脑血管病患者颈部血管多普勒血流参数的变化

Changes of Doppler hemodynamic parameters of extracranial vessels in patients with cerebrovascular disease

目的 评价颈内动脉海绵窦瘘 (CCF)、脑动静脉畸形 (AVM )、烟雾病及脑动脉瘤的供血或病变动脉颅外段血管超声血流参数特点。方法 患者组 5 2例 ,其中CCF10例 ;AVM 13例 :主要供血动脉来源于椎基底动脉系统的AVM定为Ⅰ组 ,来源于颈内动脉系统的AVM定为Ⅱ组 ;脑动脉瘤 12例 ;烟雾病 17例 ;均经脑血管造影证实。正常对照组 5 5例健康志愿者。测量双侧颈总动脉 (CCA)、颈内动脉 (ICA)及椎动脉 (VA)的最大峰值流速 (Vmax)、舒张末血流速度 (Vmin)、平均血流速度 (Vmean)及阻力指数 (RI)。结果 与正常对照组相比 :①CCF患侧颈内动脉Vmin及Vmean升高 ,RI下降 (P <0 .0 5 ) ;②Ⅰ组位于小脑的 7例中 特大型AVM ,供血侧椎动脉的Vmax、Vmin、Vmean升高 ,RI降低 (P <0 .0 5 ) ;Ⅱ组位于顶、颞、额叶等部位的 6例中 大型AVM ,供血侧颈内动脉血流参数无明显变化 (P >0 .0 5 ) ;③脑动脉瘤载瘤侧颈内动脉血流参数无明显变化 (P >0 .0 5 ) ;④烟雾病患侧颈总动脉及颈内动脉Vmean降低 ,RI升高 (P <0 .0 5 )。结论 CCF、烟雾病及位于小脑中型以上的AVM的供血或病变动脉颅外段血管超声血流参数的变化具有特征性 ,可为临床诊断脑血管病提供参考。

Objective To characterize findings provided by color Doppler imaging of extracranial cervical vessels in patients with direct carotid-cavernous fistulae (dCCF),cerebral arteriovenous malformations (AVM),cerebral aneurysm and Moyamoya disease.Methods There were 52 patients with cerebrovascular diseases confirmed by cerebral angiography in this study,included 10 cases of CCF; 13 cases of AVM (being divided into two groups:Ⅰ,feeding artery originated from vertebrobasilar artery andⅡ,feeding artery originated from internal carotid artery); 12 cases of cerebral aneurysm and 17 cases of Moyamoya disease. There were 55 healthy volunteers underwent ultrasonography as control group. Spectral Doppler ultrasonographic assessment included peak systolic velocity (Vmax),end diastolic velocity (Vmin),mean velocity (Vmean) and resistive index (RI) of common carotid artery (CCA),internal carotid artery (ICA) and vertebral artery (VA).Results Compared with control group,①both Vmin and Vmean increased and RI decreased significantly within the ipsilateral ICA in patients with dCCF (P<0.05); ②seven cases of AVM in Ⅰgroup located in cerebella which sizes of nidus ranged from medium to extra-large,Vmax,Vmin and Vmean of the VA on the side of feeding artery of AVM increased and RI decreased significantly (P<0.05). Six cases of AVM in Ⅱ group located in frontal lobe,temporal lobe and parietal lobe which sizes of nidus were medium to large,no significant difference in the hemodynamic parameters of ICA on the side of feeding artery of AVM (P>0.05); ③no significant difference in the hemodynamic parameters of ICA on the side of cerebral aneurysm (P>0.05); ④ Vmean decreased and RI increased significantly within the ipsilateral CCA and ICA in patients with Moyamoya disease (P<0.05). Conclusion The changes of hemodynamic parameters of the extracranial vessels in patients with dCCF,AVM with size of greater than medium and located in cerebella and Moyamoya disease are specific characteristic,which provide the important information in diagnosis of cerebrovascular diseases.