尚晓敏
彩色多普勒超声在诊断血管外膜囊性病变中的应用价值
尚晓敏
目的 探讨血管外膜囊性病变的超声表现,评价彩色多普勒超声对血管外膜囊性病变的诊断价值。方法 回顾性分析我院超声科12例血管外膜囊性病变患者的超声图像表现。结果 本组12例患者术前确诊8例,误诊4例,12例患者均为单发,7例位于腘动脉,4例位于髂外动脉-股动脉,1例位于髂外静脉,根据囊肿形态及管腔的狭窄特点可分为偏心性囊肿和向心性囊肿,偏心性囊肿8例,向心性囊肿4例,超声显示患者受累血管外壁均出现不同程度增宽,横切见血管外形无改变,管腔受压,内径变细,11例动脉受累的患者,囊肿与管腔之间可见3层管壁结构,狭窄处血流收缩期峰速度可加快,频谱形态呈湍流样改变,病变远心端动脉血流峰速度减低,病变位于静脉的1例患者,远心端静脉管腔增宽,血流缓慢,血管造影显示受累动脉处管腔狭窄,CT可见管腔外单腔或多腔肿物,管腔呈充盈缺损或变细,12例病例均行囊肿切除及血管外膜剥离术。结论 彩色多普勒超声能够准确显示CAD患者囊肿的位置、形态和内部回声等,准确评价管腔狭窄特点、程度和血流状态,对CAD的诊断、治疗和预后有重要的临床意义。
超声检查;血管外膜囊性病变;诊断
血管外膜囊性病变(Cystic Adventitial Disease,CAD)为单房或多房的囊肿附着于血管外膜内,压迫管壁中层及内膜,导致受累血管管腔狭窄甚至闭塞,从而引起一系列临床症状。本病一般单发,多累及动脉,也可累及静脉,被公认为是导致动脉粥样硬化性狭窄的疾病之一,针对血管外膜囊性病变的主要检查方法有彩色多普勒超声和MRI,但是国内文献针对本病的彩色多普勒超声表现较少,本研究主要回顾性分析我院超声科12例血管外膜囊性病变患者的超声图像表现,评价彩色多普勒超声对血管外膜囊性病变的诊断价值,具体报道如下。
1.1 一般资料
选择我院超声科2002年1月~2014年12月12例经过手术病理确诊的血管外膜囊性病变患者,其中男性7例,女性5例,年龄18~66岁,平均年龄(50.8±8.5)岁,4例有吸烟史,且均为男性患者,2例有高血压病史,5例主要表现为患侧下肢胀痛,7例出现间歇性跛行。
1.2 方法
使用Philips iU 22彩色多普勒超声诊断仪,探头频率3.5~6.0 MHz。患者取仰卧位,依照顺序扫查髂外动静脉、股动静脉、腘动静脉,胫后、胫前及足背动脉,重点观察患者血管管径、管壁厚度,局部有无斑块,观察管壁结构,发现囊肿后评估囊肿的大小,描述囊肿的形态并记录,将囊肿分为偏心性囊肿和向心性囊肿,根据观察的结果评估管腔狭窄程度,评价血流动力学变化。
本组12例患者术前确诊8例,误诊4例,3例超声误诊为为血管周围囊性占位,1例超声误诊为夹层动脉瘤,12例均为单发,7例位于腘动脉,4例位于髂外动脉-股动脉,1例位于髂外静脉。2例动脉管壁不规则增厚。12例囊中大小不一,囊肿最长1例达到11 cm,最宽1例达到2.5 cm,最厚处1例达到2.6 cm。12例囊肿均为单发,囊肿位于血管外膜内,与管壁走行方向一致,受压后变形,囊肿轮廓清晰,囊肿内无回声,彩色多普勒超声显示未见血流信号,根据囊肿形态及管腔的狭窄特点可分为偏心性囊肿和向心性囊肿,偏心性囊肿8例,向心性囊肿4例。偏心性囊肿纵切为椭圆形,横切为圆形或半月形,向心性囊肿纵切为椭圆形,横切为环形,向心性囊肿4例患者均可见薄壁样分隔,偏心性囊肿8例中有2例可见分隔。本研究12例患者的囊肿,7例位于腘动脉,4例位于髂外动脉-股动脉,1例位于髂外静脉。11例动脉受累的患者,血管外壁可见不同程度增宽,横切见血管外形仍然呈圆形,外观无改变,囊肿与管腔之间可见3层管壁结构,管壁中层与内膜受压,向内侧移位,血管腔内壁变狭窄。狭窄程度为38%~82%,病变位于静脉1例,囊肿与管腔间的管壁受压、移位,管腔明显变细,其远心端静脉管腔增宽。11例动脉受累患者,偏心性狭窄者可见病变处彩色血流呈边缘光滑的充盈缺损,向心性狭窄者可见血流不规则变细,血流收缩期峰速加快,频谱形态呈湍流样改变,3例病变的远心端动脉血流峰速度减低,频谱形态呈阻塞样改变,1例静脉受累,病变处血流不规则变细,病变远心端血流缓慢并可见少许泥沙样自主回声,行加压试验,回流改善,病变处血流呈充盈缺损改变。血管造影显示受累动脉处管腔狭窄,边缘光滑,可见弧形压迹,呈弯月征。
血管外膜囊性病变在临床上比较少见,一般男性比较多见,常发生于中年患者,一般单发,多发者极为罕见,累积动脉多见,静脉少见。血管外膜囊性病变患者的囊肿内充满由黏蛋白等组成的黏液样物质,发病机制尚不明确,可能与胚胎时期间充质细胞混入血管外膜、神经节的异位、血管壁的微损伤或退化等有关。血管外膜囊性病变的影像学检查目前以MRI较为常用,彩色多普勒超声依据其优势常作为初步检查手段使用,目前国内外关于血管外膜囊性病变的超声表现报道较少[1-2]。本次研究发现,囊肿附着于血管外膜,与管壁走行方向一致,囊肿与管腔之间可见3层管壁结构,这与其他报道一致[3]。偏心性囊肿纵切为椭圆形,横切为圆形或半月形,向心性囊肿纵切为椭圆形,横切为环形,这提示了囊肿包绕管腔的特点,对术前评估和手术方法选择有重要意义。
总之,彩色多普勒超声能够准确显示CAD患者囊肿的位置、形态和内部回声等,准确评价管腔狭窄特点、程度和血流状态,对CAD的诊断、治疗和预后有重要的临床意义。
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[3]郎召君,莫宗伟,杨明霞.超声诊断股静脉管腔内囊肿致股静脉狭窄1例[J].中华超声影像学杂志,2014,23(3):263.
The Value of Color Doppler Ultrasound in Diagnosis of Cystic Lesions of Tunica Adventitia Vasorum
SHANG Xiaomin Nanyang City The Central Hospital Department of Ultrasound,Nanyang 473000,China
Objective To explore the ultrasonic characteristics of cystic adventitial disease and to evaluate the value of color doppler ultrasound in diagnosis of cystic adventitial disease.Methods Retrospectively analyzed the ultrasonograms and other imaging methods of twelve patients with cystic adventitial disease conformed by surgery in nanyang central hospital.Results Eight of the twelve cystic adventitial disease cases were confirmed by color doppler ultrasound before surgery,and five were misdiagnosed,all the cases were single,with seven in popliteal artery,four in iliofemoral artery,and one in external iliac vein,were divided into the cysts into concentric cysts and eccentric cysts according to the cystic shape and the lumen stenosis,eight cases were eccentric cysts,four cases were concentric cysts,and both had septations,the affected vessel expanded,but its shape did not change and the lumen was compressed,there were three layers of wall between the cyst and the lumen,the peak systolic velocity of the affected lumen increased and the distal end systolic peak velocity decreased when lesion occurred in artery,distal end lumen reflux were slow when lesion occurred in distal veins,angiography showed the stenosis of the affected lumen,CT showed uniorlocular or multilocular cyst,and the compressed lumen,all of the eleven patients underwent the diseased adventitia resected along with excision of the cyst.Conclusion The color doppler ultrasound can display the location,shape,and internal echo of cystic adventitial disease,and thus it can accurately evaluate luminal stenosis and flow pattern,this is of important clinical significance for the diagnosis,treatment,and prognosis of cystic adventitial disease.
Ultrasonography,Cystic adventitial disease,Diagnosis
R445
B
1674-9308(2015)29-0050-02
10.3969/j.issn.1674-9308.2015.29.034
473000南阳市中心医院超声科