超声多普勒功率及其在检测颅内血流分布上的应用

本文结合背向散射超声多普勒信号模型对超声多普勒功率的概念及其特性进行了阐述，并提出了一种用超声多普勒功率来检测颅内血管血流分布的方法。实验结果证明，该方法能在噪声背景下灵敏准确地反应沿声束指向一维空间各个位置是否存在血流以及血流强度的大小。这一方法已被用于经颅多普勒（ＴＣＤ）脑血流分析仪中，解决了现有经颅多普勒检查时只能凭经验盲目搜寻颅内血管的问题，并提供了颅内血管分布的相对位置信息以帮助临床医生更方便准确地判定所检测的是哪一根血管。     

Doppler developments in the last quinquennium

The major advances which have taken place during the last five years in the development of ultrasonic Doppler devices and methods of Doppler signal analysis are reviewed. The following aspects of instrumentation are considered: crossed beam Doppler systems, range measuring Doppler systems, duplex systems, flow mapping systems, transducers and measurements of system performance. Analytical methods are discussed in the following categories: waveform analysis, including the extraction of single-value waveforms and their applications to the diagnosis of vascular disease; spectral analysis, including the derivation of frequency spectra and their application in the study of blood flow; and volume flow estimation. It is concluded that it is likely to be in the study of the information in Doppler frequency spectra, two-dimensional real-time Doppler images and in the measurement of blood flow volume that most progress will be made.     

彩色及脉冲多普勒判断乳腺肿块性质的价值

目的探讨彩色及脉冲多普勒判断乳腺肿块性质的价值。方法应用彩色及脉冲多普勒检查经手术病理证实的恶性乳腺肿块５９例,良性乳腺肿块４０例,分析与比较两者的多普勒血流频谱。结果①直径＜２ｃｍ的恶性肿块彩色血流信号检出率（９４７％）高于良性肿块（１２５％）（χ２＞３８４）。②直径≥２ｃｍ的恶性肿块彩色血流信号检出率（９５％）,高于良性肿块（７０８％）（χ２＞３８４）。③良恶性肿块动脉频谱峰值流速分别为１９９±１８３ｃｍ／ｓ、２６１±１４６ｃｍ／ｓ（Ｐ＞００５）,良恶性肿块动脉频谱阻力指数分别为０６７±０１２、０７１±０１１（Ｐ＞００５）。④７３７％出现彩色血流信号的良性肿块内可探及静脉型血流频谱,恶性肿块内未能探及静脉型血流频谱。结论在直径＜２ｍｍ的乳腺肿块内探及血流信号以恶性可能性大。直径≥２ｃｍ的良性肿块彩色血流显示率经统计学处理低于恶性肿块,考虑到良性肿块血流信号显示率已达７０８％,因此难于以此作为判断肿块性质的条件。动脉频谱峰值流速及阻力指数无助于肿块性质的判断。但是,静脉型血流频谱只在良性肿块内探及,对此应引起我们的重视。     

硫酸氢氯吡格雷治疗68例2型糖尿病患者下肢动脉病变的疗效观察

目的 观察硫酸氢氯吡格雷片治疗68例2型糖尿病患者下肢动脉病变的疗效。方法通过下肢血管彩超和踝肱比（ABI）测量明确有下肢动脉病变的2型糖尿病患者98例,随机分为硫酸氢氯吡格雷组（68例）,阿司匹林组（30例）,分别给与硫酸氢氯吡格雷75mg,1次／d,阿司匹林肠溶片75mg,1次／d,共6个月。观察治疗前后2型糖尿病患者下肢动脉病变的症状、股动脉、胭动脉、足背动脉的内径、血流速度和ABI的变化。结果硫酸氢氯吡格雷治疗组总有效率81．38％,阿司匹林治疗组总有效率52．24％,2组疗效差异具有显著性。治疗中无严重不良反应发生。硫酸氢氯吡格雷治疗组2型糖尿病患者胭动脉、足背动脉的内径增大,血流速度增加;ABI明显升高,差异均具有显著性。阿司匹林治疗组2型糖尿病患者胭动脉、足背动脉内径增大,血流速度有所增加,ABI有所升高,但差异无显著性。结论硫酸氢氯吡格雷通过对血小板聚集的影响,能明显改善2型糖尿病患者下肢动脉的血流,可用于2型糖尿病下肢动脉病变的治疗。     

A Rotating Cylinder Phantom for Flow and Tissue Color Doppler Testing

Ultrasound Doppler using two-dimensional (2D) techniques is commonly used to study blood flow and myocardial tissue motion. This use includes measurement of velocity and time intervals, often in relation to the electrocardiogram (ECG) signal. 2D Doppler is frequently considered a real-time technique but in reality the acquisition time can be as long as 200 ms per image. We have developed a test-phantom using a rotating cylinder to simulate blood flow and tissue motion in a whole sector or space angle to evaluate velocity and timing characteristics. The phantom can produce constant velocities for velocity testing, as well as accelerating movement for testing the timing characteristics of ultrasound systems. Our investigation shows that the cylinder phantom is especially suitable for timing measurements in 2D Doppler imaging and that time delays between the Doppler signals and the ECG signal exist in the tested ultrasound system. (E-mail: andrew.walker@ltv.se)     

超声心动图多种参数在评价高血压病心室功能中的比较

目的探讨高血压病患者心室功能的改变,比较不同超声参数评价高血压心室功能的价值.方法采用脉冲及组织多普勒超声方法对轻中度高血压患者的左、右心室功能进行了评价.结果高血压病早期右心室舒张功能即出现显著性改变,而收缩功能早期变化不明显.右心室舒张功能的改变要早于收缩功能的改变,右心室收缩功能的改变亦早于左心室.结论脉冲多普勒和组织多普勒超声均能准确评价高血压病心室功能的变化,二者具有较高的一致性.     

Evaluation of breast tumors with color Doppler imaging: A comparison with image-directed Doppler ultrasound

Doppler ultrasound is an adjunct to other imaging modalities in differentiating benign from malignant breast tumors. Two groups of patients with breast nodules were examined using a 10/4.5 MHz (imaging frequency/pulsed Doppler frequency) image-directed Doppler probe and a 7.0/5.0 MHz color Doppler imaging probe, separately. Whenever flow signals were detected within or at the margin of the breast nodule, the lesion was considered to be malignant. In detecting malignant breast tumors, the sensitivity was 77.3% and 94.5%, specificity 83.3% and 40.1%, accuracy 81% and 63.4% for image directed Doppler and color Doppler imaging, respectively. We found color Doppler to be easier and more efficient in detecting the flow signals of neovascularity in breast tumor. Color Doppler exhibits a higher sensitivity in detecting the malignant breast tumors. However, more false-positive diagnoses were made. Color Doppler ultrasound also expedited the examination, and the whole procedure could be shortened from 35 minutes to 8 minutes compared with our previous examination performed by image-directed Doppler ultrasound. Due to its higher sensitivity and saving in examination time, we use color Doppler imaging as a routine procedure when solid lesions are observed in x-ray mammography or sonography, as a supplement to the diagnosis of breast tumors. © 1995 John Wiley & Sons, Inc.     

Noninvasive in vivo measurements of hematocrit.

OBJECTIVE: To develop a clinically applicable method for noninvasive acoustic determination of hematocrit values in vivo. METHODS: The value of hematocrit was determined initially in vitro from the pulseecho measurements of acoustic attenuation. The testing was carried out in a laboratory setup with an ultrasonic transducer operating at 20 MHz and with the use of human blood samples at 37 degrees C. The attenuation coefficient measurements in blood in vivo were implemented by multigated, 20-MHz pulsed Doppler insonation. The Doppler signal was recorded in the brachial and radial arteries. Both in vitro and in vivo hematocrit data were compared with those obtained by the centrifuge method. RESULTS: The attenuation coefficient in vitro was determined from the measurements of 168 samples with hematocrit values varying between 23.9% and 51.6%. The attenuation from 20-MHz data was equal to 3.66 + 0.089 hematocrit (decibels per centimeter). The uncertainty of in vivo measurements in the brachial artery was determined to be within +/- 5% hematocrit. However, the measurements in the radial artery resulted in a clinically unacceptable uncertainty of +/- 20% hematocrit. CONCLUSIONS: The method proposed appears to be promising for in vivo determination of hematocrit, because 5% hematocrit error is adequate for monitoring changes in patients in shock or during dialysis. It was found that the multigate system largely simplified placement of an ultrasonic probing beam in the center of the blood vessel. Current work focuses on enhancing the method's applicability to arbitrarily selected vessels and to reducing the hematocrit measurement error to much less than 5% hematocrit.     

超声对布-加综合征的诊断价值

目的探讨灰阶与彩色多普勒、频谱多普勒及能量多普勒超声对布-加综合征的诊断价值。方法对38例经下腔静脉造影和／或经手术证实的布-加综合征患者的超声影像资料进行分析总结。结果38例布-加综合征患者中，超声确诊36例，漏诊2例，诊断准确率95％，与行下腔静脉造影相比，二者诊断准确率无显著性差异（P〉0．05）。其中下腔静脉型23例，肝静脉型5例，混合型10例。结论灰阶超声结合彩色多普勒、频谱多普勒、能量多普勒超声对布-加综合征的诊断符合率高，对临床治疗方式的选择具有重要意义。     

能量多普勒显像与彩色多普勒显像显示血管内径准确性的实验比较

目的：比较能量多普勒显像（ＰＤＩ）和彩色多普勒血流显像（ＣＤＦＩ）显示离体模拟血流血管内边界的准确性。方法：在０．４ｍｍ、３ｍｍ和８ｍｍ内径的硅胶管中模拟低速血流,分别用二维超声（２ＤＵＳ）、ＣＤＦＩ及ＰＤＩ进行显像,准确测量各显像模式中各血管的血管内径或彩色血流直径。结果：①、２ＤＵＳ测量的各种血管内径与实际内径均无明显差别（Ｐ＞０．０５）;②、ＰＤＩ在０．４ｍｍ内径血管的血流显示中,ＰＤＩ血流直径比２ＤＵＳ的血管内径大２．４倍（Ｐ＜０．０１）;在３ｍｍ和８ｍｍ内径血管,ＰＤＩ血流直径与２ＤＵＳ的血管内径无明显差异（Ｐ＞０．０５）;③、在三种内径血管显示中,ＣＤＦＩ血流直径均明显大小ＰＤＩ血流直径（Ｐ＜０．０１）,且血流前后径明显大于血流横径（Ｐ＜０．０１）。结论：ＰＤＩ用血流直径代表血管内径的准确性明显高于ＣＤＦＩ,尤其在较粗的血管中,ＰＤＩ血流直径能准确反映血管内径。     

令人费解的组织多普勒超声心动图

目的文献报道组织多普勒超声心动图(TDE)能获得潜在的临床利益,TDE已经被认为是有用的心肌功能定量工具。本文通过TDE的临床应用、TDE技术分析,探讨TDE的实际临床价值。方法随机选择28例各种不同类型心脏病患者,平均年龄(41±18)岁,男性17例,女性11例,均为窦性心律,采用彩色TDE技术记录心尖四腔心切面图像3个心动周期,使用连机的软件分别将取样容积放置在基底段室间隔、房间隔下段和上段房间隔附近的右房腔内,通过调整取样容积的位置,尽量获得这3个位置速度和时相相似的组织多普勒运动曲线,在同一时相测量这些曲线的收缩期和舒张期峰速度。结果心尖四腔心切面基底段室间隔、房间隔下段和上段房间隔附近的右房腔内TDE收缩期峰速度分别为(4.95±1.41)cm/s、(4.52±1.58)cm/s和(4.65±1.61)cm/s,收缩期峰速度之间的差异无统计学意义(P>0.05)。舒张期峰速度分别为(-5.75±2.23)cm/s、(-5.78±2.27)cm/s和(-5.41±2.47)cm/s,舒张期峰速度之间的差异无统计学意义(P>0.05)。结论在心尖四腔心切面,通过调整TDE取样容积在基底段室间隔、房间隔下段和上段房间隔附近的右房腔内,能获得速度和时相相似的TDE信息。无论是理论上还是在直接的二维超声图像上都不能接受的这一结果。TDE可能提供令人费解的信息,是一种令人失望的技术,包括TDE衍生的应变、应变率显像。多普勒最适合于血流的研究,应用于心肌组织运动是不可接受的。     

Christian doppler and the influence of his work on modern medicine

Wiener klinische Wochenschrift -     

彩色多普勒联合脉冲多普勒诊断小肝癌的研究

本文就经手术及/或病理证实的≤3cm的肝内占位性病变56例(71个病灶)进行了彩色多普勒(DCFI)和脉冲多普勒(PD)的联合研究,其中原发性肝癌38例,肝血管瘤13例,肝局灶凝固性坏死3例,其它2例。DCFI与PD联合应用,在小肝癌中有86.96％可检测到动脉谱,而肝血管瘤和肝良性肿瘤组中仅分别为37％和33％,显著低于小肝癌组,多普勒流速和阻力指数(RI)显示流速在小肝癌与肝血管瘤等组之间无显著差异,如以肝小病灶内出现彩条并且测及动脉谱和RI>50％作为诊断小肝癌的指标,则其诊断小肝癌的特异性(96％)、准确性(90.14％)均显著高于单纯的二维超声(分别为56％和67.6%),而敏感性(86.96%)亦高于单纯的二维超声。作者认为彩色多普勒和脉冲多普勒联合应用可作为小肝癌诊断的新的手段。     

门脉海绵样变的彩色多普勒超声诊断

目的：研究彩色多普勒在门脉海绵样变诊断中的应用,提高诊断的正确性。方法：对35例门静脉海绵燕变进行了彩色多普勒检查,先用两维图像显示肝门部结构、门脉主干及分支,以及周围侧枝血管回声,再用彩色多普勒显示血流方向、颜色。结果：根据形态学及超声表现可将门脉海绵样变分为三型：I型为肝外型;Ⅱ型为肝内型;Ⅲ型为肝内肝外型。门脉海绵样变的二维超声主要表现为：肝内外门静脉分支及主干狭窄或部分狭窄、闭塞,在其周围形成蜂窝状无回声区,门脉管壁回声增强,增厚,彩色多普勒超声显示血流呈红蓝相间,频谱多普勒显示门静脉血流呈毛刺状,为低速、平坦的血流流速曲线。结论：彩色多普勒血流显像对门脉海绵样变的诊断具有很高的准确性,是诊断门脉海绵样变的重要手段。     

Improved transverse flow estimation using differential maximum Doppler frequency

Conventional Doppler technique can only provide the axial component of the blood flow vector, which is actually a three dimensional (3-D) quantity. To acquire the complete flow vector, estimations of the other two velocity components are essential. For the two dimensional (2-D) Doppler-bandwidth-based transverse estimation, however, accuracy is generally limited because of the complex dependence of the Doppler spectral shape on the flow variation within the sample volume. Two factors that may lead to the Doppler spectral change were considered in this study. One is the position offset of the sample volume and the other is the length of the sample volume. Simulations were performed and experimental data were also collected. Results indicate that the position offset may result in severe underestimation of Doppler shift frequency. Consequently, Doppler bandwidth is overestimated when it is determined by the difference between Doppler shift frequency and maximum Doppler frequency. Compared with the position offset, influence of the length of sample volume on the Doppler bandwidth is minor. To overcome this problem, a novel method, which is based on the differential maximum Doppler frequency, is proposed. Specifically, two beams with different beam widths are simultaneously generated to observe the blood flow and the difference between the corresponding maximum Doppler frequencies is used to estimate the transverse velocity. It is demonstrated that the accuracy and stability of transverse estimation are significantly improved by the proposed method even when the position offset is present.     

彩色多普勒与经颅彩色多普勒联合检测椎动脉全段

目的　观察椎动脉全程及血流动力学改变。方法　应用彩色多普勒及经颅彩色多普勒联合检测椎动脉 (VA)全段 ,观察内膜、频谱形态 ,测其内径、血流速度及阻力指数。结果　 (1)检出率 :椎动脉第 1段 (VA1 ) 10 0 % ,椎动脉第 2段 (VA2 ) 10 0 % ,椎动脉第 3段 (VA3) 75 % ,椎动脉第 4段(VA4 ) 98% ;(2 )内径 :VA1 >VA2 ,左侧 >右侧 ;(3)双峰型或三峰型低阻力性频谱 ;(4 )血流速度 :VA4 最快 ,VA1 >VA2>VA3,左、右侧无明显差异 ;(5 ) RI:VA1 >VA2 >VA3>VA4 ,左、右侧无明显差异。结论　彩色多普勒 (CDFI)及经颅彩色多普勒 (TCD)联合应用 ,可观察 VA内径、走向及血流动力学变化 ,为不同段 VA改变所造成的临床症状提供一定的依据。     

健康志愿者肌腱端高频和彩色多普勒超声表现

目的　了解健康志愿者肌腱端 (Enthesis)的声像表现 ,初步探讨超声用于肌腱端检查的可行性及肌腱端声像表现的可能影响因素。方法　以高频和彩色多普勒超声检查 3 0例健康志愿者下肢共 540个肌腱端 ,对发现骨面异常者行 χ-线检查对照。结果　正常肌腱端表现为均匀的稍低回声 ,内见清晰的条索状纤维回声 ;多数见包膜回声稍高 ,与周围分界清楚 ,其内无血流信号 ,肌腱端骨面光滑连续。男性肌腱端厚度较女性大 (P<0 .0 5)。有 8例志愿者的 11个肌腱端 (占总肌腱端数的 2 .0 % )发现钙化、骨质缺损、骨质增生或血流增加 ,总计为 15项异常 ,部分异常部位有外伤史。结论　男性肌腱端厚度较女性明显 ,身高、体质量及运动可能影响肌腱端厚度 ;外伤可致肌腱端声像异常 ;超声可作为肌腱端检查的一种有效手段     

彩色多普勒血流与彩色多普勒能量对高眼压血流动力学研究

应用彩色多普勒能量图（ＣＤＰＩ）及彩色多普勒血流图（ＣＤＦＩ）对２８只青光眼和３０只正常眼分别检测眼动脉、视网膜中央动脉和睫状动脉。结果表明：彩色多普勒能量图及彩色多普勒血流图对青光眼血流病理改变均有较高的敏感性，对早期诊断及病情变化预测具有重要价值。文中结果还提示ＣＤＰＩ较ＣＤ－ＦＩ敏感度高、准确性好