Sonography for deep venous thrombosis: current and future applications.
Sonography for deep venous thrombosis: current and future applications.
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DOI：
10.1097/01.ruq.0000187024.54319.19
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发表时间：
2005-12-01
影响因子：
1.3
通讯作者：
Fleischer, Arthur C
中科院分区：
文献类型：
--
作者：
Andrews, E James Jr;Fleischer, Arthur C
深静脉血栓形成（DVT）是当今临床医生面临的最常见的问题之一。它通常是无症状的，未被诊断为潜在的致命后果。超声已成为诊断深静脉血栓形成的“金标准”，适当注意技术，该测试的灵敏度约为97%。对解剖学、病理生理学和危险因素的理解是很重要的。血栓形成通常开始于膝盖以下的瓣叶下方。大约40%会自发消退，40%会变得有组织，20%会扩散。无论是否发现小腿静脉血栓，对于有危险因素或怀疑深静脉血栓形成的患者，建议在7至10天内重复检查。血栓形成的三个主要危险因素是年龄大于75岁、既往深静脉血栓形成史和潜在恶性肿瘤。其他诊断研究包括静脉造影、CT或MRI静脉造影、Tc 99 m Apcitide研究和实验室检测D-二聚体。D-二聚体研究作为一种筛查试验越来越频繁地使用，在检测血栓（无论是深静脉血栓还是肺栓塞）方面的灵敏度为99%。然而，特异性只有大约50%，许多情况下会导致假阳性检查。因此，阴性检查有助于避免其他诊断研究，但阳性检查可能会产生误导。可能导致假阳性检查的条件包括但不限于糖尿病、妊娠、肝病、心脏病、近期手术和一些胃肠道疾病。和超声波检查一样，相隔一周的两次D-二聚体阴性检查排除了深静脉血栓形成的诊断。彩色多普勒压缩超声检查仍然是深静脉血栓形成的最佳综合检查方法。它易于执行，比大多数“高科技”研究便宜，可以作为便携式检查进行，并且在正确执行时非常可靠。
Deep venous thrombosis (DVT) is a one of the most common problems facing the clinician in medicine today. It is often asymptomatic and goes undiagnosed with potentially fatal consequences. Ultrasound has become the "gold standard" in the diagnosis of deep venous thrombosis and with proper attention to technique sensitivity of this test is approximately 97%. An understanding of anatomy, pathophysiology, and risk factors is important. Thrombus formation usually begins beneath a valve leaflet below the knee. Approximately 40% will resolve spontaneously, 40% will become organized, and 20% will propagate. Whether or not a calf vein thrombus is identified, a repeat examination in 7 to 10 days is recommended in patients with risk factors or when deep venous thrombosis is suspected. The three main risk factors for thrombus formation are age greater than 75 years, previous history of deep venous thrombosis, and underlying malignancy. Other diagnostic studies include the contrast venogram, CT or MRI venogram, Tc99m Apcitide study, and the laboratory test D-Dimer. The D-Dimer study is being used more frequently as a screening test with 99% sensitivity in detecting thrombus, whether deep venous thrombosis or pulmonary embolism. However, specificity is only approximately 50% with many conditions leading to false-positive exams. Therefore, a negative examination is useful in avoiding other diagnostic studies, but a positive one may be misleading. Conditions that can lead to a false-positive examination include, but are not limited to diabetes, pregnancy, liver disease, heart conditions, recent surgery, and some gastrointestinal diseases. Like the sonogram, two negative D-Dimer studies a week apart exclude the diagnosis of deep venous thrombosis. Compression sonography with color Doppler remains the best overall test for deep venous thrombosis. It is easy to perform, less expensive than most "high tech" studies, can be performed as a portable examination, and is highly reliable when done properly.