摘要
目的探讨超声造影在脑动静脉畸形(AVM)切除术中的应用价值。方法对20例(幕上18例、幕下2例)经术前CT、MRI及数字减影血管造影法(DSA)检查诊断为AVM的患者分别行术中彩色多普勒血流成像(CDFI)模式、频谱多普勒模式及超声造影扫查,确定病变位置、深度、大小及其与周围组织的关系,记录不同方法显示供血动脉及引流静脉的数目,术后评价手术切除率。结果 (1)20例患者术中超声准确定位畸形血管团的位置。CDFI图像表现为典型的彩色镶嵌血管团,畸形血管团大小为1.1～6.5cm,距离硬膜0～2.7cm。供血动脉术前RI值0.29～0.56,术后RI值0.54～0.65。(2)20例患者行术中超声造影检查,畸形血管团大小为1.2～6.8cm。术中经股静脉团注造影剂7～14s后开始显影。正常脑动脉和供血动脉最先显影,而后病灶和脑组织显影,静脉系统最后显影。(3)20例患者CDFI模式显示供血动脉(FA)24支,引流静脉(DV)13支;术中超声造影显示供血动脉27支,引流静脉20支。(4)20例患者术后CDFI模式检查未发现病灶残留,结果与术后DSA检查结果一致,其中4例行术后超声造影检查。结论术中超声造影有助于完整了解AVM的血供模式,明确供血动脉与引流静脉的位置和数目,术后判断病变切除情况,提高对AVM诊断的准确性和全切率。
Objective To investigate the diagnosis potential of contrast agents imaging in AVM surgical treatment. Methods Twenty patients diagnosed as AVM comfirmed by preoperative CT, MRI and DSA were enrolled. The color Doppler flow imaging （CDFI）, pulsed Doppler imaging and ultrasound contrast agents imaging in intraoperative guidance were used, the lesion location, depth, size and its relationship with the surrounding tissue were observed. The number of feeding arteries and draining veins by different methods were recorded. Results A total of 20 patients with AVM were accurately located by intraoperative ultrasound. The typical color vascular group could be shown by CDFI. The sizes of AVM were 1.1-6.5 cm, the distances between AVM and the dura mater were 0-2.7 cm. The sizes of AVM were 1.2-6.8 cm by ultrasound contrast agents imaging. The real-time perfusion of microbubbles could be observed about 7-14 seconds after SonoVue bolus injection and its perfusion pattern followed ＂artery-tissue-vein procedures＂. AVM was with 24 feeding arteries （FA） and 13 draining veins （DV） were shown by the color Doppler flow imaging; AVM had 27 feeding arteries and 20 draining veins shown by intraoperative ultrasound contrast agents imaging. Color Doppler flow imaging found no residual lesions, of which 4 cases had ultrasound contrast agents imaging, its value was comparable to intraoperative DSA. Conclusion Intraoperative contrast-enhanced ultrasound is useful to identify the AVM blood supply model and the degree of the resection, which could improve the accuracy of diagnosis and precision of the operation.
出处
《中华医学超声杂志（电子版）》
2010年第10期18-20,共3页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
首都医学发展基金重点资助项目(2005-2025)
关键词
颅内动静脉畸形
超声检查
造影剂
手术中监测
Intraranial arteriovenous malformations
Ultrasonography
Contrast media
Intraoperative monitoring
