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首页> 外文期刊>Journal of Clinical Ultrasound: JCU >Current approaches and controversial issues in the diagnosis of deep vein thrombosis via duplex Doppler ultrasound.
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Current approaches and controversial issues in the diagnosis of deep vein thrombosis via duplex Doppler ultrasound.

机译：通过双工多普勒超声诊断深静脉血栓形成的当前方法和有争议的问题。

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Duplex and color Doppler sonography (DUS) is currently the technique of choice for the diagnosis of deep venous thrombosis (DVT) in symptomatic patients, because it has proven safe and cost-effective, with a very high sensitivity and specificity (96% and 98%, respectively) for the diagnosis of proximal DVT. Several issues regarding its method and clinical indications remain controversial, however. Although isolated calf vein thrombosis does not seem to have a significant adverse outcome in the short term, scanning the calf only in patients with localized symptoms or signs is cost-effective. Bilateral examination is indicated in high-risk patients or when screening asymptomatic patients. When negative, a complete DUS examination of the proximal and distal veins, at least down to the level of the popliteal trifurcation, allows withholding anticoagulant therapy without the risk of major complications. This examination may be repeated if signs or symptoms worsen. Some populations of asymptomatic patients at high risk of DVT may benefit from DUS screening. Bilateral DUS examination of lower limb veins should be performed as the initial examination in the workflow of pulmonary embolism only in patients with risk factors for DVT. Recurrent thrombosis is a challenging diagnosis for all imaging modalities. A diagnostic strategy combining clinical probability score and D-dimer test may refine the selection of patients. The pitfalls and limitations of venous DUS are related to vein anatomy, flow changes, technical issues, and operator expertise.
机译：目前，双相和彩色多普勒超声检查（DUS）是诊断有症状患者深静脉血栓形成（DVT）的首选技术，因为它已被证明是安全且具有成本效益的，具有很高的灵敏度和特异性（96％和98） ％分别用于诊断近端DVT。然而，关于其方法和临床适应症的几个问题仍然存在争议。尽管短期内孤立的小腿静脉血栓形成似乎没有明显的不良后果，但仅对具有局部症状或体征的患者进行小腿扫描是具有成本效益的。高危患者或筛查无症状患者时应进行双侧检查。如果结果为阴性，则可以对近端和远端静脉进行全面的DUS检查，至少要降至tri三叉的水平，才可以停止抗凝治疗，而没有发生重大并发症的风险。如果体征或症状恶化，可重复进行此检查。 DUS高风险的一些无症状患者人群可能会受益于DUS筛查。仅在有DVT危险因素的患者中，下肢静脉双侧DUS检查应作为肺栓塞工作流程中的初始检查。复发性血栓形成对所有影像学检查都是具有挑战性的诊断。结合临床概率评分和D-二聚体测试的诊断策略可以优化患者的选择。静脉DUS的缺陷和局限性与静脉解剖，流量变化，技术问题和操作员专业知识有关。

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