Transcranial duplex ultrasound of the ophthalmic artery

The purpose of this study was to identify the ophthalmic artery (OA) by means of transcranial color-coded sonography using a new approach via the transtemporal bone window and to compare blood flow measurements with values obtained from the transorbital approach. A total of 105 subjects were included. Two individuals had an insufficient unilateral bone window, according to our inclusion criteria. Of the remaining 208 OAs, 206 (99%) could successfully be insonated via the transorbital approach and 190 (91%) via the transtemporal approach. Transorbital systolic and diastolic flow velocity (FVs) ranged between 15 and 67 cm/s (mean +/- SD: 35 +/- 10) and 4 to 36 cm/s (14 +/- 5), pulsatility index ranged between 0.4 to 2.8 (1.2 +/- 0.4). Transtemporal systolic and diastolic FVs ranged between 15 and 58 cm/s (33 +/- 9) and 4 to 25 cm/s (11 +/- 4). Transorbital and transtemporal FVs correlated significantly (p = 0.01). Our study demonstrates that transtemporal insonation of the proximal intracranial OA is feasible. Whenever OA assessment for analysis of collateral function is required, this simple approach, avoiding direct eye bulb insonation, should be considered.     

Bedside Transorbital Ultrasound in the Clinical Evaluation of Pediatric Optic Neuritis in the Emergency Department

Background

Headache and monocular visual disturbance are worrisome pediatric presenting complaints in the emergency department. Appropriate and timely initial evaluation is critical. Most would opt for urgent computer tomography in such cases. Pediatric optic neuritis is a rare condition and is better evaluated by magnetic resonance imaging. With the increase in the use and scope of bedside ultrasound, there might be a potential role for transorbital ultrasound to be part of the emergency department evaluation of pediatric optic neuritis.

Automatic Optic Nerve Measurement: A New Tool to Standardize Optic Nerve Assessment in Ultrasound B-Mode Images

Transorbital sonography provides reliable information about the estimation of intra-cranial pressure by measuring the optic nerve sheath diameter (ONSD), whereas the optic nerve (ON) diameter (OND) may reveal ON atrophy in patients with multiple sclerosis. Here, an AUTomatic Optic Nerve MeAsurement (AUTONoMA) system for OND and ONSD assessment in ultrasound B-mode images based on deformable models is presented. The automated measurements were compared with manual ones obtained by two operators, with no significant differences. AUTONoMA correctly segmented the ON and its sheath in 71 out of 75 images. The mean error compared with the expert operator was 0.06 ± 0.52 mm and 0.06 ± 0.35 mm for the ONSD and OND, respectively. The agreement between operators and AUTONoMA was good and a positive correlation was found between the readers and the algorithm with errors comparable with the inter-operator variability. The AUTONoMA system may allow for standardization of OND and ONSD measurements, reducing manual evaluation variability.     

Ocular sonography in patients with raised intracranial pressure: the papilloedema revisited

Invasive devices are recommended for the early detection of raised intracranial pressure (ICP) after severe traumatic brain injury. Owing to contraindication or local issues, however, invasive ICP monitoring is not always possible. Moreover, a significant proportion of moderate traumatic brain injury patients (managed without invasive ICP) will develop raised ICP. Reliable noninvasive ICP techniques are therefore needed. Soldatos and colleagues report the usefulness of ocular sonography in the diagnosis of raised ICP. Focusing on cerebrospinal fluid accumulation around the retrobulbar optic nerve, they show interesting results for the optic nerve sheath diameter in the diagnosis of raised ICP. If confirmed by further studies, and despite important limitations related to sonography, this technique could serve as a screening test in patients at risk for raised ICP, when invasive monitoring is not possible or is not clearly recommended.     

Sonographic examination of the appendix in acute infectious enteritis and acute appendicitis

PURPOSE: To use transabdominal sonography to determine the frequency of visualization of the adult normal appendix in patients with suspected acute infectious enteritis (AIE) compared with patients with acute appendicitis (AA) and a control group. METHODS: A total of 296 patients divided into 3 different groups underwent sonographic examination, including 120 randomly selected asymptomatic patients, 91 consecutive patients with AIE, and 85 consecutive patients with AA. In the 3 groups, visualization rate, outer appendiceal diameter, presence or absence of inflamed periappendiceal fat, and location of the appendix were recorded. RESULTS: The visualization rates of the appendix were 49.2%, 70.3%, and 96.5% for the control, AIE, and AA groups, respectively (P < 0.05). The mean +/- SD outer appendiceal diameters for the 3 groups were 4.5 +/- 1.2 mm, 4.5 +/- 1.4 mm, and 7.9 +/- 2.0 mm, respectively. The difference between outer appendiceal diameter in the control and AIE groups was not statistically significant. Periappendiceal inflamed fat was detected in all AA cases, but in none of the AIE cases. CONCLUSION: The appendix was visualized more often in patients with AIE than in the control group, although the outer appendiceal diameter of the AIE group was not significantly different from that of the normal appendix seen in the control group.     

Effect of hemodynamic conditions on sonographic measurements of peak systolic velocity and arterial diameter in patients with peripheral arterial stenosis

PURPOSE: We measured changes in peak systolic velocity ratio and sonogaphic vascular diameter during different hemodynamic conditions in patients with femoral or iliac artery stenosis. METHODS: In 35 patients with isolated femoral or iliac artery stenosis, prestenotic and intrastenotic peak systolic velocity and inner vascular diameter were calculated using color Doppler sonography and gray-scale sonography, respectively. The measurements were performed with the patient at rest (baseline), after leg exercise, and again after oral administration of 10 mg of the vasodilator nifedipine. RESULTS: The mean prestenotic and intrastenotic peak systolic velocity and the peak systolic velocity ratio (intrastenotic/prestenotic peak systolic velocity) were 70 +/- 31 cm/second, 360 +/- 130 cm/second, and 6.5 +/- 3.6 at baseline; 78 +/- 37 cm/second, 404 +/- 171 cm/second, and 6.6 +/- 4.2 after leg exercise; and 71 +/- 30 cm/second, 353 +/- 109 cm/second, and 5.9 +/- 3.2 after nifedipine administration. The mean prestenotic and intrastenotic diameter and percentage of diameter reduction were 5.9 +/- 3.2 mm, 2.3 +/- 1.1 mm, and 59 +/- 13% at baseline; 4.8 +/- 2.4 mm, 2.0 +/- 1.3 mm, and 62 +/- 13% after leg exercise; and 5.9 +/- 2.9 mm, 2.5 +/- 1.0 mm, and 54 +/- 14% after nifedipine administration. Only the difference in intrastenotic diameter after leg exercise was significantly different from baseline. CONCLUSIONS: The peak systolic velocity ratio in peripheral arterial stenosis seems to be relatively independent of the hemodynamic conditions and cannot be used for investigations of vasomotion of stenotic arterial segments during different hemodynamic conditions.     

Value of 3-dimensional transrectal/transvaginal sonography in diagnosis of distal ureteral calculi.

OBJECTIVE: In a prospective study, the feasibility of 3-dimensional (3D) transrectal/transvaginal sonography in comparison with transabdominal sonography and intravenous urography (IVU) in identifying distal ureteral calculi was evaluated. METHODS: Sixty-two patients in the urologic clinic with clinical suspicion of distal ureteral calculi were included. The patients consisted of 44 men and 18 women with a mean age +/- SD of 44 +/- 17 years. These patients underwent 3D transrectal/transvaginal sonography, transabdominal sonography with IVU, and, finally, ureterorenoscopy. RESULTS: Fifty-nine patients were confirmed to have distal ureteral calculi on the basis of urologic intervention (ureterorenoscopy). Three patients had a spontaneous stone passage immediately after imaging completion. The median size of the calculi was 3.7 +/- 2.00 mm. Transabdominal sonography detected 34 of the 62 patients with calculi (sensitivity, 55%). The median size of the calculi was calculated as 5.0 +/- 2.4 mm. The examination time was 6.5 +/- 2.7 minutes. Intravenous urography detected 44 of the 62 patients with ureterolithiasis (sensitivity, 71%). Herein, the median stone size was measured as 3.9 +/- 1.9 mm, and the examination time was 38 +/- 17 minutes. The combination of transabdominal sonography and IVU in visualization of ureterolithiasis raised the sensitivity to 81% (50 of 62 patients). Three-dimensional transrectal/transvaginal sonography showed ureterolithiasis in all 62 patients confirmed to have distal ureteral calculi (sensitivity and specificity, 100%). The median size of the calculi was calculated as 4.4 +/- 2.2 mm, and the examination took 1.9 +/- 0.6 minutes. CONCLUSIONS: The data in our prospective study show that transrectal/transvaginal sonography with 3D image assessment is superior to IVU and abdominal sonography for diagnosing distal ureteral calculi.     

Doppler evaluation of external iliac vein hemodynamic changes caused by lymphocele after lymphadenectomy for cervical cancer

PURPOSE: To use Doppler sonography to assess the hemodynamic changes in the external iliac vein (EIV) compressed by a pelvic lymphocele after pelvic lymphadenectomy in patients with cervical cancer. MATERIALS AND METHODS: Postoperative gray-scale and Doppler sonographic examinations were performed in 71 women after pelvic lymphadenectomy. Twenty healthy women served as controls. When present, the lymphocele was graded on a scale of 1 to 4 based on the percentage of the circumference of iliac vessels in contact with the lymphocele (ie, circumferential contiguity) (grade 1, 0-24%; grade 2, 25-49%; grade 3, 50-74%; grade 4, 75-100%), and in 3 groups according to its maximum diameter (group A, 1-40 mm; group B, 41-60 mm; group C, >60 mm). EIV velocity was measured, and waveform modulation by respiratory movements was analyzed. RESULTS: There were 40 lymphoceles in 22 patients. The mean (+/-SD) EIV velocity was 24.5 +/- 14.8 cm/s in the control group, 38.2 +/- 5.9 cm/s in group 1, 69.2 +/- 29.4 cm/s in group 2, 105.75 +/- 12.36 cm/s in group 3, and 139.5 +/- 33.79 cm/s in group 4. Spontaneous EIV blood flow could not be detected in 2 cases in the later group. EIV flow modulation was significantly lower in patients with greater lymphocele contiguity or diameter. CONCLUSIONS: Post-pelvic lymphadenectomy causes EIV extrinsic compression that results in upstream blood stasis, potentially increasing the risk for deep vein thrombosis.     

A new angle-independent Doppler ultrasonic device for assessment of blood flow volume in the extracranial internal carotid artery.

OBJECTIVE: To evaluate a new angle-independent ultrasonic device for assessment of blood flow volume in the internal carotid artery. METHODS: In vitro, a pulsatile pump was set to provide an outflow of physiological fluid at 500 mL/min through an 8-mm-diameter tube. Flow volume rates were measured 10 times by 10 different operators and compared with time-collected flow volume rates. In vivo, internal and common carotid artery blood flow volumes were measured in 28 volunteers by 2 operators using a FlowGuard device (Biosonix Ltd). Internal and common carotid artery diameters and blood flow volumes were also assessed by Duplex sonography and compared with FlowGuard measurements. In 10 volunteers, internal carotid artery blood flow volume changes in response to monitored breath manipulations were recorded. RESULTS: In vitro, intraoperator variability was 4.04% (range, 2%-5.7%). The mean error rate +/- SD was 3.54% +/- 0.8% (range, 2.7%-5.2%). In vivo, the mean common carotid artery blood flow volume was 456 +/- 39 mL/min (range, 417-583 mL/min) with a mean diameter of 6.7 +/- 0.7 mm (range, 5.8-8.7 mm). The mean internal carotid artery blood flow volume was 277 +/- 25 mL/min (range, 239-338 mL/min) with a mean diameter of 5 +/- 0.5 mm (range, 4.1-6.1 mm). No significant difference was found between operators. Internal carotid artery diameter and blood flow volume measured by the FlowGuard were closely correlated with the results of Duplex sonography. Repeated shifts of end-tidal CO2 induced reproducible changes in internal carotid artery flow volume: 187.5 +/- 18.1 mL/min at 26.8 +/- 1.9 mm Hg and 382.1 +/- 18.2 mL/min at 47 +/- 2.2 mm Hg. CONCLUSIONS: The FlowGuard showed that volume flow studies in the internal carotid artery could be easily performed, with results compatible with those of previous clinical reports. Duplex comparative results and breath-induced changes in internal carotid artery flow volume justify further evaluation of the system.     

Intima-media thickness of the common carotid artery in highway toll collectors

PURPOSE: To assess the effects of exposure to exhaust particles on intima-media thickness of the common carotid artery in highway toll collectors. METHODS: Sixty-one highway toll collectors (HTCs) between 24 and 56 years of age (mean, 36.2 +/- 7.3) and 48 controls between 24 and 64 years of age (mean, 42.6 +/- 10.6) were evaluated with gray-scale sonography to measure intima-media thickness (IMT) of the common carotid artery (CCA). Subgroups were categorized according to duration of exhaust exposure and further divided according to tobacco use. RESULTS: CCA IMT was higher (0.8 +/- 0.2 mm) in HTCs than in the control group (0.6 +/- 0.1 mm; p < 0.001) and remained higher when subgroups with similar smoking habits were compared. In HTCs, IMT was greater when the number of years working in tollbooths was greater (p = 0.023). IMT was lower in HTCs with an exposure duration of < 10 years compared with a duration of 10-20 years (p = 0.017) or > 20 years (p value not significant). CONCLUSION: Air pollution has a widely acknowledged negative effect on humans. This study confirms that exposure to exhaust particles might cause wall thickening of carotid arteries.     

Diagnosis of viability in early pregnancy with vaginal sonography

The detection rate of embryonic heart action using vaginal sonography was evaluated in 363 normal singleton pregnancies in the first trimester. Visible cardiac activity was present at the earliest at a gestational age of 40 days; in addition, the smallest chorionic cavity had a mean diameter of 9.3 mm, the lowest human chorionic gonadotropin (beta-hCG) concentration (calibrated against the first international reference preparation) measured 6,770 mIU/mL, the thinnest trophoblast was 1 mm, and the shortest crown-rump length was 2 mm. Cardiac pulsations were identified in all cases either at a menstrual age greater than or equal to 46 days, a beta-hCG greater than or equal to 47,171 mIU/mL, a mean chorionic cavity diameter greater than or equal to 18.3 mm, or a trophoblast thickness greater than or equal to 5 mm. The heart rate (mean +/- SD) increased from 110 +/- 8 beats per minute (bpm) at 5 weeks menstrual age to 170 +/- 6 bpm at 9 weeks and declined thereafter to 159 +/- 3 bpm at 13 weeks. Vaginal sonography enables a rapid and reliable assessment of embryonic life in early pregnancy.     

糖尿病视神经病变磁共振扩散张量成像诊断价值探讨

目的探讨磁共振扩散张量成像(MR-DTI)在糖尿病视神经病变检查中的诊断价值。方法对15例(30眼)Ⅱ型糖尿病合并视神经病变的患者和15例健康成年人(对照组)分别行3.0TMR-DTI检查,研究糖尿病视神经病变组和对照组视神经各向异性(FA)、平均扩散系数(MD)、平行扩散系数(λ∥)、垂直扩散系数(λ⊥)值,进行组间比较。结果糖尿病视神经病变组视神经FA、MD、λ∥、λ⊥值分别为0.321±0.090、(1808±431)×10-6mm2/s、(2393±273)×10-6mm2/s、(1488±467)×10-6mm2/s;对照组视神经分别为0.585±0.020、(935±133)×10-6mm2/s、(1654±157)×10-6mm2/s、(1026±492)×10-6mm2/s。糖尿病视神经病变组与对照组相比,FA值明显降低(P=0.000),MD值、λ∥值、λ⊥值明显升高(P=0.000)。结论 MR-DTI在糖尿病视神经病变筛查中有一定的应用价值。     

Reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale: a measure of the use of intracranial pressure-directed therapies

OBJECTIVE: To test the reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale, a novel measure of overall therapeutic effort directed at controlling intracranial pressure (ICP) in the setting of severe (Glasgow Coma Scale of 相似文献   

Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults.

AIM: To quantify the observer variation in the sonographic measurement of optic nerve sheath diameter (ONSD) in normal adults. MATERIALS AND METHODS: Sixty-seven normal adult volunteers underwent ultrasound examination of each eye by three independent observers using a 7 MHz sector probe. Three measurements were made of each eye by each observer and a mean value calculated for each eye. Median and 5th-95th centile values for both intra- and inter-observer variation were calculated for the three observers. RESULTS: The median intra-observer variation was +/-0.1 mm, with 5th-95th centile values of +/-0-0.4 mm. The median inter-observer variation was +/-0.2-0.3 mm, with 5th-95th centile values of +/-0-0.7 mm. Careful review of examination technique by the three observers after the first 17 examinations was shown to reduce both intra- and inter-observer variation. CONCLUSION: The sonographic measurement of ONSD is a readily learned, reproducible technique with low intra- and inter-observer variation. The average inter-observer variation (+/-0.2 mm) is comparable to the inherent variability of the ultrasound machine. The importance of standardisation of examination technique is stressed.     

超声测量视神经鞘直径评估颅内压增高的临床研究进展

颅内压监测在神经重症的治疗中十分重要,目前主要有无创和有创两种方法,各具优点,有创监测颅内压虽为颅内压监测的金标准,但缺点明显,无法广泛应用。视神经鞘具有特殊的解剖结构,颅内压增高时视神经鞘直径(ONSD)会出现增粗,故超声监测ONSD判断颅内压升高是一种无创、简便、易行且可以床旁重复操作的方法。本文就国内外超声监测ONSD判断颅高压研究进展进行综述。     

Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury

Objective To assess at admission to the ICU the relationship between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) and to investigate whether increased ONSD at patient admission is associated with raised ICP in the first 48 h after trauma. Design and setting Prospective, blind, observational study in a surgical critical care unit, level 1 trauma center. Patients and participants 31 adult patients with severe traumatic brain injury (TBI; Glasgow coma scale ≤ 8) requiring sedation and ICP monitoring, and 31 control patients without brain injury requiring sedation. Measurements and results ONSD was measured with a 7.5-MHz linear ultrasound probe. Two TBI groups were defined on the basis of ICP profile. If ICP exceeded 20 mmHg for more than 30 min in the first 48 h (before any specific treatment), patients were considered to have high ICP; if not, they had normal ICP. The largest ONSD value (the highest value for the right and left eye) was significantly higher in high ICP patients (6.3 ± 0.6 vs. 5.1 ± 0.7 mm in normal ICP patients and 4.9 ± 0.3 mm in control patients). There was a significant relationship between the largest ONSD and ICP at admission (r = 0.68). The largest ONSD was a suitable predictor of high ICP (area under ROC curve 0.96). When ONSD was under 5.7 mm, the sensitivity and negative predictive values for high ICP were 100%. Conclusions In the early posttraumatic period, ocular ultrasound scans may be useful for detecting high ICP after severe TBI. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. This article is discussed in the editorial available at: .     

Sonographic evaluation of the pancreatic duct in normal children and children with pancreatitis.

We investigated the diameter of pancreatic duct using ultrasonography in 51 children with pancreatitis and age-matched healthy control children over a 5 year period. The diameters of pancreatic duct and pancreatic body were measured simultaneously by sonography. The mean ages of children with acute pancreatitis and chronic pancreatitis were 9.7 +/- 3.9 and 10.3 +/- 3.1 years, respectively (range, 1 to 8 years). The mean age of normal children was 9.6 +/- 5.3 years. A significant difference was found in diameter of the pancreatic duct between children with acute and chronic pancreatitis versus that of age-matched control. In addition, a significant difference in diameter of the pancreatic body was found between children with acute pancreatitis and age-matched controls, but there was no marked difference in diameter of the pancreatic body between normal persons and those with chronic pancreatitis. The mean diameters of the pancreatic duct in acute pancreatitis and chronic pancreatitis were 2.34 +/- 0.47 mm and 2.84 +/- 0.67 mm, respectively, which was greater than that of normal children (1.65 +/- 0.45 mm). Pancreatic ducts with diameters greater than 1.5 mm in children between 1 and 6 years, greater than 1.9 mm at ages 7 to 12 years, or greater than 2.2 mm at ages 13 to 18 years were significantly associated with the presence of acute pancreatitis. Thirty-two patients, including 25 with acute pancreatitis and 7 with chronic pancreatitis, underwent follow-up measurement of pancreatic duct and serum lipase examination on at least three occasions. A good correlation between the diameter of pancreatic duct and serum lipase level was found. Thus, ultrasonography of the pancreatic duct is valuable in diagnosis and monitoring of pancreatitis in children.     

Optic nerve sheath diameter does not change with patient position

OBJECTIVES: Optic nerve sheath diameter (ONSD) has been proposed as a marker for increased intracranial pressure. Trendelenburg's position is often used in hypotensive patients and reverse Trendelenburg's position (30 degrees head up) is often used in head injury patients. We asked if there would be any change in OSND in healthy human adults between the supine, Trendelenburg's, and reverse Trendelenburg's positions. METHODS: Prospective case-control blinded study using consenting healthy adults. Three separate investigators measured the ONSD in each eye of 10 separate volunteers in the supine, Trendelenburg's, and reverse Trendelenburg's positions with 30 degrees angulation from the horizontal. Data were analyzed using the paired t test. RESULTS: In the supine position, the mean ONSD was 4.6 +/- 0.71 (SD) mm in the right eye and 4.5 +/- 0.56 (SD) mm in the left eye. In Trendelenburg's position, the mean ONSD was 4.4 +/- 0.72 (SD) mm in the right eye and 4.7 +/- 0.53 (SD) mm in the left eye. In reverse Trendelenburg's position, the mean ONSD was 4.4 +/- 0.49 (SD) mm in the right eye and 4.8 +/- 0.76 (SD) mm in the left eye. There was no significant difference in OSND between positions for either eye by analysis of variance. Interobserver agreement was +/-1 mm in at least 90% of the subjects regardless of position. CONCLUSION: Optic nerve sheath diameter measurement by ultrasound does not significantly change with Trendelenburg's or reverse Trendelenburg's position in comparison with the supine position in healthy individuals.     

Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure

Introduction  

The dural sheath surrounding the optic nerve communicates with the subarachnoid space, and distends when intracranial pressure is elevated. Magnetic resonance imaging (MRI) is often performed in patients at risk for raised intracranial pressure (ICP) and can be used to measure precisely the diameter of optic nerve and its sheath. The objective of this study was to assess the relationship between optic nerve sheath diameter (ONSD), as measured using MRI, and ICP.