颈内静脉超声在静脉源性搏动性耳鸣中的评估价值

Evaluation of internal jugular veins by ultrasound in venous pulsatile tinnitus

目的应用彩色多普勒超声研究静脉源性搏动性耳鸣(VPT)患者的颈内静脉(IJV)结构和血流动力学特点。方法纳入2019年10月~2020年7月在我院门诊诊断为单侧搏动性耳鸣并进行IJV超声检查的患者共计85例。应用彩色多普勒超声对IJV的3个水平段进行评估,主要参数包括:平静呼吸时各段最大内径、最高流速(v_(max))、血流量;压颈试验阳性患者中优势血流组和非优势血流组患/健侧各段血流动力学参数的差异。回顾分析有优势引流患者的磁共振静脉血管成像(MRV)检查结果。结果压颈试验阳性75例,其中IJV优势引流43例。IJV优势引流组中,各段流量的患侧/健侧比值差异具有统计学意义(P<0.05),J2、J3水平流速的患侧/健侧比值差异具有统计学意义(P<0.05);非优势引流组中,各段流速及流量患者/健侧差异均无统计学意义(P>0.05)。MRV结果显示,IJV优势引流共18例,其中合并乙状窦憩室3例。结论彩色多普勒超声可对VPT患者IJV的血流动力学进行综合评估。在压颈试验阳性的优势引流组中,IJV流量各水平患侧明显高于健侧。与MRV结合有望为进一步研究VPT的发生机制提供依据。

Objective To investigate the hemodyanmics characteristics of internal jugular veins(IJV)in venous pulsatile tinnitus(VPT).Methods A total of 85 individuals with unilateral VPT who had received IJV ultrasound examination from October 2019 to July 2020 in our hospital were enrolled.Three levels of IJV were evaluated by ultrasound.The parameters included the maximum diameters of the three segments during the smooth respiration period,cross section area,the maximum velocity(v_(max))and flow volume.The parameters of bilateral IJVs were compared.Magnetic resonance venography(MRV)examination was analyzed retrospectively in patients with drainage dominance.Results A total of 75 cases were positive in compression test,in which 43 cases were IJV drainage dominance.In this positive combined group,there were significant differences in the flow volume affected/healthy ratios in all the three different levels(P<0.05).There were significant differences in the v_(max) affected/healthy ratios both in J2 and J3 levels(P<0.05).In the negative combined group,there was no difference in the flow volume nor in the v_(max) affected/healthy ratio in all the three different levels(P>0.05).A retrospective analysis of ultrasound results suggested that 18 patients with superior drainage were further examined by MRV,all of which showed superior drainage.Among them,superior sigmoid sinus drainage with sigmoid sinus diverticulum were seen in 3 cases.Conclusions Color Doppler flow imaging can be used to evaluate the venous PT by assessing hemodynamics.Among the superior drainage group with positive compression test,the IJV flow of the affected side was significantly higher than that of the healthy side.MRV is expected to provide another basis for further study of the mechanism of VPT.