Gongolo A, Giraldi E, Spreafico G, Gongolo R, Ravasini R
Servizio di Radiologia, Presidio Ospedaliero ULSS 18 Venezia.
Radiol Med. 1993 Mar;85(3):182-6.
Thirty-eight patients (45 limbs on the whole) with clinical suspicion of deep venous thrombosis in the lower limbs were examined with duplex US and color-Doppler flow mapping. The results were compared with those of ascending phlebography used as a reference. Disease sites included distal localizations, limited to the leg, with no involvement of the popliteal vein, and proximal localizations, involving the popliteal vein to the iliac segment. In case of proximal thrombosis, duplex US had 81% sensitivity, 93% specificity, 86% positive and 90% negative predictive values. Color-Doppler flow mapping had 87% sensitivity, 96% specificity, 93% positive and negative predictive values. In case of distal localizations, the results were poorer with both methods; duplex sensitivity decreased to 60% and specificity to 83% with 64% positive and 80% negative predictive values. Color-Doppler results were slightly higher, with 80% sensitivity, 93% specificity, 85% positive and 90% negative predictive values. Thus, the authors believe color-Doppler flow mapping to be adequate as the imaging method of choice when deep venous thrombosis is suspected. Color-Doppler imaging yields better results in distal localizations and makes the examination easier, quicker and more panoramic. Phlebography should be employed in questionable cases and is required for the diagnosis of limited thromboses, which are at risk for embolism, as those we observed in the adductor canal, which are difficult to diagnose with US.
对38例临床怀疑下肢深静脉血栓形成的患者（共45条肢体）进行了双功超声和彩色多普勒血流图检查。将结果与作为参考的上行静脉造影结果进行比较。疾病部位包括局限于小腿的远端定位，未累及腘静脉，以及累及腘静脉至髂段的近端定位。对于近端血栓形成，双功超声的敏感性为81%，特异性为93%，阳性预测值为86%，阴性预测值为90%。彩色多普勒血流图的敏感性为87%，特异性为96%，阳性和阴性预测值均为93%。对于远端定位，两种方法的结果均较差；双功超声的敏感性降至60%，特异性降至83%，阳性预测值为64%，阴性预测值为80%。彩色多普勒的结果略高，敏感性为80%，特异性为93%，阳性预测值为85%，阴性预测值为90%。因此，作者认为当怀疑深静脉血栓形成时，彩色多普勒血流图足以作为首选的成像方法。彩色多普勒成像在远端定位中产生更好的结果，并且使检查更容易、更快且更全面。在可疑病例中应采用静脉造影，对于诊断有限的血栓形成（如我们在收肌管中观察到的有栓塞风险且难以通过超声诊断的血栓形成）是必需的。
