經顳穿顱彩色都卜勒超音波檢查技術使用於成人

Transcranial Color Doppler Ultrasonography in Adults: Transtemporal Approach

王安中(An-Chueng Wang) ； 林裕祥(Yu-Hsiang Lin) ； 王信凱(Hsin-Kai Wang) ； 丘思穎(See-Ying Chiou) ； 魏聰文(Jsong-Wen Wei) ； 邱宏仁(Hong-Jen Chiou) ； 周宜宏(Yi-Hong Chou)

《中華放射線技術學雜誌》 33卷2期 (2009/12) Pp. 79-84

https://doi.org/10.30045/CJRT.200912.0002

摘要

經顳穿顱彩色都卜勒超音波檢查，因為具有安全、經濟、方便、易於取得、非侵入性和無放射線等特性，所以常被優先考慮用來評估臨床顱內血管與血流狀況的工具。但此項檢查需有適當的儀器及充分的技術與經驗，才能得到具有診斷性的檢查品質。本次研究收集127位受檢者（104位男性：23位女性），平均年齡74.1歲，利用彩色都卜勒定位，再以頻譜都卜勒測量其結果。針對這些受檢者中，一年內曾做過電腦斷層79位受檢者進行資料收集與分析，發現中大腦動脈(middle cerebral artery, MCA)位置約在耳洞前2.7公分與上2.5公分處，進行Pearson相關係數分析發現，男性與女性受檢者其成功率有顯著差異（P值＜0.005）；鱗狀骨之厚度對檢查成功與否亦有顯著的差異（P值＜0.005）。至於超音波無法穿透頭顱顳部鱗狀骨之厚度，以電腦斷層作鱗狀骨厚度量測，骨厚度採用軟組織視窗(soft tissue window)測量約為5.6mm，另採用骨視窗(bone window)測量則約為3.3mm，此可作為選擇良好音窗之參考。此外其他條件因素如：適當的血流靈敏度調節、血管位置與血流方向及測量位置等，皆有助於檢查成功之條件。

關鍵字

經顳穿顱彩色都卜勒 ； 頻譜都卜勒 ； 電腦斷層檢查

並列摘要

The advantages of ultrasonography (US) include convenience, safety, availability, cost-benefit, non-invasive, and non-radiation. Although transcranial color Doppler (TCD) examination is generally accepted as a useful imaging tool for diagnosis and assessment of intracranial vascular diseases, its diagnostic efficacy is highly machine-dependent and operator-dependent. Adequate scanning technique and experiences of the scanner reinforce the diagnostic performance of TCD examination. In this study, we enrolled 127 patients (104 males, 23 females, mean age = 74.1±13 years) to perform TCD examination. Color Doppler flow mapping was utilized for localization of the circle of Willis. Spectral Doppler was then applied to examine the flow direction, velocity, and resistive index (RI) of the vessels. Among 127 patients, 79 had received CT scan of brain within one year. We measured the distance between external acoustic meatus (EAM) and middle cerebral artery (MCA) on CT images. The results showed that the average distance between EAM and MCA was 2.7 cm anterior and 2.5 cm superior to EAM. We then measured the thickness of the temporal bone (at the level of MCA in circle of Willis) by measuring the distance between inner and outer tables of the temporal bone on the axial images of CT scan. The average thickness of temporal bone in patients fail to obtain satisfactory TCD images was 5.6mm in soft tissue window; 3.3 mm in bone window. In pearson correlation analysis, We found that the success rate to demonstrate circle of Willis is significantly influenced by the thickness of squamous bone (p＜0.005) and the success rate in male and female patients is also significantly different (p＜0.005). Our results might be useful in searching for optimal acoustic window at TCD examination. In conclusion, the success rate of TCD examination relied on following factors: Firstly, understanding of normal intracranial vascular anatomy; Secondly, adjustment of color Doppler imaging parameters (i.e. adjustment of low pulse repetition frequency and high color gain to increase color flow sensitivity); Finally, selection of proper site for interrogation of vessels at color Doppler and spectral Doppler studies.

並列關鍵字

Transcranial color Doppler TCD ； Spectral Doppler ； Computed Tomography