彩色多普勒超声在急性孤立性小腿深静脉血栓中应用价值

目的探讨彩色多普勒超声在急性孤立性小腿深静脉血栓诊断中的临床应用价值。方法选取2016年1-12月收治的急性下肢深静脉主干血栓患者38例作为A组,急性孤立性小腿深静脉血栓患者38例作为B组。两组患者均给予彩色多普勒超声检查,比较两组超声诊断准确率。结果两组超声诊断准确率均较高,差异无统计学意义(P>0.05)。结论应用彩色多普勒超声诊断急性孤立性小腿深静脉血栓准确率高,值得在临床检查诊断工作中推广应用。     

320排CT血管造影和超声诊断下肢深静脉血栓价值比较

目的：探讨320排容积 CT 静脉造影(CTV)和超声(US)对下肢深静脉血栓(DVT)的诊断价值。方法回顾性分析经DSA 证实为下肢 DVT 的患者51例,对比直接法 CTV 及 US 对下肢不同部位栓子的检出率。结果51例患者中,CTV 共诊断DVT 48例,发现栓子124处,US 诊断静脉血栓46例,发现栓子86处。其中盆腔 DVT CTV 检出34处,US 检出10处,胫腓静脉血栓 CTV 检出25处,US 检出5处,CTV 检出股深静脉血栓2处,US 检出11处。结论直接法 CTV 及 US 对下肢 DVT 的诊断均具有较高的临床应用价值,而前者对盆腔 DVT 及胫腓静脉血栓的检出率更高,而对股深静脉血栓的显示不及后者。     

创伤骨折患者术前行血管超声检查及测定D-二聚体的意义

目的 回顾分析创伤骨折患者术前血管彩色多普勒超声检查诊断静脉血栓的价值及测定D-二聚体的意义,探讨D-二聚体与下肢静脉血栓的关系.方法 选择2008年3月-2009年4月因创伤致多发骨折、股骨骨折、胫骨或胫腓骨折当天入院,拟行手术切开复位术的1000例患者,其中男568例,女432例;年龄20～90岁[(54.8±21.50)岁].患者入院第2天清晨抽静脉血测定血清D-二聚体,拟行骨折复位术前1 d(骨折患肢消肿后,约骨折后4～10 d),行下肢血管彩色多普勒超声检查.结果 1000例患者行下肢血管彩色多普勒超声检查,64例(6.4%)存在下肢深静脉血栓,其中髂-股静脉血栓26例,胭-胫静脉血栓10例,肠腓肌、比目鱼肌血栓28例.骨折后2 d,1000例患者中有736例(73.6%)D-二聚体＞正常值(324μg/L),伤后4～10 d其中56例(7.6%)发生血栓;骨折后2 d,264例(26.4%)D-二聚体≤324μg/L,伤后4～10 d其中8例(3.0%)患者发生血栓;两组比较,差异有统计学意义(P＜0.01%).D-二聚体＞650μg/L的患者血栓发生率显著高于D-二聚体＜650μg/L的患者(P＜0.01).结论 创伤骨折术前行下肢血管彩色多普勒超声检查可降低麻醉手术期深静脉血栓引发致命性肺栓塞的风险.D-二聚体增高,可能引发血栓,但D-二聚体正常后也有发生血栓可能,不可忽视.     

Ultrasonographic demonstration of portal vein thrombosis.

For screening patients suspected of having portal vein thrombosis, the ultrasound examination is simple to perform, noninvasive, and can be accomplished rapidly. Three patients were studied in whom ultrasound examination revealed portal vein thrombosis that was subsequently confirmed by angiography or surgery. Ultrasonic findings in a series of 100 randomly selected patients are summarized.     

Moderne Ultraschalldiagnostik der Beinvenenthrombose bei unklarer Genese der Lungenembolie

PURPOSE: We compared innovative ultrasound techniques such as tissue harmonic imaging (THI) and cross-beam technique with speckle reduction imaging (SRI) to conventional fundamental B scan in the diagnosis of deep vein thrombosis. MATERIAL AND METHODS: We investigated a total number of 185 patients with clinical symptoms of acute vein thrombosis. We documented the thrombosis in the patients using multifrequency ultrasound probes (5-7 MHz, 6-9 MHz, 9-14 MHz, Logig 9, GE) and recorded ultrasound sequences in fundamental B scan, THI, and cross-beam technique with SRI (grade 2). Three blinded ultrasound investigators ranked the marking of the thrombosis in each of these image modalities and graded them with the numbers 5 = weak, 4 = moderate, 3 = satisfactory, 2 = good, and 1 = excellent. We calculated the median and a t-test for each of these image modalities. RESULTS: We diagnosed 115 thromboses (62%) in 185 investigated patients. This group could be divided as follows: 11 patients (6%) with three-level thrombosis, 37 patients (20%) with two-level thrombosis, and 67 (36%) with one-level thrombosis. The one-level thrombosis group included five (3%) patients with muscle vein thromboses, seven (4%) cases of thrombophlebitis without involvement of the deep vein system, and three (2%) cases of thrombophlebitis with involvement of the deep vein system. The t-test for unconnected samples showed significant differences (p <0.05) in iliac veins and highly significant differences (p <0.001) in the veins of the lower extremity due to the superior capabilities for detection of thrombosis using the cross-beam technique with SRI compared to THI and the fundamental B scan. CONCLUSION: The use of high-resolution linear ultrasound probes with the concomitant application of THI and cross-beam technique with SRI facilitates the diagnosis of deep vein thrombosis. The employment of these new ultrasound modalities is an advantage in distinguishing the veins from the surrounding tissue structures and helps in evaluating the compressibility of venous vessels.     

二维多普勒超声诊断肢体静脉血栓的价值及标准拟定(附148例分析)

目的：进一步探讨静脉血栓的超声特征及诊断价值。材料和方法：１４８例四肢静脉血栓患者行二维彩色多普勒超声检测，其中５２例同时行血管造影检查。拟定了周围静脉血栓的超声诊断标准，即超声的直接征象和间接征象。结果：超声诊断符合率为９２３％，血栓检出率、定位准确率、血管压缩试验及压迫试验阳性率分别为９０４％、９０４％、９４２％和９２３％。结论：研究表明超声对此病有较高的诊断价值，在观察多部位多血管血栓以及对病情和治疗效果的随访观察方面优于血管造影。     

Evaluation of the Interpretation of Serial Ultrasound Examinations in the Diagnosis of Deep Venous Thrombosis in Children: A Retrospective Cohort Study

Purpose

To assess ultrasound intrascan variability and the potential error rate of serial ultrasounds in the diagnosis of deep venous thrombosis in children.

Methods

A retrospective cohort review of imaging results of children having at least 3 serial ultrasound examinations of the same region within a 2-month period. The results were interpreted as either (1) inadequately visualized or (2) the absence or presence of deep venous thrombosis, and were categorized by location. Serial imaging findings then were further categorized based on results and clinical information.

Results

Sixty-four patients and 157 vessel segments were included in the study. Deep venous thrombosis was documented in 58 patients. Concordant results were observed in 26 patients (40.1%), clot resolution in 17 patients (26.6%), clot formation in 12 patients (18.8%), and discordant results in 9 patients (14%). Twenty-one of 64 patients (32.8%) had at least 1 vessel inadequately imaged.

Conclusions

The inconsistency of serial ultrasound results in up to 25% of patients calls attention to the potential inaccuracy of ultrasound for diagnosis and follow-up of deep venous thrombosis in children. The high proportion of patients with at least 1 inadequately visualized vessel also highlights the limitation of ultrasound in the diagnosis of pediatric deep venous thrombosis.     

Colour Doppler ultrasound of the post-phlebitic limb: sounding a cautionary note

Colour Doppler ultrasound is accurate in the diagnosis of acute lower limb venous thrombosis. Some patients, however, will re-present with recurrent lower limb swelling following the acute event, and ultrasound may also become the primary imaging modality in these patients. We, therefore, undertook a prospective study of 20 patients with a diagnosis of deep venous thrombosis proven initially on both venography and ultrasound. Sixteen patients had thrombosis in the femoro-popliteal segment and four patients had isolated calf vein thrombosis. Patients with above knee thrombosis were scanned at 1, 3 and 6 months and those with isolated calf lesions at intervals of 1 week, 1 and 3 months. Results showed that in cases of above knee thrombosis, only 50% of patients showed complete recanalization by 6 months. The remaining 50%, by this time, showed only partial recanalization of thrombus, the features of which cannot be distinguished from acute non-occlusive thrombus. With respect to the four cases of isolated calf vein thrombosis, one case showed evidence of popliteal extension of thrombus, which by 3 months had fully recanalized. The remaining three cases recanalized completely without further thrombus extension. These results show that interpretation of the ultrasonic features of the post-phlebitic limb may be difficult in patients who re-present with lower limb swelling. Based on this study, we would advise routine scanning of all patients with above knee venous thromboses at 6 months to provide a baseline scan, permitting more accurate ultrasonic assessment of any future thrombotic events. This study also highlights the question of whether isolated calf vein thrombosis can safely be regarded as a benign entity.     

Colour flow imaging of calf vein thrombosis.

Ultrasound and more recently colour Doppler ultrasound has been successfully used in the diagnosis of lower limb venous occlusive disease. Colour Doppler ultrasound has shown promise in the diagnosis of calf vein thrombosis but to date there has been no prospective trial to specifically evaluate its potential. In view of this, we carried out a prospective trial of 50 patients comparing the accuracy of colour Doppler ultrasound with venography in the diagnosis of deep venous thrombosis both above and below knee but in particular with respect to the detection of calf vein clot. Of the 50 patients studied, 10 had only one imaging modality performed as there were eight venographic failures and two ultrasonic failures. Comparison was only thus possible in 40 cases. As in previous studies, colour Doppler ultrasound was shown to be accurate in the diagnosis of thrombosis within the femoro-popliteal veins and had a sensitivity and specificity of 100% respectively. With respect to calf vein lesions, there was one false negative scan using the ultrasonic technique giving a sensitivity of 95%, specificity of 100% and accuracy of 97.5%. We feel colour Doppler ultrasound can and should be used as a first line alternative to venography and can be employed for the exclusion of both above and below knee deep venous thrombosis. Venography should now be reserved for those patients who are unsuitable for ultrasound examination or who have an equivocal ultrasound scan.     

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.     

Unsuspected lower extremity deep venous thrombosis simulating musculoskeletal pathology

Objective The purpose of this study was to highlight the critical role that MRI may play in diagnosing unsuspected lower extremity deep venous thrombosis and to stress the importance of scrutinizing MRI studies of the lower extremity showing apparently non-specific muscle edema for any evidence of intramuscular venous thrombosis.Design and patients The imaging studies of four patients in whom deep venous thrombosis was unsuspected on clinical grounds, and first diagnosed on the basis of MRI findings, were reviewed by two musculoskeletal radiologists in consensus. In all four patients the initial clinical suspicion was within the scope of musculoskeletal injuries (gastrocnemius strain, n=3; ruptured Baker cyst, n=1), explaining the choice of MRI over ultrasound as the first diagnostic modality.Results All patients showed marked reactive edema in the surrounding soft tissues or muscles. Three patients showed MR evidence of branching rim-enhancing structures within intramuscular plexuses characteristic of venous thrombosis (gastrocnemius, n=1; sural, n=2); one patient showed a distended popliteal vein. Ultrasound was able to duplicate the MRI findings in three patients: one patient showed above-the-knee extension on ultrasound; neither of the two patients with intramuscular thrombosis demonstrated on ultrasound showed extension to the deep venous trunks.Conclusion Intramuscular venous thrombosis can present as marked edema-like muscle changes on MRI, simulating primary musculoskeletal conditions. In the absence of clinical suspicion for deep venous thrombosis, only the identification of rim-enhancing branching intramuscular tubular structures will allow the correct diagnosis to be made.     

Comparison of colour Doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis

The primary imaging technique in suspected venous occlusive disease has for many years been contrast venography. Recent studies have shown ultrasound with the addition of colour Doppler imaging to be a suitable alternative method in the diagnosis of lower limb venous thrombosis. We have applied these techniques to the upper limb venous system, and have performed a prospective study of 19 patients (30 limbs) comparing colour Doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis, for which colour Doppler ultrasound has a sensitivity and specificity of 100%. If vein stenosis is included, the sensitivity falls to 89%. We propose that colour Doppler ultrasound is a suitable first-line alternative to venography in the diagnosis of axillary and subclavian vein thrombosis. In addition to showing the major venous drainage of the upper limb, ultrasound routinely assesses patency of the internal jugular vein, which is, on occasion, of clinical relevance when determining possible future sites of venous access. If, however, colour Doppler ultrasound is normal then bilateral upper limb venography is indicated to exclude a more central venous problem or localized stenotic lesion.     

Ear, nose, and throat cancer: ultrasound diagnosis of metastasis to cervical lymph nodes

We present the results of a study on the value of ultrasound in the detection of metastasis to the cervical lymph nodes in connection with cancer of the ear, nose, and throat. Comparison of clinical, ultrasound, and histological findings for 100 patients who underwent surgery revealed that clinical examination had a sensitivity of 78% versus 92.6% for ultrasound. All 18 cases of thrombosis of the internal jugular vein were detected by ultrasound. Clinical staging of the disease was modified in 28 of these patients based on ultrasound findings, including three false positive findings. Ultrasonographic follow-up at three months for a second group of 110 patients who did not undergo neck dissection provided prognostic information, since lesion stability or progression was correlated with death in less than one year in 41 of 43 patients. Ultrasound is of primary value in providing information of an anatomic nature, including the detection of subclinical lymph nodes, volumetric evaluation, and determination of vascular connections, particularly detection of internal jugular venous thrombosis. Furthermore, for patients whose necks have been thickened as a result of radiotherapy, ultrasound allows assessment of local status.     

Duplex ultrasound diagnosis of symptomatic proximal deep vein thrombosis of lower limbs.

Real time ultrasound (US) was used to examine 165 consecutive inpatients with clinically suspected deep vein thrombosis of lower limbs. In order to evaluate accuracy, the results of non-invasive techniques were compared with ascending venography, performed in all patients. Assessment included only femoro-popliteal veins, because of difficulty in visualizing calf vein with US. Diagnosis of thrombosis was based on noncompressibility of the examined veins; pulsed Doppler provided further information by evaluating blood flow. In our series Duplex ultrasound was very accurate in detecting acute thrombosis of the proximal veins, sensitivity being 97% and specificity 98%. With US it is also possible to detect conditions that mimic deep vein thrombosis, such as muscular rupture, hematoma, popliteal cyst or compressive tumors. In conclusion US is considered a valid alternative to contrast venography in the diagnosis of proximal vein thrombosis of lower limbs.     

严重多发伤合并下肢深静脉血栓33例的诊断及治疗

目的探讨严重多发伤患者合并下肢深静脉血栓的发病率、诊断和治疗情况。方法收集2013年3月~2014年3月我院创伤外科收治的30例严重多发伤合并下肢深静脉血栓形成患者的病例资料进行统计分析,其中男性28例,女性5例;平均年龄(41.2±11.1)岁。分析静脉血栓的发病率、危险因素、辅助诊断、预防及治疗现状等。结果多发伤下肢深静脉血栓的发生率为4.2%(33/785);33例经术前血管超声筛查确诊为下肢深静脉血栓;血浆D-二聚体浓度在下肢静脉血栓为阳性和阴性的严重多发伤患者中没有统计学差异;所有择期手术的下肢深静脉血栓患者术前均行下腔静脉滤网置入术。结论严重多发伤患者下肢深静脉血栓的发病率高于普通住院患者,血管超声是筛查和诊断下肢深静脉血栓的重要手段,D-二聚体对多发伤患者血栓形成诊断价值有限。     

Microbubble ultrasound contrast in the assessment of hepatic artery patency following liver transplantation: role in reducing frequency of hepatic artery arteriography

We prospectively evaluated the role of microbubble ultrasound contrast for detection of hepatic artery thrombosis following liver transplantation. The hepatic artery of adult liver transplant recipients with suspected thrombosis on surveillance Doppler ultrasound (US) were re-examined by a second observer. In patients with no hepatic spectral Doppler signal the microbubble contrast agent Levovist was used. The presence or absence of flow following microbubble contrast was evaluated against arteriography or repeated Doppler US findings. A total of 794 surveillance Doppler US examinations were performed in 231 patients. Hepatic artery flow was demonstrated in 759 of 794 (95.6%) examinations. Microbubble ultrasound contrast was administered in 31 patients (35 studies) with suspected hepatic artery thrombosis. Following microbubble US contrast the hepatic artery could not be demonstrated in 13 of 35 (37.1%) studies (12 patients). Eight patients had arteriography: there was hepatic artery thrombosis in 7 patients and 1 patient had a patent, highly attenuated artery. Detection of a patent hepatic artery increased from 759 of 794 (95.6%) to 781 of 794 (98.4%) with the addition of microbubble contrast. Upon independent reading of the data, the degree of operator confidence in the assessment of the hepatic artery patency prior to microbubble contrast was 4.7 (CI 1.92–7.5) but rose to 8.45 (CI 7.06–9.84) following microbubble contrast (p<0.0001). In 22 of 35 (62.9%) of studies arteriography could potentially have been avoided. Ultrasound microbubble contrast media may reduce the need for invasive arteriography in the assessment of suspected hepatic artery thrombosis.     

Isolated calf venous thrombosis: diagnosis with compression US

Compression ultrasound (US) is an excellent means of evaluating the femoral and popliteal veins but is generally regarded as inadequate for the diagnosis of calf vein thrombosis. This prospective study evaluated compression sonography of the calf veins in 45 symptomatic patients with normal femoral and popliteal veins. All patients underwent correlative venography. Compression US enabled identification of 15 of 17 patients with calf vein thrombosis (sensitivity, 88%). The two false-negative results were in patients with small isolated thrombi. Compression US results were true-negative in 26 of 27 patients with normal venograms (specificity, 96%). If these results can be duplicated by other investigators in larger series of patients, compression US will be an adequate screening modality for calf vein thrombosis.     

超声造影在病理性穿静脉检测定位中的应用探讨

目的:探讨超声造影在病理性穿静脉检测定位中的应用价值。方法:分析140例(166条)下肢浅静脉曲张患者术前穿静脉超声造影检查与定位的临床资料,并与手术结果比较。结果:166条下肢,CDFI共检出穿静脉316条:其中穿静脉功能不全212条,穿静脉血栓4条;X线曲张浅静脉造影术共检出穿静脉347条;超声造影后检出穿静脉345条,其中穿静脉血栓4条;手术共结扎穿静脉350条。结果显示常规超声结合超声造影对穿静脉的检出率明显高于常规多普勒超声检查,与浅静脉造影相当;但浅静脉造影却无法对穿静脉作准确体表标记。结论:超声造影结合多普勒检查是准确诊断和定位穿静脉功能不全的重要和准确的方法。     

Venous protocols, techniques, and interpretations of the upper and lower extremities

Deep venous thrombosis and pulmonary embolism are common problems and frequently included in the differential diagnosis of patients presenting to the emergency department and in the acute care setting. Clinical signs and symptoms of these entities are nonspecific and it is important to perform objective testing to confirm the diagnosis and initiate proper therapy. Compression ultrasonography is the diagnostic procedure of choice for the investigation of patients with suspected deep venous thrombosis. This article reviews the clinical indications, diagnostic techniques, and interpretation of compression ultrasound to assess deep venous thrombosis in the upper and lower extremities and to evaluate the role of compression ultrasonography in the assessment of patients with suspected pulmonary embolism.     

彩色多普勒超声在下肢深静脉血液高凝状态的临床应用价值

目的：早期发现、早期诊断下肢静脉血栓,分析和探讨彩色多普勒超声在下肢深静脉血栓形成前期的应用价值。方法：通过分析156例经彩色多普勒超声检查四肢深静脉血栓形成及血栓形成前期的图像特点及临床治疗经过与疗效复查情况。结果：彩超检查下肢深静脉血管可了解血管的形态结构、管腔血栓形成的程度及彩色血流动力学等改变。及早发现血液高凝状态即血栓前期,并在血栓形成之前及时采用药物治疗,达到临床治愈。结论：彩超检查对四肢深静脉血栓的形成具有很高的敏感性和特异性,是一种可靠的诊断依据,对临床治疗有较好的指导作用。