彩色多普勒超声诊断小腿深静脉血栓39例分析

目的：彩色多普勒超声在小腿深静脉血栓诊断中的应用。方法：应用彩色多普勒超声检测患者双侧深静脉内径变化、管腔回声、腔内彩色血流充盈情况,并跟踪随访。结果：检出39例小腿深静脉血栓。其中胫后静脉血栓6例,腓静脉血栓4例,腓肠肌静脉血栓12例,比目鱼肌静脉血栓15例,腓肠肌静脉和比目鱼肌静脉血栓2例。结论：彩色多普勒超声对小腿深静脉血栓的诊断有较高价值。     

孤立性小腿深静脉血栓的超声诊断

目的　探讨孤立性小腿深静脉血栓的声像图特点及超声诊断方法。方法　应用彩色多普勒超声检查小腿肌肉内深静脉 (比目鱼肌静脉、腓肠肌静脉 )、胫后静脉、腓静脉、胫前静脉 ,以及静脉以上近端深静脉是否有血栓形成。结果　检出的 13例孤立性小腿深静脉血栓中 ,77%为小腿肌肉内深静脉受累 ,少数为腓静脉及胫后静脉受累 ,未发现胫前静脉单独受累者 ;比目鱼肌内的单支静脉血栓为最常见的类型 ,且半数合并近端深浅静脉返流。结论　超声检查能够有效地检出孤立性小腿深静脉血栓病变 ,小腿深静脉特别是肌肉内深静脉应包括在下肢深静脉检查常规之中。     

超声对小腿肌肉静脉丛血栓的诊断价值

目的 评价彩色多普勒超声检测小腿肌肉静脉丛血栓的应用价值.方法 应用彩色多普勒超声检查42例患者的小腿肌肉内深静脉(比目鱼肌静脉、腓肠肌静脉)、胫后静脉、腓静脉、胫前静脉及腘静脉以上近端深静脉是否有血栓形成.结果 小腿肌肉静脉丛血栓形成位于左侧21例,右侧17例,双侧4例.超声随诊发现经治疗的患者中,2例血栓溶解,37例血栓未出现延伸;3例未遵医嘱者2例出现血栓延伸.结论 彩色多普勒超声能有效监测小腿肌肉内静脉血栓,可以作为首选的方法.     

彩色多普勒超声对小腿静脉血栓的诊断价值

目的 探讨彩色多普勒超声在小腿静脉血栓形成中的应用价值.方法 对28例小腿深静脉血栓患者的病例资料进行分析和探讨.结果 28例小腿深静脉血栓均为单侧病变.小腿静脉血栓的好发部位依次为:肌间静脉、腓静脉、胫后静脉,未发现胫前静脉受累.26例患者经治疗1～2周后复查无一例发生血栓延伸,2例未经治疗的患者2周后复查,1例发生血栓延伸.结论 彩色多普勒超声对小腿深静脉血栓有较高的诊断价值.     

彩色多普勒超声诊断小腿静脉血栓的价值

目的:评价彩色多普勒超声在小腿静脉血栓诊断中的应用价值。方法:回顾性分析经静脉血管造影或临床系统溶栓治疗后随访观察证实的285例小腿静脉血栓患者的超声声像图表现。结果:285例小腿静脉血栓患者中,单侧266例,双侧19例。小腿静脉血栓的好发部位依次为肌间静脉、胫后静脉、腓静脉及胫前静脉。结论:彩色多普勒超声诊断小腿静脉血栓具有特异表现,而且安全可靠,能动态观察临床治疗效果,可作为诊断小腿静脉血栓的首选影像学检查方法。     

彩色多普勒超声在颅脑损伤后围术期患者隐性孤立性小腿肌间静脉丛血栓中的应用

目的探讨彩色多普勒超声在颅脑损伤后围术期患者隐性孤立性小腿肌间静脉血栓中的应用价值.方法对解放军第一一三医院高压氧科收治的782例颅脑损伤后围术期患者行常规下肢深静脉彩色多普勒超声检查,分析孤立性小腿肌间静脉丛血栓的临床及声像图特点.结果小腿肌间静脉丛血栓119例,其中孤立性小腿肌间静脉丛血栓102例,合并近端深静脉血栓者17例.孤立性小腿肌间静脉丛血栓患者中,双肢病变13例(12.7%,13/102);单肢病变89例(87.3%,89/102),其中左侧52例(58.4%,52/89),右侧37例(41.6%,37/89).超声声像图示:受累静脉内径不规则增宽,管壁增厚,内膜粗糙,其内可见不均质异常实性回声,呈长条形,横切呈类圆形,阻塞部位管腔不能或部分能压闭;彩色多普勒超声示:无彩色血流显示或血流充盈缺损向心绕行.比目鱼肌血栓长度(2.1±0.8)cm,受累静脉内径(7.9±3.2)mm;腓肠肌血栓长度(1.7±0.6)cm,受累静脉内径(6.4±2.1)mm.比目鱼肌血栓长度及受累静脉内径大于腓肠肌,差异均有统计学意义(t值分别为4.87、4.96,P均<0.05).结论彩色多普勒超声是诊断颅脑损伤后围术期患者孤立性小腿肌间静脉丛血栓的首选方法,可显示血栓的部位、大小、累及范围,并可对血栓进行动态监测,为临床治疗及疗效评价提供可靠依据.     

彩色多普勒超声诊断小腿后肌间静脉血栓

目的探讨彩色多普勒超声对小腿后肌间静脉血栓的临床诊断价值。方法选择行膝关节或髋关节置换术患者72例共94肢,于术前行下肢静脉彩色多普勒超声检查,记录有无血栓并检测股静脉反流情况;术后14天行超声检查及顺行性下肢X线静脉造影。结果术后65肢分别经静脉造影和彩色多普勒超声检查,静脉造影发现3肢,彩色多普勒超声检查发现18肢小腿后肌间静脉内血栓形成,彩色多普勒超声对小腿后肌间静脉血栓的检出明显优于X线静脉造影。术前有反流的静脉中小腿肌间静脉血栓发生率57.14%(16/28);无反流的静脉中小腿肌间静脉血栓发生率17.78%(8/45),术前伴有股静脉反流的静脉血栓发生率高于正常静脉(P<0.01)。结论彩色多普勒超声检测小腿后肌间静脉血栓优于X线静脉造影,便于对血栓进行动态监测,可为临床治疗及疗效评价提供可靠的依据。     

彩色多普勒超声在小腿肌间静脉丛血栓诊断中应用价值

目的:总结探讨彩色多普勒超声在小腿肌间静脉丛血栓诊断中的应用价值。方法:选择2015年1月~2016年12月期间在我院经彩色多普勒超声诊断为小腿肌间静脉丛血栓的60例患者为研究对象,分析其诊断结果及超声表现特征。结果:60例患者均是单侧发病,其中25例血栓位于比目鱼肌静脉丛,12例血栓位于腓肠肌静脉丛,10例血栓位于胫后静脉,13例血栓位于腓静脉。血栓长度平均(5.1±0.5)cm,静脉管径扩张后平均直径(0.82±0.16)cm。在彩色多普勒超声扫描中可见受累的静脉管壁内径增宽、管壁不光滑、腔内有弱回声。完全闭塞的管腔内无血流信号,部分闭塞的管腔内有低速血流信号。结论:彩色多普勒超声在小腿肌间静脉丛血栓诊断中应用价值极高,能清楚显示血栓位置及其管腔扩张及血流情况等,值得推广使用。     

小腿肌间静脉曲张的超声观察及血流动力学分析

目的 应用彩色多普勒超声观察小腿肌间静脉曲张,探讨其好发部位及血流动力学特点.方法 选择经超声诊断的小腿肌间静脉曲张患者102例,病变小腿134条.对小腿后部、后侧部进行横切及纵切扫查.统计肌间静脉曲张发生的部位,比较比目鱼肌及腓肠肌内肌间静脉曲张的发病率;测量并比较肌间曲张静脉的内径和长度.结果 134条肌间静脉曲张的小腿中,肌间静脉曲张发生于比目鱼肌内者129条,占96.27%;发生于腓肠肌内者11条,占8.21%.比目鱼肌与腓肠肌内曲张的肌间静脉内径分别为(8.11±3.02)mm及(6.95±1.73)mm(P＜0.05).结论 小腿肌间静脉曲张易发于比目鱼肌,与其解剖学特征及血流动力学特点有关.     

应用彩色多普勒超声诊断小腿肌间静脉扩张及血栓形成

目的探讨彩色多普勒超声应用于小腿肌间静脉检查,在发现腓肠肌及比目鱼肌肌间静脉扩张及血栓形成中的价值。方法对腓肠肌及比目鱼肌肌间静脉均扩张的82名患者128支下肢静脉进行彩色多普勒超声检查,观测最宽内径及有无血栓形成或形成倾向。结果发现肌间静脉血栓8例(9.8%),其中4例(4.9%)并发肺栓塞;发生肌间静脉血栓的静脉内径(0.65±0.30)cm;其中并发肺栓塞的肌间静脉内径(0.62±0.29)cm;扩张的肌间静脉内具有血栓形成倾向管腔内见"泥沙流"9例(11.0%)。结论彩色多普勒超声可早期发现小腿肌间静脉扩张及血栓形成或血栓形成倾向,以辅助诊断肺栓塞的发生。     

超声诊断小腿深静脉血栓及鉴别诊断

目的分析小腿深静脉血栓的超声诊断方法及其声像图特点。方法对59例67条下肢疑诊小腿深静脉血栓患者，均行超声检查。结果59例患者的67条下肢中35例患者的37条（55．2％）下肢诊为小腿深静脉血栓（8条小腿深静脉血栓伴浅静脉血栓，其中1条伴淋巴水肿；1条小腿肌间静脉血栓伴淋巴水肿），其中32条（86％）下肢为小腿肌间静脉血栓；2条（0．5％）下肢为腓静脉血栓；3条（0．8％）下肢为胫后静脉血栓，其中2条为胫后静脉血栓合并肌间静脉血栓。未见胫前静脉受累。19例患者25条（37．3％）下肢诊为淋巴水肿，5例（7．5％）诊为肌间血肿。结论超声有助于明确小腿深静脉血栓诊断，并能对类似小腿深静脉血栓疾病症状的疾病进行鉴别。     

Real-time sonography in deep thrombosis of the pelvic and leg veins. A prospective comparison to phlebography

Real-time B mode ultrasound is a well accepted diagnostic procedure in the non-invasive vascular examination. In a prospective study we examined 101 patients with clinical suspected deep vein thrombosis of the pelvis or leg using ultrasound and contrast venography within 24 hours and we compared the results of both examinations. All veins of the pelvis and lower extremities were scanned in transverse and longitudinal planes. 113 venograms were obtained; they demonstrated the presence of isolated proximal vein thrombosis in seven patients, seven isolated calf vein thromboses and 43 thromboses of both proximal and calf veins. The sensitivity of ultrasonography for detecting deep vein thrombosis in the proximal veins of the lower extremity was 98%, the specificity was also 98%. In the veins of the pelvis the sensitivity was 78%, the specificity 98% and in calf veins 60% and 97% respectively. The sensitivity for the detection of isolated calf vein thrombosis was only 14%. We conclude that ultrasonography has a very good sensitivity for detecting proximal vein thrombosis of the lower extremity and thrombosis of the pelvic veins. Phlebography remains the better method in detecting isolated calf vein thrombosis because of the difficult visualisation of the small calf veins by ultrasonography.     

围手术期小腿深静脉血栓的早期超声诊断及预后

目的探讨围手术期小腿深静脉血栓早期超声诊断及其预后。方法136例手术患者于手术前后接受下肢深静脉彩色多普勒超声检查,并进行多次随访,了解血栓的预后。结果检出小腿深静脉血栓14例,共23处血栓,其中小腿肌间静脉血栓13处,胫后静脉血栓8处,腓静脉血栓2处。血栓在静脉内孤立存在。经治疗患者血栓范围缩小明显,术前检出血栓者与未检出血栓者下肢肌力无统计学差异（P〉0．05）,术后检出血栓者下肢肌力低于未检出血栓者（P〈0．05）。结论超声检查可发现术后无症状的小腿深静脉血栓,其可能与小腿肌力减弱有关,早期进行抗凝治疗,可预防血栓的进一步发展。     

多层螺旋CT静脉造影诊断下肢静脉血栓性病变

目的探讨多层螺旋CT静脉造影(MSCTV)对下肢静脉血栓诊断的临床应用价值.方法 MSCT下肢静脉造影检查16例,其中12例做下肢多普勒超声检查,4例做下肢静脉造影.MSCTV检查后经最大密度投影(MIP)、表面遮盖法(SSD)及容积再现法(VR)重建.结果 MSCTV显示11例存在静脉血栓.以多普勒超声作对照,MSCTV显示股腘静脉血栓的敏感性96.0%,特异性97.8%,阳性预测值96.0%,阴性预测值97.8%,准确性97.2%.MSCT尚能显示小腿、盆腔等超声检查难于显示的血栓.MSCTV较常规静脉造影更清晰显示盆腔静脉血栓.结论 MSCTV对显示股腘静脉血栓方面与超声同样敏感,MSCTV还能显示超声难于显示的髂静脉及胫腓静脉的血栓.MSCTV可作为下肢静脉血栓诊断的首选检查方法.     

彩色多普勒超声与数字减影血管造影对比评价不同节段下肢深静脉血栓的诊断价值

目的 探讨彩色多普勒超声对不同节段深静脉血栓形成(DVT)的诊断价值.方法 临床疑为DVT患者58例,应用彩色多普勒超声探测患肢各节段血管,检查结果 与DSA对照,按照四格表分析,评价彩色多普勒超卢诊断不同节段DVT的灵敏性、特异性、准确性等指标.结果 共检测150条不同节段静脉.进行四格表统计分析彩色多普勒超声对各节段血管的检出率:髂总静脉血栓检查灵敏性82.6%,特异性66.7%;髂外静脉血栓灵敏性83.3%,特异性80.0%;髂内静脉血栓灵敏性80.0%,特异性66.7%;胴静脉血栓灵敏性92.6%,特异性92.2%;股静脉血栓灵敏性96.2%,特异性93.8%;胫前静脉血栓灵敏性71.4%,特异性75.0%;胫后静脉血栓灵敏性72.7%,特异性75.0%.结论 彩色多普勒超声作为DVT的首选检查方法 ,对不同节段静脉血栓有不同的诊断价值,对股、胭及髂外静脉灵敏性较高,胫前、胫后静脉血栓检出的灵敏性较低.     

Compression sonography as a procedure in the diagnosis of acute deep venous thrombosis of the leg

It is well known that clinical symptoms of deep venous thrombosis of the leg are not reliable. We studied the diagnostic value of compression sonography in the diagnosis of venous thrombosis of the lower extremity. Ultrasound examination was performed in patients in the supine position. The venous segments were evaluated almost exclusively with transversal scanning. In the thigh lacking compressibility of the venous lumen was the only criterion for thrombosis. In the calf, unobstructed veins can usually not be seen in the patient supine. In thrombosis however the vessel is dilated by the clot and appears as sonolucent incompressible channel. 178 patients were examined comparatively by venography and ultrasound (226 one extremity phlebogramms). Phlebography demonstrated 113 thromboses which could be demonstrated by ultrasound with a sensitivity of 95% and a specificity of 100%. In 92% the extension of thrombosis was estimated accurately. Thigh vein thrombosis was detected with a sensitivity of 97% and a specificity of 99%. Occlusion or patency of the common femoral vein was seen correctly in each case. Ultrasonic diagnosis of the superficial femoral vein thrombosis had a sensitivity of 97%, that of the popliteal vein of 98% and a specificity of 100% in both. Venous occlusion confined to the calf was detected with a sensitivity of 89% and a specificity of 99%. We conclude that compression sonography is a highly accurate diagnostic procedure for the diagnosis of deep venous thrombosis of the thigh as well as the calf. It should be the first choice of imaging method in the diagnosis of venous thrombosis of the leg.     

彩色多普勒超声在下肢静脉病变中的诊断效率与误诊分析

目的评价彩色多普勒显像(CDI)对不同节段下肢静脉血栓、侧支循环形成及瓣膜功能不全的诊断效率。方法将80例患者90条静脉分为髂静脉段、股-腘静脉段、胫-腓静脉段共270个节段,并与X线静脉造影对照,分析CDI对各节段静脉血栓、侧支循环形成及瓣膜功能不全的诊断效率,分析漏、误诊原因。结果 CDI诊断髂静脉段、股-腘静脉段、胫-腓静脉段深静脉血栓、侧支循环形成、瓣膜功能不全的敏感度分别为83.33%(20/24)、94.59%(35/37)、77.78%(21/27)、66.67%(8/12)、84.09%(37/44);特异度分别为76.47%(13/17)、94.34%(50/53)、90.48%(57/63)、93.59%(73/78)、91.30%(42/46);准确率分别为80.49%(33/41)、94.44%(85/90)、77.78%(78/90)、90.00%(81/90)、87.78%(79/90);阳性预测值分别为83.33%(20/24)、92.11%(35/38)、86.67%(21/27)、61.54%(8/13)、90.24%(37/41)。髂静脉段血栓漏、误诊8条,股-腘静脉段血栓漏、误诊5条,均为急性、部分栓塞。胫-腓静脉段血栓漏、误诊12条,11例为急性、完全栓塞,1例为慢性、部分栓塞。结论 CDI诊断股-腘静脉段血栓的敏感度、特异度高于髂静脉、胫-腓静脉段。尽管CDI对侧支循环形成的敏感度和阳性预测值较低,但特异度和准确度较高。急性栓塞较易造成漏、误诊。     

Color Doppler sonographic finding of retrograde jugular venous flow as a sign of innominate vein occlusion

Occlusion or stenosis of the superior vena cava, the innominate vein, or both is an important clinical problem that requires prompt diagnosis. To confirm a suspected occlusion, imaging studies revealing the obstruction and the presence of collateral venous routes are needed. Color Doppler sonography (CDUS) is widely used to evaluate suspected venous thrombosis and collateral pathways. We present the CDUS findings in 2 cases of innominate vein occlusion. In case 1, CDUS of the neck and left upper arm, which harbored a permanent hemodialysis access, showed engorged veins in the upper arm, a patent dialysis access, and some collateral veins in the axilla. The subclavian and internal jugular veins were patent, but the flow in the left internal jugular vein was reversed. The left innominate vein was occluded. In case 2, CDUS of the upper arms showed that the veins, the dialysis access in the left upper arm, and the subclavian and jugular veins were patent, but the flow in the left internal jugular vein and in the right subclavian vein was reversed. Collateral veins were seen in the right axillary region. Both innominate veins were occluded. The resulting collateral pathways, ie, retrograde flow in the ipsilateral jugular vein crossing to the contralateral jugular vein through dural sinuses, were confirmed by venography in both cases.