RU2428918C1 - Method of diagnosing varicose disease of pelvic veins in women - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: preliminarily on upper third of right and left hips arterial tourniquets are applied. After that, intravenously in bolus way introduced is contrast substance in volume 100 ml. Then computer tomography with layer thickness of 0.9 mm is performed at the background of periodical patient's breath holding and straining. Ovarian veins and intrapelvic veinous plexes are visualised in arterial and venous phases of examination at the background of contrasted aorta and iliac arteries. Varicose disease of pelvic veins is diagnosed if detected are dilatation of ovarian veins, and/or intrapelvic venous plexes and/or internal iliac veins or their inflows at least in one of examination phases. In particular case additionally obtained is three-dimensional image of ovarian veins and intrapelvic venous plexes.

EFFECT: method makes it possible to carry out objective diagnostics of varicose disease of pelvic veins due to increase of quality of pelvic vein visualisation during examination due to contrasting pelvic veins in arterial phase of examination, indicating pelvic venous congestion in presence of juxtacapillary shunting and more clear contrasting of ovarian veins.

2 cl, 1 dwg, 2 ex

Description

The invention relates to medicine, namely to radiopaque diagnostic methods, can be used for examination of the venous system of the pelvis and diagnosis of varicose veins of the pelvis in women.

Varicose veins of the pelvic veins - a disease characterized by varicose transformation of the ovarian veins and intra pelvic venous plexuses with the formation of venous stasis in the pelvic organs. Clinical diagnosis of varicose veins of the pelvic veins is quite complicated, the symptoms of the disease are nonspecific, and therefore it is necessary to use instrumental research methods that will establish the prevalence of pelvic vein lesions, their anatomical features.

As a prototype, we chose a computed tomography method used to diagnose varicose veins of the pelvic veins (D. Karaosmanoglu, M. Karcaaltincaba, D. Karcaaltincaba, D. Akata, M. Ozmen // MDCT of the Ovarian Vein: Normal Anatomy and Pathology. AJR : 192, January 2009, p. 295-299). The disadvantages of the method are the absence of indications of contrasting of the pelvic veins in the arterial phase of the study, which indicates the presence of juxtacapillary shunting, indicating pelvic venous congestion, assessment of only the venous phase of visualization of the pelvic veins, there is no data on the state of the internal iliac vein and its tributaries, ovarian veins are not clearly contrasted .

The known method does not allow a complete diagnosis of varicose veins of the pelvic veins in women, as it does not provide a clear visualization of the pelvic veins.

The technical result obtained by the implementation of the proposed method is the objectification of the diagnosis of varicose veins of the pelvis by improving the quality of visualization of the pelvic veins during the study and identifying the initial stages (manifestations) of the disease.

The invention consists in the following.

Diagnosis of varicose veins of the pelvis in women is as follows. Arterial tourniquets are applied to the upper third of the right and left thighs, after which a contrast medium of 100 ml is injected bolus. Then perform multispiral computed tomography with a layer thickness of 0.9 mm against the background of periodic respiratory arrest and straining of the patient. At the same time, the ovarian veins and intrathic venous plexuses, internal iliac veins and their inflows into the arterial and venous phases of the study are visualized against the background of contrasted aorta and iliac arteries. The delay in the start of scanning is set after 6 and 90 seconds after administration of the contrast medium. If at one of the phases of the study the dilated ovarian veins, and / or the intrathic venous plexuses, and / or the internal iliac veins or their tributaries are detected, a varicose vein disease is diagnosed. Get a three-dimensional image of the ovarian veins and intralase venous plexuses to improve the quality of their visualization.

The method is as follows.

The patient is in a horizontal position on her back in a craniocaudal direction. First, topograms of the abdominal cavity and small pelvis are obtained in a direct projection with subsequent marking of the scanning zone, which is limited to the upper contour of the diaphragm and large trochanteric femurs. Using an automatic injector, a study is performed with a bolus injection of a non-ionic contrast medium through a cubital peripheral catheter in a volume of 100.0 ml. Prior to administration of the drug, arterial tourniquets were placed on the upper third of the thigh on the upper third of the left and right thighs to increase blood flow into the pelvic arteries, increase arterial contrast and fill the gonadal veins and pelvic venous plexuses with contrast material more quickly. After administration of the drug, the patient performs a Valsalva test, holding his breath and straining, which increases the severity of retrograde blood flow through the gonadal veins, and improves their contrast. The delay in the start of scanning to obtain the arterial, portal and venous phases is set according to the program for automatic recognition of the density of the contrast medium with the installation of a trigger of 150 units of H on the chest of the aorta. The scan delay time from reaching the specified threshold is 6, 45 and 90 seconds, respectively.

Patients with varicose veins of the pelvic veins, thanks to the application of arterial tourniquets on the hips, visualized gonadal veins and inflows of the internal iliac veins against the background of contrasted iliac arteries and aorta, which made it possible to clearly determine their anatomical and topographic relationships.

Image analysis was carried out at the EBW (Philips) workstation in axial, frontal and sagittal projections with the construction of curvilinear reconstructions along the vessels of interest, three-dimensional reconstruction of the images was performed. For subsequent analysis, data corresponding to the arterial and venous phases of the study were taken into account (scan delay of 6 and 90 seconds).

If at least one of the phases of the study revealed enlarged ovarian veins, and / or the pelvic venous plexuses, and / or the internal iliac veins or their inflows, a varicose vein disease was diagnosed.

Example 1

Patient L., 36 years old, with complaints of pain in the lower abdomen over the past 2 years, aggravated by prolonged upright stay, during and after intercourse. An examination revealed no surgical, gynecological, or urological pathology. The patient performed multispiral computed tomography of the pelvic veins in accordance with the proposed method. The patient was placed in a horizontal position. During the scan, the patient periodically strained and held her breath for 5-7 seconds. Initially, topograms of the abdominal cavity and small pelvis were obtained in a direct projection with subsequent marking of the scanning zone, which was limited to the upper contour of the diaphragm and large trochanteric femurs. Using an automatic injector, a study was performed with a bolus injection of a non-ionic contrast medium through a cubital peripheral catheter in a volume of 100.0 ml. Before administration of the drug, arterial tourniquets were applied to the upper third of the right and left thighs to increase blood flow in the pelvic arteries and increase the contrast of arteries and more quickly fill the gonadal veins and pelvic venous plexuses with contrast material. The delay in the start of scanning to obtain the arterial and venous phases was set according to the program for automatic recognition of the density of the contrast medium with the installation of a trigger of 150 units of N on the chest of the aorta. The scan delay time is 6 and 90 seconds after the administration of the contrast medium, the layer thickness is 0.9 mm. Image analysis was carried out at the EBW (Philips) workstation in axial, frontal and sagittal projections with the construction of curvilinear reconstructions along the vessels of interest, three-dimensional reconstruction of the images was performed. The drawing shows computer tomograms: A-frontal projection: 1 - left ovarian vein; 2 - iliac arteries; B - three-dimensional reconstruction of the image: 1 - expanded left ovarian vein; 2 - dilated veins of the left cluster-like plexus; 3 - aorta; 4 - iliac arteries. As a result of the study, the patient was diagnosed with varicose veins of the pelvis. The diagnosis was fully confirmed by performing selective ovarianography and pelvic venography.

Example 2

Patient R., 29 years old, with complaints of pain in the lower abdomen, worse after static and physical exertion, pain during intercourse, the presence of varicose veins on the right labia minora. The patient implemented a method of multispiral computed tomography of the pelvic veins according to the proposed method. The patient was placed in a horizontal position. During the scan, the patient periodically holds his breath for 5-7 seconds and strains. Initially, tomograms of the abdominal cavity and pelvis were obtained in direct projection with subsequent marking of the scanning zone, which was limited to the upper contour of the diaphragm and large trochanteric femurs. Using an automatic injector, a study was performed with a bolus injection of a non-ionic contrast medium through a cubital peripheral catheter in a volume of 100.0 ml. Before administration of the drug, arterial tourniquets were applied to the upper third of the right and left thighs to increase blood flow into the pelvic arteries and increase the contrast of arteries and more quickly fill the gonadal veins and pelvic venous plexuses with contrast material. The delay in the start of scanning to obtain the arterial, portal and venous phases was set according to the program for automatic recognition of the density of the contrast medium with the installation of a trigger of 150 units of H on the chest of the aorta. The scan delay time from reaching the specified threshold was 6 and 90 seconds, respectively, and the layer thickness was 0.9 mm. Image analysis was carried out at the EBW (Philips) workstation in axial, frontal and sagittal projections with the construction of curvilinear reconstructions along the vessels of interest, three-dimensional reconstruction of the images was performed.

It was revealed the presence of dilated gonadal veins, intra pelvic venous plexuses and the left internal iliac vein. The diagnosis of varicose veins was confirmed by ovarianography and pelvic venography. The method was tested in the clinic of the faculty surgery of the medical faculty of the Russian State Medical University on the basis of the city clinical hospital No. 1 named after N.I. Pirogova in 12 patients. In all cases, clear images of the ovarian veins and pelvic venous plexuses, internal iliac veins and their inflows as a result of using the proposed method are obtained. Diagnoses of varicose veins of the pelvic veins in women, made using the proposed method, were in all cases confirmed by selective ovarycography and pelvic venography.

Claims (2)

1. A method for the diagnosis of varicose veins of the pelvic veins in women, including performing multispiral computed tomography with contrasting of the pelvic veins, detecting enlargement of the ovarian veins and / or pelvic venous plexus, characterized in that arterial tourniquets are first applied to the upper third of the right and left thighs, after which 100 ml of contrast medium is administered bolus intravenously, then computed tomography is performed with a layer thickness of 0.9 mm against the background of periodic respiratory arrest and straining of the patient and, visualizing the ovarian veins, the intrathic venous plexuses, the internal iliac veins and their inflows into the arterial and venous phases of the study against the background of contrasted aorta and iliac arteries, for which a delay in the start of scanning is established 6 and 90 seconds after the administration of the contrast medium and if one of the phases of the study of dilated ovarian veins, and / or intrathoracic venous plexuses, and / or internal iliac veins, or their tributaries, is diagnosed with varicose veins of the pelvic veins. 2. The method according to claim 1, characterized in that a three-dimensional image of the ovarian veins and intra pelvic venous plexuses is obtained.

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