European Radiology:在导管引导溶栓之前使用磁共振静脉造影评估血栓年龄的临床影响

2022-08-09 shaosai MedSci原创

对于接受微创血栓清除术的患者来说,发生溶栓相关并发症的风险会进一步增加。因此,在治疗前预测CDT的成功概率可以协助临床制定最佳的的治疗策略。

随着技术的发展深静脉血栓(DVT)的微创治疗方案越来越多,因此临床上越来越多地使用双相超声以外的成像方式深静脉血栓进行评估。髂股深静脉血栓的准确介入前成像需要评估腹部-盆腔和下肢静脉。在腹部-盆腔区域,超声不是最佳的成像选择磁共振静脉成像(MRV)和计算机断层扫描静脉成像(CTV)都被证明是可行的成像选择CTV的一个主要缺点是辐射剂量因此在年轻和怀孕的病人应避免使用。磁共振静脉成像(MRV)辐射且无需碘造影剂,因此是一项极佳的成像方式。MRV不仅是评估腹盆腔静脉中血栓存在和位置的有效工具,而且可以详细评估血栓的特性。

对于接受微创血栓清除术的患者来说,发生溶栓相关并发症的风险会进一步增加。因此,在治疗前预测CDT的成功概率可以协助临床制定最佳的的治疗策略。近日,发表在European Radiology杂志的一项研究评估了髂股深静脉血栓的血栓年龄相关的MRV特征的术前识别在预测导管定向溶栓(CDT)治疗效果方面的价值,为临床早期评估患者病情及治疗预后提供了技术支持。

本研究对接受超声加速导管导向溶栓(CDT)治疗髂股深静脉血栓的患者进行了MRV研究。对血栓年龄相关的成像特征进行评分,并转化为总分(急性、亚急性或慢性)。将MRV评分与患者报告的主诉进行比,。对MRV评分组的CDT时间和成功率进行了比较。 

56名患者(29名男性;年龄50.8±16.4岁)被纳入研究。使用MRV,27个血栓被分为急性,17个亚急性,12个陈旧性。根据患者报告的主诉,这些陈旧的血栓中有11个(91.7%)会被归类为急性或亚急性,1个(3.7%)急性血栓为陈旧。CDT至>90%恢复通畅的平均持续时间在各组之间有显著差异(P<0.0001):急性血栓的平均持续时间为23小时(范围:19-25),亚急性为43小时(范围:41-62),旧血栓为85小时(范围:74-96)。与旧血栓相比,CDT在急性和亚急性血栓中的成功率几乎是旧血栓的11倍(OR:10.7;95% CI 2.1-55.5)。


 髂股深静脉血栓特征变化的示例。从左到右:研究中发现的左侧急性股总动脉血栓、亚急性髂动脉血栓和陈旧性股-髂动脉血栓的示例。请注意,急性病例显示出非常均匀的 "干净 "图像,皮下水肿。相反,在亚急性的图像中,有广泛的血管周围水肿,在陈旧血栓中,有更多的表现为不均匀的信号强度

本研究表明,基于MRV成像的血栓时期的区分可以在术前对最有可能成功进行CDT的髂股深静脉血栓患者以及最有可能对溶栓治疗产生抵抗的患者进行准确识别及选择,这有助于避免不成功的导管定向溶栓和与治疗时间有关的不必要的风险。本研究提示,磁共振静脉成像是髂股深静脉血栓患者选择接受导管定向溶栓治疗的重要影像学评估手段。

 

原文出处:

Carsten W K P Arnoldussen,Pascale Notten,Rutger Brans,et al.Clinical impact of assessing thrombus age using magnetic resonance venography prior to catheter-directed thrombolysis.DOI:10.1007/s00330-022-08599-5

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    2023-07-01 fusion
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    2022-08-11 sodoo

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