彩色多普勒超声对颈动脉海绵窦瘘血流动力学变化的评估价值

Evaluation of the Hemodynamic of Carotid Cavernous Fistula by Color Doppler Ultrasound

目的探讨颈动脉海绵窦瘘(carotid cavernous fistula,CCF)患者的血流动力学变化特征,评价彩色多普勒超声在其诊断中的应用价值。方法采用彩色多普勒血流显像(color Doppler flowi mage,CDFI)和脉冲频谱多普勒(pulse wave Doppler,PWD)超声技术对95例创伤性颈动脉海绵窦瘘(traumatic CCF,TCCF)和25例自发性颈动脉海绵窦瘘(spontaneous CCF,SCCF)患者的颅内外相关血管进行检测,比较分析两组间各血流动力学参数的差异,并与数字减影血管造影(digital subtraction angiography,DSA)结果对照。结果DSA提示TCCF组中有87例为高流瘘,8例低流瘘,SCCF组中有24例为低流量瘘,仅1例为高流瘘。高流瘘患者的彩色多普勒超声表现为患侧颈内动脉呈明显高流速低阻力频谱;瘘口远端的大脑中、大脑前动脉血流速度低于健侧,盗血明显。而低流瘘患者的双侧颈内动脉各血流参数相比无明显差异,有11例患侧颈外动脉及其分支呈高流速低阻力改变;颅底各动脉流速、PI值及频谱形态正常且基本对称,颅内血流动力学改变不明显。彩色多普勒超声表现与DSA造影结果有很好的相关性。结论彩色多普勒超声能无创、系统地观察到CCF因瘘口引起的颅内外血流动力学改变,有助于临床诊断、治疗及预后判断。

Objective To explore the hemodynamic features of carotid cavernous fistula（CCF）and the diagnostic value of color Doppler ultrasound.Methods The intra-and extracranial blood vessel in 95 patients with traumatic carotid cavernous fistulas（TCCF）and 25 patients with spontaneous carotid cavernous fistulas（SCCF）were examined by color Doppler flow image（CDFI）and pulse wave Doppler（PWD）.The hemodynamic features of the two groups were analysed and compared with the digital subtraction angiography（DSA）examination. Results DSA showed that there were 87 patients with high flow fistula and 8 low flow fistula in TCCF group, and 24 patients with low flow fistula and 1 high flow fistula in SCCF group. The hemodynamic characteristics of high-flow CCF were high velocity and low resistance on the in- volved side of internal carotid artery. The velocity of MCA, ACA on the involved side was significantly lower than on the normal side. There was no significant difference on the hernodynamic characteristics of low-flow CCF between two sides of the internal carotid artery. But the hemodynamic characteristics were high velocity and low resistance on the involved side of external carotid artery in 11 patients with low-flow CCF. The features of high flow fistula and low flow fistula in color Doppler wltrasound were in accordance with those in DSA. Omclmion Color Doppler wltrasound is a noninvasive and systematic method in surveying the features of CCF. It is helpful in clinical diagnosis, treatment, and predicting prognosis.