Comparison of detection results of hypoxic-ischemic encephalopathy at different degrees in infant patients between brain electrical activity mapping, transcranial Doppler sonography and computer tomography examinations

BACKGROUND： It has been proved that brain electrical activity mapping （BEAM） and transcranial Doppler （TCD） detection can reflect the function of brain cell and its diseased degree of infant patients with moderate to severe hypoxic-ischemic encephalopathy （HIE）. OBJECTIVE： To observe the abnormal results of HIE at different degrees detected with BEAM and TCD in infant patients, and compare the detection results at the same time point between BEAM, TCD and computer tomography （CT） examinations. DESIGN ： Contrast observation SETTING： Departments of Neuro-electrophysiology and Pediatrics, Second Affiliated Hospital of Qiqihar Medical College. PARTICIPANTS： Totally 416 infant patients with HIE who received treatment in the Department of Newborn Infants, Second Affiliated Hospital of Qiqihar Medical College during January 2001 and December 2005. The infant patients, 278 male and 138 female, were at embryonic 37 to 42 weeks and weighing 2.0 to 4.1 kg, and they were diagnosed with CT and met the diagnostic criteria of HIE of newborn infants compiled by Department of Neonatology, Pediatric Academy, Chinese Medical Association. According to diagnostic criteria, 130 patients were mild abnormal, 196 moderate abnormal and 90 severe abnormal. The relatives of all the infant patients were informed of the experiment. METHOOS： BEAM and TCD examinations were performed in the involved 416 infant patients with HIE at different degrees with DYD2000 16-channel BEAM instrument and EME-2000 ultrasonograph before preliminary diagnosis treatment （within 1 month after birth） and 1,3,6,12 and 24 months after birth, and detected results were compared between BEAM, TCD and CT examinations. MAIN OUTCOME MEASURES： Comparison of detection results of HIE at different time points in infant patients between BEAM. TCD and CT examinations. RESULTS： All the 416 infant patients with HIE participated in the result analysis. （1） Comparison of the detected results in infant patients with mild HIE at different time points after birth between BEAM, TCD and CT examinations： BEAM examination showed that the recovery was delayed, and the abnormal rate of BEAM examination was significantly higher than that of CT examination 1 and 3 months after birth [55.4%（72/130）vs. 17.0% （22/130 ）,x^2=41.66 ;29.2% （ 38/130 ） vs. 6.2% （ 8/130 ）, x^2=23.77, P 〈 0.01 ], exceptional patients had mild abnormality and reached the normal level in about 6 months. TCD examination showed that the disease condition significantly improved and infant patients with HIE basically recovered 1 or 2 months after birth, while CT examination showed that infant patients recovered 3 or 4 months after birth. （2） Comparison of detection results of infant patients with moderate HIE at different time points between BEAM, TCD and CT examinations： The abnormal rate of BEAM examination was significantly higher than that of CT examination 1,3,6 and 12 months after birth [90.8% （178/196）,78.6% （154/196）,x^2=4.32,P 〈 0.05;64.3% （126/196）,43.9% （86/196） ,x^2=16.44 ;44.9% （88/196） ,22.4% （44/196）,x^2=22.11 ;21.4% （42/196）, 10.2% （20/196）,x^2=9.27, P 〈 0.01]. BEAM examination showed that there was still one patient who did not completely recovered in the 24^th month due to the relatives of infant patients did not combine the treatment,. TCD examination showed that the abnormal rate was 23.1%（30/196）in the 1^st month after birth, and all the patients recovered to the normal in the 3^rd month after birth, while CT examination showed that mild abnormality still existed in the 24^th month after birth （1.0% ,2/196）. （3） Comparison of detection results of infant patients with severe HIE at different time points between BEAM, TCD and CT examinations： The abnormal rate of BEAM examination was significantly higher than that of CT examination in the 1^st, 3^rd, 6^th and 12^th months after birth[86.7% （78/90）,44.4% （40/90）,x^2=35.53;62.2% （56/90）,31.1% （28/90）,x^2=17.51 ;37.8% （34/90）,6.7% （6/90）, x^2=27.14, P 〈 0.01]. BEAM examination showed that mild abnormality still existed in 4 infant patients in the 24^th month after birth. TCD examination showed that the abnormal rate was 11.1% （10/90） in the 3^rd month after birth, and all the infant patients recovered in the 6^th month after birth. CT examination showed that the abnormal rate was 6.7%（6/90） in the 12^th month after birth, and all of infant patients recovered to the normal in the 24^th month after birth.CONCLUSION ： BEAM is the direct index to detect brain function of infant patients with HIE, and positive reaction is still very sensitive in the tracking detection of convalescent period. The positive rate of morphological reaction in CT examination is superior to that in TCD examination, and the positive rate is very high in the acute period of HIE in examination.

Compromised cerebrovascular modulation in chronic anxiety:evidence from cerebral blood flow velocity measured by transcranial Doppler sonography

Objective Cerebral autoregulation （CA） is the mechanism by which constant cerebral blood flow is maintained despite changes in cerebral perfusion pressure. CA can be evaluated by dynamic monitoring of cerebral blood flow velocity （CBFV） with transcranial Doppler sonography （TCD）. The present study aimed to explore CA in chronic anxiety. Methods Subjects with Hamilton anxiety scale scores 〉14 were enrolled and the dynamic changes of CBFV in response to an orthostatic challenge were investigated using TCD. Results In both the anxious and the healthy subjects, the mean CBFV was significantly lower in the upright position than when supine. However, the CBFV changes from supine to upright differed between the anxious and the healthy groups. Anxious subjects showed more pronounced decreases in CBFV with abrupt standing. Conclusion Our results indicate that cerebrovascular modulation is compromised in chronic anxiety; anxious subjects have some insufficiency in maintaining cerebral perfusion after postural change. Given the fact that anxiety and impaired CA are associated with cardiovascular disease, early ascertainment of compromised cerebrovascular modulation using TCD might suggest interventional therapies in the anxious population, and improve the primary prevention of cardiovascular disease.

Evaluation of renal artery stenosis using color Doppler sonography in young patients with multiple renal arteries

Background Some individuals have multiple renal arteries. Severe stenosis in one of the arteries may cause refractory hypertension. The detection of stenosis within one of the multiple renal arteries usually required invasive procedures, such as computed tomographic angiography （CTA） and magnetic resonance angiography （MRA）. This study reported the application of color Doppler sonography （CDS） in the detection of severe stenosis in one of the multiple arteries. Methods Patients with multiple renal arteries and one of the arteries with severe stenosis were retrospectively studied. Peak systolic velocities （PSV） of renal arteries and the intrarenal CDS patterns were collected and compared. The diagnosis was confirmed by digital subtraction angiography （DSA）. Results Four children with multiple renal arteries and one of the arteries with stenosis were investigated. They were admitted due to refractory hypertension. CDS screening identified two renal arteries in one kidney of each patient with one of the two renal arteries having stenosis 〉70%. The PSV of the stenosed arteries were much higher, and the intrarenal CDS patterns supplied by the stenosed arteries changed into T-P patterns. Conclusion Non-invasive CDS technology may be a useful method to identify severe stenosis in one of multiple renal arteries in younq patients.

Use of power Doppler sonography for differential diagnosis of small hepatocellular carcinoma and adenomatous hyperplastic nodule

To evaluate applicability of power Doppler sonography (PDS) in differential diag nosis of small hepatocellular carcinoma (SHCC) and adenomatous hyperplastic nodu le (AHN) Methods Twenty two cases of SHCC and 15 cases of AHN were investigated by PDS an d the findings were campared with those of digital subtraction angiography (DSA) Results The rates of arterial and portal flow in an afferent tumor vessel were 86 4% a n d 40 9% in SHCCs, respectively The rate of portal flow in an afferent tumor v essel was 60 0% in AHNs, while no arterial flow was detected ( P <0 01) In addition, PDS revealed a constant flow in an efferent tumor vessel (50 0%) c ontinuing to a portal branch in 10 (45 5%) of the 22 SHCCs cases to a hepatic v ein in 1 (4 5%) of the 22 SHCCs, but to nothing else in the AHNs ( P <0 01) Conclusions Power Doppler sonography is of value in distinguishing SHCC from AHN, and arteri al afferent tumor vessels from constant flow efferent tumor vessels at PDS

Effect of acupuncture at Lieque(列缺LU 7) on vertebral-basilar artery hemodynamics in patients with cervical vertigo

Objective To explore the therapeutic efficacy and mechanism of acupuncture at Lieque （列缺 LU 7） in treatment of cervical vertigo （CV）. Methods Forty CV patients met the inclusion criteria were enrolled and treated with acupuncture at bilateral LU 7 points, once daily with 10 times as a course. The changes of blood flow velocity in bilateral vertebral artery and basilar artery were observed through transcranial doppler sonography （TCD） before treatment, after deqi with acupuncture and after a course of treatment, respectively. The scores and therapeutic efficacy on clinical symptoms were assessed according to CV symptoms and the functional assessment scale as well as the Criteria-for Diagnosis and Curative Effect in TCM Syndromes before treatment and after a course of treatment. Results Before treatment, after deqi and after a course of treatment, the blood flow velocity of basilar artery （BA）, left vertebral artery （LVA） and right vertebral artery （RVA） in 22 patients with a decreased blood flow velocity were respectively 23.20±4.84 vs 26.30 ± 4.17 vs 29.20 ± 4.20 （mm/s, BA）, 21.65 ± 3.62 vs 24.20 ± 2.89 vs 26.40 ± 3.62 （mm/s, LVA） and 21.90±3.04 vs 24.25±3.01 vs 26.50_±3.95 （mm/s, RVA）, while in 18 patients with an increased blood flow velocity were respectively 39.94 ± 8.24 vs 35.17 ± 4.84 vs 32.06 ± 3.49 （mm/s, BA）, 41.83 ± 5.64 vs 37.28 ± 2.32 vs 35.61 ± 2.09 （mm/s, LVA） and 37.11 ± 9.83 vs 32.22 ± 6.13 vs 28.11 ± 4.12 （mm/s, RVA）. Except that the difference of blood flow velocity of RVA was not significant in patients with an increased blood flow velocity before treatment and after deqi （P 〉 0.05）, the Vm of all vessels in 40 patients was improved after deqi with acupuncture and a course of treatment （P〈0.01, P〈0.05）. According to CV symptoms and the functional assessment scale, before treatment and after a course of treatment, the scores were 15.68 ± 5.35 and 26.30 ± 3.76, respectively, indicating that after a course of treatment, the symptoms were significantly improved （P 〈 0.01）. According to the Criteria for Diagnosis and Curative E.f]ect in TCM Syndromes, after a course of treatment, the total effective rate was 100% （40/40） and the cured rate was 55.0% （22/40）. Conclusion Acupuncture at LU 7 not only improves the blood supply of vertebral-basilar artery in CV patients, but also has a significant curative effect on improving the clinical symptoms.

Primary study on imaging in transient ischemic attacks

Background Although transient ischemic attacks （TIA） is a clinical diagnosis, imaging findings are important for its diagnosis and treatment. This study evaluated the value and limitations of conventional CT, CT cerebral perfusion imaging and transcranial Doppler sonography （TCD） in patients with TIA. Methods Conventional CT, CT cerebral perfusion imaging and TCD were performed in 20 patients with TIA. After regular CT examination, d-0-second dynamic scans were performed on selected slice, while 40 ml of nonionic contrast materials was bolus-injected through antecubital vein with power injector. These dynamic images were processed with the perfusion software package on workstation. Cerebral blood flow （CBF） and time to peak （3~FP） were measured in specific regions of the brain. TCD was also performed in 20 patients with TIA. Comparative analysis was made on the basis of the results of conventional CT, CT cerebral perfusion imaging and TCD.Results In the 20 patients with TIA, conventional CT turned out to be normal. However, persisting abnormal perfusion changes corresponding to clinical symptoms were found in 13 cases with the prolonged TFP. The other 7 cases were normal. TFP of the affected side （ 11.6 ± 3.0） s was significantly prolonged （ t =4. 782 ,P 〈0. 01 ） in comparison with the contralateral side （8.8 ± 1.5 ） s. The difference in CBF was not statistically significant （t = 1. 912, P =0. 073） between the affected side [ （223.9 ±19.6） ml ·min^-1 ·L^-1 ] and the contralateral side [ （227.7 ± 19. 8） ml · min^-1· L^-1 ] . TCD revealed severe stenosis or occlusion of the carotid artery in 10 patients, arteriosclerosis in 6 patients, blood speed decrease in 2 patients, vasospasm in 1 patient. Conclusions Conventional CT can exclude intracerebral diseases. Perfusion CT provides valuable hemodynamic information and shows the extent of perfusion disturbances. TCD can demonstrate abnormalities of the involved arteries in patients with TIA. The combination of these three imaging methods can provide more diagnostic information.

The value of ultrasound elastography in differential diagnosisof superficial lymph nodes

The study evaluated the value of ultrasound elastography in differentiating the benign and malignant superficial lymph nodes.A total of 112 subjects,including 82 patients with enlarged lymph nodes and 30 healthy volunteers,were recruited.All the subjects were examined by B-mode ultrasonography,power Doppler ultrasonogra-phy and elastography.Most of the patients were histo-pathologically confirmed by needle aspiration cytology and some patients were diagnosed by clinical data combined with follow-upfindings.The sensitivity,speci-ficity and accuracy of B-mode ultrasonography were 59.8%,76.5%and 67.1%,those of the bloodflow classification by power Doppler ultrasonography 77.0%,82.3%and 79.4%and those of elastographic classification 74.7%,97.1%and 84.5%,respectively.The elasticity of the lymph nodes was quantitatively measured and defined as stiffness value.When the stiffness value of 2.395 was taken as the cutoff point,the sensitivity and specificity of elastography were 78.41%and 98.51%,and the Youden index reached the highest,with the value being 0.7692.The stiffness values of two indeterminate benign lymph nodes,the elastrographicfindings of which were rated as patterns 2 and 3,were below the cutoff point.The elastographicfindings of 10 malignant lymph nodes were also classified as pattern 2 or 3.Only one of them had the stiffness values below the cutoff point.It was concluded that ultrasound elastography is a novel,noninvasive and convenient tool for the differentiation of the nature of the superficial lymph nodes in clinical practice.