CT肺血管造影联合下肢CT静脉造影检查在疑诊下肢深静脉血栓患者中的应用

目的 评价64层螺旋CT肺血管造影(CTPA)联合下肢CT静脉造影检查(CTV),在下肢深静脉血栓(DVT)中的诊断作用.方法 连续收集临床上疑似下肢深静脉血栓并行64层螺旋CTPA联合下肢CTV检查的患者.按照CTPA和CTV检查的图像质量进行筛选.根据患者肺动脉和下肢深静脉内是否存在血栓进行分析,并对下肢静脉内血栓最近端位置进行统计.最终有109例患者纳入研究.结果 肺动脉和下肢静脉内同时有血栓的患者39例,单纯急性肺血栓患者1例,单纯DVT患者57例,肺动脉和下肢静脉内均无血栓的患者12例.DVT患者血栓最上端位于下腔静脉14例,位于盆腔髂静脉63例,位于大腿(股腘静脉)13例,位于小腿(胫腓静脉)6例.结论 64层螺旋CTPA联合下肢CTV检查对DVT疑似患者的肺动脉内血栓检出具有重要意义,避免了36.7%患者中肺动脉内血栓的漏诊.     

多层螺旋CT肺动脉造影联合静脉造影诊断深静脉血栓的研究

目的应用16层螺旋CT肺动脉造影联合静脉造影(CTVPA)探讨深静脉血栓发生率及部位,并与下肢彩色超声多普勒对照评价其诊断下肢深静脉血栓(DVT)的价值。方法临床怀疑肺栓塞(PE)的147例病人行CTVPA检查,以病人为单位计算两医师诊断DVT一致性;102例患者同时行下肢超声检查,计算股静脉-腘静脉段DVT诊断敏感度、特异度、阳性预测值、阴性预测值。结果147例患者中33例(22.4%)有DVT,27例合并PE。33例DVT的患者CTV共发现156个部位的血栓,腹盆腔静脉血栓共48个(31%),股静脉-腘静脉段血栓58个(37%),小腿静脉血栓50个(32%)。DVT血栓CT值为(42±13)HU。2医师诊断DVT的一致率为90%,Kappa值为0.86。以超声作为对照,CTV诊断股静脉-腘静脉段DVT的敏感度为92.3%,特异度为100%。结论CTV对股静脉-腘静脉段DVT诊断准确率高,并能显示下腔静脉、滤器内及盆腔静脉血栓,CTV的观察者间诊断一致性非常好。     

320排CT血管造影图像后处理技术在下肢深静脉血栓诊断中的应用

目的:探讨320排CT静脉造影(CTV)不同图像后处理技术对显示下肢深静脉血栓的价值。方法:回顾性分析经DSA及CTV证实为下肢深静脉血栓的患者56例,对比直接法CTV不同图像后处理方法对下肢深静脉栓子的检出率。结果:56例中,CTV结合DSA共确诊栓子128处,MPR及CPR正确显示124处(96.88%)、VR正确显示95处(74.22%)、MIP正确显示86处(67.19%),MPR及CPR对栓子诊断准确率高于其他2种后处理图像(χ~2=26.57和38.27,均P0.05),VR与MIP间差异无统计学意义(χ~2=1.53,P0.05)。结论:320排CT直接法CTV结合图像后处理技术是诊断下肢深静脉血栓的有效手段。     

MSCT静脉成像和超声诊断下肢静脉血栓的对比研究

目的:探讨多层螺旋CT静脉成像(MSCTV)和超声(US)对下肢静脉血栓形成的诊断价值。方法:将42例可疑下肢静脉血栓形成患者分别进行MSCT下肢静脉成像和US检查,并把检查结果进行对比分析。结果:42例患者中,MSCTV共发现栓子93处,US发现88处。下肢MSCTV和US对下肢静脉血栓的诊断结果无明显统计学差异(P>0.05),但本组中2例髂静脉、1例下腔静脉内栓子US均漏诊。结论:MSCTV和US对下肢静脉血栓形成均具有重要诊断价值,MSCTV对髂静脉、盆腔内深静脉血栓形成的诊断价值更大。     

64排螺旋CT静脉造影诊断下肢静脉血栓性病变

目的:探讨64排螺旋CT静脉造影(CTV)诊断下肢静脉血栓性病变的临床价值。材料和方法:下肢多层螺旋CT静脉造影(MSCTV)检查12例,同期均做下肢静脉Dopp ler超声(US)检查;其中1例同时进行了肺动脉CT血管造影,并于延迟2m in时行间接法下肢静脉造影检查。病例均采用5mm层厚和层间距行踝关节至髂骨上缘水平的增强CT扫描,并获得原始图像,图像经1.25mm层厚和50%的重叠处理后传送至工作站进行图像后处理。结果:64排螺旋CTV诊断下肢深静脉血栓(DVT)11例,诊断下肢慢性静脉功能不全1例,同时合并肺栓塞1例。以US作对照,64排螺旋CTV显示股静脉和腘静脉血栓的敏感性为100%,特异性98.6%。MSCTV上DVT表现为静脉腔内不规则低密度充盈缺损,慢性静脉功能不全表现为深静脉边缘不规则且于延迟2m in扫描见其远端引流静脉区造影剂点状残留。结论:64排螺旋CTV在显示股腘静脉血栓与US具有同等价值,MSCTV可作为下肢静脉血栓性病变诊断的常规检查方法。     

64层螺旋CT直接法静脉造影对下肢深静脉血栓的临床应用价值初步研究

目的 探讨64层螺旋CT直接法静脉造影在下肢深静脉血栓(DVT)中的诊断价值. 资料与方法 19例临床怀疑DVT患者行64层螺旋CT直接法下肢深静脉造影检查,着重分析DVT的CT征象,探讨影响其诊断准确性的因素.结果 64层螺旋CT直接法静脉造影对DVT显示较好,在15例患者中共发现DVT 25处,分别位于髂静脉(4)、股静脉(7)、胭静脉(9)和腓静脉(5).结论 64层螺旋CT直接法下肢深静脉造影结合多种后处理技术可以清楚显示DVT,具有较高的临床应用价值.     

直接法多层螺旋CT静脉造影诊断下肢深静脉血栓简

目的：探讨直接法多层螺旋CT静脉造影（MSCTV）诊断下肢深静脉血栓的临床应用价值。方法直接法多层螺旋CT（MSCT）下肢静脉造影17例,同期均行彩色多普勒超声血流显像（CDFI）检查。直接法MSCTV检查后,所得图像经处理后传送至工作站进行多平面重建（MPR）、最大密度投影（MIP）、表面遮盖（SSD）及容积再现（VR）重建。结果直接法MSCTV检查显示13例存在下肢深静脉血栓（DVT）,彩色多普勒超声检查显示10例,2例髂静脉及1例胫腓静脉血栓彩色多普勒超声未能检出。直接法MSCTV上DVT主要表现为静脉腔内造影剂充盈缺损、静脉节段性不显影、栓塞静脉远端扩张及其周围侧支循环静脉迂曲扩张、周围软组织肿胀、皮肤增厚。结论直接法MSCT能清晰显示DVT形成的部位、范围、侧支静脉情况及病变血管周围的解剖结构,对彩色多普勒超声不易检出的盆腔及小腿深静脉栓塞也能清晰显示,可以作为下肢深静脉血栓检查的常规方法。     

联合应用多层螺旋CT肺动脉造影和间接CT静脉造影诊断静脉血栓栓塞症

目的探讨联合应用多层螺旋CT肺动脉造影（MSCTPA）和间接CT静脉造影（CTV）诊断静脉血栓栓塞症（VTE）的价值。资料与方法对临床疑似VTE的87例患者,联合应用MSCTPA和间接CTV进行检查,在胭静脉至股总静脉水平,比较间接CTV与多普勒血管超声（DVUS）诊断深静脉血栓形成（DVT）的价值,计算间接CTV的敏感性、特异性、阴性预测值和阳性预测值。结果87例患者中,MSCTPA扫描肺血栓栓塞症（PTE）和DVT均显示32例,显示DVT未显示VIE8例,显示PTE未显示DVT22例。DVUS检查中,DVT42例。与DVUS相比,下肢间接CTV诊断DVT的敏感性95．5％、特异性99．2％、阳性预测值97．7％、阴性预测值98．5％。结论联合应用MSCTPA和间接CTV实现了一次检查同时诊断VIE和DVT,并能显示胸部和下肢的其他异常。     

多层螺旋CTA联合CTV在肺栓塞及下肢静脉血栓诊断中的应用

目的 评价多层螺旋CT肺动脉造影(MSCTA)及多种重建技术联合双下肢静脉扫描(CTV)在肺栓塞(PE)及下肢静脉血栓诊断中的应用价值.方法 47例经临床确诊的PE患者经MSCTA检查,扫描条件包括电压120 kV,电流210 mA,准直器宽度0.75 mm,对比剂注射速率为3～4 ml/s,延时时间的设定采用自动团注触发技术,MSCTA完成后延迟170 s行盆腔及CTV.结果 47例PE患者MsCTA及MPR、MIP、VRT等重建处理后均可显示两侧肺动脉主干、叶动脉、段及亚段肺动脉.受累动脉共363支,PE伴下肢深静脉血栓(DVT)31例,占65.9%.结论 MSCTA联合CTV诊断肺动脉栓塞及下肢静脉血栓具有重要价值.     

彩色多普勒超声诊断下肢深静脉血栓与肺栓塞的相关性

目的探讨彩色多普勒超声诊断下肢深静脉血栓与肺栓塞发生率的相关性,为临床预防和治疗提供依据。方法选择解放军总医院第一附属医院2013年5月至2014年5月收治的肺栓塞患者40例(PE组),采用彩色多普勒超声评价肺拴塞患者下肢深静脉血栓形成的发生率。另选取同期在我院接受治疗的下肢深静脉血栓患者40例(DVT组),采用超声诊断下肢深静脉血栓患者合并肺栓塞的情况。结果 PE组40例患者共检出下肢深静脉血栓33例,肺栓塞合并下肢深静脉血栓的超声检出率为82.50%。左下肢形成深静脉血栓的比例高于右下肢,差异有统计学意义(P<0.05)。DVT组40例患者共检出肺栓塞32例,下肢深静脉血栓合并肺栓塞的超声检出率为80%。双侧肺栓塞的比例高于单侧肺栓塞,差异有统计学意义(P<0.05);急性肺栓塞的比例高于亚急性和慢性肺栓塞,差异均有统计学意义(P<0.05)。肺栓塞直接征象以充盈缺损最多,间接征象以肺动脉扩张和胸腔积液出现率最高。结论彩色多普勒超声能够准确地显示静脉结构、血栓部位、阻塞程度、血管周围组织及血流动力学信息,对下肢深静脉血栓形成和肺栓塞有很高的诊断价值。     

Computed tomography pulmonary angiography with pelvic venography in the evaluation of thrombo-embolic disease

A prospective study was performed to evaluate the usefulness of CT pelvic venography (CTV) in the detection of pelvic vein thrombosis in patients referred for CT pulmonary angiography (CTPA) for suspected pulmonary embolism. Fifty consecutive patients referred for CTPA had CTV performed at the time of CTPA. All patients had duplex ultrasound (DUS) of the lower limb veins for evaluation of deep venous thrombosis (DVT) within 24 h of the CT study. Twelve (24%) of the 50 patients had pulmonary embolism diagnosed on CTPA. Associated DVT was detected in six of these patients; two cases were detected by CTV alone, while one case was detected by both CTV and DUS. The remaining three cases had DVT diagnosed by DUS alone. In the 38 patients with a negative CTPA, three patients had venous thrombus diagnosed by CTV. Of these three patients, two had a negative DUS study. CTV therefore led to a definitive imaging diagnosis of thrombo-embolic disease in two (4%) more patients. CTV adds little time and cost to the CTPA examination and leads to a moderate increase in definite imaging diagnosis of thrombo-embolic disease.     

肺栓塞和下肢深静脉血栓的多层CT联合成像

目的：探讨下肢深静脉血栓和肺栓塞的多层CT联合成像的诊断价值,并分析下肢深静脉血栓与肺栓塞的相关性。方法：对临床疑诊肺栓塞和/或下肢深静脉血栓的连续80例患者行CT肺动脉和下肢深静脉联合成像,采用16层CT,1.25mm×16模式采集,注射对比剂120ml,注射流率3～4ml/s,肺动脉延迟20～25s扫描,下肢静脉延迟150～180s扫描。结果：共发现下肢深静脉血栓52例55侧,肺栓塞21例37侧,其中肺栓塞和下肢深静脉血栓同时存在18例。结论：肺栓塞与下肢深静脉血栓关系密切,多层螺旋CT肺动脉和下肢静脉联合成像可一次性评价肺动脉和下肢静脉,是肺栓塞适宜的检查方法。     

Venous thromboembolism: additional diagnostic value and radiation dose of pelvic CT venography in patients with suspected pulmonary embolism

Purpose

To assess the additional diagnostic value of indirect CT venography (CTV) of the pelvis and upper thighs performed after pulmonary CT angiography (CTA) for the diagnosis of venous thromboembolism (VTE).

Materials and methods

In a retrospective analysis, the radiology information system entries between January 2003 and December 2007 were searched for patients who received pulmonary CTA and additional CTV of the pelvis and upper thighs. Of those patients, the radiology reports were reviewed for the diagnosis of pulmonary embolism (PE) and deep venous thrombosis (DVT) in the pelvic veins and veins of the upper thighs. In cases with an isolated pelvic thrombosis at CTV (i.e. which only had a thrombosis in the pelvic veins but not in the veins of the upper thigh) ultrasound reports were reviewed for the presence of DVT of the legs. The estimated radiation dose was calculated for pulmonary CTA and for CTV of the pelvis.

Results

In the defined period 3670 patients were referred to our institution for exclusion of PE. Of those, 642 patients (353 men, 289 women; mean age, 65 ± 15 years, age range 18–98 years) underwent combined pulmonary CTA and CTV. Among them, PE was found in 227 patients (35.4%). In patients without PE CTV was negative in all cases. In patients with PE, CTV demonstrated pelvic thrombosis in 24 patients (3.7%) and thrombosis of the upper thighs in 43 patients (6.6%). Of those patients 14 (2.1%) had DVT in the pelvis and upper thighs. In 10 patients (1.5%) CTV showed an isolated pelvic thrombosis. Of those patients ultrasound reports were available in 7 patients, which revealed DVT of the leg veins in 5 cases (1%). Thus, the estimated prevalence of isolated pelvic thrombosis detected only by pelvic CTV ranges between 1–5/642 patients (0.1–0.7%). Radiation dose ranges between 4.8 and 9.7 mSv for additional CTV of the pelvis.

Conclusion

CTV of the pelvis performed after pulmonary CTA is of neglectable additional diagnostic value for the detection of VTE, because the additional radiation dose is high and isolated pelvic DVT is very rare. Venous imaging of the legs (preferably by radiation-free ultrasound) is sufficient for the diagnosis of underlying DVT in patients with suspected PE.     

A retrospective study of the value of indirect CT venography: a British perspective

Objective

The aim of this study was to establish the value of indirect CT venography (CTV) in clinical practice within the UK.

Methods

804 combined CT pulmonary angiogram and CTV studies were retrospectively reviewed. CTV was performed 180 s after the injection of contrast using an incremental technique with a 5-mm collimation and a 5-cm interspace between images extending from the iliac crests to the tibial plateaus.

Results

12.9% of studies had isolated pulmonary emboli (PE), 3.0% had both a PE and deep vein thrombosis (DVT) and 1.1% had an isolated DVT. The proportion of positive cases diagnosed by CTV alone was 6.6%.

Conclusion

In a UK-based practice, the incidence and the proportion of isolated DVT diagnosed by CTV are lower than expected from published data. An analysis of possible causes for this is made within the paper.More than 250 000 cases of pulmonary embolism were identified in the UK between 1996 and 2006, yet the accurate diagnosis of this condition remains problematic [1]. Autopsy studies indicate that 88% of pulmonary emboli (PE) are unsuspected clinically prior to death. Although the majority of these PE are an incidental complication of an underlying comorbid condition, less than half of cases of fatal PE are correctly diagnosed ante-mortem [2,3]. It is accepted that PE originate from distant sites of venous thrombosis and that both PE and deep vein thrombosis (DVT) are facets of the same disease process, with the majority of DVT arising within the lower limb veins. The evaluation of the presence of DVT is therefore considered part of the investigation of PE, and the presence of DVT in the absence of radiological evidence of PE can be accepted as surrogate evidence of venous thromboembolism (VTE). Lower limb indirect CT venography (CTV) may be added to CT pulmonary angiography (CTPA) to identify the presence of DVT, but this is at the expense of an increased examination time and an increased radiation dose, particularly to the reproductive organs. The prospective investigation of the PE diagnosis II study demonstrated the addition of CTV to CTPA increased the sensitivity for detection of PE from 83% to 90% [4]. Despite this, the routine addition of CTV to CTPA is not recognised in current British Thoracic Society guidelines, and it is not known how many centres in the UK have adopted this technique [5].The aim of this study is to establish the incremental value of CTV in clinical practice within a British institution and ascertain whether factors such as image quality significantly influence the value of the examination. To our knowledge this is the first large British study of the value of CTV in the investigation of PE.     

Real-time ultrasound diagnosis of deep vein thrombosis: a comparison with venography

A prospective study comparing real-time ultrasound scanning with contrast venography in the diagnosis of deep venous thrombosis of the lower limb was performed in a group of 46 patients. The sensitivity of ultrasound scanning for thrombus within the iliofemoral segment, femoral vein, and popliteal vein was 94% with a specificity of 100%. Additional information obtained by ultrasound included the diagnosis of popliteal cysts, pelvic and inguinal lymphadenopathy, popliteal haematoma, and traumatic arterial aneurysm. Real-time ultrasound scanning is a rapid and non-invasive alternative to contrast venography in the diagnosis of lower limb deep venous thrombosis.     

Spiral CT venography of the lower extremities by injection via an arm vein in patients with leg swelling.

The purpose of this prospective study was to assess the role of spiral CT venography (CTV) via an arm vein injection in the detection of causes of leg swelling. 42 consecutive patients with leg swelling were studied with indirect spiral CTV and ultrasound (US). CT parameters were as follows: 5 mm beam collimation; 7-10 mm s(-1) table speed; and 2-3 mm reconstruction. Two consecutive spiral scans with a 40 s exposure time were performed from the pelvis to the knee. One bolus of 150 ml non-ionic contrast medium was injected at a rate of 3 ml s(-1) by a power injector via an arm vein. The delay times to the first and second scans were 120 s and 180 s, respectively. Spiral CTV demonstrated not only deep vein thrombosis (DVT) (n=12) but also other abnormalities (n=25). US showed DVT (n=10) and some other abnormalities (n=5). The sensitivity and specificity of spiral CTV for femoropopliteal DVT, as compared with US, were both 100%. Two cases of DVT in the left common-external iliac vein (iliac vein compression syndrome) detected by spiral CTV were not confirmed by US. We were able to evaluate DVT above the knee with this method. Indirect spiral CTV showed promise for the diagnosis of DVT and other soft tissue diseases in patients with leg swelling.     

CT venography vs ultrasound in the diagnosis of thromboembolic disease in patients with clinical suspicion of pulmonary embolism

To assess the reliability of indirect computed tomography venography (CTV) in the detection of deep venous thrombosis (DVT) in patients with clinical suspicion of pulmonary embolism (PE). 235 consecutive patients with suspicion of PE underwent an imaging protocol composed of a CT pulmonary angiography (CTPA), a CTV and an ultrasound study of the deep venous system, which was considered the “gold standard.” Sensitivity, specificity, and predictive values were calculated for CTV. ith CTV, 30 (12.8%) cases of DVT were detected, 9 (3.8%) of them without pulmonary embolism in CTPA, increasing the diagnosis of thromboembolic disease in 3.8%. However, six of these nine diagnoses were false positives, and CTV missed six cases of DVT. CTV rendered a sensitivity of 58.8%, specificity of 95.0%, a positive predictive value of 66.7%, and a negative predictive value of 93.2%. In patients with clinical suspicion of pulmonary embolism, ultrasound is preferred to CTV for the detection of DVT.