Tomkowski Witold Z, Davidson Bruce L, Wisniewska Joanna, Malek Grzegorz, Kober Jaroslaw, Kuca Pawel, Burakowska Barbara, Oniszh Karina, Gallus Alexander, Lensing Anthonie W A
Cardio-Pulmonary Intensive Care Medicine, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Plocka 26, Poland.
Thromb Haemost. 2007 Feb;97(2):191-4.
The value of vein ultrasonography for diagnosis of symptomatic deep vein thrombosis (DVT) is widely accepted. We are unaware of published data comparing ultrasonography with the "gold standard" of venography for DVT diagnosis in asymptomatic persons in the patient group of acutely ill medical patients. It was the objective of this study to evaluate sensitivity and specificity of compression ultrasound (CUS) examinations in the diagnosis of proximal and distal DVT in acutely ill medical patients [with congestive heart failure (NYHA class III and IV), exacerbations of respiratory disease, infectious disease, and inflammatory diseases] considered to be at moderate risk of venous thromboembolism (VTE). CUS examination was performed prior to ascending venography on day 6-15 of the hospital stay. Both investigations were done on the same day, each interpreted without knowledge of the other's result. Proximal and calf veins were separately evaluated. Technically satisfactory venography was obtained in 160 patients. In 12 of 160 patients (7.5%, 95% CI=[4.0%-12.7%]), venography confirmed the presence of DVT, all of which was asymptomatic. Proximal DVT was detected in five patients (3.1%, 95% CI=[1.0%-7.1%]) and distal DVT in seven patients (4.4%, 95% CI=[1.8%-8.8%]). CUS of proximal veins was technically satisfactory in all 160 patients and CUS of distal veins in 150 patients. In three of five patients with venographically proven proximal DVT, the diagnosis was confirmed by CUS (sensitivity 60%, 95%CI=[23%-88%]). In one patient, the CUS was false positive (specificity 99.4%, 95%CI=[96%-99%]). Positive and negative predictive values (PPV and NPV) of CUS in the diagnosis of proximal DVT were 75% (95%CI=[30%-95%]) and 98% (95% CI=[95%-99%]), respectively. In two of seven patients with venographically proven calf DVT, the diagnosis was confirmed by CUS (sensitivity 28.6%, 95%CI=[8%-64%]) and in two patients, CUS was false positive (specificity 98.6, 95%CI=[95%-99%]). PPV and NPV of CUS in diagnosis of distal DVT were 50% (95%CI=[15-85%]) and 96% (95% CI=[92%-98%]), respectively. In conclusion, CUS underestimates the incidence of proximal and distal DVT compared to contrast venography in acutely ill medical patients without thrombosis symptoms.
静脉超声检查在有症状的深静脉血栓形成（DVT）诊断中的价值已被广泛认可。我们尚未知晓有已发表的数据比较超声检查与静脉造影这一DVT诊断“金标准”在急性病内科患者无症状人群中的情况。本研究的目的是评估压迫超声（CUS）检查对被认为有中度静脉血栓栓塞（VTE）风险的急性病内科患者（患有充血性心力衰竭（纽约心脏协会III级和IV级）、呼吸系统疾病加重、传染病和炎症性疾病）近端和远端DVT诊断的敏感性和特异性。在住院第6 - 15天进行上行静脉造影之前先进行CUS检查。两项检查在同一天进行，每项检查的解读均不知晓另一项检查的结果。分别对近端和小腿静脉进行评估。160例患者获得了技术上满意的静脉造影。在160例患者中的12例（7.5%，95%可信区间=[4.0% - 12.7%]），静脉造影证实存在DVT，所有这些均无症状。5例患者检测到近端DVT（3.1%，95%可信区间=[1.0% - 7.1%]），7例患者检测到远端DVT（4.4%，95%可信区间=[1.8% - 8.8%]）。160例患者近端静脉的CUS在技术上均满意，150例患者小腿静脉的CUS在技术上满意。在静脉造影证实的5例近端DVT患者中，3例通过CUS确诊（敏感性60%，95%可信区间=[23% - 88%]）。1例患者CUS为假阳性（特异性99.4%，95%可信区间=[96% - 99%]）。CUS诊断近端DVT的阳性和阴性预测值（PPV和NPV）分别为75%（95%可信区间=[30% - 95%]）和98%（95%可信区间=[95% - 99%]）。在静脉造影证实的7例小腿DVT患者中，2例通过CUS确诊（敏感性28.6%，95%可信区间=[8% - 64%]），2例患者CUS为假阳性（特异性98.6，95%可信区间=[95% - 99%]）。CUS诊断远端DVT的PPV和NPV分别为50%（95%可信区间=[15 - 85%]）和96%（95%可信区间=[92% - 98%]）。总之，在无血栓症状的急性病内科患者中，与造影剂静脉造影相比，CUS低估了近端和远端DVT的发生率。
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