DIAGNOSTICA CON APPARECCHIAD ULTRASUONI

ECOCOLORDOPPLER, POWERDOPPLER ED ANGOLO DI INCIDENZA

D. Righi

DIAGNOSTICA CON APPARECCHIAD ULTRASUONI

ECOCOLORDOPPLER, POWERDOPPLER ED ANGOLO DI INCIDENZA

D. Righi

BERTINORO, 28-31 MARZO 20075° CORSO NAZIONALE CONGIUNTO

ULTRASONOLOGIA VASCOLAREDIAGNOSI E TERAPIA

BERTINORO, 28-31 MARZO 20075° CORSO NAZIONALE CONGIUNTO

ULTRASONOLOGIA VASCOLAREDIAGNOSI E TERAPIA

PER VALUTARE IL GRADO DI STENOSI DEVOCONOSCERE LA VELOCITA’ DEL SANGUE

PER VALUTARE LA VELOCITA’ DEL SANGUEDEVO CONOSCERE L’ ANGOLO

TRA IL FASCIO ULTRASONORO ED IL FLUSSO

L’ angolo di insonazione è l’ angolo tra il trasduttore (la sonda) e le strutture da esplorare, nel nostro caso i vasi.

Influenza la maniera in cui i vasi in esplorazione sono visualizzati.

La correzione d’ angolo è necessario per avere una valutazione corretta delle velocità misurate con il doppler pulsato.

Non si rende necessaria solo quando il vaso è a zero gradi rispetto al cursore ed alla linea guida.

Doppler in ObstetricsCopyright © 2002 by Kypros Nicolaides, Giuseppe Rizzo, Kurt Hecker and Renato Ximenes

PER VALUTARE IL GRADO DI STENOSI POSSOVARIARE LA DIREZIONE DEL FASCIO DI ULTRASUONI

UTILIZZANDO I COMANDI DELLA MACCHINAO MUOVENDO LA SONDA

MA LA RETTA PARALLELA AL FLUSSOE’ UNA ED UNA SOLA

ED UNO ED UNO SOLO E’ QUINDI L’ ANGOLOTRA IL FASCIO ULTRASONORO ED IL FLUSSO

Doppler in ObstetricsCopyright © 2002 by Kypros Nicolaides, Giuseppe Rizzo, Kurt Hecker and Renato Ximenes

90° - 61° = ERRATO 60° = OTTIMALE 59° - 1°= GIUSTO

ANGOLO:NELL’ ESECUZIONE DI UN ESAMEDOPPLER PW MEDIANTE DUPLEX

CONVIENE MANTENERLO TRA 45° E 60°NON SUPERARE MAI I 60°

The results of the study were published in the Journal of Vascular Surgery (“JVS”).in an article entitled, “Reliability of Extracranial Carotid Artery Duplex Ultrasound Examinations: Value of Vascular Laboratory Accreditation,” authored by O. William Brown, M.D., et.al.The objective of the study reported in this article was to evaluate the reliability of carotid duplex ultrasound testing performed by unaccredited vascular laboratories and to assess the clinical impact on patient management. The study found that of the 174 patients referred for surgical evaluation for carotid endarterectomy, 88 patients (51%) were found to have less than the 60% percent or higher stenosis that had been diagnosed by unaccredited vascular laboratories. The overestimation of stenosis by the unaccredited laboratory was attributed to technical errors (19 arteries), use of B-mode image data alone without the use of velocity criteria for confirmation of the lesion (36 arteries), and use of inappropriate velocity criteria (49 arteries). Because of the study, more than half of all patients who participated in this sub-group were spared the risks of an unnecessary surgery to "correct" a condition that did not exist.

Correlating data in all patients with a subsequent evaluation (angiography, MRA, or surgery) supported the findings of the accredited laboratories.

国外对于血管狭窄的判断标准报道不一，通常采用收缩峰值流速（ PSV ）、舒张末期流速（ EDV ）、颈内动脉／颈总动脉峰值流速比值（ PSVica ／ PSVcca ）、 PSV1 ／ PSV2 （狭窄段 1 ／狭窄远段 2 ）的比值。 Aburahma 等提出， ICA 狭窄 ≥ 70 ％的标准为： (1) ICA 的 PSV ≥ 195 cm ／ s ，敏感性为 98 ％，特异性为 75 ％，准确率为 87 ％；（ 2 ） EDV≥ 97 ． 5cm ／ s ，敏感性为 82% ，特异性为 96% ，准确率为 89% ；（ 3 ） PSV 为 185 cm ／ s ， EDV 为 75 cm ／ s ， PSVica ／ PSVcca≥2.7 ，敏感性为 82 ％，特异性为 96 ％，准确率为 89 ％。国内对诊断颈动脉狭窄≥ 70 ％的标准很少报道，我们的临床检测结果表明，采用综合的判断标准，即 PSV ＞ 170 cm ／ s 、 EDV ＞ 100 cm ／ s 和 PSV1 ／ PSV2 ＞ 4:1 ，并与 TCD 检测相结合，诊断结果与脑血管造影比较，诊断准确率为 99 ％。

国外对于血管狭窄的判断标准报道不一，通常采用收缩峰值流速（ PSV ）、舒张末期流速（ EDV ）、颈内动脉／颈总动脉峰值流速比值（ PSVica ／ PSVcca ）、 PSV1 ／ PSV2 （狭窄段 1 ／狭窄远段 2 ）的比值。 Aburahma 等提出， ICA狭窄 ≥ 70 ％的标准为： (1) ICA 的 PSV ≥ 195 cm ／ s ，敏感性为 98 ％，特异性为 75 ％，准确率为 87 ％；（ 2 ） EDV≥ 97 ． 5cm ／ s ，敏感性为 82% ，特异性为 96% ，准确率为 89% ；（ 3 ） PSV 为 185 cm ／s ， EDV 为 75 cm ／ s ， PSVica ／ PSVcca≥2.7 ，敏感性为 82 ％，特异性为 96 ％，准确率为 89 ％。国内对诊断颈动脉狭窄≥ 70 ％的标准很少报道，我们的临床检测结果表明，采用综合的判断标准，即 PSV ＞ 170 cm ／ s 、 EDV ＞100 cm ／ s 和 PSV1 ／ PSV2 ＞ 4:1 ，并与 TCD 检测相结合，诊断结果与脑血管造影比较，诊断准确率为 99 ％。

Doppler Velocity Criteria Based on Receiver Operating Characteristic Analysis for the Detection of Threshold Carotid Stenoses

Chi-Shin Hwang, MD Wen-Yi Shau, MD, PhD Charles H. Tegeler, MD

Journal of Neuroimaging Vol 12 No 2 April 2002

MEDIA: 210 cm/secMEDIA: 210 cm/sec

-POWER-POWER DOPPLER-POWER MAP-AMPLITUDE MAP-DOPPLER POWER MODE-COLOR ANGIOGRAPHY

IL COLORE DI UN PIXEL SI RIFERISCE NON ALLA FREQUENZA

MEDIA DEL SEGNALE DOPPLER OTTENUTO DA QUELLA PARTE

DELL’ IMMAGINE, MA ALLA SUA AMPIEZZA O POWER.

VIENE RAPPRESENTATO CONUN SOLO COLORE OMOGENEO.

VANTAGGI:- OTTIMO RAPPORTO SEGNALE / RUMORE- SCARSA DIPENDENZA DALL’ ANGOLO- NIENTE ALIASING

SVANTAGGI:- MANCA INFORMAZIONE SU DIREZIONE DI FLUSSO- PIU’ SENSIBILE AL MOTO DEI TESSUTI

- As the As the Power modePower mode is more sensitive than Color mode, it is used to assess the vascular system is more sensitive than Color mode, it is used to assess the vascular system of tissues and organs, especially in places with of tissues and organs, especially in places with slow or weak flow.slow or weak flow.

- Directional Power or VeloPowerDirectional Power or VeloPower combines the PD sensitivity to slow flows, with an option for combines the PD sensitivity to slow flows, with an option for - detecting the flow direction.detecting the flow direction. As the power of the reflected signal is independent of its direction, As the power of the reflected signal is independent of its direction, - Power is less sensitive to Doppler angle and therefore offers an increased sensitivity in the Power is less sensitive to Doppler angle and therefore offers an increased sensitivity in the - detection of low flow.detection of low flow.

- Power ModePower Mode VeloPowerVeloPower

Power and VeloPowerPower and VeloPower

Ultraschall Med 1999 Aug;20(4):137-43

[Area reduction in carotid stenosis of the internal carotid artery].

Lyrer P, Bont A, Marugg A, Operschall C, Radu EW

Neurologische Universitatsklinik, Abteilung zerebrale Ultraschalldiagnostik,Basel.

In 58 patients who suffered from 60 moderate to severe ICA stenoses, B-mode sonography combined with CDE -coded duplex sonography was applied to measure the extent of the stenosis by determining the residual lumen width.

CONCLUSIONS: Determination of the degree of stenosis based on CDE alone is not reliable enough to allow orrect diagnosis of severe carotid artery stenosis.

Purdue University • Department of Animal Sciences • Lilly Hall