Extracranial And Intracranial Cerebral Vessels Of Patients With Cerbral Infarction: Evaluated By Ultrasound, And Compared With MRA

Objective:To assess the extracranial and intracranial cerebral vessels of patients who subjected cerebral infarction with L12~5MHz linear array scanner,C5~2MHz convex array probe and P4~2MHz probes. And find the merits and shortcomings among B―mode (B-US), color Doppler flow imaging (CDFI) and color Doppler energy (CDE). Middle cerebral artery(MCA) and Willis circles:anterior cerebral artery(ACA),posterior cerebral artery(PCA),anterior communicating artery(ACoA),posterior communicating artery(PCoA), and basal artery(BA),posterior inferior cerebellar artery(PICA)and other arteries were detected by transcranial color-coded duplex sonography (TCCD).Extracranial cerebral vessels with unilateral severe stenosis or obstructive led to the changes of intracerebral collateral circulation were be evaluated by transcranial color-coded duplex sonography. At the same time, how to improve the display of distal extracranial internal carotid artery(ICA) and vertebral artery(VA)was investigated,too.Methods and materials:56 patients(39 males,17 females) with cerebral infarction were included in this study. The diseases were diagnosed by computer tomography(CT)or magnetic resonance imaging(MRI). Common carotid artery(CCA), extracranial internal carotid artery ,the length of the distal visualized ICA and vertebral artery were observed by conventional probe .The intracranial internal carotid artery and the bifurcation of ICA were measured through temporal window, and the intracranial V-BA were scanned through sub-occipital window by means of TCCD. Then the results were compared with MRA. All of them in the group,the peak systolic velocity (PSV) ,the end diastolic velocity (EDV) and resistent index(RI) of common carotid artery ,extracranial internal carotid artery and vertebral artery were detected by high frequency linear-array probe(HFLP)and lower frequency convex probe(LFCP);And the length of the extracranial ICA and VA were observed by the same probes. The difference between HFLP and LFCP were compared by statistics software through these results. Parts of this 40 patients'MRA can compared with its'TCCD.Results:1. The rate of display diseases in CCA,ICA and VA were 87.5% detected by ultrasonograph among 56 cases (112 blood vessels )with cerebral infarction.2. The detected length of extracranial internal carotid artery was various in different frequency ultrasonic probe: The length by lower frequency convex probe was significantly greater than that by high frequency linear-array probe. Color Doppler energy compare with CDFI and CDE had no statistical significance. There are 56 patients to be selected in the group ,the length of ICA detected by HFLP were B-US: 2.03±0.62cm, CDFI 2.08±0.60cm, CDE 2.12±0.59cm,P>0.05;the length of ICA detected by LFCP were B-US: 3.83±0.88cm,CDFI3.89±0.90cm,CDE3.95±0.91cm,P>0.05. But the detected length detected by LFCP compare with HFLP had distinguished statistical significance,P<0.05.3. The detected length of extracranial VA was various in different frequency ultrasonic probe: The length by lower frequency convex probe was significantly greater than that by high frequency linear-array probe. There are 56 patients to be selected in the group, the displayed segments of VA detected by HFLP were VA 2.30±0.60 pieces and by LFCP were 3.63±0.52 pieces, p<0.05.4. PSV and EDV of common carotid artery,extracranial internal carotid artery and vertebral artery were distinguished distinct in different frequency probe. Allowed for the extracranial cerebral vessels of patients who subjected cerebral infarction may be exist different level stenosis,and the contralateral arteries would be compensation result in the data detected by ultrasound were untruth. For this reason,right arteries to be selected to illustrate the blood flow parameter changes in this article. PSV and EDV of extracranial cerebral vessels measured by LFCP are much higher than that by HFLP. PSV of RCCA detected by HFLP and LFCP were 72.63± 22.90cm/s and 79.74±23.70cm/s,P<0.05; EDV of RCCA detected by HFLP and LFCP were 18.31±7.65 cm/s and 20.84±7.77cm/s,P<0.05 . PSV of RICA detected by HFLP and LFCP were 58.24±35.30cm/s and 70.82±37.62cm/s,P<0.05; EDV of RICA detected by HFLP and LFCP were 20.50±13.65cm/s and 25.79±14.61cm/s,P<0.05. PSV of RVA detected by HFLP and LFCP were 43.67±16.66cm/s and 50.28±19.42cm/s, P<0.05;EDV of RVA detected by HFLP and LFCP were 14.33±6.47cm/s and 16.36±7.12cm/s,P<0.05.5. The RI of CCA ,ICA and VA of different frequency probes have no significant statistics meaning. RI of RCCA detected by HFLP and LFCP were 0.75±0.55 and 0.74±0.06,P>0.05. RI of RICA detected by HFLP and LFCP were 0.59±0.19 and 0.59±0.17, P>0.05. RI of RVA detected by HFLP and LFCP were 0.66±0.11 and 0.64±0.15,P>0.05.6. 40 cases Willis circles were observed through temporal window and sub-occipital window,and the results were compared with MRA. But the cases observed through temporal window and sub-occipital window were less than 40,the reason is that some patients have no acoustic window and sub-occipital window. The detected results through 37 temporal windows were as follow: 20 MCAs were found stenosis (RMCA: 12strips, LMCA: 8strips); 4 PCoAs were opening (RPCoA: 3 strips,LPCoA: 1strip);3ACAs were suspected stenosis(RACA:1 strip,LACA:2 strips). 2 cases'RVA may be seen indistinctly and one case existed higher flow rate and RI though sub-occipital window.There are 27 blood vessels were pathological changes through 37 transaudient temporal window and the rate of masculine was 73%. The 27 disease vessels above-mentioned were diagnosed abnormity by MRA; in addition, there are 2 PCOAs were opening and 1 MCA was midrange stenosis. So MRA found 30 vessels were pathological changes, and the rate of masculine was 81%. There are 17 blood vessels were observed by sub-occipital window,and found 5 blood vessels with pathological changes(stenosis of RVA were 4strips and LVA was 1 strip),and these diseases were all located in pro- bifurcation(PICA) in VA;But there are only one blood vessel with pathological changes were found,and it located in post- bifurcation(PICA) in VA(stenosis of RVA's fillet). MRA's results revealed all the 5 blood vessels above-mentioned with disease,otherwise ,it also found another 2 blood vessels with lower grade stenosis and 8 blood vessels were abnormal,the former were located in pro- bifurcation(PICA) in VA,and the latter were located in post- bifurcation(PICA) in VA.The results of sub-occipital window were used to compare with MRA through paired chi square test. The result displayed: the rate of disease detection by temporal window (to detected MCA-M1 , ACA-A1 , PCA-P1 and PCoA) and sub-occipital window(to detected pro-bifurcation(PICA) in VA )have no significant statistics meaning,the former P> 0.05,the latter P>0.05. But the rate of disease detection by sub-occipital window to detected post-bifurcation(PICA) in VA compared with MRA have significant statistics meaning and the data's P<0.05.Conclusions:1. Ultrasonogram can display thickening of inner memb- rane,plaque and stenosis of blood vessel and other changes among patients who subjectd cerebral infarction. It can contribute to diagnose the cause of cerebral infarction.2. The imaging length of extracranial internal carotid artery showed by LFCP was significantly greater than that of HFLP,which contributes to higher display of the distal extracranial internal carotid artery's diseases.3. LFCP displayed the segment of vertebral artery were much longer than that of HFLP: 3~4 segments can be seen by LFCP,while only 2~3 segments can be seen by HFLP. LFCP can increase the rate of the sighting of distal vertebral artery, and contributes to higher display twist and stegnosis of VA.4. PSV and EDV of CCA, extracranial ICA and VA measured by LFCP had obvious statistical significance than that by HFLP;However RI had no difference.5. The displayed inner membrane, plaque's character and the degree of lumina's stenosis were clear by HFLP than that by LFCP. So apply both HFLP and LFCP to detected intracranial and extracranial vessels can make for higher displayed rate of unhealthy vessels. 6. TCCD can found the changes of intracranial internal carotid artery and vertebral artery as well as the main branches of them,the patients with cerebral infarction are also applied and the precondition was the bone windows were clear. TCCD compared with MRA was consistent in basic. But temporal window and sub-occipital window themselves prossess limitations.So it is essential to diagnose diseases by MRA when temporal window and sub-occipital window were vague, ramulus of intracranial ICA and VA with disease were suspected.