实时剪切波弹性成像及超微血管成像联合D-二聚体在下肢深静脉血栓分期中的应用

Value of shear wave elastography and superb microvasular imaging combined with D-dimer in staging of lower limb deep vein thrombosis

目的:探讨剪切波成像(SWE)及超微血管成像(SMI)技术联合D-二聚体在下肢深静脉血栓(DVT)分期中的应用价值。方法:选择109例下肢DVT患者,均行下肢静脉彩色多普勒超声及D-二聚体检查,对血栓行SWE及SMI检查。结果:不同分期患者弹性模量值、SMI评分两两比较,差异均有统计学意义(均P<0.05)。以弹性模量均值16.65 kPa为截断值,SWE诊断慢性期DVT的敏感度为55.2%,特异度为82.5%,AUC为0.72(P<0.01);以弹性模量峰值24.85 kPa为截断值,SWE诊断慢性期DVT的敏感度为47.8%,特异度为90.0%,AUC为0.68(P<0.01);以SMI评分3分为截断值,SMI诊断慢性期DVT的敏感度为75.4%,特异度为82.5%,AUC为0.81(P<0.01)。二元logistic回归分析显示,弹性模量均值、D-二聚体及SMI评分(≥3分)具有显著预测价值;三者联合诊断慢性期DVT的敏感度为84.1%,特异度为87.5%,AUC为0.89,高于单一弹性模量峰值及均值(P<0.01)。结论:SWE及SMI联合D-二聚体在DVT分期诊断中具有一定价值。

Objective:To explore the value of shear wave elastography(SWE)and superb microvasular imaging(SMI)combined with D-dimer in the staging of lower limb deep vein thrombosis(DVT).Methods:A total of 109 patients with DVT in the lower limbs were enrolled to undergo color Doppler ultrasound(SWE and SMI)for lower limb venous,and all patients were examined for D-dimer level.Results:There were statistical differences in elastic modulus value and SMI score of patients at different stages(all P<0.05).Using the mean elastic modulus value of 16.65 kPa as the cut-off value,SWE had a sensitivity of 55.2%,a specificity of 82.5%and an AUC of 0.72 for the diagnosis of DVT in chronic phase,while using the peak elastic modulus value of 24.85 kPa as the cut-off value,SWE had a sensitivity of 47.8%,a specificity of 90.0%and an AUC of 0.68.Using the SMI score value of 3 points as the cut-off value,SMI had a sensitivity of 75.4%,a specificity of 82.5%and an AUC of 0.81 in the diagnosis of DVT in chronic phase.Binary logistic regression showed that mean elastic modulus value,D-dimer and SMI score(≥3 points)had significant predictive values,and the combination of the three parameters had a sensitivity of 84.1%,a specificity of 87.5%and an AUC of 0.89,and the AUC of the combination was higher than that of the peak and mean elastic modulus in the diagnosis of DVT in chronic phase(P<0.01).Conclusion:The combination of SWE,SMI and D-dimer is valuable for staging diagnosis for DVT.