Diagnosis and follow-up of craniopharyngiomas with transcranial Doppler sonography.

OBJECTIVE: Craniopharyngiomas are the most common parasellar neoplasms in children. Because it is difficult to diagnose subtle visual or endocrinologic changes in young children at an early stage, craniopharyngiomas may grow to a considerable size before diagnosis. METHODS: We used transcranial Doppler sonography to diagnose and follow up 5 patients with craniopharyngiomas. There were 3 girls and 2 boys aged from 6 years 4 months to 10 years. RESULTS: The initial manifestations were visual defects (n = 4), headaches (n = 3), and growth restriction (n = 1). One patient had a diagnosis of a craniopharyngioma on the basis of sonography before brain computed tomography. All 5 patients were examined with transcranial color Doppler sonography before surgery and for postoperative follow-up. Sonography showed a cystic component with calcification in 4 patients and a solid component in 1 patient; these findings were compatible with the computed tomographic findings. Displacement of the vessels of the circle of Willis was found. Tumor recurrences were detected early on transcranial sonography in 4 patients at 1 to 8 months' follow-up; these were proved by computed tomography. CONCLUSIONS: Transcranial Doppler sonography is a convenient tool for the diagnosis, evaluation, and follow-up of craniopharyngiomas. It can adequately describe vessels around the tumors and show tumor recurrence at an early stage.     

Comparison of duplex and nonduplex transcranial Doppler ultrasonography

Transcranial Doppler ultrasonography is essential in the management of children with sickle cell anemia and is a valuable adjunct to the evaluation of a variety of intracranial pathologies in children and adults, including vasoconstriction caused by subarachnoid hemorrhage, demonstration of major intracranial vessel stenoses or occlusion, determination of brain death, demonstration of the nidus of arteriovascular malformations, and assessment of cerebral hemodynamics after trauma, stroke, or migraine. There are 2 types of transcranial Doppler equipment currently available: nonduplex (nonimaging) and duplex (imaging). The purpose of this review is to compare and contrast the clinically relevant differences between these 2 types of equipment.     

Test-retest reliability of functional transcranial Doppler ultrasonography

The present study evaluates the reproducibility of lateralised blood flow velocity (BFV) changes measured with transcranial Doppler (TCD) ultrasonography during various cognitive paradigms. A total of 20 right-handed volunteers were confronted twice with 13 verbal and visuospatial tasks, with a time interval of 23 to 71 days. No statistically significant differences were found between the lateralisation indices (left BFV change minus right BFV change) on the first and second examinations. Lateralisation indices of eight tasks showed a significant test-retest reliability (r = 0.61 to 0.83). The reproducibility of cognitively induced lateralised BFV changes appears to be task-dependent. The possible influence from technical, physiological, and psychological factors is discussed. We conclude that functional neuroimaging studies based on blood flow data should preferably select cognitive paradigms that demonstrated sufficient test-retest reliability.     

Transcranial Doppler ultrasonographic features during drug withdrawal from drug-induced headache. A transcranial Doppler follow-up study

BACKGROUND: A vascular component in ergotamine-induced headache has been proposed. No study has been carried out to evaluate cerebral hemodynamic changes by means of transcranial Doppler during withdrawal from migraine medication; in particular, ergotamine-containing drugs. METHOD: We examined 21 patients suffering from drug-induced headache during their in-hospital withdrawal from ergotamine (n=8) and compared them with patients during withdrawal from analgesics (n=13) and with healthy controls (n=14). Cerebral blood flow velocities were measured with transcranial Doppler, and pulsatility indices were calculated. Blood pressure, heart rate, and end-tidal carbon dioxide were documented. A subjective analog headache rating scaling was used for day-to-day evaluation of headache severity. RESULTS: Mean cerebral blood flow velocities dropped significantly after discontinuation of ergotamine-containing drugs but not after stopping common analgesics. Pulsatility indices remained unchanged. Cerebral blood flow velocities were higher in drug-ingesting patients compared to the control group and showed significant changes in patients with headache using ergotamine and in those using analgesics. Carbon dioxide, heart rate, and blood pressure remained unchanged. The headache rating scale did not show a constant trend. COMMENTS: Our results indicate that ergotamine and, to a lesser extent, common analgesics including caffeine might influence cerebral blood flow velocities and pulsatility indices causing transient and reversible disturbance of cerebral autoregulation.     

彩超对医源性股动脉假性动脉瘤及动静脉瘘的诊断

目的探讨彩超对医源性股动脉的假性动脉瘤及动静脉瘘的诊断价值。方法心导管术后出现右腹股沟搏动性包块或异常血管杂音的12例患者行彩超检查。结果12例患者中，8例诊断为假性动脉瘤，4例诊断为动静脉瘘。结论彩超能明确诊断心导管术后发生的假性动脉瘤及动静脉瘘，可作为首选的检查方法。     

功能性经颅多普勒超声的研究进展

经颅多普勒超声(TCD)是一种具有实时性的无创的诊断工具，它可连续同时监测双侧的脑血流速度(CBFV)，TCD结合彩色多普勒能量图或磁共振血管成像技术可无创地测量大脑血流量。功能性经颅多普勒超声(functional transcranial Doppler ultrasonography，fTCD)是研究认知活动时双侧半球不同动脉血流速度变化的技术。本文对有关fTCD的研究做一综述。     

Diagnosis and follow-up study of carotid cavernous fistulas with color Doppler ultrasonography: analysis of 33 cases.

OBJECTIVE: The purpose of this study was to observe image characteristics and hemodynamic changes of carotid-cavernous sinus fistulas (CCFs) and to evaluate the efficacy of interventional treatment for CCFs by color Doppler ultrasonography (CDUS). METHODS: Thirty-three patients with suspected CCFs were studied with CDUS. Forty-six volunteers took part in this study as controls. Scanning was performed through temporal, orbital, and occipital windows to measure the blood flow parameters of the internal carotid artery (ICA) and related vessels. All results were confirmed by cerebral angiography. Nineteen patients were followed after interventional treatment. RESULTS: Thirty-two patients (97%) were found to have CCFs by CDUS. Irregular mosaic flashes were observed in the cavernous sinus region, the cross-section areas of which were significantly larger than those of the normal intracranial ICA (1.7-5.2 versus 0.2-0.5 cm(2); P < .01). A lower resistive index of the ICA in the affected side was revealed with spectral analysis of relevant vessels. The peak velocity of vessels distal to the fistula was significantly lower than that of the healthy side and control group (P < .05). Superior ophthalmic veins had a reversed arterialized flow pattern with a mean velocity of 34.5 cm/s and an average resistive index +/- SD of 0.31 +/- 0.08. In follow-up study, the mosaic flashes and turbulence flow disappeared in 14 patients and remained in 5 after the interventional operation. CONCLUSIONS: Combined with the direct sign of an irregular mosaic flash in the cavernous sinus region, hemodynamic changes in relevant branch vessels, and a reversed arterialized flow pattern in superior ophthalmic veins, CDUS has great value in confirming diagnosis and follow-up study of CCFs.     

彩色多普勒超声在获得性子宫动静脉瘘的诊断及疗效评估中的应用

目的探讨获得性子宫动静脉瘘（AVM）的二维及多普勒超声特征，分析二维及彩色多普勒超声在经子宫动脉栓塞治疗后疗效观察中的价值。 方法选择11例获得性子宫AVM患者为研究对象。回顾性分析其子宫及病灶区二维声像图、彩色多普勒血流（CDFI）表现，量化分析多普勒流速曲线特点，包括收缩期峰值速率（PSV）和阻力指数（RI），结合临床症状对经子宫动脉栓塞术（UAE）治疗后病灶的声像图变化，进行分析。 结果11例患者均经彩色多普勒超声诊断为子宫AVM，二维超声图像显示为子宫肌层内见单发类圆形无回声区和（或）多个小无回声区伴低回声呈"蜂窝状"，彩色多普勒显示无回声区内有丰富红蓝镶嵌血流信号充填，呈"马赛克"或"湖泊样"改变；脉冲多普勒呈高速低阻血流流速曲线，典型者表现出静脉血流动脉化表现，11例超声检查结果与子宫动脉造影结果基本一致。患者均接受了UAE治疗，10例栓塞术后1周~6个月复查，二维超声见病灶均有明显减小或逐渐消失，彩色多普勒超声表现为低速静脉血流信号或异常血流信号消失；1例随访1周~11个月表现为病灶减小但低速低阻动脉流速曲线持续存在，再次栓塞后仍复发出血，患者因无生育需求最终切除子宫。 结论彩色多普勒超声对获得性子宫动静脉瘘的诊断及UAE后对其治疗效果的评估监测有重要价值。     

Transient arteriovenous fistulae after transrectal prostate biopsy: diagnosis with color Doppler ultrasonography.

To assess the prevalence and significance of arteriovenous fistulae after prostate biopsy, we performed color Doppler ultrasonography immediately after 136 consecutive transrectal prostate needle biopsies. Pathologic results were correlated with color Doppler ultrasonographic findings. Arteriovenous fistulae developed after 17 biopsies (13%), all closed spontaneously within 18 minutes, and none were associated with unusual bleeding. Carcinoma was noted in 25 biopsy specimens (18%), 10 (40%) of which were followed by arteriovenous fistula. The correlation between malignancy and postbiopsy arteriovenous fistula was statistically significant (P < 0.0004), consistent with hypervascularity known to be present in many prostate cancers.     

Aortic arch dissection presenting with hemodynamic spectrum of aortic regurgitation on transcranial Doppler

The diagnosis of aortic dissection is frequently missed at the time of hospital admittance. Neurological presentations are rare, and neuro-sonography is rarely used. We describe a patient with atypical clinical presentation of aortic arch dissection in whom neuro-sonological investigations showed a "cathedral like" haemodynamic spectrum of aortic regurgitation, directing the investigation towards the diagnosis.     

Comparative study of 18 gauge and 20 gauge intravenous catheters during transcranial Doppler ultrasonography with saline solution contrast

A formal technical protocol has not been established for transcranial Doppler ultrasonography in the detection of venous to arterial shunts; techniques have been adapted from contrast echocardiography. We evaluated the effect of different diameter indwelling intravenous catheters on the detection of right-to-left shunts by transcranial Doppler ultrasonography. Fifteen patients underwent transcranial Doppler sonographic evaluation with saline solution contrast using both 18 gauge and 20 gauge indwelling intravenous catheters. The larger bore intravenous catheter delivered a greater number of signals in a shorter time to the insonated middle cerebral artery. We recommend that a standardized method for transcranial Doppler sonographic contrast studies include an 18 gauge intravenous catheter.     

Transcranial color Doppler imaging of brain arteriovenous malformations in adults

This study was performed to investigate the utility of transcranial color Doppler sonography in evaluating adult cerebral arteriovenous malformations. Twelve patients with such malformations underwent sonography. Spectral Doppler sonographic assessment included peak systolic velocity, end diastolic velocity, and resistive index within the intracranial and extracranial vessels. Color Doppler sonography was used to visualize the site of shunting. Paired and unpaired Student's t-tests were used to determine significance of spectral findings. The nidus was seen in eight of 10 pial malformations. The nidi in two patients were located in the parietal region and not visualized. When compared with the corresponding contralateral artery, feeding arteries (identified in all 10 of the pial lesions) demonstrated diminished resistive indices (P = 0.09). Similarly, the end diastolic velocity was increased in all feeding arteries (P = 0.03). When compared with published normal values, the peak systolic and end diastolic velocities were significantly elevated and the resistive indices were low (P < 0.0003). Transcranial color Doppler sonography depicted the nidi of pial arteriovenous malformations in 80% of cases. Feeding arteries demonstrated abnormal peak systolic velocity, end diastolic velocity, and resistive index in all cases when compared with published values. Transcranial color Doppler sonography is not a good screening tool due to limited acoustical window, but it may be useful for noninvasive study of the physiology of arteriovenous malformations as they are treated.     

肝移植后CT与超声检查对肝血流指数监测的比较研究

目的分析超声频谱测定肝动脉阻力指数(RI)与CT灌注成像测定肝动脉灌注量(HAP)之间的关系,探讨两者在肝移植后肝动脉血流动力学监测中的价值。方法从2002年11月～2004年11月的肝移植病例中选取11例因终末期肝病行肝移植且术后无血管并发症病例于术后12～20d行CT灌注成像扫描,获得其HAP等指标。并使用超声测得其在CT扫描前后48h的肝动脉RI,同法测得11例无肝病的健康志愿者的相应指标,对自身HAP/RI相关性及显著性进行统计分析。结果正常对照组HAP/RI均显示较明显的相关性(r=-0.767,P=0.06),而在肝移植组这种相关性消失(r=0.470,P=0.123)。结论与正常人不同,在肝移植后CT灌注成像测定肝动脉灌注指标与超声频谱监测肝移植后肝动脉RI不存在明确相关性。以肝移植后肝动脉RI大小推断肝实质动脉期血流灌注量是不可靠的,它仅能作为一种动态监测肝移植后血管并发症的指标,在其出现显著变化时提示肝动脉并发症出现的可能。     

多普勒超声对创伤性动静脉瘘的诊断及鉴别诊断

目的 探讨创伤性动静脉瘘的彩色及频谱多普勒特征及其鉴别诊断。方法 回顾性分析11例动静脉瘘患者，使用彩色超声诊断仪观察瘘口处血流情况，受累血管的内径、形态、血流性质及方向，对瘘口处及受累血管血流频谱进行分析，并与健侧对照。结果 8例可直接显示瘘口，显示受累血管管壁连续性中断，瘘口处五彩镶嵌样血流自动脉流向扩张的静脉腔，脉冲多普勒示瘘口处呈双期单向连续性频谱，血流速度300～390cm／s，受累动脉近心端血流为高速低阻型，受累静脉出现脉动样血流，近心端静脉呈高速低阻型频谱；4例患者远心端静脉内出现逆向离心性血流。结论 瘘口处双期单向分流，静脉出现高速、动脉样血流频谱是动静脉瘘的特征性表现，多普勒超声对创伤性动静脉瘘能够正确诊断及鉴别诊断。     

经颅多普勒超声检测脑血流自动调节下限的初步应用

目的研究经颅多普勒（TCD）在脑血流自动调节下限检测中的应用,拓宽TCD的应用范围。方法利用TCD检测SD大鼠大脑中动脉（MCA）的血流速度,同步记录有创血压,按照临界关闭压（CCP）的理论测定脑血流自动调节下限,与常用的缓慢放血降低血压,绘制脑血流自动调节曲线法测定的自动调节下限进行比较。结果缓慢放血降低血压过程中,MCA的血流速度和颈总动脉的血流量下降趋势完全一致(r=0.95116±0.05736,P<0.001),可以用MCA的血流速度代替血流量计算CCP。CCP法检测到的脑血流自动调节下限为（70.88±24.05）mmHg（1mmHg=0.133kPa）,与放血降低血压利用血流速度和血流量变化测定的结果［分别为（72.88±26.26）mmHg和（75.63±22.22）mmHg］高度相关（r分别为0.79455和0.73846,P均<0.001）,数值相近,来源于同一群体（P分别为0.96758和0.81768）,前者可以代替后两者。结论TCD检测MCA的血流速度,同步记录动脉血压,按照CCP理论测定脑血流自动调节下限,切实可行,结果可靠,可以准确、快捷地反映脑血流动力学变化。     

彩色多普勒超声监测人工动静脉内瘘的临床应用

目的探讨彩色多普勒超声对人工动静脉内瘘术前、术后监测的临床价值。方法应用彩色多普勒超声对32例人工动静脉内瘘进行术前吻合血管（桡动脉、头静脉）的筛选、监测和术后1周及4—6周的动态观察。结果经彩色多普勒超声监测的人工动静脉内瘘手术32例,30例成功,1例失败,1例放弃手术。术后超声发现2例患者因血栓形成导致动静脉内瘘阻塞,临床处理后内瘘再通。结论彩色多普勒超声的术前监测是保障内瘘成功建立的有效手段,术后的动态观察和及时处理并发症,可进一步提高手术成功率、延长内瘘的使用时间。     

Quantitative characterization of arcuate artery hemodynamic change in normal pregnancy with Doppler ultrasonography

Using color and pulsed Doppler ultrasonography, arcuate arterial velocimetry was carried out in 91 normal women, at 16–40 weeks, menstrual age. The arcuate arterial hemodynamics was assessed by the calculation of the resistance index (RI). A curvilinear relationship was found between the RI value of the arcuate artery obtained from the placental site in the uterus and menstrual age (R² = 0.328). The relationships between the RI value of the arcuate artery obtained from the nonplacental site (R² = 0.268) or the averaged RI value between the placental and nonplacental sites (R² = 0.321) and menstrual age were both linear. Normal ranges of RI values of arcuate arteries during pregnancy for the placental site, nonplacental site, and their average values were generated. These results provide a foundation for evaluating uteroplacental velocimetry in normal pregnancy using Doppler ultrasonography. © 1993 John Wiley & Sons, Inc.