Tesis

Hubungan Trombus, Kecepatan Aliran, dan Ketebalan Dinding Vena pada USG Doppler Berwarna Sistem Vena Profunda Ekstremitas Bawah dengan Tumor Muskuloskeletal Ganas = Correlation of Thrombus, Flow Velocity, and Venous Wall Thickness on Color Doppler Ultrasound of the Deep Venous System in the Lower Extremity with Malignant Musculoskeletal Tumor.

Latar belakang: Pasien dengan tumor muskuloskeletal (MSK) ganas menunjukkan insidens deep vein thrombosis (DVT) yang bervariasi. USG Doppler berwarna merupakan modalitas terpilih untuk evaluasi DVT ekstremitas bawah. Insidens DVT ekstremitas bawah pada pasien dengan tumor MSK ganas di Indonesia belum diketahui serta terdapat tantangan geografis dan sosial dalam penatalaksanaan tumor MSK di Indonesia, di mana pasien sering datang dalam kondisi lanjut dengan ukuran tumor yang besar. Penelitian ini bertujuaan untuk menilai hubungan trombus, kecepatan aliran, dan ketebalan dinding vena pada USG Doppler berwarna sistem vena profunda ekstremitas bawah dengan tumor primer MSK ganas. Metode: Penelitian ini menggunakan data primer dari pemeriksaan USG Doppler berwarna vena profunda ekstremitas bawah, yaitu ada atau tidaknya trombus, ketebalan dinding vena, dan kecepatan aliran vena, serta data sekunder berupa ukuran tumor dari pemeriksaan magnetic resonance imaging (MRI) atau computed tomography (CT) scan dan durasi gejala tumor MSK ganas dari rekam medis. Penelitian ini dilakukan di Departemen Radiologi dan Poliklinik Orthopaedi dan Traumatologi di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPNCM) pada bulan Agustus 2020 hingga Maret 2022. Hasil: Terdapat 10% insidens trombus pada sistem vena profunda ekstremitas bawah pada 30 subyek dengan tumor primer MSK ganas di RSUPNCM. Subyek dengan trombus cenderung memiliki dimensi dan volume tumor lebih besar dibandingkan subyek tanpa trombus, namun secara statistik tidak bermakna. Durasi gejala tumor hampir sama pada subyek dengan dan tanpa trombus. Tidak terdapat korelasi antara volume dan durasi gejala tumor terhadap kecepatan aliran dan ketebalan dinding vena. Kesimpulan: Dimensi dan volume tumor pada subyek dengan trombus cenderung lebih besar dibandingkan tanpa trombus. Pada penderita tumor MSK ganas, dapat ditemukan gambaran klinis dan laboratoris yang menyerupai DVT seperti nyeri dan bengkak, namun belum tentu didapatkan trombus. Dengan demikian, USG Doppler berwarna penting untuk membedakan ada atau tidaknya DVT pada subyek dengan tumor MSK ganas.
Kata kunci: deep vein thrombosis, tumor muskuloskeletal ganas


Background: Patients with malignant musculoskeletal tumors (MSK) show varying incidence of deep vein thrombosis (DVT). Color Doppler ultrasound is the modality of choice for the evaluation of lower limb DVT. The incidence of lower extremity DVT in patients with malignant MSK tumors in Indonesia is unknown and there are geographic and social challenges in the management of MSK tumors in Indonesia, where patients often present in advanced condition with large tumor sizes. This study aims to assess the correlation between thrombus, flow velocity, and vein wall thickness on color Doppler ultrasound of the lower extremity deep vein system with primary malignant MSK tumors. Method: This study analyzed primary data from the color Doppler ultrasound examination of the deep veins of the lower extremities, including the presence or absence of a thrombus, vein wall thickness, and venous flow velocity, as well as secondary data including tumor size from magnetic resonance imaging (MRI) or computed tomography (CT) scan and duration of malignant MSK tumor symptoms from medical records. This study was conducted at the Department of Radiology and the Orthopedic and Traumatology Polyclinic at the Cipto Mangunkusumo National General Hospital (RSUPNCM) from August 2020 to March 2022. Result: There was a 10% incidence of thrombus in the lower extremity deep venous system in 30 subjects with malignant primary MSK tumors at RSUPNCM. Subjects with thrombus tended to have larger longest tumor dimensions and tumor volume than subjects without thrombus, but they were not statistically significant. The duration of tumor symptoms was almost the same in subjects with and without thrombus. There was no correlation between tumor volume and duration of tumor symptoms with venous flow velocity and venous wall thickness. Conclusion: The dimensions and volume of tumors in subjects with thrombus tend to be larger than those without thrombus. In patients with malignant MSK tumors, clinical and laboratory features that resemble DVT can be found, such as pain and swelling, but not necessarily a thrombus. Thus, CDUS is important for distinguishing the presence or absence of DVT in subjects with malignant MSK tumors.
Keywords: deep vein thrombosis, malignant musculoskeletal tumor