Quantitative analysis of aortic regurgitation: real-time 3-dimensional and 2-dimensional color Doppler echocardiographic method--a clinical and a chronic animal study.

BACKGROUND: For evaluating patients with aortic regurgitation (AR), regurgitant volumes, left ventricular (LV) stroke volumes (SV), and absolute LV volumes are valuable indices. AIM: The aim of this study was to validate the combination of real-time 3-dimensional echocardiography (3DE) and semiautomated digital color Doppler cardiac flow measurement (ACM) for quantifying absolute LV volumes, LVSV, and AR volumes using an animal model of chronic AR and to investigate its clinical applicability. METHODS: In 8 sheep, a total of 26 hemodynamic states were obtained pharmacologically 20 weeks after the aortic valve noncoronary (n = 4) or right coronary (n = 4) leaflet was incised to produce AR. Reference standard LVSV and AR volume were determined using the electromagnetic flow method (EM). Simultaneous epicardial real-time 3DE studies were performed to obtain LV end-diastolic volumes (LVEDV), end-systolic volumes (LVESV), and LVSV by subtracting LVESV from LVEDV. Simultaneous ACM was performed to obtain LVSV and transmitral flows; AR volume was calculated by subtracting transmitral flow volume from LVSV. In a total of 19 patients with AR, real-time 3DE and ACM were used to obtain LVSVs and these were compared with each other. RESULTS: A strong relationship was found between LVSV derived from EM and those from the real-time 3DE (r = 0.93, P <.001, mean difference (3D - EM) = -1.0 +/- 9.8 mL). A good relationship between LVSV and AR volumes derived from EM and those by ACM was found (r = 0.88, P <.001). A good relationship between LVSV derived from real-time 3DE and that from ACM was observed (r = 0.73, P <.01, mean difference = 2.5 +/- 7.9 mL). In patients, a good relationship between LVSV obtained by real-time 3DE and ACM was found (r = 0.90, P <.001, mean difference = 0.6 +/- 9.8 mL). CONCLUSION: The combination of ACM and real-time 3DE for quantifying LV volumes, LVSV, and AR volumes was validated by the chronic animal study and was shown to be clinically applicable.     

彩色多普勒超声在腹主动脉瘤腔内隔绝术前的应用

目的 探讨彩色多普勒血流显像（ＣＤＦＩ）在腹主动脉瘤（ＡＡＡ）腔内隔绝术术前的应用价值。方法应用ＣＤＦＩ对３２例ＡＡＡ患者术前进行检测,主要检测内容包括瘤体的大小,瘤体近远端颈的长度、内径及双侧髂总动脉的内径;对瘤体、瘤颈及双侧髂总动脉的形态进行观察;判断患者行ＡＡＡ腔内隔绝术的可行性。结果 术前超声诊断的特异性、敏感性均为１００％,２３例行手术治疗的患者中,术前超声对２０例患者术式的选择作出了正     

彩色流速成像法超声流量测定的离体实验研究

目的研究彩色流速流量定量（ＣＶＩＱ）流量测定准确性的影响因素。方法采用离体装置产生稳流,比较不同条件下ＣＶＩＱ测值差别,比较一定条件下不同流量ＣＶＩＱ测值与容器收集法结果。结果聚焦、彩标、彩色充盈度对测值影响较大;取样框大小稍有影响;彩标基线位置调节（以不产生混迭伪差为限）、取样框位置、Ｍ型取样线位置、血流方向校正线位置、壁滤波、余辉、彩色采样次数、平滑度等无明显影响。ＣＶＩＱ测值变异系数在７．３％以内。一定条件下,不同流量（８８～３００ｍｌ／ｍｉｎ）ＣＶＩＱ测值的相对误差为－０．１％～＋３．６％。结论ＣＶＩＱ流量测定重复性好;测值与仪器调节有关;合理调节仪器,能较准确测量流量。     

彩色多普勒超声诊断腹主动脉夹层动脉瘤

目的　应用彩色多普勒超声诊断腹主动脉夹层动脉瘤。方法　应用彩超测量腹主动脉内径 ,观察腹主动脉及其分支内膜分离的部位和范围 ,以及鉴别真假腔。结果　内膜分离是本病最可靠的诊断依据 ,血流分隔现象、动脉扩张和管腔内血栓等具有重要的辅助诊断价值。彩超能很好地鉴别真假腔和诊断夹层动脉瘤破裂。结论　彩超能正确地评价本病受累血管 ,是诊断腹主动脉夹层动脉瘤的一种较为可靠的影像检查方法。     

Direct quantification of transmitral flow volume with dynamic 3-dimensional digital color Doppler: a validation study in an animal model.

Accurately quantifying transmitral flow volume is clinically important not only as a measure of cardiac output, but also as a value from which to subtract aortic flow, for determining the severity of mitral regurgitation. However, controversy exists over the accuracy of pulsed Doppler for mitral flow quantification because of the complexity of mitral flow geometry and dynamic changes in flow profile and flow area. To explore the feasibility of directly quantifying transmitral flow volume with a newly developed dynamic 3-dimensional digital color Doppler technique, this in vivo experimental study was conducted to validate the method. Eight open chest sheep were imaged with a multiplane transesophageal (TEE) probe placed on the heart for digital 3-dimensional gated acquisition of mitral inflow over a 180-degree acquisition. The digital velocity data were contour detected for flow area after computing the velocity vectors and flow profile perpendicular to a spherical 3-dimensional surface across the mitral annulus. Flow areas and actual velocities were then integrated in time and space and the resulting flow volumes were compared with those obtained by a reference electromagnetic flowmeter on the aorta for 26 steady hemodynamic states. The flow volumes correlated closely to the electromagnetic references (y = 0.87x + 2.49, r = 0.92, SEE = 1.9 Ml per beat). Our study shows that transmitral flow volume can be accurately determined in vivo by this dynamic 3-dimensional digital color Doppler flow quantification method.     

计算机检测左心室流出道血流传播速度估测左心室收缩功能的可行性研究

目的为研究复杂先天性心脏病心室功能检测的方法,探讨左室流出道血流传播速度用于估测左室收缩功能的可行性。方法将39例患儿的左室流出道彩色M型血流图传输至计算机。应用自行开发的软件,分辨出初次色彩混叠的波阵面,将该波阵面的点回归成直线,此直线的斜率代表左室流出道血流传播速度。所得结果与心导管数据dp/dtmax相比较。结果左室流出道血流传播速度测得值为(92.3±11.4)cm/s,与心导管测定dp/dtmax一致性好且显著相关(r=0.71,P<0.001)。结论左室流出道血流传播速度可用来评价左室收缩功能,该方法不依赖于心室的几何形态,有望将该方法用于复杂先天性心脏病心室功能的测量。     

Volumetric blood flow measurement with the use of dynamic 3-dimensional ultrasound color flow imaging.

We describe a new method for measuring blood volume flow with the use of freehand dynamic 3-dimensional echocardiography. During 10 to 20 cardiac cycles, the ultrasonographic probe was slowly tilted while its spatial position was continuously recorded with a magnetic position sensor system. The ultrasonographic data were acquired in color flow imaging mode, and the separate raw digital tissue and Doppler data were transferred to an external personal computer for postprocessing. From each time step in the reconstructed 3-dimensional data, one cross-sectional slice was extracted with the measured and recorded velocity vector components perpendicular to the slice. The volume flow rate through these slices was found by integrating the velocity vector components, and was independent of the angle between the actual flow direction and the measured velocity vector. Allowing the extracted surface to move according to the movement of anatomic structures, an estimate of the flow through the cardiac valves was achieved. The temporal resolution was preserved in the 3-dimensional reconstruction, and with a frame rate of up to 104 frames/s, the reconstruction jitter artifacts were reduced. Examples of in vivo blood volume flow measurement are given, showing the possibilities of measuring the cardiac output and analyzing blood flow velocity profiles.     

Neonatal cerebral venous flow velocity measurement using a color flow Doppler system.

Color flow Doppler provides a simple means for studying blood flow velocity from the central cerebral veins in newborn infants. Twenty-two term infants were examined during the first four days of life to establish a normal range for velocity from the vein of Galen. A wide range of velocities was found between individuals (2.3 cm.s-1 to 9.5 cm.s-1), but short-term intraindividual variation was small (root mean square variation 1.1 cm.s-1). Light bilateral jugular venous compression was performed in 17 of the infants and produced a fall of up to 63% in venous flow velocity in 12 infants (p = 0.0005).     

Blood flow velocity changes in migraine attacks-a transcranial Doppler study

A pulsed Doppler device was used to measure blood flow velocities in the common carotid artery, the extracranial part of the internal carotid artery, the external carotid artery, the middle cerebral artery, and the anterior cerebral artery in 31 migraineurs without aura (n = 27) and with aura (n = 4), both during and outside an attack. The aims were to compare blood flow velocity during and between migraine attacks and to study asymmetries of the blood flow velocity. Compared with blood flow velocity values obtained in the attack-free interval, blood flow velocity was lower during attacks without aura in both common carotid arteries, but not in the other extra- and intracranial vessels which were examined. However, during attacks of migraine with aura, blood flow velocity tended to be lower in all examined vessels. There were no asymmetries of the blood flow velocity. We suggest that during migraine attacks without aura there is a dissociation in blood flow regulation in the common carotid and middle cerebral arteries.     

Two-dimensional color Doppler flow velocity profiles can be time corrected with an external ECG-delay device.

Although two-dimensional ultrasound color flow imaging is often considered to be a real-time technique, the acquisition time for two-dimensional color images may be up to 200 msec. Time correction is therefore necessary to obtain correct flow velocity profiles. We have developed a time-correction method in which a specially designed unit detects the QRS complex from the patient and creates a trig pulse that is delayed incrementally in relation to the QRS complex. This trig pulse controls the acquisition of the ultrasound images. A number of consecutively delayed images, with known incremental delay between the sweeps, can thus be stored in the memory of the echocardiograph and transferred digitally to a computer. The time-corrected flow velocity profile is obtained by interpolation of data from the time-delayed profiles. The system was evaluated in a Doppler string phantom test. With this technique it is possible to study time-corrected flow velocity profiles without the need to alter existing ultrasound Doppler equipment.     

Superficial masses with color flow Doppler imaging.

Color Doppler imaging findings and spectral waveforms were reviewed for 21 superficial masses in which color Doppler imaging revealed flow. This series included 5 benign hyperplastic lymph nodes, 5 malignant masses, 2 staphylococcus abscesses, and 9 pseudoaneurysms. Benign hyperplastic nodes had a vascular pattern consisting of prominent central flow with a branching radial pattern, reflecting the morphology of lymph nodes. One metastasis from melanoma demonstrated abundant peripheral flow and central avascularity, while the other 4 malignant masses and the 2 abscesses had sparse internal flow. All pseudoaneurysms had a to-and-fro imaging and spectral pattern (into the mass during systole, out during diastole), and/or a swirling pattern on real-time images (8 of 9 each). Doppler spectral analysis revealed continuous forward flow during diastole for all other masses and abscesses. Waveforms appeared similar for benign and malignant masses, and for abscesses. Conventional image-directed Doppler examinations performed prior to color Doppler studies failed to reveal flow in 2 partially thrombosed pseudoaneurysms, 1 malignant mass, and 1 abscess. Benign hyperplastic nodes, malignant masses, and pseudoaneurysms had distinctive color Doppler image appearances in this series, although demonstration of flow within a mass does not eliminate the possibility of abscess. Proper use of color and spectral Doppler analysis of superficial masses involves more than mere detection or exclusion of flow.     

主动脉夹层分离的超声心动图诊断

主动脉夹层分离（Ａｏｒｔｉｃｄｉｓｓｅｃｔｉｏｎ,ＡＤ）是血液渗入主动脉中层形成夹层血肿并沿着主动脉壁纵轴延伸剥离的严重心血管急症 ,易漏诊及误诊 ,且病死率高 ,及早诊治是降低死亡的关键［１］。我院１９９１年１月～１９９８年５月间经超声心动图（ＵＣＧ）诊断ＡＤ１２例 ,漏诊２例 ,为提高对ＡＤ的认识 ,总结分析如下。１资料和方法１ １一般资料本组１４例 ,男１２例 ,女２例 ,年龄２５～７３岁 ,平均５２ ２±１３ １岁 ,其中合并高血压１０例 ,患者在活动或情绪激动时突发胸痛或腹痛１１例 ,心悸、胸闷、呼吸困难、有主动…     

3-dimensional sonographic analysis based on color flow Doppler and gray scale image data: a preliminary report.

This paper presents preliminary results of a technique that permits acquisition and display of three-dimensional (3D) anatomy using data collected from color flow Doppler and gray scale image sonography. 3D sonographic image data were acquired as two-dimensional planar images with commercially available equipment. A translational stage permitted the transducer position and orientation to be determined. Color flow sonographic video image data were digitized into a PC-AT computer along with transducer position and orientation information. Color flow velocity and gray scale data were separated, 3D filtered, and thresholded. A surface rendering program was used to define the vessel blood-lumen interface. Planar slices of arbitrary orientation and volume rendered images were displayed interactively on a graphics workstation. The technique was demonstrated in a lamb kidney in vitro and for the carotid artery at the bifurcation in vivo. Our results demonstrate the potential of 3D sonography as a technique for visualization of anatomy. Color flow data offer direct access to the vascular system, facilitating 3D analysis and display. 3D sonography offers potential advantages over existing diagnostic studies in that it is noninvasive, requires no intravenous contrast material, offers arbitrary plane extraction and review after the patient has completed the examination, and permits vascular anatomy to be visualized clearly via rendered images.     

主动脉瓣反流的定量评估:实时三维彩色多普勒血流成像与MRI对照研究

目的探讨实时三维彩色多普勒血流成像(RT-3DCDFI)定量评估主动脉瓣反流的价值。方法选取17例单纯性主动脉瓣反流。实时三维超声心动图采集全容积数据库和三维彩色血流信号数据库,导入TomTec三维图像工作站脱机测量左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)和主动脉瓣彩色反流束容积(RJV),并计算左室每搏量(LVSV)和RJV/LVSV(%)。MRI测量LVEDV、LVESV和RJV,并计算LVSV和RJV/LVSV(%)。RT-3DCDFI和MRI的测值行相关性分析。结果RT-3DCDFI和MRI评价主动脉瓣反流的测值相关性良好,其中RJV测值相关性为r=0.92,Y=0.88X 3.32,P<0.0001,二者间的均数差为-2.0ml,标准差为9.5ml;RJV/LVSV(%)测值的相关性为r=0.88,Y=1.16X-10.74,P<0.0001,二者间的均数差为-2.8%,标准差为7.9%。结论RT-3DCDFI可对主动脉瓣反流进行准确定量评估,为临床评价主动脉瓣反流提供了一种简便、可靠的新方法。     

Hydrodynamics of color M-mode Doppler flow wave propagation velocity V(p): a computer study.

This study was designed to show the hydrodynamic mechanism of left ventricular (LV) flow wave propagation and to relate this propagated velocity to 2-dimensional (2D) color and color M-mode Doppler echocardiograms. A computer model is developed describing 3-dimensional axisymmetrical LV filling flow. The unsteady Navier-Stokes flow equations are solved in an LV truncated ellipsoid geometry with moving LV walls, including relaxation and compliance of the wall. The computed results confirm both intraventricular flow and pressure patterns during filling. Vortices are formed during the acceleration phases of the early and atrial filling waves. During the deceleration phases, the vortices are amplified and convected into the ventricle. The vortices are recognized on the derived 2D color echocardiograms as in vivo. The propagation of this vortex determines the propagation of the maximum velocity observed in the color M-mode Doppler echocardiogram. For pseudonormal filling of the left ventricle, the LV flow wave propagation velocity decreases.     

Fetal echocardiography and color Doppler flow imaging: the Rotterdam experience.

The adjunctive role of Doppler color flow mapping in the evaluation of cardiac structures and function was studied in 440 normal fetuses between 17 and 22 weeks of gestation (median, 20 weeks) and in 73 fetuses with suspected congenital heart disease between 16 and 38 weeks of gestation (median, 28 weeks). Flow through atrioventricular and arterial valves was generally easy to identify and identification was successful in approximately 90% of the normal fetuses. Flow in the pulmonary veins and through the foramen ovale was visualized in approximately 60% of normal cases. In the group with suspected congenital heart disease, Doppler color flow imaging provided additional information on both cardiac structure and function in 34 fetuses, on function alone in 13 fetuses and on structure alone in 20 fetuses. No additional information was collected in six fetuses.     

二维及彩色多普勒超声在乳腺肿块鉴别诊断中的应用

目的探讨二维及彩色多普勒超声在乳腺肿块鉴别诊断方面的临床应用价值。方法对106例经手术病理证实的乳腺肿块病例的二维及彩色多普勒超声表现与病理结果进行回顾性对比分析。结果在乳腺肿块的声像图诊断中，以形态、边界特征最为重要，它是肿块良、恶性鉴别的关键，大多数良性肿块表现为形态规则、边缘整齐光滑、有完整包膜、内部回声均匀、后方回声增强；而大多数恶性肿块表现为形态不规则、边缘粗糙、边界不清、内部回声不均匀、后方回声衰减。恶性肿块的血流显示率明显高于良性肿块，血流分布以Ⅱ、Ⅲ级为主，良性肿块则以0、Ⅰ级为主。结论乳腺肿块的超声诊断应以二维声像图为基础，同时结合彩色多普勒血流丰富程度，两者联合应用可提高超声对乳腺肿块的诊断符合率。     

Umbilical artery velocity waveforms in early pregnancy: a transvaginal color Doppler study.

In a cross-sectional study, umbilical artery velocity waveforms were recorded in 214 low-risk pregnancies at 7 weeks to 16 weeks, menstrual age, by means of transvaginal color and pulsed Doppler ultrasonography. In all the cases studied, end diastolic velocities were absent until the 10th week. From this age onward end diastolic velocities were present in a percentage of pregnancies, progressively increasing with gestation and reaching 100% at 15 weeks. Similarly, the percentage of cardiac cycles in which end diastolic velocities were absent progressively decreased with advancing menstrual age. The normal range for the pulsatility index was constructed and a quadratic function was found to optimally fit its fall during gestation. No differences in pulsatility index values were found at these menstrual ages in 12 pregnancies that later developed intrauterine growth retardation and/or pregnancy-induced hypertension, suggesting that placental alterations causing abnormalities in umbilical velocity waveforms occur later in gestation.     

乳腺肿块的彩色多普勒血流频谱形态与病理对照研究

目的 探讨乳腺肿块的彩色多普勒血流频谱形态与其病理性质之间的相关性，以提高超声对乳腺肿块的诊断符合率。方法 对116例乳腺良、恶性肿块进行彩色多普勒超声检测，检测结果与病理结果进行对照分析。结果 ①乳腺恶性肿块彩色多普勒血流频谱形态常表现为：收缩期峰值速度前移，常出现于收缩期的前三分之一时段；收缩期上升及下降速度均较快，表现为上升波和下降波陡直；舒张期起始波常出现于收缩期下降波的中点以下，舒张末期常无血流或出现反向血流频谱。②乳腺良性肿块彩色多普勒血流频谱形态为收缩期峰值速度常居中，出现于收缩期的中三分之一时段；收缩期上升及下降速度均较慢，表现为上升波和下降波倾斜；舒张期起始波常出现于收缩期下降波的中点以上，舒张末期常出现血流频谱。结论 彩色多普勒血流频谱形态是鉴别乳腺良、恶性肿块的一项值得重视的指标。