Visualisation of intracranial aneurysms by transcranial duplex sonography

We examined 72 patients with 89 angiographically confirmed intracranial aneurysms, using transcranial colour-coded duplex sonography (TCCD) to determine the location and size of the aneurysm. The patients were admitted for coil embolisation of their aneurysm following subarachnoid haemorrhage or because of a cranial nerve palsy. Using a 2/2.25 MHz transducer, 42 aneurysms (47%) were seen satisfactorily through the temporal bone window or foramen magnum. In 24 cases (27%) image quality was insufficient as a result of a poor bone window, of the aneurysm having a diameter of less than 6 mm or of its being in an unfavourable location. In 23 other cases (26%) it was not possible to detect the aneurysm. Thrombosed structures could be demonstrated using TCCD in 8 of 12 giant intracavernous or basilar artery aneurysms, and in 15 of 19 aneurysms treated by platinum coil embolisation. TCCD offers a noninvasive method for monitoring progressive intra-aneurysmal thrombosis following coil embolisation and for follow-up of patients with untreatable fusiform aeurysms, should this be required. Detection of small aneurysms is limited by spatial resolution and insonation angles.     

Transcranial colour-coded duplex sonography of cerebral arteriovenous malformations

A transcranial colour-coded duplex sonography (TCCD) study was performed to evaluate the sensitivity of detection and the feasibility of visualising details of cerebral arteriovenous malformations (AVMs). We prospectively examined 15 patients with 2 large (> 4 cm), 7 medium-size (2–4 cm) and 6 small (< 2 cm) radiologically proven supratentorial AVMs of the brain using TCCD. A feeding vessel was diagnosed if the velocities and/or the relative interhemisphere velocity difference between feeding and non-feeding anterior, middle and posterior cerebral arteries were more than two standard deviations above the means of 136 age- and sex-matched normals. The sonographer was blinded to the results of cerebral angiography. Using TCCD it was possible to detect all large and medium-size lesions, and 4 of 6 small ones, because 23 of 29 (79 %) feeding arteries showed abnormal haemodynamics. In addition, 8 of 46 (17 %) feeding branches of cerebral arteries were shown. However, all but 2 large draining veins and sinus were not detected. In view of the availability of MRI, MRA and angiography, TCCD is not the method of choice in screening for cerebral AVMs. However, careful assessment of the velocities in the intracranial arteries permits incidental detection of cerebral AVMs and characterisation of the haemodynamics in the feeding arteries. Received: 1 March 1995 Accepted: 23 January 1996     

Abdominal Takayasu's arteritis: imaging with color duplex sonography

Takayasu's arteritis is a inflammatory process of unknown etiology affecting mainly the thoracic and abdominal aorta and producing steno-occlusive findings of various degrees in different sites. We present a case of Takayasu's disease in a young woman, studied by color duplex sonography and verified by angiography. Received 22 April 1996; Revision received 4 September 1996; Accepted 15 July 1997     

Percutaneous vascular access guided by color duplex sonography

Color duplex sonography (CDS) is primarily applied as a diagnostic procedure. It has not yet established itself as an aid in punctures or other interventions. The aim of this study was to evaluate the value of CDS in arterial and venous vascular punctures. One hundred and sixty-five CDS-assisted vascular punctures were performed in a prospective study after three unsuccessful palpation-guided vasopunctures or in the absence of a palpable pulse. All CDS-assisted punctures were successful. The duration of each attempted puncture showed no statistically significant difference compared with the palpation-guided puncture technique. In the cases with three unsuccessful palpation-guided vascular punctures, the CDS-assisted technique was successful after 1.66 attempts on the average. It is concluded that CDS-assisted vascular puncture is a fast and safe alternative for puncturing a pulseless vessel or for puncturing under difficult conditions. Received 4 September 1996; Revision received 20 December 1996; Accepted 3 February 1997     

Contrast-enhanced colour duplex sonography of carotid arteries

By means of a multicenter study a new contrast medium (SHU SOS A, Schering, Berlin, Germany) for colour cluplex sonography (CDS) was tested in 29 patients with cerebrovascular disease who showed in the native investigation (computed sonography system Acuson 128 XMP, Acuson, Calif., USA) insufficient signal intensity (SI) caused by dorso-medial origin of the internal carotid artery (ICA), mural calcifications, and for optimal evaluation of stenosis-grading, plaque morphology and demonstration of a residual lumen of the ICA. In all cases sufficient-to-optimal rise in CDS SI occurred, and no serious events during or after contrast-medium application were observed. The test agent is considered to be a convenient drug for raising CDS Sl in patients with low native colour signals. A systematical analysis of the multicenter study follow this report. Correspondence to: H. Meents     

Portal hypertension correlates with splenic stiffness as measured with MR elastography

Purpose:

To investigate the correlation between MR elastography (MRE) assessed spleen stiffness and direct portal vein pressure gradient (D‐HVPG) measurements in a large animal model of portal hypertension.

Materials and Methods:

Cholestatic liver disease was established in adult canines by common bile duct ligation. A spin echo based echo planar imaging (EPI) MRE sequence was used to acquire three‐dimensional/three axis (3D/3‐axis) abdominal MRE data at baseline, 4 weeks, and 8 weeks. Liver biopsies, blood samples, and D‐HVPG measurements were obtained simultaneously.

Results:

Animals developed portal hypertension (D‐HVPG: 11.0 ± 5.1 mmHg) with only F1 fibrosis after 4 weeks. F3 fibrosis was confirmed after 8 weeks despite no further rise in portal hypertension (D‐HVPG: 11.3 ± 3.2 mmHg). Mean stiffnesses of the spleen increased over two‐fold from baseline (1.72 ± 0.33 kPa) to 4 weeks (3.54 ± 0.31 kPa), and stabilized at 8 weeks (3.38 ± 0.06 kPa) in a pattern consistent with changes in portal pressure. A positive correlation was observed between spleen stiffness and D‐HVPG (r² = 0.86; P < 0.01).

Conclusion:

These findings indicate a temporal relationship between portal hypertension and the development of liver fibrosis in a large animal model of cholestatic liver disease. The observed direct correlation between spleen stiffness and D‐HVPG suggest a noninvasive MRE approach to diagnose and screen for portal hypertension. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

彩色双功能超声在诊断颈内动脉粥样硬化狭窄中的临床应用

目的:探讨彩色双功能超声在颈内动脉粥样硬化狭窄中的临床应用价值。方法:对58例由于动脉粥样硬化导致颈内动脉狭窄的患者进行二维超声及彩色多普勒血流显像检查,并利用脉冲多普勒对动脉血管狭窄处及狭窄前的血流信号进行测量,同时测量颈总动脉的血流速度。结果:通过测量颈内动脉狭窄处收缩期峰值流速和舒张末期血流速度、颈总动脉收缩期峰值流速和舒张末期血流速度,将二者血流速度相比较并进行分析,同时与彩色多普勒血流显像通过狭窄处血管面积的变化所测的狭窄程度相对照,共检出62支颈内动脉狭窄,其中5支颈内动脉血管腔内血栓形成。二者相结合诊断颈内动脉狭窄的灵敏性和准确性分别为96%和94%。结论:彩色双功能超声在颈内动脉狭窄的诊断中具有重要的临床价值。     

经颅彩色双功超声在脑血管疾病中的临床应用和进展

经颅彩色双功超声是一种新型、无创的超声诊断仪,高空间分辨率显示颅内血管和脑实质的结构,笔者查阅了近年来相关文献,主要综述经颅彩色多普勒血流显像在颅脑血管疾病中的诊断价值,同时讨论二维经颅超声的应用及新的实验性显像技术。     

超声测量脾静脉与门静脉内径比对诊断特发性门脉高压的意义

目的研究特发性门脉高压综合征(IdiopathicPortalHypertensionSyndrome,IPH)的超声诊断标准。方法利用超声分别测量9例IPH与30例肝硬化组及30例正常对照组脾静脉(splenicvein,SpV)与门静脉主干(portalvein,PV)内径(Dsp,Dp),并计算它们的比值。结果IPH组Dsp/DP均大于1.0,与肝硬化组,正常对照组相比均有显著性差异(P<0.05)。结论Dsp/Dp大于1.0作为超声诊断标准能够简单易行地对IPH作出诊断。     

部分性脾动脉栓塞对门脉高压患者门脉血流动力学的影响

目的探索部分性脾栓塞术对肝硬化门脉高压脾功能亢进病人门脉血流动力学的改变.方法选择24例肝炎后肝硬化门脉高压伴脾亢病人作部分性脾栓塞术(PSE),术中动态观察其自由门脉压变化,PSE前后用多普勒超声观测门脉系统血管内径、血流速度的数值,作自身对照研究.结果PSE后自由门脉压平均下降3.2±0.4mmHg,平均下降11.2%;门脉血流量及脾静脉血流量均下降,门脉血流量由1104ml/min降到793ml/min,脾静脉血流量由897ml/min降到355ml/min.结论PSE在短期内可改善门脉高动力循环状态.     

Transcranial duplex sonography of middle cerebral artery stenosis: a comparison of colour-coding techniques – frequency- or power-based Doppler and contrast enhancement

Abstract The main limitation of transcranial colour-coded duplex sonography (TCCD) is the inadequate acoustic window, which prevents transtemporal identification of the basal cerebral arteries in up to 30 % of cases, especially in the elderly. TCCD with different colour-coding techniques, including frequency-based colour-flow (CFD) or power (PD) Doppler sonography, used alone or in combination with contrast media, were used in 23 patients with middle cerebral artery (MCA) stenosis. In 10 patients a contrast medium (400 mg/ml SHU 508 A) was administered because of inadequate colour-coded visualisation with TCCD. The data were compared with angiographic methods. Digital subtraction angiography (DSA) revealed 2 low-grade, 11 middle-grade and 10 high-grade stenoses in the M1 segment. With TCCD, we found a 7.7 % higher blood flow velocity (systolic peak velocity) than with transcranial duplex sonography without colour-coding because of visual angle correction and a 20 % higher systolic peak velocity using contrast enhancement. CFD did not differ from PD in identification of low- and middle-grade MCA stenoses, but PD alone revealed two more cases of high-grade stenosis than CFD. The contrast medium increased diagnostic confidence in 8 of 10 cases. Only 2 of 23 MCA stenoses (9 %) could not be shown using TCCD. Received: 27 May 1997 Accepted: 5 January 1998     

彩色双功能超声在诊断巨细胞动脉炎中的应用价值

目的:探讨双功能彩色超声检查在诊断巨细胞动脉炎中的临床应用价值。方法:自2001年5月~2004年10月间我室共检查了27例临床疑似巨细胞动脉炎病例,其中男性19例,女性8例,平均年龄为66.4岁。其中15例经彩色双功能超声诊断为颞浅动脉炎,所有超声确诊病例均进行颞动脉活检,CT强化扫描检查并行颞动脉血管三维重建,双功能彩色超声的高频线阵探头对双侧颞动脉进行检查主要观察颞浅动脉在形态学上的特征性改变,巨细胞动脉炎的超声形态学特征性改变为:在彩色多普勒血流显像检查时颞动脉血管腔周围有一低回声“晕”,血流信号呈充盈缺损样改变,血管腔狭窄或闭塞;或者血管内膜呈不规则增厚,回声增强,血管腔不规则狭窄,类似于动脉硬化斑块形成。结果:彩色双功能超声诊断阳性病例为15例,临床病理活检证实12例,3例为假阳性,超声诊断准确率为80%。结论:在诊断巨细胞动脉炎中高分辨力彩色双功能超声的诊断准确率高,可以替代颞动脉病理活检。     

Spontaneous aneurysmal intrahepatic portosystemic venous shunt

A 55-year-old man with hepatic cirrhosis, gastroesophageal varices, ascites, slight abdominal pain, and transient encephalopathy experienced unexpected spontaneous relief of his symptoms during hospitalization. Percutaneous transhepatic portography showed an aneurysmal intrahepatic portosystemic venous shunt. Three years later, the shunt was still patent and had led to disappearance of the patient's varices and ascites. The patient remains stable 6 years later.     

Assessment of portal venous system patency in the liver transplant candidate: a prospective study comparing ultrasound,microbubble-enhanced colour Doppler ultrasound,with arteriography and surgery

AIM: To determine the role of microbubble-enhanced colour Doppler ultrasound (CDUS) in assessing portal venous patency prior to liver transplantation. MATERIALS AND METHODS: Over a 2-year period, all patients with chronic liver disease undergoing routine pre-transplant CDUS examination in whom the portal venous system was inadequately demonstrated were recruited to the study. CDUS was performed in 368 patients and 33 patients (9%) were recruited. A repeat CDUS examination following an intravenous bolus injection of the microbubble contrast agent Levovist (Schering Healthcare AG, Berlin, Germany) was performed. Diagnostic confidence was recorded on a free linear analogue scale for both examinations. Findings were compared with indirect portography and surgery. RESULTS: Of the 33 patients with sub-optimal baseline examinations, improvement in portal vein visualization was achieved in 31 patients (94%). Median diagnostic confidence increased from 50% (interquartile range 30-60) to 90% (interquartile range 75-98) (P < 0.001) following administration of Levovist. Overall accuracy of portal vein assessment using microbubble-enhanced CDUS in 15 patients in whom a definitive diagnosis was made within 2 months was 87%. CONCLUSION: Microbubble-enhanced CDUS is a simple, inexpensive adjunct to standard pre liver transplant screening of the portal vein. It is particularly helpful in patients with end-stage cirrhosis who are at high risk of portal vein thrombosis and in whom the conventional examination is sub-optimal.     

Arterial and venous thromboembolic complications of COVID-19 detected by CT angiogram and venous duplex ultrasound

Emergency Radiology - To investigate the incidence of thromboembolic events, specifically pulmonary embolism (PE), deep vein thrombosis (DVT), and cerebrovascular accidents (CVA), in patients who...     

肝源性溃疡63例临床分析

目的探讨肝源性溃疡的临床特点及诊治方法。方法回顾性分析63例肝源性溃疡患者临床资料。结果肝源性溃疡以上腹痛最多见但缺乏规律性;胃溃疡多于十二指肠溃疡;肝源性溃疡的发生与肝功能损害及食管静脉曲张程度呈正相关(P<0.01)。结论肝源性溃疡症状不典型,发生率高,其发生与肝功能分级及门静脉高压密切相关,难治愈,及时正确诊治肝源性溃疡,可降低病死率。     

经颈内静脉门腔分流术治疗肝外门静脉分叉部门静脉瘤1例

门静脉瘤(portal vein aneurysm,PVA)是门静脉系统的梭形或瘤样扩张,临床罕见,治疗以外科手术为主.本中心采用TIPS术治疗门静脉分叉部门静脉瘤1例,术后门静脉瘤逐渐缩小消失,现报道如下. 临床资料 患者男,48岁.以“感染乙肝15年,反复消化道出血6个月”为主诉入院.5年前,因上消化道出血曾行脾切除断流术.     

The diagnostic value of colour duplex ultrasound for symptomatic carotid stenosis in clinical practice

We assessed the accuracy of colour duplex ultrasound for the detection of severe (70–99 %) symptomatic carotid stenosis in a clinical setting, in order to assess whether it could make carotid angiography unnecessary. In 152 patients with a transient ischaemic attack or non-disabling ischaemic stroke in the carotid distribution, we compared the degree of colour duplex ultrasound stenosis with angiographic stenosis by receiver-operating-characteristic analysis. The angiograms were evaluated by blinded observers, and compared with routine reports of the colour duplex examination. We computed the sensitivity and specificity of colour duplex, and the number of angiograms and sonographic studies needed to prevent one stroke within 3 years, taking into account the risks of angiography, and the risks and efficacy of endarterectomy. The estimates were adjusted for nonverification bias. We found 34 patients (22 %) with a severe (70–99 %) symptomatic carotid stenosis. In 16 patients (11 %) the symptomatic artery was occluded. The sensitivity and specificity of duplex ultrasound were 76 % and 85 %, respectively. The number of patients needed to undergo angiography to prevent one stroke was reduced from almost 200 to 33, when colour duplex was used as a preoperative examination. After adjustment for the effects of nonverification, the sensitivity dropped to 58 % and the number of duplex studies needed to prevent one stroke would double. The number of angiograms needed after positive duplex sonography would be virtually unaffected. Were colour duplex sonography to have been the sole preoperative investigation, the number needed to diagnose to prevent one stroke within 3 years would be approximately 350, more than twice as many as with the combined diagnostic strategy. The diagnostic accuracy of colour duplex sonography in clinical practice seems less impressive than previous studies have suggested, but it remains an effective way to select patients for angiography. Its use as a single preoperative assessment cannot be recommended. Received: 24 March 1998 Accepted: 21 May 1998     

肝硬化肝内门-体静脉短路的螺旋CT表现

目的探讨肝硬化自发性肝内型门-体静脉交通(ISPS)的螺旋CT表现及其临床意义。方法回顾性地分析了15例肝内自发性门-体静脉交通的螺旋CT表现及有关临床资料。结果15例分为3种类型:①门静脉右后支型12例,表现为位于肝右叶后段的扭曲的管状阴影,呈血管性强化两端分别与门静脉右后支和肾上腺旁的下腔静脉(IVC)相连。②肝静脉型2例,表现为门静脉肝内分支在肝内与肝静脉分支相连。③肝顶型1例,表现为自肝顶部方叶发出血管向左上走行汇入左侧内乳静脉。15例中血氨升高11例,肝性脑病2例。结论门静脉右后支型、肝静脉型和肝顶型是肝硬化自发性肝内型门-体静脉交通的罕见类型,加深对其认识有助于肝内病变的鉴别诊断。