電腦斷層間接靜脈攝影術用於深部靜脈血栓症之探討

深部靜脈血栓症(DVT; deep venous thrombosis)易發生於下肢，並常併發足以致命的肺栓塞(pulmonary embolism)。以往診斷DVT的檢查方法為傳統的下肢靜脈攝影或彩色都卜勒超音波，但靜脈攝影檢查因具侵犯性，且常因患者腳部腫脹無法施行檢查。彩色都卜勒超音波在近年來雖已逐漸取代成為診斷DVT之主流，但卻常受限於操作技術上的問題，無法被廣泛的使用。本研究目的在於探討以間接性電腦斷層靜脈攝影術(ICTV;indirect computed tomographic venography)取代傳統檢查方法之可行性及技術性因素。本研究嘗試以低於國外類似研究之造影劑使用量，測試病患自上肢靜脈注入造影劑後，下肢靜脈影像的最佳擷取時間範圍。並研究以止血帶壓迫病患之踝關節及膝關節處後，是否可提高下肢靜脈的顯影效果。在獲得適當攝影條件後，實際應用於臨床病患，部分病患並同時接受傳統靜脈攝影，以比較其差異。結果顯示：患者在足部未以止血帶加壓的情形下以3 ml/秒自上肢靜脈注射100 ml的造影劑，在注射後200秒開始至300秒之間，膝後靜脈(popliteal vein)均可達到較高及穩定的顯影效果。患者在以止血帶於膝關節及踝關節處加壓的情形後，雙側膝後靜脈的CT值與未加壓之狀況下亦無明顯差異。本文選擇以足部不加壓的方式實際應用於臨床十三位病患，均能得到良好的診斷效果。在六名同時接受傳統靜脈攝影之病患，ICTV與靜脈攝影均能清楚診斷下肢之DVT，但ICTV較靜脈攝影更能清楚顯示骨盆腔內DVT，同時亦能同時偵測患者其他合併病灶。

關鍵字

深部靜脈血栓症；間接性電腦斷層靜脈攝影術；靜脈攝影

並列摘要

Deep vein thrombosis(DVT)is a common disease of the lower limbs. It is a life threatening disease because of its fatal complication: pulmonary embolism. There have been a variety of examinations for the detection of DVT: color Doppler sonography, venogram, nuclear medicine and computed tomography(CT).Venogram for the lower limbs has been regarded as the golden standard for the diagnosis of DVT, but it has many limitations after year’s usage: poor detection rate for the DVT of the pelvic venous system and the deep femoral vein, severs pain due to the contrast medium irritation and possible contrast medium irritation and possible contrast medium leakage, inability to perform in patients of severe swelling of the feet. Color Doppler ultrasound has replaced the venogram in many instiutions in recent years. However, it is also limited clinically because of its operator-dependence and unsatisfactory detection rate for the pelvic venous system. CT has been tried via catheterization and contrast medium injection through the venous system of the dorsal foot(direct CTV) or the upper limbs (indirect CTV). The indirect CTV is easy to perform and not limited by the difficulty of venopuncture in patients with severe swelling of the lower limbs. The aim of this research was to establish the optimal contrast medium dosage and timing of scanning for the indirect computed tomographic venogram. These studies were carried out with antecubital venous injection of 100 ml contrast medium with injection rate of 3 ml/sec in 13 patients of clinically suspected of hepatocellular carcinoma receiving dynamic CT scanning. CT density measurements for bilateral popliteal veins were performed from 180 to 350 seconds after contrast medium injection. Our results showed: 1. 200 to 300 seconds after contrast medium injection is suitable for ICTV.2. Tourniquet appliance is not beneficial for ICTV. 3.ICTV is good for DVT in the pelvis, which is better than angiogram or color Dopper ultrasound. 4. ICTV offers information regarding other conditions contributing to the lower limb edema at the same time. 5. 100 ml contrast medium injection is adequate to get a good ICTV result. In conclusion, ICTV should be the choice of examination in patients with suspected DVT not suitable for conventional venogram. ICVT offers information of the pelvic venous system, which is difficult to get with conventional venogram or color Doppler ultrasound.

並列關鍵字

Deep venous thrombosis ； indirect computed tomographic venography ； venography

國際替代計量

電腦斷層間接靜脈攝影術用於深部靜脈血栓症之探討

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