剪切波弹性成像评估下肢远端深静脉血流滞缓的临床价值  

Clinical value of shear wave elastography in the assessment of blood flow retardation in the distal deep vein of lower extremity

作　　者：黄虹宁 李陶 HUANG Hongning;LI Tao(Department of Ultrasound Diagnosis,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院超声诊断科,重庆市400042

出　　处：《临床超声医学杂志》2024年第2期131-136,共6页Journal of Clinical Ultrasound in Medicine

基　　金：重庆市技术创新与应用示范社会民生类一般项目(cstc2018jscx-msybX0018);重庆市影像医学与核医学临床医学研究中心(CSTC2015YFPT-gcjsyjzx0175)。

摘　　要：目的应用剪切波弹性成像(SWE)检测比目鱼肌弹性,探讨其预测下肢远端深静脉血流滞缓的临床价值。方法选取在重庆市中医骨科医院行双下肢深静脉超声检查患者136例,依据是否存在小腿肌肉静脉扩张将双下肢分为正常组与病例组,正常组包含67条左下肢和87条右下肢;病例组包含69条左下肢和49条右下肢。应用常规超声获取深静脉二维超声表现(“暴风雪征”半定量分度及分型)及血流动力学参数(腘静脉最大管径、腘静脉峰值流速、腘静脉血流瘀滞指数);SWE获取比目鱼肌杨氏模量值,比较两组上述参数的差异。绘制受试者工作特征(ROC)曲线分析下肢常规超声参数及SWE参数预测远端深静脉血流滞缓的诊断效能。结果与正常组比较,病例组左、右侧比目鱼肌杨氏模量和右侧腘静脉峰值流速均减低,左、右侧腘静脉最大管径和腘静脉瘀滞指数均增大,左、右侧下肢“暴风雪征”分度以中、重度为主(76.8%、85.7%),分型以中央型、全管腔型为主(79.7%、89.8%),差异均有统计学意义(均P<0.05);两组左侧腘静脉峰值流速比较差异无统计学意义。ROC曲线分析显示,左、右侧比目鱼肌杨氏模量值预测下肢远端深静脉血流滞缓的曲线下面积分别为0.960、0.950,灵敏度分别为92.06%、95.92%,特异度分别为97.26%、91.95%,其预测下肢远端深静脉血流滞缓的曲线下面积均高于左、右侧各常规超声参数。结论SWE在评估下肢远端深静脉血流滞缓状态方面具有一定的临床价值。Objective To investigate the clinical value of shear wave elastography(SWE)in the detection of soleus muscle elasticity for predicting blood flow retardation in the distal deep vein of lower extremity.Methods A total of 136 patients who underwent deep venous ultrasound examination of both distal deep vein of lower extremity in Chongqing Orthopaedic Hospital of Traditional Chinese Medicine were selected.According to the presence or absence of calf muscle vein dilatation,the bilateral lower extremities were divided into the normal group and the case group.The normal group included 67 left and 87 right lower extremities.The case group included 69 left and 49 right lower extremities.Two-dimensional ultrasound images of the deep veins(semi-quantitative grading and classification about the visualization of erythrocyte“storm floating sign”)and hemodynamic parameters(popliteal vein internal diameter,popliteal vein peak flow velocity and popliteal vein flow stasis index)were obtained by conventional ultrasound.SWE was used to obtain the Young’s modulus in the soleus muscle.The differences of the above parameters between the two groups were compared.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of lower extremity conventional ultrasound parameters and SWE parameters in the prediction for blood flow retardation in the distal deep vein of lower extremity.Results Compared with the normal group,the Young’s modulus of bilateral soleus muscle and the maximum velocity of right popliteal vein in the case group were decreased,while the bilateral popliteal vein diameter and popliteal vein stasis index were increased.The degree of“blizzard sign”in bilateral lower extremities were predominantly moderate to severe(left:76.8%,right:85.7%),and the central type and whole lumen type were the most prevalent patterns observed(left:79.7%,right:89.8%),with statistically significant differences(all P<0.05).The maximum flow velocity of the left popliteal vein showed no significant difference

关 键 词：超声检查 剪切波弹性成像 静脉血流滞缓 孤立性远端深静脉血栓 小腿肌肉静脉 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.6[医药卫生—诊断学]