Allen试验与高频超声评价桡尺动脉侧支循环的对比研究

目的:判断高频超声桡动脉(RA)、尺动脉(UA)及手掌侧支循环的相关性及后两者在临床诊断中的准确性。方法:采用改良和量化SaO2-Allen试验方法,判断受试者手掌侧支循环建立时间。采用高频超声检测受试者RA受压迫前后,RA、UA、RA掌浅支和拇指动脉的血流动力学参数。结果:207例受试者的手掌侧支循环建立时间:量化SaO2-Allen试验坐位为7.34(Q2.5～Q97.5:4.35～13.22)s,卧位为7.30(Q2.5～Q97.5:3.63～13.22)s,改良Allen试验坐位为3.02(Q2.5～Q97.5:1.17～11.38)s,卧位为2.77(Q2.5～Q97.5:1.28～11.29)s;高频超声检测:以高频超声检测拇指动脉血流消失为异常标准,对量化SaO2和改良Allen试验进行受试者工作特征曲线分析,得出曲线下面积(AZ),量化SaO2-Allen试验AZ=0.52～0.53,改良Allen试验AZ=0.53～0.55。结论:与高频超声检测结果比较,量化SaO2和经典Allen试验诊断准确性较低。     

Transcranial Doppler ultrasonography in siblings with sickle cell disease

Summary. The risk of stroke in sickle cell disease (SCD) may be influenced by either genetic or environmental factors. Elevated blood flow velocity in the large cerebral arteries, detected by transcranial Doppler (TCD) ultrasonography, predicts an increased stroke risk in children with SCD. We undertook this study to investigate the possibility of a familial predisposition to elevated cerebral blood flow velocity, a surrogate marker for stroke risk. We analysed the results of TCD studies performed on 63 children from 29 families that had more than one child with SCD. We assessed the association of elevated cerebral blood flow velocity with sibling TCD results as well as age and haemoglobin level, which are factors known to affect cerebral blood flow velocity. Positive or negative TCD results were highly correlated between family members ( r =  0·61). The presence of a sibling with a positive TCD result was significantly associated with an elevated cerebral blood flow velocity in other siblings with SCD (odds ratio = 41·9, 95% confidence interval 8·2–214·7, P  < 0·001). Furthermore, children who had a sibling with a positive TCD result had a significantly higher TCD velocity than children with SCD but without a sibling who were matched for age, sex, genotype and haemoglobin level. Our results are consistent with a familial predisposition to cerebral vasculopathy in SCD.     

Color Doppler ultrasonography in patients with subacute thyroiditis.

We studied the utility of color Doppler ultrasonography in patients with subacute thyroiditis. Eighteen patients with subacute thyroiditis (SAT) with painful goiter and thyrotoxicosis underwent color Doppler ultrasonography during the acute and recovery stages of the disease. Thyroid vascularization in these patients was compared with that of 15 untreated patients with Graves' disease and 17 control subjects. During the acute stage of subacute thyroiditis, color Doppler ultrasonography showed low echogenicity without increased tissue vascularity in the affected swollen thyroid. In the recovery stage, color Doppler ultrasonography showed isoechogenicity with slightly increased vascularization. Vascularization became normal at 1 year follow-up time. In contrast, marked by increased vascularization was observed in patients with untreated Graves' disease. Color Doppler ultrasonography showed clear differences between SAT and Graves' disease patients. Vascularity was significantly correlated with serum free thyroxine (FT4) and thyrotropin (TSH) concentrations in the recovery stage (3 months after the initial ultrasonography). Color Doppler ultrasonography accurately visualized lesions without increased vascularity in the acute stage of SAT and lesions of slightly increased vascularity in the recovery stage. Color Doppler ultrasonography may be a useful, noninvasive, and rapid method for differentiating SAT from Graves' disease and for evaluating and monitoring the location and activity of lesions in SAT.     

Transcranial Doppler ultrasonography in siblings with sickle cell disease

The risk of stroke in sickle cell disease (SCD) may be influenced by either genetic or environmental factors. Elevated blood flow velocity in the large cerebral arteries, detected by transcranial Doppler (TCD) ultrasonography, predicts an increased stroke risk in children with SCD. We undertook this study to investigate the possibility of a familial predisposition to elevated cerebral blood flow velocity, a surrogate marker for stroke risk. We analysed the results of TCD studies performed on 63 children from 29 families that had more than one child with SCD. We assessed the association of elevated cerebral blood flow velocity with sibling TCD results as well as age and haemoglobin level, which are factors known to affect cerebral blood flow velocity. Positive or negative TCD results were highly correlated between family members (r = 0.61). The presence of a sibling with a positive TCD result was significantly associated with an elevated cerebral blood flow velocity in other siblings with SCD (odds ratio = 50.7, 95% confidence interval 10.1-253.7, P < 0.001). Furthermore, children who had a sibling with a positive TCD result had a significantly higher TCD velocity than children with SCD but without a sibling who were matched for age, sex, genotype and haemoglobin level. Our results are consistent with a familial predisposition to cerebral vasculopathy in SCD.     

Splenic vein thrombosis. Diagnosed with Doppler ultrasonography.

The case of a 31-year-old pregnant woman with an isolated splenic vein thrombosis, diagnosed with Doppler ultrasonography is presented. Routine ultrasound examination in the fourth month of the pregnancy revealed massive splenomegaly of unknown origin. Doppler ultrasonography subsequently revealed splenic venous thrombosis with absence of blood flow. Noteworthy gastric varices were present at the endoscopic examination. On splenectomy, a spleen weighing 2,600 was removed, and numerous venous collaterals were found in the perigastric region. The postoperative course was satisfactory, pregnancy evolved normally, and a healthy female baby was delivered at term. The patient remained in excellent health with normal clinical and laboratory data.     

Mesenteric malignant lymphoma detected with routine color Doppler ultrasonography

This report concerns a case of primary mesenteric malignant lymphoma detected with routine color Doppler ultrasonography. When a 44-year-old man underwent a first-time medical checkup, ultrasonographic imaging and computed tomography showed the presence of a large tumor measuring about 8 cm in transverse diameter. Color Doppler ultrasonography identified the characteristic vessel structure of a nodal lesion, namely, a hilar vessel, a curved section of the central vessel together with peripheral branches, and focal absence of perfusion in a hypoechoic imaging of the left periumbilical area. These findings contributed to the diagnosis of a malignant lymphoma and the surgical treatment of the tumor was successful.     

肝硬化患者门静脉血流动力学彩色多普勒超声检测分析

[目的]探讨通过彩色多普勒测定肝硬化患者门静脉血流动力指标改变的临床价值.[方法]随机入选79例肝硬化患者为观察组,根据Child-Pugh法予以肝功能分级示A级27例,B级26例,C级26例;再入选79例肝功能正常者作为对照组.对2组患者门静脉内径、血流速度、血流量以及脾静脉内径、厚度、各项体征腹水情况等指标进行彩色超声检测.[结果]观察组门静脉内径、血流量、血流速度、血流量、脾静脉内径、腹水及食管静脉曲张出血情况与对照组比较,差异有统计学意义(P＜0.05);观察组中不同肝功能分级患者间超声结果亦存在差异性(P＜0.05).[结论]予以彩色多普勒对门静脉血流动力学进行观察监测,有助于临床对肝硬化进展状况的准确判断,是肝硬化极为重要的临床辅助检查手段.     

A method of venous study by real time ultrasonography associated with directional and continuous Doppler ultrasonography

The authors propose a method of investigation of the superficial and deep venous axes of the limbs, neck, abdomen and pelvis by using successively directional and continuous wave Doppler and real time high resolution echotomography. The principle is to recognise normal and pathological venous flow by the Doppler technique and to detect the intrinsic (thrombus, agenesis) or extrinsic abnormalities causing local haemodynamic disturbances or distal emboli even in the absence of flow disturbance by echotomography. If the suggested protocol is strictly observed, the method allows diagnosis of the majority of pathologies, not only their haemodynamic consequences but also the underlying causes.     

Evaluation of systolic murmurs by Doppler ultrasonography

Non-invasive continuous and pulsed wave Doppler ultrasonography was performed in 102 consecutive patients with clinically ill defined systolic murmurs to differentiate between flow murmurs, mitral regurgitation, aortic stenosis, and ventricular septal defect, as well as to assess the severity of aortic stenosis. Diagnoses with the Doppler method were based on velocity, direction, and duration of flow signals and were subsequently verified by cardiac catheterisation in all patients. Multiple evaluations were made in 31 patients. Sensitivity and specificity were 0.87 and 0.77 in mitral regurgitation, 0.9 and 1.0 in aortic stenosis, and 1.0 and 1.0 in ventricular septal defect. In 67 patients the estimation of severity of aortic stenosis using the Doppler technique to calculate aortic pressure gradients from maximum flow velocity was significantly correlated with that determined at catheterisation. It is concluded that Doppler ultrasonography is a highly useful technique for the non-invasive evaluation of clinically ill defined systolic murmurs.     

Assessment of synovitis in early rheumatoid arthritis by CXCL13 serum levels and power Doppler ultrasonography: Correlation with disease activity

Aim of the workAssessment of synovitis in rheumatoid arthritis (RA) is a major issue for proper treatment; it has been proven that high resolution ultrasound (US) examination could be of valuable help. The B-cell chemokine, CXCL13, is a proposed serum biomarker of synovitis in RA. We aimed to find out the presence of synovitis in patients with recent-onset RA and its correlation with disease activity.Patients and methodsWe evaluated 30 patients with early RA for the presence and degree of synovitis by performing high resolution US and obtaining serum CXCL13 levels. In addition, we correlated these results with disease activity score 28 (DAS 28). Results of high resolution US and serum CXCL13 were also obtained for 20 healthy age- and sex-matched volunteers and served as controls.ResultsSerum CXCL13 level was significantly increased in early RA patients vs. controls (p < 0.001). High resolution US revealed that RA patients had a significant increased synovial thickness and high power Doppler US score. In RA patients, DAS 28 had a significant correlation with serum CXCL13 (r = 0.42, p = 0.02), synovial thickness (r = 0.39, p = 0.03) and power Doppler US score (r = 0.43, p = 0.02). Serum CXCL13 level correlated with synovial thickness (r = 0.63, p = 0.001) and power Doppler US score (r = 0.69, p = 0.001).ConclusionRecent-onset RA patients suffer from synovitis as evidenced by significantly increased serum CXCL13 and by high resolution US. Serum CXCL13 is a reliable marker of synovial inflammation which correlates better with synovial thickening and power Doppler US scores than DAS28.     

经颅多普勒超声对大脑后动脉发育不良的血流动力学检测

目的 应用经颅多普勒超声（TCD）分析大脑后动脉（PCA）发育不良的血流动力学特点并探讨TCD对其的诊断价值.方法 选择经TCD和磁共振血管成像（MRA）筛查的52例大脑后动脉交通前段（PCA-P1）发育不良的患者,进行颈动脉压迫试验前、后血流动力学改变的观察,并与52例无血管变异的健康者（对照组）比较.结果 ①52例PCA-P1发育不良患者的不良侧PCA-P1的收缩期峰值流速为（55±8）cm/s,低于对照组的（60±6）cm/s,差异有统计学意义（P〈0.01）.分别压迫同侧颈总动脉（CCA）后,发育不良侧的PCA-P1收缩期峰值血流速度为（192±25）cm/s,高于对照组的（96±14）cm/s,差异有统计学意义（P〈0.01）.发育不良者的PCA-P1收缩期峰值血流速度于颈动脉压迫试验前、后的比值（Vp后/Vp前）为3.52±0.53,高于对照组的1.60±0.17,差异有统计学意义（P〈0.01）.②压迫同侧CCA后,发育不良侧PCA-P1舒张期末血流速度与压迫前的比值（Vd后/Vd前）为4.48±1.28,高于对照组1.6l±0.25（P〈0.01）.③发育不良侧PCA-P1血管搏动指数为1.00±0.22,高于对照组的0.78±0.09,差异有统计学意义（P〈0.01）.④52例患者中有28例血流频谱呈高阻力型改变,24例血流频谱正常.同侧CCA压迫前、后,高阻力型频谱组与压迫前比值（Vd后/Vd前）为5.3±1.1,高于血流频谱正常组的3.5±0.6,差异有统计学意义（P〈0.01）,但VP后/VP前与正常频谱组间差异无统计学意义（P〉0.05）.⑤TCD疑诊PCA-P1发育不良者39例,经MRA确诊32例,阳性符合率为82.1%;其中表现为高阻力型血流频谱患者17例,经MRA确诊PCA.P1发育不良的有16例,阳性符合率为94.1%.结论 根据CCA压迫试验前后的PCA-P1的血流动力学变化参数,结合血流频谱形态,TCD可初步诊断PCA-P1发育不良.     

Detection of previous proximal venous thrombosis with Doppler ultrasonography and photoplethysmography

To evaluate the reliability of two noninvasive tests, the photoplethysmograph (PPG) and venous Doppler ultrasound, in determining the presence or absence of previous proximal deep vein thrombosis (DVT), we performed a blinded retrospective cohort study of patients with objectively confirmed (DVT+) or refuted (DVT-) previous episodes of suspected DVT. Twenty-nine of 33 DVT+ patients had abnormal PPG and/or reflux by venous Doppler ultrasound, whereas 39 of 49 DVT- patients had normal PPG and no Doppler reflux (sensitivity, 88%; specificity, 80%). Of 33 DVT+ patients, 20 had abnormal Doppler results (sensitivity, 61%), in contrast to 46 of 49 DVT- patients with normal results (specificity, 94%). Moreover, 23 of 33 DVT+ patients showed abnormal PPG results (sensitivity, 70%), whereas 40 of 49 DVT- patients had normal PPG (specificity, 82%). Based on our findings, the presence of Doppler reflux is specific for previous proximal DVT, whereas a combination of normal PPG and Doppler ultrasound is reliable for excluding previous proximal DVT. Abnormal PPG with normal Doppler ultrasound does not reliably predict the presence or absence of previous DVT. However, this occurred in only 16 of 82 patients. Therefore, the combination of PPG and venous Doppler ultrasound can reliably predict the presence or absence of previous proximal DVT in most patients.     

Diagnosis of rectal varices via color Doppler ultrasonography

OBJECTIVES: There has been no report on the hemodynamic evaluation of rectal varices by percutaneous color Doppler ultrasonography. Here, we report the usefulness of color Doppler ultrasonography for this purpose. METHODS: Color Doppler ultrasonography was performed in 44 patients: 31 patients with portal hypertension, 7 with liver cirrhosis (LC) without portal hypertension, and 6 non-LC patients. We examined color flow images and measured velocity of blood flow in rectal varices using fast-Fourier transform (FFT) analysis. Next, we performed colonoscopy on these 44 patients as follow-up to confirm findings by color Doppler. Endoscopic findings of rectal varices were evaluated according to the grading system outlined in "The General Rules for Recording Endoscopic Findings of Esophageal Varices" prepared by the Japanese Research Committee on Portal Hypertension. RESULTS: Rectal varices were shown by Doppler color flow images in 27 of the 31 patients (87.1%) with portal hypertension. Blood flow velocity in those 27 rectal varices ranged from 2.0 to 11.6 cm/s (mean 6.5 +/- 2.4 cm/s). Rectal varices were observed in all 27 of these cases by colonoscopy. On the other hand, rectal varices were not observed by colonoscopy in the 7 LC patients without portal hypertension and the 6 non-LC patients not shown to have rectal variceal blood flow via color Doppler ultrasonography. Sensitivity, specificity, and accuracy were 27/27 (100%), 17/17 (100%), 44/44 (100%), respectively, for detection of rectal varices with color Doppler ultrasonography. Next, we compared velocities of rectal varices obtained by color Doppler ultrasonography with colonoscopic findings. Mean velocity (7.1 +/- 2.3 cm/s) in Cb variceal cases (N = 20) was significantly higher than that (4.9 +/- 1.7 cm/s) in the Cw rectal variceal cases (N = 7) (P < 0.05). Mean velocity (8.5 +/- 2.0 cm/s) in the RC-positive cases (N = 9) was significantly higher than that (5.4 +/- 1.8 cm/s) in RC-negative cases (N = 18) (P < 0.01). Mean velocity (9.8 +/- 1.6 cm/s) in rectal bleeding cases (N = 3) was significantly higher than that (6.1 +/- 2.1 cm/s) in patients without bleeding (N = 24) (P < 0.05). Seven days after endoscopic injection sclerotherapy (EIS) treatment, color Doppler ultrasonography showed an extreme decrease in blood flow in all three rectal varices in comparison with values before EIS. CONCLUSIONS: Color Doppler ultrasonography can be considered a very useful noninvasive tool for diagnosis of rectal varices.     

Evaluation of systolic murmurs by Doppler ultrasonography.

Non-invasive continuous and pulsed wave Doppler ultrasonography was performed in 102 consecutive patients with clinically ill defined systolic murmurs to differentiate between flow murmurs, mitral regurgitation, aortic stenosis, and ventricular septal defect, as well as to assess the severity of aortic stenosis. Diagnoses with the Doppler method were based on velocity, direction, and duration of flow signals and were subsequently verified by cardiac catheterisation in all patients. Multiple evaluations were made in 31 patients. Sensitivity and specificity were 0.87 and 0.77 in mitral regurgitation, 0.9 and 1.0 in aortic stenosis, and 1.0 and 1.0 in ventricular septal defect. In 67 patients the estimation of severity of aortic stenosis using the Doppler technique to calculate aortic pressure gradients from maximum flow velocity was significantly correlated with that determined at catheterisation. It is concluded that Doppler ultrasonography is a highly useful technique for the non-invasive evaluation of clinically ill defined systolic murmurs.     

CT angiography of stented carotid arteries: comparison with Doppler ultrasonography.

PURPOSE: To determine whether computed tomographic angiography (CTA) is a feasible modality for assessing stented carotid arteries and whether in-stent restenosis based on CTA concurs with ultrasonography (US). METHODS: A retrospective review was conducted of 37 follow-up CTA and US images from 27 patients (23 men; median age 70 years, range 56-77) who received 34 nitinol carotid stents. CTA and US images were compared with respect to assessability and percent stenosis. Both visual estimation (>or=50% or not) and the NASCET method were used to determine percent stenosis in CTA images. For US, a determination of >or=50% stenosis was based on peak systolic velocity (>or=200 cm/s) and an internal carotid artery to common carotid artery ratio >or=2.5. Percent stenosis values by CTA were also compared to values (n=7, 21%) determined by catheter angiography. RESULTS: CTA and US images were "totally assessable" in 27 (73%) and 15 (41%), "totally non-assessable" in 0 (0%) and 3 (8%), and "partially assessable" in 10 (27%) and 19 (51%), respectively. Assessability of CTA images was equal to or better than that of US images in 33 (89%). The percent stenoses by CTA and US were comparable in 20 cases. CTA found >or=50% stenosis using the NASCET method in 4 of 20 stents; none of these showed >or=50% stenosis by visual estimation of CTA or by spectral Doppler US. Compared with catheter angiography, CTA overestimated percent stenosis from 34% to 66% (mean 53%). US confirmed 2 angiographically proven restenoses, but CTA identified only 1. CONCLUSION: CTA provides better image quality for stented carotid arteries than US, but it might be inferior to US in determining restenosis in assessable cases. Therefore, CTA is likely to be an alternative to US in cases of non-assessability. A large-scale study including more restenosis cases is warranted to reveal which modality is more reliable for diagnosis of restenosis.     

Utility of color Doppler ultrasonography predicting tips dysfunction

OBJECTIVES: Color Doppler ultrasonography (CDUS) has been proposed as an alternative to portal pressure gradient (PPG) measurement to detect transjugular intrahepatic portosystemic shunt (TIPS) dysfunction but with inconsistent results. This study aimed at developing and validating CDUS criteria to assess TIPS dysfunction. METHODS: A total of 117 consecutive follow-up simultaneous CDUS and hemodynamic evaluations in 34 patients with TIPS were analyzed. TIPS dysfunction was defined as a PPG >12 mmHg. A predictive model was obtained with logistic regression and was validated in an independent, prospective sample of 119 consecutive paired CDUS/hemodynamic evaluations in 55 patients. RESULTS: TIPS dysfunction was present in 57 of the 117 studies in the retrospective series. At multivariate analysis, mean maximum flow velocity at the portal vein (mVPmax) and direction of flow in the intrahepatic portal vein branches (FD) were the only independent predictors of TIPS dysfunction. The prediction rule for TIPS dysfunction derived from the model (mVPmax <28 cm/s when flow is hepatofugal or mVPmax <39 cm/s when flow is hepatopetal) had 90% sensitivity, 45% specificity, and negative likelihood ratio of 0.23. This prediction rule was validated both in patients with bare stents and in patients with polytetra fluoroethylene (PTFE)-covered stents, showing an overall 87% sensitivity, 57% specificity, and 0.23 negative likelihood ratio. CONCLUSIONS: The combination of two CDUS parameters correlate with TIPS dysfunction with high sensitivity and low specificity but with a good negative likelihood ratio. TIPS catheterization can be safely avoided in half of the patients using this predictive rule.     

Non-invasive grading of aortic regurgitation by Doppler ultrasonography

Doppler ultrasound without concomitant echocardiographic imaging was used to grade isolated aortic regurgitation in 21 patients. The severity of aortic regurgitation was subsequently graded (from 0 to IV) angiographically. A 2 MHz continuous wave Doppler transducer was placed over the apex of the heart and the beam was aimed parallel to the mitral flow by means of acoustic guidance. Mitral pressure half time was calculated from the analogue maximum velocity tracing and it was less than or equal to 60 ms in 10 controls; 50-120 ms in five patients with grade II, 120-160 ms in nine patients with grade III, and greater than or equal to 160 ms in seven patients with grade IV aortic regurgitation. These results indicate that a semi-quantitative grading of aortic regurgitation may be obtained non-invasively with non-imaging Doppler ultrasonography in patients without concomitant mitral valve disease.