Cassou-Birckholz Maria Fernanda, Engelhorn Carlos Alberto, Salles-Cunha Sérgio Xavier, Engelhorn Ana Luiza, Zanoni Cassiana Casagrande, Gosalan Carlos José, Ribas Emerson, Chociai Ana Carolina Alves dos Santos, Camargo Camila Faversani
Pontifical Catholic University of Paraná, Curitiba, Parana, Brazil.
Ultrasound Q. 2011 Mar;27(1):55-61. doi: 10.1097/RUQ.0b013e31820e157d.
This study aimed to determine whether grayscale median (GSM) ultrasound (US) analysis could differentiate acute from subacute femoropopliteal deep venous thrombosis (DVT) classified based on (a) the time of symptoms onset and (b) sonographers' evaluation of US images.
Patients who had US because of suspected DVT were included. Patients with history of previous DVT, with normal US results or US with findings of isolated calf thrombosis were excluded. A total of 128 venous segments of 63 patients were analyzed. Thrombosed veins and adjacent arteries images were recorded. Thrombi GSM were calculated. Grayscale median was compared with (a) the time of symptoms onset and (b) US image thrombi classification as acute or subacute done by 2 sonographers blinded to patient information. Statistical analysis included GSM Pearson intraobserver variability and t test comparisons of GSM means for (a) short versus long onset periods and (b) acute versus subacute US class, χ comparison between onset history and US class, creation of GSM accuracy, predictive values, and sensitivity curves for acute versus subacute DVT.
Intraobserver variability correlation varied between 0.92 and 0.95. Thrombus mean GSM was 23 ± 12 versus 31 ± 16 if symptoms onset was shorter or longer than 2 weeks (P = 0.004). Mean GSM was 20 ± 11 versus 35 ± 14 for acute versus subacute thrombi (P < 0.001). Acute thrombi correlated with onset shorter than 2 weeks (P < 0.001). Grayscale median less than 13, equal to 22, or 33 or less had 85% positive predictive value (17/20), 77% accuracy (98/128), and 90% sensitivity (53/59) to differentiate acute from subacute thrombi.
Grayscale median of US images documenting femoropopliteal DVT correlated with (a) the time between symptoms onset and US examination and (b) the sonographers' interpretation of acute versus subacute thrombosis.
本研究旨在确定基于超声灰阶中位数（GSM）分析能否区分以下两种情况的急性与亚急性股腘深静脉血栓形成（DVT）：（a）症状发作时间；（b）超声检查医师对超声图像的评估。
纳入因疑似DVT而接受超声检查的患者。排除既往有DVT病史、超声检查结果正常或仅发现小腿孤立性血栓的患者。共分析了63例患者的128个静脉节段。记录血栓形成的静脉及相邻动脉的图像。计算血栓的GSM。将GSM与以下两项进行比较：（a）症状发作时间；（b）由两名对患者信息不知情的超声检查医师对超声图像血栓进行的急性或亚急性分类。统计分析包括GSM的Pearson观察者内变异性以及对GSM均值进行t检验比较：（a）发作期短与长的情况；（b）急性与亚急性超声分类；对发作病史与超声分类进行χ检验比较；绘制急性与亚急性DVT的GSM准确性、预测值和敏感性曲线。
观察者内变异性相关性在0.92至0.95之间。如果症状发作时间短于或长于2周，血栓的平均GSM分别为23±12和31±16（P = 0.004）。急性与亚急性血栓的平均GSM分别为20±11和35±14（P < 0.001）。急性血栓与发作时间短于2周相关（P < 0.001）。GSM小于13、等于22或33及以下对区分急性与亚急性血栓具有85%的阳性预测值（17/20）、77%的准确性（98/128）和90%的敏感性（53/59）。
记录股腘DVT的超声图像的GSM与（a）症状发作至超声检查的时间以及（b）超声检查医师对急性与亚急性血栓形成的解读相关。
