彩色多普勒超声和多层螺旋CTA诊断下肢动脉硬化性闭塞症的临床价值

回顾性地分析21例下肢动脉硬化性栓塞病的彩色多普勒超声及多层螺旋CT血管成像(CTA)图像改变.结果下肢动脉硬化性闭塞症二维超声图像上表现为病变血管内中膜呈不规则增厚,局部呈强回声斑,并向血管腔内突起,血管腔内径呈不规则狭窄,病变段血管腔内可见实性低回声光团充填;彩色多普勒血流显像显示血管腔内无血流信号;多层螺旋CTA显示病变段血管区域无对比剂,同时显示侧支动脉的走行及起始部位.认为彩色多普勒超声及多层螺旋CTA对下肢动脉硬化闭塞症的诊断均有重要价值.     

联合应用头颈部血管超声诊断颅内外动脉多支血管病变一例

颈动脉多普勒超声是广泛应用于颈部动脉粥样硬化性血管病变筛查的检查方法,可以明确显示斑块部位、大小、性质和易损性等,并评估颈动脉的狭窄程度;颅内动脉超声可以显示颅内前、后循环各血管深度、血流速度、血流方向、血管搏动指数及有无侧支代偿等血流动力学情况。该文报道1例通过联合应用颅内动脉超声与颈动脉多普勒超声诊断颅内、外多支血管狭窄、闭塞性病变患者,诊断为双侧颈总动脉节段性狭窄、双侧椎动脉起始段狭窄、左侧锁骨下动脉狭窄、右侧锁骨下动脉闭塞、左侧颈内动脉颅外段病变、双侧颈内动脉终末段狭窄、右侧大脑前动脉发育不良、左侧椎动脉颅外段病变、基底动脉中度狭窄、右侧锁骨下动脉盗血(Ⅱ级)。颅内动脉超声与颈动脉多普勒超声联合检查对综合判断颅内、外动脉多支血管病变的诊断有较大帮助,可提高血管超声科医师对复杂颅内与颈动脉血管狭窄、闭塞性病变诊断的准确性,为临床提供准确、可靠的超声诊断信息。     

彩色多普勒超声诊断急性上肢动脉栓塞的价值探讨

总结分析我院收治的8例急性上肢动脉栓塞的二维、彩色多普勒、频谱多普勒超声检查资料。结果栓塞部位二维超声主要表现为栓塞处管腔实质团块;彩色多普勒显示,完全性栓塞时阻塞段彩色血流信号中断或消失,不完全栓塞时可见沿血管内壁一侧走行、五彩镶嵌、不规则细条状彩色血流;脉冲多普勒显示,栓塞处动脉管腔内未探及血流频谱。认为彩色多普勒超声诊断急性上肢动脉栓塞方便、快捷、准确、敏感,可作为首选检查方法。     

彩色多普勒超声评价脑梗死和颈动脉斑块的临床价值

目的 探讨彩色多普勒超声评价脑梗死和颈动脉斑块之间的联系.方法 对225例脑梗死患者进行颈动脉彩色多普勒超声检查,分别观察颈动脉有无斑块,发观有颈动脉斑块者,测量颈动脉的内-中膜厚度、斑块大小及血管内血流动力学指标,并观察有无血管狭窄.结果 225例脑梗死患者超声检查有197例出现颈动脉内-中膜增厚,合并粥样硬化斑块形成.斑块出现部位多集中在颈总动脉分叉处,其中扁平斑块78例,软斑块64例,溃疡型斑块31例,硬斑块24例.结论 粥样硬化的颈动脉斑块形成与脑梗死的发生有密切关系,彩色多普勒超声检查颈动脉粥样硬化对预测脑梗死有重要的临床意义.     

彩色多普勒超声诊断多发性大动脉炎的外周血管病变

目的 探讨彩色多普勒超声对多发性大动脉外周血管病变的诊断价值.方法 使用二维及彩色多普勒超声对22例多发性大动脉炎的外周血管进行检查,分析病变动脉的二维声像图及彩色多普勒超声特征.结果 22例多发性大动脉炎受累动脉分布情况:颈总动脉15例,锁骨下动脉13例,腹主动脉7例,肾动脉3例,股总动脉1例,肠系膜上动脉1例.受累动脉二维声像图表现多为动脉管壁弥漫性向心性增厚,管腔出现不同程度的狭窄、闭塞,彩色多普勒超声多表现为受累动脉内血流束变细、消失,部分出现盗血.结论 彩色多普勒超声可较准确、直观地反映多发性大动脉炎的受累范围及受累动脉病变情况,可作为多发性大动脉炎的常规检查.     

彩色多普勒超声对主动脉瘤的诊断价值

目的 探讨彩色多普勒技术对主动脉瘤的诊断价值。方法 应用彩色多普勒技术分析临床证实为主动脉瘤的12例病人的超声图像,包括瘤体大小、形态、内部回声、血流方向、血流速度等。结果 彩色多普勒均能显示动脉瘤体大小、范围、动脉管壁情况及瘤腔内的血流信号,其中5例主动脉夹层可显示真、假腔及破口的血流频谱信号。有硬化斑及血栓者可见血流充盈缺损。结论 彩色多普勒超声对诊断主动脉瘤有较高的价值。     

彩色双功能超声诊断下肢动脉硬化性闭塞症的临床价值

对81例下肢动脉硬化性闭塞症患者行二维超声及彩色多普勒血流显像检测,结果二者均可显示下肢动脉硬化症的阳性改变。二维超声表现为病变血管内、中膜不规则增厚,局部强回声斑,并向血管腔内突起,血管腔内径不规则狭窄,病变段血管腔内充填实性光团;彩色多普勒血流显像示血管腔内无血流信号。认为双功能超声对下肢动脉硬化闭塞症的诊断具有很高的灵敏性和准确性。     

彩色多普勒超声对老年脑梗死患者颈部动脉斑块的诊断价值

目的分析彩色多普勒超声对老年脑梗死患者颈部动脉斑块的诊断价值。方法选取2015年8月—2016年8月武汉市第一医院收治的老年脑梗死患者80例,均行彩色多普勒超声检查,以数字减影血管造影(DSA)检查结果作为"金标准",分析彩色多普勒超声对老年脑梗死患者颈部动脉斑块的诊断价值。结果彩色多普勒超声与DSA对老年脑梗死患者颈部动脉斑块的诊断准确率比较,差异无统计学意义(P0.05)。结论彩色多普勒超声对老年脑梗死患者颈部动脉斑块的诊断准确率较高,且无创无痛,可满足临床诊疗需求。     

颈动脉内膜切除术治疗颈内动脉扭曲合并颈动脉重度狭窄

目的探讨颈动脉内膜切除术(CEA)治疗颈内动脉扭曲合并颈动脉重度狭窄患者的临床疗效。方法回顾性分析苏州大学附属第一医院神经外科2013年1月至2018年2月连续收入的18例颈内动脉扭曲合并颈动脉重度狭窄患者的临床资料。患者术前均经颈部血管彩色多普勒超声、CT血管成像(CTA)、DSA评估病变血管,经CT灌注(CTP)成像评价大脑半球的血流灌注情况。MetzⅡ级6例和Ⅲ级4例行外翻式CEA+切除多余颈内动脉治疗; MetzⅠ级8例行标准式CEA治疗。术后行颈部血管超声、CTA和CTP检查,了解手术血管通畅情况以及颈内动脉扭曲被纠正情况。随访时间6～72个月,复查颈部血管彩色多普勒血流显像、CTA评估有无再狭窄及MRI评估有无新发脑梗死。结果 18例患者手术均成功,所有患者术后血管通畅性良好。术后复查CTA,10例行外翻式CEA治疗的患者,示扭曲血管已不同程度地拉直; 8例采用标准式CEA治疗的患者,斑块切除满意,无管腔狭窄。术后1例出现舌下神经损伤症状,3个月后好转; 1例发生轻度高灌注综合征,2周后好转;无死亡病例。随访复查示所有患者无颈动脉再狭窄及新发卒中事件。结论对颈内动脉扭曲合并颈动脉重度狭窄患者,CEA是一种有效和安全的治疗方法。根据术前评估的病变特点,合理选择手术方式。     

经阴道彩超鉴别诊断子宫平滑肌瘤与子宫腺肌瘤39例分析

目的 探讨经阴道彩色多普勒超声技术对子宫平滑肌瘤与子宫腺肌瘤的鉴别诊断价值.方法 对39例患者进行术前经腹部彩色多普勒超声和经阴道彩色多普勒超声检查,并与术后病理结果对比分析.结果 39例患者经阴道彩色多普勒超声与术后对照,超声诊断符合率90%.超声特点子宫肌瘤瘤体有假包膜,边界清晰,瘤体假包膜血流成环状包绕,瘤体内血流呈条状、网状,频谱形态与子宫动脉略有不同,舒张期切迹模糊或消失,瘤体内阻力指数低于肌壁内子宫动脉的阻力指数.而子宫腺肌瘤无包膜,内部回声多是粗大颗粒状,后方常伴有放射状细淡声影,其内多见星点闪烁状彩色血流信号,频谱显示低速高阻动脉或静脉低速血流.结论 经阴道彩色多普勒超声能清晰地反映子宫腺肌瘤与子宫平滑肌瘤特征,在二者的鉴别上有较好的可比性.     

Farbdopplersonographie bei der Untersuchung peripherer Gelenke und Sehnen

Doppler ultrasound is able to visualize blood flow by the change in frequency (Doppler shift) of sound waves which are reflected by moving blood cells inside the vessels (Doppler effect). As hyperemia caused by vasodilatation and angiogenesis is the earliest detectable pathologic change in the beginning of synovitis, Doppler ultrasonography can be used to assess inflammatory activity. Several studies could show a strong correlation between magnetic resonance imaging (MRI) as well as histological findings (blood vessel density) and Doppler sonographic determination of synovial perfusion. Equipment settings must be adapted to slow blood flow in very small blood vessels to reach an appropriate imaging quality. Color and power Doppler ultrasound can depict different grades of intra-articular and peritendinous blood flow, which allows an estimation of inflammatory activity and facilitates the differentiation and monitoring of rheumatic diseases during follow up.     

Blood flow velocity in the middle cerebral artery during carotid cross-clamping: loss of regulatory response to carbon dioxide partial pressure. A transcranial Doppler intraoperative study

The CO2 reactivity of blood flow velocity in the Middle Cerebral Artery (MCA) was explored by Doppler ultrasound, in nine patients, at the time of common carotid artery cross-clamping during vascular surgery, in order to detect if a regulatory response apply during operative occlusion of common carotid artery. Transcranial Doppler was used to monitor ipsilateral MCA blood velocity during carotid surgery. MCA velocity, arterial blood pressure and pCO2 (arterial or end-tidal) were measured, during carotid cross clamping, before and after an increase in pCO2 was induced by changing respiratory rate and volumes. No relevant changes in MCA flow velocities were detected in patients with stable arterial blood pressure. In those patients showing an increase in blood pressure during the surgical procedure the MCA velocity increased accordingly. It is suggested that the cross-clamping of common carotid artery is a critical condition in which no regulatory response can be elicited: blood flow velocity tends to parallel the perfusion pressure and also CO2 reactivity is lost.     

颈动脉粥样硬化病变的彩色多普勒超声诊断

目的探讨彩色多普勒超声对颈动脉粥样硬化的诊断价值及临床意义。方法对621例住院和门诊患者的颈动脉进行彩色多普勒超声检查。结果动脉粥样硬化斑块好发部位以颈总动脉分叉部最为常见；其发生率随年龄的增长而增加，且男性多于女性；声像图特征以扁平斑多见。结论彩色多普勒超声是检测颈动脉粥样硬化斑块的可靠方法，为有效预防和治疗血管性病变提供依据。     

Cerebrovascular insufficiency: diagnostic technics compared]

The ability of angiodynography (or Color Flow Imaging) to achieve accuracy in image resolution of thin details of venous as well as arterial vessels has made continuous wave Doppler and frequency analysis Doppler almost obsolete techniques. Some controversies exist about the effectiveness of color flow imaging versus duplex scanner imaging, but recent progress in ultrasound imaging technology seems to overcome the problem. Angiodynography can effectively substitute X-ray angiography in some specific instances and is able to limit the use of invasive techniques to cases in which surgical procedures are really foreseeable. The non-invasiveness of angiodynography makes it useful to follow-up the asymptomatic lesions, particularly those of the carotid artery, as well as operated patients. Moreover, people for whom contrast angiography is contraindicated can be operated safely on the bases of angiodynography alone. This paper reports the results of one-year activity of Ultrasound Vascular Laboratory with 1982 patients: 923 (48.7%) had their epiaortic arterial vessels examined, with 180 (19.5%) follow-up controls, 297 (39.9%) negative explorations, 234 (31.5%) hemodynamically not significant lesions, 135 (18.2%) subjects affected with moderate (50-70% stenosis) and non ulcerated carotid stenosis, and 77 (10.4%) patients with ulcerated plaques or > 70% stenosis.     

彩色多普勒超声在糖尿病患者下肢血管病变中的应用

目的探讨彩色多普勒超声在糖尿病患者下肢血管病变中的应用价值。方法选择2010年10月至2012年12月期间广东省人民医院院收治的2型糖尿病患者96例作为研究组,另选同期在我院进行健康体检者100名作为对照组。采用彩色多普勒超声诊断仪对两组受检者行下肢动脉血管血流动力学检测。比较分析两组受检者下肢动脉血管病变发生情况以及下肢动脉血流变学情况。结果与对照组比较,研究组2型糖尿病患者硬化斑块、血管狭窄以及血管闭塞等下肢动脉血管病变的发生率均明显提高,分别达63．54％、23．96％和11．46％,两组组间差异均有统计学意义（P〈0．05）。与此同时,与对照组比较,研究组下肢股动脉、胭动脉、胫动脉以及足背动脉血管内径均明显缩小,血流量均明显减少,频谱宽度均明显提高,两组间差异均有统计学意义（P〈0．05）。结论彩色多普勒超声在2型糖尿病患者下肢血管病变的早期诊断、治疗以及相关并发症的预防中均具有重要的临床应用价值。     

Plaque rupture on the carotid artery observed by Doppler ultrasonography--a case report.

Plaque rupture may play an important role in acute cerebral events. Recent technological advances in ultrasonographic systems provide a feasible diagnostic modality of atherosclerotic lesion by clearly visualizing flow conditions and vessel morphology. A 58-year-old man with chronic renal failure underwent duplex Doppler ultrasound in which ruptured plaque on carotid arterial wall was imaged. Color Doppler imaging showed that the plaque shoulder at the proximal site was hit by forward flow to the brain and ruptured. Curling flow in the inner space of the plaque was observed. Carotid arteriography at the corresponding site of ruptured plaque revealed the space within the plaque similarly contrasted. A magnetic resonance imaging of brain performed after identifying plaque rupture revealed small cerebral infarcts at the cerebral cortex. Plaque rupture could be demonstrated by color Doppler imaging at the proximal edge of plaque and curling flow in the intraplaque space may have released small thrombi to vessel lumen. Plaque rupture of the carotid artery may play an important role in the development of small cerebral infarction.     

Noninvasive detection of a coronary arteriovenous fistula by two-dimensional color Doppler echocardiography

The diagnosis of a left circumflex coronary artery--coronary sinus fistula draining into the right atrium was confirmed by echocardiographic analysis. Two-dimensional echocardiography revealed a dilatation of the left main coronary artery, the left circumflex artery, the coronary sinus and a fistulous communication. Pulsed Doppler echocardiographic study showed a turbulent, continuous flow within the dilated coronary artery, in the coronary sinus and at the site of its drainage into the right atrium. There was a diastolic flow-reversal in the descending aorta in absence of aortic insufficiency. Color Doppler echocardiography enhanced the finding of the correct diagnosis by simultaneously displaying blood flow within various parts of the heart and the coronary vessels. This technique aided in establishing the exact location of the fistula by demonstrating a turbulent blood flow, even in narrow cardiac structures. The echocardiographic diagnosis was confirmed by coronary angiography.     

颈部大动脉粥样硬化与短暂性脑缺血发作的相关研究

目的　评价颈部大动脉粥样硬化与短暂性脑缺血发作 (TIA)的相关性。方法　对 16 8例TIA患者进行颈部大动脉彩色多普勒检测 ,同期来院健康体检者 6 0例为对照组。结果　TIA患者颈动脉内膜中层厚度 (IMT)和斑块的发生率较对照组明显增加 ,两组比较差异有显著性意义 (P <0 .0 1)。椎 基底动脉系统TIA患者锁骨下动脉起始处的斑块发生率明显多于颈内动脉系统TIA患者 ,差异有显著性意义 (P <0 .0 1)。TIA患者颈内动脉的IMT值与血浆总胆固醇、甘油三酯、纤维蛋白原的含量成正相关 (P <0 .0 1)。结论　彩色多普勒超声可作为颈部大动脉粥样硬化检测的可靠方法。颈部大动脉粥样硬化的形成与TIA的发病密切相关     

颈动脉粥样硬化与冠心病发生的相关性

目的：探讨颈动脉粥样硬化与冠心病发生的相关性。方法：应用彩色多普勒超声技术检测了90例冠心病患的颈动脉,其中20例进行了冠状动脉造影检查。结果：（1）各组冠心病患颈动脉管壁内－中膜厚度,斑块指数均显增高,其中心肌梗死患伴有明显的血流参数异常;（2）20例患冠状动脉造影与颈动脉超声检查符合率为75％而且冠状动脉病变越重,颈动脉硬化发生率越高。结论：颈动脉粥样硬化程度可间接反映冠状动脉病变程度。     

血压水平对脑血管和颈部血管血液动力学检测指标的影响

目的 应用超声技术,探讨不同血压水平对脑血管和颈部血管血液动力学检测指标的影响.方法 对225例伴颈动脉粥样硬化斑块的高血压患者,根据血压控制水平分为轻度高血压组(n=30)、中度高血压组(n=61)和重度高血压组(n=129).选择同期检测的无高血糖、高血脂及无颈动脉粥样硬化斑块且血压正常的患者94例作为对照组.经颅多普勒超声检测大脑中动脉、大脑前动脉、大脑后动脉以及椎动脉的平均血流速度和搏动指数的变化特征.采用颈部B超检测颈总动脉、颈内动脉以及椎动脉的平均血流速度和搏动指数的变化特征.结果 (1)各高血压组24 h动态血压水平与对照组比较均显著增高(P<0.05).(2)各高血压组脑部血管的平均血流速度和搏动指数与对照组比较差异均有统计学意义(P<0.05);各高血压组之间比较,随着血压水平的增加,脑部血管的平均血流速度降低,搏动指数增大(P<0.05).(3)各高血压组颈部血管的平均血流速度和搏动指数与对照组比较差异均有统计学意义(P<0.05);各高血压组之间比较,随着血压水平的增加,颈部血管的平均血流速度降低,搏动指数增大.结论 血压水平对脑部和颈部血管血液动力学均有影响,随着血压水平的增高,血流动力学指标的异常程度呈现渐进加重的趋势.从脑血管和颈部血管的血液动力学角度看,理想的血压水平应不超过140/90 mmHg.经颅多普勒超声结合颈动脉超声可对高血压痛患者颅内外动脉血流动力学的变化进行客观评价,为临床诊治提供依据.