下肢深静脉血栓形成MRA和CTA的临床价值——与DSA比较研究

目的探讨下肢深静脉血栓形成的磁共振血管成像（MRA）和多层螺旋CT血管成像（MSCTA）两种影像检查方法的临床价值。方法对40例临床确诊下肢深静脉血栓形成的患者，24例进行了MR检查，16例行MSCTA检查。MRA采用二维时间飞越法磁共振血管成像（2D TOF MRA）；血栓信号及软组织的观察选用SE序列T1WI、FSE序列T2WI、FAST序列。MSCTA检查14例患者采用间接法MSCTA，2例患者采用直接法MSCTA。40例患者均作了数字减影血管造影（DSA）检查，MRA和MSCTA的检查结果与DSA进行对照分析。结果下肢深静脉血栓形成的MRA表现有：静脉充盈缺损（14例）、静脉闭塞和中断（7例）、静脉再通（3例）、侧支循环形成（24例）。以DSA为诊断标准，MRA诊断符合率为95．65％。血栓信号：急性血栓（18例）：血栓在SE序列T1WI、FSE序列T2WI和FAST序列上多为等信号或高信号，信号多不均匀，6例急性血栓可见血管周围水肿；慢性血栓（6例）：血栓在SE序列T1WI、FSE序列T2WI和FAST序列上多均为低信号或等信号。下肢深静脉血栓形成的MSCTA表现有：静脉充盈缺损（8例）；静脉闭塞和中断（5例）：静脉再通（3例）；侧支循环形成（10例）。结论MRA和DSCTA对下肢深静脉血栓诊断都有较高的诊断价值，临床应用时可根据具体情况，任选其一。

Evaluation of the clinical values of MRA and MSCTA in detection of deep vein thrombosis in the low legs-comparison of DSA

Objective To assess the clinical values of magnetic resonance angiograph (MRA) and multi-slice CT angiography (MSCTA) in detection of deep vein thrombosis in the low legs. Methods Forty patients of deep vein thrombosis in the low legs were confirmed by clinic. Twenty-four patients were performed with two-dimensional time of flight magnetic resonance angiograph (2D TOF MRA). Magnetic resonance direct thrombus imaging (MRDTI) was examined with spine echo sequence T1-weight image (SE T1WI), fast spine echo sequence T2-weighyed image (FSE T2WI) and Fourier acquired steady state sequence (FAST). Sixteen patients were performed with 16-slice heical CT angiography (MSCTA). The findings of MRA and MSCTA were compared with that of digital subtraction angiography (DSA). Results The MRA findings of detection of deep vein thrombosis in the low legs included venous filling defect (14 cases), occlusions and interruptions of veins (7 cases), venous recandizations (3 cases), collateral veins (24 cases). When the results of DSA were regard as golden standard, the accuracy of MRA was 95.65%. Acute thrombi (18 cases) were intermediate or high signal intensity with heterogeneous internal structure in T1WI, T2WI and FAFT and chronic thrombi (6 cases) were low or intermediate signal intensity in T1WI, T2WI and FAST. The MSCTA findings of detection of deep vein thrombosis in the low legs included venous filling defect (8 cases), occlusions and interruptions of veins (5 cases), venous recandizations (3 cases), collateral veins (10 cases). When the results of DSA were regard as golden standard, the accuracy of MSCTA was 100%. Conclusion Both 2D TOF MRA and MSCTA have clinical values in diagnosis of deep vein thrombosis in the low legs. We can choose one of them according to concrete situation.