骨盤内静脈うっ滞症候群 (Intrapelvic venous congestion syndrome) の診断における経直腸的超音波断層法と経会陰的カラードプラ法の意義

Abstract

The present study was designed to reveal the possible use of transrectal sonography (TRS) and transperineal color Doppler flow imaging in predicting intrapelvic venous congestion syndrome (IVCS), as evaluated by three dimensional magnetic resonance venography (3D-MRV). Thirty-one patients with prostatodynia and eleven control men were enrolled in this study. The diagnosis of IVCS was made based on the findings by 3D-MRV, such as the dilation of the prostatic capsular vein, the dilation of the pudendal plexus, the interruption of the internal pudendal vein and the dilation of the plexus behind the bladder. The prostatic capsular vein was observed ultrasonically as "sonolucent zone (SZ)", and the maximum width of SZ was measured on sonograms. Transperineal color Doppler flow imaging was used to detect blood flow images of the prostatic capsular vein. The maximum velocity of it was also measured on sound spectrogram. IVCS was confirmed in 29 cases (IVCS group) and the other 13 cases were regarded as non-IVCS group. IVCS was recognized much more frequently in patients with prostatodynia than in controls (87% vs 18%, p < 0.0001). The maximum width of SZ was 2.4 mm (mean) in non-IVCS group, compared to 4.4 mm in IVCS group (p < 0.0001). The cutoff value of 3.0 mm for the maximum width of SZ showed as high as 86% of sensitivity for the detection of IVCS. The maximum velocity of retrograde venous flow during Valsalva's maneuver in IVCS group (mean 14.4 cm/s) was faster than non-IVCS group (mean 7.1 cm/s, p < 0.05). The cutoff value of 10 cm/s for the maximum retrograde venous flow velocity showed as high as 69% of sensitivity for the detection of IVCS. Both TRS and transperineal color Doppler flow imaging were usefull as a predictor for IVCS.