Giess C S, Bach A M, Hann L E
Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA.
AJR Am J Roentgenol. 2001 Apr;176(4):1049-52. doi: 10.2214/ajr.176.4.1761049.
We correlated the diagnostic yield of unilateral and bilateral lower extremity venous sonograms in a high-risk cancer population with the clinical indication for the examination.
Reports from 433 bilateral and 619 unilateral lower extremity Doppler sonograms obtained over an 18-month period in patients with cancer were retrospectively reviewed, and clinical indication and findings were determined.
Overall, 228 (22%) of 1052 examinations revealed deep venous thrombosis (DVT): 83 (19%) of 433 bilateral and 145 (23%) of 619 unilateral. Among studies performed for unilateral symptoms (pain, edema, or postorthopedic procedure), 23% (135/581) of unilateral and 27% (44/162) of bilateral studies revealed DVT. Among these 44 bilateral studies with positive findings performed for unilateral symptoms, there were 30 DVT in the symptomatic side, 12 bilaterally, and two in the asymptomatic side alone. Ten percent (11/110) of the bilateral studies performed for bilateral symmetric symptoms revealed DVT. Among studies performed for bilateral asymmetric symptoms, 13% (1/8) of the unilateral and 8% (2/25) of the bilateral studies revealed DVT; both bilateral studies showed positive findings in the more symptomatic side. Among studies performed for suspected or proven pulmonary embolus, 20% (23/113) of bilateral and 54% (7/13) of unilateral studies had positive findings.
In a high-risk cancer population, the incidence of DVT in patients with unilateral symptoms is more than twice that of patients with bilateral symptoms. Because DVT isolated to an asymptomatic lower extremity is rare (1%), bilateral sonographic examination is generally unnecessary with unilateral lower extremity symptoms.
我们将高危癌症人群中单侧和双侧下肢静脉超声检查的诊断率与检查的临床指征进行了关联分析。
回顾性分析了18个月内癌症患者接受的433例双侧和619例单侧下肢多普勒超声检查报告，确定了临床指征和检查结果。
总体而言，1052例检查中有228例（22%）发现深静脉血栓形成（DVT）：433例双侧检查中有83例（19%），619例单侧检查中有145例（23%）。在因单侧症状（疼痛、水肿或骨科手术后）进行的检查中，单侧检查中有23%（135/581）发现DVT，双侧检查中有27%（44/162）发现DVT。在这44例因单侧症状检查结果为阳性的双侧检查中，症状侧有30例DVT，双侧均有12例，无症状侧仅有2例。因双侧对称症状进行的双侧检查中有10%（11/110）发现DVT。在因双侧不对称症状进行的检查中，单侧检查中有13%（1/8）发现DVT，双侧检查中有8%（2/25）发现DVT；两项双侧检查均在症状更明显的一侧发现阳性结果。在因疑似或已证实的肺栓塞进行的检查中，双侧检查中有20%（23/113）结果为阳性，单侧检查中有54%（7/13）结果为阳性。
在高危癌症人群中，单侧症状患者的DVT发生率是双侧症状患者的两倍多。由于孤立于无症状下肢的DVT很少见（1%），因此对于单侧下肢症状，一般无需进行双侧超声检查。
