MSCTA对盆腔静脉淤血综合征的应用价值

发布时间：2019-03-07 20:01

【摘要】：目的采用多层螺旋CTA对盆腔静脉淤血综合征(PCS)的扩张、淤血的卵巢静脉及盆腔静脉丛进行血管重建，，探讨多层螺旋CT血管造影(MSCTA)对盆腔静脉淤血综合征的临床应用价值。材料与方法对38例盆腔静脉淤血综合征的患者和46例同期因其他系统疾病来诊（排除妇科疾病）患者作为对照组，两组均进行MSCTA检查。对所得图像进行MPR重组及VR、MIP重建，在MSCT二维图像上测量左侧卵巢静脉和宫旁静脉最大直径，采用双盲法由两名资深影像诊断医师分别在MSCT平扫及增强扫描的图像上从不同角度观察左侧卵巢静脉和盆腔静脉丛的走行位置、数目、形态等。统计两组之间左侧卵巢静脉及宫旁静脉的直径，比较两组之间左侧卵巢静脉、宫旁静脉的直径及盆腔静脉丛对比剂廓清时间在统计学上有无显著性差异；比较两组之间动脉期左侧卵巢静脉显影有无统计学意义。结果 MSCTA表现为卵巢静脉扩张，走行迂曲，盆腔静脉丛数目明显增加，数目不等，管径粗细不均，迂曲、扩张，呈串珠样、蚯蚓状表现，并且沿子宫阔韧带向两侧发展。盆腔静脉淤血综合征的患者和对照组的左侧卵巢静脉直径分别为：8.7±1.6mm，5.4±1.1mm；盆腔静脉丛最粗静脉直径分别为：7.2±1.2mm，3.5±0.46mm，两组之间统计学有明显差异(P0.001)。左侧卵巢静脉及盆腔静脉丛的显影情况，盆腔静脉淤血综合征有30例左侧卵巢静脉及22例盆腔静脉丛提前显影，则说明卵巢静脉功能不全其内有返流存在，同时盆腔扩张的静脉丛与周围小动脉之间有异常交通，两组之间动脉期左侧卵巢静脉及盆腔静脉丛显影有明显统计学意义；盆腔静脉淤血综合征的患者（38例）盆腔静脉丛与下腔静脉在延迟期出现了较明显的CT差值36±4.8HU（CT差值大于30HU以上），两组之间盆腔静脉丛对比剂廓清时间之间有统计学意义，说明盆腔静脉淤血综合征的患者确有血流缓慢、对比剂廓清时间延长的现象。结论 1、盆腔静脉淤血综合征的MSCT及MSCTA表现为一侧或双侧卵巢静脉扩张，子宫两侧可见数目明显增加、管径异常增粗不均、走行迂曲、扩张的静脉丛。2、盆腔静脉淤血综合征的患者盆腔静脉丛存在血流淤滞现象，对比剂廓清时间延长。3、部分盆腔静脉淤血综合征的患者出现卵巢静脉及盆腔静脉丛动脉期显影现象，说明卵巢静脉功能不全，其内有返流存在及盆腔扩张的静脉丛与小动脉形成异常交通的可能性。4、螺旋CT及血管成像技术可全方位显示盆腔静脉淤血综合征的血管解剖关系，清晰、直观的显示静脉曲张及其继发的病因，为临床治疗及手术方案的选择提供准确、客观的诊断依据，具有重要的临床指导意义。
[Abstract]:Objective to investigate the effect of multi-slice spiral CTA on the expansion of (PCS) in pelvic venous congestion syndrome and the vascular reconstruction of ovarian vein and pelvic venous plexus in patients with pelvic venous congestion syndrome. To evaluate the clinical value of multi-slice spiral CT angiography (MSCTA) in pelvic venous congestion syndrome. Materials and methods 38 patients with pelvic venous congestion syndrome and 46 patients with other systemic diseases (excluding gynecological diseases) were selected as control group. MSCTA was performed in both groups. The images were reconstructed by MPR and VR,MIP, and the maximum diameters of the left ovarian vein and paraverymal vein were measured on the two-dimensional MSCT image. The position, number and shape of the left ovarian vein and pelvic venous plexus were observed from different angles on the plain and enhanced MSCT images of two senior imaging diagnostic physicians by double blind method. The diameters of left ovarian vein and paraverymal vein were compared between the two groups, and there was no significant difference in the diameter of the left ovarian vein, the paruterine vein and the contrast medium clearance time of pelvic venous plexus between the two groups. There was no significant difference between the two groups in the development of left ovarian vein in arterial phase. Results MSCTA showed ovarian vein dilatation, twists and turns, a marked increase in the number of pelvic vena cava plexus, uneven diameter, tortuous, dilated, beaded, earthworm-like appearance, and developed to both sides along the broad ligaments of the uterus. The diameters of left ovarian vein in patients with pelvic venous congestion syndrome and control group were 8.7 卤1.6 mm and 5.4 卤1.1 mm;, respectively. The diameter of the thickest vein of pelvic venous plexus was 7.2 卤1.2 mm and 3.5 卤0.46 mm respectively. There was significant difference between the two groups (P0.001). In the development of left ovarian vein and pelvic venous plexus, 30 cases of left ovarian vein and 22 cases of pelvic venous plexus developed ahead of time in pelvic vena cava congestion syndrome, indicating that there was regurgitation in ovarian venous insufficiency. At the same time, there was abnormal communication between pelvic dilated venous plexus and peripheral arterioles, and the left ovarian vein and pelvic venous plexus showed significant statistical significance between the two groups during arterial phase. In 38 patients with pelvic venous congestion syndrome, there was a significant difference of CT between pelvic venous plexus and inferior vena cava in the delayed period. The difference between pelvic venous plexus and inferior vena cava was 36 卤4.8 Hu (the difference of CT was greater than that of 30HU). The clearance time of pelvic venous plexus contrast medium was statistically significant between the two groups, indicating that there was a slow blood flow in the patients with pelvic venous congestion syndrome, and the clearance time of the contrast medium was prolonged. Conclusion 1. The MSCT and MSCTA of pelvic vena cava congestion syndrome showed dilatation of one or both sides of ovarian vein, and the number of two sides of uterus increased obviously, the diameter of the vessel increased unevenly, the diameter of the vein was irregular, the course was tortuous and dilated venous plexus. 2. The pelvic venous plexus in the patients with pelvic venous congestion syndrome has the phenomenon of stagnation of blood flow, and the clearance time of contrast medium is prolonged. 3, some of the patients with pelvic venous congestion syndrome appear ovarian vein and pelvic venous plexus arterial phase. It is suggested that the ovarian venous insufficiency, the presence of reflux and the possibility of abnormal communication between the venous plexus and the small artery in the presence of reflux and pelvic dilatation. 4. Spiral CT and angiography can show the vascular anatomical relationship of pelvic venous congestion syndrome in an all-round way. Clearly and intuitively showing varicose veins and its secondary causes provides accurate and objective diagnostic basis for the choice of clinical treatment and surgical schemes. It is of great significance for clinical guidance.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.8;R711

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