彩色多普勒超声在硬脑膜动静脉瘘诊断中的应用  

Clinical application of color Doppler ultrasonography in diagnosis of dural arteriovenous fistulas

作　　者：周晓彦[1] 段云友[1] 刘禧[1] 曹铁生[1] 

机构地区：[1]第四军医大学唐都医院超声诊断科,西安710038

出　　处：《中华超声影像学杂志》2005年第8期580-583,共4页Chinese Journal of Ultrasonography

摘　　要：目的探讨硬脑膜动静脉瘘(DAVF)的彩色多普勒血流显像(CDFI)表现,评价超声影像在DAVF诊断中的价值。方法应用CDFI观察13例DAVF瘘口部位,测量其范围、血流频谱,检测供血动脉、引流静脉及颅外动脉血流参数的变化,包括收缩期峰值流速(Vmax)、舒张末流速(Vmin)、平均流速(Vmean)、阻力指数(RI),并与全脑血管造影结果进行对比分析。结果①DAVF瘘口部位表现为异常不规则团状血流信号,呈多方向、不规则的湍流频谱,Vmax(105.6±32.9)cm/s,Vmin(72.0±22.9)cm/s,Vmean(87.0±26.0)cm/s,RI0.31±0.04;②DAVF瘘口部位的检出率为61.4%,横窦-乙状窦区DAVF检出率71.4%(5/7),海绵窦区DAVF全部检出;③供血动脉检出42支(72.4%),经横窦及眼上静脉的引流均检出,经上矢状窦及皮层静脉的引流均未能检出;④颈外动脉Vmin、Vmean增快,RI降低(P<0.05);枕动脉、颞浅动脉Vmax、Vmin、Vmean增快,RI降低(P<0.05)。结论CDFI可较好地显示横窦-乙状窦区及海绵窦区DAVF的瘘口部位,检出大部分颅内、颅外的供血动脉和引流静脉;通过对病变部位和颅外血管血流动力学改变的分析,CDFI有助于DAVF的诊断。Objective To present the manifestation of color Doppler flow imaging （CDFI） in dural arteriovenous fistulas （DAVF） and to evaluate the diagnostic value of CDFI in DAVF. Methods Thirteen patients with DAVF were studied by CDFI for their fistula position. The diseased area and spectral were detected. Hemodynamic parameters such as systole peak velocity（Vmax）, diastole end velocity （Vmin）, mean velocity （Vmean） and resistance index（RI） were measured in the feeding artery, draining vein and extracranial artery. All results were compared with that of cerebral angiography. Results ① The imaging of DAVF presented as heterogenous mosaic flashes at the fistula. The spectral were of multiple direction and irregular with Vmax （105.6± 32.9）cm/s, Vmin （72.0 ± 22.9） cm/s, Vmean （87.0 ± 26.0） cm/s and RI 0.31 ± 0.04. ②Totally eight cases （61.4%） were correctly identified by CDFI for their fistula position. Identification rate were 71.4% （5/7） for the DAVF of transverse-sigmoid sinus and 100% （3/3） for the DAVF of cavernous sinus. ③Feeding arteries detected by CDFI counted up to 42 branches （72.4%）. The venous drainage through transverse sinus and superior ophthalmic vein were all detected. However,venous through superior sagittal sinus and cortical vein could not be detected. ④Vmin,Vmean increased and RI decreased in external carotid artery （ P 〈0.05）; Vmax,Vmin,Vmean increased and RI decreased in occipital artery and superficial temporal artery （ P 〈0.05）. Conclusions Fistula of DAVF in transverse-sigmoid sinus and cavernous sinus could be well detected by CDFI. Most feeding arteries and draining veins can be identified by CDFI. With analyzing the position of lesion and change of hemodynamie parameters in extraeranial arteries, the diagnosis of DAVF can be proposed by CDFI.

关 键 词：彩色多普勒超声 硬脑膜动静脉瘘 超声诊断 血流动力学 血流速度 脑血管造影 

分 类 号：R743.3[医药卫生—神经病学与精神病学]