直接法多层螺旋CT静脉造影诊断下肢深静脉血栓

摘要

Objective To evaluate the clinical value of direct multi-slice spiral CT venography (MSCTV) in the diagnosis of the lower extremity deep venous thrombosis. Methods Seventeen patients underwent direct MSCTV and color Doppler flow imaging (CDFI).The data of direct MSCTV were reconstructed with multi-planar reformation (MPR), maximum intensity projection (MIP), shade surface displayment (SSD) and volume rendering (VR). Results Deep ve-nous thrombosis was revealed by direct MSCTV images in 13 patients and by CDFI in 10 patients. Iliac venous throm-bosis in 2 patients and calf venous thrombosis in 1 patient were not revealed by CDFI. The direct MSCTV images of 13 patients with DVT showed low density resulted from filling defect in veins, and it was of no filling in the veins , segment, venous dilatation distal obstruction, the lumens were not dilated but may stenosis even obstracted, lateral branches and superior veins increased, the surrounding soft tissue swelling and the skin thickening. Conclusion Di-rect MSCTV can clearly show the position ,range of DVT and the configuration of the lateral branches veins. The iliac veins and calf veins that poorly shown on songraphy, are also depicted by direct MSCTV. Direct MSCTV may be a conventional selective technique in diagnosing lower extremity deep venous thrombosis.%目的：探讨直接法多层螺旋CT静脉造影（MSCTV）诊断下肢深静脉血栓的临床应用价值。方法直接法多层螺旋CT（MSCT）下肢静脉造影17例，同期均行彩色多普勒超声血流显像（CDFI）检查。直接法MSCTV检查后，所得图像经处理后传送至工作站进行多平面重建（MPR）、最大密度投影（MIP）、表面遮盖（SSD）及容积再现（VR）重建。结果直接法MSCTV检查显示13例存在下肢深静脉血栓（DVT），彩色多普勒超声检查显示10例，2例髂静脉及1例胫腓静脉血栓彩色多普勒超声未能检出。直接法MSCTV上DVT主要表现为静脉腔内造影剂充盈缺损、静脉节段性不显影、栓塞静脉远端扩张及其周围侧支循环静脉迂曲扩张、周围软组织肿胀、皮肤增厚。结论直接法MSCT能清晰显示DVT形成的部位、范围、侧支静脉情况及病变血管周围的解剖结构，对彩色多普勒超声不易检出的盆腔及小腿深静脉栓塞也能清晰显示，可以作为下肢深静脉血栓检查的常规方法。