Napoli V, Vignali C, Braccini G, Bagnolesi P, Cioni R, Russo R, Bartolozzi C
Istituto di Radiologia, Università degli Studi, Pisa.
Radiol Med. 1993 Jun;85(6):733-40.
This study was aimed at assessing the clinical utility of conventional and color duplex-Doppler US in the diagnosis of thoracic outlet syndrome. Conventional US and Doppler examinations were performed in a prospective study. The results were correlated with angiographic findings. Thirteen patients affected with thoracic outlet syndrome were studied by means of both conventional US and spectral Doppler flow imaging. Five cases (5/13) had neurovascular symptoms in the right upper limbs, 7/13 in the left upper limbs and 1/13 in both upper limbs. An accessory cervical rib was demonstrated in 2/13 cases (associated with muscular hypertrophy in one case and bilateral in the other), by means of plain films of the spine. Conventional US depicted muscular hypertrophy in 7/13 cases--bilateral in one case and monolateral in 6/13 cases, with marked muscular asymmetry. In 5/13 cases, no bone/muscle anomalies were demonstrated. The patients with an accessory cervical rib and scalenus muscle hypertrophy were seen to exhibit two types of hemodynamic alterations in the subclavian artery--i.e., turbulence and changes in the systolic window with no increase in peak systolic velocity in 5/13 cases with mild stenosis, normal or reduced peak systolic velocity with changes in the reversed flow in 3/13 cases with mild/medium-grade stenosis, either during indifferent position or after dynamic tests. In 2/13 patients with no bone/muscle alterations, turbulence was demonstrated in the subclavian artery. However, in 3/13 cases Doppler US revealed no arterial flow abnormalities--3/13 false negatives relative to mild vascular compression. Selective arteriography demonstrated vascular alterations in the subclavian artery in all cases, with or without Doppler anomalies; while angiography was often positive during hyperabduction maneuvers color duplex Doppler demonstrated hemodynamic alterations at rest with indifferent position of the upper limb. In conclusion, conventional US allowed the evaluation of the thickness of both anterior and middle scalene muscles and of possible muscular asymmetries. Color duplex Doppler US demonstrated primary and secondary alterations in the subclavian artery or vein. Therefore, conventional US, duplex and color Doppler prove to be valuable non-invasive tools in the patients with neurovascular symptoms in the upper limbs and could allow the selection of the cases to submit to arteriography.
本研究旨在评估传统超声和彩色双功多普勒超声在胸廓出口综合征诊断中的临床应用价值。在一项前瞻性研究中进行了传统超声和多普勒检查。将结果与血管造影结果进行关联分析。通过传统超声和频谱多普勒血流成像对13例胸廓出口综合征患者进行了研究。5例（5/13）患者右上肢有神经血管症状，7/13患者左上肢有症状，1/13患者双上肢均有症状。通过脊柱X线平片，在13例中有2例（1例合并肌肉肥大，另1例为双侧）显示有颈肋。传统超声在13例中有7例显示肌肉肥大——1例为双侧，6/13例为单侧，肌肉明显不对称。13例中有5例未显示骨骼/肌肉异常。有颈肋和斜角肌肥大的患者，锁骨下动脉出现两种血流动力学改变——即，5/13例轻度狭窄患者出现湍流和收缩期窗改变，但收缩期峰值流速未增加；3/13例轻度/中度狭窄患者在中立位或动态试验后出现反向血流改变，收缩期峰值流速正常或降低。13例无骨骼/肌肉改变的患者中有2例，锁骨下动脉出现湍流。然而，13例中有3例多普勒超声未显示动脉血流异常——相对于轻度血管受压有3/13例假阴性。选择性动脉造影显示所有病例锁骨下动脉均有血管改变，无论有无多普勒异常；虽然血管造影在过度外展动作时往往为阳性，但彩色双功多普勒在休息时上肢中立位即可显示血流动力学改变。总之，传统超声可评估前、中斜角肌的厚度及可能存在的肌肉不对称情况。彩色双功多普勒超声可显示锁骨下动脉或静脉的原发性和继发性改变。因此，传统超声、双功超声和彩色多普勒在有上肢神经血管症状的患者中是有价值的非侵入性检查工具，可用于选择需要进行动脉造影的病例。
