3D和2D-DSA对慢性静脉功能不全型非血栓性髂静脉病变的诊断评估价值比较

目的：3D髂静脉造影在慢性静脉功能不全型非血栓性髂静脉病变（NIVL）诊断中的应用价值。方法：回顾性分析我科2015年1月至2016年12月收治的NIVL患者的临床资料，比较3D和2D髂静脉DSA对NIVL的诊断差异及在造影剂量和曝光时间上的区别。结果：共选取175例患者，3D-DSA诊断NIVL的敏感性为91.1%，特异性为91.2%，Youden指数为0.823，阳性似然比分别为11.234，阴性似然比为0.097；Kappa值为0.825；McNemar检验提示P＞0.05，诊断NIVL的AUC＞0.9，3D造影时造影剂用量及造影曝光时间均更少（P＜0.05）。结论：3D-DSA对慢性静脉功能不全型NIVL诊断的敏感性、特异性均较好，与2D-DSA有较好的一致性，且造影剂量与曝光时间较2D-DSA更具优势。

A comparison between 3D and 2D-DSA in the evaluation of nonthrombotic iliac venous lesions with chronic venous insufficiency

Objective: To investigate the value of 3D-iliac vein DSA in nonthrombotic iliac venous lesions (NIVL) with chronic venous insufficiency (CVI). Methods: Clinical data of patients with NIVL with CVI experienced both 3D and 2D-distal subtraction angiography (DSA) examination in our department from January 2015 to December 2016 were analyzed. The differences of two methods in the diagnosis of NIVL with CVI were compared. Results: Altogether 175 cases were collected. Compared with DSA in the diagnosis of NIVL with CVI, sensitivity, specificity, Youden index, positive likelihood ratio and negative likelihood ratio was 91.1%, 91.2%, 0.823, 11.234 and 0.097 respectively. Kappa value was 0.825 and there was no significant difference (P>0.05, McNemar test) between the two groups. Both areas under curves (AUC) were>0.9, showed by receiver operating characteristic (ROC) curve; imaging contrast agents and imaging exposure time of 3D-DSA were less (P<0.05), with statistical difference. Conclusion: 3D-DSA is remarkable in sensitivity and specificity for NIVL with CVI, which is consistent with 2D-DSA. There is no significant difference between 3D and 2D-DSA in the diagnosis of NIVL with CVI. 3D and 2D-DSA is important in the diagnosis and preoperative assessment of NIVL with CVI, imaging contrast agents and imaging exposure time of 3D-DSA were less.