彩色多普勒对眩晕患者椎动脉病变的诊断意义

应用彩色多普勒血流显像技术对61例眩晕患者进行颅外段颈部血管，尤其是椎动脉内径、峰值血流速度（Vp）、每分钟血流量（Q）、压力降半时间（HT）、阻力指数（RI）、窗口指数（WI）等血流频谱参数进行了测定及分析研究。结果表明:（1）眩晕患者中59％出现不同程度椎动脉供血不足改变。（2）椎动脉狭窄与年龄成正相关。61例中36例超声检查异常者均40岁以上，约占40岁以上眩晕患者的63％。（3）椎动脉内径左侧优势（P＜0.01）。（4）椎动脉供血不足发病率明显高于颈总及颈内动脉。所查61例眩晕患者中，25例椎动脉单或双侧狭窄，4例颈总动脉分支前管壁粥样斑块形成，7例椎动脉走向弯曲。（5）脉冲多普勒频谱分析示，椎动脉狭窄患者的椎动脉Vp显著降低，HT延长，外周阻力增高，WI减低表明频带沿水平轴展开，频带展宽，每分钟血流量Q减低，阻力指数RI显著增高（P＜0.01或P＜0.001）。彩色多普勒血流显示，病变部彩色血流信号失落。认为:采用切面超声、脉冲多普勒、彩色血流显像三结合检测椎动脉颅外段可为临床眩晕患者诊断提供有价值依据，此方法安全、无创、敏感性高，当为首选方法。     

彩色多普勒超声诊断椎动脉夹层的价值分析

目的探讨彩色多普勒血流显像(CDFI)检测椎动脉夹层(VAD)患者的血管内径、血管内回声及血流动力学变化,评价其诊断椎动脉夹层的临床价值。方法经超声检查、数字减影血管造影(DSA)证实椎动脉夹层患者14例,研究其超声影像学特征、血流动力学参数变化。结果根据血管结构特征分为双腔型、壁内血肿型及夹层动脉瘤型,14例椎动脉夹层患者中,壁内血肿型9例(累及V1段4例,累及V2段3例,累及V1、V2段2例),双腔型5例(累及V1段3例,累及V2段1例,累及V1、V2段1例),患侧椎动脉病变部位原始管腔明显增宽,真腔内径变窄且小于原始管腔内径1/2以上时,峰值流速(PSV)和搏动指数(PI)明显高于健侧,差异有统计学意义(P0.05)。结论彩色多普勒超声可以根据患侧椎动脉二维声像图及血流动力学特征初步筛查椎动脉夹层,为临床早期诊断和治疗提供可靠信息。     

椎动脉颅外段病变的彩色多普勒检查分析

应用彩色多普勒血流显像技术对５０例椎动脉病变患者进行检查分析。结果可见椎动脉颅外段的异常表现：（１）椎动脉内径变细、走行异常、管腔有异常回声２８例，占５６％。（２）脉冲多普勒异常４３例，占８６％。（３）彩色多普勒血流显像异常１８例，占３６％。根据二维超声切面，结合彩色血流显像，综合判断脉冲多普勒所测定血流参数对判断椎动脉颅外段病理及机能状态，特别是对判断椎动脉供血不足的诊断有重要价值     

经颅多普勒超声诊断锁骨下动脉盗血综合征的分析

目的:分析锁骨下动脉盗血患者的椎动脉血流速度及频谱的改变,探讨经颅多普勒超声在诊断锁骨下动脉盗血综合征的临床意义及可靠性。方法:用经颅多普勒超声仪检测双侧椎动脉血流速度及观察频谱的变化,并经彩色多普勒超声证实锁骨下动脉/或无名动脉是否存在血管的闭塞或狭窄。结果:患侧椎动脉血流速度减慢,对侧椎动脉血流速度增快及基底动脉血流速度增快或正常范围内,部分盗血者频普收缩峰反向或完全盗血者患侧椎动脉呈典型的全心动周期反向血流频谱;基底动脉血流速度正常或与健侧椎动脉血流速度代偿性增快。束臂试验阳性。结论:经颅多普勒超声可诊断锁骨下动脉盗血综合征,可以提高诊断锁骨下动脉盗血综合征的可靠性,为临床及早的诊断和治疗提供了的依据。     

彩色多普勒超声对椎基底动脉供血不足的临床诊断

目的探讨彩色多普勒超声血流显像及参数对椎基底动脉供血不足的诊断。方法用10Hz探头探查颅外段椎基底动脉血管形态、内径、血流频谱及血流动力学变化。结果156例患者有124例异常,表现为频谱形态的改变及血流速度的异常。结论彩色多普勒超声能准确判断椎动脉的血管结构,定量血流动力学变化。     

彩色超声多普勒对脑梗死病人颅外段脑动脉血管结构和血流动力学变化的研究

我院应用彩色超声多普勒技术在 1990年月 10月至2 0 0 0年 2月对 30 0例脑梗死病人颅外段脑动脉的血管结构和血流动力学变化进行分析 ,并与 10 5名健康人进行对照 ,现报道如下。资料和方法 :脑梗死组病人 30 0例 ,均经ＣＴ或ＭＲＩ证实。男 2 42例 ,女 5 8例 ,年龄 40～ 84岁。其中单侧脑梗死177例 ,双侧脑梗死 12 3例 ;对照组 10 5名 ,均无心、脑血管疾患及颈椎病等。男 5 0名 ,女 5 5名 ,年龄 41～ 72岁。为健康体检者。观察颈总动脉、颈内动脉及椎动脉的走行及血管结构的改变 ,检测血流信息 ,测定收缩期最大血流速度 (ＭＡＸ)、舒张期最…     

眩晕病人彩色多普勒超声检测椎动脉的临床意义

目的应用彩色多普勒超声检测椎动脉血流,探讨椎动脉供血情况与眩晕的关系。方法眩晕病人27例,经CT排除颅内病变存在。健康对照组20例,均经检查无心脑血管疾病。利用彩色多普勒进行双侧椎动脉内径、心率及相关血流参数测量,计算椎动脉血流量。结果27例眩晕病人中,有16例一侧或双侧椎动脉血流量较正常对照组低,有明显统计学意义,P<0.01。结论眩晕病人与彩色多普勒超声检测椎动脉血流量减低有一定的关系,经彩色多普勒检测椎动脉对无颅内病变的眩晕病人病因的确定有明确的临床意义。     

经颅多普勒与彩色多普勒超声显像技术联合应用对锁骨下动脉盗血综合征的诊断价值

目的 探讨经颅多普勒(TCD)与彩色多普勒超声显像(CDFI)技术联合应用对锁骨下动脉盗血综合征(SSS)的诊断价值.方法 对25例临床表现为椎一基底动脉供血不足的经TCD与CDFI联合检测证实的SSS患者的TCD与CDFI资料进行分析.结果 TCD检测显示:25例患者患侧椎动脉均为正向血流(血流信号逆转),其中完全性盗血8例(32%),部分性盗血17例(68%).CDFI检测显示:25例患者中23例(92%)锁骨下动脉起始段探及动脉粥样硬化斑块,2例(8%)动脉内膜增厚,25例血管内径明显变窄,甚至完全闭塞;血流柬变细或无血流信号;患侧椎动脉管腔内呈红蓝交替的双向血流或转为完全出颅方向的血流,并出现相应血流动力学改变.结论 TCD与CDFI联合应用对SSS能更准确地作出诊断.     

实验性兔侧壁动脉瘤模型建立及彩色多普勒研究

目的:仿造浆果样动脉瘤形态建立兔侧方动脉瘤模型,并行彩色多普勒超声检测评估。方法:20只兔采用全麻和显微外科的方法,将颈外静脉段与颈总动脉行端侧吻合,术后及1个月后分别行彩色多普勒超声检测。结果:20只兔制成17个大小相似的侧壁型动脉瘤并行超声检测。1个月后,11只兔完成第二次多普勒检查。彩色多普勒可鲜明地显示动脉瘤内的血流方向和状态。结论:应用颈外静脉段与颈总动脉行端侧吻合建立兔动脉瘤模型切实可行,但成功率较大动物低。超声检测可反映出瘤内的血流状态。     

经颅多普勒诊断血管性偏头痛的临床意义

目的 应用经颅多普勒超声(TCD)分析仪,检测脑血管血流动力学改变,对偏头痛患者的诊断及治疗提供客观依据。方法 采用以色列产彩色经颅多普勒分析仪,对108例偏头痛患者进行脑血流检测,经枕窗探测基底动脉及双侧椎动脉;经颞窗探测大脑中、前、后动脉,记录流速及搏动指数,同时观察频谱、频声等参数。结果 在108例偏头痛患者中48例脑血流速度加快,16例血流速度减慢,余44例脑血流速度不稳定及双侧脑血流速度不对称。结论 对脑血管进行TCD检测,为偏头痛患者的诊断及指导治疗提供客观依据。     

应用M-模经颅多普勒超声技术评价头痛与卵圆孔未闭的关系

目的观察头痛、有先兆偏头痛(MA)、无先兆偏头痛(MO)患者卵圆孔未闭(PFO)的发生率,以及较大分流的发生率。方法头痛患者268例,其中MA组59例,MO组158例,其他类型头痛组51例,健康对照组75例。以肘前静脉注射激活的生理盐水作为造影剂,并结合Valsava动作,行M-模经颅多普勒超声(mpTCD)监测,诊断PFO并对分流量进行分级。安静状态时出现阳性结果则判断为永久型分流,Valsava动作后出现阳性结果则判断为功能型分流。注射生理盐水后20 s内微栓子信号超过30个判断为大量分流。结果全部头痛患者中PFO的发生率为44%,其中永久型分流53例,功能型分流43例。MA组存在分流的患者数显著多于对照组(P<0.001),也多于其他头痛组(P<0.01)。MO组存在分流的患者数高于对照组及其他头痛组,但未获得统计学差别(分别为P=0.054和P=0.3)。较大分流量在MA组、MO组、其他头痛组和对照组的发生率分别为37%、15%、8%、4%,MA组、MO组均显著高于对照组(分别为P<0.01和P<0.05)。结论有先兆偏头痛组患者存在较多PFO,而且偏头痛组较大分流量的患者较多。     

130例代谢综合征患者经颅多普勒检测分析

目的探讨经颅多普勒在代谢综合征患者脑血管病变早期诊断中的应用价值。方法应用Multi-DopX4型TCD仪对130例代谢综合征患者进行经颅多普勒检测,并对其结果进行统计学分析。结果 112例呈现动脉硬化性病变,总异常率86.2%;其中43例在动脉硬化的基础上呈现节段性血流增快狭窄型改变,与对照组相比差异有统计学意义(χ2=60.35,P<0.01)。含有高血压的组合中,节段性血流增快狭窄型明显增多(χ2=11.57,P<0.05)。结论脑动脉硬化是代谢综合征患者早期常见的脑血管病变,高血压是代谢综合征患者脑血管狭窄型改变的重要原因。     

经颅多普勒早期预警动脉瘤性蛛网膜下腔出血致延迟性脑缺血

目的探讨经颅多普勒(transcranial Dopler,TCD)对动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,a SAH)致迟发性脑缺血(delayed cerebral ischemia,DCI)的早期预警作用及意义。方法应用经颅多普勒技术前瞻性地对85例a SAH病例进行动态连续监测,经临床证实后分为迟发脑缺血(DCI)组和非迟发脑缺血(NDCI)组,并对两组大脑中动脉平均血流速度(mean cerebral blood flow velocity,MBF,cm/s)、搏动指数(pulsatility index,PI)及预后进行对比分析。结果全组中符合迟发脑缺血(DCI)组诊断30例(35.3%),其中56.7%的病例发生在起病6~8d以内;DCI组MBF较入院首测明显增加(t=23.847,p=0.000),PI值增加不明显(t=0.733,p=0.468)。NDCI组MBF、PI值与入院首测无明显改变(t=0.547,p=0.585;t=0.573,p=0.568);GOS评分DCI组良好率显著低于NDCI组(χ~2=11.5145,P=0.001),DCI组中残、植物生存率明显高于NDCI组(χ~2=4.1098,P=0.043;P=0.041)。两组重残、死亡率无统计学意义(P=0.339,0.122)。结论经颅多普勒因无创、可连续监测的优点可成为早期预警动脉瘤性蛛网膜下腔出血致延迟性脑缺血的有效手段,并可为临床干预提供指导。     

Transcranial Doppler ultrasonographic evaluation of vertebral artery hypoplasia and aplasia

BACKGROUND AND PURPOSE: Evaluation of vertebral artery (VA) with transcranial Doppler ultrasonography (TCD) is difficult due to anatomical variations of hypoplasia (HP) or aplasia (AP). TCD findings of HP or AP of VA are rarely known. Comparing with magnetic resonance angiography (MRA), we tried to evaluate characteristic findings of HP or AP of VA using TCD. METHODS: Consecutive healthy patients who underwent TCD and MRA were included. VA was classified as normal (NL), hypoplasia (HP), and aplasia (AP) according to MRA. TCD parameters of mean flow velocity (MFV), pulsatility index (PI), vertebral/basilar artery flow velocity ratio (VA/BA FVR), and asymmetry index (AI) of VA were compared between three groups. RESULTS: Four hundred and ten patients were included, and 298 patients (72.7%) were classified as NL, 98 (23.9%) as HP and 14 (3.4%) as AP. MFV, PI and VA/BA FVR of ipsilateral VA were not different between groups. However, MFV of contralateral VA and AI were significantly increased in HP and AP groups (p<0.001). AI was significantly different between the three groups (17.7% and 30.5%, p<0.001). Sensitivity and specificity for HP or AP were 20.5% and 90.9%, if AI over 40% were adopted as diagnostic criteria. CONCLUSION: MFV of VA should be interpreted with caution for its frequent anatomical variations. Increased MFV of unilateral VA may indicate not only as ipsilateral stenosis, but also as contralateral HP or AP. AI over 40% is specific to predict unilateral HP or AP with clinical correlation.     

Comparison of continuous wave Doppler ultrasound of the radial artery and laser Doppler flowmetry of the fingertips with sympathetic stimulation

Abstract. Laser Doppler is widely used to evaluate sympathetic vasoconstrictor function. Continuous wave (cw)–Doppler of the radial artery may be an alternative but less expensive approach to quantify sympathetically induced resistance changes in the peripheral vascular system. In order to compare the power of both methods, this study was performed with simultaneous assessment of cw Doppler and laser Doppler flowmetry in volunteers. Twenty–five healthy subjects (median age years, range 20–27) rested in a relaxed supine position and were asked to perform a deep inspiratory gasp and a commanded cough (DIG + C). Radial artery blood flow was assessed with a standard cw Doppler device, arteriolar blood flow was assessed simultaneously employing a single point laser Doppler perfusion monitor at the fingertips. We quantified the latency between stimulus and onset of vasoconstriction, the latency to the maximum vasoconstriction and the duration of response. The decrease in flow velocities (cw Doppler) after stimulus was compared with the decrease in capillary flow (laser Doppler). While the flow profile as measured with laser Doppler remained monophasic after stimulation, cw Doppler showed biphasic flow (or absent diastolic flow) in all subjects after DIG + C. The latencies between stimulus and onset of reaction were significantly shorter when measured with laser Doppler (1.8 s vs. 2 s, p = 0.049), the latencies till the maximum extent of the reaction was reached did not differ significantly (3.2 vs. 3.3 s). The duration of the response was significantly shorter when measured by laser Doppler (12.0 vs. 14.5 s (p < 0.0001). While skin blood flow in the laser Doppler measurement decreased after stimulation from 654 flux units (FU) to 319 FU (–59%), mean flow velocities in the radial artery declined from 1.07 kHz to 0.14 kHz (–87%). This relative change was significantly different (p < 0.0001). The correlation between the decline of flux units as measured by laser Doppler and cw Doppler changes was r = 0.616 (p = 0.004). Both methods are feasible to monitor flow changes due to sympathetic stimulation. Latencies and relative quantitative changes were closely correlated.Thus, cw Doppler is a valid alternative approach to laser Doppler flowmetry in healthy volunteers.     

Power Doppler Imaging and Color Doppler Flow Imaging for the Evaluation of Normal and Pathological Vertebral Arteries

Recently, an ultrasound method for vascular applications using the amplitude of the reflected echosignal for the generation of intravascular color signals has been introduced. We compared the utility of this power Doppler imaging (PDI) with conventional color Doppler flow imaging (CDFI) for examination of vertebral arteries (VA) Forty-nine patients with signs and symptoms suggesting ischemia within the posterior circulation were evaluated. Quality of blood flow visualization by PDI and CDFI at the different VA segments was classified according to a four point scale. Furthermore, combined sonographic findings were correlated with the results of digital substraction and/or magnetic resonance angiography (DSA, MRA). Power Doppler imaging provided a significantly superior visualization of the intertransversal VA, whereas display of the intracranial V4 segment was superior 1ignificantly on CDFI. Both methods were complementary for the evaluation of the VA at the origin. With respect to the angiographic findings, combined CDFI and PDI achieved a sensitivIty of 90.63% and a specificity of 97.22% for the differentiation of healthy and pathologic VAs. Power Doppler imaging is complementary to CDFI for the sonographic assessment of VA disease. Combined use of PDI and CDFI achieves a high sensitivIty and specificity, thus increasing diagnostic confidence.     

The use of two-dimensional Doppler sonography (color Doppler) in the diagnosis of hydranencephaly

Hydranencephaly, first described by Cruveilhier, may be defined as a rare condition in which the cerebral hemispheres are replaced by membranous sacs filled with cerebrospinal fluid. Cerebral angiography is especially useful in differentiating hydranencephaly and severe hydrocephalus, massive subdural hygromas and alobar holoprosencephaly, but it is no better than other neuroradiological diagnosis methods in the neonate. This report outlines the diagnostic use of two-dimensional Doppler (color Doppler) in a child with hydranencephaly. Color Doppler was performed using an SSA-270A (Toshiba) with a 3.75 MHz phase-array sector scanning probe and no sedation. In this study, color Doppler demonstrated the internal carotid artery in the proximal portion, but the secondary and tertiary branches were not observed. In summary, color Doppler permitted early, easy diagnosis of hydranencephaly. In addition, the use of color Doppler was beneficial in diagnosing other anomalies of the central nervous system in neonates.     

微血管多普勒在脑动脉瘤夹闭术中的应用

目的探讨微血管多普勒（MVD）在脑动脉瘤夹闭术中的应用价值。方法在23例26个脑动脉瘤夹闭前、后，使用MVD对动脉瘤、载瘤动脉和相关穿支动脉检测血流动力学的改变。动脉瘤夹闭后，瘤体内涡流存在时，加强瘤颈的夹闭力，载瘤动脉或穿支动脉血流降低或消失时，改变动脉瘤夹夹闭位置，使载瘤动脉和或穿支动脉的血流恢复至正常。结果所有动脉瘤均检测到涡流或毛刺样血流信号。21个动脉瘤夹闭术后，瘤体内涡流消失，载瘤动脉及其分支血流频谱良好；3个动脉瘤行孤立术后，瘤体内频谱消失，2个巨大动脉瘤行动脉瘤夹闭加清除术。动脉瘤夹闭术中，不完全夹闭2个动脉瘤，4个动脉瘤载瘤动脉血流速度增快，调整动脉瘤夹夹闭位置后，血流速度恢复正常。术后头颅CT示，所有病例无脑梗死。3例眼动脉瘤、2例小脑后下动脉瘤和1例小脑上动脉瘤出院前作DSA检查，动脉瘤消失，载瘤动脉和相关血管无闭塞或狭窄现象。其他病例均作CTA复查，载瘤动脉及周围血管保留良好，动脉瘤消失。结论MVD在动脉瘤夹闭术中是一种安全直接，快速简便和经济有效的监测方法。     

Bedside Emergency Transcranial Doppler Diagnosis of Severe Carotid Disease Using Orbital Window Examination

BACKGROUND: Identifying internal carotid artery (ICA) stenosis in the acute stroke setting can provide clinically useful information. Transcranial Doppler (TCD) through the orbital window is an easy test to perform and to track and identify different vessels. Previous TCD studies have suggested that a reversed ophthalmic artery (OA) flow is a useful collateral pattern to predict ICA disease. The authors sought to evaluate the TCD orbital window for predicting cervical ICA (cICA) stenosis in the setting of acute stroke and TIA. METHOD: Power M-mode/TCD was performed in acute stroke and transient ischemic attack patients at 2 institutions. Each orbital window depth was detected on M-mode and evaluated for the direction of flow and resistance pattern. Gold standard for comparison was carotid evaluation using carotid duplex, computed tomography angiogram, or conventional angiography. The assessment of cICA disease was categorized by degree of stenosis or occlusion. RESULTS: A total of 216 transorbital exams were performed in 117 patients. Twenty-five cICA occlusions and 8 critical cICA stenoses (>or=95%) were identified by gold standard imaging. Reversed OA flow at 50 to 60 mm depth revealed high specificity (100%; confidence interval [CI], 97.6%-100.0%) and good sensitivity (75%; CI, 53.3%-90.2%) for identifying cICA occlusion or critical stenosis (>or=95%). Low pulsatility index (<1.2) and mean flow velocity (<15 cm/s) discriminated critical severe ICA stenosis or occlusion when OA flow was anterograde with good sensitivity (87.2%) and specificity (95.2%). CONCLUSION: The reversed OA sign at 50 to 60 mm depth is very specific for identifying cICA occlusion or critical stenosis. When OA flow is anterograde, a low mean flow velocity or pulsatility index is also useful to identify cICA critical stenosis or occlusion.