Noninvasive assessment of brachial artery endothelial function with digital ultrasound and 13-MHz scanning frequency: feasibility of measuring the true inner luminal diameter using the intima-lumen interface

Previous studies assessing endothelial function as flow-mediated changes in the brachial artery diameter have not been able to measure the true inner luminal diameter. This is due to the lack of image quality, which has hampered the visualisation of the lumen-intimal interface. Because increases in resolution and scanning frequency have recently led to improved ultrasound (US) image quality, we assessed the feasibility of measuring the true brachial artery diameter using digital US and 13-MHz scanning frequency. Satisfactory true inner diameter measurements were obtained in all subjects (n = 148, middle-aged men, mean age 54 +/- 7 y) participating in a risk factor study. At baseline flow, the intima to intima diameter was 4.03 +/- 0.49 and 4.67 +/- 0.52 mm measured conventionally from the anterior to the posterior media-adventitia interface (difference 0.64 +/- 0.10 mm). After hyperaemia, the intima to intima diameter was 4.23 +/- 0.46 mm and the adventitia to adventitia diameter 4.86 +/- 0.50 mm. Flow-mediated dilation (FMD) expressed as the percentage change from the baseline diameter measured 5.3 +/- 4.3% using the true inner diameters and 4.3 +/- 3.7% using the conventional outer diameters. The difference in FMD values was systematic, and there was a good linear correlation between them (r = 0.93, p < 0.0001). If FMD is presented as the percentage change from baseline to hyperaemia, this new method gives values that are approximately 1% unit higher, compared with values when brachial luminal diameter is measured in the conventional way between the adventitia-media interfaces.     

Systematic analysis on the relationship between luminal enhancement, convolution kernel, plaque density, and luminal diameter of coronary artery stenosis: a CT phantom study

To systematically investigate into the relationships between luminal enhancement, convolution kernel, plaque density, and stenosis severity in coronary computed tomography (CT) angiography. A coronary phantom including 63 stenoses (stenosis severity, 10–90 %; plaque densities, ?100 to 1,000 HU) was loaded with increasing solutions of contrast material (luminal enhancement, 0–700 HU) and scanned in an anthropomorphic chest. CT data was acquired with prospective triggering using 64-section dual-source CT; reconstructions were performed with soft-tissue (B26f) and sharp convolution kernels (B46f). Two blinded and independent readers quantitatively assessed luminal diameter and CT number of plaque using electronic calipers. Measurement bias between phantom dimensions and CT measurements were calculated. Multivariate linear regression models identified predictors of bias. Inter- and intra-reader agreements of luminal diameter and CT number measurements were excellent (ICCs > 0.91, p < 0.01, each). Measurement bias of luminal diameter and plaque density was significantly (p < 0.01, each) lower (?12 % and 58 HU, respectively) with B46f as opposed to B26f, especially in plaque densities >200 HU. Measurement bias was significantly (p < 0.01, each) correlated (ρ = 0.37–55 and ρ = ?0.70–85) with the differences between luminal enhancement and plaque density. In multivariate models, bias of luminal diameter assessment with CT was correlated with plaque density (β = 0.09, p < 0.05). Convolution kernel (β = ?0.29 and ?0.38), stenosis severity (β = ?0.45 and ?0.38), and luminal enhancement (β = ?0.11 and ?0.29) represented independent (p < 0.05,each) predictors of measurement bias of luminal diameter and plaque number, respectively. Significant independent relationships exist between luminal enhancement, convolution kernel, plaque density, and luminal diameter, which have to be taken into account when performing, evaluating, and interpreting coronary CT angiography.     

应用高频超声对颈动脉粥样硬化与冠心病关系的探讨

目的探讨冠心病与颈动脉粥样硬化的相关性。方法应用高频彩色多普勒超声检测80例冠心病患者的双侧颈动脉粥样硬化斑块、颈动脉内-中膜厚度（IMT）及僵硬系数（β）,并与对照组进行比较。结果冠心病组与对照组斑块发生率分别为86．2％和25．0％,前者显著多于后者（P〈0．005）;冠心病组软斑构成比显著高于对照组（P〈0．01）,而扁平斑和硬斑显著低于对照组（P〈0．01）;冠心病组与对照组比较,前者颈动脉IMT、β显著高于后者（P〈0．05）。颈动脉IMT与β呈正相关（r=0．785,P〈0．05）。结论颈动脉粥样硬化与冠心病密切相关,可作为预测及评价冠心病的重要指标之一。     

超声对冠状动脉搭桥术桥血管-桡动脉选择的临床研究

目的 探讨超声在冠状动脉搭桥术（CABG）选择桡动脉作为桥血管的主要条件.方法 对拟行CABG的216例患者进行Allen试验.超声检测桡动脉、尺动脉及拇指主要动脉（TA）,记录管壁情况,测量血流峰值速度,记录桡骨茎突水平及其上方5 cm处桡动脉内径,压迫桡动脉后检测侧支循环情况.对桡动脉作为桥血管的CABG病例术后随访半年以上.结果 216例患者中,Allen试验阳性者39例,超声发现16例患者桡动脉管壁有斑块及/或管腔狭窄,3例患者TA为桡动脉依赖型,与超声检查结果比较,Allen试验假阳性率高,二者比较差异有统计学意义（P 〈 0.01）.超声提示197例患者TA为非桡动脉依赖型,压迫桡动脉后尺动脉峰速度明显增加,桡动脉桡骨茎突水平与其上方5 cm处血管内径比较差异无统计学意义,其中桡动脉桡骨茎突水平内径≥1.8 mm者160例,占81.2%.结论 ①桡动脉作为CABG桥血管的选择条件为管壁无钙化斑、无狭窄;TA为非桡动脉依赖型;桡动脉远段管腔内径≥1.8 mm.②桡动脉内径测量段在茎突至其上方5 cm内任意位置均可.超声筛查桡动脉作为CABG桥血管具有方便、无创及准确等优点,临床可推广应用.     

高频超声与CT诊断喉癌的临床研究

目的探讨高频超声及CT对喉癌的诊断价值。方法对69例喉癌患者进行高频彩色多普勒超声和CT分型及分期，将超声诊断结果与CT、纤维喉镜及手术病理进行比较分析。结果超声与CT对喉癌分型准确率分别为94．2％及91．3％，均优于纤维喉镜(73．9％)。T分级超声准确率分别为T1 85．9％，T2 88．5％，T3 94．1％，T4 88．9％，T3高于CT(68．8％)和纤维喉镜(75．0％)，T4高于纤维喉镜(66．7％)。超声检出淋巴结转移37例(53．6％)，高于CT的19例(27．5％)。彩色多普勒血流显像喉癌内血流信号检出率为94．2％，多为低阻型动脉频谱。结论高频超声对喉癌分期的准确性高于纤维喉镜和CT检查，高频超声检查对喉癌治疗方案的选择和预后的判断有重要参考价值。     

高频超声检测颈动脉早期诊断颅内颈内动脉系统远端阻塞性病变

目的：利用高频超声检测颈动脉早期诊断颅内颈内动脉系统远端阻塞性病变。方法：对三组（正常组、无脑梗死颈动脉粥样硬化组、脑梗死颈动脉粥样硬化组）共120例患者行超声检查颈动脉，观察动脉硬化情况，记录血流值。对三组同侧颈内动脉与颈总动脉血流收缩期血流速度比值（ICA／CCA）进行统计学F检验。结果：正常组、无脑梗死颈动脉粥样硬化组与脑梗死颈动脉粥样硬化组的IcA／CCA比值有统计学显著差异（P〈0．05），正常组与无脑梗死颈动脉粥样硬化组的ICA／CCA比值无统计学显著差异（P〉0．05）。结论：同侧颈内动脉与颈总动脉血流收缩期血流速度比值（ICA／CCA）有助于早期诊断颅内颈内动脉系统远端阻塞性病变。     

高频彩超对穿支皮瓣血管的探索研究

目的应用超声探测和定位腹壁下动脉穿支血管、胸背动脉穿支血管、旋股外侧动脉穿支血管,探讨高频彩超在穿支血管检查中的有效性和应用价值,为临床提供参考依据。方法运用高频彩超对43例穿支皮瓣移植术患者行穿支血管探测,其中腹壁下动脉穿支皮瓣36例,胸背动脉穿支皮瓣5例,股前外侧穿支皮瓣2例。重点为探测各穿支血管出肌点的精确位置,并在该处体表作标记。结果43例穿支皮瓣血管均能显示,并较为精确地定位。穿支血管管径极细,平均约0．7mm;变异较大。出肌点极不恒定。结论超声能清晰显示和定位腹壁下动脉穿支血管、胸背动脉穿支血管、股前外侧穿支皮瓣穿支血管．是目前唯一精确有效的术前检查手段,能在皮瓣血管检查中发挥重要作用。     

Use of ultrasound guidance in the insertion of radial artery catheters

OBJECTIVE: To assess the role of a portable ultrasound device in the insertion of radial artery catheters. DESIGN: Prospective, randomized, comparative study. SETTING: Tertiary university hospital. PATIENTS: Elective surgery patients requiring arterial catheter insertion for intraoperative monitoring. INTERVENTIONS: A portable ultrasound device was used to visualize the radial artery at the wrist and to direct arterial catheter insertion. This new technique of arterial catheter insertion was compared with the classic palpation technique. MEASUREMENTS AND MAIN RESULTS: A total of 69 patients requiring an arterial catheter were randomized to either the ultrasound (34 patients) or palpation technique (35 patients). The time taken from skin puncture to successful arterial catheter insertion, the time taken per insertion attempt, the number of attempts required, and the number of cannulae used were recorded for each group. The arterial cannula was inserted on the first attempt in 21 (62%) cases using ultrasound vs. 12 (34%) cases by palpation (p =.03). Significantly fewer attempts were required for catheter insertion using ultrasound as compared with palpation (mean +/- sd, 1.6 +/- 1.0 vs. 3.1 +/- 2.4; p=.003); however, the time taken for each successful attempt was longer (26.1 +/- 2.0 vs. 17.3 +/- 1.6 secs, p=.001). A trend toward shorter overall time required for catheter insertion was found for the ultrasound group (55.5 +/- 63.8 vs. 111.5 +/- 121.5 secs, p=.17). There were four failures in the ultrasound group and one in the palpation group (not significant). CONCLUSIONS: Ultrasound is a useful adjunct to arterial catheter insertion and increases the rate of success at first attempt. The technique is easy to learn and may reduce the time taken to insert the catheter.     

高频超声观察运动对血管功能的影响

目的评价高频超声观察运动对健康成年人血管功能的影响。方法选取49例健康志愿者,分别于运动基础、运动峰值及恢复期,应用超声射频信号血管僵硬度（QAS）技术获取右侧颈动脉顺应性（CC）、扩张性（Dc）、硬度参数（α、β）及脉搏波传播速度（PWV）,应用二维斑点追踪（X-strain）技术获取右侧颈动脉内膜环向应变（EN-CS）、外膜环向应变（EP-CS）、内膜环向应变率（EN-CSR）、外膜环向应变率（EP-CSR）,分析EN-CS、EP-CS、EN42SR、EP-CSR与CC、DC、α、β、PWV的相关性。结果在运动基础、运动峰值及恢复期,CC分别为（1．436±0．448）mm^2/KPa、（1．041±0．432）mm^2/KPa、（1．191±0．467）mm^2／kPa,DC分别为（0．040±0．016）1／kPa、（0．031±0．013）1／kPa、（0．034±0．013）1／kPa,CC、DC随时间改变呈先降低后增高的趋势（F=12．99、7．65,P均〈0．01）：PwV分别为（5．037±0．798）m／s、（5．845±1．165）m／s、（5．683±1．367）m／s,α分别为2．298±0．633、3．303±1．697、3．0924±1．533,β分别为4．762±1．284、6．794±2．515、6．158±3．089,PWV、α、β随时间改变呈先增高后降低的趋势（F=9．21、13．24、12．33,P均〈0．01）。在运动基础、运动峰值及恢复期,EN．CS分别为（7．825±2．445）％、（9．105±4．234）％、（6．271±2．527）％,EN-CSR分别为（0．831±0．276）S-。、（1．219±0．556）s^-1、（0．765±0．282）S^-1,EP。CS分别为（6．894±2．465）％、（7．936±3．628）％、（5．489±2．306）％,EP．CSR分别为（0．714±0．247）s^-1、（1．019±0．414）s^-1、（0．656±0．237）s^-1,EN-CS、EN-CSR、EP-CS、EP-CSR随时间改变呈先增高后降低的趋势（F=25．92、43．76、21．22、47．98,P均〈O．01）。相关性分析表明：EN．CS、EN．CSR、EP。CS、EP．CSR与Pwv、α、β呈正相关（r=0．253～0．494,P均〈0．05）,与CC、DC呈负相关（r=-0．234- -0．562,P均〈0．05）。结论血管功能参数CC、DC、α、β、PWV、EN-CS、EN-CSR、E-CS、E-CSR均可从不同角度反映血管功能的变化,适当的运动能够改善血管弹性。     

彩色多普勒超声诊断桡动脉瘤1例

患儿男,5岁,因父母发现左手腕上方肿块就诊,无外伤史.灰阶超声检查于左手腕关节上方桡侧见大小为1.0 cm×0.7 cm无回声结节,其后部见厚0.14 cm弱回声斑,诊断为左腕关节上方囊性结节(病理性质待定).     

穿刺置管术中桡动脉痉挛影像特点的超声学研究

目的探讨穿刺术中桡动脉痉挛（RAS）的影像特点及其影响因素。方法使用高频超声观察局麻和全麻状态下行桡动脉穿刺患者的血管影像特点,并测量穿刺前后桡动脉内径（RAD-1、RAD-2）及狭窄段长度（L-Spasm）。结果 264例患者中发生RAS者131例,发生率为49.6%;其中影像特点RAS可以分为局限痉挛、局部痉挛和弥漫痉挛三种类型。两组患者穿刺前桡动脉内径RAD-1差异无统计学意义（P〉0.05）;穿刺术后,全麻组桡动脉内径RAD-2较局麻组明显减小,而L-Spasm较后者明显增大（P〈0.05）。通过logistic回归分析证实,女性、高龄（≥60岁）、糖尿病及RAD-1≤2mm者是RAS的高危人群,穿刺时间长及穿刺次数增多可引起并加重RAS,利多卡因局部浸润麻醉有助于减少RAS的发生率（P=0.017,OR=0.446）。结论 RAS发生率相对较高,其影像特点和影响因素亦众多;局部使用利多卡因有助于减少RAS的发生。     

高频超声检查胎儿尸体心脏的研究

目的探讨高频超声检查胎儿尸体心脏的方法与价值。方法应用高频超声对71例引产后胎儿尸体心脏进行多切面扫查,并采用辅助方法即经胎儿脐静脉或直接用注射器向心腔内注水后再次行超声扫查。对比分析胎儿尸体心脏高频超声检查及尸检结果。结果在71例胎儿尸体标本中高频超声检查成功36例,成功率为50．7％（36／71）,其中17例检测出心脏畸形（共37处心脏结构异常）,与产后尸体解剖结果相比较30处相符,产后尸体高频超声正确诊断率81．08％（30／37）,漏误诊率18．92％（7／37）。结论可应用高频超声检查胎儿尸体心脏,必要时可采用辅助方法,如心脏检查成功,诊断准确率较高。对由于家属拒绝尸检者,判断胎儿心脏产前超声诊断准确性具有非常重要的意义。     

高频超声诊断不同臂丛神经病变研究进展

臂丛神经结构复杂,走形迂曲,位置表浅,支配上肢及肩部的运动及感觉。随着科学技术的发展,臂丛神经损伤呈现逐年上升的趋势。如何对臂丛神经损伤做出及时且精准的诊断,术前明确区分节前与节后损伤,一直是近年来临床研究的热点、难点。本文旨在重点介绍高频超声在不同臂丛神经病变诊断中的研究进展。     

涎腺少见局灶性病变的高频超声表现

目的探讨涎腺少见局灶性病变的超声表现。方法回顾性分析并总结经病理证实的20例涎腺少见局灶性病变的超声表现,包括病变部位、大小、形状、回声、边界、内部血流等情况。结果良性病变14例(包括良性淋巴上皮病变5例,基底细胞腺瘤4例,毛细血管瘤3例,肌上皮瘤1例,嗜酸细胞腺瘤1例),大多为圆形或椭圆形(11/14,78.6%)、低回声(10/14,74.1%)、边界清楚(11/14,78.6%)。14例CDFI分别为:1例无血流信号、4例血流稀少、9例血流丰富。恶性病变6例(包括黏液表皮样癌2例,腺样囊性癌1例,囊腺癌1例,腺癌1例,非霍奇金淋巴瘤1例),4例圆形或椭圆形(4/6,66.7%),2例形态不规则(2/6,33.3%)。大多为混合回声(5/6,83.8%)、边界不清(4/6,66.7%),其中3例(3/6,50.0%)病灶内见点状钙化。其中5例有CDFI资料,1例无血流信号、1例血流稀少、3例血流丰富。结论了解涎腺少见病变的超声表现有助于涎腺病变的诊断和鉴别诊断,但部分良恶性病变超声表现有重叠,可能误诊。     

高频超声经腹壁诊断小儿肠系膜淋巴结炎

目的 探讨使用高频彩色多普勒超声经腹壁诊断小儿肠系膜淋巴结炎的临床应用价值。方法使用高频探头7～10MHz，经腹壁对急性腹痛患儿25例进行超声检查，重点探查右下腹。结果25例腹痛患儿超声表现为右下腹及脐旁可见数个大小不等的低回声椭圆形团块，边缘清晰，完整，内部回声均匀．长径与短径之比均大于2。结论使用高频超声能为临床诊断急性肠系膜淋巴结炎提供可靠依据。     

高频超声对女性肛门括约肌完整性评估的可行性研究

目的 利用高频超声对女性肛门括约肌进行显像与评价,验证高频超声运用于女性肛门括约肌完整性评估的可行性。方法 2020年1月-2021年3月期间行盆底超声检查的110例女性受检者,通过高频线阵探头分别从横断面及矢状面对其肛门括约肌进行连续性扫查,而后两位经验不同的研究人员在互盲情况下独立对肛门括约肌的影像进行完整性评价,记录肛门括约肌损伤情况并进行统计分析。结果 在全部受检者中,高频超声均可从横断面及矢状面清晰地显示各水平肛管特征性的解剖结构,从而当出现异常的超声表现时,可以实现对肛门括约肌损伤的检出。通过Kappa一致性检验可得高频超声对肛门括约肌的完整性评价在不同经验的研究人员间也具有较强的一致性(Kappa=0.888,P<0.05)。结论 高频超声通过对各水平肛管的清晰成像,可以实现对肛门括约肌的完整性评价,为肛门括约肌的评估提供一种新的影像学手段。     

Complications during and following radial artery cannulation: a prospective study

One hundred and eighteen 20-g radial artery catheters were prospectively evaluated in 109 cardiovascular surgical patients. 0.024% papaverine in saline was used as a continuous flushing solution. Using the Doppler method, obstruction of the radial artery with the catheter in situ was found in 11 (9.8%) patients. Decannulation was performed at the end of the monitoring in 93 (78.9%) cases while 25 (21.1%) catheters had to be removed earlier. According to Allen's radial flush and Doppler evaluation after decannulation, three (2.5%) radial artery occlusions and one stenosis persisted. However, no vascular insufficiency occurred during the study period. Female patients developed more complications with the catheter in situ but not after catheter removal. Wrist size did not predict the complications. Age, concomitant diseases, traumatic cannulation, type of the surgery, longer cannulation time and perioperative complications did not influence the incidence of abnormal radial blood flow after decannulation. Our results confirm the low incidence of significant complications following radial artery cannulation.     

高频超声对糖尿病患者颈动脉内膜-中膜厚度及斑块形成检测的意义

目的:探讨颈动脉高频超声在糖尿病动脉硬化中的应用价值。方法:使用ATL HDI-5000型高频超声对57例糖尿病患者及43例非糖尿病患者进行对照,观察其颈动脉内径、内膜-中膜厚度(IMT)、斑块形成及血流动力学情况。结果:糖尿病组颈总动脉最大IMT、阻力指数及斑块发生率均明显大于对照组,两组间有显著差异(P<0.01);血流PSV、EDV速度两组间无明显差异(P>0.05)。有合并症的糖尿病组最大IMT及斑块检出率大于无合并症糖尿病组。结论:高频超声能清晰显示颈动脉有无形态学改变(IMT、狭窄、阻塞及斑块的形态、结构)、观察血流状态,对判断糖尿病动脉硬化的病情进展、治疗效果、了解预后及对并发症的预防都有重要意义。