下肢深静脉血栓的影像分期对介入溶栓疗效的指导意义

发布时间：2017-12-31 08:05

本文关键词：下肢深静脉血栓的影像分期对介入溶栓疗效的指导意义　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:采用T1加权磁共振血栓成像(Black-blood Thrombus Imaging,BTI)技术对下肢深静脉血栓(DVT)进行诊断及分期,初步探讨血栓的影像分期对介入溶栓疗效的预后评估。方法:2015年9月-2017年2月,番禺中心医院介入科共有100例符合纳入标准的急性期下肢深静脉血栓患者入组,所有患者均签署知情同意书。入组患者均行BTI序列和双下肢静脉增强磁共振血管造影(Contrast Enhanced Magnetic Resonance Venography,CE-MRV)检查,扫描范围均包括下腔静脉下段至小腿静脉远端。在磁共振后处理工作站上对CE-MRV与BTI序列图像进行曲面重建(Curve planar reformation,CPR),并将重建CE-MRV图像与BTI图像进行配准,由两名有经验的医师比较分析这两种序列在诊断血栓的部分及范围的一致性。以CE-MRV结果为标准,计算BTI诊断血栓的敏感度、特异度、阳性预测值、阴性预测值、准确度。不同时期DVT表现在磁共振图像上的血栓信号不同,为了量化不同时期血栓的信号变化,在重建的BTI图像上测量血栓与肌肉的对比噪声比(contrast-to-noise ratio,CNR)。于磁共振检查后第二天对病人患肢行经导管直接溶栓术(catheter—directed thrombolysis,CDT)进行治疗,治疗后评估病人患肢的溶栓率。采用Pearson相关性分析评估溶栓率与血栓CNR、病史天数、溶栓天数、溶栓剂量、年龄之间的相关性。同时以溶栓率为因变量,血栓CNR、病史天数、溶栓天数、溶栓剂量、年龄作为自变量,采用多重线性回归模型分析溶栓率与血栓CNR、病史天数、溶栓天数、溶栓剂量、年龄之间的关联性。结果:以CE-MRV的诊断结果为标准,两位医生采用BTI技术诊断血栓的结果的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为98.26%,99.50%,99.03%,99.09%,99.07%和 97.11%,98.98%,98.05%,98.48%,98.33%。在 BTI 图像上血栓与肌肉之间CNR平均值为56.31±43.95。溶栓治疗后,有54人行球囊扩张术或髂股静脉支架植入术。Pearson相关分析显示血栓CNR与溶栓率之间呈负相关性(r=-0.865;P0.01),CNR越低者溶栓效果越好,说明血栓信号与肌肉信号相近,即血栓呈等信号者溶栓效果越好;病史天数、溶栓剂量与溶栓率之间呈负相关(r=-0.430,P=0.000.05;r=-0.281,P=0.0050.01)。多重线性回归分析显示血栓CNR对溶栓率有显著影响(P0.01),两者之间呈负相关,而病史天数、溶栓天数、溶栓剂量、年龄对溶栓率无显著影响(P0.05)。结论:BTI技术可以准确诊断血栓的部分及范围,血栓呈等信号时,考虑为急性早期,溶栓效果最佳,因此,依据血栓的T1加权信号特点有望实现DVT治疗的预后评估,可指导临床治疗方案的选择。
[Abstract]:Objective: to use T1-weighted magnetic resonance thrombography (T1WI) with Black-blood Thrombus Imaging. BTI technique was used to diagnose and stage DVT of deep vein thrombosis of lower extremity and to evaluate the prognosis of thrombotic therapy by imaging staging. Methods: from September 2015 to February 2017. A total of 100 patients with acute deep venous thrombosis of lower extremity in Panyu Central Hospital were included in the study. All the patients signed informed consent form. All the patients in the group underwent BTI sequence and contrast-enhanced magnetic resonance angiography of both lower extremities (. Contrast Enhanced Magnetic Resonance Venography. CE-MRV) examination. The scanning range includes inferior vena cava to distal leg vein. Surface reconstruction of CE-MRV and BTI sequence images was performed on Mr postprocessing workstation. Curve planar reformation. The reconstructed CE-MRV image was registered with the BTI image. The consistency of the two sequences in the diagnosis of thrombus was compared and analyzed by two experienced physicians. The sensitivity and specificity of BTI in diagnosing thrombus were calculated according to CE-MRV results. Positive predictive value, negative predictive value, accuracy. DVT showed different thrombus signal on MRI image in different period, in order to quantify the change of thrombus signal in different period. The contrast noise ratio of thrombus to muscle was measured on reconstructed BTI images. The patients were treated with catheter-directed thrombolysis via catheter direct thrombolysis (CDT) on the second day after magnetic resonance examination. Pearson correlation analysis was used to evaluate thrombolytic rate and thrombus CNR, history days, thrombolytic days, thrombolytic dose. At the same time, thrombolysis rate as dependent variable, thrombus CNR, history days, thrombolytic days, thrombolytic dose, age as independent variables. Multiple linear regression model was used to analyze the relationship between thrombolytic rate and thrombus CNR, history days, thrombolytic days, thrombolytic dose and age. Results: the diagnostic results of CE-MRV were taken as the standard. The sensitivity, specificity, positive predictive value and negative predictive value were 98.26%, 99.50% and 99.03%, respectively. And 99.09% and 97.11% and 98.98%, 98.05% and 98.48%, respectively. The mean value of CNR between thrombus and muscle on BTI images was 56.31 卤43.95.After thrombolytic therapy. 54 patients underwent balloon dilatation or stenting of iliac femoral vein. Pearson correlation analysis showed that there was a negative correlation between thrombus CNR and thrombolytic rate. The lower the P0.01CNR, the better the thrombolytic effect, which indicates that the thrombus signal is similar to the muscle signal, that is, the thrombolytic effect is better if the thrombus signal is equal. There was a negative correlation between thrombolytic dose and thrombolytic rate. Multiple linear regression analysis showed that thrombotic CNR had a significant effect on thrombolytic rate (P 0.01), and there was a negative correlation between the two. There was no significant effect of thrombolysis days, thrombolytic dose and age on thrombolysis rate (P 0.05). Conclusion the proportion and scope of thrombus can be accurately diagnosed by BTI. Thrombolytic effect is the best. Therefore, according to the characteristics of T 1-weighted signal of thrombus, it is hopeful to evaluate the prognosis of DVT therapy and to guide the choice of clinical treatment regimen.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R543.6

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