Differential diagnosis of gall-bladder masses using colour Doppler ultrasonography

To evaluate the diagnostic accuracy of colour Doppler ultrasonography in the differential diagnosis of gall-bladder lesions, we studied colour Doppler flow imaging of gall-bladder masses in 75 patients with gall-bladder masses, including 26 patients with cancer, 18 with benign polyps, 10 with adenomyomatosis and 21 with pseudo-tumorous sludge and 28 healthy subjects as controls. The presence of a colour signal, pattern of the colour signal, blood flow velocity and resistive index (RI) within lesions were assessed using colour Doppler ultrasonography. In cancerous lesions, the colour signal pattern was diffuse or arborizing (sensitivity 90.5% (19/21); specificity 62.5% (10/16)) and the velocity and RI were (mean ± s.d.) 39.0 ± 12.4 cm/s and 0.62 ± 0.12, respectively, which was significantly different (P< 0.01) compared with controls (11.4 ± 2.5 and 0.75 ± 0.03, respectively). The colour signal pattern obtained from polyps was linear at their base in 62.5% (10/16) of cases, but the velocity (13.6 ± 5.5) and RI (0.74 ± 0.08) did not differ from those of the controls. Lesions other than cancer and polyp had no colour signal. There were overlaps in the values of velocity and RI between malignant and benign lesions. When 20 cm/s for velocity and 0.65 for RI were used as the respective cut-off values, the sensitivity and specificity of this method in the diagnosis of malignant lesions was 95.2% (20/21) and 87.5% (14/16) for velocity and 66.7% (14/21) and 87.5% (14/16) for RI, respectively. In a prospective study consisting of 10 patients with cancer and 21 patients with polyps, the sensitivity and specificity were 90 and 66.7% for the colour signal, 100 and 100% for velocity and 80 and 90.4% for RI, respectively. In conclusion, colour Doppler ultrasonography can be useful in the diagnosis of gallbladder masses in combination with conventional ultrasonographic findings of gall-bladder masses, especially in the differentiation of cancers from benign lesions.     

Use of color Doppler ultrasonography in the diagnosis of anomalous connection in pancreatobiliary disease

AIM: To estimate the detectability of anomalous connection in pancreatobiliary disease (ACPBD) cases, measuring gallbladder wall blood flow (GWBF). METHODS: In the retrospective study, we enrolled 42 subjects with gallbladder wall thickening. GWBF velocity was determined as an average value of the peak velocity of color signals on the gallbladder wall, three times in each case. Based on the findings on endoscopic ultrasonography (EUS) or endoscopic retrograde cholangiopancreatography (ERCP), the 42 subjects were divided into 11 cases with ACPBD and 31 cases without ACPBD, In the prospective study, the subjects were 92 cases with gallbladder wall thickening. Using the cut-off level of the flow velocity obtained in the retrospective study, the usefulness of measuring GWBF velocity in diagnosing ACPBD was evaluated. RESULTS: In the retrospective study, imaging of GWBF was obtained in 40 of the 42 subjects. The mean GWBF velocity of the ACPBD cases was 29.4±3.9 cm/s (mean±SD), which was significantly different (P<0.0001; 95% CI 5.48-13.2) from that of the without ACPBD cases (20.1±5.9 cm/s). Based on this result, we prepared a receiver operating characteristic curve, and the cut-off level appropriate for diagnosing ACPBD was estimated to be 25 cm/s. In the prospective study, GWBF was detected in 86 of the 92 subjects. Based on the EUS or ERCP findings, the 92 subjects were divided into 15 cases with ACPBD and 77 cases without ACPBD. When a cut-off level of 25 cm/s was employed, ACPBD could be diagnosed with a sensitivity of 87.0% (13/15) and a specificity of 87.3% (62/71). CONCLUSION: Meas urement of GWBF velocity, which is less invasive and provides objective values, is very useful for diagnosing ACPBD prior to the development of malignant tumors in cases with gallbladder wall thickening.     

Gall-bladder wall thickening in patients with liver cirrhosis

Gall-bladder wall thickening is commonly seen in patients with cirrhosis, but its exact causes have not been well established. We evaluated clinical, biochemical and haemodynamic data of patients with cirrhosis with respect to the presence of thickening of the gall-bladder wall. After excluding patients who presented with gallstones, acute or chronic cholecystitis, heart failure, a serum creatinine level greater than 2 mg/dL and/or a serum alanine aminotransferase level greater than 400 U/L, 77 patients with cirrhosis (75 male, two female; mean age 58±8 years) were enrolled in the study. Clinical, biochemical, ultrasound and haemodynamic data were obtained in every patient. Fortyone (53%) of 77 patients with cirrhosis had gall-bladder wall thickening (>4mm). Compared with patients with a normal gall-bladder wall, patients with gall-bladder wall thickening had significantly lower serum albumin levels (3.6±0.6 vs 2.9±0.7 gm/dL, respectively; P< 0.05), a longer prothrombin time (13±6 vs 16±6s, respectively; P<0.05), more patients with Child-Pugh class C (6 vs 37%, respectively; P<0.05) and more patients with ascites (8 vs 50%, respectively; P<0.05). In addition, compared with patients with a normal gall-bladder wall, those patients with gall-bladder wall thickening had a higher hepatic venous pressure gradient (13.9±4.5 vs 17.1±4.1 mmHg, respectively; P<0.01) and a lower systemic vascular resistance (SVR; 1144±332 vs 1010±318 dyn.s/cm⁵, respectively; P< 0.05). Using a multivariate analysis, the presence of ascites and SVR lower than 900 dyn.s/cm⁵, were independently correlated with the presence of gall-bladder wall thickening, while a hepatic vein pressure gradient greater than 10 mmHg had only a marginally significant association. The presence of ascites, decreased SVR and portal hypertension are related to the occurrence of gall-bladder wall thickening in patients with cirrhosis, indicating that the development of gall-bladder wall thickening may be multifactorial.     

The blood flow velocity in the wall of the gallbladder is an indicator of the degree of inflammation in acute cholecystitis

BACKGROUND/AIMS: To determine whether gallbladder wall blood flow velocity reflected the degree of inflammation, these were measured in 2 acute cholecystitis groups treated with percutaneous transhepatic gallbladder aspiration (PTGBA) or antibiotics alone. METHODOLOGY: Six patients underwent PTGBA and 5 patients were treated conservatively. Clinical indicators of systemic inflammation and blood flow velocity in the gallbladder wall were determined. The resistance index (RI) was calculated. RESULTS: In the PTGBA group, maximum blood flow (Vmax) decreased sharply the day after PTGBA and remained at a low level thereafter. In the conservative group, the Vmax did not significantly fall until 7 days after the therapy. The RI was significantly decreased on the first to third day after PTGBA but not thereafter. In the conservative group, the RI was not significantly changed throughout the period. CONCLUSIONS: The gallbladder wall blood flow velocity indicated the degree of inflammation in the acute cholecystitis patients. The RI of the blood flow in the gallbladder wall may also be an effective method of monitoring gallbladder inflammation.     

Effect of calcitonin on gall-bladder volume in man

The effect of increasing intravenous doses of synthetic salmon calcitonin (0.0044, 0.0088, 0.0175, and 0.0350 iu/kg per min) versus placebo on the fasted gall-bladder volume was assessed in seven normal subjects according to a double-blind study protocol. In addition, the action of calcitonin on meal-induced gall-bladder emptying was examined. Gall-bladder volumes were measured by means of real-time ultrasonography. Calcitonin evoked a dose-dependent relaxation of the fasted gall-bladder. A statistically significant increase of the fasted gall-bladder volume was observed with 0.0175 (23.4 +/- 5.5 cm3 placebo versus 33.9 +/- 7.7 cm3 calcitonin, P less than 0.001) and 0.0350 (21.4 +/- 4.6 cm3 placebo versus 36.1 +/- 8.4 cm3 calcitonin, P less than 0.01) iu/kg per min calcitonin, whereas a mean increase of the gall-bladder volume amounted to 32.1% and 46.5%, respectively. A significant delay of the gall-bladder emptying after calcitonin was reflected by a decrease of the ejection fraction: 23.2 +/- 8.3% calcitonin versus 57.8 +/- 6.9% placebo (P less than 0.02) at 20 min, and 40.5 +/- 8.8% calcitonin versus 67.2 +/- 3.8% placebo (P less than 0.02) at 30 min after the test meal. Calcitonin is concluded to have a potent relaxing effect on the human gall-bladder.     

Association between anomalous pancreaticobiliary ductal union and adenomyomatosis of the gall-bladder

A frequent association of biliary tract carcinoma and anomalous pancreaticobiliary ductal union (APBD) is well recognized, especially gall-bladder carcinoma in undilated type APBD. However, little is known about the presence and incidence of adenomyomatosis (AMT) of the gall-bladder, a presumed premalignant lesion, in patients with APBD. This retrospective study was conducted to elucidate the clinical features and incidence of AMT in APBD patients with relation to undilated type and dilated type APBD. We reviewed the clinicopathological records of 30 patients with APBD (28 women and two men) encountered during the past 10 years. Among them, 22 patients underwent cholecystectomy and the resected specimens were subjected to histopathological examinations. Eleven cases of APBD patients were undilated type and 11 cases were dilated type. Adenomyomatosis was found in six (55%) of 11 undilated type and one (9%) of 11 dilated type, and fundal type was predominantly observed in six (86%) of seven AMT. An overall incidence of AMT in APBD patients was 32%. An undilated type of APBD is frequently associated with AMT and we believe, therefore, that clinicians should be aware of a possible coexistence of APBD and AMT.     

Induced gall-bladder contraction accelerates fragment clearance after extracorporeal shockwave lithotripsy

At the end of extracorporeal shockwave lithotripsy (ESWL) gallstone fragments are dispersed throughout the gall-bladder. In this state they should be expelled more easily than when later sedimented to the gall-bladder fundus. Thus, a randomized study was performed to evaluate the clinical benefit of induced gall-bladder contraction after ESWL. One hundred and five patients with radiolucent gallstones (1–3 stones, diameter ≤ 30 mm) were randomized to received either saline or an infusion of 0.2 μg/kg ceruletide. Stone clearance rates and incidence of biliary symptoms were recorded. Clearance rates at 6 weeks and 3 months after ESWL were significantly (P≤ 0.025) improved by the ceruletide infusion. This effect, resulting in shortened bile acid therapy, was limited to patients with small solitary stones and dependent on a good initial fragmentation. Major side effects attributable to ceruletide were not observed. These results suggest that induced gall-bladder contraction can be successfully applied as an adjuvant treatment in a subgroup of patients with small solitary gallstones.     

Detection of abnormal left ventricular function by Doppler tissue imaging in patients with a first myocardial infarction and showing normal function assessed by conventional echocardiography.

AIMS: The aim of the study was to characterize left ventricular (LV) function by Doppler tissue imaging (DTI) after a first myocardial infarction (MI) where the conventional echo-Doppler parameters showed no abnormalities. METHODS: Out of 202 patients who were referred for an echocardiogram, 19 patients were previously healthy and had a normal ejection fraction and no wall motion abnormalities at echocardiogram. These 19 patients were compared with 16 age-matched healthy subjects (HS). The longitudinal LV function was assessed using the mitral annular velocities (mean value from four different sites of the LV) determined by DTI. RESULTS: The patients with MI had significantly reduced peak systolic and peak early diastolic mitral annular velocities compared to HS (8.6 v. 9.7 cm/s, P<0.001 for systolic velocity, and 10.9 v. 12.3 cm/s, P<0.01 for diastolic velocity, respectively). The patients had normal diastolic LV function assessed by the conventional Doppler echocardiogram (e.g. transmitral flow, IVRT and pulmonary venous flow patterns). To assess the LV filling pressure, the ratio of the transmitral early wave velocity assessed by conventional echo-Doppler and peak early diastolic mitral annular velocity determined by DTI (E/Edti) was used. The E/Edti was significantly higher in patients than in HS (7.0 v. 5.7, P<0.05). CONCLUSION: Previously healthy subjects who are suffering from a first MI and showing normal systolic and diastolic LV function, determined by conventional echo-Doppler methods, show decreased mitral annular systolic and diastolic velocities determined by DTI compared to healthy subjects. This is probably evidence of mild subendocardial damage due to MI that remains undetected by conventional echo-Doppler methods.     

Doppler US of superior mesenteric artery in the assessment of ulcerative colitis. A prospective study

BACKGROUND/AIMS: The purpose of this study was to correlate blood flow velocity in the superior mesenteric artery and activity of ulcerative colitis. METHODOLOGY: Doppler spectral analysis of superior mesenteric artery blood flow velocities were obtained in a blind study from 28 patients after fasting (A1: 13 patients with pancolitis, A2: 5 patients with subtotal colitis, B: 10 patients with left-sided colitis) and 50 healthy volunteers (control group). Disease activity was determined with clinical and endoscopic findings. RESULTS: A significant increase in superior mesenteric artery blood flow measurements was observed in the active pancolitis group A1 [Vsyst = 3.64 +/- 0.18 m/sec and Vdiast = 0.94 +/- 0.09 m/sec as compared with healthy volunteers (Vsyst = 1.14 +/- 0.07 m/sec, Vdiast = 0.38 +/- 0.04 m/sec) P < 0.01. A minor increase in superior mesenteric artery blood flow velocity was observed in patients with subtotal colitis, group A2 (Vsyst = 2.06 +/- 0.14 m/sec, Vdiast = 0.45 +/- 0.05 m/sec) as compared with healthy volunteers P < 0.01. In group B with left sided colitis superior mesenteric artery velocity changes were not statistically significant (P > 0.05). CONCLUSIONS: Doppler US velocity measurement of superior mesenteric artery may be used as an adjunct in the assessment of ulcerative colitis extension and activity.     

The effect of simvastatin and bezafibrate on bile composition and gall-bladder emptying in female non-insulin-dependent diabetics

Abstract Female non-insulin-dependent diabetics have a high prevalence of gallstones. Treatment of hyperlipidaemia in these patients may modify the risk. Seventeen female non-insulin-dependent diabetics (age 35–65) were treated with simvastatin ( n = 10) or bezafibrate ( n = 7) and had the cholesterol saturation index (CSI) of bile and gall-bladder emptying measured before and after 3 months therapy. In both groups, there was a significant reduction in serum cholesterol following treatment. The mean pretreatment cholesterol saturation indices of bile did not differ between the two groups but, after 3 months therapy, there was a highly significant difference in CSI between the bezafibrate group (2.0 ± 0.33) and the simvastatin group (1.1 ± 0.14) P < 0.002. Whereas the increase in the CSI (42%) observed with bezafibrate therapy was significant, the decrease in the simvastatin group (14%) was only significant in those whose pretreatment cholesterol saturation indices were elevated. Despite the differences in CSI observed between the two treatment groups, no changes in gall-bladder emptying were detected.     

Cystic lymphangioma of the gall-bladder: A case report

Intra-abdominal cystic lymphangiomas are rare lesions that can be difficult to diagnose. We present a report of a patient with a giant multilocular cystic lesion in the abdomen. Ultrasonography and computed tomography scans of the abdomen revealed that the cyst had originated in the gallbladder fossa. There was some calcification and thickening of the cyst wall. Endoscopic retrograde cholangiopancreatography demonstrated a medially deviated common bile duct, an elongated cystic duct and an inferior compressed gallbladder. There was no apparent communication between the cyst and the biliary tract; however, an abdominal angiogram revealed that the lesion was supplied by a branch of the cystic artery. Histological findings obtained intra-operatively were consistent with a cystic lymphangioma. Its characteristic histology was observed in the subserous layer of the gall-bladder. This case is a rare instance of a cystic lymphangioma originating in the gall-bladder.     

Doppler ultrasound findings in healthy wrists and finger joints

OBJECTIVE: To evaluate the presence of flow by Doppler ultrasound (DUS) in the wrist and finger joints (carpometacarpal 1 (CMC1), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints) of healthy controls. METHODS: Twenty seven healthy volunteers (15 women, 12 men; mean age 45 years, range 18-93) with a total of 324 joints were examined by DUS. The synovial vascularisation was determined by colour Doppler and the spectral Doppler resistive index (RI). Patients were only included if no synovitis was suspected at the clinical examination and the values for biochemical analysis were within the normal range. RESULTS: We found colour pixels in 15 of the 27 examined wrist scans and in 8 of these a measurable RI. In the CMC1 joint, colour pixels were found in 11 of the 27 scans and in 9 of these a measurable RI. For the MCP joints, colour pixels were found in 10 out of 135 scans and in 3 of these a measurable RI. The mean RI for all three types of joints was 0.85 and the mean pixel fraction varied from 0.05 to 0.08. Only one PIP joint scan was found to have colour pixels and a flow with an RI of 0.67. CONCLUSION: Synovial vascularisation may be detected in healthy subjects using DUS. Newer US machines have higher Doppler sensitivity, and it is necessary to be able to distinguish normal from pathological synovial flow.     

Relation between extent of left ventricular hypertrophy and diastolic filling abnormalities in hypertrophic cardiomyopathy

In hypertrophic cardiomyopathy, the relation between left ventricular diastolic impairment and magnitude of left ventricular hypertrophy has not been clearly defined. In the present study, Doppler echocardiographic indexes of left ventricular diastolic filling were compared in 78 patients with hypertrophic cardiomyopathy and in 72 normal control subjects of similar age, and the relation between abnormalities of diastolic filling and magnitude of left ventricular hypertrophy was assessed. In patients with hypertrophic cardiomyopathy, isovolumic relaxation was prolonged (94 +/- 25 ms); peak early diastolic flow velocity (53 +/- 18 cm/s), deceleration of flow velocity in early diastole (341 +/- 142 cm/s2) and the ratio between early and late peaks of flow velocity (1.6 +/- 0.9) were reduced; and peak late diastolic flow velocity was increased (38 +/- 15 cm/s) compared with values in control subjects (76 +/- 12 ms, 65 +/- 12 cm/s, 512 +/- 131 cm/s2, 2.3 +/- 0.8 and 30 +/- 7 cm/s, respectively; p less than 0.001). Individual patient analysis showed that diastolic filling was abnormal in 52 (67%) of the 78 patients with hypertrophic cardiomyopathy. However, within the patient group, none of the Doppler diastolic indexes showed a significant correlation with maximal left ventricular wall thickness or the wall thickness index (correlation coefficients ranged from -0.15 to 0.10).(ABSTRACT TRUNCATED AT 250 WORDS)     

Gall-bladder glycoprotein synthesis and secretion during cholesterol gallstone formation in the mouse

Abstract Glycoprotein synthesis by the gall-bladder was studied during cholesterol gallstone formation in mice fed a diet supplemented with 1% cholesterol and 0.5% cholic acid for up to 6 weeks. Within 1 week, this lithogenic diet induced a 5 fold increase in the cholesterol saturation of gall-bladder bile, which remained near-saturated for the next 5 weeks. Cholesterol gallstones were infrequent until the fourth week of the diet. Glycoprotein synthesis was measured as the incorporation of ³H-glucosamine by mouse gall-bladder explants in organ culture and was found to double after 4 weeks of the diet when expressed per gall-bladder. This increase could be explained by a marked enlargement of the gall-bladder with a greater number of mucus-secreting cells. Gall-bladder glycoprotein synthesis and secretion did not appear to be regulated by prostaglandins, since indomethacin blocked prostaglandin synthesis but did not inhibit glycoprotein synthesis. High molecular weight mucin glycoprotein accounted for around one-third of gall-bladder glycoprotein secretion.
These results are consistent with the hypothesis that gall-bladder mucin acts as a nucleating agent for cholesterol crystal and gallstone formation. However, this mouse model for cholesterol gallstone formation is different from the prairie dog model, not only in dietary requirements, but also in the effect of the diet on the gall-bladder, and possibly in the mechanism of regulation of gall-bladder much glycoprotein synthesis.     

Case Report: Multiple Cancers: Hepatocellular carcinoma and adenocarcinomas of the common bile duct and the gall-bladder in a woman with primary biliary cirrhosis

We present a case of primary biliary cirrhosis associated with simultaneous triple cancers: a hepatocellular carcinoma and adenocarcinomas of the common bile duct and gall-bladder. A 70 year old Japanese woman, who had been diagnosed with primary biliary cirrhosis (stage 2 by Scheuer) 15 years before, was admitted to Koseiren Kamo Hospital in a comatose state. Laboratory data were as follows: the ammonia level was high (164.0 μg/dL), the antimitochondrial antibody showed a 320-fold increase, a high level of alpha-fetoprotein was indicated (2677 ng/mL), hepatitis B surface antigen was negative and hepatitis C antibody by enzyme immunoassay was negative, although a test for the RNA of hepatitis C virus by polymerase chain reaction was positive (10^3.5 copies/50 μL). The patient's condition gradually worsened and the patient died of liver failure. Autopsy showed triple cancers in the liver (hepatocellular carcinoma; trabecular type, moderately differentiated), the common bile duct (well-differentiated papillary adenocarcinoma) and the gall-bladder (well-differentiated papillary adenocarcinoma) with primary biliary cirrhosis (stage 4). Primary biliary cirrhosis has been believed to be a low risk for the development of hepatocellular carcinoma, despite the high risk of extrahepatic malignancy. The simultaneous occurrence of triple cancers with primary biliary cirrhosis, to the best of our knowledge, has never been reported. The present case may provide additional evidence for a predisposition to malignancy in primary biliary cirrhosis.     

Ventricular long-axis contraction as an earlier predictor of outcome in asymptomatic aortic regurgitation

The long-term prognostic significance of left ventricular (LV) long-axis contraction was investigated prospectively in 65 consecutive patients aged 58+/-15 years with asymptomatic aortic regurgitation, normal LV ejection fraction at rest, and no coronary artery or aortic root disease. A complete transthoracic echocardiographic study was performed at baseline and 12 months later. In 24 of 65 patients with peak systolic wave velocity at the lateral mitral annulus (LatS)<9 cm/s, LV diameter (p<0.01), volume (por=9 cm/s, none of these parameters was significantly affected during follow-up. Aortic valve replacement was performed in 6 of 24 patients (25%) with peak systolic wave velocity at the lateral mitral annulus<9 cm/s and none with peak systolic wave velocity at the lateral mitral annulus>or=9 cm/s. In patients with peak systolic wave velocity at the lateral mitral annulus<9 cm/s, a cut-off value of 6.25 cm/s predicted aortic valve replacement within the next year with 97% sensitivity and 83% specificity. In conclusion, ventricular long-axis contraction seems to be a reliable indicator for outcome prediction in patients with asymptomatic aortic regurgitation.     

Diagnostic usefulness of selected tumor markers (CA125, CEA, CYFRA 21-1) in bronchoalveolar lavage fluid in patients with non-small cell lung cancer

Numerous studies have been performed to determine diagnostic or prognostic utility of tumor markers in patients with lung cancer. The aim of the study was to evaluate the diagnostic usefulness of the tumor markers CA 125, CEA and CYFRA 21-1 in bronchoalveolar lavage fluid (BALF) in patients with non-small cell lung cancer (NSCLC). BAL was performed in 13 patients with NSCLC during diagnostic bronchofibroscopy. The control group consisted of 12 patients with sarcoidosis and 13 healthy volunteers. Tumor markers were determined in BALF supernatants using electrochemiluminescence technique (Elecsys 1010, Roche). To determine optimal cut-off values of tumor markers in BALF ROC curve was used. CEA and CA 125 concentration in BALF were significantly higher in NSCLC patients than in healthy volunteers and patients with sarcoidosis. CYFRA 21-1 in BALF was higher in NSCLC patients than in healthy volunteers, but no significant difference was found between NSCLC and sarcoidosis patients. The cut-off values of BALF concentration of CA 125, CEA and CYFRA 21-1 were 95 IU/mL, 3 ng/ml and 3 ng/ml, respectively. The sensitivity and specificity of CEA and CA 125 in BALF were 100%, 84% and 92%, 80%, respectively. In conclusion, we suggest that among the chosen markers, determination of CEA in BALF is the most useful in diagnosis of NSCLC. It may be a complementary method in diagnosing of patients in whom tumor cannot be visualized by bronchofibroscopy. These results need confirmation in larger groups of patients.     

脑积水患者行经颅多普勒检测的意义

目的明确脑积水患者经颅多普勒（TCD）监测结果与颅内压的关系。方法选择我院32例行脑室腹腔分流术的脑积水患者（观察组），分别于术前1d和术后5d行大脑中动脉（MCA）的TCD监测；另选择27名门诊体检健康个体为对照组，行大脑中动脉TCD监测，并与观察组作对照。结果观察组患者行分流手术前TCD监测显示MCA收缩期血流速度（Vs）、舒张期血流速度（Vd）以及平均血流速度（Vm）较对照组明显下降（P〈0．05）；而搏动指数H和阻抗指数砌却明显高于对照组（P〈0．01）。观察组患者治疗前、后MCA的PI、RI、Vd、Vm间差异有显著性意义（P〈0．05）。结论经颅多普勒中RI和PI值可作为评价脑积水患者颅内高压的有效手段。     

Non-invasive assessment of coronary flow reserve in idiopathic dilated cardiomyopathy: hemodynamic correlations.

BACKGROUND: Impaired vasodilator myocardial blood flow response has been observed in dilated cardiomyopathy (DCMP). However, the mechanisms responsible for this blunted response are not clear. In the present study, we investigated whether the blunted vasodilator flow response is related to indices of left ventricular performance in patients with idiopathic dilated cardiomyopathy. METHODS AND RESULTS: Eighteen DCMP patients and 12 healthy subjects (C) underwent transoesophageal echocardiography within 48 h from cardiac catheterization. Coronary flow velocity reserve (CFR) was measured in the proximal LAD as the ratio of the peak diastolic coronary flow velocity (Vd-M) after intravenous administration of adenosine to peak baseline diastolic flow velocity (Vd-R). Left ventricular (LV) mass index was positively correlated with baseline coronary diastolic velocity (r=0.415; p=0.043) and inversely correlated with coronary flow reserve (r=-0.570; p=0.003). The baseline coronary diastolic velocity was higher in DCMP vs C (56+/-13 cm/s vs 35+/-12 cm/s; p=0.04). In DCMP pts Vd-R positively correlated with end-diastolic wall stress (r=0.654; p=0.01). Vd increased in both C (96+/-32 cm/s; p<0.05 vs baseline) and DCMP patients (108+/-20 cm/s; p<0.01 vs baseline). The CFR was lower in DCMP patients vs C (1.93+/-0.78 vs 2.99+/-1.01; p=0.009). In DCMP pts CFR was negatively correlated with right atrial pressure (r=-0.595; p=0.015), LVEDP (r=-0.576; p=0.015), pulmonary capillary wedge pressure (PCWP: r=-0.772; p<0.001) and positively with ejection fraction (EF: r=0.683; p=0.003). CONCLUSION: Pts with DCMP have lower CFR compared to controls. This blunted CFR is due to higher baseline coronary flow and reflects higher wall stress. The close relation between CFR and EF, PCWP and LVEDP suggests that not only a higher baseline Vd but also compressive forces due to left ventricular dysfunction might be responsible for the observed blunted adenosine-mediated coronary vasodilation.     

经颅多普勒超声对大脑前动脉和前交通动脉变异的血流动力学检测

目的分析经颅多普勒超声（TCD）检测大脑前动脉（ACA）和前交通动脉（ACoA）变异的血流动力学特点。方法选择经MR血管成像（MRA）确诊的ACA或ACoA变异的患者62例（患者组）,无血管变异的健康者48名（对照组）。应用TCD检测两组颅内外血管血流动力学的变化。结果①患者组中,48例为一侧大脑前动脉交通前段（ACA—A1）发育不良,细小侧ACA—A1血流速度为（61±16）cm／s,显著低于对照组的（86±15）cm／s;粗大侧ACA—A1血流速度为（125±12）cm／s,显著高于对照组,均P〈0．01;细小侧血流速度约为粗大侧的1／2。②压迫对侧颈总动脉（CCA）后,双侧ACA—A1血流速度均有不同程度的增高。在细小侧压迫前、后收缩峰血流速度的比值（Vp后／Vp前）为3．10±0．50,显著高于对照组的1．93±0．24;粗大侧Vp后／Vp前为1．33±0．11,显著低于对照组,差异均有统计学意义,P〈0．01。细小侧Vp后／Vp前为粗大侧的2倍以上。③9例为一侧ACA—A1缺如,健侧ACA—A1血流速度为（131±17）cm／s,显著高于对照组及同侧大脑中动脉的血流速度。57例ACA—A1细小或缺如侧的颈内动脉颅外段血流速度为（47±11）cm／s,显著低于对侧的（60±13）cm／s,P〈0．01。④对5例ACoA缺如的患者,分别压迫同侧CCA,ACA血流信号均消失。结论根据双侧ACA压迫颈动脉试验前后的血流动力学的改变,结合颈内动脉颅外段血流速度及血流信号的强度、血流分布等辅助指标,TCD可初步诊断ACA或ACoA变异。