彩色多普勒血流显像诊断脾动脉瘤的价值

Diagnostic value of splenic artery aneurysm with color Doppler flow imaging

目的探讨脾动脉瘤的彩色多普勒血流显像（CDFI）表现及其诊断价值。方法回顾性分析15例脾动脉瘤患者的超声结果，包括二维及彩色多普勒血流显像表现。结果在15例脾动脉瘤患者中，单发13例，多发2例（各2个瘤体），共17个瘤体。瘤体位于脾动脉近段3个，中段1个，远段（脾门处）13个。二维超声表现为：脾动脉呈囊状扩张的无回声，直径2．0～5．5cm，平均3．6cm。CDFI显示无回声两端与脾动脉相连，内充满彩色血流信号，呈涡流，其内引出动脉血流频谱。4例合并附壁血栓，壁上可见低回声，CDFI见该处血流信号充盈缺损。CDFI诊断准确率88．2％（15／17），1例误诊为左侧肾上腺肿瘤；1例多发脾动脉瘤的2个瘤体中，超声诊断1个，漏诊1个。结论脾动脉瘤多数单发，且多位于脾动脉远段。CDFI诊断准确性较高，可以作为脾动脉瘤首选影像学检查及随诊方法，其主要诊断依据为瘤体内充满动脉血流信号或充盈缺损，两端与脾动脉相连。

Objective To evaluate the appearances of splenic artery aneurysms with color Doppler flow imaging （CDFI） and to determine the diagnostic value. Methods Appearances of gray-scale ultrasonography and CDFI of fifteen cases of splenic artery aneurysm were analyzed retrospectively. Results Fifteen cases with 17 splenic artery aneurysms, 13 cases were solitary, 2 cases were multiple. Three aneurysms were located in the proximal third of splenic artery, one in the middle third, thirteen in the distal third. The size of aneurysms ranged from 2.0 cm to 5.5 cm in diameter, average 3.6 cm. Ultrasonographic appearances of splenic artery aneurysms; aneurysms were saccular, completely filled with color Doppler signals, showed arterial velocity waveform with pulsed Doppler, and connected with splenic artery. If there was thrombosis in the aneurysms, hypoechoic would be found on the wall, and indicated filling defect of CDFI. The accurate diagnostic rate was 88.2% （15/17）, one was misdiagnosed as adrenal gland tumor,and another patient had two aneurysms, one of them was diagnosed by CDFI, another was missed. Conclusions Splenic artery aneurysm were most solitary and located in the distal third of the splenic artery. The diagnostic accuracy of CDFI was high. CDFI could be the first imaging modality for diagnosis and follow up of splenic artery aneurysms. The mass found in CDFI, which was completely filled with color Doppler signals or filled defect and connected with splenic artery, was the key diagnostic criteria.