Larcom P G, Lotke P A, Steinberg M E, Holland G, Foster S
Hospital of the University of Pennsylvania, Philadelphia, USA.
Clin Orthop Relat Res. 1996 Oct(331):209-15. doi: 10.1097/00003086-199610000-00029.
Magnetic resonance venography is a recently developed, noninvasive means of visualizing the proximal veins of the lower extremity and pelvis. Magnetic resonance venography is compared with standard contrast venography in the diagnosis of proximal deep vein thrombosis after total joint arthroplasty. Two hundred seven extremities were evaluated in a blinded study 5 to 7 days after surgery. Standard contrast venography identified 11 proximal deep vein thromboses. Initial interpretations of the magnetic resonance venographies by staff radiologists identified 5 of the proximal vein thromboses (sensitivity 45%). Two patients with negative standard contrast venographies were identified as positive (specificity 99%). A retrospective review of all magnetic resonance venographies by a dedicated magnetic resonance angiographer identified 10 of 11 deep vein thromboses seen on standard contrast venography (sensitivity 91%). Both false negatives were identified as positives. Standard contrast venography remains the gold standard for identifying proximal vein thromboses. Emerging magnetic resonance imaging techniques have created a potential alternative modality by which to identify deep vein thrombosis. The present study suggests that standard contrast venography continues to be the most accurate modality currently available. Although magnetic resonance venography seems to be accurate, its interpretation requires experience. As costs diminish and experience increases, magnetic resonance venography will have increased importance in the clinical recognition of deep vein thrombosis.
磁共振静脉造影是一种最近开发的用于观察下肢和骨盆近端静脉的无创方法。在全关节置换术后近端深静脉血栓形成的诊断中，对磁共振静脉造影与标准造影剂静脉造影进行了比较。在一项双盲研究中，于术后5至7天对207条肢体进行了评估。标准造影剂静脉造影发现了11例近端深静脉血栓形成。放射科工作人员对磁共振静脉造影的初步解读发现了5例近端静脉血栓形成（敏感性45%）。2例标准造影剂静脉造影结果为阴性的患者被判定为阳性（特异性99%）。一位专门的磁共振血管造影师对所有磁共振静脉造影进行回顾性分析，发现标准造影剂静脉造影显示的11例深静脉血栓形成中有10例（敏感性91%）。2例假阴性结果均被判定为阳性。标准造影剂静脉造影仍然是识别近端静脉血栓形成的金标准。新兴的磁共振成像技术为识别深静脉血栓形成创造了一种潜在的替代方法。本研究表明，标准造影剂静脉造影仍然是目前最准确的方法。尽管磁共振静脉造影似乎很准确，但其解读需要经验。随着成本降低和经验增加，磁共振静脉造影在深静脉血栓形成的临床诊断中将变得更加重要。
