CAJ | 학술논문

目的：评价超声造影（ CEUS ）在监测肝硬化患者经颈静脉肝内门体支架分流术（ TIPS）后支架管通畅情况中的应用价值。方法回顾性分析2012年1-10月四川大学华西医院211例TIPS术后肝硬化患者的超声检查资料，其中40例行CEUS检查，14例行增强CT检查。以增强CT检查及临床随访结果作为金标准，分别计算彩色多普勒血流成像（ CDFI）及CEUS诊断TIPS术后支架管闭塞的敏感度、特异度、阳性预测值及阴性预测值。结果二维超声显示所有支架管均位于门静脉与下腔静脉之间；CDFI显示171例患者支架管内血流充盈良好，38例支架管内未见血流信号，2例支架管血流充盈缺损。 CEUS显示21例支架管通畅，17例支架管闭塞，2例支架管附壁血栓。17例CEUS诊断为支架管闭塞的患者中3例失访，14例行增强CT检查，均显示支架管闭塞。 CDFI诊断TIPS术后支架管闭塞的敏感度、特异度、阳性预测者及阴性预测者分别为100％、89％、40％和100％；CEUS诊断TIPS术后支架管闭塞的敏感度、特异度、阳性预测者及阴性预测者均为100％。结论超声检查作为监测肝硬化患者TIPS术后支架管是否通畅的常规检查手段，CEUS能更加准确的显示支架管闭塞，尤其是CDFI显示支架管血流困难时采用CEUS可明确支架管的通畅情况。
목적：평개초성조영（ CEUS ）재감측간경화환자경경정맥간내문체지가분류술（ TIPS）후지가관통창정황중적응용개치。방법회고성분석2012년1-10월사천대학화서의원211례TIPS술후간경화환자적초성검사자료，기중40례행CEUS검사，14례행증강CT검사。이증강CT검사급림상수방결과작위금표준，분별계산채색다보륵혈류성상（ CDFI）급CEUS진단TIPS술후지가관폐새적민감도、특이도、양성예측치급음성예측치。결과이유초성현시소유지가관균위우문정맥여하강정맥지간；CDFI현시171례환자지가관내혈류충영량호，38례지가관내미견혈류신호，2례지가관혈류충영결손。 CEUS현시21례지가관통창，17례지가관폐새，2례지가관부벽혈전。17례CEUS진단위지가관폐새적환자중3례실방，14례행증강CT검사，균현시지가관폐새。 CDFI진단TIPS술후지가관폐새적민감도、특이도、양성예측자급음성예측자분별위100％、89％、40％화100％；CEUS진단TIPS술후지가관폐새적민감도、특이도、양성예측자급음성예측자균위100％。결론초성검사작위감측간경화환자TIPS술후지가관시부통창적상규검사수단，CEUS능경가준학적현시지가관폐새，우기시CDFI현시지가관혈류곤난시채용CEUS가명학지가관적통창정황。
Objective To evaluate the application value of contrast-enhanced ultrasonography (CEUS)in monitoring the stent patency after transjugular intrahepatic portosystemic shunt (TIPS)on patients with cirrhosis .Methods The ultrasonic manifestations of 211 patients with cirrhosis after TIPS in West China Hospital of Sichuan University from January 2012 to October 2012 were analyzed retrospectively . Among these cases ,40 patients underwent CEUS examination ,14 cases were examined by enhanced-CT.The results of enhanced-CT and clinical follow-up were regarded as gold standard to calculate the sensitivity , specificity,positive predictive value and negative predictive value of color doppler flow imaging (CDFI)and CEUS in the diagnosis of stent occlusion after TIPS .Results Two-dimensional ultrasound showed all stents were located between portal vein and inferior vena cava .CDFI showed well-filled blood flow within stent in 171 patients,no blood flow within stent in 38 cases and filling defected blood flow within stent in 2 cases. CEUS showed stents patency in 21 cases,stents occlusion in 17 cases and stents mural thrombosis in 2 cases. Among these 17 cases with stents occlusion diagnosed by CEUS ,3 cases were failed to follow-up and 14 cases underwent enhanced-CT.The results of enhanced-CT showed all stents were occluded .The sensitivity, specificity,positive predictive value and negative predictive value of CDFI in the diagnosis of stent occlusion after TIPS were 100%, 89%, 40% and 100% respectively , and those of CEUS were all 100%. Conclusions CEUS as a conventional examine method in monitoring the stents patency after TIPS on patients with cirrhosis ,it is more accurate than CDFI in the determination of stent occlusion .Using CEUS can definitely diagnose the stent patency especially when CDFI shows blood flow within the stent difficultly .