Bartels Eva
Department of Clinical Neurophysiology, Georg-August-University Göttingen, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany.
J Ultrasound Med. 2005 Nov;24(11):1511-7. doi: 10.7863/jum.2005.24.11.1511.
The clinical value of transcranial color-coded duplex sonography (TCCS) in the evaluation of arteriovenous malformations (AVMs) has not yet been fully investigated. In this study, 54 intracranial AVMs confirmed by angiography were prospectively examined over 6 years. The purpose of the study was to describe their typical sonographic features and to define sensitivity for diagnosis with regard to the location of an AVM.
Transcranial color-coded duplex sonographic findings for 54 patients with intracranial AVMs are presented. The vessels of the circle of Willis were identified by location, course, and direction of flow on color flow images.
In accordance with digital subtraction angiography, the intracranial AVMs could be visualized in 42 cases (sensitivity, 77.8%). The pathologic vessels were coded in different shades of blue and red, corresponding to varying blood flow directions in the AVM. The major feeding vessels could be easily identified. Hemodynamic parameters showing increased systolic and diastolic flow velocities and a decreased pulsatility index were better attainable with TCCS than with conventional transcranial Doppler sonography. Arteriovenus malformations located near the cortex, that is, in the parietal, frontal, occipital, and cerebellar regions of the brain, could not be visualized. In contrast, AVMs located in the basal regions were very easy to image (sensitivity, 88.9%). Additionally, TCCS proved useful for follow-up examinations postoperatively or after embolization.
Transcranial color-coded duplex sonography is a valuable noninvasive method for the diagnosis and long-term follow-up of intracranial AVMs. Arteriovenous malformations located in the axial imaging plane can be more easily detected. Nevertheless, TCCS should not be used as a screening method.
经颅彩色编码双功能超声（TCCS）在评估动静脉畸形（AVM）中的临床价值尚未得到充分研究。在本研究中，对6年间经血管造影证实的54例颅内AVM进行了前瞻性检查。本研究的目的是描述其典型的超声特征，并确定AVM位置的诊断敏感性。
呈现了54例颅内AVM患者的经颅彩色编码双功能超声检查结果。通过彩色血流图像上血管的位置、走行和血流方向来识别 Willis 环的血管。
与数字减影血管造影一致，42例（敏感性77.8%）颅内AVM可被可视化。病变血管以不同深浅的蓝色和红色编码，对应于AVM中不同的血流方向。主要供血血管易于识别。与传统经颅多普勒超声相比，TCCS能更好地获取显示收缩期和舒张期血流速度增加以及搏动指数降低的血流动力学参数。位于皮质附近，即大脑顶叶、额叶、枕叶和小脑区域的动静脉畸形无法被可视化。相比之下，位于基底区域的AVM非常容易成像（敏感性88.9%）。此外，TCCS被证明对术后或栓塞后的随访检查有用。
经颅彩色编码双功能超声是一种用于颅内AVM诊断和长期随访的有价值的非侵入性方法。位于轴向成像平面的动静脉畸形更容易被检测到。然而，TCCS不应作为一种筛查方法。
