彩色多普勒超声诊断恶性肿瘤合并颈内静脉血栓效果研究

摘要

目的 观察彩色多普勒超声对恶性肿瘤合并颈内静脉血栓的临床诊断效果.方法 选取2015年3月至2016年5月于本院接受治疗的54例恶性肿瘤合并颈内静脉血栓患者为研究对象,分别给予彩色多普勒超声检查及静脉造影检查.以静脉造影结果作为诊断金标准,观察两种检查方式的诊断差异,并利用彩色多普勒超声检查观察患者的血流动力学、管腔内回声及血管管径等特征,绘制接受者操作特征曲线(receiver operating characteristic curve,ROC曲线).结果 彩色多普勒超声血流图像显示完全阻塞患者腔内无血流信号,未完全阻塞患者血流充盈缺损;二维声像图表现为静脉管径改变,管壁弥漫性增厚,腔内可探及实质回声、类似无回声区,大部分为节段性或完全阻塞,乏氏试验结果显示静脉管径变化不明显或无变化,加压探头显示管腔无明显变形或不变形.静脉造影检出54例(100.00%)颈内静脉血栓,无误诊、漏诊;彩色多普勒超声检出52例(96.30%)颈内静脉血栓,2例(3.70%)因彩色多普勒血流图像未显示血流信号、横断面扫描表现为类圆形等回声而误诊为淋巴结.彩色多普勒超声诊断恶性肿瘤合并颈内静脉血栓的准确性与静脉造影相比无显著差异(P>0.05).彩色多普勒超声诊断的ROC曲线下面积为0.924,置信区间为0.857~0.948,标准误为0.015,特异性为94.80%,敏感性为92.40%.结论 彩色多普勒超声可显示管腔阻塞情况及血栓形态,在恶性肿瘤合并颈内静脉血栓的临床诊断中具有重要的应用价值,但在检查过程中应注意纵断面与横断面扫查相结合,避免误诊和漏诊.%Objective To observe and analyze the clinical effect of color Doppler ultrasonography in the diagnosis of malignant tumor with jugular vein thrombosis. Method Randomly selected 54 patients with malignant tumor combined with jugular vein thrombosis from March 2015 to May 2016 in our hospital as the research objects. Patients of the two groups were given color Doppler ultrasound and phlebography separately. Phlebography was the gold standard for diagnosis, observed the diagnostic difference of two kinds of examination way. Color Doppler ultrasound was used to observe the hemodynamics, lumen echo and vascular diameter characteristics of patients, and draw two sets of receiver operating characteristic curve (ROC curve). Result Color Doppler blood flow image showed no complete occlusion of blood flow within the cavity signal, not completely blocked cases of blood filling defect; two-dimensionalultrasound showed venous diameter changes, diffuse thickening of the vascular wall wall, the cavity can be explored and the real echo, similar to the echo-free zone, the majority of segmental or complete obstruction. Valsalva test showed that vein diameter did not change significantly or no change, pressure probe showed no significant deformation or deformation of the lumen; vein 54 cases (100.00%) of internal jugular vein thrombosis detected by phlebography, no misdiagnosis and missed diagnosis; color Doppler ultrasonic detected 52 cases (96.30%)of internal jugular vein thrombus, 2 cases (3.70%) were misdiagnosed as lymph nodes because of color Doppler flow image showed no blood flow signal and cross sectional scan showed sub-circular equal echo, the accuracy of color Doppler ultrasound in the diagnosis of malignant tumor combined with internal jugular vein thrombosis was not significantly different compared with phlebography (P>0.05). Area under the ROC curve was 0.924, the confidence interval was 0.857~0.948, the standard error was 0.015, the specificity was 94.80% and the sensitivity was 92.40%. Conclusion Color Doppler ultrasound can show the obstruction and thrombosis formation, it has important application value in the clinical diagnosis of malignant tumor combined with thrombosis of the internal jugular vein thrombus, but in the inspection process should use vertical section scan combined with cross sectional scan, to avoid the occurrence of misdiagnosis and missed diagnosis.