Massenburg Benjamin B, Himel Harvey N, Blue Robert C, Marin Michael L, Faries Peter L, Ting Windsor
Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Ann Vasc Surg. 2015 Nov;29(8):1619-24. doi: 10.1016/j.avsg.2015.06.083. Epub 2015 Aug 24.
Proximal venous outflow obstruction (PVOO) in the abdomen and pelvis is increasingly recognized as an important contributor to venous disease of the lower extremity. There are currently no guidelines regarding a noninvasive screening tool for PVOO, although magnetic resonance venography (MRV) is commonly used in many practices. The objective of this study was to determine the value and utility of MRV in diagnosis and screening for PVOO.
This retrospective study consisted of 46 consecutive patients, all of whom presented with signs and/or symptoms of PVOO and were evaluated with MRV followed by intravascular ultrasound (IVUS) and venography. Of these 46 patients suspected to have PVOO based on clinical evaluation, 24 patients had PVOO confirmed with IVUS and venography and PVOO was not observed on IVUS and venography in the remaining 22 patients. The MRV of these 46 patients was retrospectively reviewed in a blinded fashion and then correlated with IVUS and venography by 1 vascular surgeon. A scoring system was developed to define the types of radiography findings that were observed: normal, suspicious, and abnormal.
When compared with IVUS and multiplane venography, the interpretation of MRV had a sensitivity of 100% and a specificity of 22.7%. The positive predictive value of MRV was 58.5%, and the negative predictive value was 100%.
The high sensitivity (100%) and low specificity (22.7%) of MRV suggest that it can be a screening tool at best, used only to rule out PVOO; it cannot be used to confirm PVOO, given its a 41.5% false positive rate. Thus, the development of a different, noninvasive diagnostic test that can more accurately assess patients with suspected PVOO during the initial evaluation of their lower-extremity venous disease should be explored.
腹部和盆腔近端静脉流出道梗阻（PVOO）日益被认为是下肢静脉疾病的一个重要原因。目前尚无关于PVOO无创筛查工具的指南，尽管磁共振静脉造影（MRV）在许多临床实践中常用。本研究的目的是确定MRV在PVOO诊断和筛查中的价值及实用性。
这项回顾性研究纳入了46例连续患者，所有患者均有PVOO的体征和/或症状，并接受了MRV检查，随后进行血管内超声（IVUS）和静脉造影。在这46例经临床评估怀疑患有PVOO的患者中，24例经IVUS和静脉造影确诊为PVOO，其余22例在IVUS和静脉造影中未观察到PVOO。对这46例患者的MRV进行了盲法回顾性分析，然后由1名血管外科医生将其与IVUS和静脉造影结果进行关联。开发了一个评分系统来定义观察到的影像学表现类型：正常、可疑和异常。
与IVUS和多平面静脉造影相比，MRV的解读敏感性为100%，特异性为22.7%。MRV的阳性预测值为58.5%，阴性预测值为100%。
MRV的高敏感性（100%）和低特异性（22.7%）表明，它充其量只能作为一种筛查工具，仅用于排除PVOO；鉴于其41.5%的假阳性率，它不能用于确诊PVOO。因此，应探索开发一种不同的无创诊断测试，以便在对下肢静脉疾病进行初步评估时，能够更准确地评估疑似PVOO的患者。
