本文關(guān)鍵詞：下肢深靜脈血栓的影像分期對介入溶栓療效的指導意義　出處：《廣州中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 下肢深靜脈血栓 導管直接溶栓術(shù) 預后評估

【摘要】：目的:采用T1加權(quán)磁共振血栓成像(Black-blood Thrombus Imaging,BTI)技術(shù)對下肢深靜脈血栓(DVT)進行診斷及分期,初步探討血栓的影像分期對介入溶栓療效的預后評估。方法:2015年9月-2017年2月,番禺中心醫(yī)院介入科共有100例符合納入標準的急性期下肢深靜脈血栓患者入組,所有患者均簽署知情同意書。入組患者均行BTI序列和雙下肢靜脈增強磁共振血管造影(Contrast Enhanced Magnetic Resonance Venography,CE-MRV)檢查,掃描范圍均包括下腔靜脈下段至小腿靜脈遠端。在磁共振后處理工作站上對CE-MRV與BTI序列圖像進行曲面重建(Curve planar reformation,CPR),并將重建CE-MRV圖像與BTI圖像進行配準,由兩名有經(jīng)驗的醫(yī)師比較分析這兩種序列在診斷血栓的部分及范圍的一致性。以CE-MRV結(jié)果為標準,計算BTI診斷血栓的敏感度、特異度、陽性預測值、陰性預測值、準確度。不同時期DVT表現(xiàn)在磁共振圖像上的血栓信號不同,為了量化不同時期血栓的信號變化,在重建的BTI圖像上測量血栓與肌肉的對比噪聲比(contrast-to-noise ratio,CNR)。于磁共振檢查后第二天對病人患肢行經(jīng)導管直接溶栓術(shù)(catheter—directed thrombolysis,CDT)進行治療,治療后評估病人患肢的溶栓率。采用Pearson相關(guān)性分析評估溶栓率與血栓CNR、病史天數(shù)、溶栓天數(shù)、溶栓劑量、年齡之間的相關(guān)性。同時以溶栓率為因變量,血栓CNR、病史天數(shù)、溶栓天數(shù)、溶栓劑量、年齡作為自變量,采用多重線性回歸模型分析溶栓率與血栓CNR、病史天數(shù)、溶栓天數(shù)、溶栓劑量、年齡之間的關(guān)聯(lián)性。結(jié)果:以CE-MRV的診斷結(jié)果為標準,兩位醫(yī)生采用BTI技術(shù)診斷血栓的結(jié)果的敏感度、特異度、陽性預測值、陰性預測值、準確度分別為98.26%,99.50%,99.03%,99.09%,99.07%和 97.11%,98.98%,98.05%,98.48%,98.33%。在 BTI 圖像上血栓與肌肉之間CNR平均值為56.31±43.95。溶栓治療后,有54人行球囊擴張術(shù)或髂股靜脈支架植入術(shù)。Pearson相關(guān)分析顯示血栓CNR與溶栓率之間呈負相關(guān)性(r=-0.865;P0.01),CNR越低者溶栓效果越好,說明血栓信號與肌肉信號相近,即血栓呈等信號者溶栓效果越好;病史天數(shù)、溶栓劑量與溶栓率之間呈負相關(guān)(r=-0.430,P=0.000.05;r=-0.281,P=0.0050.01)。多重線性回歸分析顯示血栓CNR對溶栓率有顯著影響(P0.01),兩者之間呈負相關(guān),而病史天數(shù)、溶栓天數(shù)、溶栓劑量、年齡對溶栓率無顯著影響(P0.05)。結(jié)論:BTI技術(shù)可以準確診斷血栓的部分及范圍,血栓呈等信號時,考慮為急性早期,溶栓效果最佳,因此,依據(jù)血栓的T1加權(quán)信號特點有望實現(xiàn)DVT治療的預后評估,可指導臨床治療方案的選擇。
[Abstract]:Objective: to use T1-weighted magnetic resonance thrombography (T1WI) with Black-blood Thrombus Imaging. BTI technique was used to diagnose and stage DVT of deep vein thrombosis of lower extremity and to evaluate the prognosis of thrombotic therapy by imaging staging. Methods: from September 2015 to February 2017. A total of 100 patients with acute deep venous thrombosis of lower extremity in Panyu Central Hospital were included in the study. All the patients signed informed consent form. All the patients in the group underwent BTI sequence and contrast-enhanced magnetic resonance angiography of both lower extremities (. Contrast Enhanced Magnetic Resonance Venography. CE-MRV) examination. The scanning range includes inferior vena cava to distal leg vein. Surface reconstruction of CE-MRV and BTI sequence images was performed on Mr postprocessing workstation. Curve planar reformation. The reconstructed CE-MRV image was registered with the BTI image. The consistency of the two sequences in the diagnosis of thrombus was compared and analyzed by two experienced physicians. The sensitivity and specificity of BTI in diagnosing thrombus were calculated according to CE-MRV results. Positive predictive value, negative predictive value, accuracy. DVT showed different thrombus signal on MRI image in different period, in order to quantify the change of thrombus signal in different period. The contrast noise ratio of thrombus to muscle was measured on reconstructed BTI images. The patients were treated with catheter-directed thrombolysis via catheter direct thrombolysis (CDT) on the second day after magnetic resonance examination. Pearson correlation analysis was used to evaluate thrombolytic rate and thrombus CNR, history days, thrombolytic days, thrombolytic dose. At the same time, thrombolysis rate as dependent variable, thrombus CNR, history days, thrombolytic days, thrombolytic dose, age as independent variables. Multiple linear regression model was used to analyze the relationship between thrombolytic rate and thrombus CNR, history days, thrombolytic days, thrombolytic dose and age. Results: the diagnostic results of CE-MRV were taken as the standard. The sensitivity, specificity, positive predictive value and negative predictive value were 98.26%, 99.50% and 99.03%, respectively. And 99.09% and 97.11% and 98.98%, 98.05% and 98.48%, respectively. The mean value of CNR between thrombus and muscle on BTI images was 56.31 鹵43.95.After thrombolytic therapy. 54 patients underwent balloon dilatation or stenting of iliac femoral vein. Pearson correlation analysis showed that there was a negative correlation between thrombus CNR and thrombolytic rate. The lower the P0.01CNR, the better the thrombolytic effect, which indicates that the thrombus signal is similar to the muscle signal, that is, the thrombolytic effect is better if the thrombus signal is equal. There was a negative correlation between thrombolytic dose and thrombolytic rate. Multiple linear regression analysis showed that thrombotic CNR had a significant effect on thrombolytic rate (P 0.01), and there was a negative correlation between the two. There was no significant effect of thrombolysis days, thrombolytic dose and age on thrombolysis rate (P 0.05). Conclusion the proportion and scope of thrombus can be accurately diagnosed by BTI. Thrombolytic effect is the best. Therefore, according to the characteristics of T 1-weighted signal of thrombus, it is hopeful to evaluate the prognosis of DVT therapy and to guide the choice of clinical treatment regimen.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.2;R543.6

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