Doppler ultrasonography findings in ocular Behçet's disease

The aim of this prospective study was to determine and compare the orbital Doppler ultrasonography parameters of patients with Behçet's disease (with or without ocular involvement) with those of healthy subjects. We evaluated ophthalmic artery (OA), central retinal artery, posterior ciliary artery (PCA), central retinal vein, and superior ophthalmic vein (SOV) flow velocities and resistance indices (RIs). Detection of the decreased flow velocities in the OA and SOV and the increased RI in the OA and PCA might allow the identification of active period of patients with Behçet's disease.     

Optic neuritis: evaluation with orbital Doppler sonography

PURPOSE: To evaluate orbital blood flow velocities with Doppler sonography in patients with acute unilateral optic neuritis. MATERIALS AND METHODS: Orbital Doppler sonography was performed in 20 patients with acute unilateral optic neuritis. Optic neuritis was diagnosed by a neurologist on the basis of clinical presentation, presence of decreased visual acuity, and assessment of visual evoked potentials. The peak systolic and end diastolic velocities and the resistive index were measured in the ophthalmic and central retinal arteries of both orbits. The values obtained from affected and unaffected orbits were compared by using the paired t test. RESULTS: The peak systolic and end diastolic velocities in the ophthalmic artery were significantly increased in the affected orbits (for peak systolic velocity P <.001, for end diastolic velocity P <.05). Resistive indexes in the ophthalmic arteries did not differ (P >.05). The difference between the peak systolic and end diastolic velocities and resistive indexes in the central retinal arteries of affected and normal eyes was not statistically significant (P >.05). CONCLUSION: Peak systolic and end diastolic velocities in the ophthalmic artery are increased in patients with acute optic neuritis.     

彩色多普勒超声对缺血性视乳头病变早期血流动力学的研究

目的:探讨缺血性视乳头病变早期患者眼血流动力学变化。材料和方法:应用彩色多普勒血流成像(CDFI)技术检测40例患者与36例健康志愿者眼动脉、视网膜中央动脉、睫状后动脉收缩峰值速度(PSV)、舒张末期流速(EDV)、阻力指数(RI)及视网膜中央静脉最大流速(Vmax)。结果:与正常组比较,患者组眼动脉PSV无显著差异(P>0．05), EDV减低、RI增高(P<0．05);视网膜中央动脉PSV、EDV减低,RI增加(P<0．05);睫状后动脉PSV、EDV明显减低, RI明显增加(P<0．01);视网膜中央静脉Vmax减低(P<0．05)。结论:CDFI可评估缺血性视乳头病变早期眼血流动力学变化,为临床提供诊断信息。     

彩色多普勒对糖尿病患者眼底血管血流动力学研究

目的:研究糖尿病患者眼底血管的血流动力学改变。方法:采用彩色多普勒技术对30例正常人和90例糖尿病患者视网膜中央动脉(CRA)、视网膜中央静脉(CRV)和眼动脉(OA)的血流参数进行检测。结果:糖尿病患者CRA血流速度较对照组降低(P<0.05),以舒张期末血流速度(Vd)降低为显著(P<0.01),阻力指数(RI)比对照组增高(P<0.05);CRV血流速度较对照组升高(P<0.05),CRA/CRV比值降低;OA收缩期峰值血流速度(Vs)和舒张期末血流速度(Vd)比对照组均降低(P<0.05),以Vd降低明显(P<0.01),RI比对照组显著增高(P<0.01)。糖尿病合并增殖性视网膜病变的患者(C组),收缩期峰值血流速度(Vs)、平均血流速度(Vmean)比糖尿病无视网膜病变患者(A组)降低(P<0.05)。结论:糖尿病患者眼底血管的血流动力学异常,对糖尿病视网膜病变的早期诊断、防治有重要意义。     

Embolization of extensive facial arteriovenous malformation via the orbital branches of the ophthalmic artery

Facial arteriovenous malformation (AVM) occasionally involves the orbit, and surgery for the orbital portion is complicated by its hypervascularity. We successfully embolized the orbital branches of the ophthalmic artery to decrease intraoperative bleeding of a facial AVM, sparing the ocular branches. There has been only one report dealing with embolization of the orbital branches of the ophthalmic artery.     

Effect of an internal carotid stenosis on orbital blood velocity.

PURPOSE: To examine how an internal carotid artery (ICA) stenosis influences the orbital blood velocity and to determine which velocity parameters are most useful. MATERIAL AND METHODS: The study group comprised 94 randomly selected patients examined with orbital US; most of the patients had a carotid artery stenosis. There were 58 men and 36 women, ranging in age from 22 to 88 years with a mean age of 63.1 years. The ICA stenosis grade was determined with carotid US. Peak systolic (Vp) and end-diastolic blood velocities, systolic acceleration, mean velocity, pulsatile index (PI) and resistance index (RI) were measured within the central retinal artery (CRA) and the ophthalmic artery (OA), and peak velocity was measured within the central retinal vein (CRV). The area under the ROC curve was used to compare the outcome of diagnostic tests. RESULTS: Only a severe (> or =80%) ICA stenosis decreased orbital blood velocity significantly, while milder stenoses did not cause significant flow decrease or side differences. According to ROC curve analysis, the threshold values giving the highest accuracy in detecting a > or =80% ICA stenosis were Vp < or =0.08 cm/s for the CRA and Vp < or =0.14 cm/s for the OA. The sensitivities for detecting a > or =80% ICA stenosis were 45% for Vp CRA and 60% for Vp OA. Systolic acceleration also decreased in severe stenoses, but RI, PI and velocity in the CRV did not correlate with ICA pathology. Reversal of OA flow was seen in 92% of ICA occlusion and in 47% of severe ICA stenosis. CONCLUSION: Orbital Doppler combined with carotid Doppler can be helpful in the diagnosis of the ocular ischaemic syndrome and in the evaluation of whether the symptoms are related to occlusion of the ophthalmic or central retinal vessels or are a consequence of carotid artery stenosis.     

Investigation of the effect of exhaust particles on ocular blood flow in highway toll collectors using color Doppler ultrasonography

PURPOSE: To investigate the effect of exhaust particles on orbital blood flow velocity of the ophthalmic artery, central retinal artery, and posterior ciliary artery by color Doppler ultrasonography in highway toll collectors. MATERIAL AND METHODS: Color Doppler imaging was used to measure the peak-systolic and end-diastolic flow velocities and resistivity indices of the ophthalmic artery, central retinal artery, and posterior ciliary artery in 20 toll collectors and 20 controls. RESULTS: Both the peak-systolic and the end-diastolic flow velocities were decreased in the ophthalmic artery, central retinal artery, and posterior ciliary artery, and the resistivity index was increased in the central retinal artery in toll collectors when compared with control groups. Results were considered statistically significant if P<0.05. CONCLUSION: It was determined that the effect of exhaust particles reduced ocular blood flow velocity in toll collectors as measured by color duplex Doppler ultrasonography.     

眼眶血管瘤的影像学诊断(附41例报告)

目的:作者报告眼眶血管瘤的影像诊断与分型,以帮助临床及时诊断和治疗,提供可靠依据。材料和方法:对经X线、B超、CT检查、手术病理证实的眼眶血管瘤41例影像表现,作了回顾性的分析,并进行了分型。结果:41例眼眶血管瘤的影像表现:1、眼眶扩大5例,眼眶周围及眶内软组织肿块密影,大小不等;2、眼静脉造影可见内眦静脉或上眼静脉增粗,血管瘤引流血管显示;3、眼底荧光血管造影见视网膜血管迂曲、扩张,血管团影;4、B超表现为回声稍强光团或低回声光团;5、CT表现为眼球凸出,球后肿块密影呈园形、椭园型,增强扫描有较明显强化。作者根据本组41例血管瘤的影像学表现与手术所见,把眼眶血管瘤按发生部位和范围分为二型:即局限型和弥漫型。局限型血管瘤又分为,(1)限脸皮下血管瘤;(2)球后眶内血管瘤;(3)球结膜血管瘤;(4)视网膜血管瘤;(5)脉络膜血管瘤。结论:分型有利于临床治疗。     

Normative measurements of orbital structures using MRI

PURPOSE: The purpose of this work was to establish criteria for the diameters of normal extraocular muscles and superior ophthalmic vein and width of the optic nerve-sheath complex, to determine normal globe position as seen on MRI, and to investigate the effects of age and sex on these structures. METHOD: Diameters of the extraocular muscles and superior ophthalmic vein, width of the optic nerve-sheath complex, and distance from the interzygomatic line to the posterior margin of the globe were calculated for 200 normal orbits of 100 patients on T1-weighted MR scans. RESULTS: Normal ranges for diameters of the extraocular muscles were as follows (mean +/- 2 SD): medial rectus, 3.2-4.9 mm; lateral rectus, 2.6-4.8 mm; inferior rectus, 3.7-6.0 mm; superior group, 3.1-5.6 mm; superior oblique, 2.4-4.1 mm. The normal position of the posterior pole of the globe was 8.9 mm behind the interzygomatic line (range 5.0-12.7 mm). The mean diameters of the extraocular muscles in male patients were significantly larger than those in female patients (p < 0.001). CONCLUSION: These data may be of value in quantitatively evaluating MRI of the orbit.     

Thoracic outlet syndrome: evaluation of the subclavian vessels by color duplex sonography.

Changes in flow in the subclavian artery and vein resulting from the use of a hyperabduction maneuver during Doppler sonography in 20 volunteers were compared with retrospective findings in 16 patients clinically suspected of having thoracic outlet syndrome. Significant compression of the subclavian artery showed in the Doppler waveform as at least a doubling of peak systolic velocity or complete cessation of flow with hyperabduction; significant compression of the subclavian vein was diagnosed by complete cessation of blood flow or loss of atrial and respiratory dynamics in the waveform of the subclavian vein with hyperabduction. In volunteers, asymptomatic compression of the subclavian vein with arm abduction was seen in two (10%) and asymptomatic compression of the subclavian artery was seen in four (20%). Of the 16 patients, thrombosis of the subclavian vein was found in seven, compression of the subclavian vein with hyperabduction was found in six, and diagnoses other than thoracic outlet syndrome were established as the cause of pain in three. When duplex sonography was compared with venography, which was performed in 10 patients, one false-negative case was found because a subclavian vein thrombus had not been detected. The subclavian artery was examined in five of the six patients with positional compression of the subclavian vein; compression of the subclavian artery was found in three. The clinical significance of compression of the subclavian artery cannot be determined from our data because of the small number of patients involved. When the sonographic criteria of subclavian vein clot or compression resulting in a complete loss of normal venous phasicity with arm abduction and the clinical criterion of subsequent improvement in symptoms after curative surgery are used, color Doppler sonography is 92% sensitive and 95% specific for the diagnosis of thoracic outlet syndrome. This preliminary study shows that Doppler sonography has potential in the evaluation of thoracic outlet syndrome.     

Follow-up MRI in dural arteriovenous malformations involving the cavernous sinus: emphasis on detection of venous thrombosis

Summary Six patients with a dural arteriovenous malformation (dural AVM) involving the cavernous sinus were followed up with magnetic resonance imaging in order to assess change in the lesions. Spin-echo (SE) imaging of three patients in whom the AVM appeared to have closed at least 1 month earlier (two of them spontaneously, and one after external carotid artery embolization) showed neither apparent flow void in the involved cavernous sinus nor evidence of venous thrombosis. SE images of the other three patients who had not been cured by external carotid artery embolization (two of whom were examined within a week of treatment), detected persisting arteriovenous shunts, including high-flow cortical venous drainage, seen as flow void. Two-dimensional time-of-flight MR angiography (2D TOF MRA) was performed simultaneously in three patients. Whereas shunting blood and the normal cavernous sinus were of high intensity, presumed thrombosed cavernous sinuses were isointense with stationary brain tissue. SE imaging can confirm the resolution of arteriovenous shunts, but poorly delineates ver acute and chronic thrombosis of the draining veins. In contrast, 2D TOF MRA directly demonstrates flowing blood, permitting the diagnosis of venous thrombosis; it should be included in follow-up of a dural AVM involving the cavernous sinus when venous thrombosis is suspected.     

超声对颈动脉内膜剥除前、后颅内外血流动力学变化的评价

目的:探讨彩色多普勒血流成像(CDFI)和经颅彩色多普勒血流成像(TCCDFI)评价颈动脉内膜剥除术(CEA)治疗前、后患者颅内外动脉血流动力学的变化。方法:用CDFI和TCCDFI分别对23例颅外段颈内动脉(EICA)狭窄患者CEA治疗前、后狭窄局部管径、收缩期峰值流速(PSV)及同侧大脑中动脉(MCA)、眼动脉(OA)CEA治疗前、后PSV、搏动指数(PI)和颅内侧支循环的建立情况进行分析。结果:EICA狭窄患者CEA术后原狭窄处内径、PVS及患侧MCA、OA的PSV、PI恢复正常,侧支循环关闭。结论:CDFI与TCCDFI结合可评价颈动脉狭窄患者行CEA治疗前、后颅内外动脉的血流动力学变化,对判断CEA的疗效具有重要的临床价值。     

Value of local ophthalmic artery fibrinolysis in severe forms of central retinal vein occlusion]

PURPOSE: To assess the value of selective ophthalmic artery thrombolysis as a treatment for central retinal vein occlusion (CRVO) for which no alternative therapy is available. MATERIALS AND METHODS: Patients included in this study presented with recent severe non-ischemic CRVO. Urokinase (300,000 IU) was perfused for 40 minutes into the ophthalmic artery. Visual acuity, fundoscopy and retinal arteriovenous transit time were assessed during one year of follow-up. RESULTS: Five of the 13 patients treated experienced a marked improvement of vision (p = 0.05) and retinal perfusion within 24-48 hours, and exhibited progressive lesion regression at fundoscopy within 2-4 weeks. The clinical course of the 5 patients prior to treatment resembled that of combined central retinal artery and vein obstruction (CRAO/CRVO), which typically has a poor visual outcome. One patient relapsed 1 month after thrombolysis. No technical complications were observed. CONCLUSION: Although there was no control group, the short period between fibrinolysis and significant visual improvement combined with marked retinal perfusion improvement, suggests that local thrombolysis is beneficial for CRVO, especially recent CRAO/CRVO.     

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。     

多普勒超声在肝移植中的应用

目的: 探讨多普勒超声在肝移植中的应用价值.材料和方法: 对105例原位肝移植的患者分别于术前、术中和术后多次行彩色及频谱多普勒超声检查.结果: 20例出现排斥反应,多普勒表现为肝静脉频谱变钝,正向波消失,门静脉流速减低,肝动脉阻力指数增高.7例出现肝动脉并发症,其中2例狭窄,5例血栓形成,CDFI主要表现为肝动脉血流信号消失,肝静脉和门静脉充盈良好,经血管造影证实;CDFI发现下腔静脉狭窄1例,门静脉狭窄1例,经球囊扩张后,血流灌注恢复正常.结论: 多普勒超声对移植肝血流动力学的监测、手术中及术后并发症的早期诊断具有重要作用.     

CT observations pertinent to septic cavernous sinus thrombosis

The use of high-resolution computed tomography (CT) is described in four patients with septic cavernous sinus thrombosis. In all patients CT findings included multiple irregular filling defects in the enhancing cavernous sinus. Unilateral or bilateral inflammatory changes in the orbital soft tissues were also present. Enlargement of the superior ophthalmic vein due to extension of thrombophlebitis was noted in three patients.     

16层螺旋CT在血管病变诊断中的临床应用

目的评价16层螺旋CT血管造影(16SCTA)及重建技术在血管病变诊断中的临床应用价值。方法100例血管病变行16SCTA,采用准直0.75 mm,层厚1 mm,间隔0.5 mm。重建应用多平面重建(MPR),最大密度投影(M IP)及容积显示技术(VRT)。结果100例血管病变中65例经手术病理或DSA证实。100例病变中,8例脑动脉瘤,2例脑动静脉畸形,6例肺动静脉畸形,9例肺动脉栓塞伴下肢深静脉血栓,4例肺隔离症,20例冠状动脉软斑块和/或钙化,12例主动脉瘤,3例肾动脉狭窄,2例肠系膜上动脉血栓,1例股动脉狭窄,33例软组织血管瘤。这3种重建技术均能显示病变的大小、形态及范围,对病变可进行任意角度重建和观察,VRT可立体地显示病变。MPR和M IP可显示血栓,M IP和VRT显示钙化。结论综合应用16层螺旋CT的各种重建技术,能够全面而清晰地显示血管病变,可取代DSA,为患者提供一种安全可靠的诊断手段,对临床治疗具有重要指导意义。     

Hemodynamic effects of a prostacyclin analog (Prostavasin) in systemic scleroderma patients

PURPOSE: We examined the effects of a prostacyclin analogue (Prostavasin) on the circulation of upper extremity, cerebral, ocular and visceral districts such as portal vein, hepatic artery, superior mesenteric artery, and interlobar renal artery in scleroderma patients. MATERIALS AND METHODS: peripheral vasculature was evaluated by the brachial artery flow-mediated dilatation by the high resolution ultrasound cross-sectional measurement, splenic arterial pulsatility index (PI) resistance index (RI) of the middle cerebral artery, the central retinal artery, the visceral arteries and the portal vein flow were assessed by colour Doppler sonography in an experimental group (EG) of 50 scleroderma patients, not affected by cerebrovascular, ocular, hepatic diseases or nephropathy, before and after 3 days of Prostavasin infusion and before and after 3 days in a control group (CG) of 10 patients not receiving any treatment. RESULTS: EG patients showed significant increasement in the brachial artery flow-mediated dilatation, in the portal vein velocity and in the splenic arterial PI (pre-Prostavasin vs post-Prostavasin treatment, p < 0.001) whereas CG patients had no significant changes. Values of the middle cerebral artery, the central retinal artery, the interlobar renal artery, the superior mesenteric artery and the hepatic artery RI were reduced after treatment in the majority of EG patients although the difference did not achieve a satisfactory statistical significance. CONCLUSIONS: our results indicate that Prostavasin has a powerful effect in improving the peripheral circulation of scleroderma patients. Prostavasin significantly increases the portal vein flow but also the splenic arterial PI not supporting the hypothesis of its direct and specific action on relaxation of the hepatic micro circle.     

彩色多普勒对视网膜脱离血液动力学研究

目的 :利用彩色多普勒技术评价视网膜脱离 (RD)患者球后血流动力学变化。方法 :视网膜脱离患者 3 5例 ,55只眼。对照组 2 6例 ,51只眼。彩色多普勒超声指导下 ,采用脉冲多普勒超声检测眼动脉 (OA)、视网膜中央动脉 (CRA)、睫状后动脉(PCA)收缩期 (PSV)、舒张期 (ESV)、平均血流速度 (AV)及阻力指数 (RI)、搏动指数 (PI)。结果 :RD与对照组的OA血流速度无明显差异 (P >0 .0 5) ;CRA、PCA的PSV、EDV、AV血流速度均减低 (P <0 .0 5) ;PI、RI值无显著性差异 (P >0 .0 5)。结论 :视网膜脱离的血流动力学的变化直接影响到视网膜的微循环状态。彩色多普勒超声可正确评估球后血流灌注情况与病变的关系 ,较传统的荧光血管造影法更为直接和敏感 ,为视网膜脱离的基础研究及药物辅助治疗提供了重要的依据     

Orbital venography in painful ophthalmoplegia (Tolosa-Hunt syndrome).

Twenty-six patients with painful ophthalmoplegia were classified as having the Tolosa-Hunt syndrome on the basis of their clinical findings and response to steroid therapy. All patients underwent orbital venography, a review of which forms the contents of this investigation. Orbital venography, a review of which forms the contents of this investigation. Orbital venograms were normal in 16 patients and abnormal in 10. The major abnormalities were (1) obstruction of the superior ophthalmic vein in its third segment without displacement; (2) collateral venous flow through small venous channels or collateral veins; and (3) poor opacification of the ipsilateral cavernous sinus.