低机械指数灰阶超声造影诊断下肢深静脉血栓的价值

Clinical value of contrast-enhanced ultrasonogrphy and low mechanical index gray-scale imaging in diagnosing lower limp deep venous thrombosis

目的:对比分析应用低机械指数灰阶超声造影与彩色多普勒超声诊断下肢深静脉血栓(deep vein thrombosis,DVT)的价值。方法:分析30例临床拟诊为下肢DVT患者的临床及影像资料,以X线静脉造影或手术结果为金标准,对比分析彩色多普勒超声与实时灰阶超声造影与DSA或手术结果的一致性。结果:彩色多普勒超声与SonoVueTM低机械指数实时灰阶超声造影诊断下肢DVT的敏感度、特异度、准确率、阳性预测值、阴性预测值分别为81.25%、55.00%、73.53%、81.25%、55.00%和93.75%、70.00%、86.76%、88.24%、82.35%;诊断小腿DVT的敏感度、特异度、准确率、阳性预测值、阴性预测值分别为55.56%、55.00%、55.26%、52.63%、57.89%和83.33%、70.00%、76.32%、71.43%、82.35%;2种方法诊断大腿DVT的结果与金标准一致;超声造影微泡灌注到达时间、达峰时间和峰值强度健侧均小于患侧;对比剂微泡与股总静脉管壁间低回声厚度健侧小于患侧。结论:低机械指数实时灰阶超声造影与彩色多普勒超声均是诊断下肢DVT的良好方法;超声造影是超声诊断下肢DVT的一种补充手段,尤其是在常规超声显示困难的小腿DVT诊断中具有优势,值得进一步推广和应用。

Objective：To explore the clinical value of contrast enhanced ultrasonography and low mechanical index gray-scale imaging and color Doppler ultrasound in diagnosing deep vein thrombosis of lower limp extremity. Methods：30 cases were suspected to have deep vein thrombosis of lower extremity and were performed routine exam by color Doppler ultrasound and the contrast-enhanced ultrasonography. The 30 cases were confirmed by radiation venography or surgery; and the radiation venography or the results of surgery were taken as the standard to investigate the characteristic of thrombosis by color Doppler ultrasound and the contrast-enhanced ultrasonography, and to assess their clinical value. Results：（1）The sensitivity, specificity, accuracy rate and positive predictive value, negative predictive value of contrast-enhanced ultrasonography and color Doppler ultrasound in diagnosing lower limp deep venous thrombosis were81. 250/00,55.00%, 73.53%, 81.25%, 55.00% and 93.75%, 70.00%, 86.76%, 88.24%, 82.35% respectively. （2）There was no statistically significant difference in diagnosing deep vein thrombosis of the thigh by color Doppler ultrasound and the contrast-enhanced ultrasonography,in the other words,the result was consistent with results of the surgery. The sensitivity, specificity, accuracy rate and positive predictive value,negative predictive value of contrast-enhanced ultrasonography and color Doppler ultrasound in diagnosing calf deep venous thrombosis were 55.56%,55.00%,55.26%,47.62%,57.89% and 83.33%, 70.00%,76.32%,71.43%,82.35%,respectively. @The healthy side of the contrast media arrival time and the time to peak enhancement were earlier than the trouble side. The peak intensity of the healthy side was lower than contralateral. @The low echo in trouble side was thicker than the healthy side. Conclusions： The color Doppler ultrasound and contrast-enhanced ultrasonography and low mechanical index gray-scale imaging is the good way to diagnose deep vein thrombosis of lower extremity. The contrast-enhanced ultrasonography is the supplementary means to diagnose deep vein thrombosis of lower extremity by the color Doppler ultrasound, especially there are distinct advantages in diagnosing deep vein thrombosis of lower extremity which is difficult to be diagnosed by the routine color Doppler ultrasound. It is worthy of promotion and application.