间接法CT静脉造影和磁共振静脉造影在下肢深静脉血栓形成中的诊断价值

Diagnostic value of indirect CT venography and magnetic resonance venography in deep venous ;thrombosis of lower limbs

目的：探讨间接法CT静脉造影（CTV）和磁共振静脉造影（MRV）在下肢深静脉血栓形成（DVT）中的诊断价值。方法回顾性分析2014年4月至2015年12月于本院就诊的45例下肢DVT患者的临床资料，27例行间接法MRV检查、18例行间接法CTV检查，其中两例患者同时行肺动脉CT血管造影（CTA）和下肢CTV检查。分析CTV和MRV图像表现，并与数字减影血管造影（DSA）进行比较，计算CTV和MRV诊断下肢DVT的敏感度、特异度、阳性预测值和阴性预测值。结果下肢DVT的CTV和MRV图像主要表现为静脉管腔不同程度狭窄、闭塞或中断，横断位同心圆或偏心性充盈缺损和侧支循环形成，检查结果易受植入物、心功能等因素影响。两例患者行肺动脉CTA及下肢CTV检查均显示肺动脉栓塞和下肢DVT。MRV诊断下肢DVT的敏感度为96.2%（76/79）、特异度为99.7%（352/353）、阳性预测值为98.7%（76/77）、阴性预测值为99.2%（352/355）。CTV诊断下肢DVT的敏感度为94.5%（52/55）、特异度为99.1%（231/233）、阳性预测值为96.3%（52/54）、阴性预测值为98.7%（231/234）。结论间接法CTV和MRV均可准确诊断下肢DVT，临床可根据需要选择合适的检查方法。

Objective To investigate the diagnostic value of indirect CT venography（CTV）and magnetic resonance venography（MRV）in deep venous thrombosis（DVT）of lower limbs. Methods The clinical data of 45 patients with DVT of lower limbs,who were hospitalized in our hospital between April 2014 and December 2015,were analyzed retrospectively. Twenty-seven patients underwent indirect MRV and 18 patients underwent indirect CTV,including 2 patients who underwent pulmonary CT angiography（CTA） and CTV of lower limbs. The images of CTV and MRV were analyzed. Compared with the results of digital subtraction angiography（DSA）,the sensitivity,specificity,positive predictive value and negative predictive value of DVT of lower limbs diagnosed by CTV and MRV were calculated. Results The images of CTV and MRV of DVT of lower limbs mainly showed different degrees of venous stenosis,occlusion or interruption, and the formation of axial concentric or eccentric filling defect and collateral circulation,which were easily influenced by implants and heart function. Two patients,who underwent pulmonary CTA and CTV of lower limbs,showed pulmonary embolism and DVT of lower limbs. The sensitivity,specificity,positive predictive value and negative predictive value of DVT of lower limbs diagnosed by MRV were 96.2%（76/79）,99.7%（352/353）,98.7%（76/77） and 99.2%（352/355）,respectively. The sensitivity,specificity,positive predictive value and negative predictive value of DVT of lower limbs diagnosed by CTV was 94.5%（52/55）, 99.1%（231/233）,96.3%（52/54）and 98.7%（231/234）,respectively. Conclusion Indirect CTV and＆amp;nbsp;MRV may accurately diagnose DVT of lower limbs,which can be selected for clinical use accordingly.