下肢深静脉血栓形成介入治疗前后CT血管成像的临床价值

发布时间：2018-08-29 09:59

【摘要】：目的探讨下肢深静脉血栓形成(DVT)介入治疗前后CT血管成像(CTA)的临床价值。方法 54例临床诊断下肢DVT的患者拟介入术前、30例下肢DVT患者介入术后行128层螺旋CT扫描及血管三维重建,观察下肢DVT的CT表现,与DSA检查进行比较,计算DVT的CTA诊断符合率。结果介入术前组病例中,DVT分布在左下肢31例,右下肢16例,双下肢7例,26例DVT的范围和近心端CTA显示较DSA清楚,下肢DVT合并肺动脉栓塞8例。21例伴有髂静脉受压综合征,10例CT检查显示伴有其他原因的静脉阻塞:布-加氏综合征2例,盆腔肿块压迫髂总静脉4例,盆腔血肿压迫髂静脉1例,腹股沟区淋巴结、囊肿压迫髂外静脉3例。介入术后组病例中,25例髂股深静脉CTA显示:12例静脉血管成型术加血管内支架术,9例位置形态正常,1例位置异常,1例血管内支架术远端血栓形成,1例血管内支架静脉周围血肿形成;其余13例,6例下肢静脉通畅,4例血栓复发,3例下肢慢性DVT综合征,表现为静脉纤细、不光整、闭塞或部分闭塞。12例下腔静脉内滤器置入术后的CT检查显示:7例位置正常,5例下腔静脉内滤器变形或角度异常;其中4例可见滤器附近少量血栓,2例下腔静脉髂静脉广泛DVT形成。以DSA为诊断标准,DVT的CTA诊断符合率为98.8%。结论 CTA能准确诊断下肢DVT的机械性梗阻原因,清楚地显示DVT的位置、范围,与常规DSA对比有较高的符合率,介入术前CTA检查有一定的价值;CTA能够明确显示介入治疗后并发症是否存在以及病变程度,对DVT介入治疗后并发症的诊断有重要价值。
[Abstract]:Objective to evaluate the clinical value of CT angiography (CTA) before and after (DVT) intervention for deep vein thrombosis of lower extremity. Methods Fifty-four patients with lower extremity DVT were enrolled in this study. Thirty patients with lower extremity DVT underwent 128-slice spiral CT scanning and three dimensional vascular reconstruction after interventional operation. The CT findings of lower extremity DVT were observed and compared with DSA examination. The diagnostic coincidence rate of DVT CTA was calculated. Results the distribution of DVT in 31 cases of left lower extremity, 16 cases of right lower extremity, 7 cases of bilateral lower extremities and 26 cases of DVT in patients before interventional intervention were better than that of DSA. Lower extremity DVT combined with pulmonary embolism (n = 8). 21 cases with iliac vein compression syndrome (n = 10). The results of CT showed that there were 2 cases of Budd-Chiari syndrome and 4 cases of pelvic mass compression of common iliac vein. Pelvic hematoma compressed iliac vein in 1 case, inguinal lymph node in 3 cases and cyst in 3 cases. CTA of 25 cases of deep iliac femoral vein after interventional surgery showed that 12 cases of venous angioplasty and stent stenting in 9 cases had normal position, 1 case had abnormal position, 1 case had distal thrombosis and 1 case had stenting. Hematoma formation around veins; In the remaining 13 cases, 6 cases had venous patency of lower extremity, 4 cases had thrombus recurrence and 3 cases had chronic DVT syndrome of lower extremity. CT examination of 12 cases with occlusion or partial occlusion showed that 7 cases had normal position and 5 cases had abnormal angle or distortion of IVC filter. In 4 cases, a small amount of thrombus was seen near the filter. 2 cases had extensive DVT formation in inferior vena cava iliac vein. The diagnostic coincidence rate of CTA with DSA as diagnostic criterion was 98.8%. Conclusion CTA can accurately diagnose the cause of mechanical obstruction of lower extremity DVT, clearly show the location and range of DVT, and have a higher coincidence rate with conventional DSA. The CTA examination before interventional therapy has certain value. CTA can clearly show whether there are complications and the degree of pathological changes after interventional therapy, which is of great value in the diagnosis of complications after interventional therapy of DVT.
【作者单位】：南京医科大学附属南京医院(南京市第一医院)放射影像科;
【基金】：南京市医学科技发展重点项目(编号:ZKX10004) 南京市医学科技发展重大项目(宁卫规[2012]6号)
【分类号】：R543.6;R816.2

【参考文献】