Puls I, Hauck K, Demuth K, Horowski A, Schliesser M, Dörfler P, Scheel P, Toyka K V, Reiners K, Schöning M, Becker G
Department of Neurology, Bayerische Julius-Maximilians-Universität, Würzburg, Germany.
Stroke. 1999 Nov;30(11):2291-5. doi: 10.1161/01.str.30.11.2291.
The diagnosis and quantification of microangiopathy in dementia is difficult. The assessment of small-vessel disease requires expensive and sophisticated nuclear medicine techniques. This study was performed to identify microangiopathy related to the integrity of cerebral microcirculation by sonographic measurements (arteriovenous cerebral transit time [cTT]).
We performed transcranial color-coded duplex sonography in 40 patients with vascular dementia, 20 patients with Alzheimer's disease or Lewy body disease, and 25 age-matched controls. The clinical diagnosis was established by history of dementia and neuroimaging findings. Cognitive impairment was assessed by the Mini-Mental State Examination and Alzheimer's Disease Assessment Scale. cTT is defined as the time required by an ultrasound contrast agent to pass from a cerebral artery to a vein. This was measured by recording the power-Doppler intensity curves in the P2 segment of the posterior cerebral artery and the vein of Galen. Previous studies have shown a prolongation of cTT in patients with cerebral microangiopathy.
cTT was substantially prolonged in patients with vascular dementia (5.8 seconds; 25th percentile 4.5; 75th percentile 7.5; U test, P<0.001) compared with controls (3.1 seconds; 2.3; 3.4) but not in patients with degenerative dementia (3.7 seconds; 3.7; 4.2). In patients with vascular dementia, cTT was significantly correlated with cognitive impairment.
cTT may be useful tool to disclose small-vessel disease in demented patients. Examination is noninvasive and quickly performed. It may be also useful in follow-up examinations in patients undergoing therapy.
痴呆症中微血管病变的诊断和量化颇具难度。小血管疾病的评估需要昂贵且复杂的核医学技术。本研究旨在通过超声测量（脑动静脉传输时间[cTT]）来识别与脑微循环完整性相关的微血管病变。
我们对40例血管性痴呆患者、20例阿尔茨海默病或路易体病患者以及25例年龄匹配的对照者进行了经颅彩色编码双功超声检查。临床诊断依据痴呆病史和神经影像学检查结果确定。认知障碍通过简易精神状态检查和阿尔茨海默病评估量表进行评估。cTT定义为超声造影剂从脑动脉到静脉所需的时间。这通过记录大脑后动脉P2段和大脑大静脉的功率多普勒强度曲线来测量。先前的研究表明，脑微血管病变患者的cTT会延长。
与对照组（3.1秒；第25百分位数2.3；第75百分位数3.4）相比，血管性痴呆患者的cTT显著延长（5.8秒；第25百分位数4.5；第75百分位数7.5；U检验，P<0.001），而退行性痴呆患者则不然（3.7秒；3.7；4.2）。在血管性痴呆患者中，cTT与认知障碍显著相关。
cTT可能是揭示痴呆患者小血管疾病的有用工具。该检查无创且操作迅速。它在接受治疗患者的随访检查中可能也很有用。
