超声造影在血管疾病中的应用

目的 探讨超声造影在门静脉、颈动脉及下肢深静脉疾病中的应用价值.方法 应用超声造影观察门静脉,颈动脉及下肢深静脉疾病患者63例,其中门静脉栓子20例,下肢深静脉血栓15例,颈动脉狭窄28例,分别观察造影剂增强及血管充盈情况,并与增强CT及DSA对照.结果 15例门静脉瘤栓造影后均表现为不同程度增强,5例血栓无增强,表现为充盈缺损,颈动脉超声造影可清晰显示动脉内-中膜厚度,发现21个造影前未发现的斑块,勾勒出动脉斑块大小及形态.与DSA对照,应用CDFI、超声造影诊断动脉粥样硬化所致颈部动脉闭塞的敏感性分别为55.6%、55.6%,特异性分别为84.2%、94.7%,准确率分别为75.0%、82.0%.普通超声检查下肢下肢DVT的发现率为47%,超声造影后下肢下肢DVT的发现率为87%.患侧股总静脉造影剂出现时间及达峰值时间分别为(56.76±11.24)8、(61.43±7.12)S,健侧造影剂出现达峰值时间为(42.46±7.28)S、(51.57±5.79)s,双侧比较差异有统计学意义(P<0.05);患侧低回声带宽度为(0.31±0.08)cm,健侧为(O.09±0.03)cm,差异有统计学意义.结论 超声造影有助于门静脉栓子良恶性的鉴别诊断,提高了颈动脉斑块及静脉栓子的显示率,有助于动脉狭窄程度判断以及静脉血栓形成的诊断.

Study of constrast-enhanced ultrasound in vascular diseases

Objective To investigate the value of contrast-enhanced ultrasonography in the disease of portal vein, cervical artery and thrombosis in the deep vein of lower extremity. Methods Sixty-three cases including 20 portal vein thrombi, 15 DVT and 28 carotid artery stenosis were examined with contrast-enhanced ultrasonography. The enhancement and vascular filling were observed after the injection of the agent, and the results were compared with CT and DSA diagnosis. Results Portal vein thrombosis in 15 cases enhanced rapidly with varying degrees. No enhancement was noted in 5 benign thrombi in arterial phase and portal phase. Twenty-one plaques could be found and the intima-media thickness (IMT) became more clear after injection of the contrast agent. The morphology and structure of plaques could be observed at the same time. The sensitivity of CDFI and CEUS compared with DSA in detection of occlusion was 55.6%, 55.6%, the specificity was 84.2%, 94.7% and the accuracy was 75.0%, 82.0%, respectively. The detection rate using ultrasound of DVT was 47%, the rate of detection the DVT was 87% after injection of contrast agent (USCA). The arrival time and peak intensity time of the morbid side was (56.76±11.24)s and (61.43±7.12)s in the study group, the control side was (42.46±7.28)s and (51.57±5.79)s (P<0.05). In addition, in study group, the width between edge of USCA and the wall of CFV was (0.31±0.08)cm in the morbid side, and the control side was (0.09±0.03)cm (P<0.05). Conclusion Contrast-enhanced ultrasound can be used to differentiate the malignant thrombi from benign ones. CEUS can improve the detection of the arterial plaque and venous thrombi, and determine the extent of artery stenosis and the diagnosis of venous thrombosis.