王贤明,张文君,华先平,郭少文,赵珊珊.彩色多普勒超声诊断中弓韧带压迫综合征[J].中国医学影像技术,2017,33(2):242~246
彩色多普勒超声诊断中弓韧带压迫综合征
Color Doppler flow imaging in diagnosis ofmedian arcuate ligment syndrome
投稿时间:2016-06-28  修订日期:2016-11-03
DOI:10.13929/j.1003-3289.201606159
中文关键词:  腹腔动脉  中弓韧带压迫综合征  超声检查,多普勒,彩色
英文关键词:Celiac artery  Median arcuate ligment syndrome  Ultrasonography,Doppler,color
基金项目:湖北省教育厅指导项目(B2016123);随州市卫生计生委重点项目(2015SMR001)。
作者单位E-mail
王贤明 南方医科大学附属小榄医院超声影像科, 广东 中山 528415
湖北医药学院第五临床学院医学影像系教研室, 湖北 随州 441300 
 
张文君 湖北医药学院附属太和医院超声影像科, 湖北 十堰 442000  
华先平 心南方医科大学附属小榄医院血管内科, 广东 中山 528415 25030926@qq.com 
郭少文 湖北医药学院附属太和医院超声影像科, 湖北 十堰 442000  
赵珊珊 湖北医药学院第五临床学院医学影像系教研室, 湖北 随州 441300  
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中文摘要:
      目的 探讨彩色多普勒超声诊断中弓韧带压迫综合征(MALS)的价值。方法 采用彩色多普勒超声对41例腹痛患者的腹腔动脉进行筛查,观察腹腔干起始段走行、管腔内径,再分别测量起始段狭窄处平静状态、深吸气末、深呼气末收缩期峰值速度(PSVcalm、PSVinsp、PSVexp),并计算深呼气末与深吸气末血流速度变化率(流速变化率)。对照组为100例接受腹部超声检查的无腹痛患者,分别测量上述各参数,比较MALS患者(MALS组)和对照组各参数的差异。以CTA结果为金标准,构建ROC曲线分析PSVexp、流速变化率以及两者联合诊断MALS的价值。结果 彩色多普勒超声共检出20例MALS,CTA检出19例。超声诊断MALS的敏感度为89.47%(17/19)、特异度为86.36%(19/22)、准确率为87.80%(36/41)、阳性预测值为85.00%(17/20)。MALS组腹腔干起始段血流峰值速度及流速变化率明显高于对照组(P均<0.01)。PSVexp、流速变化率的ROC曲线下面积分别为0.936、0.920(P<0.01)。以PSVexp=330 cm/s为阈值,诊断MALS的敏感度和特异度分别为85.7%和90.9%。当流速变化率=120%时,诊断MALS的敏感度和特异度分别为87.7%和89.4%。结论 彩色多普勒超声可清晰显示腹腔干狭窄的部位、狭窄程度;将PSVExp≥330 cm/s或流速变化率≥120%或两者联合作为超声参考指标评估MALS,均有较高的诊断价值,且两者联合诊断的特异度最高。
英文摘要:
      Objective To explor the value of color Doppler flow imaging (CDFI) in diagnosis of median arcuate ligment syndrome (MALS).Methods The celiac trunk of forty-one patients with abdominal pain were screened with CDFI. The initial segment of celiac trunk and lumen diameter were observed, and the peak systolic velocity (PSV) of stenotic location in calm (PSVcalm), maximum end-inspiration (PSVinsp) and end-expiration (PSVexp) was measured, and velocity variation rate between maximum end-inspiration and end-expiration were calculated. The control group was one hundred patients without abdominal pain, the same hemodynamic parameters were measured. The difference of hemodynamic parameters of MALS patients (MALS group) and control group was analyzed. Taking CTA as gold standard, the ROC curve was established to evaluate the diagnostic value of PSVexp, velocity variation rate and combination of the both parameters.Results Twenty cases considered as MALS revealed by sonography, and nineteen MALS cases were diagnosed with CTA; the sensitivity, specificity, accuracy and positive predictive value of ultrasonogrphic diagnosis of MALS were 89.47%(17/19), 86.36%(19/22), 87.80%(36/41), 85.00%(17/20). The PSV and velocity variation rate in MALS group were higher than those of the control group (all P<0.01). The area under ROC curve of PSVexp and velocity variation rate were 0.936 and 0.920 (P<0.01). The diagnostic sensitivity and specificity of MALS were 85.7% and 90.9%, when PSVexp was 330 cm/s. The diagnostic sensitivity and specificity of MALS were 87.7% and 89.4%, when the velocity variation rate was 120%.Conclusion CDFI can clearly show the location and stenosis degree of the celiac artery. PSVExp ≥330 cm/s or velocity variation rate ≥120% or combination of the both as a ultrasonic reference of MALS have a higher diagnostic value, and the specificity of the combination diagnosis is the highest.
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