Color Doppler Twinkling Artifacts in Various Conditions During Abdominal and Pelvic Sonography

Objective. The aims of this study were to describe the mechanisms likely to be responsible for color Doppler twinkling artifacts and their associated machine factors and to illustrate the various conditions that cause twinkling artifacts and those pitfalls. Methods. We evaluated various sonographic machine‐associated factors that influence artifact appearance and identified various conditions that display twinkling artifacts during abdominal and pelvic sonography. Results. The presence of twinkling artifacts was found to be dependent on focal zones, gray scale gains, color write priorities, and pulse repetition frequencies. Twinkling artifacts were found to be associated with calcified lesions in the liver, gallbladder adenomyomatosis, hepatic bile duct hamartoma, gallstones and choledocholithiasis, chronic pancreatitis, urinary stones, encrusted indwelling urinary stents, bowel gas, and metallic foreign bodies. However, some of the twinkling artifacts were found to be associated with false‐negative and ‐positive results. Conclusions. Color Doppler twinkling artifacts are additional useful sonographic signs in the diagnosis of calcified lesions, urinary and biliary stones, gallbladder adenomyomatosis, and some miscellaneous conditions.     

Color Doppler ultrasonography in occlusive diseases of the brachiocephalic and proximal subclavian arteries.

OBJECTIVE: The purpose of this study was to investigate the capability of color Doppler ultrasonography (CDU) in showing the brachiocephalic and proximal subclavian arteries and to determine the accuracy of CDU for diagnosis of occlusive diseases of those arteries. METHODS: Two groups of patients were examined. The first group was examined with CDU to determine whether the brachiocephalic and subclavian artery origins could be seen. The second group, including patients with occlusive arterial disease, was examined with CDU before digital subtraction angiography (DSA). Results of CDU and DSA were compared. RESULTS: In the first group, the origins of 42 (84%) of 50 brachiocephalic arteries, 48 (96%) of 50 right subclavian arteries, and 25 (50%) of 50 left subclavian arteries could be displayed by CDU. In the second group, 8 (89%) of 9 lesions on the right and 23 (96%) of 24 lesions on the left were diagnosed correctly. Color Doppler ultrasonography had sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values of 88%, 94%, 78%, 97%, and 94%, respectively, for detecting major stenosis and 100%, 98%, 94%, 100%, and 99% for detecting occlusion. Agreement between the CDU and DSA findings was substantial for stenosis (kappa = 0.78) and almost perfect for occlusion (kappa = 0.96). CONCLUSIONS: The percentage of proximal left subclavian arteries shown on CDU was considerably lower compared with the right subclavian and brachiocephalic arteries. However, there was no significant difference between the two sides in diagnosing occlusive arterial diseases. With CDU, occlusion can be diagnosed more accurately than stenosis.     

彩色多普勒超声监测妊娠期高血压疾病子宫螺旋动脉分析

目的探讨彩色多普勒超声监测对妊娠期高血压疾病的意义。方法观察我院收治的妊娠期高血压疾病孕妇45例(疾病组)及正常孕晚期孕妇475例(正常组)彩色多普勒超声子宫螺旋动脉血流频谱,并对搏动指数(PI)、阻力指数(RI)及收缩期最大血流速度与舒张末期血流速度比(S/D)进行比较。结果正常组彩色多普勒超声子宫螺旋动脉血流频谱,收缩期上升缓慢,舒张期下降缓慢且持续存在,收缩期及舒张期均为低流速,呈"低阻型",PI、RI及S/D在正常范围;疾病组彩色多普勒超声子宫螺旋动脉血流频谱,收缩期上升曲线陡直,下降曲线稍缓慢,PI、RI及S/D较正常组高,两组比较差异均有统计学意义(P0.05)。结论应用彩色多普勒超声监测子宫螺旋动脉可为妊娠期高血压疾病患者临床诊断及治疗提供可靠依据。     

血流剪切率与颈动脉粥样硬化斑块的关系

目的:应用超声多普勒技术探讨血流剪切率在颈动脉粥样硬化斑块形成中的作用。方法:将78例高血压患者按颈动脉内是否存在粥样斑块分为斑块组和无斑块组。生化测定TC、TG、HDL、LDL、BS水平,计算最大剪切率。结果:斑块组患者的年龄、颈动脉内径明显高于无斑块组,最大剪切率低于无斑块组。结论:最大剪切率减低及颈动脉内径增宽是颈动脉粥样斑块形成的重要危险因素。     

经颅二维彩色多普勒超声对脑梗死患者大脑中动脉血流速度的研究

目的探讨经颅二维彩色多普勒超声(TCCS)对脑梗死患者大脑中动脉血流速度。方法应用经颅彩色多普勒超声对临床经血管造影确诊为脑梗死的患者48例(其中18例大脑中动脉主干梗死,14例大脑中动脉分支梗死,16例颅外单侧颈内动脉梗死)和50例健康成人分别采用经颅彩色多普勒血流显像(CDF I)进行探测,测量双侧大脑中动脉舒张末期血流速度(EDV),并计算舒张末期双侧大脑中动脉血流速度比率(健侧与患侧的比值)。结果在健康成人组中,舒张末期血流速度和舒张末期比率为:(42.79±13.72)cm/s、1.25±0.31;在大脑中动脉水平段主干梗死组及大脑中动脉分支梗死组舒张末期血流速度和舒张末期比率分别为:(17.20±5.65)cm/s、3.56±1.20,(20.14±4.35)cm/s、1.82±0.46;颅外单侧颈内动脉梗死组中,梗死侧的舒张末期血流速度和舒张末期比率为:28.70±11.21(cm/s)、1.68±0.57,所有梗死组舒张末期血流速度明显低于对照组,而舒张末期比率明显高于对照组。结论经颅二维彩色多普勒对大脑中动脉(MCA)水平段血流速度和舒张末期比率的检测,有助于大脑中动脉梗死的鉴别诊断。     

Effect of Doppler angle in diagnosis of internal carotid artery stenosis.

OBJECTIVE: The purpose of this study was to compare velocity measurements obtained with 2 fixed insonation angles and to investigate whether there is a difference in their ability in determining internal carotid artery (ICA) stenosis. METHODS: Eighty-seven patients with ICA stenosis were examined with color duplex ultrasonography. Velocity measurements were made at 60 degrees and 45 degrees insonation angles, and they were compared with Bland-Altman and receiver operating characteristic curve analysis. RESULTS: Peak systolic velocity (PSV) and end-diastolic velocity measurements obtained at the 60 degrees insonation angle were higher compared with those obtained at the 45 degrees insonation angle (24.2% and 24.7%, respectively). The ICA-to-common carotid artery PSV ratio, conversely, was slightly higher (3.9%). Although the threshold values for the same velocity parameters obtained at 2 different insonation angles were different, the accuracy ratios (sensitivity and specificity) were not. With application of the Society of Radiologists in Ultrasound consensus criteria to the data obtained at either of the 2 insonation angles, the accuracy ratios of PSV and end-diastolic velocity were found to be statistically different. In the ICA-to-common carotid artery PSV ratio, however, there were no statistically significant differences in the accuracy ratios. CONCLUSIONS: Doppler velocity measurements made at different fixed insonation angles show considerable differences. In determining ICA stenosis, although optimal thresholds are different, the diagnostic performance is not different. In determining ICA stenosis with color duplex ultrasonography, angle-specific thresholds must be determined, and examinations must be made at a fixed angle.     

Doppler ultrasound measurement of cerebral blood flow in healthy pregnant women

Purpose To compare global cerebral blood supply in healthy pregnant women and nonpregnant women. Materials and Methods Flow volumes in the common, internal, and external carotid, arteries and the vertebral arteries were determined using color Doppler ultrasonography in 17 nonpregnant women, 55 healthy pregnant women at 10 to 40 weeks gestation, and 24 puerperal women within 1 week after spontaneous delivery. Global cerebral blood flow was defined as the sum of flow volumes in the bilateral internal carotid and vertebral arteries. Results In the nonpregnant group, mean flow volumes of the common, internal, and external carotid arteries and the vertebral arteries, and mean global cerebral blood flow volume were (mean±SD) 863±108 ml/min, 554 ±94 ml/min, 386±65 ml/min, 115±24 ml/min, and 669±104 ml/min, respectively. During the second trimester, flow volumes of the common and external carotid arteries increased significantly in the healthy pregnant women, to about 130 percent and 140 percent of the nonpregnant level, respectively. Global cerebral blood flow volume remained unchanged during pregnancy. Conclusion During pregnancy, increase in flow volumes in the common carotid arteries were accompanied by elevated flow volumes of the external carotid arteries but not the internal carotid arteries. This distribution would tend to regulate the volume of global cerebral blood flow throughout the period of pregnancy.     

经颅多普勒超声屏气试验评价重度颈动脉狭窄脑血管储备功能

目的:应用经颅多普勒超声(TCD)屏气试验评价重度颈动脉狭窄患者脑血管储备(CVR)功能。方法:选取30例健康对照者(正常对照组)、26例单侧重度颈动脉狭窄患者(颈动脉狭窄组),其中无症状性颈动脉狭窄14例(无症状亚组)、症状性颈动脉狭窄12例(症状亚组)。症状亚组中9例行颈动脉支架置入(CAS)术。比较各组患者的屏气指数(BHI),评估CVR功能。结果:与正常对照组比较,颈动脉狭窄组狭窄侧的BHI明显降低(P=0.000);与无症状亚组狭窄侧相比,症状亚组狭窄侧BHI明显降低(P=0.000);颈动脉狭窄组症状亚组患者CAS术后狭窄侧BHI与术前比较升高(P=0.021),术后狭窄侧的BHI低于健侧(P=0.019)。结论:重度颈动脉狭窄患者狭窄侧CVR功能降低,症状性颈动脉狭窄患者较无症状性颈动脉狭窄患者降低更明显,CAS可以改善症状性颈动脉狭窄患者CVR功能。     

前循环缺血性卒中老年患者颈动脉斑块及其稳定性与血流壁振荡切应力的关系

目的通过探讨前循环缺血性卒中老年患者颈总动脉分叉处血流壁振荡切应力的水平,分析其在颈动脉斑块形成过程中的影响。方法选择前循环缺血性卒中老年患者,应用经皮血管彩色多普勒超声测量颈动脉斑块及其稳定性,测量患侧颈动脉血流速度、血管内径和血液黏滞度,通过公式计算血流壁振荡切应力。结果血流壁振荡切应力在无斑块组(13.418±4.250)和有斑块组(18.052±6.880)dyn/cm2之间(P<0.01)、高回声斑块组(16.235±5.505)dyn/cm2和低回声斑块组(19.753±7.627)dyn/cm2之间(P<0.05)差别均有统计学意义。结论与平均血流切应力相比,高血流壁振荡切应力在颈动脉斑块,尤其是在预测不稳定斑块的形成中更有意义。     

彩色多普勒超声在非动脉炎性前部缺血性视神经病变患者中的诊断价值

目的探讨彩色多普勒超声（CDFI）在非动脉炎性前部缺血性视神经病变（NAION）患者颈动脉、眼球后血管血流参数检测中的价值。方法选取我院收治的NAION患者80例作为NAION组,另选80例无眼部相关疾病的志愿者作为对照组;采用CDFI检测两组研究对象的颈内动脉血流参数、颈内动脉血管弹性参数、眼球后动脉血流参数,采用相干光层析血管成像术检测两组的视杯视盘直径比、黄斑神经节细胞复合体厚度、视盘视网膜神经纤维层厚度;采用简单线性相关Pearson相关分析法分析颈内动脉血流参数、颈内动脉血管弹性参数、眼球后动脉血流参数与NAION病变的关系。结果NAION组颈内动脉舒张期峰值流速值低于对照组（P < 0.05）,NAION组颈内动脉RI、IMT值高于对照组（P < 0.05）;NAION组颈内动脉动脉扩张性、动脉紧张度、压力-应变性系数值低于对照组（P < 0.05）;NAION组眼动脉动脉的收缩期峰值流速、舒张期峰值流速测定值低于对照组（P < 0.05）;NAION组眼动脉的RI测定值高于对照组（P < 0.05）;NAION组的水平及垂直视杯视盘直径比、黄斑神经节细胞复合体厚度均低于对照组（P < 0.05）。EDV值与水平及垂直视杯视盘直径比、黄斑神经节细胞复合体厚度呈正相关（P < 0.05）,RI值与水平及垂直视杯视盘直径比、黄斑神经节细胞复合体厚度呈负相关（P < 0.05）。结论NAION患者颈动脉、眼球后血管血流参数常发生显著改变,并且与NAION患者眼部病变程度有一定的关系。     

彩色多普勒检测主动脉瓣病变患者颈动脉血流变化

为探讨主动脉瓣病变对颈动脉血流动力学变化的影响，对正常组４２例，观察组４７例：其中主动脉瓣关闭不全１３例，主动脉瓣狭窄伴关闭不全３３例，主动脉瓣狭窄１例，进行了彩色多普勒血流检测。正常颈总动脉频谱形态呈三峰形，收缩期两峰Ｖｓ１＞Ｖｓ２；舒张早期可有反向频谱，△Ｔ／Ｔ比值＜１／１０。主动脉瓣狭窄伴关闭不全时，颈总动脉收缩期可出现“Ｍ”形频谱，出现率为７２．２％；１例主动脉瓣狭窄，颈动脉频谱形态呈“圆顶状”状。主动脉瓣关闭不全时，颈总动脉出现“舒张期返流”频谱，即△Ｔ／Ｔ≥１／１０。“舒张期返流”频谱的出现与瓣膜返流程度有关：轻度返流，△Ｔ／Ｔ比值正常或＜１／４，中度返流，在１／４～１／２之间，△Ｔ／Ｔ≥１／２，均为重度返流。６例瓣膜置换术后，４全颈动脉频谱形态恢复正常，２例仍有“舒张期返流”频谱，其主动脉瓣中度关闭不全。结果表明：主动脉瓣狭窄伴关闭不全时，颈总动脉收缩期可出现特征性“Ｍ”形；主动脉瓣关闭不全舒张期可见“舒张期返流”频谱。“舒张期返流”频谱是区分轻与中重度瓣膜关闭不全的简便方法，也可大致区分中与重度关闭不全。比较换瓣前后，颈动脉异常频谱形态变化，可作为间接评价主动脉人工瓣功能的方法之一     

颈动脉彩超联合颅脑MRI可评估前循环动脉粥样硬化性脑梗死患者的病情

目的  探究前循环动脉粥样硬化性脑梗死患者采用颈动脉彩超联合颅脑MRI评估病情严重程度临床价值。方法  回顾性分析2021年1月~2021年11月医院收治50例前循环动脉粥样硬化性脑梗死患者的资料,依据美国国立卫生研究院脑卒中量表评分,将患者分别纳入轻型脑梗死组（≤7分,n=40）与重型脑梗死组（> 7分,n=10）。患者均接受颈动脉彩超及颅脑MRI检查,分析两者联合在患者病情严重程度上评估价值。结果  重型脑梗死组患者不稳定斑块比例、狭窄率、搏动指数（PI）、阻力指数（RI）均高于轻型脑梗死组患者,峰值流速（PSV）、舒张末期流速（EDV）低于轻型脑梗死组患者（P < 0.05）;重型脑梗死组患者表面弥散系数（ADC）低于轻型脑梗死组患者（P < 0.05）,两组患者T1WI信号与T2WI信号检出情况的差异无统计学意义（P > 0.05）;Spearman相关性分析显示,ADC、不稳定斑块、PI、RI、PSV、EDV与患者病情严重程度存在相关性（P < 0.05）;ROC曲线显示ADC、不稳定斑块、PI、PSV、RI、EDV用于重型脑梗死评估曲线下面积分别为0.638、0.556、0.600、0.608、0.798、0.713,各指标联合曲线下面积值为0.968。结论  前循环动脉粥样硬化性脑梗死患者病情可以采用颈动脉彩超与颅脑MRI进行评估,两者用于患者病情严重程度评估均有一定价值。      

彩色多普勒超声对颈动脉狭窄支架成形术疗效及术后残余狭窄的评估价值

目的:探讨彩色多普勒超声对颈动脉狭窄支架成形术(carotid artery stenting,CAS)患者疗效及术后残余狭窄的评估价值。方法:前瞻性选取2018年1月至2020年9月在池州市人民医院神经外科治疗的110例CAS患者,对比手术前后超声相关测量指标。依据数字减影血管造影(digital subtraction angiography,DSA)检查统计术后残余狭窄发生率,并分为残余狭窄组与正常组(未发生残余狭窄)。比较两组临床资料和超声相关指标,并分析CAS术后残余狭窄发生的影响因素。结果:CAS术后狭窄部位狭窄程度[(26.51±5.78)%]低于术前[(83.57±10.20)%],术后颈动脉近中端、颈动脉远端的收缩期血流峰值流速(peak systolic velocity,PSV)、舒张期末流速(end diastolic velocity,EDV)也均较术前显著下降,差异有统计学意义(P<0.05)。CAS术后残余狭窄发生率为22.73%。残余狭窄组CAS术后颈动脉近中端PSV[(131.48±11.92)cm/s]、EDV[(47.20±5.24)cm/s]均高于正常组[(98.86±10.26)cm/s、(38.14±5.06)cm/s],斑块形态不规则(76.00%)、斑块钙化(72.00%)发生率均明显高于正常组(38.82%、61.18%),差异有统计学意义(P<0.05)。多因素logistic回归分析显示:斑块形态不规则(OR=1.572,95%CI:1.021~2.256)、斑块钙化(OR=2.380,95%CI:1.364~3.527)均是CAS患者发生术后残余狭窄的独立危险因素(P<0.05)。结论:彩色多普勒超声能有效评估CAS血管再通的疗效和观察有无残余狭窄,斑块形态不规则和斑块钙化是CAS术后残余狭窄发生的危险因素。     

2型糖尿病合并微量蛋白尿患者颈动脉CDFI超声表现与实验室检查的相关性

目的 探讨2型糖尿病(T2DM)合并微量蛋白尿(MA)患者的颈动脉彩色多普勒(CDFI)超声表现与实验室检查各项指标结果关系.方法 将178例T2DM患者按尿白蛋白排泄率(UAER)分为2组,UAER≥30～300mg·d-1为合并MA组(T2DM1组,104例),UAER＜30 mg· d-1者为不合并MA组(T2DM2组,74例),对2组患者均进行颈动脉CD-FI超声检查,包括颈动脉内-中膜厚度(IMT)、动脉粥样斑块情况(低/等回声、强回声及混合回声)等;实验室检查包括餐后2h血糖(2 hPG)、空腹血糖(FPG)、UAER、尿酸(URIC)、血肌酐(CREA)、糖化血红蛋白(HbAlc)、血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)及体质指数(BMI)等指标.对2组CDFI的表现(IMT、动脉粥样斑块情况)及实验室各项检测指标进行比较.结果 2组患者颈动脉斑块检出数目及斑块回声比较差异无统计学意义(x2=0.645,P＞0.05).2组斑块检出率排序为低/等回声＞混合回声＞强回声(均P＜0.05).T2DM1组IMT厚度、BMI、UAER、2 hPG、CREA、HbA1c、TC均高于T2DM2组(均P＜0.05).2组FPG、URIC、TG、LDL、HDL比较差异均无统计学意义(均P＞0.05).Pearson相关分析结果:IMT与UAER、CREA、HbA1c及病程呈正相关,(r=0.315、0.320、0.463及0.354,均P＜0.05).多元线性回归分析结果:病程、UAER、HbA1c是IMT增厚的独立预测因子(r=0.362、0.240、0.395,均P＜0.05).结论 CDFI超声能够准确地检出T2DM合并MA患者颈动脉IMT及粥样斑块;IMT增厚情况与UAER、CREA、HbA1c及病程密切相关.     

颈动脉彩超结合脂蛋白相关磷脂酶A2水平对冠心病高危人群的预测价值

目的探讨颈动脉彩超联合血清脂蛋白相关磷脂酶A2（Lp-PLA2）在冠心病高危人群中的应用价值。方法选取2018年1月~2021年1月在我院就诊的冠心病高危人群300例,分析冠心病和非冠心病患者颈动脉中膜厚度、斑块及血清Lp-PLA2差异,采用受试者工作特征曲线（ROC）分析颈动脉中膜厚度、斑块及血清Lp-PLA2预测冠心病、多支病变的价值。结果经冠脉造影检查确诊冠心病患者73例,冠心病发生率为24.33%;冠心病患者颈动脉中膜厚度、颈动脉斑块比例、血清Lp-PLA2高于非冠心病患者（P < 0.05）;冠心病多支病变患者颈动脉中膜厚度、颈动脉斑块比例、血清Lp-PLA2分高于单支病变患者（P < 0.05）;颈动脉中膜厚度、斑块、Lp-PLA2联合预测冠心病的ROC曲线下面积为0.821（P < 0.05）,诊断敏感度和特异性分别为80.00%和78.50%;颈动脉中膜厚度、斑块、Lp-PLA2联合预测冠心病多支病变的ROC曲线下面积为0.894（P < 0.05）,诊断敏感度和特异性分别为92.00%和82.50%。结论颈动脉彩超联合血清Lp-PLA2在冠心病高危人群筛查中有较好的应用价值,在诊断冠心病及多支病变中价值较高。