Postert T, Braun B, Pfundtner N, Sprengelmeyer R, Meves S, Przuntek H, Büttner T
Department of Neurology, Ruhr-University Bochum, Germany.
Ultrasound Med Biol. 1998 Sep;24(7):953-62. doi: 10.1016/s0301-5629(98)00059-3.
The purpose of this study was to evaluate the potential of contrast-enhanced three-dimensional (3-D) power Doppler (CE3DPD) in the assessment of intracranial vascular structures, and to compare the results with unenhanced 3-D power Doppler (3DPD) and magnetic resonance angiography (MRA) findings. We insonated 25 patients without cerebrovascular diseases through the temporal bone window using 3DPD and CE3DPD; for comparison, 13 patients underwent MRA. Identification rates of vascular segments and of small branches of intracranial vessels were evaluated by two independent investigators blinded to MRA results. In 21 patients with adequate insonation conditions, CE3DPD significantly improved identification rates compared to 3DPD for the complete visualization of the P1 segment (80.9 vs. 19.0%, p < 0.005, P2 segment (80.9 vs. 42.8%, p < 0.05 and A1 segment (85.7 vs. 38.1%, p < 0.005). Furthermore, CE3DPD depicted, in significantly more examinations, branches of the middle (MCA) and posterior cerebral artery (PCA). Interobserver agreement was higher than 95% for the main intracranial segments and branches of the MCA, but relatively low (80.1-85.7%) for branches of the PCA. In comparison to CE3DPD, MRA identified only parieto-occipital branches of the PCA, temporal branches of the MCA, frontal branches of the anterior cerebral artery and the MCA bifurcation more frequently and accurately. In 4 patients with inadequate acoustic temporal bone windows, the application of a galactose-based microbubble suspension allowed clear 3-D visualization of almost all major intracranial vascular segments and some branches of the large arteries. In conclusion, CE3DPD is a more sensitive ultrasonic tool compared to unenhanced 3-D reconstructions. It makes 3-D ultrasound imaging of the basal cerebral circulation easier to perform and interpret, by providing an improved spatially oriented display of image position. As such, this method may increase operator diagnostic confidence level under pathologic conditions.
本研究的目的是评估对比增强三维（3-D）功率多普勒（CE3DPD）在评估颅内血管结构方面的潜力，并将结果与未增强的三维功率多普勒（3DPD）及磁共振血管造影（MRA）结果进行比较。我们使用3DPD和CE3DPD通过颞骨窗对25例无脑血管疾病的患者进行了超声检查；作为对照，13例患者接受了MRA检查。两名对MRA结果不知情的独立研究者评估了血管节段及颅内血管小分支的识别率。在21例具备充分超声检查条件的患者中，与3DPD相比，CE3DPD显著提高了P1段完整可视化的识别率（80.9%对19.0%，p<0.005）、P2段（80.9%对42.8%，p<0.05）以及A1段（85.7%对38.1%，p<0.005）。此外，CE3DPD在更多检查中显示出大脑中动脉（MCA）和大脑后动脉（PCA）的分支。对于MCA的主要颅内节段和分支，观察者间一致性高于95%，但对于PCA的分支相对较低（80.1 - 85.7%）。与CE3DPD相比，MRA仅更频繁且准确地识别出PCA的顶枕支、MCA的颞支、大脑前动脉的额支以及MCA分叉。在4例颞骨窗声学条件不佳的患者中，应用基于半乳糖的微泡混悬液可实现几乎所有主要颅内血管节段及一些大动脉分支的清晰三维可视化。总之，与未增强的三维重建相比，CE3DPD是一种更敏感的超声工具。它通过提供改进的图像位置空间定向显示，使基底脑循环的三维超声成像更易于实施和解读。因此，该方法可能会提高操作者在病理情况下的诊断信心水平。
