MSCTA對(duì)盆腔靜脈淤血綜合征的應(yīng)用價(jià)值
發(fā)布時(shí)間：2019-03-07 20:01
【摘要】：目的 采用多層螺旋CTA對(duì)盆腔靜脈淤血綜合征(PCS)的擴(kuò)張、淤血的卵巢靜脈及盆腔靜脈叢進(jìn)行血管重建，，探討多層螺旋CT血管造影(MSCTA)對(duì)盆腔靜脈淤血綜合征的臨床應(yīng)用價(jià)值。 材料與方法 對(duì)38例盆腔靜脈淤血綜合征的患者和46例同期因其他系統(tǒng)疾病來診（排除婦科疾病）患者作為對(duì)照組，兩組均進(jìn)行MSCTA檢查。對(duì)所得圖像進(jìn)行MPR重組及VR、MIP重建，在MSCT二維圖像上測(cè)量左側(cè)卵巢靜脈和宮旁靜脈最大直徑，采用雙盲法由兩名資深影像診斷醫(yī)師分別在MSCT平掃及增強(qiáng)掃描的圖像上從不同角度觀察左側(cè)卵巢靜脈和盆腔靜脈叢的走行位置、數(shù)目、形態(tài)等。統(tǒng)計(jì)兩組之間左側(cè)卵巢靜脈及宮旁靜脈的直徑，比較兩組之間左側(cè)卵巢靜脈、宮旁靜脈的直徑及盆腔靜脈叢對(duì)比劑廓清時(shí)間在統(tǒng)計(jì)學(xué)上有無顯著性差異；比較兩組之間動(dòng)脈期左側(cè)卵巢靜脈顯影有無統(tǒng)計(jì)學(xué)意義。 結(jié)果 MSCTA表現(xiàn)為卵巢靜脈擴(kuò)張，走行迂曲，盆腔靜脈叢數(shù)目明顯增加，數(shù)目不等，管徑粗細(xì)不均，迂曲、擴(kuò)張，呈串珠樣、蚯蚓狀表現(xiàn)，并且沿子宮闊韌帶向兩側(cè)發(fā)展。盆腔靜脈淤血綜合征的患者和對(duì)照組的左側(cè)卵巢靜脈直徑分別為：8.7±1.6mm，5.4±1.1mm；盆腔靜脈叢最粗靜脈直徑分別為：7.2±1.2mm，3.5±0.46mm，兩組之間統(tǒng)計(jì)學(xué)有明顯差異(P0.001)。左側(cè)卵巢靜脈及盆腔靜脈叢的顯影情況，盆腔靜脈淤血綜合征有30例左側(cè)卵巢靜脈及22例盆腔靜脈叢提前顯影，則說明卵巢靜脈功能不全其內(nèi)有返流存在，同時(shí)盆腔擴(kuò)張的靜脈叢與周圍小動(dòng)脈之間有異常交通，兩組之間動(dòng)脈期左側(cè)卵巢靜脈及盆腔靜脈叢顯影有明顯統(tǒng)計(jì)學(xué)意義；盆腔靜脈淤血綜合征的患者（38例）盆腔靜脈叢與下腔靜脈在延遲期出現(xiàn)了較明顯的CT差值36±4.8HU（CT差值大于30HU以上），兩組之間盆腔靜脈叢對(duì)比劑廓清時(shí)間之間有統(tǒng)計(jì)學(xué)意義，說明盆腔靜脈淤血綜合征的患者確有血流緩慢、對(duì)比劑廓清時(shí)間延長(zhǎng)的現(xiàn)象。 結(jié)論 1、盆腔靜脈淤血綜合征的MSCT及MSCTA表現(xiàn)為一側(cè)或雙側(cè)卵巢靜脈擴(kuò)張，子宮兩側(cè)可見數(shù)目明顯增加、管徑異常增粗不均、走行迂曲、擴(kuò)張的靜脈叢。2、盆腔靜脈淤血綜合征的患者盆腔靜脈叢存在血流淤滯現(xiàn)象，對(duì)比劑廓清時(shí)間延長(zhǎng)。3、部分盆腔靜脈淤血綜合征的患者出現(xiàn)卵巢靜脈及盆腔靜脈叢動(dòng)脈期顯影現(xiàn)象，說明卵巢靜脈功能不全，其內(nèi)有返流存在及盆腔擴(kuò)張的靜脈叢與小動(dòng)脈形成異常交通的可能性。4、螺旋CT及血管成像技術(shù)可全方位顯示盆腔靜脈淤血綜合征的血管解剖關(guān)系，清晰、直觀的顯示靜脈曲張及其繼發(fā)的病因，為臨床治療及手術(shù)方案的選擇提供準(zhǔn)確、客觀的診斷依據(jù)，具有重要的臨床指導(dǎo)意義。
[Abstract]:Objective to investigate the effect of multi-slice spiral CTA on the expansion of (PCS) in pelvic venous congestion syndrome and the vascular reconstruction of ovarian vein and pelvic venous plexus in patients with pelvic venous congestion syndrome. To evaluate the clinical value of multi-slice spiral CT angiography (MSCTA) in pelvic venous congestion syndrome. Materials and methods 38 patients with pelvic venous congestion syndrome and 46 patients with other systemic diseases (excluding gynecological diseases) were selected as control group. MSCTA was performed in both groups. The images were reconstructed by MPR and VR,MIP, and the maximum diameters of the left ovarian vein and paraverymal vein were measured on the two-dimensional MSCT image. The position, number and shape of the left ovarian vein and pelvic venous plexus were observed from different angles on the plain and enhanced MSCT images of two senior imaging diagnostic physicians by double blind method. The diameters of left ovarian vein and paraverymal vein were compared between the two groups, and there was no significant difference in the diameter of the left ovarian vein, the paruterine vein and the contrast medium clearance time of pelvic venous plexus between the two groups. There was no significant difference between the two groups in the development of left ovarian vein in arterial phase. Results MSCTA showed ovarian vein dilatation, twists and turns, a marked increase in the number of pelvic vena cava plexus, uneven diameter, tortuous, dilated, beaded, earthworm-like appearance, and developed to both sides along the broad ligaments of the uterus. The diameters of left ovarian vein in patients with pelvic venous congestion syndrome and control group were 8.7 鹵1.6 mm and 5.4 鹵1.1 mm;, respectively. The diameter of the thickest vein of pelvic venous plexus was 7.2 鹵1.2 mm and 3.5 鹵0.46 mm respectively. There was significant difference between the two groups (P0.001). In the development of left ovarian vein and pelvic venous plexus, 30 cases of left ovarian vein and 22 cases of pelvic venous plexus developed ahead of time in pelvic vena cava congestion syndrome, indicating that there was regurgitation in ovarian venous insufficiency. At the same time, there was abnormal communication between pelvic dilated venous plexus and peripheral arterioles, and the left ovarian vein and pelvic venous plexus showed significant statistical significance between the two groups during arterial phase. In 38 patients with pelvic venous congestion syndrome, there was a significant difference of CT between pelvic venous plexus and inferior vena cava in the delayed period. The difference between pelvic venous plexus and inferior vena cava was 36 鹵4.8 Hu (the difference of CT was greater than that of 30HU). The clearance time of pelvic venous plexus contrast medium was statistically significant between the two groups, indicating that there was a slow blood flow in the patients with pelvic venous congestion syndrome, and the clearance time of the contrast medium was prolonged. Conclusion 1. The MSCT and MSCTA of pelvic vena cava congestion syndrome showed dilatation of one or both sides of ovarian vein, and the number of two sides of uterus increased obviously, the diameter of the vessel increased unevenly, the diameter of the vein was irregular, the course was tortuous and dilated venous plexus. 2. The pelvic venous plexus in the patients with pelvic venous congestion syndrome has the phenomenon of stagnation of blood flow, and the clearance time of contrast medium is prolonged. 3, some of the patients with pelvic venous congestion syndrome appear ovarian vein and pelvic venous plexus arterial phase. It is suggested that the ovarian venous insufficiency, the presence of reflux and the possibility of abnormal communication between the venous plexus and the small artery in the presence of reflux and pelvic dilatation. 4. Spiral CT and angiography can show the vascular anatomical relationship of pelvic venous congestion syndrome in an all-round way. Clearly and intuitively showing varicose veins and its secondary causes provides accurate and objective diagnostic basis for the choice of clinical treatment and surgical schemes. It is of great significance for clinical guidance.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R816.8;R711
本文編號(hào)：2436415
[Abstract]:Objective to investigate the effect of multi-slice spiral CTA on the expansion of (PCS) in pelvic venous congestion syndrome and the vascular reconstruction of ovarian vein and pelvic venous plexus in patients with pelvic venous congestion syndrome. To evaluate the clinical value of multi-slice spiral CT angiography (MSCTA) in pelvic venous congestion syndrome. Materials and methods 38 patients with pelvic venous congestion syndrome and 46 patients with other systemic diseases (excluding gynecological diseases) were selected as control group. MSCTA was performed in both groups. The images were reconstructed by MPR and VR,MIP, and the maximum diameters of the left ovarian vein and paraverymal vein were measured on the two-dimensional MSCT image. The position, number and shape of the left ovarian vein and pelvic venous plexus were observed from different angles on the plain and enhanced MSCT images of two senior imaging diagnostic physicians by double blind method. The diameters of left ovarian vein and paraverymal vein were compared between the two groups, and there was no significant difference in the diameter of the left ovarian vein, the paruterine vein and the contrast medium clearance time of pelvic venous plexus between the two groups. There was no significant difference between the two groups in the development of left ovarian vein in arterial phase. Results MSCTA showed ovarian vein dilatation, twists and turns, a marked increase in the number of pelvic vena cava plexus, uneven diameter, tortuous, dilated, beaded, earthworm-like appearance, and developed to both sides along the broad ligaments of the uterus. The diameters of left ovarian vein in patients with pelvic venous congestion syndrome and control group were 8.7 鹵1.6 mm and 5.4 鹵1.1 mm;, respectively. The diameter of the thickest vein of pelvic venous plexus was 7.2 鹵1.2 mm and 3.5 鹵0.46 mm respectively. There was significant difference between the two groups (P0.001). In the development of left ovarian vein and pelvic venous plexus, 30 cases of left ovarian vein and 22 cases of pelvic venous plexus developed ahead of time in pelvic vena cava congestion syndrome, indicating that there was regurgitation in ovarian venous insufficiency. At the same time, there was abnormal communication between pelvic dilated venous plexus and peripheral arterioles, and the left ovarian vein and pelvic venous plexus showed significant statistical significance between the two groups during arterial phase. In 38 patients with pelvic venous congestion syndrome, there was a significant difference of CT between pelvic venous plexus and inferior vena cava in the delayed period. The difference between pelvic venous plexus and inferior vena cava was 36 鹵4.8 Hu (the difference of CT was greater than that of 30HU). The clearance time of pelvic venous plexus contrast medium was statistically significant between the two groups, indicating that there was a slow blood flow in the patients with pelvic venous congestion syndrome, and the clearance time of the contrast medium was prolonged. Conclusion 1. The MSCT and MSCTA of pelvic vena cava congestion syndrome showed dilatation of one or both sides of ovarian vein, and the number of two sides of uterus increased obviously, the diameter of the vessel increased unevenly, the diameter of the vein was irregular, the course was tortuous and dilated venous plexus. 2. The pelvic venous plexus in the patients with pelvic venous congestion syndrome has the phenomenon of stagnation of blood flow, and the clearance time of contrast medium is prolonged. 3, some of the patients with pelvic venous congestion syndrome appear ovarian vein and pelvic venous plexus arterial phase. It is suggested that the ovarian venous insufficiency, the presence of reflux and the possibility of abnormal communication between the venous plexus and the small artery in the presence of reflux and pelvic dilatation. 4. Spiral CT and angiography can show the vascular anatomical relationship of pelvic venous congestion syndrome in an all-round way. Clearly and intuitively showing varicose veins and its secondary causes provides accurate and objective diagnostic basis for the choice of clinical treatment and surgical schemes. It is of great significance for clinical guidance.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R816.8;R711
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