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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1 Duplex color coded ultrasonography for evaluation of the vertebrobasilar arteries Kozue Saito, Satoshi Ueno Nara Medical University, Department of Neurology Duplex color-coded ultrasonography performed for evaluation of the cerebrovascular arterial system consists of transcranial and carotid ultrasonogaphy. Vertebral arteries (VAs) pass through the foramina of the cervical transverse processes and unite to form the basilar artery, which affects the blood flow in each vertebral artery. Neck motions also affect the blood flow in the VAs. Carotid ultrasonography enables us to diagnose occlusion of the VAs, the subclavian steal phenomenon, VA dissection, and the Bow-Hunter syndrome. These disturbances of blood supply in the VAs often cause vertigo and dizziness, which result in vertebrobasilar insufficiency, sometimes resulting in cerebral infarction. The level of VA occlusion is diagnosed as follows; 1) Absence of apparent flow signals in the VAs indicates origin occlusion. 2) Preserved systolic velocity, but zero end-diastolic velocity indicates occlusion before the branching off into the posterior inferior cerebellar arteries (PICA). 3) Mean velocity (MV) 18 cm/sec and MV-ratio (mean flow velocity in the contralateral VA divided by that in the target VA) 1.4 indicate PICA-end or VA occlusion after branching off of the PICA. These could be further distinguished as follows: A diameterratio (diameter of the contralateral VA divided by the diameter of the target VA) 1.4 indicates PICA-end occlusion. A diameter-ratio 1.4 indicates VA occlusion after branching off of the PICA. Retrograde VA flow indicates the subclavian steal phenomenon, which can cause vertebrobasilar ischemia during exercise of the upper extremeties. Neck motions sometimes damage the VAs and cause dissection, which produces flaps and stenoses in the VAs. Rotational VA occlusion, the so-called Bow-Hunter syndrome, can be diagnosed by transient change of the blood flow velocity to the occlusive pattern during neck rotations. Transcranial ultrasonography allows direct evaluation of the blood flow in the intracranial vertebrobasilar arteries. This method enables us to confirm the results of carotid ultrasonography, such as in basilar artery occlusion, in which retrograde flow is observed in the basilar artery. Duplex color-coded ultrasonography is less invasive and feasible for bedside examination, and allows real-time evaluation of the cerebrovascular arteries. ( 184 )

2 Key words: duplex color-coded ultrasonography, vertebral artery, vertebrobasilar, insufficiency PICA AICA PICA PICA 7.5 MHz post-stenotic pattern MRI MR angiography PICA PICA-end ( 185 )

3 PICA PICA EDV PICA MV 18 cm/s PICA Mean-ratio MVMV Mean-ratio 1.4 PICA PICA-end PICA-end Diameter-ratio VA VA Diameter-ratio 1.4 PICA-end Subclavian steal phenomenon to-and-fro Bow hunter ( 186 )

4 A B MR angiography ( 187 )

5 PICA PICA PICA-end Wallenberg flap Bow hunter PICA PICA PICA ( 188 )

6 notch flap ( 189 )

7 MR angiography ( 190 )

8 MR angiography VBI: vertebro-basilar insufficiency hemodynamic VBI hvbi slow blood flow 2 MHz ( 191 )

9 mm mm AICA AICA MR angiography CT angiography Amarenco P, Rosengart A, DeWitt LD, et al.: Anterior inferior cerebellar artery territory infarcts. Mechanisms and clinical features. Arch Neurol 50: , 1993 Saito K, Kimura K, Nagatsuka K, et al.: Vertebral artery occlusion in duplex color-coded ultrasonography. Stroke 35: , 2004 Yip PK, Liu HM, Hwang BS, et al.: Subclavian steal phenomenon: a correlation between duplex sonographic and angiographic findings. Neuroradiology 34: , 1992 Kliewer MA, Hertzberg BS, Kim DH, et al.: Vertebral artery Doppler waveform changes indicating subclavian steal physiology. AJR Am J Roentgenol 174: , 2000 Hosoya T, Nagahata M, Yamaguchi K: Prevalence of vertebral artery dissection in Wallenberg syndrome: neuroradiological analysis of 93 patients in the Tohoku District, Japan. Radiat Med 14: , 1996 Hosoya T, Watanabe N, Yamaguchi K, et al.: Intracranial vertebral artery dissection in Wallenberg syndrome. AJNR Am J Neuroradiol 15: , 1994 Bartels E, Flugel KA: Evaluation of extracranial vertebral artery dissection with duplex color-flow imaging. Stroke 27: , 1996 Sakaguchi M, Kitagawa K, Hougaku H, et al.: Mechanical compression of the extracranial vertebral artery during neck rotation. Neurology 61: , 2003 Lin HC, Chao PZ, Lee HC: Sudden sensorineural hearing loss increases the risk of stroke: a 5-year follow-up study. Stroke 39: , 2008 Hemodynamic VBI Yamasoba T, Kikuchi S, O Uchi T, et al.: Magnetic resonance angiographic findings in vertiginous patients with slow vertebrobasilar blood flow. Acta Otolaryngol Suppl 520 Pt 1: , 1995 Koga M, Kimura K, Minematsu K, et al.: Relationship between findings of conventional and contrast-enhanced transcranial colorcoded real-time sonography and angiography in patients with basilar artery occlusion. AJNR Am J Neuroradiol 23: , 2002 ( 192 )

Online publication October 3, 2011 原 著 第 51 回総会座長推薦論文 内頸動脈起始部狭窄病変における収縮期加速時間の有用性 要 旨 : acceleration time; AcT AcT AcT 110 msec NASCET 60

Online publication October 3, 2011 原 著 第 51 回総会座長推薦論文 内頸動脈起始部狭窄病変における収縮期加速時間の有用性 要 旨 : acceleration time; AcT AcT AcT 110 msec NASCET 60 Online publication October 3, 2011 原 著 第 51 回総会座長推薦論文 内頸動脈起始部狭窄病変における収縮期加速時間の有用性 1 2 3 要 旨 : acceleration time; AcT 137 266 AcT AcT 110 msec NASCET 60 AcT J Jpn Coll Angiol, 2011, 51: 365 371 Key words:

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