Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Medicine (Baltimore). 2022 Sep 9;101(36):e30360. doi: 10.1097/MD.0000000000030360.
Thoracic outlet syndrome (TOS) presents with a variety of neurovascular symptoms, and its diagnosis cannot be established purely on the basis of clinical assessments. Computed tomography angiography (CTA) is currently the most useful investigative modality for patients with suspected vascular TOS. However, CTA facilities are limited, and CTA itself is an expensive and a resource-intensive technique associated with risks such as radiation exposure and contrast toxicity. Therefore, a screening test to identify the need for CTA may facilitate clinical management of patients with suspected TOS. Data for patients with suspected arterial TOS who underwent duplex ultrasound with arterial hemodynamic assessment (HDA) (pulse-volume recording and Doppler arterial pressure measurement) at King Saud University Medical City Vascular Lab between 2009 and 2018 were collected. The sensitivity, specificity, positive and negative predictive values (NPV), and area under the curve for duplex ultrasound and arm arterial HDA with CTA were reviewed. The data for 49 patients (mean age, 31 ± 14 years) were reviewed, of which 71% were female. The sensitivity, specificity, positive predictive value, and NPV of duplex ultrasound were 86.7%, 49.3%, 26.5%, and 94.6%, respectively. For arm arterial HDA, these values were 73.3%, 78.9%, 42.3%, and 93.3%, respectively. The combination of arm arterial HDA with duplex ultrasound scores yielded sensitivity, specificity, positive predictive value, and NPV of 93.3%, 42.3%, 25.5%, and 96.8%, respectively. The combination of duplex ultrasound with arm arterial HDA showed higher sensitivity and NPV than either test alone. The specificity of arm arterial HDA was significantly higher than that of the other measurements. When suspected, arterial TOS could be ruled out using duplex ultrasound and arm arterial HDA. These 2 investigations may help determine the need for CTA.
胸廓出口综合征（TOS）表现出多种神经血管症状，其诊断不能仅基于临床评估。计算机断层血管造影（CTA）目前是怀疑血管 TOS 患者最有用的检查方法。然而，CTA 设施有限，且 CTA 本身是一种昂贵且资源密集型的技术，存在辐射暴露和对比毒性等风险。因此，一种筛选试验来确定是否需要 CTA 可能有助于管理疑似 TOS 的患者。收集了 2009 年至 2018 年在沙特国王大学医疗城血管实验室接受双功能超声和动脉血流动力学评估（脉冲容积记录和多普勒动脉压力测量）（HDA）的疑似动脉 TOS 患者的数据。回顾了双功能超声和 CTA 的臂动脉 HDA 的灵敏度、特异性、阳性和阴性预测值（NPV）和曲线下面积。共回顾了 49 名患者（平均年龄 31 ± 14 岁）的数据，其中 71%为女性。双功能超声的灵敏度、特异性、阳性预测值和 NPV 分别为 86.7%、49.3%、26.5%和 94.6%。对于臂动脉 HDA，这些值分别为 73.3%、78.9%、42.3%和 93.3%。臂动脉 HDA 与双功能超声评分相结合的灵敏度、特异性、阳性预测值和 NPV 分别为 93.3%、42.3%、25.5%和 96.8%。臂动脉 HDA 与双功能超声相结合的敏感性和 NPV 均高于单项检查。臂动脉 HDA 的特异性明显高于其他检查。当怀疑有动脉 TOS 时，可以使用双功能超声和臂动脉 HDA 排除。这两种检查可能有助于确定是否需要 CTA。
