小腿静脉血栓的影像学诊断

目的探讨彩色多普勒超声及静脉造影对小腿静脉血栓的诊断价值.方法采用彩色多普勒超声检出219例小腿静脉血栓,其中18例行下肢静脉造影.结果彩色多普勒超声检查出小腿陈旧性或附壁血栓152例,新鲜血栓67例.与静脉造影对照,彩色多普勒超声检测小腿胫后静脉、腓静脉的敏感性分别为87.5%、90.9%,特异性分别为100%、100%,而对于小腿腓肠肌和比目鱼肌间静脉血栓,彩色多普勒超声的诊断显示率明显高于静脉造影.小腿静脉血栓发生于单侧肢体者明显多于同时发生于双侧肢体者.两侧小腿血栓分布部位的次序都是腓静脉(28%)>胫后静脉(23.0%)>肌间静脉(15.1%)>肌间静脉 腓静脉(14.6%).结论彩色多普勒超声对小腿胫后、腓、胫前静脉、腓肠肌和比目鱼肌间血栓有较高的敏感性和特异性,可以了解小腿静脉血栓的发生部位、分布、延伸和大小的变化.静脉造影可以确诊胫后、腓、胫前静脉的血栓,但对小腿肌间静脉血栓的诊断有限.

Imaging diagnosis of deep venous thrombosis in the calf

Objective To discuss the diagnostic value of color Doppler ultrasound (CDUS) and venography in deep venous thrombosis of isolated calf veins. Methods From Jan. 2001 to Jan. 2004, 219 cases of isolated venous thrombosis in the calf were diagnosed by CDUS, 18 cases performed venography. Results One hundred and fifty-two cases of stale thrombosis and 67 cases fresh thrombosis were found by CDUS. Compared with venography, CDUS showed a sensitivity of 87.5% in posterior tibial vein and 90.9% in peroneal vein, a specificity of 100% and 100%, respectively. The incidence of thrombosis in calf vein in one leg was higher than that in both legs. The distributed order of thrombosis in calf vein was peroneal vein (28%) > posterior tibial vein (23.0%) > muscular vein (15.1%) > muscular vein peroneal vein (14.6%). Conclusion CDUS showed a high sensitivity and specificity in peroneal vein and posterior tibial vein. It can be used to detect the patterns and distribution of thrombosis in calf veins. Venography could detect the thrombosis in posterior tibial veins, peroneal veins and anterior tibial veins, but it is limited to detect the soleal and gastrocnemius venous thrombosis.