经颅超声造影在颅内动脉狭窄闭塞性疾病的应用

目的探讨经颅超声造影在颅内动脉狭窄闭塞性疾病的应用价值。方法 59例患者超声造影前、后分别经颅超声探查颅内动脉及颈内动脉颅内段,比较造影前、后颅内动脉的显示率,总结经颅超声造影在颅内动脉狭窄闭塞性疾病的血流特点,并与MRA或DSA结果对比。结果造影增强经颅彩色多普勒(CE-TCCS)对于大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)显示率较常规经颅彩色多普勒(TCCS)明显提高,其中对于MCA(M2段)、ACA(A1、A2段)、PCA(P1、P2段)的显示率与TCCS比较,差异有统计学意义(P0.01)。21例椎-基底动脉造影前显示率为71.3%(15/21),造影后显示率为100%;CE-TCCS检出3例MCA闭塞,15例MCA狭窄,3例ACA狭窄,2例PCA狭窄;4例颈内动脉颅内段闭塞,7例颈内动脉颅内段狭窄。颈内动脉颅外段闭塞3例和狭窄8例,患者同侧颅内动脉血流灌注减少,血流速度减低。2例MCA狭窄支架置入术后,CE-TCCS显示血流通畅,速度在正常范围,所有结果均经MRA、DSA证实。结论经颅超声造影可以提高颅内动脉的显示率;有助于判断颅内动脉狭窄,也可用于颅内动脉狭窄支架置入术后疗效评价。

The application of transcranial contrast-enhanced ultrasound in intracranial arterial stenosis and occlusion disease

Objective To explore the value of transcranial contrast-enhanced ultrasound in intracranial arterial stenosis and occlusion disease. Methods Tracranial sonogrphy was performed in 59 patients before and after injection of ultrasound contrast agent. The display rate of intracranial arteries were compared before with after injecion contrast agent. The blood flow characteristics of transcranial contrast-enhanced ultrasound in the intracranial artery stenosis and occlusion disease were summarized and compared with MRA or DSA. Results The display rate of anterior cerebral artery （ ACA）, middle cerebral artery （ MCA）, posterior cerebral artery （PCA） improved obviously by contrast-enhanced transcranial color sonography （ CE- TCCS） compared with conventional transcranial color sonography （TCCS） , in which the difference of the display rate of MCA （M2 segment）, ACA （A1, A2 segment）, PCA （P1, P2 segment） between CE-TCCS and TCCS were statistically significant （P 〈0.01 ）. The display rate of 21 cases of vertebral - basilar artery was 71.3% （ 15/21 ） before injection of contrast agent, and the display rate was 100% after injection of con- trast agent. Three cases of MCA occlusion, 15 cases of MCA stenosis, 3 cases of ACA stenosis, 2 cases of PCA stenosis, 4 cases of intracranial segment of internal carotid artery occlusion, 7 cases of intracranial internal carotid artery stenosis were detected by CE-TCCS. Three cases of occlusion and 8 cases of stenosis of extracranial carotid artery were showed and the velocity of ipsilateral intracranial arterie reduced. The veloci- ty was in the normal range of 2 cases of MCA stenosis after stent implantation. All results were confirmed by MRA or DSA. Conclusion Transcranial contrast-enhanced ultrasound can increase the display rate of intracranial arteries, which contribute to determine the intracranial arterial stenosis. In addition, it can be used to evaluate the stent implantation of intracranial artery stenosis.