颈动脉体瘤的血管造影诊断(附二例报道)

颈动脉体瘤的血管造影诊断（附二例报道）河北省廊坊市医院（０６５０００）放射科李志欣监悟帅张慈佑例１：女，２８岁，右侧颈部逐渐增大性肿物就诊。体检：右颈部可触及７ｃｍ×３ｃｍ×３ｃｍ椭圆形肿物，肿物表面光滑，边缘清楚，可活动，局部可闻及血管杂音。动脉Ｄ...     

椎基底动脉供血不足患者颈部MRA和经颅多普勒检查的临床意义

目的探讨椎基底动脉供血不足（VBI）患者核磁共振血管成像（MRA）和经颅多普勒（TCD）的表现及在临床诊断中的意义。方法共62例患者，男39例，女23例，年龄38～72岁，平均年龄（53．9±9．7）岁。符合椎基底动脉供血不足诊断标准，分别进行了颈部MRA和TCD检查。结果MRA椎动脉异常37例（59．68％），其中22例椎动脉扭曲变细3例（8．1％），单侧椎动脉变细或局部狭窄29例（78．38％），单侧椎动脉显影模糊4例（10．81％），左侧动脉完全闭塞1例（2．7％）。TCD检查异常45例（72．58％），其中椎基底动脉血流速度减慢21例（46．66％），血管弹性减低5例（11．11％），血管痉挛13例（28．89％），血管狭窄6例（13．33％）。37例MRA异常病例中78．37％（29／37）的患者TCD异常。结论颈部MRA对VBI的诊断具有重要价值。对临床考虑VBI患者应采用TCD、MRA联合检查，某些情况下可以代替选择性血管造影。     

三维对比增强MRA在颈部动脉血管成像中的应用价值

【目的】探讨三维对比增强MRA（3DCE-MRA）技术及在颈部动脉血管成像中的应用价值。【方法】使用3DCE-MRA技术对72例颈部动脉进行血管成像,并对3DCE-MRA图像质量和表现进行分析。【结果】72例颈部动脉3DCE-MRA均成功,图像质量符合诊断要求。颈部动脉3DCE-MRA显示正常25例,异常47例,主要表现为动脉节段性狭窄、扭曲变细、闭塞。【结论】3DCE-MRA可做为颈部血管的常规检查方法。     

彩超对老年高血压及糖尿病患者颈动脉粥样硬化的评价与分析

目的探讨彩超在观察老年高血压及糖尿病患者颈动脉粥样硬化中的应用。方法应用超声分别对正常组（A组）、高血压患者组（B组）及高血压合并糖尿病组（C组）的颈部动脉的粥样斑块形成情况及颈总动脉血流频谱数值的变化。结果高血压患者和高血压合并糖尿病患者的颈部动脉血管的超声多支异常明显增多,并且两组的各项颈动脉血流动力学的指标较正常组明显异常,均以高血压合并糖尿病最为严重。结论高血压合并糖尿病会增加老年人颈动脉粥样斑块的发生几率,彩超检查对该病的诊断提供确切的证据,对病情的评价有很大的帮助。     

颈部动脉扭曲的超声诊断

颈部动脉扭曲系指颈部动脉的过度弯曲，严重、频繁迂曲者，扭曲的动脉形成锐角，称之为扭结。本病为相对少见的颈部动脉走行异常，多见于中老年人。本研究回顾性分析了经彩色多普勒超声检查及经造影或CT三维重建证实为颈部动脉扭曲的67例患者的声像图资料，旨在探讨颈部动脉扭曲的彩色多普勒声像图表现及超声诊断价值，提高对本病的认识。[第一段]     

肺动静脉瘘的诊断及治疗

１９７８～１９９６年，我院手术治疗肺动静脉瘘１０例，其中男７例，女３例，平均年龄３４（１５～５２）岁，单发６例，多发４例，主要临床表现为紫绀，红细胞增多症，低氧血症，胸部异常血管杂音及肺门有粗大血管相连的肺部阴影，手术适应症为：（１）所有单发病变；（２）肺动脉静脉瘘为循环供血；（３）有一种或多种并发症；（４）肺内存在大量右向左分流。多发患者手术的选择应首先世除病变最集中的肺叶，其它肺周的小病灶可见     

老年前期颈部动脉彩色多普勒检测504例结果分析

老年前期颈部动脉彩色多普勒检测５０４例结果分析张旗１资料和方法本组男４２３例，女８１例，年龄５０～５９岁，用Ａｃｕｓｏｎ１２８ｘｐ／１０ｍ彩色电脑声像仪，线阵探头，７．０ＭＨｚ，选用血管软件，依次测量颈部各动脉的内径，包括颈总动脉（距窦部１～２ｃｍ）...     

高血压患者颈部动脉病变的超声分析

目的：应用彩色多普勒超声对高血压患者颈动脉病变情况进行分析探讨。方法：采用高频探头对临床确诊高血压病患者183例及对照组非高血压患者120例,分组进行对比分析,观察颈部动脉内有无动脉斑块形成,管腔有无狭窄,测量血管内径,内中膜厚度。结果：高血压患者与对照组相比,血流动力学改变的发生率高于正常对照组（二者差异有显著性,P〈0.01）。结论：高血压患者颈部血管粥样硬化的发生率高于正常组。颈部动脉超声可以直接显示动脉病变程度和斑块性质,为临床诊断和治疗提供重要依据。     

彩超诊断颈总动脉走行扭曲1例

患者女，60岁。自幼发现右颈部肿物，无不适，触之有搏动。超声检查：见肿物为走行扭曲的右颈总动脉（图1）。扭曲近段内径较左侧同部位增宽，扭曲近段血流最大流速31.8cm/s，扭曲远段血流最大流速53.55cm/s。左颈总动脉内径及走行无异常，超声诊断：右颈总动脉走行扭曲。     

外周血管超声检查

一、外周血管超声多普勒检查适应证 （一）动脉系统 １．动脉栓塞及动脉血栓形成。 ２．先天性发育异常。 ３．动脉损伤。 ４．动脉粥样硬化。 ５．动脉炎。 ６．动脉受压性疾病。 ７．某些功能性动脉疾病。 ８．动脉疾病治疗后随访。 （二）静脉系统 １．静脉血栓形成及静脉炎。 ２．先天性静脉发育异常。 ３．肢体肿胀的鉴别诊断。 ４．静脉瓣膜功能的检测。 ５．静脉瘤。 ６．静脉疾病治疗后随访。 二、外周血管超声多普勒检查的基本方法 （一）体位： 根据所检查的血管及病变部位，确定体位。 （二）探头频率： 一般采用５．０－７．５…     

Transcranial Doppler evaluation of common and classic migraine. Part I. Ultrasonic features during the headache-free period

To study vascular abnormalities in migraine, transcranial Doppler (TCD) was used for evaluation of 100 consecutive patients with either common or classic migraine during the headache-free period. We insonated the basal cerebral arteries and the internal carotid artery (ICA) in the neck. Particular ultrasonic features in migraineurs included intracranial elevations of mean flow velocity (MFV) above 3 standard deviations of normal values in 16%, probably reflecting increased vasotonus. Marked asymmetry of MFV in corresponding intracranial arteries was found in 12%, and could represent "asymmetrical" vascular tone. Characteristic vascular bruits of low frequency and sometimes harmonic quality were detected in 56%. When compared to TCD findings in 40 young controls, MFV were significantly higher in all intracranial arteries in migraineurs, but not in the cervical ICA. Marked differences were also found for incidence of MFV elevations and vascular bruits (p less than 0.0001). Vascular reactivity in response to eye closing as measured by flow changes in the posterior cerebral artery (visually evoked flow) was significantly greater in migraineurs than in controls (%MFV change, 14.1 +/- 5.4 vs 11.4 +/- 4.8; p = 0.004). TCD features did not discriminate common from classic migraine. Taken together, our results support the view of intracranial vascular abnormality in migraineurs reflecting, in particular, a narrower and more reactive arterial tree. The value of TCD in the differential diagnosis of "vascular headache" and in the study of migraine pathophysiology will have to be determined in the future.     

Association between bone mineral density and arterial stiffness in hypertensive patients

Hypertension and osteoporosis are two common diseases in the elderly population. Recently, reduced bone mineral density has been found in hypertensive patients compared with healthy controls. Reduced bone mineral density is associated with increased arterial stiffness in chronic dialysis patients and healthy postmenopausal women. However, relationships between bone mineral density and arterial stiffness in hypertensive patients have not been fully assessed. We examined the relationships between bone mineral density and both arterial stiffness and nutritional status in 52 hypertensive patients (27 male and 25 female subjects; mean age 71±8 years) who had been treated with antihypertensive drugs for at least one year. The bone mineral density of the calcaneus was measured with a quantitative ultrasound measurement device, and the stiffness index was determined as a parameter of the bone mineral density. We measured the cardio-ankle vascular index (CAVI) to assess arterial stiffness and used the serum albumin to assess nutritional status. Increased arterial stiffness as assessed with CAVI is associated with reduced bone mineral density (r=-0.289, p=0.038). However, the correlation between CAVI and bone mineral density is not as strong as the correlation between serum albumin and bone mineral density (r=0.501, p<0.001). In conclusion, nutritional status is an important indicator of bone mineral density in hypertensive patients. Moreover, increased arterial stiffness is associated with reduced bone mineral density in hypertensive patients. Therefore, hypertensive patients with increased arterial stiffness may have a high risk of bone fracture due to osteoporosis.     

Pressor response to a postural change in cirrhosis: an experimental study in the CCl4-treated rat.

1. Systemic hypotension, blunted cardiovascular responsiveness to noradrenaline and an abnormal hypertensive pressor response to a postural change have been described in cirrhotic patients. 2. We have examined the role of blunted responsiveness in these abnormalities by studying basal arterial blood pressure and its response to a postural change (vertical head-up 90 degrees tilting) in conscious and pithed CCl4-treated (cirrhotic) rats, as well as assessing the pressor response to noradrenaline in vivo and the vascular contractile response to noradrenaline in vitro. 3. A diminished hypotensive response to a change in posture was found in pre-cirrhotic portal hypertensive rats, whereas an inverted hypertensive pressor response in the face of systemic hypotension occurred in the cirrhotic rats with portal hypertension. 4. The inverted pressor response was abolished in the pithed portal hypertensive cirrhotic rats. 5. The pressor response to noradrenaline in vivo in conscious cirrhotic rats and the vascular contractile responsiveness to noradrenaline in vitro were intact. 6. We conclude that blunted responsiveness to noradrenaline is not a contributory factor to the development of systemic hypotension or the inverted pressor response to a change in posture in cirrhosis.     

原发性高血压合并颈椎病患者倾斜后血压和心率的变化

目的 探讨原发性高血压(EH)合并颈椎病患者头高位倾斜后血压和心率的变化及可能机制.方法 EH 49例,根据临床症状,运用X光机、颈椎CT或MRI和椎动脉彩超等检查方法,确诊合并颈椎病23例(合并颈椎病组),不合并颈椎病患者26例(单纯EH组),测定2组患者血压、血脂、血糖,并测定头高位倾斜后的血压、心率.结果 合并颈椎痛组和单纯EH组头高位倾斜后血压变化差异有统计学意义[4(-21～14)mm Hg与-9(-27～-3)mm Hg,H=25.44,P<0.01],心率变化差异有统计学意义[2(-1-14)次/min与5(-2～11)次/min,H=9.30,P<0.01].结论 合并颈椎病患者头高位倾斜后血压不下降与交感神经兴奋可能有关.     

Urate affection of kidneys and metabolic disturbances in hypertensive patients]

AIM: To detect urate renal affection and correlations between purine metabolism, hyperinsulinemia, obesity, dyslipidemia in patients with arterial hypertension (AH). MATERIALS AND METHODS: 78 patients with mild, moderate and severe hypertension have undergone 24-h monitoring of arterial pressure and microalbuminuria test. RESULTS: Hyperuricemia was diagnosed in 21 of 78, hyperuricosuria in 27 patients. 13 patients had combination of hyperinsulinemia with obesity, dyslipidemia, arterial hypertension. Renal symptoms occurred in almost half of the patients with hyperuricemia. Disturbed 24-h rhythm and variability of arterial pressure were encountered more frequently in patients with hyperuricemia and hyperinsulinemia than in patients with normal purin metabolism and no other metabolic shifts. CONCLUSION: Renal abnormalities were found more frequently in hypertensive patients with hyperuricemia and those free of urate disturbances and metabolic changes. A positive correlation exists between body mass index and insulinemia (r = 0.58, p < 0.01), body mass index and uricemia (r = 0.37, p < 0.01), insulinemia and uricemia (r = 0.32, p < 0.01).     

Abnormal arterial flow pattern in untreated essential hypertension: possible link with the development of atherosclerosis

1. We compared the velocity waveforms in the superficial femoral artery measured by multichannel Doppler ultrasound in 45 subjects: 21 patients with untreated essential hypertension and 24 normal subjects of similar age and sex. 2. The pattern of arterial flow was abnormal in hypertensive patients, with the acceleration time, the duration of reverse flow and the time to maximum flow reversal being abbreviated. The internal arterial diameter, calculated from the velocity profile, was reduced despite raised pressure, suggesting altered arterial wall mechanics in essential hypertension. 3. These abnormalities will influence the wall shear stress, a major determinant of arterial function. The abnormal arterial wall mechanics and abnormal blood flow pattern may contribute to the increased risk of arterial disease in patients with untreated hypertension.     

高血压前期动脉弹性与胰岛素抵抗的相关性研究

目的探讨高血压前期大动脉、小动脉弹性与胰岛素抵抗的相关关系。方法选择高血压前期36人、1-2级高血压患者46例、理想血压健康者30人,使用CVProfilorDO-2020动脉弹性功能测定仪检测桡动脉脉搏波形和动脉弹性指数C1和C2,采用HOMA-IR公式计算胰岛素抵抗指数（IR）;比较各组间大动脉、小动脉弹性情况,对高血压前期者动脉弹性与IR进行相关分析。结果校正了年龄和病程后,高血压组与理想血压组、高血压前期组比较,C1和C2均降低（P〈0.05）;高血压前期组与理想血压组比较,C2降低（P〈0.05）,高血压前期组和高血压组与理想血压组比较,HOMA-IR升高（P〈0.05）。C2与HOMA-IR负相关（r=-0.687,P〈0.05）。结论高血压前期者已经存在小动脉弹性的减退及胰岛素抵抗,且两者之间呈负相关。     

Transcranial Doppler evaluation of common and classic migraine. Part II. Ultrasonic features during attacks

Transcranial Doppler (TCD) examinations were performed in 13 patients with common and 5 patients with classic migraine during attacks and compared to TCD findings during the headache-free period. Two distinct patterns of flow changes were detected to distinguish common from classic migraine on the basis of TCD findings. During attacks, patients with common migraine exhibited reduction of flow velocities associated with an increase of pulse wave amplitudes. Vascular bruits that were heard during the headache-free interval often disappeared. Opposite changes were found in attacks of classic migraine during the headache phase with increase of flow velocities, decrease of pulsatility and more prominent or newly appearing bruits. These findings were often diffuse and did not appear to correlate with side of headache or side of neurological aura. Uniform changes occurred in the cervical internal carotid artery and the basal cerebral arteries in either form of migraine. We propose that these changes represent caliber fluctuations of the large arteries, suggesting vasodilatation during attacks of common migraine and vasoconstriction during attacks of classic migraine. We do not intend to imply a casual role of these preliminary findings in migraine pathogenesis, but we suggest that TCD be used in combination with other methods to study vascular changes in migrainous disorders.     

青年甲亢患者的经颅超声多普勒研究

目的：应用TCD探讨甲亢的脑血流动力学特点及其应用价值。方法：按常规探测50例青年甲亢患者颅内各动脉的血液动力学指标,与30例健康正常组对照。50例患者并分为血流速度显著增高（A组）、中度增高（B组）、轻度增高（C组）三组。结果：所有患者血流速度均增高,收缩峰高尖,博动指数正常,血管杂音占70％,头痛占60％。A组T3、T4值显著高于B、C组,TSH值显著低于B、C线;B组T3、T4值显著高于C组,TSH值显著低于C组。A组其血管杂音、头痛比例明显高于其它两组。结论：脑血流速度的增高程度可初步反映甲亢的严重程度,并与血管杂音及头痛的发生有关,TCD可用来评价甲亢的严重程度并可提高早期确诊率。     

Color Doppler characteristics in normal lower extremity arteries.

The purpose of this study was to determine the normal characteristics of the lower extremity arterial system as seen with color Doppler. A total of 420 arterial segments from the level of the proximal abdominal aorta to the distal tibial and peroneal vessels were examined with a color ultrasound scanner in 10 normal volunteers. Each arterial segment was examined for the presence of triphasic flow, wall irregularities, calcification, bruits, collaterals, and post-stenotic flow patterns. Standard duplex spectral waveform data were also obtained at each site. As expected, triphasic flow was present and detected by color Doppler in the majority of arterial segments. Color patterns suggesting the presence of bruits, collaterals, or post-stenotic flow were absent in all cases.