仰卧位结合直立位超声诊断正中弓状韧带综合征的价值  

Supine and Erect Color Doppler Ultrasonography in the Diagnosis of Median Arcuate Ligament Syndrome

作　　者：肖青 赵华 华先平 郑国良 Xiao Qing;Zhao Hua;Hua Xianping;Zheng Guoliang(Department of Ultrasound Medicine,Wuchuan Hospital of Traditional Chinese Medicine,Wuchuan,Guangdong 524500,China;Department of Radiology,Wuchuan Hospital of Traditional Chinese Medicine,Wuchuan,Guangdong 524500,China;Department of Cardiology,Heyou Hospital,Shunde District,Foshan,Guangdong 528000,China;Department of Radiology,Xiaolan Hospital,Southern Medical University,Zhongshan,Guangdong 528415,China)

机构地区：[1]吴川市中医院超声医学科,广东省吴川市524500 [2]吴川市中医院放射科,广东省吴川市524500 [3]佛山市顺德区和祐医院心血管内科,广东省佛山市528000 [4]南方医科大学附属小榄医院放射科,广东省中山市528415

出　　处：《中国超声医学杂志》2025年第2期216-219,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨仰卧位和直立位超声诊断正中弓状韧带综合征的价值。方法记录疑诊正中弓状韧带综合征患者的超声表现,包括直立位与仰卧位不同呼吸时相(静息状态、深吸气、深呼气)腹腔动脉的血流速度,肝总动脉血流方向,以及有无狭窄后扩张,同时计算两种体位下流速的变化值和变化率,并进行CT血管造影检查。绘制受试者工作特征(ROC)曲线,计算诊断阈值和诊断效能,并评估各血流参数曲线下面积差异。结果共35例患者完成超声和CTA检查,超声检出阳性28例,阴性7例。阴性患者腹腔动脉流速、肝总动脉血流方向均正常。阳性患者表现为仰卧位呼气末流速增高或闭塞、肝总动脉逆向,直立位恢复正常,闭塞者血流重新出现,仰卧位狭窄后瘤样扩张者直立位扩张消失。CTA证实超声结果中假阴性1例,假阳性2例。采用ROC曲线对诊断效能进行评价,静息状态及呼气末的流速变化值和变化率4个参数的诊断效能远高于吸气末的2个参数(P<0.05),变化值越大特异度越高。上述4个参数的曲线下面积比较,差异无统计学意义(P>0.05)。结论仰卧位联合直立位超声可作为疑诊正中弓状韧带综合征患者的一线筛查方法,静息状态和呼气末流速减低值或减低率这4个血流参数均有同等诊断价值,且数值越大诊断特异度越高。Objective To evaluate the value of supine and erect color Doppler ultrasonography in the diagnosis of median arcuate ligament syndrome(MALS).Methods The patients suspected with MALS were detected by color Doppler ultrasonography,the peak systolic velocity of celiac artery in calm,deep inspiration and deep expiration at different positions(including supine and erect position),the flow direction in the common hepatic artery,and post-stenosis dilatation presence or absence were recorded,and velocity decline(VD)and decline rate of velocity(VDR)on different respiratory phase were calculated,and then compared with computed tomographic angiography(CTA).A receiver operating characteristic(ROC)curve of each hemodynamic parameter was drawn,and the areas under the curve were compared.Results A total of 35 cases were accomplished by color Doppler ultrasonography and CTA,28 positive and 7 negative cases were revealed by ultrasonography.The velocity of celiac artery and the flow direction of common hepatic artery were normal in the negative cases,but velocity of celiac artery accelerated or occluded at end-expiratory and flow direction of common hepatic artery reversed were observed in positive cases on supine position,with flow velocity revert to normal or recurrence on erect position.Post-stenosis dilatation of celiac artery on supine position were disappeared on erect position.In all cases,2 false-positive and 1 false-negative cases were identified by CTA.The diagnostic efficacy were identified by ROC curve,the four parameters of VD and VDR on calm and end-expiratory had a higher diagnostic efficacy than that on end-inspiration,and higher value led to higher specificity.There was no significant difference(P>0.05)among the four above parameters.Conclusions Color Doppler ultrasonography on supine position combined with erect position is a first-line screening method for patients suspected with MALS.The four hemodynamic parameters(VD and VDR on calm and end-expiratory)can contribute to the diagnosis with same value,and the spe

关 键 词：彩色多普勒超声 正中弓状韧带综合征 直立位 CT血管造影 

分 类 号：R44[医药卫生—诊断学]