超声造影识别下肢Klippel-Trenaunay综合征伴发淋巴管病变的应用价值  

Application Value of Percutaneous Contrast-enhanced Ultrasound in Identifying Lymphatic Lesions Associated with Klippel-Trenaunay Syndrome of Lower Limbs

作　　者：文哲 童冠圣 邵敬 王萤萤 赵晓宁 刘勇 Wen Zhe;Tong Guansheng;Shao Jing;Wang Yingying;Zhao Xiaoning;Liu Yong(Department of Nuclear Medicine,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Ultrasound,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院(北京大学第九临床医学院)核医学科,北京市100038 [2]首都医科大学附属北京世纪坛医院(北京大学第九临床医学院)超声科,北京市100038

出　　处：《中国超声医学杂志》2021年第5期587-590,共4页Chinese Journal of Ultrasound in Medicine

基　　金：北京市医院管理中心临床医学发展专项经费资助(No.XMLX202113);北京市科委首都临床诊疗技术研究及示范应用(No.Z191100006619051);中国国家铁路集团有限公司科技研究开发计划项目(No.J2019Z604);首都医科大学附属北京世纪坛医院淋巴外科开放课题专项基金(No.2019-LB03)。

摘　　要：目的探讨超声造影(CEUS)检出下肢Klippel-Trenaunay综合征(KTS)所伴发淋巴管病变的价值。方法前瞻性纳入34例单侧下肢KTS患者,入组后行99mTc-右旋糖酐[99mTc-Dextran(DX)]淋巴显像,核素检查前后1个月内行双下肢经皮CEUS,比较两种方法检出淋巴管异常有无差异,并比较患肢与健肢CEUS显像中淋巴-皮肤反流、淋巴囊肿、交通支淋巴管显影、深淋巴管显影、造影剂间质弥散等异常征象的检出率有无统计学差异。结果核素淋巴显像显示健肢中32例浅淋巴管显示完整,2例大腿中上段可见局限示踪剂滞留;患肢34例全部检出不同程度皮下示踪剂滞留,31例腹股沟区淋巴结未显影,6例检出淋巴囊肿。健肢CEUS显示:30例可完整显示浅淋巴管,27例腹股沟区淋巴结显影,3例检出淋巴-皮肤反流。患肢CEUS显示:浅淋巴管异常32例,其中未显影19例,连续中断6例,异常扭曲扩张7例;深淋巴管显影17例;淋巴-皮肤反流32例;间质弥散8例;淋巴囊肿5例;仅1例腹股沟区淋巴结显影。两种显像方法在浅淋巴管显影、腹股沟淋巴结显影、造影剂滞留或弥散、淋巴囊肿征象检出比较中,差异均无统计学意义(P>0.05);CEUS下患肢浅淋巴管异常、淋巴囊肿、交通支淋巴管显影、深淋巴管显影、造影剂间质弥散的检出率明显高于健肢,差异有显著统计学意义(P<0.001)。结论采用足部皮下注射超声造影剂可以精准显示KTS下肢淋巴管病变。Objective To explore the application value of percutaneous contrast-enhanced ultrasound(CEUS)in detecting lymphangiopathy in patients with Klippel-Trenaunay syndrome(KTS)of lower limbs.Methods Prospectively enrolled 34 patients with unilateral lower extremity KTS.Radionuclide imaging was performed to observe whether there was any abnormality in limb lymphatic imaging.CEUS was performed on both lower limbs,and the difference between the two imaging methods was compared.Results Radionuclide imaging showed that 32 cases of superficial lymphatic vessels in healthy limbs showed integrity and inguinal lymph nodes were developed,and 2 cases of limited subcutaneous tracer retention were found.However,all 34 cases of affected limb were found to have different degrees of subcutaneous tracer retention,only 3 cases of inguinal lymph nodes(ILN)were not developed,and 6 cases were found to have lymphatic cysts.CEUS of healthy limbs showed that superficial lymphatic vessels could be completely displayed in 30 cases,ILN could be displayed in 27 cases,and lymphatic-skin reflux was detected in 3 cases.CEUS of the affected limb showed that there were 32 cases with abnormal development of superficial lymphatic vessels,including 19 cases without development,6 cases with continuous interruption and 7 cases with abnormal distortion;17 cases showed deep lymphatic vessels;Lymph-skin reflux in 32 cases;Interstitial diffusion in 8 cases;lymphatic cyst in 5 cases;Only one case of ILN could be displayed.There was no significant difference between the two imaging methods(P>0.05).The detection rates of abnormal signs in the affected side were significantly higher than those in the normal side(P<0.001).Conclusions Percutaneous CEUS has practical value in the identification of lower extremity lymphangiopathy in KTS.

关 键 词：KLIPPEL-TRENAUNAY综合征 超声造影 核素淋巴显像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543[医药卫生—诊断学]