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.     

彩色多普勒血流显像和多普勒能量图诊断脉络膜脱离的价值

目的 探讨彩色多普勒血流显像(CDFI)和多普勒能量图(CDPI)诊断脉络膜脱离的价值。方法 用彩色多普勒超声对30例脉络膜脱离患者进行检查，在超声检查眼球形态、晶状体、玻璃体及视网膜的基础上，对眼内带状回声行CDFI和CDPI检查，了解其血流情况，并与手术结果对照。结果 30例脉络膜脱离患者，超声诊断符合率为80．0％，超声联合CDFI和CDPI诊断符合率上升为96．7％。脉络膜脱离的CDFI和CDPI声像图特点为血流丰富，血流束呈长条带状或短棒状。4例视网膜脱离3例见血流信号，但不丰富，血流束呈星点状。合并玻璃体积血14例，玻璃体混浊8例及玻璃体增殖机化4例。27例脉络膜脱离超声诊断与临床手术符合。结论 超声联合CDFI和CDPI检查可为脉络膜脱离的诊断和治疗提供有价值的参考。     

Three cross-sectional planes for fetal color Doppler echocardiography.

Routine use of color Doppler during every fetal cardiac examination remains controversial. Many examiners still believe that color should be reserved for cases of suspected congenital heart defect (CHD). In our opinion, color Doppler should be applied in every cardiac scan due to the increase in speed and accuracy that it allows. The purpose of this review is to first explain how color Doppler presets can be optimized and, second, to propose the use of three cross-sectional planes to simplify color Doppler fetal echocardiography: the four-chamber (4CV), five-chamber (5CV) and three-vessel (3VV) views. A practical approach to the detection of CHD with these planes is presented, with typical findings and possible abnormalities evident during systole and diastole. The diastolic pattern on the 4CV is characterized by two equal color stripes. Connection ('H'-sign) or size inequality of the two stripes, or a unilateral color stripe, are important abnormal findings. In systole valve regurgitation should be excluded. In the 5CV, turbulent flow, ventricular septal defect or an overriding aorta ('Y'-sign) can be detected. In the 3VV the aorta and pulmonary trunk should be of nearly equal size and demonstrate antegrade flow. Abnormal findings encountered include absence of one vessel, discrepant size of the vessels, retrograde flow in one of the vessels, or the 'U'-sign, where the trachea is enclosed between both vessels, suggesting right-sided aortic arch. In summary, we propose that color Doppler examination utilizing these three planes alone is sufficient to obtain adequate information for the detection of most common CHD.     

彩色多普勒超声诊断帆状胎盘32例分析

目的探讨彩色多普勒超声对帆状胎盘的诊断价值及其临床意义。方法回顾性分析32例帆状胎盘的二维及彩色多普勒超声声像图特点,随访胎儿预后。结果产后临床诊断帆状胎盘例32例,超声正确诊断帆状胎盘22例,漏诊6例,4例误诊为球拍状胎盘;16例合并血管前置。典型的声像图特征是脐带胎盘入口远离胎盘,脐血管在胎膜下延伸进入胎盘实质,合并血管前置时,见胎膜下延伸的脐血管跨过宫颈内口,为脐动脉频谱;剖宫产24例,经阴道分娩8例,活婴30例,死婴2例。结论彩色多普勒超声检查能直接显示脐带根部胎盘入口部位与胎盘实质、宫颈内口的位置关系,是诊断帆状胎盘及筛查血管前置的首选方法,具有较高的临床价值。     

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.     

全肺静脉异位引流的超声诊断

目的探讨超声心动图对全肺静脲异位引流（ＴＰＶＡＤ）的探测方法及其表现特征。方法应用彩色多普勒超声或声学造影检查３７例ＴＰＶＡＤ,其中死亡７例,２９例经手术或尸检证实。结果３７例中心上型ＴＰＶＡＤ２２例,心内型１１例,心下型３例,混合型１例。除混合型超声漏诊外,其诊断正确率为９６．６％（２８／２９）。超声检查无肺静脉回流入左房为诊断该病的特征表现,根据分型不同超声心动图有相应改变。本组左房、左室校正     

三维能量多普勒与彩色多普勒超声对颈动脉狭窄诊断的对比研究

目的 比较三维能量多普勒超声(3D-PDI)与二维彩色多普勒血流显像(CDFI)在颈动脉狭窄诊断中的应用,探讨3D-PDI在颈动脉狭窄中的诊断价值.方法 49例经CDFI诊断为颈动脉狭窄的患者,进行自由臂模式3D-PDI,测量血管内斑块及动脉狭窄的情况,并于1周内进行数字减影血管造影(DSA)检查,同时与CDFI比较.结果 3D-PDI可直观显示狭窄区的立体形状,包括斑块数量、狭窄部位、血管腔大小及血流空间走行等征象.3D-PDI与CDFI测量颈动脉内径狭窄率比较,差异无统计学意义[(52.0±0.9)%对(51.7±0.8)%,P＞0.0s];3D-PDI测量的颈动脉面积狭窄率与CDFI面积狭窄率比较,差异有统计学意义[(58.0±0.2)%对(52.0±0.5)%,P＜0.01].狭窄分级中,CDFI、3D-PDI诊断颈动脉轻度、中度和重度狭窄比较,差异有统计学意义(P＜0.05).3D-PDI与DSA诊断颈动脉狭窄程度结果差异无统计学意义(χ2=0.0538,P＞0.05))3D-PDI与CDFI对颈动脉分叉处的斑块数量检出率比较,差异有统计学意义(P＜0.01).结论 3D-PDI检测颈动脉狭窄、斑块的准确性优于CDFI,能为颈动脉狭窄的诊断及治疗提供更丰富的信息.     

彩色多普勒超声在部分脾栓塞术中的应用

目的 探讨彩色多普勒超声在部分脾栓塞术（PSE）中的应用价值。方法 36例患者行PSE治疗,分别于栓塞术前1周内,栓塞后1～6周及2～6个月行彩色多普勒超声检查。观察脾脏大小,门静脉及脾静脉的内径、血流参数,了解栓塞区回声变化及外周血象变化,分析结果判断疗效。结果 PSE2个月后脾脏开始萎缩变小,6个月后显著性缩小;栓塞区的脾实质内无动静脉血流信号;栓塞后门静脉及脾静脉的血流速度明显减慢,血流量显著性减少;术后2～6个月门静脉及脾静脉内径显著性缩小;外周血象明显改善。结论 彩色多普勒超声可作为评价PSE临床疗效的客观依据之一。     

二次谐波显像和彩色多普勒血流显像对乳腺癌的诊断

超声检查是鉴别乳腺肿瘤良恶性的有效手段.本文通过对251例乳腺癌患者的高频超声二次谐波声像特征及彩色多普勒血流显像与手术病理结果对照分析,进一步探讨和评价其对乳腺癌的诊断价值.     

Aortico-left ventricular tunnel: diagnosis based on two-dimensional echocardiography, color flow Doppler imaging, and magnetic resonance imaging

Aortico-left ventricular tunnel is a rare congenital cardiac lesion that often results in severe aortic insufficiency in infancy. In previously reported cases, the diagnosis has often been missed initially despite use of cardiac catheterization and angiography. We describe a patient who underwent successful surgical correction of this malformation at 10 months of age after the diagnosis had been established by use of two-dimensional echocardiography, color flow Doppler imaging, and magnetic resonance imaging. Aortico-left ventricular tunnel can be diagnosed by use of these noninvasive means without cardiac catheterization.     

Doppler color flow imaging: a new technique for visualization and characterization of the blood flow jet in mitral stenosis

We used Doppler color flow imaging, a new noninvasive technique for mapping of intracardiac blood flow, to visualize and characterize the blood flow jet in 42 patients with mitral stenosis. Color flow imaging provides information about the direction of blood flow, its velocity, and the presence of turbulence. Although we found various jet configurations, most frequently the jet was centrally and apically directed and had a "candle flame" appearance (a central blue zone surrounded by hues of yellow and orange). The blood flow jet can be used to guide the positioning of the continuous-wave Doppler beam parallel to the blood flow; thus, the accuracy of the Doppler data can be enhanced. This new technology has promising potential for other clinical applications in cardiology.     

彩超及二维血流显像技术在PICC置管中的应用及效果

目的探讨彩色多普勒血流显像技术(简称彩超技术)及二维血流显示技术(简称B-Flow技术)在PICC置管的应用及效果。方法将87例需行PICC置管的患者分为对照组和试验组,分别在彩超引导和彩超及B-Flow引导下置管,对两组的置管成功率、操作时间、局部组织损伤、术后血栓发生率进行比较。结果试验组置管成功率、局部组织损伤、术后血栓发生率与对照组比较,差异有统计学意义。结论彩超及B-Flow引导下PICC置管是一种实用、安全的置管方法,它使彩超引导下置管变得更加容易,对局部血管状况差的患者更突显其优势。     

彩色多普勒和彩色能量图在诊断乳腺癌中的价值

目的应用CDFI和CDE观测乳腺肿块的血流特点,评价其在鉴别乳腺良恶性肿块方面的意义。方法应用CDFI和CDE检测145个乳腺肿块,并与病理结果对照。按肿块大小分为Ⅰ组(直径>2.0cm)和Ⅱ组(直径≤2.0cm)。观察肿块二维和彩色血流特点并用频谱3个参数进行定量分析。结果①CDFI显示:恶性肿块血流显示率明显高于良性;Ⅱ组乳腺良、恶性肿块SPV、PI、RI均有显著差异,Ⅰ组则不明显。②CDE显示:血流检出率恶性高于良性,良性肿块以0'型或Ⅰ'型为主,多表现为环绕、点线状血流;恶性肿块以Ⅲ'型或Ⅳ'型为主,表现为穿入、转折和增粗分叉。③联合应用CDFI与CDE对两组肿块诊断敏感性、特异性和准确性分别为95.24%、86.67%、91.67%和93.94%、85.00%、89.04%,明显高于单独应用CDFI或CDE。结论乳腺癌的CDFI和CDE血流检出率均高于良性;SPV、PI、RI可作为小乳癌的鉴别诊断指标之一;联合应用CDFI和CDE能够明显提高乳腺癌的诊断敏感性、特异性和准确性。     

Dynamic three-dimensional color Doppler ultrasound of human fetal intracardiac flow.

OBJECTIVES: To develop dynamic three-dimensional ultrasound techniques for prenatal imaging of the intracardiovascular flow as well as the cardiovascular structure to address difficulties in assessing the spatially complex hemodynamics and morphology of the fetal heart. METHODS: Gray-scale and color (velocity) Doppler echocardiography were performed on 12 fetuses to provide serial anatomical and rheological tomograms which were spatially registered in three dimensions. Using a second ultrasound machine simultaneously, spectral Doppler ultrasound was performed to record umbilical arterial waveforms, thus providing the temporal (fourth) dimension in terms of the cardiac cycle and facilitating removal of motion artifacts. RESULTS: Acquisitions were successful in eight of 15 attempts. Imaging of the flow of blood in four dimensions was achieved in six of the eight datasets. In one case with complex cardiac malformations, three-dimensional reconstructions at systole and diastole offered dynamic diagnostic views not appreciated on the cross-sectional images. CONCLUSIONS: Our novel technique has made possible the prenatal visualization of the spatial distribution and true direction of intracardiac flow of blood in four dimensions in the absence of motion artifacts. The technique suggests that diagnosis of cardiac malformations can be made on the basis of morphological and hemodynamic changes throughout the entire cardiac cycle, offering unique and significant information complementary to conventional techniques. Further work to integrate the several non-purpose-built machines into a single system will improve the rate of acquisition of data, and may provide a new means of imaging and modeling structure and hemodynamics, not only for the fetal heart but for many other moving body parts.     

Comparison of flow disturbances in small carotid atheroma using a multi-gate pulsed Doppler system and Doppler color flow imaging.

The capacity of a multi-gate pulsed Doppler (MPD) system and Doppler color flow imaging (DCFI) for the evaluation of flow patterns was studied in 14 patients with 17 nonstenotic carotid plaques (luminal narrowing less than 40%). Plaque morphology was assessed by means of a high-resolution B-mode system with subsequent three-dimensional reconstruction of the lesion surface. MPD velocity profiles obtained proximally, centrally and distally to the plaque (51 analyses) were normal in 31 sites corresponding to 28 undisturbed and 3 turbulent flow patterns assessed by Doppler color flow imaging (90% specificity). Of the 10 irregular MPD flow profiles, DCFI detected turbulence in 7 (70% sensitivity). 10 asymmetric MPD waveforms without irregularities were normal in 7 and turbulent in 3 DCFI studies. These results suggest, that MPD is superior to DCFI for the detection of nonturbulent flow asymmetry nearby small carotid plaques. However, DCFI displays turbulence with a high specificity and reasonable sensitivity and visualizes the morphologic-hemodynamic interaction in carotid atherosclerosis simultaneously.     

Estimation of left ventricular end-diastolic pressure by color M-mode Doppler echocardiography and tissue Doppler imaging.

OBJECTIVES: The aim of this study was to estimate left ventricular end-diastolic pressure (LVEDP) noninvasively by tissue Doppler imaging and color M-mode echocardiography. MATERIAL AND METHODS: We studied 3 groups of patients who were proven by angiography to be free of significant coronary artery lesions (<40% stenosis) with an LVEDP < 10 mm Hg (group A: n = 24; 16 men, 18 women; mean age +/- SD = 55 +/- 13 years), an LVEDP of 10 to 15 mm Hg (group B: n = 21; 17 men, 4 women; mean age 56 +/- 11 years), or an LVEDP > 15 mm Hg (group C: n = 35; 20 men, 15 women; mean age 58 +/- 9 years). Tissue Doppler imaging of the lateral mitral annulus and color M-mode imaging of the mitral valve in the apical 4-chamber view were obtained with an echocardiographic system. Early and late diastolic velocities (Em and Am, respectively), Em deceleration time (EmDT), Am time (Am-t), and mitral propagation velocity time delay (VpDT) were measured in each patient. RESULTS: In group A, sensitivity and specificity for EmDT < or = 100 ms, Am-t < or = 90 ms, Em/Am > or = 1, and VpDT < or = 45 ms were found to be 0.57 and 0.89, 0.66 and 0.88, 0.86 and 0.92, and 0.73 and 0.89, respectively. In group B, sensitivity and specificity for EmDT 100 to 120 ms, Am-t 90 to 110 ms, Em/Am 1 to 0.5, and VpDT 45 to 60 ms were found to be 0.57 and 0.84, 0.69 and 0.82, 0.66 and 0.75, and 0.55 and 0.83, respectively. In group C, sensitivity and specificity for EmDT > 120 ms, Am-t > 110 ms, Em/Am < 0.5, and VpDT > 60 ms were found to be 0.88 and 0.81, 0.71 and 0.80, 0.86 and 0.72, and 0.78 and 0.86, respectively. CONCLUSION: The EmDT, Am-t, Em/Am, and VpDT measurements obtained noninvasively by left ventricular tissue Doppler imaging and mitral flow propagation velocity were found to be useful in the estimation of LVEDP.     

降主动脉及降主动脉瘤的二维和多普勒经胸超声心动图表现

目的研究位于后纵隔的降主动脉及其动脉瘤的经胸超声检查法及其二维和彩色多普勒表现.方法二维、M型、彩超多路径检查30例正常降主动脉、12例降主动脉瘤或夹层动脉瘤的声像图及测值并进行比较.结果前、后胸,胸、锁骨上窝,剑下多切面可见降主动脉上、中、下段的长、短轴图像.正常降主动脉外、内径分别为(2.25±0.20)cm、(1.82±0.14)cm,降主动脉前壁距体表距离9.5～15.3cm,平均(12.80±1.50)cm.左心室后长轴中上段呈略向后的弧形,肺动脉分叉深部,略呈斜行,上段前壁距体表距离7.50～13.30cm.CDFI显示收缩期血流呈红、蓝色,降主动脉流速23.00～56.10 cm/s,平均(36.8±16.62)cm/s.单发性降主动脉瘤占8.3%,伴升主动脉瘤或夹层动脉瘤占91.7%.瘤体呈梭形、半圆形或憩室样膨大,粗细不等,外径3.0～6.5cm,平均(3.83±1.35)cm;夹层呈条索状中高回声,随血流飘动.结论经胸超声检查降主动脉与其动脉瘤图像清晰,为诊断和了解病变范围、大小与邻近组织关系提供依据.     

二维及彩色多普勒超声对先天性主动脉瓣畸形的鉴别诊断

目的　利用二维及彩色多普勒技术探讨各种先天性主动脉瓣畸形的超声鉴别诊断标准。方法　通过左室长轴、大血管短轴等切面观察主动脉瓣的数目、形态及活动; 通过彩色多普勒直接地观察主动脉瓣的狭窄及关闭不全。结果主动脉瓣二叶畸形时收缩期开放时呈“二”字形, 关闭时呈偏心的“一”字形; 三叶畸形时三个瓣叶有不同程度的改变, 过小、过大或增粗等; 四叶畸形时左室长轴观关闭呈“”型, 短轴呈“十”字形。以上几种先天性主动脉瓣畸形均伴有不同程度的狭窄和关闭不全。结论　二维及彩色多普勒对先天性主动脉瓣畸形的鉴别诊断具有重要意义。     

彩色多普勒超声对胎儿心脏病的诊断研究

目的 探讨彩色多普勒超声对胎儿心脏病的产前诊断价值。方法 随机对6000例孕妇进行胎儿超声心动图检查。结果 产前检出30例胎儿心脏病，16例经引产尸体解剖证实，产后彩超检查证实14例。声像图显示四腔心不对称者占30．0％（9／30），有室间隔缺损者占73．3％（22／30）。结论 常规胎儿心动图检查对产前检出胎儿心脏病具有重要的临床价值；四腔心不对称和室间隔缺损是胎儿心脏病最主要的声像图表现。