Habscheid W, Höhmann M, Wilhelm T, Epping J
Department of Medicine and Radiology, University of Würzburg, West Germany.
Angiology. 1990 Aug;41(8):599-608. doi: 10.1177/000331979004100803.
One hundred twenty-six patients with clinically suspected acute deep venous thrombosis of the lower extremity (DVT) were examined comparatively with ultrasound and venography. In total, 174 lower extremity venograms were obtained. Ultrasonic examinations were performed on patients in the supine position. The venous segments were evaluated almost exclusively with transversal scanning. In the thigh, the only criterion for DVT was the reduced or absent compressibility of the venous lumen when gently compressed with the transducer. In the calf, normal unobstructed veins can usually not be viewed in the supine patient, whereas thrombotic veins appear as sonolucent, incompressible channels. Eight-three of the 174 lower extremity venograms were positive for DVT. In the majority of cases (53 of 83) the thrombotic process had involved two or more segments in combination. The sites of involvement of the different venous segments were distributed as follows: 24 occlusions of the common femoral vein, 52 of the superficial femoral vein, 56 of the popliteal vein, and 71 of the calf veins. Ultrasound had a sensitivity of 100% for thrombosis of the common femoral vein, 96% for the superficial femoral veins, 98% for the popliteal vein, and 93% for the calf veins. For the entire lower extremity, in regard to the diagnosis of thrombosis, the overall sensitivity was 95%. In 90% the extension of the occlusion was foreseen correctly. In no cases were false-positive results reported. Thus the overall specificity was 100%. The authors conclude that real-time ultrasound is a highly accurate method for the diagnosis of DVT of the lower extremity. It is the only indirect method capable of evaluating the venous system of the thigh, as well as that of the calf, with high accuracy. It should be the first choice of diagnostic imaging method in the diagnosis of deep venous thrombosis of the lower extremity.
对126例临床怀疑下肢急性深静脉血栓形成（DVT）的患者，采用超声和静脉造影进行了对比检查。共获得174例下肢静脉造影图像。超声检查在患者仰卧位时进行。静脉节段几乎完全通过横向扫描进行评估。在大腿部，DVT的唯一标准是用探头轻轻压迫时静脉腔的可压缩性降低或消失。在小腿部，仰卧位患者通常看不到正常无阻塞的静脉，而血栓形成的静脉表现为无回声、不可压缩的管道。174例下肢静脉造影中有83例DVT阳性。在大多数病例（83例中的53例）中，血栓形成过程累及两个或更多节段。不同静脉节段的受累部位分布如下：股总静脉闭塞24例，股浅静脉闭塞52例，腘静脉闭塞56例，小腿静脉闭塞71例。超声对股总静脉血栓形成的敏感性为100%，对股浅静脉为96%，对腘静脉为98%，对小腿静脉为93%。对于整个下肢，在血栓形成的诊断方面，总体敏感性为95%。在90%的病例中，闭塞的范围被正确预测。未报告假阳性结果。因此总体特异性为100%。作者得出结论，实时超声是诊断下肢DVT的一种高度准确的方法。它是唯一能够高精度评估大腿以及小腿静脉系统的间接方法。在下肢深静脉血栓形成的诊断中，它应作为诊断成像方法的首选。
