Colour-coded Doppler sonography of common carotid artery dissection

Colour Doppler sonography allowed noninvasive confirmation of bilateral common carotid artery dissection in a patient with previous aortic dissection. It also cast light on the pathophysiology.     

The detection of intracranial carotid artery disease by continuous-wave Doppler sonography

Summary We have investigated 6,587 patients with directional continuous-wave (c-w) Doppler sonography of the carotid arteries during the last 33 months, and have developed criteria for the diagnosis of a significant increase in peripheral resistance of the internal carotid artery in conjunction with 1,671 retrograde brachial and direct carotid angiograms. We distinguished stenoses proximal (15 cases) and distal (4) to the origin of the ophthalmic artery, supraclinoid internal carotid artery occlusions (8), stenoses (2) and acute occlusions (10) of the middle cerebral artery. Stenoses in the carotid siphon (proximal or distal to the origin of the ophthalmic artery) of at least 60% reduction in lumen diameter showed a reduction of the relative end-diastolic flow velocity (modified Pourcelot's index) of more than 40%; additionally, stenoses proximal to the origin of the ophthalmic artery exhibited a variable alternating flow, or flow reversal, in the supratrochlear artery. Stenoses distal to the origin of the ophthalmic artery rarely revealed the theoretically expected increase in orthograde flow velocity in the supratrochlear artery. Stenoses of the middle cerebral artery consisting of more than atherosclerotic irregularities proved to be an exception. Supraclinoid occlusions of the internal carotid artery were reliably demonstrated by Doppler sonography. However, the majority of acute occlusions of the middle cerebral artery could not be detected by this means, probably due to anastomoses between the anterior and the middle cerebral arteries, which were detected by angiography. Thus, we believe that c-w Doppler sonography is a reliable tool to detect stenoses of the carotid siphon of more than 60% reduction in lumen diameter and supraclinoid carotid artery occlusions. Barriers to the cerebral blood flow located more peripherally cannot be diagnosed reliably with this technique.     

基底动脉中段支架术后穿支动脉闭塞的相关研究

目的 探讨基底动脉中段支架术后穿支动脉闭塞的影响因素,提供改善临床疗效的方法.方法 回顾性分析26例应用Wingspan支架治疗症状性颅内基底动脉中段狭窄的疗效,观察其技术成功率、狭窄率的改变、围手术期并发症及术后症状改善情况.结果 26例患者共植入27枚Wingspan支架,技术成功率为100％.术后即刻血管造影证实,狭窄率由(78.8±7.5)％降为(23.1±7.4)％.2例患者出现围手术期并发症.按照Malek评分,分别评价术后24 h,术后1个月的预后情况:术后24 h评分,1分25例,4分1例;1个月后评分1分24例,4分1例,5分1例(术后2周死于肺部感染);随访术后6～21个月,1分22例,3分1例,5分2例(1例患者术后7个月死于脑出血),失访1例.结论 应用Wingspan支架治疗症状性基底动脉中段狭窄对于穿支动脉的闭塞可以通过积极的措施预防及治疗,初步结果显示效果良好,但仍须大样本随机对照研究进行验证.     

Extracranial internal carotid artery Salmonella mycotic aneurysm complicated by occlusion of the internal carotid artery: depiction by Color Doppler sonography,CT and DSA

Mycotic aneurysms of the extracranial carotid artery are rare. Seventy-four cases have been described in the medical literature and only eight secondary to Salmonella infection. To our knowledge, color Doppler sonography, computed tomography (CT), and digital subtraction angiography (DSA) findings relating to the diagnosis and follow-up of extracranial internal carotid artery mycotic aneurysm complicated by occlusion have not previously been described in the literature. We present a report of color Doppler sonography, CT, and DSA findings of a mycotic aneurysm of the right extracranial internal carotid artery due to Salmonella associated with occlusion of the internal carotid artery, promptly diagnosed and followed up using these imaging modalities.     

Colour Doppler and duplex sonography and angiography of the carotid artery bifurcations

We undertook a prospective double-blind study of 128 carotid artery bifurcations using colour Doppler and duplex sonography and angiography. Sixty-four patients with cerebrovascular events were admitted for angiography. All underwent sonography within 24 h of angiography. Standard duplex sonography and colour Doppler imaging without spectral analysis were performed, on the same device, by two sonographers, using defined morphological and haemodynamic criteria. Digital radiological data on vessel diameter were interpreted independently by two radiologists.The two sonographic methods gave similar grading of stenosis, compared to angiography, with an accuracy ranging from 96% in severe to 83% in minor stenoses. Colour Doppler studies gave better area measurements than standard duplex sonography, except for major stenoses. Discrepancies between ultrasonography and angiography were due mainly, to minor stenoses and large plaques of calcification on the vessel walls, which masked very segmental 70% stenoses in 2 cases. Angiography is limited by its own resolution, does not show uncalcified vessel walls and does not give cross-sectional data. It would therefore be inappropriate for showing small plaques, the full extent of ectasia or for defining the carotid bulb accurately.The advantages of colour methods were in investigating sinuous or deep vessels and hypoechoic plaques. Analysis of the residual lumen of a stenosis and its extent could be determined more rapidly. Haemodynamic quantification of stenoses by standard duplex sonography may be difficult because of limited sample volume and error in estimation of angle, whereas colour Doppler allows semiquantitative estimation of haemodynamics. Standard duplex sonography permits good analysis of vessel wall over a limited distance and quantification of velocity; colour Doppler affords overall demonstration of turbulence, acceleration and backward flow.     

Amplitude coded-colour Doppler sonography in paediatric renal disease

The aim of our study was to assess the ability of amplitude coded-colour Doppler sonography (ACDS) to depict altered perfusion in paediatric renal disease in a prospective study. Colour Doppler sonography (CDS) and ACDS examinations were performed in 180 renal units (90 patients; age range newborn to 16 years) with unilateral or bilateral renal disease (e. g. reflux nephropathy, renal scars, end-stage renal disease, ureteropelvic junction obstruction, urinary tract infection, renal failure, haemolytic uraemic syndrome, nephrotic syndrome, systemic lupus erythematosus (LE), renal biopsy, congenital dysplasia, tumour/infiltration). The ACDS results were compared with scintigraphy or CT as well as to clinical findings. Amplitude colour-coded Doppler sonography accurately demonstrated normal vasculature in 49 of 51 healthy kidneys ( = 96 %); 3 healthy kidneys could not be evaluated due to motion/artefacts. In 39 of 43 kidneys with focally altered perfusion ACDS could be performed and correctly depicted focally impaired vasculature/perfusion in 35 kidneys ( = 89.7 %). Seventy-three of 83 kidneys with diffusely impaired perfusion could be evaluated by ACDS and altered pattern was correctly depicted in 58 kidneys ( = 79.4 %), with an overall percentage of agreement of 87.1 %. Amplitude CDS appears to be useful in infants and children. Compared with CDS it improves visualisation of especially focally impaired vasculature/perfusion and should be considered a valuable adjunct to conventional investigations. Received: 12 June 1999 Revised: 10 December 1999 Accepted: 11 August 2000     

Balloon occlusion of the internal carotid artery in 40 cases of giant intracavernous aneurysm: technical aspects,cerebral monitoring,and results

Summary We have studied the results of carotid occlusion in the treatment of giant intracavernous carotid artery (ICA) aneurysms in 40 patients. Clinical, angiographic, Doppler and cerebral blood flow (CBF) criteria for tolerance of occlusion are discussed. The patients had headaches (47.5%), cranial nerve compression (87.5%), decreased visual acuity (20%), ruptured aneurysm (15%) and 5% were asymptomatic. Balloon occlusion tests were performed under light sedation anaesthesia: a successful test required perfect clinical tolerance and adequate angiographic collateral circulation in arterial, parenchymatous, and venous phases. Additional criteria include xenon 133 CBF measurements, and transcranial Doppler sonography of the middle cerebral artery. According to these criteria, 5 patients did not tolerate test occlusion and required an extra-intracranial (EC-IC) bypass. Mean follow-up was 4.7 years. All patients were radiologically cured of their ancurysm, and in 35 the symptoms resolved, although 3 had persistent ocular motor nerve palsies, and in 4 visual defects were unchanged. Complications were 1 permanent and 3 transient neurological deficits. Balloon occlusion of the ICA is an effective, reliable form of treatment for intracavernous giant aneurysm and should replace surgical ligation of the cervical carotid artery. With CBF or Doppler monitoring, the risk of neurological deficit is diminished. EC-IC bypass prior to ICA occlusion is indicated if test occlusion is not tolerated.     

Evaluation of breast lesions by power Doppler sonography

The aim of this study was to determine the value of power Doppler sonography in the detection of tumor vascularity in breast lesions and to find new diagnostic criteria for differential diagnosis. Power Doppler sonography was prospectively performed in 102 patients with 118 histologic (n = 116) and cytologic (n = 2) results. A semisubjective scoring system for the intratumoral increase in blood flow compared with the flow in normal breast parenchyma (reference structure) was introduced and the flow pattern registered. The difference in the flow increase for benign and malignant breast disease was highly significant (p≤ 0.0001). This applied especially to invasive cancer above a maximum tumor diameter of 5 mm excluding cancer stage Tis and T1 a. A positive correlation between cancer size and flow increase were found. The flow pattern was an additional feature. The sensitivity was calculated to be between 74.5 and 78.8 %, and the specificity between 74.6 and 77.8 %. The level of flow increase in Power Doppler sonography is an important feature in the differential diagnosis of breast lesions and should be considered together with the established criteria in B-mode ultrasound. The flow pattern might also add some important information. Received: 3 March 2000 Revised: 7 August 2000 Accepted: 26 September 2000     

Differentiation of benign and malignant tumors of the parotid gland: value of pulsed Doppler and color Doppler sonography

To establish criteria for the differentiation of benign and malignant tumors of the parotid gland using color Doppler sonography (CDS) and pulsed Doppler sonography (PDS) we examined 37 patients with parotid tumors by gray-scale ultrasound, CDS, and PDS. Tumor vascularization displayed by CDS was graded subjectively on a 4-point scale (0 = no vascularization, 3 = high vascularization). From the Doppler spectrum, the highest systolic peak flow velocity, the resistive index (RI), and the pulsatility index (PI) were calculated. There were 11 malignant and 26 benign tumors. Tumor vascularization by CDS was grade 0 or 1 in 88.5 % of benign lesions, whereas it was grade 2 or 3 in 82 % of malignant lesions (P < 0.0001). The highest systolic peak flow velocity was statistically significantly higher in malignant lesions than in benign lesions. Using a threshold systolic peak flow velocity of 25 cm/s, sensitivity was 72 % and specificity was 88 % for the detection of a malignant tumor. Evaluation of tumor vascularization by CDS and PDS cannot differentiate between benign and malignant parotid tumors with certainty. However, high vascularization and high systolic peak flow velocity in tumor vessels should raise the suspicion of malignancy, even if tumor morphology on gray-scale sonography indicates a benign lesion. Received 5 February 1998; Accepted 5 March 1998     

彩色多普勒超声监测Graves病甲状腺动脉栓塞后血流变化的临床研究

目的 研究彩色多普勒超声在监测甲状腺动脉栓塞治疗Grayes病后甲状腺血流变化，以及对临床疗效的评估作用。方法 31例确诊Graves病的患者行甲状腺动脉栓塞治疗，其中11例用彩色多普勒超声监测治疗前后甲状腺的血流变化，观察指标有甲状腺内部血流信号、甲状腺上动脉舒张期内径、收缩期最大血流速度(Vmax)、舒张期最小血流速度(Vmin)、阻力指数(RI)和甲状腺大小。同时观察临床症状和相关的实验室检查指标的变化情况。结果 Graves病甲状腺动脉栓塞治疗后，甲状腺上动脉舒张期内径、Vmax和Vmin明显降低，甲状腺内部血流明显减少，甲状腺体积缩小。临床症状好转或消失，相关的实验室检查指标恢复正常。结论 彩色多普勒超声可用于评估甲状腺动脉栓塞治疗Grayes病的疗效，是一种较好的无创性动态监测方法。     

机械取栓治疗伴椎基底动脉闭塞的轻型卒中2例分析

目的：探讨机械取栓治疗伴椎基底动脉闭塞的后循环轻型卒中的有效性及安全性。 方法：通过对2例伴椎基底动脉闭塞轻型卒中患者进行机械取栓治疗,并引用文献进行分析,探讨该治疗方法的有效性及安全性。 结果：2例合并椎基底动脉闭塞的轻型卒中通过机械取栓治疗均取得良好的效果,未出现明显的并发症。 结论：对合并椎基底动脉闭塞的轻型卒中进行机械取栓治疗安全有效;治疗过程中准确评估血栓长度及部位,采取综合措施再通血管同时防止血栓远端脱落是最关键的治疗要素。     

The efficacy of EC-IC anastomoses: Evaluation by directional c-w Doppler sonography

Summary We report the results obtained by means of directional c-w Doppler sonography on 33 patients with superficial temporal-to-middle cerebral artery anastomoses. The efficiency of the anastomosis was evaluated by the modified Pourcelot indices (relative end-diastolic flow velocities) of the preauricular superficial temporal artery and of the bypass-supplying branch at the edge of the burr-hole. The influence of intermittent compression of the bypass-supplying branch on the modified Pourcelot index of the ipsilateral common carotid was used as a further criterion in the sonographic evaluation. All efficient anastomoses, defined by a modified Pourcelot index of at least 0.20 at the edge of the burr-hole, exhibited a reduction of the relative end-diastolic flow velocity of 0.08 on the average in the common carotid during compression. In the 18 cases with unilateral occlusion of the internal carotid, bypass surgery was predominantly efficacious in those patients who showed a reduction in the sum of the modified Pourcelot indices of the remaining brain-supplying arteries of at least two standard deviations with respect to the mean of age-matched controls. The subgroups of patent and absent collaterals through the ophthalmic artery did not show any difference with respect to the percentage of efficient anastomoses. In all 4 patients with bilateral internal carotid artery occlusion, bypass surgery was effective, while 50% of the patients with intracranial carotid artery disease exhibited an insufficient anastomosis. The 2 patients with a stenosis or an occlusion of the M-1 segment of the middle cerebral artery showed modified Pourcelot indices of the anastomosis-supplying branch of 0.45 and 0.46 at the edge of the burr-hole, respectively. Thus, we believe that the efficiency of a superficial temporal-to-middle cerebral artery anastomosis can be evaluated semiquantitatively by directional c-w Doppler sonography. The preoperatively calculated sum of the modified Pourcelot indices of the remaining brain-supplying arteries can be used as an additional criterion for the evaluation of the necessity of bypass surgery, at least in cases of unilateral and bilateral internal carotid occlusions.     

Evaluation of breast nodules with echo colour Doppler sonography: preliminary findings

The authors report the results of using colour Doppler sonography in the evaluation of breast pathology. In particular, 65 solid breast masses were examined by mammography, sonography and colour Doppler. Thirty-eight lesions were proved histologically and 27 cytologically. The lesions had an average diameter of 17 mm (range 6–40 mm). Colour Doppler sonography demostrated the presence of vascularisation in 94.4% of breast cancers while this finding was noted in only 41.4% of benign lesions. Bidirectional blood flow was present in 94.1% of carcinomas compared with 50% of fibroadenomas, and irregular blood flow figured in 61.8% of malignant lesions compared with 8.3% of the benign lesions. In 60% of cancers in which neovascularisation was present, the colour Doppler signals occupied more than 10% of the area of the lesion; in contrast, benign masses were characterised by a low colour dot-nodular area ratio. These preliminary results using colour Doppler did not allow sensitivity and specificity values to be quantified and compared with those for traditional breast imaging techniques; however, we think colour Doppler may be very useful in adding dynamic information to the mammographic and sonographic morphological examinations. Correspondence to: G. M. Giuseppetti     

颌下腺肿瘤的彩色多普勒超声表现及诊断价值

目的探讨颌下腺肿瘤的彩色多普勒超声表现及临床价值。方法回顾性分析经病理证实的29例颌下腺肿瘤的二维超声图像、彩色多普勒及脉冲多普勒频谱特征。结果29例颌下腺肿瘤中,恶性肿瘤约占41.4%(12/29),良性肿瘤约占58.6%(17/29)。本组颌下腺肿瘤超声表现共同特征是颌下三角出现肿块,内部可见实质性或混合性回声团,彩色多普勒超声显示颌下腺恶性肿瘤内部及周边血流信号丰富、杂乱,动脉血流频谱收缩期血流峰值速度(PSV)7.8~24cm/s,阻力指数(RI)0.43~0.94。颌下腺良性肿瘤内部及周边无或偶见点状血流信号。结论彩色多普勒超声诊断颌下腺肿瘤具有较高临床价值。     

Transcranial Doppler sonography in children: review of a seven-year experience

AIM: We report the use of transcranial Doppler sonography (TCD) examinations in children (mean age 12.7 years; range 0.5-18 years) without an open fontanelle, using TCD equipment with a 2 MHz pulse wave transducer. Our results over a 7-year period are described. MATERIAL AND METHODS: A total of 858 children were referred from the paediatric outpatient department. All patients were divided into three groups according to the reason for referral. RESULTS: We found positive pathological results in the following: (1) headache and orthostatic dysregulation (0.4%, three out of 728); (2) acute neurological symptoms (5.4%, six out of 112); (3) other indications (22.2%, four out of 18). The positive predictive value of finding an abnormality was very low (0.50). CONCLUSION: TCD examination is ineffective in children with non-specific headache or orthostatic dysregulation due to the specific limitations of this method. We found a higher percentage of abnormal results in children referred for other indications. However, since these children usually undergo MR imaging (and MR angiography, if necessary), in our opinion the TCD examination does not add any additional information. The value of TCD in children is not in the primary diagnosis of disease but in the follow up of known vascular processes (e.g. stenoses) or in chronic diseases including angiitis and sickle cell disease.     

Gray scale and color Doppler sonography in the diagnosis of carpal tunnel syndrome

Purpose

To determine the diagnostic accuracy of gray scale and color Doppler sonography in the diagnosis of patients with carpal tunnel syndrome.

Patients and methods

A total of 53 wrists in 41 consecutive patients with clinical suspicion of carpal tunnel syndrome, referred from the Department of Physical medicine, Rheumatology & Rehabilitation were examined with ultrasonography using a 12 MHz linear array transducer. The presence of median nerve edema, swelling, and bowing of the flexor retinaculum was evaluated by gray scale sonography, while intraneural hypervascularity was evaluated by color Doppler sonography. Sensitivity and specificity were calculated for each sonographic feature and compared with electrodiagnostic test (EDT) results.

Results

Electrodiagnostic tests confirmed carpal tunnel syndrome in 48 wrists. A median nerve cross sectional area (CSA) of 11 mm² was calculated as a definition of median nerve swelling. In comparison with electrodiagnostic tests, median nerve swelling showed the highest accuracy (89%) among the gray scale sonographic criteria, and the presence of median nerve hypervascularization showed the highest accuracy (94%) among all sonographic criteria. Median nerve edema and bowing of the flexor retinaculum showed accuracies of 81% and 77% respectively.

Conclusion

Median nerve intraneural hypervascularity detected by color Doppler sonography is more accurate in detection of median nerve involvement than gray scale sonography criteria in patients with suspected carpal tunnel syndrome.     

Doppler sonography of the deep lingual artery

Purpose: To clarify the Doppler sonographic features of the lingual artery in normal subjects and to evaluate those of patients with cancer of the tongue.Material and Methods: Sixty-seven volunteers and 12 patients with cancer and/or leukoplakia of the tongue were examined with an intraoral sonographic probe. The visibility of the deep lingual artery was determined on transverse and anteroposterior images. On the transverse images, the vascular index, which was defined as the number of colored pixels, was measured on bilateral lingual arteries. Thereafter, the degree of symmetry was evaluated for normal subjects and patients.Results: In normal subjects, between younger and older volunteers, there were no significant differences in visibility of the trunk but differences were found between the two groups for the dorsal branches. The vascular indices of the right and left sides were not different. The characteristic Doppler sonographic feature was vasculature in and around the tumors in the patients with cancer of the tongue. The symmetry indices of the cancer patients were significantly different from those of normal subjects.Conclusion: Doppler sonography should be an important procedure for evaluation of tongue neoplasms.     

经阴道彩色多普勒超声在子宫内膜癌术前筛查中的应用

目的：探讨经阴道彩色多普勒超声（TVCDS）在子宫内膜癌筛查中的应用。方法：应用TVCDS筛查子宫内膜癌高危因素妇女326例,记录子宫内膜形态及病灶的部位、子宫内膜厚度、病灶内血流、阻力指数（RI）等,判断子宫内膜癌及肌层浸润程度等。将TVCDS诊断结果与病理结果对照。结果：326例高危因素妇女中TVCDS诊断子宫内膜癌52例,后经手术病理证实48例,TVCDS诊断子宫内膜癌准确率为92%。结论：TVCDS无创、简便、价廉、易于重复,诊断子宫内膜癌准确率高,在子宫内膜癌术前筛查中具有良好的应用价值。     

多普勒超声在乳腺小肿块诊断及鉴别中的应用

目的:评价多普勒超声在乳腺小肿块诊断与鉴别诊断中的应用价值。方法:应用彩色多普勒、能量多普勒及脉冲多普勒超声对123例直径小于2cm的乳腺肿块进行检查。结果:72例良性肿块有57例检出血流信号,51例乳腺癌有45例检出血流信号,二者无显著差异。以0~Ⅰ级为少血流信号,Ⅱ~Ⅲ级为多血流信号,对乳腺癌与良性肿块的血流信号多少进行对比分析,二者有显著差异(P<0.01),良性肿块以0~Ⅰ级为主,乳腺癌以Ⅱ~Ⅲ级为主。良性肿块Vmax为9.14±3.25cm/s(-x±SD),乳腺癌Vmax为14.33±3.31cm/s(-x±SD)(P<0.01),良性肿块阻力指数为0.60±0.21(-x±SD),乳腺癌阻力指数为0.71±0.24(-x±SD)(P<0.05),两组数值均有显著性差异。结论:乳腺良性小肿块与乳腺癌在血流丰富程度及血流动力学指标方面有明显差异,多普勒超声在乳腺小肿块诊断及鉴别中有重要作用。