TCD与经颅彩色多普勒对大脑中动脉狭窄的检测

目的 :比较 TCD与经颅彩色多普勒 (TCCD)和能量多普勒 (PDI)对 2 8例大脑中动脉 (MCA)狭窄的诊断。方法 :应用 TCD仪检出高流速改变的 MCA,再经 TCCD及 PDI准确测量 MCA的血流速度和血管内径 (或彩色血流直径 )。结果 :TCD对 MCA狭窄的检出率与 TCCD和 PDI的检出率明显相关。结论 :TCCD和 PDI极大提高了颅内血管病变检出的准确性 ,TCD对脑血管造影的患者起了良好的筛选作用     

腔隙性脑梗塞患者颈动脉B超与颅底大动脉TCD检查结果分析

目的:探索腔隙性脑梗塞患者的颅底大动脉病变情况.方法:对99例腔隙性脑梗塞患者行颈动脉彩色多普勒超声(B超)检查和(或)颅底动脉经颅多普勒(TCD)检查.结果:60例行颈动脉B超检查者中有颈动脉粥样硬化38例(63.33%),斑块形成29例(48.33%),管腔狭窄10例(16.67%),颈动脉B超总异常率达63.33%.93例行颅底动脉TCD检查者中发现有颈动脉系统与椎基动脉系统狭窄和(或)供血不足56例(60.22%).结论:腔隙性脑梗塞患者的颅底大动脉病变发生率较高,应重视临床干预     

TCD联合血清D-D检测对急性脑梗死患者颅内动脉狭窄的诊断价值

探讨经颅多普勒超声(TCD)联合血清D二聚体(D-D)对急性脑梗死颅内动脉狭窄的诊断价值。【方法】选取2018年7月至2020年7月在本院诊治的急性脑梗死患者112例为研究对象。所有患者均接受CT血管造影(CTA)和TCD检查,且均采集静脉血检测其血清D-D水平。比较TCD与CTA检测颅内动脉狭窄的结果,以CTA检测结果为金标准,分析TCD对颅内血管狭窄的诊断价值,用受试者工作曲线(ROC)分析血清D-D诊断颅内血管狭窄的诊断价值,记录曲线下面积(ALTC)。【结果】CTA检查结果显示:112例患者中检出颅内血管狭窄者81例,总检出狭窄血管202条,无狭窄者31例。TCD检测出狭窄血管191条,TCD对狭窄血管的诊断一致性较好,Kappa值=0.762,其中TCD对双侧大脑中动脉(MCA)血管狭窄的诊断价值最高,灵敏度为91.76%,阳性预测值为93.98%,一致性最好,Kappa值=0.852。ROC曲线分析结果显示:血清D-D诊断颅内血管狭窄的AUrC值为0.714,以>0.85 mg/L为分界点时诊断价值最高,灵敏度为48.15%,特异度为87.10%;TCD联合血清D-D诊断颅内血管狭窄的灵敏度为93.83%,准确性为95.54%,明显高于血清D-D单一检测(P<0.05),与TCD单一检测比较差异无统计学意义(P>0.05)。【结论】TCD联合血清D-D检测对急性脑梗死颅内动脉狭窄的诊断价值较高,尤其对MCA血管狭窄诊断准确性较高。     

经颅多普勒超声和CT在腔隙性脑梗死中的应用价值

目的探讨经颅多普勒(TCD)与CT在腔隙性脑梗死中的诊断价值.方法对210例腔隙性脑梗死患者行TCD与CT检测,并进行对比分析.结果CT首次确诊为腔隙性脑梗死149例(70.9%),而TCD检测结果193例异常,异常率达91.9%,异常率明显高于CT.CT显示72.38%的病例发生在基底节区域,TCD则显示病灶区的脑血流动力学异常,表现为动脉供血不足、脑血管痉挛、血管狭窄、脑动脉硬化症.结论同时对患者行TCD和CT检测,对腔隙性脑梗死患者的临床诊断、病因和危险因素的追查可提供依据.     

经皮血管内支架成形术治疗颅内动脉狭窄11例

我院2004年4月~2006年3月应用经皮血管内支架成形术(PTA)治疗颅内动脉血管狭窄11例,成功释放支架10枚,1枚未能输送到位,手术失败,术后3例出现严重并发症。现报告如下。1临床资料1·1一般资料本组11例,男6例,女5例;年龄52~70岁,平均59·7岁。术前均行脑CT或MR I检查,4例显示脑部有陈旧性腔隙梗死灶;经颅多普勒超声(TCD)及数字减影全脑血管造影(DSA),狭窄率在50%~90%,均为颅内症状性罪犯血管,其中大脑中动脉7例,椎基底动脉3例,颈内动脉颅内段1例。术前均行全面评估,无绝对禁忌证[1]。1·2手术方法1·2·1术前准备:术前7天予肠溶阿司匹林…     

腔隙性脑梗死后脑血流动力学研究

目的:探讨腔隙性脑梗死后患者脑血流动力学变化。方法:采用经颅多普勒超声仪检测105例腔隙性脑梗死患者(病例组)和101例健康体检者(对照组),记录颅内血管MCA,ACA,PCA,ICA,BA和VA的平均血流速度(Vm)。结果:病例组颅内各组血管平均血流速度均较对照组减低(P<0.05),病例组双侧MCA与ICA血流速度不对称率高于对照组(P<0.05)。结论:腔隙性脑梗死后脑血流平均速度减慢,脑血流对称性下降。     

经颅多普勒超声联合呼气末二氧化碳分压评估脑血管狭窄患者脑血管储备功能的临床意义

目的研究经颅多普勒超声联合呼气末二氧化碳分压评估脑血管狭窄患者脑血管储备功能的临床意义,从而建立高效合理的评估方法。方法选取对照组42例和试验组40例进行临床试验。两组均采用经颅多普勒超声联合呼气末二氧化碳分压法进行评估,通过吸入自身的CO_2诱导的血液中高碳酸浓度,通过过度换气诱导血液中低碳酸浓度来评价脑血管储备功能,再测定呼气末CO_2分压。结果 (1)单血管狭窄组患侧和多血管狭窄病变较重侧的血管扩张储备值均小于对照组,差异具有统计学意义(F=4.543,P0.05;F=5.231,P0.05)。(2)在平静呼吸、低碳酸血症、高碳酸血症时,单血管狭窄组和多血管狭窄组与对照组的呼气末CO_2分压相比,差异无统计学意义(F=0.391、0.972、1.163,P0.05)。(3)血管病变程度和血管扩张储备、整体储备功能呈负相关,相关系数分别是r=-0.465、-0.483,差异具有统计学意义(P0.05)。结论经颅多普勒超声联合呼气末二氧化碳分压评估患者脑血管储备功能方法简便,技术可靠,可更加广泛应用于临床。     

脑动脉收缩峰值流速异常增高判断脑梗塞部位的临床价值:102例TCD与CT结果的比较

本文102例接CT及MRI检查结果分成脑梗塞组73例、非脑梗塞组29例。后者的颅内动脉TCD测值与文献报道的国人同年龄组的正常值相近，而前者的颅内动脉血流速度多有增高，尤以收缩期及平均速度难高明显。以VsACA≥90cm／s，MCA＞100cm≥s、PCA≥90cm／s作为判断受检动脉有无狭窄的指标，脑梗塞组中50例的脑动脉Vs异常增高，非脑梗塞组中仅5例的MCAVs≥100cm／s。16例单侧脑腔梗中有11例同侧、双侧脑腔模10例中有5例单侧或双侧ACA或MCA及PCA的TCD上血流显示异常增高。单侧多发性脑梗塞15例中是2例的同侧ACA、MCA及PCA的Vs异常增高，29例双侧多发性脑梗塞中11例双侧、11例单侧颅内动脉血流TCD检出有异常。TCD对脑梗塞部位病变血管的检出阳性预期值为90．6％，特异度82．8％，与CT及MRI的诊断符合率为70．6％。     

缺血性脑血管病的相关因素分析

目的评估脑动脉狭窄与缺血性脑血管病之间的关系。方法本文通过观察141例缺血性脑血管病患者的临床表现、数字减影主动脉弓及全脑血管造影(DSA)、头颅CT或MRI等影像学结果,分析脑动脉狭窄的分布特点。结果正常未见血管狭窄41例,占29.1%;狭窄或闭塞100例,占70.9%。腔隙性梗死(LI)组54例无血管狭窄20例,发现狭窄34例,非腔隙性梗死(NL)组46例无血管狭窄6例,有狭窄40例,有明显差异。年龄、高血压病、糖尿病、高脂血症与动脉狭窄发生率显著相关,而性别差异与动脉狭窄发生率无显著关系。结论颅内外大动脉狭窄和闭塞是导致缺血性脑血管病重要因素,腔隙性梗死组血管狭窄发生率明显低于非腔隙性脑梗死组,年龄、高血压、糖尿病、高脂血症是脑动脉狭窄的危险因素。     

经颅多普勒超声在大脑中动脉狭窄血管成形术前后及随诊中的应用

目的:探讨经颅多普勒超声(TCD)在观察症状性大脑中动脉(MCA)狭窄支架成形术和介入治疗后的血流动力学改变。方法:回顾性分析接受颅内动脉支架成形术的MCA狭窄病例22例,所有病例治疗前后均行TCD检查,平均随访4.6个月。结果:①术前TCD改变:病变侧大脑中动脉流速显著增高,频谱异常。14例患者病侧大脑前动脉(ACA)流速代偿性增快,6例患者病侧大脑后动脉(PCA)流速代偿性增快。②术后TCD改变:多数患者术后当天及3~14月后TCD示病侧MCA流速出现不同程度的下降,1例术后2天出现血管痉挛。③平均随诊4.6个月,1例术后11月出现支架内再狭窄,TCD与复查的血管造影结果相符。结论:TCD是观察MCA狭窄及介入治疗随访的敏感方法,能准确的评价治疗效果并可用于长期随访。     

Relationships of transcranial blood flow Doppler parameters with major vascular risk factors: TCD study in patients with a recent TIA or nondisabling ischemic stroke

PURPOSE: The relationship between intracranial vascular disease and cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, and total serum cholesterol in patients with recent cerebral ischemia is not well established. We used transcranial Doppler (TCD) sonography tests as parameters of intracranial vascular disease and investigated the relationship between these parameters and conventional cardiovascular risk factors. METHODS: We prospectively studied 598 patients with a minor ischemic stroke or transient ischemic attack (TIA). In all patients, flow velocities in the left and right middle cerebral artery (MCA), and cerebrovascular reactivity to CO2 were measured by means of TCD sonography. Student's t-test and linear regression analysis were used to determine the relationship between the baseline characteristics, vascular risk factors, and TCD parameters. RESULTS: After adjustment for other vascular risk factors, a statistically significant relationship with mean flow velocity in the MCA was found for age (3.5 cm/s/10 years of age; 95% CI, 2.5-4.5 cm/s/10 years of age; p < 0.0001), sex (-2.9 cm/s for male sex; 95% CI, -5.5 to -0.3 cm/s; p = 0.03), diabetes (5.6 cm/s for diabetics; 95% CI, 2.1-9.1 cm/s; p = 0.002), and total serum cholesterol (2.4 cm/s per mmol increase in total serum cholesterol; 95% CI, 1.4-3.5 cm/s; p < 0.0001). Total serum cholesterol and hypertension were related to cerebrovascular reactivity to CO2. CONCLUSIONS: Cerebral flow velocity is influenced by multiple interacting factors. Results of TCD investigations should be adjusted for age, sex, diabetes, and cholesterol when used for diagnostic or prognostic purposes.     

脑栓塞病人急性期TCD异常与预后

目的 探讨脑栓塞病人急性期TCD检测在病人预后判断中的作用。方法 34例大脑中动脉(MCA)栓塞病人在病后次日行TCD检查，分析TCD参数变化与病人病后30d预后的关系。结果 脑梗死侧MCA32％无血流(11例)，15％血流不对称(5例)，53％血流正常(18例)。梗死侧MCA无血流者9／11(82％)预后差，而MCA血流正常者仅4/18(22％)预后差，两者差异显著。与预后好者比较，预后差者双侧MCA舒张末期血流速度(DFV)显著下降，博动扩(PI)显著增高。结论 脑栓塞病人急性期行TCD检测有助于病人预后判断。     

TCD对缺血性脑血管病颅内动脉狭窄的诊断价值

目的：观察经颅多普勒超声（TCD）对颅内血管狭窄诊断的可靠性。方法：对确诊的128例缺血性脑血管病进行TCD与数字减影血管造影（DSA）检查，观察颅内血管的变化情况。结果：128例中共检查血管1112条，TCD发现狭窄血管183条，其中135条与DSA诊断一致，但在TCD检查正常的血管中DSA发现血管狭窄29条，显示TCD诊断血管狭窄的敏感性82．3％，特异性94．9％，阳性预测值73．7％，阴性预测值96．8％，其中对大脑中动脉的价值最大，其后依次为椎动脉、大脑前后动脉。结论：TCD对诊断脑内动脉狭窄具有较高的敏感性和特异性，尤其对大脑中动脉和椎动脉，对大脑前动脉和大脑后动脉诊断须慎重。     

Detection of stenoses in the anterior circulation using frequency-based transcranial color-coded sonography

Atherosclerotic stenoses of the intracranial vessels are less frequent than those of the extracranial vessels, but they are associated with a considerable annual stroke rate. The aim of the present study was to investigate the usefulness of frequency-based transcranial color-coded sonography (TCCS), transcranial Doppler sonography (TCD) and digital subtraction angiography (DSA) in patients with middle cerebral artery (MCA) and intracranial internal carotid artery (ICA) stenosis. Forty patients presenting with 48 intracranial stenoses of the anterior circulation were involved in the study. The stenoses were detected in the neurovascular laboratory during routine TCD examinations. All patients underwent an additional frequency-based TCCS examination. Both the axial and coronal planes were obtained to allow the exact localization of MCA stenosis and differentiation from intracranial ICA stenosis. Angle-corrected flow velocity measurements were performed if straight vessel compartments were 20 mm or more in length. A total of 18 stenoses (44%) were investigated additionally with DSA. According to the investigation with TCD, 20 (42%) stenoses were low-grade, 12 (25%) were moderate, and the remaining 16 (33%) were severe. Angle-corrected flow velocity measurements obtained with the integrated pulse-wave Doppler device of the TCCS machine were highly correlated (0.912, p < 0.001) with those obtained with TCD. TCCS achieved a reliable differentiation of MCA main stem stenosis vs. intracranial ICA stenosis in 7 patients and vs. MCA branch stenosis in 4 patients, but TCD failed in these two subgroups. The agreement between DSA and TCCS to evaluate semiquantitatively 18 intracranial stenoses resulted in a weighted-kappa value of 0.764. The major clinically relevant advantages of TCCS over TCD in MCA stenosis are its ability to differentiate MCA trunk stenosis from terminal ICA or MCA branch stenosis reliably and to perform angle-corrected flow velocity measurements.     

Transcranial Doppler evaluation of middle cerebral artery stenosis

Symptomatic stenoses of the middle cerebral artery (MCA) are not uncommon, although Corston observed the occurrence of stroke in 24% of patients with MCA stenoses during a 6-year follow-up study. We tried to use transcranial Doppler (TCD) sonography for the detection and evaluation of MCA stenoses. Intra-arterial angiography demonstrated 16 MCA stenoses of more than 30% diameter reduction in 15 patients (14 atheromatous stenoses, 2 dysplasias). Severe associated lesions were present in 2 cases (more than 75% internal carotid artery stenosis). These 15 patients with MCA stenosis were examined with TCD in a blind study. A Doppler signal from the MCA was obtained through the temporal bone and was recognized on the result of common carotid artery compression test. We ascertained MCA stenosis when TCD demonstrated 1) segmental flow acceleration with peak systolic frequency of more than 3 KHz with or without high energy low frequency direct or reverse components; or 2) segmental increase in systolic peak frequency of more than 20%. Using these criteria, we confirmed through TCD the presence of MCA stenosis in nine out of 12 cases with diameter reduction of at least 50%, and one among four cases with less than 50% diameter reduction. Although our results are consistent with Aaslid and von Reutern's figures, methodological problems and diagnostic criteria have to be improved. Nevertheless, TCD seems to be a useful tool for the detection of stenosis with at least 50% diameter reduction, where it proved to offer a 75% sensitivity. Further studies are necessary to improve sensitivity and specificity.     

Transcranial Doppler findings in middle cerebral arterial occlusive disease in relation to degree of stenosis and presence of concomitant stenoses

PURPOSE: We evaluated the accuracy of transcranial Doppler (TCD) criteria in detecting middle cerebral artery (MCA) stenoses other than solitary severe stenoses. METHODS: Three TCD criteria were evaluated in patients with acute MCA territory infarction who also underwent angiography: abnormalities in mean velocity (MV), focal areas of spectral waveform abnormalities, and compensatory increase in MV in collateral vessels. RESULTS: Among 102 patients studied, angiography revealed MCA lesions in 48: 16 had uncomplicated lesions (single stenosis of moderate to severe degree), 19 had mildly complicated lesions (single MCA stenosis of other than moderate to severe degree, or moderate to severe MCA stenosis with a concomitant lesion outside the MCA), and 13 had severely complicated lesions (MCA stenosis of other than moderate to severe degree with a concomitant lesion outside the MCA). The sensitivity of abnormalities in MV in uncomplicated MCA lesions was 81%, whereas it was 53% in mildly complicated MCA lesions and 38% in severely complicated MCA lesions. However, a compensatory increase in MV in collaterals was more frequently found in complicated MCA lesions, and focal areas of spectral waveform abnormalities were observed fairly consistently in all groups. CONCLUSIONS: TCD findings of focal areas of spectral waveform abnormalities and compensatory collateral flow were common in complicated MCA lesions and may improve the specificity of TCD in the diagnosis of MCA stenosis.     

Cerebral blood flow and CO2 reactivity in interictal migraineurs: a transcranial Doppler study

There is still some controversy about alterations in velocity of blood flow and in cerebral vasomotor reactivity of intracranial arteries in migraineurs during the interictal phase. By means of simultaneous bilateral transcranial Doppler ultrasonography we, therefore, assessed intracranial blood flow velocities and cerebrovascular reactivity to carbon dioxide of all three basal brain arteries in 20 migraineurs during the interictal phase and 30 nonheadache-prone control subjects. Mean blood flow velocities were higher in migraineurs than in controls in all three arteries on both sides, with a significant difference (P < 0.05) for the right anterior cerebral artery and middle cerebral artery under basal conditions and for the right posterior cerebral artery during hypercapnia. Similarly, the cerebrovascular reactivity to carbon dioxide was always higher in patients than in controls, with a significant difference for the left anterior and the right middle cerebral arteries (P < 0.05) and the right posterior cerebral artery (P < 0.01). The broad overlap of cerebrovascular blood flow velocities and CO2 reactivities in patients and controls precluded identification of values diagnostic of migraine. Nevertheless, transcranial Doppler ultrasonography offers the opportunity to noninvasively monitor cerebral blood flow parameters and, therefore, represents a valuable tool for vascular research in migraine.     

超声在缺血性脑血管病介入治疗中的诊断价值

目的：探讨彩色多普勒超声（CDI）、经颅多普勒超声（TCD）对缺血性脑血管病的诊断及在脑血管成形支架植入术后随访中的价值，并与全脑数字减影血管造影（DSA）比较。方法：对261例缺血性脑血管病患者行颈部血管听诊、CDI、TCD检查，其中175例加行DSA检查，对有手术指征49例患者行脑血管成形支架植入术并随访。结果：①CDI证实颅外段脑血管狭窄〉50％的患者血管杂音的阳性率高达82％。TCD提示颅内段脑血管狭窄患者血管杂音阳性率达50％。②CDI及TCD示颅外段颈、椎动脉狭窄〉50％的患者中DSA符合率达82％；TCD提示颈内动脉虹吸段或大脉中动脉狭窄〉50％的患者中DSA符合率达98％。③脑血管成形支架植入术后患者CDI可清楚显示支架位置形态及支架内膜增生情况。CDI及TCD在术后监测发现狭窄段血流速度较术前明显降低；而术后支架内再狭窄的发生则表现为血流速度的再度增快。结论：CDI、TCD联合应用对缺血性脑血管病介入治疗前的诊断及术后随访提供了一种可靠的无创性综合检查方法。     

脑血管狭窄与血管运动反应性及眩晕的相关性

目的利用彩色多普勒血流成像技术及经颅多普勒超声探讨脑血管狭窄及血管反应性与眩晕的相关性。方法选取在我院行经颅多普勒超声检查的无其他神经体征的头晕或眩晕患者156例,先选48例健康体检者为正常对照组。于平静呼吸下探查脑血管颅外段及颅内段的血流动力学指标;颈动脉内-中膜厚度(IMT)、斑块、狭窄程度及屏气(15 s)颈内动脉平均速度(MFV),计算血管运动反应性(VMR)。比较各组间脑血管狭窄、血管运动反应性、颈动脉斑块发生率的差异,对VMR与年龄、血压、空腹血糖、IMT进行多元线性回归分析。结果脑血管狭窄眩晕组明显高于头晕组(P0.05),单纯椎-基底动脉系统血管狭窄率眩晕组高于头晕组(P0.05),头晕组、眩晕组VMR明显低于对照组(P=0.001,P=0.003),头晕组、眩晕组颈部血管斑块发生率高于对照组(P=0.009,P=0.004);眩晕组VMR与年龄、收缩压、空腹血糖和颈动脉内-中膜厚度有明显相关性。结论眩晕患者脑血管狭窄率高于头晕患者,且以椎-基底动脉系统为主,头晕及眩晕患者血管运动反应性降低,血管运动反应性与年龄、收缩压、空腹血糖及IMT明显相关。     

脑梗死患者不同时期脑血管反应性临床研究

目的 应用经颅多普勒超声技术和屏气试验评价脑梗死患者在急性期、恢复期的脑血管反应性.方法 脑梗死患者107例,健康对照组43名,分别在急性期(3～5d)、恢复期(6个月左右)通过经颅多普勒超声(TCD)技术和屏气试验观察双侧大脑中动脉血流速度变化,计算呼吸抑制指数(BHI).结果 在急性期,梗死组与对照组比较血流速度减慢,梗死侧更明显,BHI明显低于对照组.恢复期与急性期比较血流速度有所加快(P＞0.05),BHI有所升高,但仍明显低于对照组(P＜0.05);其中82例的BHI值较急性期无显著性变化,25例显著增高.Logistic回归分析显示BHI下降与脑梗死相关(P＜0.05).结论 脑梗死患者在急性期脑血管反应性受到损害,恢复期尽管得到一定程度修复,但是一些患者血管反应性仍损害较明显.