经颅多普勒超声对诊断儿童烟雾病的价值探讨

Diagnostic Value of Transcranial Doppler in Children with Moyamoya Disease

目的:探讨分析经颅多普勒超声(TCD)检查在儿童烟雾病诊断中的应用价值。方法:选择疑似烟雾病患儿24例,均进行TCD检查察看其颅内血管血流动力学改变,并以经头颅磁共振血管成像(MRA)为确诊依据,分析TCD对儿童烟雾病的诊断效果。结果:(1)MRA确诊20例烟雾病,而TCD检查中能够明确诊断的有18例,其诊断确诊率为90.0%;(2)在血流动力学变化方面,TCD检测出双侧颈内动脉末端及大脑前、中动脉狭窄样改变、闭塞样改变均与MRA的影像特征相符合,且TCD能够检测出眼动脉、前后交通动脉等侧支代偿血管的搏动指数、血速改变。结论:TCD虽然无法直观显示血管的形态与走向,但其对烟雾病的检查结果与MRA相符,且具有操作简便、无创、重复性好、经济等优势,能够探及细小烟雾血管血流信号并可通过颈总动脉压迫试验鉴别颅内动脉和了解侧支循环功能状态。因此,在临床上可将TCD检查用于疑似烟雾病筛查及辅助诊断中。

Objective： To explore the value of transcranial doppler（TCD） in the diagnosis of children with moyamoya disease. Methods： 24 children with suspected moyamoya disease were examined by TCD to observe the hemodynamic changes of intracranial vessels,and the results of TCD were diagnosed by MRA. Results： 20 cases of moyamoya disease were diagnosed by MRA,and 18 cases were diagnosed by TCD,the coincidence rate of TCD diagnosis was 90%.TCD detected changes like the end of bilateral internal carotid artery and brain artery stenosis,occlusion,these changes were consistent with the image features of MRA,and TCD can detect the ophthalmic artery,before and after the traffic artery collateral circulation blood flow velocity and pulsatility index change. Conclusion： Although TCD cannot directly show the shape and movement of blood vessels,its diagnosis result of moyamoya disease is consistent with the result of MRA.TCD has the advantages of non-invasive,economical,easy to operate and good reproducibility,and can detect the blood flow signals of fine smoke blood vessels,which can be used in the screening and auxiliary diagnosis of suspected moyamoya disease.