经双侧大隐静脉入路的双下肢CTV/A成像技术在髂静脉压迫综合征中的应用价值

Value of computed tomography venography/angiography of both lower extremities via both great saphenous veins in the imaging diagnosis of iliac vein compression syndrome

目的:探讨经双侧大隐静脉入路的双下肢静脉造影/成像(computed tomography venography/angiography,CTV/A)技术在髂静脉压迫综合征(iliac vein compression syndrome,IVCS)影像诊断中的应用价值。方法:回顾性分析109例(男49,女60)后经DSA确诊为髂静脉压迫综合征的患者,随机分为2组:A组57例(男25,女32)、B组52例(男24,女28)。A组采用双侧大隐静脉(膝关节下方)对比剂入路,B组采用双侧足背静脉对比剂入路。2组均行对比剂团注追踪触发扫描,A组监测腹主动脉,B组监测下腔静脉。三维容积重组(three-dimensional volume rendering,3DVR)、最大密度投影(maximum intensity projection,MIP)、多平面重组(multiplanar reformation,MPR)、曲面重组(curved planar reconstruction,CPR)多种后处理方式显示动静脉压迹和迂曲开放侧支。由3名经验丰富的医生分别从图像质量腹主动脉-下腔静脉对比度(直接征象)和侧支显示率(间接征象)进行评价。结果:①迂曲的盆腔静脉、马尾静脉丛、腹壁侧支显影率:A组>B组(58.14%vs. 13.95%,P<0.001),双下肢曲张静脉网显影率:A、B组无明显差异(98.83%vs. 96.51%,P=0.312)。②血管密度:下腔静脉主干:A、B组无统计学差异[(354.07±26.49)HU vs.(303.59±30.57)HU,t=11.57,P<0.001],髂动脉主干:A组>B组[(177.28±14.95)HU vs.(74.24±13.49)HU,t=47.45,P>0.001]。③对比剂涡流发生率:A组<B组(23.26%vs. 62.79%,P<0.001)。④CTV/A对髂静脉压迫综合征的确诊率:A组>B组(93.6%vs.10.22%,P<0.001)。结论:双侧大隐静脉入路下肢CTV/A成像检查清晰展示髂动静脉的解剖关系和髂静脉压迫综合征的直接和间接征象,提高了图像质量和诊断率。

Objective:To investigate the value of computed tomography venography/angiography(CTV/A)via both great saphenous veins in the imaging diagnosis of iliac vein compression syndrome(IVCS). Methods:A retrospective analysis was performed on 109 cases(49 males and 60 females)diagnosed as IVCS by digital subtraction angiography. They were randomly divided into group A(57 cases;25 males and 32 females)and group B(52 cases;24 males and 28 females). Group A and group B were injected with a contrast agent through both great saphenous veins(below the knee joint)and both dorsalis pedis veins,respectively. A bolus tracking scan was performed in both groups;we monitored the abdominal aorta and the inferior vena cava in group A and group B,respectively. Arteriovenous nicking and distorted open collateral vessels were displayed by postprocessing methods such as three-dimensional volume rendering,maximum intensity projection,multiplanar reformation,and curved planar reconstruction. Three experienced diagnosticians evaluated the image quality,abdominal aorta-inferior vena cava contrast ratio(direct sign),and collateral display rate(indirect sign). Results:①The display rate of the distorted pelvic vein,caudal venous plexus,abdominal wall branches was significantly higher in group A than in group B(58.14% vs. 13.95%,P<0.001);the display rate of varicose veins in both lower limbs was not significantly different between group A and group B(98.83% vs. 96.51%,P=0.312). ②There was no significant difference in the vascular density of the inferior vena cava trunk between group A and group B(354.07 ±26.49 HU vs. 303.59 ±30.57 HU,t =11.57,P <0.001);group A had a significantly higher vascular density of the iliac artery trunk than group B(177.28±14.95 HU vs. 74.24±13.49 HU,t=47.45,P>0.001). ③The incidence of contrast agent eddy current was significantly lower in group A than in group B(23.26% vs. 62.79%,P<0.001). ④Group A had a significantly higher diagnostic accuracy rate of IVCS than group B(93.6% vs. 10.22%,P<0.001). Conclusion:Lower limb CTV/A via both great saphenous veins can clearly demonstrate iliac arteriovenous anatomy and the direct and indirect signs of IVCS,thus improving image quality and the diagnostic accuracy rate of IVCS.