CT静脉造影显示下肢深静脉血栓分布的临床价值

The clinical value of CT venography in displaying the distribution of deep venous thrombosis of lower extremities

目的探讨CT静脉造影(CTV)显示深静脉血栓形成(DVT)在下肢静脉各段分布的临床价值。方法对105例下肢DVT患者CTV和DSA影像学资料进行对比分析。比较CTV三维图像和DSA造影结果 ,观察下肢深静脉各段内血栓分布,分析血栓形成原因。χ^2检验法对比CTV和DSA对下腔静脉,双侧髂外静脉、股浅静脉、腘静脉、髂内静脉、股深静脉血栓形成的诊断准确性。结果 CTV显示105例患者中DVT在双下肢11例,左下肢71例,右下肢23例。DSA未能显示20处髂内静脉血栓和31处股深静脉血栓。CTV显示下肢血栓近心段及双侧肾静脉是否受累比DSA更清晰。CTV和DSA对下腔静脉血栓诊断差异无统计学意义(χ^2=1.33,P>0.05);对左髂外静脉(χ^2=0, P>0.05)、右髂外静脉(χ^2=1.33, P>0.05)、左股浅静脉(χ^2=0.50, P>0.05)、右股浅静脉(χ^2=0, P>0.05)、左腘静脉(χ^2=0, P>0.05)、右腘静脉(χ^2=0, P>0.05)血栓诊断差异均无统计学意义;对左髂内静脉(χ^2=12.07, P<0.05)、右髂内静脉(χ^2=4.16, P<0.05)、左股深静脉(χ^2=22.04, P<0.05)、右股深静脉(χ^2=5.14, P<0.05)血栓诊断差异均有统计学意义。结论下肢局部血栓形成好发于易受到外压的左髂总静脉分叉处、腹股沟区和腘窝区。CTV既能清晰显示下肢各段静脉血栓形成,也能显示DSA难以诊断的髂内静脉和股深静脉血栓形成,为介入治疗方案制定提供帮助。

Objective To discuss the clinical value of CT venography(CTV) in displaying deep venous thrombosis(DVT) distribution in different segments of lower extremity veins. Methods The CTV and DSA imaging data of 105 patients with lower extremity DVT were compared and analyzed. CT three-dimensional(3-D) reconstruction images were compared with DSA findings, the distribution of thrombus in each segment of deep veins of lower extremities was documented, and the causes of thrombosis were analyzed. Using χ^2 testing, the diagnostic accuracies for the thrombosis in inferior vena cava(IVC), bilateral external iliac veins,superficial femoral vein, popliteal vein, internal iliac vein and deep femoral vein were compared between CTV and DSA. Results CTV showed that DVT was located in bilateral lower extremities(n=11), left lower extremity(n=71) and right lower extremity(n=23). DSA failed to display 20 thromboses in internal iliac vein and 31 thromboses in deep femoral vein. CTV displayed the proximal segment of lower extremity thrombus and the involvement of bilateral renal veins more clearly than DSA. In diagnosing IVC thrombosis (χ^2=1.33,P>0.05), left external iliac vein thrombosis(χ^2=0, P>0.05), right external iliac vein thrombosis (χ^2=1.33,P>0.05), left superficial femoral vein thrombosis(χ^2=0.50, P>0.05), right superficial femoral vein thrombosis(χ^2=0, P>0.05), left popliteal vein thrombosis (χ^2=0, P>0.05) and right popliteal vein thrombosis (χ^2=0,P>0.05), no statistically significant differences existed between CTV and DSA, while statistically significant differences in diagnosing left internal iliac vein thrombosis (χ^2=12.07, P <0.05), right internal iliac vein thrombosis( χ^2=4.16, P<0.05), left deep femoral vein thrombosis( χ^2=22.04, P<0.05) and right deep femoral vein thrombosis(χ^2=5.14, P<0.05) existed between CTV and DSA. Conclusion Local thrombosis of lower extremities usually occurs at the bifurcation of left common iliac vein, the inguinal region and the popliteal fossa region, where the veins are vulnerable to external pressure. CTV can not only clearly show the thrombosis in the lower extremity veins, but also distinctly display the thrombosis in the internal iliac vein and deep femoral vein which is difficult to be diagnosed by DSA. Therefore, CTV can help make the formulation of interventional treatment scheme.(J Intervent Radiol, 2019, 28: 1140-1143)