常规超声联合弹性成像在鉴别急性和慢性小腿肌间静脉血栓中的应用

Application of routine ultrasound combined with elastography in differentiating acute and chronic calf muscular venous thrombosis

目的探讨常规超声及弹性成像技术在鉴别急、慢性孤立性小腿肌间静脉血栓的应用价值。方法选取住院患者术前超声检查未发现肌间静脉血栓,但术后2周内复查发现孤立性肌间静脉血栓形成的90例患者作为急性血栓组,另选取既往超声检查发现孤立性小腿肌间静脉血栓,至少30天后复查超声仍显示血栓的68例患者作为慢性血栓组。超声灰阶图像测量两组患者肌间静脉血栓的最大宽度,对比观察血栓形态、回声强度、有无钙化,彩色多普勒超声检查观察肌间静脉内血流信号充盈情况,并采用弹性成像技术进行图像分级。结果灰阶超声显示急性血栓组血栓最大宽度大于慢性血栓组,急性血栓组血栓以形态规则的低回声为主,而慢性血栓组多为不规则混合回声或高回声,部分可伴有钙化,差异均有统计学意义(P<0.05);彩色多普勒超声检查显示急性血栓组血栓多无血流信号,部分见少量贴壁血流信号;慢性血栓组血栓多可见血流信号显示,差异有统计学意义(P<0.05);弹性成像显示急性血栓组血栓评分多为1~3分,慢性血栓组血栓多为4~5分,差异有统计学意义(P<0.05)。结论常规超声可以从宽度、形态、回声强度、有无钙化及有无血流信号等方面鉴别急、慢性小腿肌间静脉血栓,而弹性成像技术可以直观显示血栓的硬度信息,可进一步为临床鉴别提供帮助。

Objective To explore the value of conventional ultrasound and elastography in differentiating acute and chronic calf muscular venous thrombosis.Methods 90 hospitalized patients who were not found intermuscular venous thrombosis in preoperative ultrasound examination and found calf muscular venous thrombosis in reexamination within 2 weeks after operation were included in the acute thrombosis group,and 68 patients who were found calf muscular venous thrombosis in previous ultrasound and still showing thrombosis after at least 30 days were selected and classified into the chronic thrombosis group.The maximum width of calf muscular venous thrombosis in the two groups was measured by gray-scale ultrasound image,and the morphology,echo intensity and calcification of the thrombus were compared.The blood flow signal filling in the intermuscular vein was observed by color Doppler,and the image classification was carried out by elastography technology.Results In gray-scale ultrasound,the maximum width of thrombus in the acute thrombus group was greater than that in the chronic thrombus group.The thrombus in the acute thrombus group was mainly hypoechoic with regular morphology,while the chronic thrombus group was mostly irregular mixed echo or hyperechoic,and some of them could be accompanied by calcification.The above differences were statistically significant(P<0.05).Color Doppler showed that most of the thrombus in the acute thrombus group had no blood flow signals,and some of them had a small amount of adherent blood flow signals,while most of the thrombi in the chronic thrombus group had blood flow signals,and the difference was statistically significant(P<0.05).Elastography showed that the thrombus score in the acute thrombus group was mostly 1~3 points,and that in the chronic thrombus group was mostly 4~5 points,the difference was statistically significant(P<0.05).Conclusion Routine ultrasound can distinguish acute and chronic calf muscular venous thrombosis from the aspects of width,shape,echo intensity,calcification and blood flow signal,while elastography technology can visually display the hardness information of thrombus,which can further provide help for clinical differentiation.