Longley D G, Yedlicka J W, Molina E J, Schwabacher S, Hunter D W, Letourneau J G
Department of Radiology, University of Minnesota Hospital, Minneapolis 55455.
AJR Am J Roentgenol. 1992 Mar;158(3):623-30. doi: 10.2214/ajr.158.3.1739007.
Changes in flow in the subclavian artery and vein resulting from the use of a hyperabduction maneuver during Doppler sonography in 20 volunteers were compared with retrospective findings in 16 patients clinically suspected of having thoracic outlet syndrome. Significant compression of the subclavian artery showed in the Doppler waveform as at least a doubling of peak systolic velocity or complete cessation of flow with hyperabduction; significant compression of the subclavian vein was diagnosed by complete cessation of blood flow or loss of atrial and respiratory dynamics in the waveform of the subclavian vein with hyperabduction. In volunteers, asymptomatic compression of the subclavian vein with arm abduction was seen in two (10%) and asymptomatic compression of the subclavian artery was seen in four (20%). Of the 16 patients, thrombosis of the subclavian vein was found in seven, compression of the subclavian vein with hyperabduction was found in six, and diagnoses other than thoracic outlet syndrome were established as the cause of pain in three. When duplex sonography was compared with venography, which was performed in 10 patients, one false-negative case was found because a subclavian vein thrombus had not been detected. The subclavian artery was examined in five of the six patients with positional compression of the subclavian vein; compression of the subclavian artery was found in three. The clinical significance of compression of the subclavian artery cannot be determined from our data because of the small number of patients involved. When the sonographic criteria of subclavian vein clot or compression resulting in a complete loss of normal venous phasicity with arm abduction and the clinical criterion of subsequent improvement in symptoms after curative surgery are used, color Doppler sonography is 92% sensitive and 95% specific for the diagnosis of thoracic outlet syndrome. This preliminary study shows that Doppler sonography has potential in the evaluation of thoracic outlet syndrome.
在20名志愿者中，比较了在多普勒超声检查期间使用过度外展动作引起的锁骨下动静脉血流变化，并与16例临床怀疑患有胸廓出口综合征患者的回顾性检查结果进行了对比。锁骨下动脉的显著受压在多普勒波形中表现为收缩期峰值速度至少增加一倍或过度外展时血流完全停止；锁骨下静脉的显著受压通过过度外展时锁骨下静脉波形中血流完全停止或心房及呼吸动力丧失来诊断。在志愿者中，两名（10%）出现手臂外展时锁骨下静脉无症状受压，四名（20%）出现锁骨下动脉无症状受压。在这16例患者中，发现7例锁骨下静脉血栓形成，6例发现过度外展时锁骨下静脉受压，3例确定疼痛原因不是胸廓出口综合征。在10例患者中进行了静脉造影，并与双功超声检查进行比较，发现1例假阴性病例，原因是未检测到锁骨下静脉血栓。在6例锁骨下静脉体位性受压患者中的5例检查了锁骨下动脉，发现3例锁骨下动脉受压。由于涉及的患者数量较少，我们的数据无法确定锁骨下动脉受压的临床意义。当采用超声检查标准，即手臂外展时锁骨下静脉血栓形成或受压导致正常静脉搏动完全消失，以及采用临床标准，即根治性手术后症状随后改善时，彩色多普勒超声对胸廓出口综合征诊断的敏感性为92%，特异性为95%。这项初步研究表明，多普勒超声在胸廓出口综合征的评估中具有潜力。
