１９－３／１９－３ ガイドライン 頭蓋内超音波検査
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1 113 t-pa TCDTC-CFI TCD TC-CFI TCD TIBI TC-CFI MCA TCD TCD examination and normal values Transcranial Doppler Transcranial Doppler criteria for intracranial arterial stenosis Ophthalmic artery Doppler flow imaging TCD TCD in vasomotor reactivity testing and evaluation of collateral blood flow TCCS Transcranial color-coded sonography Examination methods and normal values of flow velocity in the intracranial cerebral artery TCCS Diagnosis of stenotic lesions of cerebral artery with transcranial color-coded real-time sonography
2 114 Neurosonology
3 115 TCD MHz TCD MCA, ACA, ICA PCA VA, BA cm s Transcranial Doppler : TCD TCD TCD MHz TCD TCD color duplex sonography TCD mm ICA MCAACAPCA mm MCA mm M M mm ICA MCA ACA PCA MCA PCA VA BA nasion mm VA V TCD MCA PCA Neurosonology
4 116 Neurosonology V VA mm VA BA VA BA mm BA VA BA VA, BA V TCD Vmean : time-averaged maximum flow velocity PI MCA cm s, ACA cm s, PCA cm s, VA BA cm s TCD Levovist Khan HG, Gailloud P, Bude RO, Martin JB, Szopinski KT, Khaw C, Rufenacht DA, Murphy KJ : The effect of contrast material on transcranial Doppler evaluation of normal middle cerebral artery peak systolic velocity. Am J Neuroradiol Tong D, Albers GW : Normal Values, in Babikian VL, Wechsler LR ed : Transcranial Doppler Ultrasonography. nd ed, Woburn : Buterworth-Heinemann, pp A cm s cm s BTIBI Thrombolysis In Brain Ischemia C A B A B A A B A B A B TCD TCD TCD A M cut-off cm sec turbulence wave form compensatory flow diversion low frequency noise microembolic signals B MTIBI Thrombolysis In Brain Ischemia
5 117 MR angiography TCD cm s cm s MR angiography Power motion mode TCD mm cm s mm cm s D angiography mm cm s mm M rt-pa C M M power amplitude A cm s cm s TIBI grading system Demchuk AM, et al. Stroke TIBI Grade TCD TIBI TIBI mm cm s cm s B Neurosonology
6 118 Power motion mode TCD PMD-TCD MR angiography PMD-TCD TIBI minimal flow TIBI microembolic signals turbulence TIBI MR angiography Neurosonology A cm s cm s A TCD B A P P cm s B A cm s B A cm s TCD B Demchuk AM, Christou I, Wein TH, Felberg RA, Malkoff M, Grotta JC, Alexandrov AV. Specific transcranial Doppler flow findings related to the presence and site of arterial occlusion. Stroke Lindegaard KF, Bakke SJ, Aaslid R, Nornes H. Doppler diagnosis of intracranial artery occlusive disorders. J Neurol Neurosurg Psychiatry Felberg RA, Christou I, Demchuk AM, Malkoff M, Alexandrov AV. Screening for intracranial stenosis with transcranial Doppler : the accuracy of mean flow velocity
7 119 DC mmamm cm s B mm cm s thresholds. J Neuroimaging Arenillas JF, Molina CA, Montaner J, Abilleira S, Gonzalez -Sanchez MA, Alvarez-Sabin J. Progression and clinical recurrence of symptomatic middle cerebral artery stenosis : a long-term follow-up transcranial Doppler ultrasound study. Stroke Wong KS, Li H, Lam WW, Chan YL, Kay R. Progression of middle cerebral artery occlusive disease and its relationship with further vascular events after stroke. Stroke Segura T, Serena J, Castellanos M, Teruel J, Vilar C, Davalos A. Embolism in acute middle cerebral artery stenosis. Neurology Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR, Alvarez-Sabin J, Montaner J, Saqqur M, Demchuk AM, Moye LA, Hill MD, Wojner AW. Ultrasound enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med Demchuk AM, Burgin WS, Christou I, Felberg RA, Barber PA, Hill MD, Alexandrov AV. Thrombolysis in brain ischemia TIBI transcranial Doppler flow grades predict clinical severity, early recovery, and mortality in patients treated with intravenous tissue plasminogen activator. Stroke Alexandrov AV, Demchuk AM, Felberg RA, Christou I, Barber PA, Burgin WS, Malkoff M, Wojner AW, Grotta JC. High rate of complete recanalization and dramatic clinical recovery during tpa infusion when continuously monitored with -MHz transcranial doppler monitoring. Stroke Power motion mode TCD mm Alexandrov AV, Felberg RA, Demchuk AM, Christou I, Burgin WS, Malkoff M, Wojner AW, Grotta JC. Deterioration following spontaneous improvement : sonographic findings in patients with acutely resolving symptoms of cerebral ischemia. Stroke Babikian V, Sloan MA, Tegeler CH, DeWitt LD, Fayad PB, Feldmann E, Gomez CR. Transcranial Doppler validation pilot study. J Neuroimaging Hennerici M, Rautenberg W, Schwartz A. Transcranial Doppler ultrasound for the assessment of intracranial arterial flow velocitypart. Evaluation of intracranial arterial disease. Surg Neurol Rorick MB, Nichols FT, Adams RJ. Transcranial Doppler correlation with angiography in detection of intracranial stenosis. Stroke Cantu C, Yasaka M, Tsuchiya T, Yamaguchi T. Evaluation of the basilar artery flow velocity by transcranial Doppler ultrasonography. Cerebrovasc Dis Ribo M, Garami Z, Uchino K, Song J, Molina CA, Alexandrov AV. Detection of reversed basilar flow with power-motion Doppler after acute occlusion predicts favorable outcome. Stroke Neurosonology
8 120 Neurosonology PI MHz MHz B FDA mw cm MI B mm Vs Vd TAMXpulsatility index PIresistance index RI Vs cm sec Vs m sec Vd m sec TAMX m sec PIRI Vs PI A to and fro B C Vs D E Vs PI Belden C J, Abbitt PL, Beadles KA : Color Doppler US of the orbit. Radiographics Neurosonology Kouvidis GK, Benos A, Kyriakopoulou G, Anaastopoulos G, Triantafyllou D : Colour Doppler ultrasonography of the ophthalmic artery : flow parameters in normal subjects. Int Angiol Kawaguchi, S., Sakaki, T., Uranishi, R. : Color Doppler flow imaging of the superior ophthalmic vein in dural arteriovenous fistulas. Stroke
9 121 A B to and fro CD E TCD CO Acetazolamide SPECT static autoregulation TCD beat-tobeat real time dynamic autoregulation TCD real time beat-to-beat PeCO CO TCD TCD A a static autoregulation Phenylephrine a Phenylephrine mmhg mmhg b ABP M MFV c ABP CVR static cerebral autoregulation sca CVR ABP CVR ABP MFV CVR CVRpre CVRpostCVRpre, ABP ABPpre ABPpostABPpre Norepinephrine Steiner LA Stroke a Norepinephrine CPP static autoregulation b Static rate of autoregulation SROR CVR CPP, CPP MAP ICP b dynamic autoregulation Rapid leg cuff deflation a mmhg Neurosonology
10 122 Autoregulation:intact sca=100% Autoregulation:impaired sca=0% Dynamic autoregulation:intact ARI=6, 5 Dynamic autoregulation:impaired ARI=2 static autoregulation Y ABP, mmhg LRMCAcm s X sec phenyrephrine LRMCA static cerebral autoregulation sca LRMCA sca Frank P. Tiecks,Stroke Neurosonology mmhg M TCD b ARI Autoregulation Index ARI Head-up tilt HUThead-down tilt HDT a Hughson RL Repeated HUT Stroke HUT cycle M MFV CPP CVRi b Sato J HUT MFVMCA M ABPMCACritical Crossing Presure Pcc Pcc ABPs- ABPs-ABPd FVs-FVd xfvscpp :ABPMCA-CPP CVR : CPP FVMCA HUT HDT AJP-Heart Beat-to-beat spontaneous transient pressor and dynamic autoregulation Y cm sx sec Rapid leg cuff deflation Autoregulation Index ARI dynamic autoregulation ARI dynamic autoregulation ARI Frank P. Tiecks,Stroke depressor changes in mean arterial pressure a M flow velocity b ARI c Correlation Coefficient Index Sx, Dx, Mx Mx Reinhard MStroke d power spectral analysis M Transient hyperaemic response ratio THRR Smielewski P Stroke a M THRR FVsystolic hyperemia FVsystolic baseline
11 123 b normocapnia CO Full range vasodilation : CO a CO M M VMR b mean c VMR VMR severe reduction moderate reduction normal range CO a MCO M b CO Breath-holding Index BHICO golden standerd Full range vasodilation a M BHI b c BHI Acetazolamide aacetazolamide g M B TCD Vernieri F breath-holding index BHI BHI Stroke A Balloon occlusion test BOT BOT a BOT b BOT TCD MMFV Pulsatility Index PI c MFV PI Mathis JM AJNR d TCD BOT TCD TCD TCD STA MCA CEA, CAS BOT a CEA MFV cm s b CAS BOT CEA c CAS balloon protection device test occlusion tolerance or intolerance d TCD BOT MFV test occlusion stent Neurosonology
12 124 mmhg beats/min cm/sec Balloon occlusion test : Stump pressure R.CCA R Balloon occlusion test : R.MCA(M1) L min (-) Balloon occlusion test Balloon occlusion test Mcm s cm s BOT Balloon occlusion test : mmhg beats/min cm/sec Stump pressure R.CCA R.MCA(M1) TCD Neurosonology min Balloon occlusion test stump pressure BOT TCD e CEA CAS CAS test occlusion f M g TCD BOT B a b c TCD Sloan MA, Alexandrov AV, Tegeler CH, Spencer MP, Caplan LR, Feldmann E, Wechsler LR, Newell DW, Gomez CR, Babikian VL, Lefkowitz D, Goldman RS, Armon C, Hsu CY, Goodin DS : Assessment : Transcranial Doppler ultrasonography, Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. NEUROLOGY Tiecks FP, Lam AM, Aaslid R, Newell DW : Comparison of Static and Dynamic Cerebral Autoregulation
13 125 Measurements. Stroke Eames PJ, Blake MJ, Dawson SL, Panerai RB, Potter JF : Dynamic cerebral autoregulation and beat to beat blood pressure control are impaired in acute ischaemic stroke. J Neurol Neurosurg Psychiatry Ringelstein EB, Sievers C, Ecker S, Schneider PA, Otis SM : Noninvasive Assessment of CO -Induced Cerebral Vasomotor Response in Normal Individuals and Patients With Internal Carotid Artery Occlusions. Stroke Markus H, Cullinane M : Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion. Brain Maeda H, Matsumoto M, Handa N, Hougaku H, Ogawa S, Itoh T, Tsukamoto Y, Kamada T : Reactivity of Cerebral Blood Flow to Carbon Dioxide in Various Types of Ischemic Cerebrovascular Disease : Evaluation by the Transcranial Doppler Method. Stroke Markus HS, Harrison MJG : Estimation of Cerebrovascular Reactivity Using Transcranial Doppler, Including the Use of Breath-Holding as the Vasodilatory Stimulus. Stroke Müller M, Schimrigk K : Vasomotor Reactivity and Pattern of Collateral Blood Flow in Severe Occlusive Carotid Artery Disease. Stroke Belardi P, Lucertini G, Ermirio D : Stump Pressure and Transcranial Doppler for Predicting Shunting in Carotid Endarterectomy. Eur J Vasc Endovasc Surg Sakaguchi M, Kitagawa K, Hougaku H, Hashimoto H, Nagai Y, Yamagami H, Ohtsuki T, Oku N, Hashikawa K, Matsushita K, Matsumoto M, Hori M : Mechanical compression of the extracranial vertebral artery during neck rotation. Neurology transcranial color-coded sonography ; TCCS B MCA : MM ACA : A PCA : PP VABA transcranial color-coded sonography ; TCCS B MCA : MM ACA : A PCA : PP VABA TCCS TCCS A MHz B MCA M M A B TCCS A B B Neurosonology
14 126 A B P2 MCA PCA MCA PCA P2 ACA ACA P1 TCCS AB MCA,ACA,PCA BA Willis PCA PCA A B M1 M2 M2 Rt. MCA Lt. MCA M1 TCCS MCA MM A MM B MM Neurosonology MCA ACA PCA PCA PP P MCA VA VA VA BA B TCCS TCCS MCA mg ml ml booming C MCA VA BA D B
15 127 M1 M1 Rt. VA Lt. VA BA TCCS MCA M M TCCS VA,BA VA BA VA BA mm time -averaged maximum flow velocity : TAMX time-averaged flow velocity : TAV TCCS Aaslid R, Nornes H : Noninvasive transcranial Doppler B ultrasound recording of flow velocities in basal cerebral arteries. J Neurosurg. Tsuchiya T, Yasaka M, Yamaguchi T, et al : Imaging of the basal cerebral arteries and measurement of blood velocity in adults by using transcranial real-time color flow Doppler sonography. Am J Neuroradiol. Nabavi DG, Droste DW, Schulte-Altedorneburg G, et al : Diagnostic benefit of echocontrast enhancement for the insufficient transtemporal bone window. J Neuroimaging Griewing B, Schminke U, Motsch L, et al : Transcranial duplex sonography of middle cerebral artery stenosis : a comparison of colour-coding techniques frequency or power-based Doppler and contrast enhancement. Neuroradiology. Goertler M, Kross R, Baeumer M, et al : Diagnostic impact and prognostic relevance of early contrast-enhanced transcranial color-coded duplex sonography in acute stroke. Stroke. Postert T, Federlein J, Przuntek H, et al : Comparison of transcranial power Doppler and contrast-enhanced color- Neurosonology
16 128 MCA ACA,PCA,VA,BA coded sonography in the identification of intracranial arteries. J Ultrasound Med. Gahn G, Gerber J, Hallmeyer S, et al: Noninvasive assessment of the circle of Willis in cerebral ischemia : the potential of CT angiography and contrast-enhanced transcranial colorcoded duplexsonography. Cerebrovasc Dis. Kimura K, Yasaka M, Wada K, et al : Diagnosis of middle cerebral artery stenosis by transcranial color-coded real-time sonography. Am J Neuroradiol. Ogata T, Kimura K, Nakajima M, et al : Transcranial color -coded real-time sonographic criteria for occlusion of middle cerebral artery in acute ischemic stroke. Am J Neuroradiol Martin PJ, Evans DH, Naylor AR : Transcranial color-coded sonography of the basal cerebral circulation. Reference data from volunteers. Stroke ED-ratio TCCS MCA gold standard MRA A MCA TCCS MCA Vs MCA MCA TCCS Vscm TCCS Vscm MCA TCCS CE TCCS MCA Vscm MCA Neurosonology TCCS TCCS Vs MCA TCCS CE TCCS cm CE-TCCS cm MCA MCA Vd B TCCS PCA Vscm TCCS TCCS Vs A MCA TCCS MCA MCA ACA PCA
17 129 MCA MCA MCA Vd Vd ED ratio MCA Vd ED ratio MCA B TCCS A Vscm TCCS cm MCA ICA Vmca Vica Baumgartner RW, Mattle HP, Schroth G : Assessment of and intracranial stenoses by transcranial color-coded duplex sonography. Stroke Kimura K, Yasaka M, Wada K, Minematsu K, Yamaguchi T, Otsubo R : Diagnosis of middle cerebral artery stenosis by transcranial color-coded real-time sonography. AJNR Am J Neuroradiol Ogata T, Kimura K, Nakajima M, Naritomi H, Minematsu K : Diagnosis of middle cerebral artery occlusive lesions with contrast-enhanced transcranial color-coded real-time sonography in acute stroke. Neuroradiology Kimura K, Minematsu K, Yasaka M, Wada K, Yamaguchi T : Evaluation of posterior cerebral artery flow velocity by transcranial color-coded real-time sonography. Ultrasound Med Biol Chen YC, Chen ST, Chen CJ, Lee TH : Absent middle cerebral artery signal in transcranial color-coded sonography : a reliable indicator of occlusion? Cerebrovasc Dis Kimura K, Hashimoto Y, Hirano T, Uchino M, Ando M : Diagnosis of middle cerebral artery occlusion with transcranial color-coded real-time sonography. AJNR Am J Neuroradiol Ogata T, Kimura K, Nakajima M, Ikeno K, Naritomi H, Minematsu K : Transcranial color-coded real-time sonographic criteria for occlusion of the middle cerebral artery in acute ischemic stroke. AJNR Am J Neuroradiol Koga M, Kimura K, Minematsu K, Yamaguchi T : Relationship between findings of conventional and contrast -enhanced transcranial color-coded real-time sonography and angiography in patients with basilar artery occlusion. AJNR Am J Neuroradiol Krejza J, Mariak Z, Lewko J : Standardization of flow velocities with respect to age and sex improves the accuracy of transcranial color Doppler sonography of middle cerebral artery spasm. AJR Am J Roentgenol Krejza J, Kochanowicz J, Mariak Z, Lewko J, Melhem ER : Middle cerebral artery spasm after subarachnoid hemorrhage : detection with transcranial color-coded duplex US. Radiology Neurosonology
18 130 A B M1 M1 MCA PCA MCA PCA ACA ACA P TCCS AB MCA,ACA,PCA BA Willis P TCCS MCA M M A M1 M2 B M2 M1 mmhg beats/min cm/sec Balloon occlusion test : Stump pressure R.CCA P TCCS MCA MM A MM B MM R.MCA(M1) min (-) P Balloon occlusion test Balloon occlusion test : Rt. VA Lt. VA mmhg beats/min cm/sec R.CCA Neurosonology BA P TCCS VA,BA VA BA VA BA Stump pressure min R.MCA(M1) P Balloon occlusion test stump pressure BOT TCD
19 131 GE ME Neurosonology
３．超音波検査―椎骨脳底動脈系の超音波検査について―
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