May-Thurner综合征的影像学诊断进展

Progress in imaging diagnosis of May-Thurner syndrome

May-Thurner综合征(MTS)是由于左侧髂总静脉长期受到右侧髂总动脉和第5腰椎的压迫,导致局部狭窄、闭塞或腔内粘连而引起的静脉疾病。MTS的病理变化会随着时间的推移而加重,因此,早期识别尤为重要。评估髂静脉压迫综合征的初始测试工具是双功能超声,具有快速、无创、易操作的特点,但因髂静脉位置较深,可能被腹壁脂肪和肠内气体遮挡而在显示髂静脉异常方面存在很大的局限性。计算机断层扫描静脉成像(CTV)和磁共振静脉造影(MRV)可以显示静脉压迫部位、狭窄程度和周围的侧支血管,在解剖层面对MTS进行确诊,但也受缺乏连续性、造影剂、放射性等限制。当CTV或MRV检查结果显示阴性而临床高度怀疑MTS时,则仍应该通过数字减影血管造影(DSA)和血管内超声(IVUS)检查确诊,但检查的侵入性限制了其作为常规检查手段,而通常仅作为血管内介入治疗的一部分。目前,尚无影像学检查方法能够全面诊断MTS,各种诊断方法各有优劣,随着对MTS愈加重视和新设备的研发,新的影像学检查手段也逐渐增多,为了提高对MTS影像学诊断的认识,本文对MTS的影像学诊断进展进行综述。

May-Thurner syndrome(MTS)is a venous disease caused by the local stenosis,occlusion,or intravascular adhesion due to compression of the left common iliac vein by the right common iliac artery and the 5th lumbar spine,and the pathological manifestation of MTS progresses over time,so the early identification is important.The initial testing tool to assess iliac vein compression syndrome is duplex ultrasound,which is rapid,noninvasive,and easy to perform.However,there are significant limitations in demonstrating iliac vein abnormalities due to the deep location of the iliac veins,which may be obscured by abdominal wall fat and intestinal gas.Computed tomography venography(CTV)and magnetic resonance venography(MRV)can show the site of venous compression,degree of stenosis,and surrounding collateral vessels to confirm the MTS anatomically,which,however are limited by the lack of continuity,use of contrast agents,and radioactivity.When CTV or MRV results are negative but there is a high clinical suspicion of MTS,the diagnosis should be confirmed by digital subtraction angiography(DSA)and intravascular ultrasound(IVUS).However,the invasive nature of the exam limits the use as a routine screening tool,usually as part of endovascular interventions.There is no single imaging method that can fully diagnose MTS currently,and each diagnostic method has its own advantages and disadvantages.With the increasing attention to this disease and the development of new equipment,new imaging methods are gradually increasing.This paper reviews the progress of imaging diagnosis of MTS in order to improve the understanding of imaging diagnosis of the disease.