Value of color-coded duplex sonography in diagnosis of extracranial vascular changes]

72 patients at the age of 44 to 76 years with transitory ischaemic attacks which happened and for a short time reversible deficits, respectively, were diagnosed both conventionally duplex-sonographically and with the colour-coded duplex sonography under the question of vascular stenotic process in the region of the cervical vessels. After the ultrasound examination within two weeks an angiography was performed. As a result was shown that in 10 patients with an angiogram without pathological findings by means of the colour-coded duplex sonography in 3 cases plaque formations could be proved which could be clearly diagnosed only by colour marking.     

Doppler spectrum analysis and vascular imaging in the diagnosis of extracranial carotid artery disease

Ultrasound methods are well suited for the exploration of the carotid system. High resolution echography can visualize atheromatous defects on the vessels walls with a resolution better than one mm, whereas Doppler examination detects haemodynamic disturbances due to these plaques. Conventional Doppler examination can reveal moderate or severe stenosis (greater than 60%); the recent development of frequency analysis of the Doppler audio signal makes now possible the detection of very light haemodynamic disturbances due to low grade stenosis even as small as 15%. Spectral distribution abnormalities have been classified in four grades according to their amplitude. The combination of the morphological and functional data provided by echography and Doppler spectrum analysis has drastically increased the diagnostic possibilities of the ultrasound methods in the field of the extracranial vascular pathology. With a new duplex system which combines echography and C.W. Doppler examination (duplex probe) it is possible to detect, and quantify carotid stenosis (in percentage of the lumen reduction), and to evaluate blood flow volume in ml/mn.     

Methodologic aspects and criteria for evaluating extracranial carotid Doppler sonography

Doppler-sonographic and internal angiological findings of 57 patients with extracranial stenosis or obliteration of the internal carotid artery were evaluated. On the basis of the audio-signals and Doppler speed curves derived from the supratrochlear artery, the common and internal carotid arteries haemodynamically relevant extracranial obstructions of the vascular system could be objectified and judged with regard to their collateral compensation. Diagnostically valuable were the comparison of the sides and the additional calculation of the indices of the resistance. The Doppler sonography of the carotid artery should be used within the clarification of a cerebrovascular insufficiency and before every invasive diagnostics.     

Use of computer-assisted Doppler sonography and rheography in acral vascular diagnosis in progressive systemic sclerosis

For the quantitative characterization of the blood flow of patients with progressive systemic sclerosis a combined computer-assisted Doppler sonographic as well as rheographic measuring place was established. An aimed examination of the peripheral situation of the blood supply was performed in 15 patients with progressive systemic sclerosis in comparison to a control group of patients with healthy vessels. The demonstration of the corresponding parameters of time and form of the curves resulted in significant differences for the two examination groups, particularly of the pulsation index (PI) and the index of the peripheral resistance (PWI) in the Doppler flow curves as well as for the maximum increase (A) and the peak time (GZ) in the rheogrammes. The computer-assisted functional-diagnostic investigation methods in the peripheral vascular region offer themselves for the objectivation and the assessment of the course of the participation of the vessels in the collagenoses.     

血管性痴呆和Alzheimer病的经颅多普勒超声研究

目的　探讨经颅多普勒超声 ( TCD)对血管性痴呆 ( VD)和 Alzheimer病 ( AD)的诊断价值。　方法　对 2 1例 VD、3 7例 AD老年患者及对照组 3 0例进行 TCD检测 ,并将结果进行分析。　结果　 VD组 TCD异常率为 94 .2 %,AD组为 89.3 %。两组的异常表现相似 ,除 VD组 3例患者外 ,均表现为全脑平均血流速度降低 ,且显著低于对照组 (均为 P<0 .0 1 ) ,VD组与 AD组差异无显著性( P>0 .0 5)。痴呆的严重程度与脑血流速度呈正相关 ( VD组 r=0 .72 ,P<0 .0 1 ;AD组 r=0 .69,P<0 .0 5)。　结论　常规 TCD指标无法鉴别 VD、AD,但对揭示痴呆患者的脑血流动力学改变及判定痴呆的严重程度有一定价值。     

Color flow Doppler sonography for the etiologic diagnosis of hyperthyroidism.

Color flow Doppler sonography (CFDS) is gaining importance for the functional evaluation of the thyroid disorders. We aimed to determine the value of CFDS for the etiological diagnosis of hyperthyroidism. Fifty-five patients with hyperthyroidism (29 Graves' disease [GD] and 26 toxic adenoma [TA]), 24 patients with Hashimoto's thyroiditis (HT), and 39 euthyroid controls were included. Etiological diagnoses were carried out using standard methods. Conventional gray scale sonography was performed, followed by CFDS. Doppler patterns of the glands were scored and peak systolic velocity (PSV) measurements were obtained from intrathyroidal, perithyroidal, and perinodular vasculature. Vascular patterns were significantly more prominent, and the mean PSV values were significantly higher in the GD patients compared to the HT patients ( p < 0.001) and controls ( p < 0.001). Perinodular and intranodular signals and the mean perinodular PSV values were significantly higher in TAs compared to controls. CFDS could differentiate the untreated GD from the HT, which had similar gray scale findings. Hot nodules could also be differentiated from cold nodules with more prominent vascular patterns and significantly higher PSV values. As an inexpensive, fast, and noninvasive imaging procedure, CFDS could be helpful in the initial clinical evaluation and may avoid scintigraphy in a substantial number of thyrotoxic patients.     

彩色超声在胃肠道间质瘤诊断中的应用

目的:探讨彩色超声在胃肠道间质瘤(GIST) 诊断中的应用价值. 方法:回顾性分析经病理证实的45 例GIST 的超声声像图特征,将超声与手术病理结果进行对比分析. 结果:超声测量肿瘤的最大径线数值病理测量方法差异无统计学意义(t = 1.328,P >0.05). 肿瘤的形态及内部回声与其危险性高低有关:危险性低、形态规则、内部回声均;危险性高,形态不规则,内呈现混杂回声. 彩色血流分布与肿瘤危险性高低无明显相关. 超声在胃GIST 的诊断准确率高于肠道GIST. 结论:彩色超声检查在GIST 诊断中具有实用价值,结合其他检查可提高GIST 诊断准确性.     

Doppler sonography in rheumatology

The importance of ultrasonography in rheumatology has increased dramatically within the last few years both with regard to clinical practice and to research. High-resolution colour Doppler ultrasound equipment is, to date, widely available. Colour and power Doppler studies of intra-articular and peritendinous blood flow allow an estimation of the inflammatory activity and aid in distinguishing anatomical structures. Contrast agent increases the ability of ultrasonography to detect even minor perfusion. These findings have a practical clinical impact on the management of inflammatory rheumatic diseases. The resolution of ultrasonography is superior to that of magnetic resonance imaging (MRI) and computed tomography (CT) with regard to superficial anatomical structures. Furthermore, ultrasonography can depict the artery wall in contrast to angiography. In temporal arteritis and Takayasu's arteritis, ultrasonography depicts characteristic, homogenous wall thickening, stenoses and acute occlusions. These pathologies resolve quickly with treatment in the temporal arteries and much more slowly in larger arteries.     

Dynamic contrast-enhanced power Doppler sonography improves the differential diagnosis of liver lesions

The aim of this paper was to investigate the diagnostic value of dynamic contrast-enhanced power Doppler sonography in the differential diagnosis of liver lesions. We prospectively examined 85 focal liver lesions in 71 patients by real-time gray-scale sonography, power Doppler sonography, and contrast-enhanced power Doppler using two ultrasound contrast agents (Levovist, Optison). Amount and architecture of lesion vascularity and the kinetics of contrast enhancement within the lesions were analyzed. Vascularity was detected in 61% of liver lesions (52/85) by conventional power Doppler, compared to 86% (73/85) by contrast-enhanced power Doppler sonography. Dynamic contrast-enhanced power Doppler identified arterial radial hypervascularity <16 s after contrast injection in 19/22 focal nodular hyperplasias (86%). Irregular hypervascularity was seen with contrast enhancement in the arterial phase in 14/15 hepatocellular carcinomas (93%). In 14/25 hemangiomas (56%), a circular vascularization pattern was noted. Specific lesion diagnosis based on B-scan and conventional and dynamic contrast-enhanced power Doppler sonography led to correct diagnosis in 86% (73/85, 95% confidence interval 78%-94%) compared to 57% (48/85, 95% confidence interval 47%-94%) by B-scan criteria and conventional power Doppler sonography. Contrast-enhanced power Doppler sonography improves diagnostic accuracy in the differential diagnosis of focal liver lesions.     

Usefulness of ultrasonography and color Doppler sonography in the diagnosis of major salivary gland diseases

The algorithm for imaging of the salivary glands depends on the clinical scenario with which the patient presents to the clinician. Ultrasound has been increasingly used in recent years and thanks to high performance, easy to use apparatus, it can now be used for exploration of the salivary glands. This non invasive, painless and relatively inexpensive examination provides rapid visualisation of the salivary glands and is a useful adjunct to computed tomography and magnetic risonance imaging examination, particularly in tumour pathology. In recent years, publications have highlighted the potential uselfulness of salivary gland ultrasonography as a simple and non-invasive adjunctive test for the detection of gland involvement in Sj?gren's syndrome (SS). SS is a chronic inflammatory disease of the salivary glands characterised by focal lymphocytic infiltrates that cause progressive destruction of the acinar structures. The findings of a previous study lead us to believe, in agreement with other examiners, that semiquantitative assessment of ultrasonographic images of the salivary glands is a sensitive and very useful means of evaluating salivary involvement in SS. Color Doppler sonography is a recently introduced method which makes it possible to evaluate intra- and perilesional vascularization and to perform a hemodynamic study of the area being explored. The color Doppler sonography can provide a useful adjunct to conventional ultrasound, increasing diagnostic accuracy in submandibular- parotid masses and to analyze physiologic changes that occur during salivary stimulation in normal subjects and the flow alterations that occur in diseased glands of SS patients. This article reviews the normal ultrasound anatomy of the salivary glands along with lithiasic, inflammatory, tumoral, and autoimmune disease such as SS.     

经眶和经颞多普勒检测无创激光针对脑血管的影响

本文首次报道的激光针代表着一种新的无创性视觉刺激方法.在一项随机交叉对照试验中,我们对27名健康志愿者[平均年龄(25.15±4.12)岁,范围21～28岁;男性13例,女性14例]某些脑部指标的激光针针刺与运针的差别进行了研究.平均血流速度(Vm)显示,在对与视觉相关的穴位进行激光针针刺(P=0.01)和运针(P＜0.001)时,眼动脉血流出现特异性的显著增加.同时还发现,2种针刺方法对大脑中动脉Vm无显著改变.本研究采用的8枚激光针装在光导纤维的末端,每条光纤与一个发射波长为685nm、主要输出功率约为55mW的半导体激光二极管相连接.采用经过适当调整的激光针进行光学刺激时,具有患者几乎感觉不到刺激以及操作人员也不知道激光针系统是否在运行的优点.因此,在针刺研究中可以实施真正的双盲研究.     

Color Doppler sonography (angiodynography) in the assessment of the arterial vascular bed of the lower extremities

With color Doppler ultrasonography, since its inception two years ago, through combination of color-coded flow and gray-coded vessel and tissue imaging, a new technique is available with which, based on the information derived from the Doppler principle, characterization is enabled of the direction of blood flow coded in red or blue, the velocity in varying color intensities and turbulent flow through color mixing. For determination of the velocity of flow at any point in the vessel, additionally, the pulsed Doppler method is available. The diagnosis of obstruction is based on delineation of plaques in the vascular lumen as well as changes in profile of the flowing blood. Color Doppler ultrasonography enables differentiation of high-grade stenosis from occlusion, aids and rapid localization of a stenosis and permits correction of the angle between the Doppler beam and flow in the vessel without providing quantitative evaluation of the degree of stenosis; the latter, however, can be mediated from the recorded velocity profile of the pulsed Doppler method Through demonstration of color-coded blood flow, the patency of bypass grafts can be documented. Additionally, information can be obtained with regard to the proximal and distal anastomoses, flow patterns in the region of preserve venous valves, stenoses and arterio-venous fistulas. Pseudoaneurysms are seen as cavity-like perivascular structures devoid of echo signals, the contiguous access to the lumen of which can be verified by display of pulsatile, systolic-diastolic flow in the color-coded image. With color Doppler ultrasonography abnormal flow patterns incurred through atherosclerotic changes in the vessel wall, stenoses, anastomoses, aneurysms and pseudoaneurysms can be reliably detected.(ABSTRACT TRUNCATED AT 250 WORDS)     

Doppler ultrasound parameters for peripheral arterial vascular diagnosis

In order to control the valency of Doppler-sonographic parameters for the arterial vascular diagnostics, in patients with arterial obstructive disease apart from the measurement of the blood pressure characteristics of Doppler speed curves were analysed. Proximal obstacles of the vascular system of haemodynamic relevance led to the systolic decrease of pressure in the area of the extremities and to the monophasic configuration of curves with increased diastolic flow velocity and loss of the reflux component. Relations to the degree of severity of the ischaemia were found. The Doppler-sonographic comprehension of a changed local behavior of resistance and blood supply was valuable also for the differential diagnosis.     

Color-coded Doppler in the diagnosis of vascular complications following heart catheterization]

To determine the value of color Doppler in the diagnosis of vascular complications resulting from cardiac catheterization 5 consecutive patients, with the clinical suspicious of vascular iatrogenesis potentially requiring surgical repair, were analyzed. In 2 patients a femoral mass developed after a diagnostic catheterization but 3 patients underwent previously an interventional catheterization technique. In 3 patients color Doppler readily visualized a systolic jet originated in the femoral artery entering an anterior echo-free cavity, and a reversal flow in diastole, suggesting a femoral pseudoaneurysm. In 1 patient the clinical diagnosis of arteriovenous fistulae was confirmed by color Doppler which demonstrated a continuous turbulent flow within the femoral vein. In the remaining patient a diagnosis of simple femoral haematoma was made after the demonstration of a relatively echogenic structure overlying the femoral artery and vein but not interfering with their flows. In the 3 patients with femoral pseudoaneurysms and in the patient with arteriovenous fistulae the diagnosis was confirmed by angiography and during surgery. Our preliminary findings underscore the value of color Doppler, using the technology currently available in echocardiographic laboratories, in the differential diagnosis of vascular complications after cardiac catheterization.     

呈振荡型血流频谱的椎动脉颅外段闭塞的经颅多普勒超声鉴别诊断

目的探讨经颅多普勒超声（TCD）在鉴别一侧椎动脉颅外段闭塞和锁骨下动脉盗血综合征Ⅱ期（SSSⅡ期）所致的椎动脉颅内段振荡型血流频谱中的作用。方法采用TCD筛查出一侧椎动脉颅内段呈振荡型血流频谱改变者42例,其中SSSII期组25例、椎动脉颅外段闭塞组17例,患者的病变均经DSA证实。另选25名健康体检者为对照组。比较三组TCD血流动力学参数的差异。计量资料采用中位数（25％～75％分位）表示。结果①SSSⅡ期组、椎动脉颅外段闭塞组患侧椎动脉均为收缩期反向、舒张期正向血流频谱。SSSⅡ期组逆转的收缩期时相较长;椎动脉闭塞组逆转的收缩期时相较短暂,频谱呈小尖波改变。SSSⅡ期组患侧椎动脉收缩期流速为[44（30～60）]cm／s,舒张期流速为[20（18～32）]cm／s;椎动脉颅外段闭塞组为[（27（11—34）]cm／s、[18（14～24）]cm／s,两组比较差异均有统计学意义。（2）SSSⅡ期组健侧椎动脉收缩期流速为[101（60～134）]cm／s,搏动指数（PI）为1．5（1．3～1．8）;椎动脉颅外段闭塞组分别为[53（45～79）]cm／s、1．0（0．9～1．1）;健康对照组为[55（44～66）]cm／s、0．9（0．8～1．0）。SSSⅡ期组与椎动脉颅外段闭塞组、健康对照组比较差异均有统计学意义;椎动脉颅外段闭塞组与健康对照组比较差异无统计学意义。③束臂试验或运动试验后,SSSⅡ期组收缩期逆转信号均增强,椎动脉颅外段闭塞组逆转信号改变不明显。（4）TCD与DSA诊断SSSⅡ期的敏感性为100％（25／25）,诊断椎动脉颅外段闭塞的特异性为88．2％（15／17）。结论椎动脉颅内段振荡型血流频谱不仅见于SSSⅡ期,还可以见于椎动脉颅外段闭塞的患者。TCD的椎动脉血流频谱、血流动力学参数对比有助于其鉴别诊断。     

The usefulness of conventional and echo colour Doppler sonography in the differential diagnosis of toxic multinodular goitres

OBJECTIVE: To assess the potential role of conventional sonography and colour flow Doppler (CFD) sonography (CFDS) in the differential diagnosis of toxic multinodular goitres. SUBJECTS AND METHODS: We investigated 55 patients with untreated hyperthyroidism (24 with typical toxic diffuse goitre of Graves' disease (Group A); 26 with multinodular goitre (Group B); and five with single toxic adenoma (Group C); 22 euthyroid subjects (12 with non-toxic multinodular goitre (Group D) and ten normal subjects (Group E)) were included as controls. In all cases free thyroxine, free tri-iodothyronine, TSH, TSH receptor antibodies (TRAb), anti-thyroperoxidase antibody, anti-thyroglobulin antibodies and anti-thyroid microsomal antibodies were determined and a [(99m)Tc]pertechnetate thyroid scan was performed. RESULTS: Patients with toxic multinodular goitre displayed two different CFDS patterns: 18 patients (Group B-1) had nodules with normal vascularity surrounded by diffuse parenchymal hypoechogenicity with markedly increased CFD signal and maximal peak systolic velocity (PSV) (a pattern similar to Group A patients with Graves' disease); eight patients (Group B-2) had increased intra- and perinodular CFD signal and PSV with normal extranodular vascularity (a pattern similar to that found in Group C patients with single toxic adenoma). Patients of Group B-1 showed a proportion of clinically evident thyroid ophthalmopathy, positive TRAb and other thyroid autoantibodies similar to that observed in Group A patients, while no evidence of thyroid autoimmunity was found in Group B-2. Sixteen out of 18 (89%) patients from Group B-1 displayed a scintiscan pattern of diffuse uneven radionuclide distribution, while seven out of eight (87.5%) of those from Group B-2 had localized uptake in multiple discrete nodules. Taken together, these data strongly suggest that Group B-1 mostly represents patients with the multinodular variant of Graves' disease, while Group B-2 represents patients with non-autoimmune toxic multinodular goitre. CONCLUSIONS: This study shows that combined conventional sonography and CFDS may easily distinguish nodular variants of Graves' disease from non-autoimmune forms of toxic multinodular goitre and confirms the clinical usefulness of this technique in the first-line evaluation of hyperthyroid patients.