经颅彩色多普勒血流显像诊断颈动脉海绵窦瘘的临床价值

目的:评价经颅彩色多普勒血流显像(TCCS)诊断颈动脉海绵窦瘘的临床应用价值。方法:本组9例颈动脉海绵窦瘘经脑血管造影证实。采用经颅彩色多普勒血流显像通过颞窗和眶窗进行扫查。沿颈内动脉颅内段走行仔细探查海绵窦瘘的异常彩色血流团测量颈内动脉、颈外动脉和眼上静脉的血流频谱。结果:9例颈动脉海绵窦瘘中7例(A型)经颅超声可明确诊断(78%),I(D型)例可疑诊断(11%),I(B型)例漏诊(11%)。确诊的7例均可探及明显的海绵窦瘘彩色血流影,患侧颈内动脉呈高速低阻血流频谱,眼上静脉血流速度亦显著加快。结论:经颅彩色多普勒血流显像对A型颈动脉海绵窦瘘具有较高的临床应用价值。     

外伤性颈动脉海绵窦瘘的综合影像评价

目的 评价各种影像学检查手段在诊断外伤性颈内动脉海绵窦瘘中的作用。资料与方法 回顾性分析15例颈动脉海绵窦瘘患者的各种影像学表现，其中CT、超声检查15例，脑血管造影12例，MRI检查3例。结果 颈内动脉海绵窦瘘CT表现为：眼球突出，眼上静脉扩张和海绵窦增大(15／15)，眶内软组织肿胀(9／15)和眼外肌肥厚(10／15)。MRI表现与CT大致相同，MRA可立体显示扩张的眼上静脉和瘘口(2／3)。脑血管造影于动脉期可见患侧海绵窦扩大显影并眼上静脉逆向充盈显影(12／12)，并可见瘘口显示(11／12)，压迫患侧颈总动脉，健侧颈内动脉造影可见患侧颈内动脉和海绵窦显影(9／12)。经颅多普勒超声检查可显示眼上静脉和海绵窦区的异常血流信号(15／15)，并能准确评价颈内动脉各段血流动力学改变。结论 各种影像学检查手段都有其优势和局限性，各种手段综合应用才能满足临床需要。     

MRI对颈动脉海绵窦瘘的诊断价值

目的　探讨MR对颈动脉海绵窦瘘的诊断价值。方法　 2 3例经DSA检查证实的颈动脉海绵窦瘘 ,应用Toshiba 0 .5T磁共振扫描仪进行眼部及颅脑常规MRI及 3DTOFMRA扫描 ,回顾性分析其MRI及MRA表现。结果　 2 3例颈动脉海绵窦瘘的主要MRI及MRA表现 :全部病例均可见患侧海绵窦扩大 ,海绵窦主要属支静脉眼上静脉迂曲扩张 ;患侧眼下静脉扩张 3例 ,大脑浅静脉中组扩张 5例 ;海绵窦引流静脉岩上窦显示扩张 3例、岩下窦扩张 2例。吻合支翼静脉丛迂曲扩张 2例 ,对侧海绵窦扩大 3例。大脑动脉环后交通动脉开放 17例 19支。结论　MRI及MRA检查能够明确颈动脉海绵窦瘘的诊断 ,且MRA可同时显示脑供血代偿的情况 ,有助于选择DSA介入治疗时机。     

椎动脉造影导致脊髓前根动脉夹层并破裂

脑血管造影具有潜在危害,凡造影后24小时内发生的意外情况均认为是造影并发症。作者报道1例罕见的椎动脉造影引起颈髓前根动脉发生夹层动脉瘤并破裂。 54岁男性病人,血管造影诊断为自发性颈动脉海绵窦瘘(CCF),瘘位于右脑膜侧支动脉和下岩窦之间,为一个低流速脑膜动-静脉畸形。     

颈动脉海绵窦瘘的临床及影像学诊断

目的:分析颈动脉海绵窦瘘的临床及影像学特征。方法:回顾性分析25例具有完整临床资料的颈动脉海绵窦瘘患者的临床、全脑血管造影及10例螺旋CT表现。结果:临床表现为颅内杂音、不同程度的搏动性突眼、眼球运动障碍,视力减退或伴有复视、结膜水肿和充血。CT表现为眼球突出、眼上静脉增粗、海绵窦扩大、密度增高、眼球边缘模糊、眼睑肿胀。全脑血管造影表现为对比剂自颈内动脉或颈外动脉分支溢入海绵窦,形成一团浓密的不规则阴影,海绵窦及眼静脉等早期显影而颈内动脉床突上段和大脑前、中动脉不易充盈,并且可观察到瘘口位置、大小及侧支循环情况。结论:根据颈动脉海绵窦瘘的临床表现和CT征象可以诊断颈动脉海绵窦瘘,脑血管造影是其诊断的金标准,并为进一步选择治疗方案提供依据。     

颈动脉海绵窦瘘的诊断和血管内治疗

颈动脉海绵窦瘘(Carotid-cavernous fistu-la,CCF)的定义是颈内动脉海绵窦段、或为其分支及海绵窦周围颈外动脉硬脑膜小分支破裂与海绵窦之间形成异常的动静脉沟通。CCF 的常见原因一、自发性 CCF(一)先天性动脉发育异常常导致:1.海绵窦段颈内动脉或其分支动脉瘤破裂;2.原始     

MSCT双期血管成像对颈内动脉海绵窦瘘的临床诊断价值

目的：探讨多层螺旋CT双期脑血管成像对颈内动脉海绵窦瘘（ICCF）的诊断价值。方法：10例临床怀疑或确诊颈内动脉海绵窦瘘（ICCF）患者,均行颅脑CTA双期增强扫描,其中7例为术前检查,3例为介入栓塞术后复查,5例同期行DSA检查。采用容积再现（VR）、最大密度投影（MIP）、多平面重组（MPR）等技术处理图像。结果：7例术前CTA动脉期示患侧海绵窦早显扩大,同侧眼上静脉扩张纡曲,其中3例可见瘘口,3例同侧皮层静脉扩张,5例见岩上和岩下窦扩张．4例对倒海绵窦及眼上静脉显影扩大,3例患者有颅骨或颅底骨折。3倒术后复查CTA示患侧海绵窦及眼上静脉无旱显扩张,与DSA所见一致。结论：16层CT双期脑血管成像对颈内动脉海绵窦瘘的诊断及介入栓塞术后疗效观察有重要价值。     

64层螺旋CT对颈内动脉海绵窦瘘的诊断价值

目的探讨64层螺旋CT在颈内动脉海绵窦瘘（ICCF）诊断中的价值。方法回顾性分析我院经血管内栓塞治疗成功的ICCF共16例,所有患者均经64层螺旋CT及DSA检查。结果 CT主要表现：所有患者患侧眼球突出、海绵窦扩大、眼上静脉扩张,部分患者眼下静脉、内眦静脉、面静脉、小脑半球上表面外侧脑膜静脉扩张,岩上、下窦扩张,眼外肌肿胀,眼球壁增厚。利用高级血管处理软件显示直接型瘘10例,间接型瘘6例。结论 64层螺旋CT克服了常规CT对颈动脉海绵窦瘘直接征象的显示并不满意的弱点,可清楚显示颈动脉海绵窦瘘瘘口的位置和大小,同时可以有效地评价Willis环的功能,可为颈动脉海绵窦瘘的诊断、治疗及疗效评价提供有价值的信息。     

颈动脉海绵窦瘘23例疗效探讨

目的总结23例颈动脉海绵窦瘘﹙CCF﹚的临床诊治经验并探讨治疗策略。方法回顾性分析23例各种类型CCF的诊治体会,患者:Barrow分型A型14例、B型1例、C型1例、D型7例。结果20例经动脉入路,2例静脉入路,1例放弃栓塞治疗。9例采用单纯球囊行瘘口栓塞,5例直接行患侧颈内动脉和瘘口闭塞;5例采用NBCA胶栓塞瘘口;1例采用明胶海绵颗粒部分栓塞联合颈动脉压迫治疗;2例采用弹簧圈海绵窦内栓塞;1例单纯采用颈动脉压迫治疗。21例痊愈,2例好转。结论CCF具有复杂性、难治性特点,血管内治疗应作为主要治疗手段。     

少见类型颈内动脉海绵窦瘘血管内治疗四例

颈动脉海绵窦瘘(carotid-cavemous fistula，CCF)以外伤性颈内动脉一海绵窦瘘多见，其诊断和介入治疗已不成问题。但复杂、少见的CCF诊断与治疗往往很困难。我院近年来收治了4例特殊的创伤性CCF。现就其诊断和治疗报告如下。     

睾丸畸胎瘤的彩色多普勒超声表现及其诊断价值

目的探讨睾丸畸胎瘤的彩色多普勒超声表现及其诊断价值。方法回顾性分析经病理证实的11例睾丸畸胎瘤的二维声像图,彩色多普勒及脉冲多普勒频谱特征。结果在11例睾丸畸胎瘤中,恶性畸胎瘤2例(18%),良性畸胎瘤9例(82%)。本组睾丸畸胎瘤超声表现共同特征是:患侧睾丸增大,内部可见实质性或混合性回声团。彩色多普勒超声显示睾丸恶性畸胎瘤内部及周边血流信号丰富,杂乱,动脉血流频谱(PSV:6～7cm/s,RI:0.34～0.37),睾丸良性畸胎瘤内部及周边无或偶见点状血流信号。结论彩色多普勒超声诊断睾丸畸胎瘤具有较高的准确性,是诊断睾丸畸胎瘤的主要方法。     

睾丸精原细胞瘤的彩色多普勒超声表现及其诊断价值

目的探讨睾丸精原细胞瘤的彩色多普勒超声表现及其诊断价值。方法回顾性分析经病理证实的23例睾丸精原细胞瘤的二维声像图,彩色多普勒及脉冲多普勒频谱特征。结果在23例睾丸精原细胞瘤中,外生肿块型8例,内生肿块型11例,弥漫浸润型4例。本组睾丸精原细胞瘤超声表现共同特征是：显示患侧睾丸增大,内部可见实质性回声团,彩色多普勒超声显示睾丸精原细胞瘤内部及周边血流信号丰富、杂乱、动脉血流频谱,收缩期最大峰值流速（PSV）为11～23 cm/s,阻力指数（RI）为0.34～0.57。结论彩色多普勒超声在诊断睾丸精原细胞瘤中起重要作用,应作为诊断本病的主要方法。     

彩超检测双侧椎动脉血流总量诊断椎基底动脉供血不足的价值

目的应用彩色多普勒超声检测双侧椎动脉血流总量(S-BFV)为诊断椎基底动脉供血不足(VBI)提供可靠的量化依据。方法应用彩色多普勒超声检测VBI组51例,VBI伴颈动脉硬化组33例及健康对照组84例的S-BFV,均做配对t检验。结果 VBI组、VBI伴颈动脉硬化组与对照组的S-BFV有显著差异(P<0.001),但VBI组与VBI伴颈动脉硬化组之间无显著性差异(P>0.05)。结论彩色多普勒超声检测S-BFV可作为VBI的量化诊断依据。     

彩色多普勒超声在监测自体动静脉内瘘中的应用价值

目的探讨彩色多普勒超声对慢性肾功能衰竭患者自体动静脉内瘘的监测作用。方法应用彩色多普勒超声检查41例慢性肾功能衰竭患者动静脉内瘘的功能。结果 41例慢性肾功能衰竭患者17例动静脉内瘘血流通畅,血液透析量达标;24例出现并发症:局部血栓形成未完全闭塞4例(头静脉侧3例,瘘口处1例),完全闭塞9例(瘘口处闭塞7例,头静脉侧闭塞2例),栓塞后再通2例,狭窄6例(瘘口处狭窄5例,流出静脉狭窄1例),假性动脉瘤1例,静脉瘤样扩张2例。根据检查结果,采取相应的临床措施(内瘘重建术,溶栓等)取得满意的效果。结论彩色多普勒超声能够快速、准确地判断慢性肾功能衰竭患者动静脉内瘘的通畅情况,有无并发症,为临床及时治疗提供科学依据。     

可脱球囊栓塞术在海绵窦瘘治疗中的应用 (附 2 7例报告 )

目的　研究微导管可脱球囊技术治疗海绵窦瘘的临床意义。方法 :2 6例外伤性颈内动脉海绵窦瘘 (TCCF)患者和 1例大脑前动脉 (A1段 )动脉瘤破裂合并海绵窦瘘患者采用微导管可脱球囊技术进行栓塞治疗 ,以经颅多普勒 (TCD)进行复查 ,所有患者均随访 6月以上。结果 :2 2例CCF患者均成功栓塞瘘口并保持颈内动脉通畅 ,其中 2 0例为一次栓塞成功 ,2例因球囊过早泄漏而行 2次栓塞治疗。对 1例A1段动脉瘤破裂合并海绵窦瘘患者成功施行了双球囊动脉瘤颈孤立术。 4例行颈内动脉闭塞术。本组病例未发生严重并发症。结论 :微导管可脱球囊技术是对海绵窦瘘的一种微创、安全、有效的治疗方法。     

Ultrasonographically predicting the extent of collateral flow through superficial temporal artery-to-middle cerebral artery anastomosis

BACKGROUND AND PURPOSE: This study was performed to elucidate whether the extent of bypass flow through superficial temporal artery-to-middle cerebral artery (STA-MCA) anastomosis could be indirectly estimated by measuring the blood flow velocity in the superficial temporal artery (STA) by using duplex ultrasonography. METHODS: We analyzed 29 patients (31 sides) who underwent STA-MCA bypass surgery for occlusive cerebrovascular disease (28 sides) or unclippable cerebral aneurysm that required therapeutic occlusion of the internal carotid artery (three sides). The flow velocities of the STA were measured by using ultrasonography. For patients who underwent the surgery unilaterally, the flow velocity ratios of the operated side to the contralateral side for the individual arteries were calculated. The correlation between these flow velocity parameters and the extent of bypass flow, which was graded based on the findings of cerebral angiography, was investigated. RESULTS: Both the affected STA flow velocity and the STA flow velocity ratio, particularly those in the end diastole, increased in patients with more extensive bypass flow. In patients with extensive, moderate, and poor bypass flow, the end diastolic flow velocities of the operated STA were 27.4 +/- 8.8, 23.0 +/- 7.8, and 13.5 +/- 7.5 cm/s, respectively and the end diastolic flow velocity ratios of the STA were 3.4 +/- 0.8, 2.1 +/- 0.5 and 1.3 +/- 0.4, respectively. The pulsatility index and resistance index of the affected STA were significantly lower in the patients with more extensive bypass flow. The optimal threshold value of the end diastolic flow velocity ratio of STA for the group with extensive bypass flow was 2.75, whereas that for the group with poor bypass flow was 1.60. With the obtained values, the sensitivity and specificity were 87.5% and 93.9% for the group with extensive bypass flow and 95.2% and 95.0% for the group with poor bypass flow, respectively. CONCLUSION: The blood flow velocity in the operated STA seems to be a highly sensitive parameter for predicting the extent of bypass flow in patients undergoing STA-MCA anastomosis.     

The detection of intracranial carotid artery disease by continuous-wave Doppler sonography

Summary We have investigated 6,587 patients with directional continuous-wave (c-w) Doppler sonography of the carotid arteries during the last 33 months, and have developed criteria for the diagnosis of a significant increase in peripheral resistance of the internal carotid artery in conjunction with 1,671 retrograde brachial and direct carotid angiograms. We distinguished stenoses proximal (15 cases) and distal (4) to the origin of the ophthalmic artery, supraclinoid internal carotid artery occlusions (8), stenoses (2) and acute occlusions (10) of the middle cerebral artery. Stenoses in the carotid siphon (proximal or distal to the origin of the ophthalmic artery) of at least 60% reduction in lumen diameter showed a reduction of the relative end-diastolic flow velocity (modified Pourcelot's index) of more than 40%; additionally, stenoses proximal to the origin of the ophthalmic artery exhibited a variable alternating flow, or flow reversal, in the supratrochlear artery. Stenoses distal to the origin of the ophthalmic artery rarely revealed the theoretically expected increase in orthograde flow velocity in the supratrochlear artery. Stenoses of the middle cerebral artery consisting of more than atherosclerotic irregularities proved to be an exception. Supraclinoid occlusions of the internal carotid artery were reliably demonstrated by Doppler sonography. However, the majority of acute occlusions of the middle cerebral artery could not be detected by this means, probably due to anastomoses between the anterior and the middle cerebral arteries, which were detected by angiography. Thus, we believe that c-w Doppler sonography is a reliable tool to detect stenoses of the carotid siphon of more than 60% reduction in lumen diameter and supraclinoid carotid artery occlusions. Barriers to the cerebral blood flow located more peripherally cannot be diagnosed reliably with this technique.     

高频彩色多普勒超声在乳腺肿瘤诊断中的应用价值

目的探讨高频彩色多普勒超声对鉴别乳腺良恶性肿块的应用价值。方法对86例经手术病理确诊的乳腺疾病患者（56例良性,30例恶性）进行术前彩超检查,对比性分析了两组间高频声像图、彩色多普勒血流成像（CDFI）、病灶内血流Adler分级、阻力指数（RI）、峰值流速（PSV）的差异。结果乳腺良恶性肿块声像图鉴别以肿块边界及形态特征最重要,彩色多普勒显示乳腺癌内的血流较良性肿块明显丰富（P〈0．05）,乳腺癌的血管分布异常、频谱多普勒示肿块内动脉血流PSV、RI也是显著高于良性肿块且有显著性差异（P〈0．05）。结论综合分析和评价血流Adler分级及频谱多普勒各项血流动力学参数（PSV,RI）指标,有助于对乳腺良恶性肿块的鉴别。     

The cerebral circulation in cases of carotid cavernous fistula

Summary Ten patients with carotid cavernous fistula (CCF) were reviewed. Single photon emission computed tomography (SPECT) for regional cerebral blood flow (rCBF) study was performed in six patients with fast flow shunt. Five of these six patients with fast flow shunt angiographically demonstrated cortical venous drainage, and two of these patients suffered intracerebral hemorrhage. The rCBF decreased in the region demonstrating the cortical venous drainage in five patients, and in one patient the angiography demonstrated arterial steal and the rCBF decreased in a part of the ipsilateral cerebral hemisphere. SPECT proved to be useful in assessing the cerebral circulation in cases of CCF.