间接CTV与超声在下腔静脉、髂静脉及下肢深静脉血栓中的对照研究  

Comparative study of indirect CTV and ultrasound in detection of deep vein thrombosis of the inferior vena cava, iliac vein and lower extremity vein

作　　者：李文智 罗林 杨昆良 刘成华 李正海 蒋超梅 

机构地区：[1]曲靖市第一人民医院放射科,云南曲靖655000

出　　处：《实用放射学杂志》2015年第12期2003-2006,共4页Journal of Practical Radiology

摘　　要：目的 评价间接CT静脉成像（CTV）对下腔静脉、髂静脉及下肢深静脉血栓（DVT）的诊断价值。方法 回顾性分析本院临床怀疑下肢深静脉血栓，行CT肺动脉造影（CTPA）联合下腔、下肢CTV检查及下肢静脉加压超声检查414例患者的影像学资料，以下肢静脉加压超声检查结果为参照标准，评价间接下肢CTV诊断DVT的敏感性、特异性、阳性预测值和阴性预测值；评价2种方法对下腔静脉、髂静脉及下肢深静脉内血栓显示的一致性，采用Kappa检验及卡方检验对数据进行分析。结果 ①414例患者中，CTV和下肢超声检查均发现下肢深静脉内血栓301例，均为阴性72例，CTV阳性而下肢超声阴性15例，下肢超声阳性而CTV阴性26例。采用Kappa检验，Kappa值=0.715，采用卡方检验，χ^2=2.439，P=0.118。CTV诊断下肢DVT的敏感性为92.0％（301／327）、特异性为78.2％（68／87）、阳性预测值为95.3％（301／316）、阴性预测值为69.4％（68／98）。②CTV和超声检查对显示股腘静脉内血栓的一致性较好（Kappa值=0.845-0.927，P值均为0.000），对显示小腿深静脉及髂外静脉内血栓的一致性降低（Kappa值=0.454-0.658，P值均为0.000），对显示下腔静脉、髂总静脉及髂内静脉内血栓的一致性较差（Kappa值=0.041-0.182，P值分别为0.000-0.003）。结论 间接CTV对诊断下肢深静脉血栓具有较高的准确性，同时可以准确地检出下腔、髂静脉内血栓。Objective To evaluate indirect CT venography （CTV} in the diagnosis of deep venous thrombosis （DVT） of inferior vena cava,iliac vein and lower extremity vein. Methods 414 patients with clinically suspected DVT underwent CT pulmonary angiography （CTPA） and CTV examinations in combination with lower limb compression ultrasound were analyzed retrospectively. Using the results of lower limb compression ultrasound as a reference standard,the sensitivity, specificity, positive predictive value and negative predictive value of indirect CTV were calculated. The consistency of inferior vena cava,iliac vein and lower extremity DVT between lower extremity venous ultrasound and indirect CTV was assessed with Kappa and Z2 analysis. Results Of 414 patients,the DVT was found by CTV and ultrasound simultaneously in 301 patients,meanwhile no DVT was found in 72 patients by both examinations. 15 patients were diagnosed as DVT with CTV but not with ultrasound,and other 26 patients with DVT were confirmed only by ultrasound. The consistency between lower extremity venous ultrasound and indirect CTV was nice for lower extremity DVT （Kappa ： 0. 715;Х^2= 2. 439,P〈 0.118）. The sensitivity, specificity, positive predictive value and negative predictive value of indirect CTV was 92.0%（301/327） ,78.2% （68/87） ,95.3%（301/316） and 69.4%（68/98） respectively. The consistency between lower extremity venous ultrasound and indirect CTV was also nice for femoropopliteal vein （Kappa value range from 0. 845 to 0. 927 ,P= 0. 000）. For calf veins and external iliac vein,the consistency was decreased （Kappa value range from 0. 454 to 0. 658,P=0. 000）. The consistency for inferior vena cava,common iliac vein and internal iliac vein was poor （Kappa value range from 0. 041 to 0. 182, P value range from 0. 000 to 0. 003 ）. Conclusion The indirect CTV has high accuracy in the diagnosis of DVT,which is accurate in detection of inferior vena cava and iliac vein thrombosis.

关 键 词：静脉血栓 下肢 下腔静脉 髂静脉 CT静脉成像 超声 

分 类 号：R543.6[医药卫生—心血管疾病] R814.43[医药卫生—内科学]