BERTINORO, 28-31 MARZO 2007
5° CORSO NAZIONALE CONGIUNTO
ULTRASONOLOGIA VASCOLARE
DIAGNOSI E TERAPIA
DIAGNOSTICA CON APPARECCHI
AD ULTRASUONI
ECOCOLORDOPPLER, POWERDOPPLER
ED ANGOLO DI INCIDENZA
D. Righi
PER VALUTARE IL GRADO DI STENOSI DEVO
CONOSCERE LA VELOCITA’ DEL SANGUE
PER VALUTARE LA VELOCITA’ DEL SANGUE
DEVO 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 Obstetrics
Copyright © 2002 by Kypros Nicolaides, Giuseppe Rizzo, Kurt Hecker and Renato Ximenes
PER VALUTARE IL GRADO DI STENOSI POSSO
VARIARE LA DIREZIONE DEL FASCIO DI ULTRASUONI
UTILIZZANDO I COMANDI DELLA MACCHINA
O MUOVENDO LA SONDA
MA LA RETTA PARALLELA AL FLUSSO
E’ UNA ED UNA SOLA
ED UNO ED UNO SOLO E’ QUINDI L’ ANGOLO
TRA IL FASCIO ULTRASONORO ED IL FLUSSO
Doppler in Obstetrics
Copyright © 2002 by Kypros Nicolaides, Giuseppe Rizzo, Kurt Hecker and Renato Ximenes
ANGOLO:
NELL’ ESECUZIONE DI UN ESAME
DOPPLER PW MEDIANTE DUPLEX
CONVIENE MANTENERLO TRA 45° E 60°
NON SUPERARE MAI I 60°
90° - 61° = ERRATO
60° = OTTIMALE
59° - 1°= GIUSTO
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 Bmode 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
(angiography, MRA, or surgery) supported
accredited laboratories.
subsequent evaluation
the findings of the
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
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
率为87％；（2）EDV≥
97．5cm／s，敏感性为
／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 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＞170 185
cm／s、EDV＞100
cm／s和PSV1 ／PSV2 ＞4:1，并与TCD检测相结
96%，准确率为 89%；（3）PSV为
cm／s，EDV为
75 cm／s
合，诊断结果与脑血管造影比较，诊断准确率为99％。
，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％。
MEDIA: 210 cm/sec
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
-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 CON
UN 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
Power and VeloPower
-
-
As the Power mode is more sensitive than Color mode, it is used to assess the vascular system
of tissues and organs, especially in places with slow or weak flow.
Directional Power or VeloPower combines the PD sensitivity to slow flows, with an option for
detecting the flow 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
detection of low flow.
Power Mode
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