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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2020, Vol. 17 ›› Issue (02) : 172 -177. doi: 10.3877/cma.j.issn.1672-6448.2020.02.016

所属专题： 文献；

生殖泌尿超声影像学

术前及术中超声造影对下腔静脉癌栓是否合并血栓的诊断价值
李秋洋1, 李楠1, 梁舒媛1, 王一茹1, 罗渝昆1, 唐杰1,†(), 马鑫2, 张旭2   
  1. 1. 100853　北京，解放军总医院超声诊断科
    2. 100853　北京，解放军总医院泌尿外科
  • 收稿日期:2019-05-18 出版日期:2020-02-22
  • 通信作者: 唐杰
  • 基金资助:
    国家自然科学基金(81801698); 解放军总医院临床科研扶持基金(2018XXFC-17)

Diagnostic value of preoperative and intraoperative contrast-enhanced ultrasound in differentiating bland from inferior vena cava tumor thrombus

Qiuyang Li1, Nan Li1, Shuyuan Liang1, Yiru Wang1, Yukun Luo1, Jie Tang1,†(), Xin Ma2, Xu Zhang2   

  1. 1. Department of Ultrasound, PLA General Hospital of China, Beijing 100853, China
    2. Department of Urology, PLA General Hospital of China, Beijing 100853, China
  • Received:2019-05-18 Published:2020-02-22
  • Corresponding author: Jie Tang
  • About author:
    Corresponding author: Tang Jie, Email:
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李秋洋, 李楠, 梁舒媛, 王一茹, 罗渝昆, 唐杰, 马鑫, 张旭. 术前及术中超声造影对下腔静脉癌栓是否合并血栓的诊断价值[J]. 中华医学超声杂志（电子版）, 2020, 17(02): 172-177.

Qiuyang Li, Nan Li, Shuyuan Liang, Yiru Wang, Yukun Luo, Jie Tang, Xin Ma, Xu Zhang. Diagnostic value of preoperative and intraoperative contrast-enhanced ultrasound in differentiating bland from inferior vena cava tumor thrombus[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(02): 172-177.

目的

探讨术前及术中超声造影对下腔静脉癌栓是否合并血栓的诊断价值。

方法

选取2017年10月至2019年3月解放军总医院收治的发现肾肿瘤伴下腔静脉癌栓并行腹腔镜手术治疗的患者60例，所有患者均于术前及术中行超声造影检查，以典型增强模式判断癌栓是否合并血栓，并最终取得术后病理结果。以术后病理结果为"金标准"，计算术前及术中超声造影评估癌栓合并血栓的敏感度、特异度、准确性、阳性预测值和阴性预测值。

结果

60例下腔静脉癌栓患者均接受了机器人辅助腹腔镜下根治性肾切除联合下腔静脉内癌栓切除术。根据病理结果，下腔静脉癌栓合并血栓者10例（16.7%），其中术前超声造影漏诊2例，另有2例癌栓头部坏死组织被术前及术中超声造影误诊为血栓。术前与术中超声造影评估癌栓合并血栓的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为80.0%、96.0%、93.3%、80.0%、96.0%和100.0%、96.0%、96.7%、83.3%、100.0%。

结论

术前及术中超声造影对下腔静脉癌栓是否合并血栓有较好的鉴别诊断效能，可为手术方式的选择提供重要信息和依据，具有较高的临床应用价值。

关键词: 超声造影, 下腔静脉, 癌栓, 血栓
Objective

To evaluate the diagnostic value of preoperative and intraoperative contrast-enhanced ultrasound (CEUS) in differentiating bland from inferior vena cava tumor thrombus.

Methods

From October 2017 to March 2019, 60 cases of renal tumor who had inferior vena cava tumor thrombus and underwent laparoscopic surgery were selected. All patients underwent contrast-enhanced ultrasound before and during the operation to determine whether the tumor thrombus was combined with bland thrombus in typical enhancement mode, and postoperative pathological results were finally obtained. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of preoperative and intraoperative contrast-enhanced ultrasound were statistically analyzed.

Results

All 60 patients with IVC tumor thrombus underwent robot-assisted laparoscopic radical nephrectomy and IVC thrombectomy. The tumor thrombus was accompanied by bland thrombus in ten cases. Two cases of bland thrombus were missed by preoperative contrast-enhanced ultrasound, and the necrotic tissues in the head of tumor thrombus in another two cases were misdiagnosed as bland thrombus by both pre-and intra-operative CEUS. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of preoperative CEUS in differentiating bland thrombus from tumor thrombus were 80.0%, 96.0%, 93.3%, 80.0%, and 96.0%, respectively; the corresponding values of intraoperative CEUS were 100.0%, 96.0%, 96.7, 83.3%, and 100.0%.

Conclusion

Preoperative and intraoperative contrast-enhanced ultrasound performs well in the differential diagnosis of inferior vena cava tumor thrombus from bland thrombus, and it can provide important information and basis for the choice of operation mode, which is highly valuable in clinical application.

Key words: Contrast-enhanced ultrasound, Inferior vena cava, Tumor thrombus, Thrombus
图1 患者，男性，53岁，左侧肾肿瘤伴下腔静脉癌栓，行机器人辅助腹腔镜下下腔静脉癌栓切开取出术。图a为超声造影示左肾静脉及下腔静脉癌栓内可见造影剂灌注，呈高增强；图b为常规超声示肝右静脉腔内可见实性回声；图c为超声造影示肝右静脉内可见癌栓合并血栓（箭头所示）；图d为超声造影示下腔静脉癌栓近心端合并血栓（箭头所示）；图e为术中超声造影示血栓内未见造影剂灌注；图f为腹腔镜术中证实癌栓合并血栓（箭头所示）
图2 患者，女性，55岁，右侧肾肿瘤伴下腔静脉癌栓，行机器人辅助腹腔镜下下腔静脉离断术。图a为超声造影示癌栓远心端可见无灌注区，提示癌栓合并血栓（箭头所示）；图b为腹腔镜超声术中图像；图c为术中超声造影示癌栓内可见造影剂灌注（箭头所示）；图d为术中超声造影示血栓内未见造影剂灌注（箭头所示）
表1 术前超声造影与术后病理诊断癌栓合并血栓的结果分析（例）
术前超声造影 术后病理 合计
癌栓合并血栓 癌栓不合并血栓
癌栓合并血栓 8 2 10
癌栓不合并血栓 2 48 50
合计 10 50 60
表2 术中超声造影与术后病理诊断癌栓合并血栓的结果分析（例）
术中超声造影 术后病理 合计
癌栓合并血栓 癌栓不合并血栓
癌栓合并血栓 10 2 12
癌栓不合并血栓 0 48 48
合计 10 50 60
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