腔内凸阵超声探头检测颈动脉参数的初步研究

1、腔内凸阵超声探头检测颈动脉参数的初步研究        【中文摘要】1、腔内凸阵超声探头检测颈动脉参数的初步研究目的和意义北美有症状颈动脉内膜剥脱试验(The North American Symptomatic CarotidEndarterectomy Trial NASCET)和欧洲颈动脉手术试验(European Carotid SurgeryTrial,ECST)研究结果显示,当颈动脉狭窄程度超过50%时要密切观察病情变化,当狭窄程度超过70%时要及时手术或参与治疗,治疗后可大幅降低脑梗死的发生率。这一结

2、果引发国内外医学界重新研究颈动脉的*。数字减影血管造影术(digital substraction angiography,DSA)虽被公以为诊断血管病变的金标准,但其有创,价格昂贵,病人常不愿接受,人们一直在寻找有效的替换检查方法。高频超声被以为是首选的替换检查方法,也是目前颈动脉检查最常用的方法,其优点是简便无创、重复性好、并具有较高的正确性,但也存在一定的局限性:受声波穿透力及下颌骨对声束的影响,高频线阵探头(high frequencylinear-array probe,HFLP)对颈内动脉中远段的检测常欠满足,尤其是当病人肥胖、颈部粗短或动脉分叉位置较高时,颈内动脉的显示更为困难,

3、这类病人在临床并不少见。针对这一情况,有学者建议采用腹部低频凸阵探头(low frequencyconvex array probe,LFCP)检查颈内动脉。但我们在实际操纵过程中也留意到腹部低频凸阵探头虽可增大颈内动脉的显示长度,并可获得良好彩色血流及血流频谱图,但也存在二维图像分辨率低、彩色血流信号外溢等缺点;当颈内动脉细小及血流速度较低时,常难以显示并有可能被颈内静脉血流掩盖而无法分辨的可能。国外有学者报道用腔内凸阵探头经口腔途径扫查颈动脉的方法,可获得极佳的颈内动脉中远段二维及彩色血流图像。其原因可能是探头频率高、图像分辨率高的缘故,但也存在对咽喉部有强刺激,病人难以接受及探头消毒困难

4、等缺点。受此研究启发,本研究将腔内凸阵探头置于颈部,从体外途径扫查颈总及颈内动脉,利用其探头频率高、图像分辨力高的优点,同时又避开高频线阵探头声束穿透力弱、腹部低频凸阵探头图像分辨力差及经口腔途径对咽喉部有强刺激等诸多缺点,探讨腔内凸阵探头体外途径检查颈动脉的可行性,有关这方面的研究尚未见有文献报道。材料和方法1)研究对象:选取2007年6月2009年2月来我科行颈动脉检查的43例患者86支颈动脉。其中男21例,女22例,年龄3265岁,均匀49.4±11.3岁;受试者身体健康,无心、脑血管病史,无高血压、糖尿病史。高频线阵探头扫查颈总动脉内-中膜厚度(intimae-medial

5、thickness,IMT)1.0mm者排除进选。每支颈动脉均作为一个独立的研究对象。2)仪器:使用PhilipsIU-22彩色多普勒超声诊断仪,探头型号C52(频率2.05.0MHz)低频凸阵探头:在血管条件下探查;L93(频率3.09.0MHz)腔内凸阵探头;L125(频率5.012.0MHz)高频线阵探头颈动脉条件下探查。图像深度根据需要及时调整。3)检查方法:所有受试者均取仰卧位,颈后垫薄枕,头后仰,充分暴露颈部,检测左侧颈动脉时让患者头偏向右侧,检测右侧颈动脉时让患者头偏向左侧。所测参数包括颈总动脉IMT;颈内动脉显示长度、舒张末期血流速度(end-diastolicvelocity

6、,EDV)、阻力指数(resistent index,RI);颈总动脉和颈内动脉收缩期峰值血流速度(peak systolic velocity,PSV),内径,及观察颈内动脉形态。丈量颈总动脉内径与颈总动脉内中膜厚度取颈动脉长轴切面,于颈内动脉与颈外动脉分叉以下1.0cm处丈量。丈量颈总动脉血流速度时避开壶腹部等有涡流处,在平直处丈量,且保证声束与血流的夹角小于60°。所有受试者左、右颈动脉均用三种不同频率超声探头进行检测,以上所有操纵均由同一名技术熟练的超声医师完成。4)统计学处理:所有丈量数据用(?)±s表示。颈内动脉、颈外动脉内径、峰值血流速度等参数以单因素重复丈量

7、方差分析法分析,比较三种方法所测各项参数之间有无统计学差异;颈总动脉内中膜厚度及颈内动脉显示长度参数用单向方差分析法比较,P0.05表示差异有统计学意义。所用统计学软件为SPSS13.0。结果1)3种不同频率超声探头所测43例患者86支颈动脉PSV值比较:高频线阵探头、低频凸阵探头与腔内凸阵探头分别于颈总动脉、颈内动脉内录得血流频谱,颈内动脉与颈总动脉PSV比较(P0.05,P=0.000),有统计学差异,且颈总动脉PSV高于颈内动脉。组间比较,颈总动脉PSV值3种方法测值之间比较无统计学差异(P0.05,P=0.087)。颈内动脉PSV值三者之间比较有统计学差异(P0.05,P=0.021)

8、比较,高频线阵探头与低频凸阵探头、高频线阵探头与腔内凸阵探头测值之间有统计学差异(P0.05,P=0.037),低频凸阵探头与腔内凸阵探头测值比较无统计学差异(P0.05,P=0.074)。2)3种不同频率超声探头所测43例患者86支颈内动脉EDV和RI比较:颈内动脉EDV高频与低频探头测值比较有统计学差异(P0.05,P=0.010),低频探头与腔内探头测值比较差异无统计学意义(P0.05)。颈内动脉血流RI高频与低频、高频与腔内测值比较有统计学意义(P0.001),低频探头与腔内探头比较差异无统计学意义(P0.05,P=0.221)3)3种不同频率超声探头所测43例患者86支颈总动脉、颈内

9、动脉内径比较:3种方法测得的颈总动脉内径与颈内动脉内径比较P0.001,差异有统计学意义,且颈总动脉内径大于颈内动脉内径;颈总动脉内径3种方法测值两两比较(均P0.05)、颈内动脉内径3种方法测值两两比较(均P0.05),无统计学差异。4)3种不同频率超声探头所测43例患者86支颈内动脉显示长度及颈总动脉的内-中膜厚度(IMT)比较:颈总动脉IMT及内径于颈总动脉长轴切面,同一在颈内动脉与颈外动脉分叉以下1.0cm处丈量,高频线阵探头、低频凸阵探头与腔内凸阵探头丈量43例86支颈总动脉IMT分别为0.087±0.034cm、0.088±0.031cm和0.087±

10、0.032cm,用LSD法比较,三者之间比较P0.05,(高频与低频比较P=0.945;高频与腔内探头比较P=0.722;低频与腔内探头比较P=0.671),差异无统计学意义。二维图像及彩色多普勒观察43例患者86支颈内动脉的显示长度,高频线阵探头在颈动脉模式下检测颈内动脉的显示长度为2.13±0.62cm,低频凸阵探头在腹部血管模式下检测到的颈内动脉的显示长度为4.42±0.86cm,腔内凸阵探头在腹部血管模式下检测到的颈内动脉的显示长度为3.44±0.73cm,通过One-Way ANOVA法分析,由于不满足方差齐性(P=0.021),以Tambane'

11、;sT2法比较,三者之间两两比较P0.001,差异有统计学意义,说明超声检测颈内动脉病变的显示长度低频优于高频线阵探头与腔内凸阵探头,而腔内凸阵探头优于高频线阵探头。5)颈内动脉形态的观察在86支颈内动脉中,高频、低频和腔内探头观察颈内动脉走形,异常形态血管(迂曲血管可呈多种形态如“V”、“S”等)分别为7支、19支、17支,经比较腔内探头与低频探头之间无统计学差异(P0.05,P=0.141),腔内探头与高频探头之间有统计学差异(P0.05,P=0.028)。结论腔内凸阵探头应用于颈动脉的探查,由于受探头角度及分辨率的影响较小,能够明显增加颈内动脉显示长度,进步颈内动脉血流参数检测的正确性,

12、对颈内动脉中远段的检测具有较高的价值,可作为诊断颈内动脉病变的重要影像检查手段。2、腔内凸阵探头检测颈动脉狭窄病变的应用价值探讨:目的和意义颈动脉病变与脑组织血供有密切关系,正确判定颈动脉病变对选择治疗方案有重要参考价值,可以有效预防或减少脑血管突发事件。高频超声是颈动脉病变最常用的检测方法,甚至仅凭超声检查结果就可决定治疗方式的选择,但高频线阵探头对颈内动脉中远段病变的检测仍有一定局限性,特别当颈动脉分叉位置较高、颈部短粗、体形肥胖或血管位置较深时,为解决这一题目,本研究探讨腔内凸阵探头在颈内动脉疾病检测中的应用价值。资料和方法1)临床资料:2007年6月2009年2月来我科行颈动脉检查的3

13、5例患者70支颈动脉,男16例,女19例,年龄3280岁,均匀60.2±12.1岁,经DSA检查证实14例颈动脉有狭窄存在(单侧),狭窄程度在7099%之间;另21例经DSA或超声检查颈动脉无明显狭窄。2)仪器与方法:用飞利蒲IU22型彩色多普勒超声,高频线阵探头为L12-5,频率5-12MHz;腔内探头为L9-3,频率3-9MHz(图1)。检查时肩部垫薄枕,头后仰,充分暴露颈部,检查一侧时头偏向对侧。先用高频线阵探头进行扫查,然后用腔内凸阵探头重复扫查。探头沿血管走行进行纵、横扫查,观察颈内动脉管径、内膜回声、斑块大小、彩色血流状况及频谱形态。丈量颈内动脉显示长度、收缩期峰值血流速

14、度(Peak systolic velocity,PSV),狭窄患者还丈量PSVICA/PSVCCA比值。每一位患者操纵均由同一名技术熟练的超声科医师完成,多普勒血流检测角度60°。3)统计分析用SPSS13.0统计分析软件包对数据经进行处理,计数资料用均数±标准差的形式表示,成对数据间的比较选择配对t检验;计量资料比较选择x2检验,均以P0.05表示差异具有统计学意义。结果70支颈内动脉高频线阵探头检测其显示长度为2.05±0.35cm,PSV为89.8±20.9cm/s;腔内凸阵探头检测显示长度为4.41±0.32cm,PSV值为116.8

15、±35.1cm/s,两组测值比较差异均具有统计学意义(P0.05)。20支颈内动脉高频线探头检测困难者,腔内凸阵探头均获得满足二维、彩色血流及频谱图。腔内凸阵探头检出15支颈内动脉走行迂曲呈“V”或“S”等形态,而高频线阵探头仅检出9支异常血管形态。在14例DSA检查颈内动脉狭窄为7099%之间者,高频线阵探头评估狭窄程度的正确率为78.5%,而腔内凸阵探头的正确率为92.8%。结论腔内凸阵探头能明显增大颈内动脉显示长度,对颈内动脉中远段疾病的检测具有较大价值,可作为高频线阵探头检查困难者的有效补充手段。');【Abstract】 1.Preliminary studys o

16、n the carotid artery parameters Detected by Intracavitary Convex Array ProbePurpose and SignificanceFinal results of The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the MRC European Carotid Surgery Trial(ECST) displayed that carotid artery(CA) must be observed intimately whe

17、n stegnosis degree is higher than 50%and it must have an operation or interventional therapy in time when stegnosis degree is higher than 70%.Incidence of cerebral infarction can be decreased greatly by therapy.This results in more research about carotid artery made by scholars at home and abroad.Di

18、gital subtraction angiography(DSA) has been considered as a gold standard of CA diagnosis.However,It is not received widely for DSA because of its invasion and expensive price.High-frequency ultrasound is considerd as substitute check preferentially Because of its reproducibility,portability and acc

19、uracy.However, high-frequency ultrasound has some limitation because of its effect on acoustic wave' penetrating power and inferior maxilla.Especially,internal carotid artery(ICA) cann't be displayed clearly by high-frequency linear array probe when it is used to this patients with obesity,c

20、ervical part short and carotid furcation position is higher.These patients is considerable.Thus,some scholars suggested that abdomen low frequency convex array probe should be used to detect ICA.We observed that it can scale-up display length of ICA、obtained fine color flow image and frequency spect

21、rogram, but its 2-D image resolution ratio is lower and its color flow signal is color-spillover. When ICA blood flow is small and its velocity is slow,ICA blood flow signal is not displayed by abdomen low frequency convex array probe because of masking of internal jugular vein.Some scholars reporte

22、d that transoral intracavitary convex array probe can obtain excellent 2D image and color blood flow image of middle- distal segment ICA.This phenomenon is related possibly to high frequency and resolution of this probe.This method also has powerfully stimulative to throat and degermation difficultl

23、y of probe.Illuminated by this study,we detected CCA and ICA by putting this probe on cervical part in our study.Characteristic of this method is that it can get out of disadvantage of abdomen low frequency convex array probe in image resolution and high-frequency linear array probe in penetrating p

24、ower and transoral intracavitary convex array probe in throat stimulation.Our purpose is approach feasibility of this method.Recently,reports about this aspect isn't read.Materials and Methods1)Study objects:A trial was conducted in the department of ultrasound of Southern Hospital,Southern Medi

25、cal University,from January 2007 to February 2009.We choosed 86 carotid arteries of 43 patients.We excluded patients who had any follow conditions:(1) cerebral infarction,(2) aortosclerosis,(3) coronary heart disease,(4) doubtful transient ischemic attacks or carotid artery pathological changes.We i

26、ncluded(recruited) healthy subjects.All subjects were examined by three different frequency ultrasound probe.Each Carotid Artery is considered as a study objects.2)Equipment:The equipment used was PhilipsIU22 color Doppler ultrasound withL125(frequency512MHz),C52(frequency 25MHz) and L93 (frequency

27、3gMHz) probe.3)Detection method:All subjects were asked to be supine position,pad thin pillow,make head hypsokinesis,sufficiently expose cervical part.They were examined with intracavitary convex array probe,low frequency convex array probe and high-frequency linear probe respectively to collect fol

28、lowing data of CCA(common carotid artery) and ICA:ICA visible length,CCA intimae-medial thickness(IMT);CCA and ICA end-diastolic velocity(EDV),peak systolic velocity(PSV),internal diameter,resistent index(RI) color Doppler appearance et al.All operation were finished by same expert ultrasound doctor

29、.4)Statistical analysis:Data were expressed as mean±standard deviation.SPSS 13.0 software was used to analyze the data.The means comparison of IMT and ICAvisible length parameters above measureed by three different frequency ultrasound probe were evaluated statistically by One-Way ANOVA.Others

30、were evaluated statistically by repeated measurement ANOVA and Multiple comparison between means(LSD).The P value below 0.05 was considered statistically significant.Result1) peak systolic velocity(PSV) of ICA and CCA:PSV was recorded with High-frequency linear array probe,low-frequency convex array

31、 probe and intracavitary convex array probe,which were put on ICA and CCA.There was significant different on the peak velocity artery during systolic among three groups(P0.001),and the rate of blood flow in CCA was faster than that in ICA.From Inter-group comparison,there was significant difference

32、between High-frequency linear array probe and low-frequency convex array probe(P0.05, P=0.037),but there was no significant difference between high-frequency linear array probe and cavity convex array probe(P0.05,P = 0.074).2)EDV and RI of ICA:EDV of ICA detected with High-frequency linear array pro

33、be and low-frequency convex array probe has significant difference(P=0.010),there was significant difference between low-frequency convex array probe and intracavitary convex array probe(P0.000),but there was no significant difference between high-frequency linear array probe and intracavitary conve

34、x array probe(P0.05,P = 0.759).There was significant difference between low-frequency convex array probe and intracavitary convex array probe,between high-frequency linear array probe and cavity convex array probe(P0.001) in RI of ICA,but there was no significant difference between low-frequency con

35、vex array probe and intracavitary convex array probe(P0.05,P = 0.221);3)Visible length of ICA:Observating the length of 86 ICA in 43 patients by three different frequency probes through the 2-D image and color Doppler,there was significant difference among three groups(P0.001),which showed that the

36、low-frequency convex array probe was superior to the high-frequency linear array probe and intracavitary convex array probe,and intracavitary convex array probe was superior to high-frequency linear array probe.4) intimae-medial thickness(IMT) and internal diameter of CCA:Measuring the IMT of 86 CCA

37、 in 43 cases by three different frequency probes, there were no significant difference among three groups(P0.05,between low-frequency convex array probe and intracavitary convex array probe P=0.671; high-frequency linear array probe and intracavitary convex array probe P= 0.722;High-frequency linear

38、 array probe and low-frequency convex array probe P=0.945).Comparison to internal diameter of CCA measured by above-mentioned three modes,there was significant difference between high-frequency linear array probe and low-frequency convex array probe(P0.001),while there was no significant difference

39、between low-frequency convex array probe and intracavitary convex array probe(P0.05,P=0.163).5)2-D image and color-doppler flow signal:On both 2-D image resolution and color flow signal,high-frequency linear array probe was superior to low-frequency convex array probe and intracavitary convex array

40、probe in CCA,but in ICA, low-frequency probe was broader than the other two probe,because of low-frequency and low-resolution,two-dimensional image of low-frequency convex array probe was inferior to the other two probe.Meanwhile,low-frequency convex array probe showed color-spillover phenomenon,whi

41、le there were better color blood-flow signal in the other two probes.ConclusionVisible length of ICA was lengthened and accurace of ICA flow parameters was elevated which detected by intracavitary convex array probe.As a important image examination tool,intracavitary convex array probe has significa

42、nt value for detection of middle- distal segment of ICA.2.Value of intracavitary convex array probe in detecting internal carotid arterial diseasePurpose and SignificanceCarotid artery disease is related intimately to brain tissue' blood supply.There are reference value importantly to treatment

43、plan by exactly assessing carotid artery disease.Cerebral vessels incident can be decreased and prevented.High-frequency ultrasound is considered as a detection method used frequently.Treaty methods can be choosed only by sonography outcomes.However,high-frequency ultrasound has some limitation abou

44、t detection of middle-distal segment ICA.Especially,internal carotid artery(ICA) cann't be displayed clearly by high-frequency linear array probe when it used to this patients with obesity,cervical part short and carotid furcation position is higher.To solve this question,this study will approac

45、h value of intracavitary convex array probe in detecting internal carotid arterial disease.Materials and Methods1)Study subjects:A trial was conducted in the department of ultrasound of Southern Hospital,Southern Medical University,from January 2007 to February 2009.We choosed 70 carotid arteries of

46、 35 hospitalized patients,16men and 19women,all aged from 32 to 80.The mean age of the study population was 60.2±12.1 years old.14 subjects proved by DSA is carotid artery stenosis70%.Others is not obviously stenosis.All subjects were examined by three different frequency ultrasound probe.Each Carotid Artery is considered as a study objects.2)Methods:70 internal carotid arteries(ICA) of 35 cases were examined with intracavitary convex array probe and high-frequency linear probe respectively to collect following data:visible length,color Doppler ap