彩色多普勒超声在诊断血管外膜囊性病变中的应用价值

目的探讨血管外膜囊性病变（CAD）的超声表现,评价彩色多普勒超声对CAD的诊断价值。 方法回顾性分析2005年8月至2014年2月于中国医科大学附属第一医院就诊并经手术确诊的8例CAD患者的超声图像表现及其它影像检查方法的特点。 结果术前超声确诊5例,误诊3例。8例CAD均为单发,5例位于于腘动脉,2例位于髂外动脉-股动脉,1例位于髂外静脉。依据囊肿形态及管腔的狭窄特点将其分为偏心性囊肿和向心性囊肿,偏心性囊肿6例,其中2例囊肿内有分隔,向心性囊肿2例,囊肿内均有分隔。受累血管外壁均不同程度增宽,但横切见血管外形均无改变,管腔受压,内径变细。动脉受累者,囊肿与管腔之间可见3层管壁结构,狭窄处血流收缩期峰速度可加快,频谱形态呈湍流样改变,病变远心端动脉血流峰速度减低。病变位于静脉者,其远心端静脉管腔增宽,血流缓慢。血管造影显示受累动脉处管腔狭窄,呈"弯月征"。CT可见管腔外单腔或多腔肿物,管腔呈充盈缺损或变细。8例病例均行囊肿切除及血管外膜剥离术。 结论彩色多普勒超声能够准确显示CAD患者囊肿的位置、形态和内部回声等,准确评价管腔狭窄特点、程度和血流状态,对CAD的诊断、治疗和预后有重要的临床意义。

The value of color Doppler ultrasound in the diagnosis of cystic adventitial disease

ObjectiveTo explore the ultrasonic characteristics of cystic adventitial disease (CAD) and to evaluate the value of color Doppler ultrasound in diagnosis of CAD. MethodsWe retrospectively analyzed the ultrasonograms and other imaging methods of eight patients with CAD conformed by surgery in The first Hospital of China Medical University. ResultsFive of the eight CAD cases were confirmed by color Doppler ultrasound before surgery, and three were misdiagnosed. All the cases were single, with five in popliteal artery, two in iliofemoral artery, and one in external iliac vein. We divided the cysts into concentric cysts and eccentric cysts according to the cystic shape and the lumen stenosis. Six cases were eccentric cysts, in which two had septations; two cases were concentric cysts, and both had septations. The affected vessel expanded, but its shape did not change and the lumen was compressed. There were three layers of wall between the cyst and the lumen. The peak systolic velocity of the affected lumen increased and the distal end systolic peak velocity decreased when lesion occurred in artery. Distal end lumen reflux were slow when lesion occurred in distal veins. Angiography showed the stenosis of the affected lumen, which was described as "scimitar sign". CT showed uniorlocular or multilocular cyst, and the compressed lumen. All of the eight patients underwent the diseased adventitia resected along with excision of the cyst. ConclusionsThe color Doppler ultrasound can display the location, shape, and internal echo of CAD, and thus it can accurately evaluate luminal stenosis and flow pattern. This is of important clinical significance for the diagnosis, treatment, and prognosis of CAD.