An Analysis Defection Of The Vascular Abnormalities And Hemodynamic Changes By VBI By CDFI And TCCD

Vertebrobasilar insufficiency is a common clinical ischemic cerebrovascular disease which showed dizziness, headache, nausea, tinnitus, visual impairment, and ill limb. It was often prominent, the short duration and repeatedly attacks. But the nervous system inspection showed no often obvious signs. The Duration of the symptom more than 24 hours caused vertebral - basilar artery thrombosis. The incidence gradually increased and age of onset was getting smaller and smaller in recent years. The disease that seriously affected people's health has become a growing concern in clinical. In accordance with pathophysiological basis and hemodynamic changes, its etiology and pathogenesis primarily related to the following factors:①the hemodynamic changes: Some artery of the vertebrobasilar artery system of patients has a severe and original stenosis or occlusion but collateral circulation could usually maintain the blood supply. Once the blood pressure lowered and then resulted in reducing blood flow, the regional blood that relied on the collateral circulation occurr transient ischemia.②Mechanical factors: When the atherosclerosis or congenital tortuous or longer and twisted of the vertebral artery and Hyperosteogeny compressed cervical artery, the extension, flexion or turning to the side of head-neck may be caused insufficient blood supply.③Vessel wall changes: The most common was cerebral arteriosclerosis, including atherosclerosis and arteriosclerosis resulting from hypertension. In addition, there could be cerebral arteritis, congenital vascular abnormalities, vascular injury and other factors.④Others: Such as steal syndrome of the cerebral artery, cerebral vasospasm, hypercoagulable state, and severe anemia. Patients are often recurrent but positive signs were more difficult to find. The diagnosis mainly based on clinical manifestations. Now DSA was the gold standard for the measurement and diagnosis of associated disease of the carotid artery and vertebral artery but the complexity of its operations and invasive was difficult to be accepted by patients. Although Magnetic resonance angiography (MRA) that was a noninvasive imaging methods showing cerebral vascular morphology was able to show the integrated vertebral artery, it could not show the formation of atherosclerotic plaque and the inspection was time-consuming and costly. So it cannot be used as conventional methods. Color Doppler ultrasound was a non-invasive diagnosis and one of the methods to assess the insufficiency of vertebra-basilar artery. With the continuous advancement of technology, it was increasingly being recognized. In this study, the CDFI and TCCD were jointly applied to observe characteristics of two-dimensional ultrasound of VBI, color Doppler ultrasound, Doppler spectrum. We analyzed the vascular abnormalities and hemodynamic changes of patients by DSA, MRA and Color Doppler ultrasound, which aimed to investigate the value and significance of clinical application of color Doppler ultrasound. Selected cases:There are about 200 Vertebrobasilar insufficiency cases that were diagnosed by neurology department in our hospital from 2007.01 to 2008.06. They were 122 male patients and 78 female patients, their age ranged 29 to 87 years old and the average age was 53.4±12.6 years old. In cases, 61 cases were hypertension, diabetes was 9 cases, and 21 cases were heart disease. Selected patients were inexperted in the incidence of week-long high-frequency CDFI of carotid and intracranial TCCD detection of low frequency, of which 32 cases of patients with CTA or DSA examination. The control group for the same period 40 cases of healthy volunteers, male 26 cases, 14 cases of women, age range 23-71 years old, average age 48.9±12.7 years old, selected are no cardiovascular history, no dizziness, re, ataxia, such as vertebrobasilar symptoms of arterial insufficiency. Detecting procedures:To use GE Logiq 700 ultrasound, frequency of detecting head of CDFI was 12 MHz; frequency of detecting head of TCCD was 2 MHz. CDFI Conventionally detected carotid artery, internal and external carotid, and vascular course, diameter, anatomical structure, and blood flow direction of the cervical segments and vertebrae segments of vertebral artery. TCCD detected blood flow direction and the spectrum shape and measured the blood flow parameters and then recorded the measured parameters of bilateral anterior cerebral artery (ACA) and middle cerebral artery (MCA) from the temporal window and the paragraph intracranial vertebral artery (VAi) and basilar artery (BA) from the pillow window. The ultrasound characteristics of 200 selected cases were compared with results of DSA and MRA about vascular anomalies and their hemodynamic changes.Results:1. in the 200 VBI cases, 187 cases was diagnosed with vascular anomaly and abnormal hemodynamics by CDFI and TCCD, the detection rate was 93.5%.2. Vertebral artery asymmetry in 62 cases of small growth; vertebral artery 46 cases of abnormal course (course of 25 cases of bending, 21 cases of abnormal penetration); extracranial vertebral artery stenosis 10 cases of segmental;3.VBI bilateral vertebral artery flow in patients with asymmetric asymmetry index and the rate of growth more evident than normal.4. When mild carotid stenosis, the change of blood flow velocity of vertebrobasilar artery was not obvious; when severe stenosis, the blood flow velocity of vertebrobasilar artery was positively correlated with stenosis, the correlation coefficient was 0.485 (P value <0.001).5. The match rate of ultrasound for diagnosis of vertebral artery stenosis and abnormal results of courser with the CTA and DSA was 91.1%. Conclusion:1. The combination of the high-frequency CDFI and low frequency TCCD could more comprehensively showed the vascular abnormalities and hemodynamic changes in patients with VBI and improved the diagnostic accuracy of VBI. majority of VBI in patients with cervical vertebral artery CDFI and intracranial segment of the test results with TCCD significant correlation. But there are also some inconsistencies in the results of two cases, can not rule out a check to the existence of VBI. In order to comprehensively and systematically to understand the patterns of vertebral artery structure and blood supply, should be as far as possible the use of combined detection of CDFI with TCCD.2. In accordance with bilateral vertebral, basilar artery flow velocity ratio and flow rate of bilateral vertebral artery asymmetry index, VBI asymmetric blood flow velocity in patients with more pronounced than normal, with the contralateral vertebral artery blood flow more quickly compensated by obviously relevant.3. Ultrasound on the development of small vertebral artery, abnormal course, Subclavian Steal is an ideal method of diagnosis;4. When mild carotid stenosis, the change of blood flow velocity of vertebrobasilar artery was not obvious; when severe stenosis, the blood flow velocity of vertebrobasilar artery more significantly increased than the average flow speed, more obvious at systolic state, which has statistical difference.5. There was the high match rate of ultrasound about diagnosis of vertebral artery stenosis and abnormal results of courser with the CTA and DSA.In the diagnosis of VBI, the TCCD was complementary with the CDFI, The combination of both could increase sensitivity and significantly decreased the rate of missed diagnosis, which the combination could supply more comprehensive diagnosis to vertebrobasilar insufficiency。...