脉综合征（IVCS）27例，左髂总静脉受到右髂总动脉的压迫，受压程度55．41％～100．00％，平均（77．1±16．8）％；下腔静脉先天性狭窄或闭塞3例；布加综合征2例；盆腔肿块压迫髂总静脉4例；右侧腹股沟增大的淋巴结压迫右股静脉3例；左侧腹股沟增大的淋巴结压迫左股静脉2例；其他机械性阻塞原因6例，右侧髂动脉瘤压迫右髂静脉1例、盆腔自发性血肿压迫左髂静脉1例、左股浅静脉狭窄2例、右侧髂静脉狭窄1例、左侧胭静脉狭窄1例。CTA与DSA对髂股血栓的诊断一致性好（Kappa=0．978），对下腔静脉血栓的诊断一致性好（Kappa=0．737），对髂内静脉血栓的诊断一致性差（Kappa=0．189）。CTA与DSA对左、右髂股静脉内血栓（分别为52、51例）的诊断差异无统计学意义（χ2=0．00，P〉0．05），对下腔静脉内血栓（分别为21、17例）的诊断差异亦无统计学意义（χ2=1．50，P〉0．05），对髂内静脉血栓（分别为14、2例）的诊断差异有统计学意义（χ2=8．33，P〈0．05）。结论CTA能清楚地显示血栓的位置、范围，与常规DSA对比有较高的诊断符合率，并且能准确诊断造成下肢DVT的机械性梗阻原因。Objective To explore the diagnostic value of the CT angiography （CTA） in the detection of mechanical obstructive cause of deep venous thrombosis of lower extremity. Methods Forty-seven cases of CTA and DSA image data of DVT in lower extremity with mechanical obstruction were retrospectively analyzed. The CTA three-dimensional reconstruction images were compared with DSA results, and the position and size of thrombus, collateral circulation of blood vessels, vascular compression area and the corresponding outside vascular lesions were evaluated. The causes of venous occlusion were analyzed. Diagnostic agreement of CTA and DSA was assessed by Kappa statistics. The difference of the accuracy between CTA and DSA in the diagnosis of the left and right iliac femoral vein, inferior vena cava, internal iliac vein thrombosis were analyzed with X2 test. Results There were 47 patients with lower extremity DVT. Of them, DVT was detected in the left leg in 28 patients, in the right leg in 14 patients and in both lower extremities in 5 patients. Mechanical obstruction caused DVT in all of them, There were 27 patients of iliac vein compression syndrome （IVCS） complicated with lower limb DVT. The left iliac vein was oppressed by the right common iliac artery with compression degree from 55.41% to 100.00%, and mean of （77.1 ±16.8）%. There was congenital stenosis or occlusion of inferior vena cava in 3 patients. There was Budd-Chiari syndrome in 2 patients. There was pelvic mass pressing the common iliac vein in 4 patients. Enlarged right inguinal lymph nodes oppressed the right femoral vein in 3 patients and enlarged left inguinal lymph nodes oppressed the left femoral vein in 2 patients. Other mechanical obstruction factors caused DVT in 6 patients, including right iliae artery aneurysms, spontaneous hematoma, etc. The agreement of CTA and DSA on the diagnosis of the iliac femoral thrombosis was good （Kappa = 0.978）, the diagnosis agreement on the inferior vena cava thrombus was good （Kappa = 0.737）, while t

关 键 词：下肢 静脉 闭塞 血栓形成 体层摄影术 X线计算机 

分 类 号：R543.6[医药卫生—心血管疾病]