经颅多普勒超声和颈动脉超声检测无脑缺血症状的2型糖尿病患者颅内外动脉粥样硬化病变

目的 分析无脑缺血症状的2型糖尿病患者颅内动脉粥样硬化性狭窄和颅外颈动脉粥样硬化病变的发生频率及分布特征,并探讨其危险因素.方法 对94例无脑缺血症状的2型糖尿病住院患者用经颅多普勒超声(TCD)和颈动脉超声判断颅内外动脉粥样硬化病变,颅内动脉只分析狭窄,颅外动脉病变包括颈动脉斑块及狭窄.分析各危险因素的影响.结果 55例(58.5%)有颅内外动脉粥样硬化病变.22例(23.4%)发现有颅内动脉狭窄,明显高于颅外颈动脉狭窄或闭塞(3/94,3.2%,χ~2=16.66,P＜0.01).大脑中动脉是颅内最常受累的动脉(狭窄率17.0%),占狭窄动脉数的58.5%.48例(51.0%)有颅外颈动脉粥样斑块或狭窄.Logistic多元回归分析显示糖尿病病程和合并高血压是颅内外动脉粥样硬化病变的独立危险因素.结论 无脑缺血症状的2型糖尿病住院患者,半数以上有颅内外动脉粥样硬化改变,且与糖尿病病程及合并高血压有关,提示对上述高危患者应常规进行超声检测.     

颈动脉狭窄的经颅多普勒超声检查及临床意义

Aaslid等于1982年首次报告了应用多普勒超声扫描记录颅内动脉血液速度的新技术，并推出了经颅多普勒超声（TCD）检查仪，其具有无创、检查费用低、易重复，可以在危重患床边检查等优点。     

颈部血管彩色超声和经颅多普勒超声联合检查评价前循环脑动脉粥样硬化

目的应用颈部血管彩色超声和经颅多普勒超声(TCD)联合检查方法,对急性缺血性脑卒中患者前循环脑动脉粥样硬化的程度进行评价,并讨论其临床意义。方法107例50～85岁急性前循环缺血性脑卒中患者,于发病后2周内完成颈部血管彩色超声及TCD检查。分别记录颈动脉颅外段狭窄组CT/MRI阳性侧和阴性侧颈总动脉/颈内动脉颅外段(CCA/EICA)不同回声斑块、斑块大小以及动脉狭窄程度;前循环颅内血管狭窄组CT/MRI阳性侧和阴性侧颈内动脉虹吸段(SCA)、颈内动脉末段(TICA)、大脑中动脉M1段(MCA-M1)、大脑前动脉A1段(ACA-A1)狭窄程度及双侧颈总动脉/颈内动脉颅外段不同回声斑块检出率;前循环颅内外动脉联合狭窄组CT/MRI阳性侧和阴性侧颈总动脉/颈内动脉颅外段、大脑中动脉M1段及大脑前动脉A1段狭窄程度。结果颈动脉颅外段狭窄组:CT/MRI阳性侧颈总动脉/颈内动脉颅外段和阴性侧比较,不同回声斑块大小及阳性检出率差异无统计学意义(P>0.05);狭窄程度为40%～50%、>50%～70%的颈总动脉/颈内动脉颅外段,两侧狭窄血管阳性检出率差异无统计学意义(P>0.05);当狭窄程度达>70%～90%和>90%时,CT/MRI阳性侧检出率均大于阴性侧(P<0.05)。前循环颅内血管狭窄组:CT/MRI阳性侧颈总动脉/颈内动脉颅外段与阴性侧之间不同回声斑块大小及阳性检出率差异均无统计学意义(P>0.05);颈内动脉虹吸段或颈内动脉末段和大脑中动脉M1段狭窄发生率,CT/MRI阳性侧大于阴性侧(P<0.05);大脑前动脉A1段狭窄发生率两侧差异无统计学意义(P>0.05)。前循环颅内外动脉联合狭窄组:CT/MRI阳性侧颈总动脉/颈内动脉颅外段狭窄程度>70%和大脑中动脉M1段狭窄阳性检出率均大于阴性侧(P<0.05);大脑前动脉A1段狭窄血管两侧阳性检出率差异无统计学意义(P>0.05)。结论同一组脑动脉粥样硬化患者颈动脉粥样硬化进展程度基本相同,根据斑块回声和溃疡形成与否不能确定动脉-动脉栓塞的"责任斑块";颈部血管彩色超声检查提示颈总动脉/颈内动脉颅外段狭窄程度>70%,以及TCD提示颈内动脉虹吸段、颈内动脉末段、大脑中动脉M1段狭窄≥50%者,与同侧脑卒中的发生明显相关,二者联合应用有助于确定急性缺血性脑卒中的"责任动脉"。     

经颅多普勒超声对颅内外动脉狭窄及侧支循环的评估价值

近年来,随着国内神经科医生对动脉粥样硬化性脑动脉狭窄在缺血性脑血管病的病因和发病机制中认识的不断深入,经颅多普勒超声(transcranial Doppler sonograply,TCD)检查的作用和地位也在不断提高.……     

经颅彩色多普勒超声对颅内动脉狭窄或闭塞的诊断

大动脉狭窄占住院急性卒中或一过性短暂性脑缺血发作（transient ischemic attack,TIA）患者的15．6％。经颅彩色多普勒超声（transcranial Doppler,TCD）是一种无创性地检测颅底大动脉血流动力学的诊断技术,通过检测颅底动脉的血流方向、血流速度、频谱形态、音频特点等能较准确地反应脑动脉的狭窄、闭塞和侧枝循环情况。     

经颅多普勒及颈动脉超声联合应用于脑动脉硬化及脑梗死早期诊断中的临床意义

目的分析经颅多普勒及颈动脉超声联合应用于脑动脉硬化及脑梗死早期诊断中的临床意义。方法收集脑梗死组、脑动脉硬化症组和对照组各70例患者,通过颈部血管彩超和经颅多普勒检查记录3组患者的IMT、斑块大小、形态、血管狭窄程度、Vs、Vd、PI、RI、S/D及颅内血管狭窄或闭塞例数,并进行比较。结果脑梗死组IMT高于脑动脉硬化组和对照组,差异有统计学意义(P0.05);脑梗死组血管狭窄程度25%~50%及75%的患者多于对照组和脑动脉硬化组,差异均有统计学意义(P0.05)。结论脑动脉硬化症患者早期监测上述相关指标,尽早进行药物治疗等干预手段,可降低脑动脉硬化症进展为脑梗死的发生率,对脑梗死的预防有重要意义。     

颈动脉超声联合经颅多普勒超声对缺血性脑血管病的诊断价值

目的探讨颈动脉超声与经颅多普勒超声联合在缺血性脑血管疾病中的价值及意义分析。方法选取2018-01—2019-12在济源市人民医院接受缺血性脑血管疾病治疗的308例患者为研究组。并选取同时期进行体检的150名健康者作为对照组。2组均行颈动脉超声与经颅多普勒超声联合检测,并比较其检测结果。结果研究组椎动脉及基底动脉的Vm低于对照组,而PI指数则高于对照组(P0.05);经颅多普勒与颈动脉超声联合检测的敏感性为97.0%(228/235)、特异性为86.3%(63/73)、阳性预测值为95.8%(228/238),均高于单纯的经颅多普勒超声的88.1%(207/235)、71.2%(52/73)、90.8%(207/228),2组比较存在明显差异(P0.05)。结论对缺血性脑血管疾病患者采用颈动脉超声与经颅多普勒超声联合的检测方法,能够有助于对病情进行及时、有效的判定,且符合度相对较高,利于临床治疗方案的确立及有效实施。     

颈部血管超声与经颅多普勒联合检测颅内、外血管与DSA对比分析

目的探讨缺血性脑血管病颈动脉超声与经颅多普勒(TCD)联合检测的必要性。方法对64例缺血性脑血管病患者的颈动脉超声及TCD表现与数字化脑血管造影(DSA)对比分析。结果 DSA共检出狭窄和闭塞血管160条。颈动脉超声和TCD共检出狭窄和闭塞血管与DSA符合117条。TCD与DSA比较符合率70.8%。颈动脉超声与DSA比较符合率76.5%。结论颈动脉超声与TCD联合检测缺血性脑血管病高危人群必不可少,为其病因诊断、干预治疗及预后提供依据。     

脑动脉硬化诊断与经颅多普勒超声

自Aaslid在1981年发明经颅多普勒超声（transcranial Doppler,TCD）并将其应用于临床已经有近50年的历史,从上世纪八十年代末以超声科华扬教授和神经科黄一宁教授为代表的中国第一批学者将其引入我国也走过二十年的路程,TCD的临床价值在世界范围内已经得到广泛认同,对颅内动脉狭窄的诊断已经被写入美国和欧洲卒中指南,对脑血流中微栓子信号的识别也被写入欧洲早中指南,对脑动脉自动调节功能研完的文章正如雨后春笋般出现在国际医学杂志。但在我国,TCD依然被误读误解,王拥军教授心痛无比地比喻TCD在中国是一个被委屈的孩子。     

The value of carotid Doppler ultrasound in asymptomatic extracranial arterial disease

Carotid Doppler is an accurate, safe and repeatable method of assessing arterial calibre, for distinguishing harmless neck bruits and to identify the stroke prone individual. It is completely non-invasive and can be used serially to monitor progression in carotid stenosis. It is a valuable clinical tool in diagnosis and management in patients at risk of stroke, but has definite limitations, such as in differentiating carotid occlusion from severe stenosis. B-mode imaging, although valuable in identifying arterial anatomy, and detecting plaques, cannot accurately evaluate the degree of stenosis. It is of limited value in identifying plaque hemorrhage and ulceration. Doppler ultrasound technology has advanced rapidly in the last decade, especially in the combination of B-mode imaging and Doppler (Duplex), as well as in evaluating of the intracranial circulation (transcranial Doppler). In the next decade, it may become the new gold standard for evaluating the extracranial and intracranial circulation.     

经颅多普勒超声评估单侧颈内动脉颅外段闭塞患者颅内侧支循环的临床意义

目的 探讨经颅多普勒超声(TCD)评估单侧颈内动脉颅外段闭塞(ICAO)患者颅内侧支循环的临床价值.方法 回顾性连续纳入2018年1月至2020年12月就诊于苏州大学附属第一医院卒中中心、行颈部血管超声检查为单侧ICAO及数字减影血管造影(DSA)证实患者145例,其中症状组109例,无症状组36例.记录TCD评估颅内...     

经颅多普勒超声对颅外段颈内动脉狭窄诊断价值的评估

目的评价经颅多普勒超声(TCD)对颅外段颈内动脉(ICA)狭窄、闭塞的诊断价值及探讨TCD评价动脉狭窄程度的参数。方法对临床有缺血性脑血管病症状的患者,先做TCD检查,筛选出可疑有颅外段颈内动脉病变的患者．再行数字减影血管造影(DSA)及(或)多层面螺旋CT血管成像(CTA)检查,确定颅外段颈内动脉狭窄的诊断,并计算狭窄程度,然后将DSA／CTA证实颈内动脉狭窄的患者的TCD资料进行回顾性分析。结果(1)脑血流速度:单侧ICA闭塞患者,ICA血流信号消失或极低(<20cm／s);重度狭窄者,狭窄程度与流速呈正比:狭窄程度越重,收缩期峰值流速(PSV)增高越明显;中度狭窄者局部流速轻度增加;轻度狭窄者血流速度与正常流速比较无明显变化。(2)ICA狭窄段PSV与ICA狭窄远端PSV的比值:重度狭窄为3．13-4．56,中度狭窄为2．24-2．73,轻度狭窄无明显变化。(3)侧支循环开放:颈动脉完全闭塞中93．1％侧支循环开放,狭窄程度>90％者86．6％存在侧支循环开放,70％-90％狭窄者74．3％侧支循环开放,轻、中度狭窄者无1例侧支循环开放。(4)频谱图形:重度狭窄患者,TCD表现为频谱增宽、湍流改变;中度狭窄者可出现涡流改变;轻度狭窄者TCD仅表现为层流消失,频谱呈高强度血流充填信号,声频钝。结论TCD对颅外段ICA重度狭窄、闭塞的患者具有较高的诊断价值．可为介入治疗或手术治疗提供参考依据。     

Use of transcranial Doppler ultrasonography for evaluation of intracranial pressure]

Transcranial Doppler (TCD) studies are very useful for the evaluation of intracranial pressure changes. The most informative for the TCD increase diagnosis are the diastolic pressure decrease and increase of two computed indices: pulsatility index (PI) and resistance index (RI). Single measurements can be misleading and therefore, monitoring of neurosurgical intensive care patients is suggested. Additional information is provided by TCD studies in cerebral blood flow autoregulation tests. The usefulness of TCD in brain death diagnosis is discussed also.     

Prevalence of asymptomatic atherosclerosis of extracranial vessels among hypertensive patients in southern Egypt: An extracranial duplex study

Objectives:The prevalence of atherosclerosis in extracranial vessels among hypertensive patients in southern Egypt is still unknown. Carotid ultrasound is an accurate method used to identify and follow patients with cerebrovascular disorders. The aim of our study is to detect the prevalence and pattern of extracranial atherosclerosis among those patients.Methods:Our case-control study was performed from January 2017 to January 2018, including 200 subjects, 100 patients recruited consecutively from the Hypertension Clinic in Assiut University hospitals, Egypt, and 100 healthy controls. Detailed history collection and thorough physical examinations were carried out for each patient. All subjects underwent extracranial ultrasound. We omitted patients with history of ischemic stroke and TIAs.Results:The presence of increased intima media thickness was detected in 37 patients (37%). 22 patients (22%) had internal carotid artery (ICA) stenosis, 17 patients (17%) had non-significant stenosis <50%, while five patients (5%) had stenosis 50-69%. 9% had stenosis < 50% in vertebral artery. In addition, age and uncontrolled hypertension have a greater impact on increasing the CCA intima media thickness, which is considered an early sign of atherosclerosis.Conclusions:Uncontrolled hypertension is an important risk factor for atherosclerosis and hence ischemic stroke (IS). The cost of screening is considered low compared to IS management. Greater emphasis should be directed toward regular screening programs in this risky population.

Ischemic stroke (IS) is a major health problem that leads to increased morbidity and mortality all over the world. Moreover, IS has very serious economic consequences, both for its management or during post-stroke care.1 Reducing the burden of stroke requires identification of the most common modifiable risk factors to control and follow. Hypertension is one of the major modifiable risk factors for IS.2 The approximate prevalence rate of hypertension in Egypt was 26.3%,3 and it is more prevalent in the south than in the north of Egypt.3 Hypertension leads to atherosclerosis through several mechanisms like vascular endothelial dysfunction, early vascular aging, systemic inflammation and thickening of the basal membrane .4 Chronic hypertension accelerates the atherosclerotic process by increasing intraluminal pressure and vessel wall thickness.5 Atherosclerosis can lead to IS through progressive stenosis and hence occlusion of the extra or intracranial vessels and or arterio-arterial embolization from an athermanous plaque.6 The classification of subtypes of acute ischemic stroke (TOAST Trial),7 which established the etiologic classification of IS, found that large-artery atherosclerosis played a significant role in the etiology of IS. The incidence rate of stroke among treated hypertensive patients was 289/100,000 and 363/100,000 among untreated hypertensive patients.8 Stroke is more easily prevented than treated, so follow up and early intervention of hypertensive patients could help to prevent the occurrence of IS. Carotid Ultrasound is a cheap and reliable method that enables the early detection and accurate monitoring of the extent and degree of the atherosclerosis of the extracranial vessels.9 Early identification within risky patients could stop them from developing stroke. Up to our knowledge, no previous studies estimating the prevalence and pattern of atherosclerosis among asymptomatic hypertensive patients were performed in southern Egypt. The aim of our work then is to determine the prevalence of asymptomatic atherosclerosis of extracranial vessels and/or stenosis among hypertensive patients who had no other risk factors, previous history of IS or transient ischemic attack (TIA) within the Assiut Governorate in southern Egypt.     

Noninvasive transcranial Doppler ultrasound in intracranial angiomas

Transcranial Doppler ultrasound is a noninvasive method to evaluate flow velocities in the basal cerebral arteries. It can provide hemodynamic data like velocity distributions, intracranial steal phenomena, and functional stenoses in angiomas as illustrated in four patients. This information may supplement conventional neuroradiologic procedures for therapeutic decisions and follow-up.     

高血压不同中医证型与经颅和颈动脉多普勒超声的相关性分析

目的探讨高血压中医辨证分型与经颅和颈动脉多普勒超声检测值之间的关系。方法选择我院2010-07—2014-02收治的高血压患者134例,应用多普勒超声仪检测不同中医证型患者的大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)的平均血流速度(Vm)、脉动指数(PI)和颈动脉狭窄程度。结果经Spearman相关性分析显示,高血压中医分型中肝火亢盛、阴虚阳亢、阴阳两虚和痰湿壅盛型与MCA、ACA、PCA的Vm呈负相关性(r=-0.54、-0.34、-0.30,P0.05),与MCA、ACA、PCA的PI呈正相关(r=0.32、0.29、0.22,P0.05)。本组134例高血压患者中颈动脉超声检测显示72例发生不同程度的颈动脉狭窄。轻、中、重度颈动脉狭窄患者间各中医证型比较差异有统计学意义(P0.05),均以痰湿壅盛型狭窄最为严重。结论不同中医证型高血压反映不同程度的颈动脉血管结构改变,超声检测中Vm、PI有可能作为高血压不同中医辨证分型的重要依据。