切换至 "中华医学电子期刊资源库"

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:
引用本文:

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/OL]. 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/OL]. 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。

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.

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)
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)
1
Blute ML, Leibovich BC, Lohse CM, et al. The mayo clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus [J]. BJU Int, 2004, 94(1): 33-41.
2
Ayyathurai R, Garcia-Roig M, Gorin MA, et al. Bland thrombus association with tumor thrombus in renal cell carcinoma: analysis of surgical significance and role of inferior vena caval interruption [J]. BJU Int, 2012, 110(11pt B): E499-E455.
3
Hutchinson R, Rew C, Chen G, et al. The adverse survival implications of Bland thrombus in Renal Cell carcinoma with Venous Tumor Thrombus [J]. Urology, 2018, 115: 119-124.
4
Cosgrove D. Ultrasound contrast agent: an overview [J]. Eur J Radilo, 2006, 60(3): 324-330.
5
周平,李瑞珍,刘浔阳, 等. 超声造影在门静脉栓子良恶性鉴别诊断中的价值[J]. 中国超声医学杂志, 2006, 22(8): 616-618.
6
任杰,曾婕,吕艳, 等. 超声造影、常规超声、增强CT鉴别诊断门静脉癌栓与血栓的比较 [J]. 中华超声影像学杂志, 2011, 20(11): 944-946.
7
Tarantino L. Contrast-enhanced ultrasound in differentiating malignant from benign portal vein thrombosis in hepatocellular carcinoma [J]. World J Gastroenterol, 2015, 21(32): 9457.
8
Wang B, Li H, Huang Q, et al. Robot-assisted Retrohepatic Inferior Vena Cava Thrombectomy: First or Second Porta Hepatis as an Important Boundary Landmark [J]. Eur Urol, 2018, 74(4): 512-520.
9
Wang B, Li H, Ma X, et al. Robot-assisted Laparoscopic inferior Vena Cava Thrombectomy: Different Sides Require Different Techniques [J]. Eur Urol, 2016, 69(6): 1112-1119.
10
Wang B, Huang Q, Liu K, et al. Robot-assisted Level Ⅲ-Ⅳ Inferior Vena Cava Thrombectomy: Initial Series with Step-by-step Procedures and 1-yr Outcomes [J]. Eur Urol, 2019. In Press.
11
Lee A. VET in patients with cancer-diagnosis, prevention and treatment [J]. Thromb Res, 2008, 123(suppl 1): S50-S54.
12
Hallscheidt PJ, Fink C, Haferkamp A, et al. Preoperative staging of renal cell carcinoma with inferior cava thrombus using multidetector CT and MRI [J]. J Comput Assist Tomogr, 2005, 29(1): 64-68.
13
Kaufman LB, Yeh BM, Breiman M, et al. Inferior vena cava filling detects on CT and MRI [J]. AJR Am J Roentgenol, 2005, 185(3): 717-724.
14
Matin SF, Gill IS. Laparoscopic ultrasonography [J]. J Endourol, 2001,15(1): 87-92.
15
Shaaban H, Welch A, Rao S. Laparoscopic ultrasound for the diagnosis of choledocholithiasis: Quick, safe and effective [J]. Surg Laparosc Endosc Percutan Tech, 2014, 24(3): 274-276.
16
Ellebaek SB, Fristrup CW, Mortensen MB. Laparoscopic ultrasound imaging in colorectal cancer resection may increase the detection rate of small liver metastases [J]. Ugeskr Laeger, 2016, 178(24): V01160007.
17
Wang XZ, Yu ZX, Guo RJ, et al. Application of laparospic ultrasonography in surgery of small renal cell carcinoma [J]. Asian Pan J Cancer Prev, 2014, 15(21): 9113-9116.
18
Kang N, Niu Y, Zhang J, et al. Intraoperative ultrasonography: A useful tool in retrolaparoscopic nephron-sparing surgery [J]. Urol Int, 2012, 88(3): 338-342.
19
Alenezi AN, Karim O. Role of intra-operative contrast-enhanced ultrasound(CEUS) in robotic-assisted nephron-sparing surgery [J]. J Robot Surg, 2015, 9(1): 1-10.
20
Rao AR, Gray R, Mayer E, et al. Occlusion angiography using intraoperative contrast-enhanced ultrasound scan(CEUS): A novel technique demonstrating segmental renal blood supply to assist zero-ischaemia robot-assisted partial nephrectomy [J]. Eur Urol, 2013, 63(5): 913-919.
[1] 王亚红, 蔡胜, 葛志通, 杨筱, 李建初. 颅骨骨膜窦的超声表现一例[J/OL]. 中华医学超声杂志(电子版), 2024, 21(11): 1089-1091.
[2] 汪洪斌, 张红霞, 何文, 杜丽娟, 程令刚, 张雨康, 张萌. 低级别阑尾黏液性肿瘤与阑尾黏液腺癌超声及超声造影特征分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 865-871.
[3] 宋勇, 李东炫, 王翔, 李锐. 基于数据挖掘法分析3 种超声造影剂不良反应信号[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 890-898.
[4] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[5] 王博冉, 乔春梅, 李春歌, 王欣, 王晓磊. 超声造影评估类风湿关节炎亚临床滑膜炎疾病进展的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 802-808.
[6] 马晓菊, 梁潇, 段云友, 袁丽君, 赵萍. NBAV脂质纳泡对ApoE -/-小鼠动脉粥样硬化病变的评估和干预[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 608-616.
[7] 谢江燕, 王亚菲, 贺芳. 妊娠合并血栓性血小板减少性紫癜2例并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 556-563.
[8] 李星月, 董伟, 徐永波, 张文法, 胡晓璇, 钟玉绪, 褚海波. 浅表血栓性静脉炎管壁基质金属蛋白酶及其抑制剂表达研究[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 338-343.
[9] 叶美妮, 刘思嘉, 臧玉玮, 刘云建. 肝硬化门静脉血栓形成的研究进展[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 379-384.
[10] 林巧, 周丽. RFA联合LAH术治疗原发性肝癌并门静脉癌栓的临床效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 521-524.
[11] 台苏鹏, 梁朝朝, 郝宗耀, 邰胜, 陶军跃, 周骏. 机器人辅助腹腔镜治疗肾错构瘤合并下腔静脉瘤栓两例报道并文献复习[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 473-478.
[12] 郑大雯, 王健东. 胆囊癌辅助诊断研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 769-773.
[13] 于洁, 金小红, 顾艳楣, 王慧, 葛杨杨, 李燕. 癌症相关静脉血栓栓塞症患者疾病体验与需求的质性研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 739-744.
[14] 温绍敏, 王雅晳, 施依璐, 段莎莎, 云书荣, 张小杉. 靶向超声造影技术在动脉粥样硬化治疗中的应用进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 496-499.
[15] 史宛瑞, 崔立刚. 颈动脉一过性血管周围炎综合征的影像学诊断研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 516-519.
阅读次数
全文


摘要