Chance J F, Abbitt P L, Tegtmeyer C J, Powers R D
Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville.
Ann Emerg Med. 1991 May;20(5):494-6. doi: 10.1016/s0196-0644(05)81600-2.
Accurate diagnosis of deep venous thrombosis (DVT) is a clinical problem in emergency practice. A prospective trial was conducted comparing real-time ultrasound with contrast venography in the diagnosis of proximal DVT.
Seventy patients whose clinical presentations mandated diagnostic evaluation for DVT had real-time ultrasound of the involved leg followed by contrast venography. Initial readings of ultrasound and venography were compared with each other and with final readings to assess reliability of interpretation.
Final ultrasound readings agreed with final venogram readings in all patients. Negative initial ultrasound readings agreed with final venogram readings in 56 of 56 patients (negative predictive value, 100%; 95% confidence interval, 94 to 100). Eighteen patients had positive initial ultrasound readings compared with 14 who had positive final venogram readings (positive predictive value, 78%; 95% confidence interval, 55 to 91).
Negative real-time ultrasonography reliably excludes proximal DVT. Positive ultrasound reliably diagnoses proximal DVT only in experienced hands.
在急诊实践中，准确诊断深静脉血栓形成（DVT）是一个临床难题。开展了一项前瞻性试验，比较实时超声与静脉造影在近端DVT诊断中的应用。
70例因临床表现需对DVT进行诊断评估的患者接受了患侧下肢的实时超声检查，随后进行静脉造影。将超声和静脉造影的初始读数相互比较，并与最终读数进行比较，以评估解读的可靠性。
所有患者的超声最终读数与静脉造影最终读数一致。56例初始超声读数为阴性的患者中，56例的读数与静脉造影最终读数一致（阴性预测值为100%；95%置信区间为94%至100%）。18例患者初始超声读数为阳性，而最终静脉造影读数为阳性的患者有14例（阳性预测值为78%；95%置信区间为55%至91%）。
实时超声检查结果为阴性可可靠排除近端DVT。只有经验丰富的医生才能通过阳性超声可靠地诊断近端DVT。
