彩色多普勒超声在颈内动脉海绵窦瘘诊断中的应用

Clinical application of color Doppler ultrasonography in the diagnosis of carotid cavernous sinus fistulas

目的 评价彩色多普勒超声 (CDFI)在颈内动脉海绵窦瘘 (CCSF)诊断及术后疗效观察中的应用价值。方法 应用CDFI对 2 7例疑为CCSF患者病变处进行观察 ,测量其大小、范围、血流频谱 ,对所有患者颅内、颈部及眼部血管进行探测 ,分别测量相关血流参数 ,并对 12例CCSF栓塞术后的患者随访观察 ,病例诊断均经脑血管造影证实。结果 ①CDFI对CCSF病变部位的检出率为 96% ;②CDFI显示患侧前床突后下方出现不规则片状血流团影 ,与正常颈内动脉的横断面血流影相比差异有显著性意义 (1.7～ 3 .9cm2 vs 0 .2～ 0 .5cm2 ,P <0 .0 1) ;频谱多普勒呈多方向、不规则的湍流 ,速度 65～ 170cm /s ;③瘘口近端血管阻力减低 ,远端分支血管如大脑中动脉 (MCA)、大脑前动脉 (ACA)、眼动脉 (OA)等流速减低 (P <0 .0 5 ) ,眼上静脉 (SOV )检出具特征性的脉动样血流频谱 ,平均Vmax3 4.5cm /s ,阻力指数 0 .3 1± 0 .0 8;④ 12例CCSF栓塞术后的患者检出 8例完全栓塞 ,4例不完全栓塞。结论 结合二维超声显像、相关血管的血流动力学变化及眼上静脉的特征性改变 ,超声检查可诊断CCSF 。

Objective To evaluate the clinical application of color Doppler flow imaging (CDFI) in carotid cavernous sinus fistulas(CCSF).Methods Twenty seven patients suspected of CCSF were studied by CDFI.The size,range and spectral were detected.Relevant vessels such as MCA?ACA?OA etc.were examined and the blood flow parameters such as V max ,V min ,PI,RI were measured.All cases were confirmed by cerebral angiography.Twelve patients performed tubolization with silicone detachable balloon were followed up after operation.Results ①Twenty six cases(96%) were correctly identified by CDFI.②The fistula showed heterogenous mosaic flashes,of which the area was larger significantly than the normal( 1.7 ～ 3.9 cm 2 vs 0.2 ～ 0.5 cm 2,P< 0.01 ).③Proximal vessels near the fistula showed low RI.Blood flow velocity of distant branches decreased significantly(P< 0.05 ).Superior ophthalmic veins(SOV) showed a typical flow as arterialization with mean V max 34.5 cm/s,RI 0.31 ± 0.08 .④Eight of twevel cases were considered as complete obliteration of the focus and 4 were incomplete by follow up study.Conclusions Combined with 2 dimensional imaging,relevant hemodynamic parameters and typical manifestation of SOV,CDFI is a valuable method for diagnosis and post treatment follow up of CCSF.