经颅彩色多普勒血流显像在脑血管病诊断中的应用

Application of Diagnosis in Cerebrovascular Disease with Transcranial Color Doppler Flow Imaging

目的 评价经颅彩色多普勒超声对颈内动脉海绵窦瘘（ＣＣＳＦ）、脑动静脉畸形（ＡＶＭ） 、脑动脉瘤及烟雾瘤的诊断价值，同时对声学造影剂增强经颅彩色多普勒血流显像作用进行了初步观察。方法 患者组１１０ 例，其中ＣＣＳＦ２２ 例，ＡＶＭ４５ 例，脑动脉瘤２３ 例及烟雾病２０ 例，所有病例诊断均经脑血管造影证实。对照组９５ 例健康志愿者。声学造影剂应用Ｌｅｖｏｖｉｓｔ。经颞、枕、眼窗行彩色及能量多普勒检查，确定病灶部位，并利用频谱多普勒测量颅内动脉、病灶内及相关血管的最大血流速度、平均血流速度及阻力指数等参数。结果 经颅彩色及能量多普勒诊断不同脑血管病检出率分别为ＣＣＳＦ１００％ （２２／２２ 例）、ＡＶＭ８２－２ ％ （３７／４５ 例） 、脑动脉瘤６０－９ ％ （１４／２３ 例） 及烟雾病６０－０ ％（１２／２０ 例） 。同时总结了ＣＣＳＦ、ＡＶＭ、脑动脉瘤及烟雾病的超声诊断标准。声学造影后使造影前不能清楚显示的直径０－８ｃｍ 动脉瘤得以明确显像，更能直观显示烟雾血管形态及全貌。结论 证明该项技术对ＣＣＳＦ及大部分ＡＶＭ、脑动脉瘤及烟雾病患者可以作出正确诊断，显示了声学造影剂对经颅彩色多普勒血流显像的增强作用。

Objective The study was to evaluate ultrasound diagnostic value in carotid cavernous sinus fistula (CCSF),cerebral arteriovenous malformations (AVM),cerebral aneurysm and Moyamoya disease with transcranial color Doppler flow imaging as well as to observe contrast enhanced transcranial color Doppler imaging.Methods 110 cases of patients with cerebrovascular disease were involved in this study: CCSF 22 cases,AVM 45 cases,cerebral aneurysm 23 cases and Moyamoya diseases 20 cases,all demonstrated by cerebral angiography.Another 95 cases of normal volunteers were taken as control group.Levovist ultrasound contrast agent was used.Transcranial CDFI and CDE were performed through temporal,occipital and orbitalis windows,determine the location of cerebral lesions and measure blood flow parameters such as Vmax,Vmin and RI of cerebral arteries and relevant blood vessels.Results The detection rate of various cerebrovascular diseases with CDFI was respectively described as following:CCSF 100%(22/22),AVM 82.2% (37/45),cerebral aneurysm 60.9%(14/23),moyamoya disease 60.0%(12/20).On the other hand,CDFI diagnostic standard of CCSF,AVM,cerebral aneurysm and Moyamoya disease was established.After contrast,diameter 0.8cm cerebral aneurysm and abnormal vessels of Moyamoya disease were showed clearly by CDFI.Conclusions Our study indicates that transcranial CDFI and CDE could provide a definite diagnosis to CCSF and most of AVM,cerebral aneurysm and Moyamoya disease,and show the contrast agent enhancement to transcranial color Doppler signals effectively. [