2016 中国脑血管超声临床应用指南

2016-07-30 中华医学会神经病学分会脑血管病学组 中华神经科杂志.2016,49(7):507-517.

中国脑血管超声临床应用指南(下简称为“指南”)由国内长期从事神经科和超声领域工作的专家学者参考了大量国外相关指南和检查规范,经反复磋商讨论,最后落笔成文。本指南围绕实用性这个核心,尽量简化和规范化,以期达到指导临床操作和诊治的目的。

中文标题:

2016 中国脑血管超声临床应用指南

发布日期:

2016-07-30

简要介绍:

超声技术因其实时、便携、无创、可反复检查,甚至可长程监测的优点,临床应用价值正不断增加。即使是在广泛应用计算机断层扫描、核磁共振成像、血管造影等先进技术的同时,超声也可为其提供许多互补的信息,因而在神经系统疾病诊断中占有重要地位。目前,脑血管超声已经从传统的经颅多普勒超声(transcranial Doppler,TCD),扩展到检测微栓子、检测心脏或者肺动静脉异常右向左分流(right toleft shunt,RLS)、脑血流血管自动调节,以及可对中枢神经系统变性病和周围神经病等进行临床诊断甚至治疗的应用领域。


中国脑血管超声临床应用指南(下简称为“指南”)由国内长期从事神经科和超声领域工作的专家学者参考了大量国外相关指南和检查规范,经反复磋商讨论,最后落笔成文。本指南围绕实用性这个核心,尽量简化和规范化,以期达到指导临床操作和诊治的目的。

血管狭窄诊断的敏感度和特异度 

TCD或者经颅彩色多普勒血流成像(transcranialcolorcodedDoppler,TCCD)检查可以诊断颅内动脉狭窄或闭塞。 

TCD诊断血管狭窄主要依据:

(1)血流速度:以收缩期血流速度最为重要,直观,容易检测。平均血流速度反映的信息更多,诊断血管狭窄的特异度较高,但是需要很好的信噪比,部分患者声窗不好时,将影响检查结果的准确性。50岁以上受试者有5%一10%没有理想颞窗,需要采用其他声窗辅助判断颅内血管,如眼窗、枕窗。

(2)频谱分布:正常脑血流为层流频谱,当出现紊乱的频谱时,是血管狭窄重要依据,但是血管的迂曲等因素会导致血流速度的升高,出现异常血流频谱,单独依靠频谱分布紊乱诊断血管狭窄存在不准确性。 

(3)声频改变:正常脑血流(层流)的多普勒声频信号是柔和悦耳的,当出现粗糙、鸥鸣样杂音则提示血管狭窄。 

TCD单纯分析多普勒频谱提供的血流动力学参数,而TCCD可将二维灰阶实时显像、彩色多普勒血流显像和多普勒频谱分析技术结合在一起,使得操作者易于根据颅内解剖学标志识别所观察的血管,跟踪血管走向,根据血流方向与超声束所成的角度校正血流速度,得出的结果更加准确,容易区分血管,辨别是否有迂曲等因素。彩色血流显像在血管狭窄处血流束变细,色彩明亮或发生彩色翻转,典型者呈束腰征,频谱多普勒显示狭窄处血流速度异常增高,狭窄前后血流速度较狭窄处低,频谱形态呈湍流。血管狭窄节段较长或狭窄严重时,血流速度可以不增快,此时不能单凭血流速度未加快而做出无狭窄的诊断,TCCD结合彩色多普勒血流成像(color Doppler flow imaging,CDFI)可以做出综合判断。

制定者:
中华医学会神经病学分会
中华医学会神经病学分会脑血管病学组
中华医学会神经病学分会神经影像学协作组

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    2021-03-15 小郑医生

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    2021-01-29 ms7000001691666476

    学习应用

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    2021-01-29 ms7000001691666476

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    2021-01-29 ms7000001691666476

    需要下载

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