面颈深部静脉畸形和淋巴管畸形的彩色多普勒超声鉴别诊断

摘要/Abstract

摘要： 目的分析面颈深部静脉畸形和淋巴管畸形的彩色多普勒超声特点,总结其鉴别诊断要点,探讨彩色多普勒超声在2种深部病变鉴别诊断中的意义。方法回顾分析2012年12月—2013年12月临沂市肿瘤医院收治的经手术病理或DSA下经皮穿刺瘤体造影确诊的32例静脉畸形和29例面颈部淋巴管畸形的临床和彩色多普勒超声资料,分析静脉畸形和淋巴管畸形的彩色多普勒超声特点,以病理诊断或DSA诊断为金标准,应用SPSS 18.0软件包对数据进行统计学分析,计量特异度和敏感度。结果 32例静脉畸形病例,二维超声均显示无回声,无间隔,14例病变内见低回声血栓,11例内见高回声静脉石。多普勒超声均见周边动脉血流, PSV为(13.98±7.93) cm/s,RI为(0.71±0.83) cm/s, 30例探头加压可见静脉频谱的血流信号;29例淋巴管畸形病例,单囊者8例,多囊者10例,网格状11例,二维超声也均呈无回声,但21例病变内可见多发强回声间隔;多普勒超声2例探头加压见血流信号,PI下为静脉频谱,间隔内均可见动脉血流信号,PSV为(14.32±6.57) cm/s,RI为(0.68±0.79) cm/s。经t检验,2组PSV和RI比较无显著差异（P均>0.05）。经χ²检验2组低回声血栓、高回声静脉石、探头加压见血流信号和多发强回声间隔出现率,有显著差异（P<0.05）。探头加压见血流信号诊断静脉畸形的敏感度为93.75%,低回声血栓、高回声静脉石和探头加压见血流信号诊断静脉畸形的特异度较高,分别为96.55%、93.33%和100%。多发强回声间隔诊断淋巴管畸形的敏感度和特异度较高,分别为72.41%和100%。结论彩色多普勒超声鉴别面颈深部静脉畸形和淋巴管畸形具有无创、价廉、准确的特点。病变内出现低回声血栓或高回声静脉石,探头加压出现血流信号支持静脉畸形诊断;病变内有多发强回声间隔,同时间隔内见动脉血流信号时支持淋巴管畸形诊断。

关键词: 静脉畸形, 淋巴管畸形, 彩色多普勒超声, 鉴别诊断

Abstract: PURPOSE: To study the diagnostic significance of color Doppler ultrasound in deep facial and cervical lymphatic malformation and venous malformation by analyzing their color Doppler ultrasonographic characteristics. METHODS: The color Doppler ultrasonographic data of 29 cases of deep-seated facial and cervical lymphatic malformation and 32 cases of venous malformation which had been confirmed by surgical pathology or percutaneous puncture biopsy guided by DSA in Linyi Tumour Hospital from December 2012 to December 2013 were retrospectively analyzed. With final pathology or DSA as gold standard, specificity and sensitivity were calculated and compared with SPSS 18.0 software package. RESULTS: Of the 32 cases of venous malformation, there was no echo and interval by 2-dimensional ultrasound, hypoechoic thrombosis was found in 14 cases and high echo vein stone was found in 11 cases. There were artery flow around and PSV result was (13.98±7.93) cm/s, RI was (0.71±0.83) cm/s. In 30 cases vein blood flow signals were seen under probe pressure. Of the 29 cases, eight were single cystic lymphatic malformation, ten multiple and 11 mesh grid. There was no echo by 2-dimensional ultrasound but multiple hyperechoic interval was found in 21 cases. In 2 cases flow signals were seen under probe pressure which appeared as vein in PI. There were arterial blood flow signals in these intervals, PSV was 14.32±6.57 cm/s,RI was 0.68±0.79 cm/s. There was no significant difference between PSV results and RI results by Student′s t test （t=1.346, 1.474, P>0.05）, while there was significant difference (P<0.05) between the 2 groups in hypoechoic thrombosis (χ²=13.352), high echo vein stone (χ²=12.162), flow signals under probe pressure (χ²=46.015), occurrence of multiple hyperechoic interval (χ²=35.338) by Chi-square test (P<0.05). The sensitivity was 93.75% with probe pressure of blood flow signal to diagnose venous malformation, and the sensitivities of hypoechoic thrombosis (96.55%), hyperechoic vein stone (93.33%) and probe pressure (100%) were all high in diagnosis of venous malformation. The sensitivity and specificity of multiple hyperechoic interval to diagnose venous malformation was 72.41% and 100%, respectively. CONCLUSIONS: Color Doppler ultrasound is noninvasive, inexpensive and accurate in diagnosis of deep-seated facial and cervical lymphatic malformation and venous malformation. Multiple hyperechoic interval with arterial blood flow signals could support the diagnosis of lymphatic malformation, whereas hypoechoic thrombosis or high echo vein stone in the lesion and flow signals under probe pressure would help to confirm venous malformation.

Key words: Lymphatic malformation, Venous malformation, Color Doppler ultrasound, Differential diagnosis

中图分类号:

R782.2

李爱萍, 邰茂众, 秦中平. 面颈深部静脉畸形和淋巴管畸形的彩色多普勒超声鉴别诊断[J]. 中国口腔颌面外科杂志, 2015, 13(1): 54-57.

LI Ai-ping, TAI Mao-zhong, QIN Zhong-ping. Diagnosis of deep facial and cervical lymphatic malformation and venous malformation with color Doppler ultrasonography[J]. China J Oral Maxillofac Surg, 2015, 13(1): 54-57.

参考文献

[1] Rabe E, Pannier F. Sclerotherapy in venous malformation [J]. Phlebology, 2013, 28(Suppl 1): 188-191.
[2] 郑家伟, 秦中平, 张志愿.口腔颌面部淋巴管畸形的治疗 [J]. 上海口腔医学, 2005, 14(6): 553-556.
[3] Adams MT, Saltzman B, Perkins JA. Head and neck lymphatic malformation treatment: a systematic review [J]. Otolaryngol Head Neck Surg, 2012, 147(4): 627-639.
[4] Karaveliolu A, Temuçin CM, Tanyel FC, et al. Sclerotherapy with bleomycin does not adversely affect facial nerve function in children with cervicofacial cystic lymphatic malformation [J]. J Pediatr Surg, 2010, 45(8): 1627-1632.
[5] Okada A, Kubota A, Fukuzawa M, et al. Injection of bleomycin as a primary therapy of cystic lymphangioma [J]. J Pediatr Surg, 1992, 27(4): 440-443.
[6] Lee B, Laredo J. Venous malformation: treatment needs a bird's-eye view [J]. Phlebology, 2013, 28(2): 62-63.
[7] Kim DW. OK-432 sclerotherapy of lymphatic malformation in the head and neck: factors related to outcome [J]. Pediatr Radiol, 2014, 44(7): 857-862.
[8] Griessenauer CJ, Bilal M, Kankirawatana P, et al. Lymphatic malformation of the tongue with coexisting intractable epilepsy treated with corpus callosotomy: a case report [J]. Clin Neurol Neurosurg, 2014, 117: 68-170.
[9] Miccoli S, Tempesta A, Corsalini M, et al. Oro-facial lymphatic malformation:management with a new three steps.Laser protocol [J], Ann Stomatol (Roma), 2013, 4 (Suppl 2): 31-32.
[10] CalıM, KonaE, Takcı , et al. Aggressive giant cystic lymphatic malformation in a newborn [J]. Turk J Pediatr, 2013, 55(4): 447-450.
[11] Díaz-Manzano JA, Pelegrín-Hernández JP, Mínguez-Merlos N, et al. Oropharyngeal approach as a surgical alternative for cervical lymphatic malformation with airway compression [J]. Int J Pediatr Otorhinolaryngol, 2014, 78(7): 1176-1178.

[1]	邰茂众, 秦中平, 郑家伟, 李克雷, 刘学键, 李凯, 袁斯明, 范新东, 周德凯, 董长宪, 吉毅, 顾松, 霍然, 杨耀武, 王绪凯. 局限性血管内凝血诊断与治疗中国专家共识[J]. 中国口腔颌面外科杂志, 2024, 22(4): 313-321.
[2]	张芳, 寿卫东, 李妍. 医护协同下聚多卡醇泡沫硬化剂治疗头颈部静脉畸形疗效评价[J]. 中国口腔颌面外科杂志, 2024, 22(3): 274-278.
[3]	李晓, 王豪伟, 杨西涛, 王德明, 范新东, 苏立新. 颌骨骨内动静脉畸形介入栓塞治疗远期疗效分析[J]. 中国口腔颌面外科杂志, 2024, 22(1): 78-83.
[4]	闫婷婷, 张鹏, 韩合理, 王荷静, 王奇民, 陈行, 袁荣涛. 腭静脉畸形合并遗传性出血性毛细血管扩张症1例报告[J]. 中国口腔颌面外科杂志, 2023, 21(6): 626-629.
[5]	闫志伟, 沈艳玲, 郭军, 刘源, 杨霞, 李欢, 冯瑶, 孙沫逸, 杨耀武. 纤维蛋白胶复合平阳霉素栓塞硬化治疗面颈部静脉畸形的实验研究[J]. 中国口腔颌面外科杂志, 2023, 21(4): 340-344.
[6]	李晓, 范新东, 郑家伟. 脉管异常的ISSVA分类概要及分子生物学研究进展[J]. 中国口腔颌面外科杂志, 2023, 21(3): 286-290.
[7]	邰茂众, 陈涛, 李克雷, 葛春晓, 徐振国, 秦中平. 2种病变内平阳霉素注射方法治疗68例儿童唇面部微囊型淋巴管畸形疗效分析[J]. 中国口腔颌面外科杂志, 2022, 20(3): 268-272.
[8]	庄乾伟, 李芳芳, 孟箭, 顾倩平, 李志萍. 射频消融联合经皮造影DSA引导下聚多卡醇泡沫硬化剂灌注治疗口腔颌面部静脉畸形38例疗效评价[J]. 中国口腔颌面外科杂志, 2022, 20(2): 135-140.
[9]	吴海威, 于淼, 郑家伟. 口腔颌面部静脉畸形诊治：经验与进展[J]. 中国口腔颌面外科杂志, 2021, 19(2): 186-192.
[10]	郑家伟. 西罗莫司治疗静脉畸形研究现状[J]. 中国口腔颌面外科杂志, 2020, 18(6): 553-558.
[11]	靳能皓, 南欣荣, 闫星泉, 李明. 手术结合平阳霉素注射治疗巨舌症1例报告[J]. 中国口腔颌面外科杂志, 2020, 18(2): 190-192.
[12]	刘朝阳, 唐璟, 杨宏宇. 颈上部支气管源性囊肿1例报告及文献复习[J]. 中国口腔颌面外科杂志, 2019, 17(4): 382-384.
[13]	雷书赞, 汪接兵, 张银喜. 气管切开全麻下无水乙醇栓塞治疗咽喉部静脉畸形20例报道[J]. 中国口腔颌面外科杂志, 2019, 17(1): 74-76.
[14]	杜仲, 马海龙, 张凌, 郑家伟, 王延安. TIE2-R849W突变斑马鱼模型的建立及其在静脉畸形发病中的作用探讨[J]. 中国口腔颌面外科杂志, 2018, 16(1): 6-11.
[15]	闫志伟, 张春谊, 郭军, 杨霞, 王维戚, 杨涛, 孙沫逸, 杨耀武. 纤维蛋白胶复合平阳霉素栓塞硬化治疗面颈部动静脉畸形效果观察[J]. 中国口腔颌面外科杂志, 2018, 16(1): 52-55.