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Farbduplexsonographie der extrakraniellen hirnversorgenden Arterien

Color duplex sonography of extracranial brain-supplying arteries

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Zusammenfassung

Die Ultraschalluntersuchung der extrakraniellen hirnversorgenden Arterien ermöglicht die gleichzeitige Erfassung morphologischer und hämodynamischer Befunde in hoher örtlicher und zeitlicher Auflösung. Für die Stenosedetektion und -quantifizierung an der A. carotis und A. vertebralis ist die intrastenotische systolische Maximalgeschwindigkeit von mehr als 120 cm/s der Schwellenwert für eine >50%ige Diameterreduktion. Daneben existieren weitere direkte und indirekte Stenoseparameter (intra- und poststenotische Strömungsstörungen, erhöhte Pulsatilität in der prästenotischen A. carotis communis [ACC], intra- oder extrakranielle Umgehungskreisläufe), die in der Zusammenschau mit der Durchmesser- und Flächenreduktion im B-Bild zu einer hohen Zuverlässigkeit der Farbduplexsonographie (FKDS) bei Stenosen der A. carotis interna (ACI) führen. Sonographisch-pathoanatomische Vergleichsstudien haben bei gleichzeitiger Verwendung mehrerer Ultraschallkriterien eine hohe Übereinstimmung gezeigt (r >0,9). Nach Stenting der ACI sind die Flussgeschwindigkeiten im Stent generell erhöht, sodass erst ab einer systolischen Flussbeschleunigung von 300–450 cm/s von einer ≥70%igen In-stent-Restenose gesprochen wird. Bei der Beschreibung arteriosklerotischen Plaques im B-Bild sollten keine histologischen Begriffe, sondern vielmehr die Ultraschallterminologie zur Beschreibung der Plaquebinnenstruktur, -oberfläche und -bewegung sowie Schallschattenbildung verwendet werden.

Abstract

Ultrasound examination of extracranial blood-supplying arteries allows the simultaneous acquisition of morphologic and hemodynamic information with high spatial and temporal resolution. For detection and quantification of stenoses in the carotid and vertebral arteries, an intrastenotic peak systolic velocity of more than 120 cm/s is the threshold value for a diameter reduction of >50%. In addition there are further direct and indirect stenosis parameters (intrastenotic and poststenotic circulation disturbance, increased pulsatility in the prestenotic common carotid artery, intracranial or extracranial collateral pathways) which together with diameter and area reduction in the B-scan, lead to a high reliability of color duplex sonography for stenoses of the internal carotid artery (ICA). Sonographic and patho-anatomic comparative studies have shown a high agreement (r >0.9) by using a battery of several ultrasound criteria. Following stenting of the ICA the blood flow velocity in the stent is generally increased so that a ≥70% in-stent restenosis is present in case of a peak systolic velocity of 300-450 cm/s. For the description of arteriosclerotic plaques in the B-scan, ultrasound terminology but not histological terms should be used to describe the internal, surface and motion structure of plaques as well as the sonic shadow formation.

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Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie & Nuklearmedizin, Städtisches Klinikum München GmbH, Klinikum Harlaching, Sanatoriumsplatz 2, 81545, München, Deutschland

    G. Schulte-Altedorneburg

  2. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Großhadern, München, Deutschland

    D.-A. Clevert

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  1. G. Schulte-Altedorneburg
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Correspondence to G. Schulte-Altedorneburg.

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Schulte-Altedorneburg, G., Clevert, DA. Farbduplexsonographie der extrakraniellen hirnversorgenden Arterien. Radiologe 49, 1016–1023 (2009). https://doi.org/10.1007/s00117-009-1872-5

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  • DOI: https://doi.org/10.1007/s00117-009-1872-5

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