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Washio T, Watanabe H, Suzuki K, Saito S, Ogoh S. Site-specific different dynamic cerebral autoregulation and cerebrovascular response to carbon dioxide in posterior cerebral circulation during isometric exercise in healthy young men. Auton Neurosci 2022; 238:102943. [PMID: 35086019 DOI: 10.1016/j.autneu.2022.102943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/16/2021] [Accepted: 01/16/2022] [Indexed: 11/23/2022]
Abstract
Different cerebral blood flow (CBF) responses to exercise between the posterior cerebral artery (PCA) and vertebral artery (VA) have been previously observed, though the physiological mechanisms remain unknown. There is regional heterogeneity in sympathetic innervation between the PCA and VA, which may affect CBF regulation, especially during sympathoexcitation. Thus, in the present study, we hypothesized that different CBF regulatory mechanisms between PCA and VA contribute to heterogeneous CBF responses to isometric exercise. To test this hypothesis, in thirteen healthy young men, dynamic cerebral autoregulation (CA) and cerebrovascular CO2 reactivity (CVR), were identified in each artery during a 2-min isometric handgrip (IHG) exercise at 30% of maximum voluntary contraction. Similar to previous data, PCA cerebrovascular conductance (CVC) index was decreased from rest (P < 0.004), but not VA CVC during IHG exercise (P > 0.084). Dynamic CA in both PCA and VA were unaltered during the IHG exercise (P = 0.129). On the other hand, PCA CVR was increased during the IHG exercise (P < 0.001) while VA CVR was unchanged (P = 0.294). In addition, individual exercise-induced changes in end-tidal partial pressure of CO2 was related to the individual change in PCA blood velocity (P < 0.046), but was not observed for VA blood flow (P > 0.420). Therefore, these exercise-induced differences in CVR between PCA and VA may contribute to exercise-induced heterogeneous CBF response in the posterior cerebral circulation. These findings indicate that the site-specific posterior CBF should be considered in further research for assessing posterior cerebral circulation.
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Affiliation(s)
- Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Hironori Watanabe
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Kazuya Suzuki
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Shotaro Saito
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan; Neurovascular Research Laboratory, University of South Wales, UK.
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Sentenac P, Charbit J, Maury C, Bory P, Dagod G, Greco F, Capdevila X, Perrigault PF. The Frontal Bone Window for Transcranial Doppler Ultrasonography in Critically Ill Patients: Validation of a New Approach in the ICU. Neurocrit Care 2021; 33:115-123. [PMID: 31664626 PMCID: PMC7392931 DOI: 10.1007/s12028-019-00869-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVE The temporal bone window (TBW) for transcranial Doppler (TCD) often fails to insonate the anterior cerebral artery (ACA). The frontal bone window (FBW) has never been evaluated in intensive care units (ICU). The main objective was to determine the ability of the FBW to assess ACA velocities in critically ill patients. METHODS A prospective study was conducted in two ICUs of the Montpellier University Hospital (France), between November 2014 and September 2016. Adult patients admitted to ICU for brain injury, with a Glasgow Coma Scale score ≤ 13, were enrolled within 3 days after admission. A first TCD examination was carried out bilaterally through the TBW and FBW by an intensivist expert in TCD, repeated by the same examiner, and 15 min later by an intensivist certified in TCD, designated as non-expert, blinded. The success of the FBW examinations was defined by the ability to measure the ACA velocities. Intra- and interobserver agreements were analyzed according to the Bland and Altman method. RESULTS A total of 147 patients were analyzed. The FBW succeeded in insonating the ACA in 66 patients [45%, CI (37-53)], 45 bilaterally and 21 unilaterally. For 16 patients (11%), the FBW was the only way to measure ACA velocities. By combining the two techniques, the ACA success rate increased from 62% CI (54-70) to 73% CI (65-79) (P = 0.05). Intra- and interobserver mean biases and 95% limits of agreement for ACA systolic velocity measurements through the FBW were 1 (- 33 to 35) and 2 (- 34 to 38) cm s-1, respectively. For paired TBW and FBW measures of ACA velocities, mean biases (± SD) for ACA systolic, and mean and diastolic velocities were relatively close to zero, but negatives (- 7 ± 33, - 2 ± 19, - 1 ± 15 cm s-1, respectively), highlighting that ACA velocities were lower with the FBW (A2 segment) than TBW (A1 segment). The correlation coefficient for ACA systolic velocities measured by the FBW and TBW was R = 0.47, CI (0.28-0.62). No risk factors for failure of the FBW were identified. CONCLUSIONS In ICU, the FBW was able to insonate the ACA in 45% of patients admitted for brain injury, without the use of contrast agents. The FBW could improve the detection of ACA vasospasms.
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Affiliation(s)
- Pierre Sentenac
- Anesthesia and Critical Care Medicine Department, Trauma ICU, Level 1 Regional Trauma Center, Lapeyronie Teaching Hospital, Montpellier University School of Medicine, 34295, Montpellier, France.
- Anesthesia and Critical Care Medicine Department, Neurological ICU, Gui de Chauliac Teaching Hospital, Montpellier University School of Medicine, 34295, Montpellier, France.
- PhyMedExp, Unité 1046, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, University of Montpellier, 34295, Montpellier, France.
- Anesthesia and Critical Care Medicine Department, Heart and Lung center, Arnaud de Villeneuve Teaching Hospital, Montpellier University School of Medicine, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
| | - Jonathan Charbit
- Anesthesia and Critical Care Medicine Department, Trauma ICU, Level 1 Regional Trauma Center, Lapeyronie Teaching Hospital, Montpellier University School of Medicine, 34295, Montpellier, France
| | - Camille Maury
- Anesthesia and Critical Care Medicine Department, Trauma ICU, Level 1 Regional Trauma Center, Lapeyronie Teaching Hospital, Montpellier University School of Medicine, 34295, Montpellier, France
| | - Paul Bory
- Anesthesia and Critical Care Medicine Department, Neurological ICU, Gui de Chauliac Teaching Hospital, Montpellier University School of Medicine, 34295, Montpellier, France
| | - Geoffrey Dagod
- Anesthesia and Critical Care Medicine Department, Trauma ICU, Level 1 Regional Trauma Center, Lapeyronie Teaching Hospital, Montpellier University School of Medicine, 34295, Montpellier, France
| | - Frédéric Greco
- Anesthesia and Critical Care Medicine Department, Neurological ICU, Gui de Chauliac Teaching Hospital, Montpellier University School of Medicine, 34295, Montpellier, France
| | - Xavier Capdevila
- Anesthesia and Critical Care Medicine Department, Trauma ICU, Level 1 Regional Trauma Center, Lapeyronie Teaching Hospital, Montpellier University School of Medicine, 34295, Montpellier, France
- Institut des Neurosciences de Montpellier (INM), Unité 1051, Institut National de la Santé et de la Recherche Médicale, University of Montpellier, 34091, Montpellier, France
| | - Pierre-François Perrigault
- Anesthesia and Critical Care Medicine Department, Neurological ICU, Gui de Chauliac Teaching Hospital, Montpellier University School of Medicine, 34295, Montpellier, France
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Abstract
Transcranial Doppler ultrasonography (TCD) is a noninvasive, bedside, portable tool for assessment of cerebral hemodynamics. Modern TCD head frames allow continuous hands-free emboli detection for risk stratification and assessment of treatment efficacy in several cardiovascular diseases. Identifying a focal stenosis, arterial occlusion, and monitoring the treatment effect of intravenous tissue plasminogen activator can easily be accomplished by assessing TCD waveforms and determining prestenotic and poststenotic mean flow velocities. TCD is an excellent screening tool for vasospasm in aneurysmal subarachnoid hemorrhage. The use of intraoperative TCD during carotid endarterectomy and stenting allows optimal intraoperative hemodynamic management. Other applications are also discussed.
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Affiliation(s)
- Ryan Hakimi
- Director, Neuro ICU, Inpatient Neurology, and TCD Services, Greenville Memorial Hospital, Prisma Health-Upstate, University of South Carolina School of Medicine-Greenville, 200 Patewood Drive, Suite B350, Greenville, SC 29615, USA.
| | - Andrei V Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163, USA
| | - Zsolt Garami
- Institute for Academic Medicine, Research Institute, Houston, TX, USA; Vascular Ultrasound Laboratory, Houston Methodist Hospital, Weill Cornell Medical College, 6550 Fannin Street, Suite 1401, Houston, TX 77030, USA
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Zhang X, Karuna T, Yao ZQ, Duan CZ, Wang XM, Jiang ST, Li XF, Yin JH, He XY, Guo SQ, Chen YC, Liu WC, Li R, Fan HY. High wall shear stress beyond a certain range in the parent artery could predict the risk of anterior communicating artery aneurysm rupture at follow-up. J Neurosurg 2019; 131:868-875. [PMID: 30265195 DOI: 10.3171/2018.4.jns173179] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/26/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Among clinical and morphological criteria, hemodynamics is the main predictor of aneurysm growth and rupture. This study aimed to identify which hemodynamic parameter in the parent artery could independently predict the rupture of anterior communicating artery (ACoA) aneurysms by using multivariate logistic regression and two-piecewise linear regression models. An additional objective was to look for a more simplified and convenient alternative to the widely used computational fluid dynamics (CFD) techniques to detect wall shear stress (WSS) as a screening tool for predicting the risk of aneurysm rupture during the follow-up of patients who did not undergo embolization or surgery. METHODS One hundred sixty-two patients harboring ACoA aneurysms (130 ruptured and 32 unruptured) confirmed by 3D digital subtraction angiography at three centers were selected for this study. Morphological and hemodynamic parameters were evaluated for significance with respect to aneurysm rupture. Local hemodynamic parameters were obtained by MR angiography and transcranial color-coded duplex sonography to calculate WSS magnitude. Multivariate logistic regression and a two-piecewise linear regression analysis were performed to identify which hemodynamic parameter independently characterizes the rupture status of ACoA aneurysms. RESULTS Univariate analysis showed that WSS (p < 0.001), circumferential wall tension (p = 0.005), age (p < 0.001), the angle between the A1 and A2 segments of the anterior cerebral artery (p < 0.001), size ratio (p = 0.023), aneurysm angle (p < 0.001), irregular shape (p = 0.005), and hypertension (grade II) (p = 0.006) were significant parameters. Multivariate analyses showed significant association between WSS in the parent artery and ACoA aneurysm rupture (p = 0.0001). WSS magnitude, evaluated by a two-piecewise linear regression model, was significantly correlated with the rupture of the ACoA aneurysm when the magnitude was higher than 12.3 dyne/cm2 (HR 7.2, 95% CI 1.5-33.6, p = 0.013). CONCLUSIONS WSS in the parent artery may be one of the reliable hemodynamic parameters characterizing the rupture status of ACoA aneurysms when the WSS magnitude is higher than 12.3 dyne/cm2. Analysis showed that with each additional unit of WSS (even with a 1-unit increase of WSS), there was a 6.2-fold increase in the risk of rupture for ACoA aneurysms.
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Affiliation(s)
- Xin Zhang
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Tamrakar Karuna
- 2Department of Neurosurgery, CMS-Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Zhi-Qiang Yao
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,3Department of Interventional Neuroradiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Chuan-Zhi Duan
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xue-Min Wang
- 4Key Laboratory of Psychiatric Disorders of Guangdong Province, Department of Neurobiology, School of Basic Medical Science, Southern Medical University, Guangzhou; and
| | - Shun-Ting Jiang
- 5Department of Neurosurgery, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xi-Feng Li
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jia-He Yin
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xu-Ying He
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shen-Quan Guo
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yun-Chang Chen
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wen-Chao Liu
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ran Li
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hai-Yan Fan
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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The role of wall shear stress in the parent artery as an independent variable in the formation status of anterior communicating artery aneurysms. Eur Radiol 2018; 29:689-698. [PMID: 30019140 DOI: 10.1007/s00330-018-5624-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/01/2018] [Accepted: 06/21/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The study aimed to determine which hemodynamic parameters independently characterize anterior communicating artery (AcomA) aneurysm formation and explore the threshold of wall shear stress (WSS) of the parent artery to better illustrate the correlation between the magnitude of WSS and AcomA aneurysm formation. METHODS Eighty-one patients with AcomA aneurysms and 118 patients without intracranial aneurysms (control population), as confirmed by digital subtraction angiography (DSA) from January 2014 to May 2017, were included in this cross-sectional study. Three-dimensional-DSA was performed to evaluate the morphologic characteristics of AcomA aneurysms. Local hemodynamic parameters were obtained using transcranial color-coded duplex (TCCD). Multivariate logistic regression and a two-piecewise linear regression model were used to determine which hemodynamic parameters are independent predictors of AcomA aneurysm formation and identify the threshold effect of WSS of the parent artery with respect to AcomA aneurysm formation. RESULTS Univariate analyses showed that the WSS (p < 0.0001), angle between the A1 and A2 segments of the anterior cerebral artery (ACA) (p < 0.001), hypertension (grade II) (p = 0.007), fasting blood glucose (FBG; > 6.0 mmol/L) (p = 0.005), and dominant A1 (p < 0.001) were the significant parameters. Multivariate analyses showed a significant association between WSS of the parent artery and AcomA aneurysm formation (p = 0.0001). WSS of the parent artery (7.8-12.3 dyne/cm2) had a significant association between WSS and aneurysm formation (HR 2.0, 95% CI 1.3-2.8, p < 0.001). CONCLUSIONS WSS ranging between 7.8 and 12.3 dyne/cm2 independently characterizes AcomA aneurysm formation. With each additional unit of WSS, there was a one-fold increase in the risk of AcomA aneurysm formation. KEY POINTS • Multivariate analyses and a two-piecewise linear regression model were used to evaluate the risk factors for AcomA aneurysm formation and the threshold effect of WSS on AcomA aneurysm formation. • WSS ranging between 7.8 and 12.3 dyne/cm 2 was shown to be a reliable hemodynamic parameter in the formation of AcomA aneurysms. The probability of AcomA aneurysm formation increased one-fold for each additional unit of WSS. • An ultrasound-based TCCD technique is a simple and accessible noninvasive method for detecting WSS in vivo; thus, it can be applied as a screening tool for evaluating the probability of aneurysm formation in primary care facilities and community hospitals because of the relatively low resource intensity.
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Washio T, Sasaki H, Ogoh S. Transcranial Doppler-determined change in posterior cerebral artery blood flow velocity does not reflect vertebral artery blood flow during exercise. Am J Physiol Heart Circ Physiol 2017; 312:H827-H831. [PMID: 28188214 DOI: 10.1152/ajpheart.00676.2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/22/2022]
Abstract
We examined whether a change in posterior cerebral artery flow velocity (PCAv) reflected the posterior cerebral blood flow in healthy subjects during both static and dynamic exercise. PCAv and vertebral artery (VA) blood flow, as an index of posterior cerebral blood flow, were continuously measured during an exercise trial using transcranial Doppler (TCD) ultrasonography and Doppler ultrasound, respectively. Static handgrip exercise significantly increased both PCAv and VA blood flow. Increasing intensity of dynamic exercise further increased VA blood flow from moderate exercise, while PCAv decreased to almost resting level. During both static and dynamic exercise, the PCA cerebrovascular conductance (CVC) index significantly decreased from rest (static and high-intensity dynamic exercise, -11.5 ± 12.2% and -18.0 ± 16.8%, means ± SD, respectively) despite no change in the CVC of VA. These results indicate that vasoconstriction occurred at PCA but not VA during exercise-induced hypertension. This discrepancy in vascular response to exercise between PCA and VA may be due to different cerebral arterial characteristics. Therefore, to determine the effect of exercise on posterior cerebral circulation, at least, we need to carefully consider which cerebral artery to measure, regardless of exercise mode.NEW & NOTEWORTHY We examined whether transcranial Doppler-determined flow velocity in the posterior cerebral artery can be used as an index of cerebral blood flow during exercise. However, the changes in posterior cerebral artery flow velocity during exercise do not reflect vertebral artery blood flow.
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Affiliation(s)
- Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe-shi, Japan
| | - Hiroyuki Sasaki
- Department of Biomedical Engineering, Toyo University, Kawagoe-shi, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-shi, Japan
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Carminati M, Agnifili M, Arcidiacono C, Brambilla N, Bussadori C, Butera G, Chessa M, Heles M, Micheletti A, Negura DG, Piazza L, Saracino A, Testa L, Tusa M, Bedogni F. Role of imaging in interventions on structural heart disease. Expert Rev Cardiovasc Ther 2014; 11:1659-76. [DOI: 10.1586/14779072.2013.854166] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lucht B, Hubbell A, Hynynen K. Contrast-enhanced transcranial two-dimensional ultrasound imaging using shear-mode conversion at low frequency. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:332-344. [PMID: 23245822 DOI: 10.1016/j.ultrasmedbio.2012.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 09/06/2012] [Accepted: 09/07/2012] [Indexed: 06/01/2023]
Abstract
The distortion and attenuation of transcranial ultrasound (US) signals are significant problems in US imaging of the brain. Of the variety of proposed solutions, shear-mode transmission through the skull is one of the more recent options and has been shown to reduce distortion of the US beam. This study examined the effects of transcranial shear-mode transmission on the images of a contrast-agent-filled polytetrafluoroethylene tube produced by a 32-element 750 kHz linear phased array transducer through an ex vivo human skull section. Although the tube was successfully imaged using shear-mode transmission with subharmonic imaging in 6 of 9 cases, the tube was visible in only 1 of 9 cases for both the fundamental and the second harmonic frequencies. Some improvement in the location of the axial image was seen at the fundamental frequency using shear mode. No improvement was seen at the other two frequencies, but this may be due to low transducer sensitivity. As well, neither the presence of the skull nor the incident angle changed the distance at which signals from the two tubes could be resolved. With this transducer, these distances were found to be 5 mm laterally and 3 mm axially for the fundamental and second harmonic images, and 10 mm and 5 mm for the subharmonic images. The results show that the subharmonic signal was the most successful of the three examined in penetrating a thick skull but that the success comes at the cost of image resolution.
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Affiliation(s)
- Benjamin Lucht
- Imaging Research, Sunnybrook Research Institute, Toronto, ON, Canada.
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Zamboni P, Menegatti E, Viselner G, Morovic S, Bastianello S. Fusion imaging technology of the intracranial veins. Phlebology 2011; 27:360-7. [DOI: 10.1258/phleb.2011.011069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Fusion imaging technology (FIT) combines different imaging techniques by means of properly designed software. The aim of this study was to validate the ultrasonographic representation of intracranial vein anatomy by combining transcranial echo-colour Doppler (TECD) with conventional magnetic resonance imaging (MRI). In addition, we investigated the possibility of insonating the veins of the base of the skull through the novel condylar window. Methods We examined venous brain circulation in five healthy subjects by means of FIT, using a 1.5 T MR scanner and an ultrasound TECD equipped with Virtual Navigator technology. Results and conclusions Insonation of the Rosenthal and other intracranial veins through the classical transtemporal window, based on anatomical assumption, but never before validated by means of FIT study, was confirmed. Moreover, in all five subjects, FIT demonstrated the possibility of insonating the petrosal sinuses and the cavernous sinus area through the novel transcondylar approach. In conclusion, the feasibility of FIT of the intracranial veins potentially permits to study subjects in different postures and/or at the bed of non-transportable patients, after the initial MRI acquisition. Finally, the novel transcondylar approach allows obtaining haemodynamic information from the cavernous and the petrosal sinuses usually not investigated by TECD alone.
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Affiliation(s)
- P Zamboni
- Vascular Disease Center, University of Ferrara, Ferrara
| | - E Menegatti
- Vascular Disease Center, University of Ferrara, Ferrara
| | - G Viselner
- Neuroradiological Department, Fondazione Istituto Neurologico Nazionale Casimiro Mondino, University of Pavia, Pavia, Italy
| | - S Morovic
- Vascular Disease Center, University of Ferrara, Ferrara
| | - S Bastianello
- Neuroradiological Department, Fondazione Istituto Neurologico Nazionale Casimiro Mondino, University of Pavia, Pavia, Italy
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10
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Meairs S, Hennerici M, Mohr J. Ultrasonography. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Yoshimura S, Koga M, Toyoda K, Mukai T, Hyun BH, Naganuma M, Nagatsuka K, Minematsu K. Frontal bone window improves the ability of transcranial color-coded sonography to visualize the anterior cerebral artery of Asian patients with stroke. AJNR Am J Neuroradiol 2009; 30:1268-9. [PMID: 19213827 DOI: 10.3174/ajnr.a1452] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The frontal bone window (FBW) is a promising approach in evaluating the anterior cerebral artery. The goal of the present study was to determine the rates of detection of the basal cerebral arteries by using the FBW alone and a combination of the FBW with the temporal bone window (TBW) in 163 patients. The combined application improved detection rates of A1 (58.6% versus 46.0%, P = .001) and A2 (43.6% versus 6.7%, P < .001) compared with the TBW alone.
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Affiliation(s)
- S Yoshimura
- Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan
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Kaspera W, Ładziński P, Słowiński J, Kopera M, Tomalski W, Ślaska-Kaspera A. Blood flow velocity in the arteries of the anterior cerebral artery complex in patients with an azygos anterior cerebral artery aneurysm: A transcranial color-coded sonography study. Clin Neurol Neurosurg 2009; 111:63-8. [DOI: 10.1016/j.clineuro.2008.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2007] [Revised: 06/10/2008] [Accepted: 08/04/2008] [Indexed: 10/21/2022]
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Alexandrov AV, Sloan MA, Wong LKS, Douville C, Razumovsky AY, Koroshetz WJ, Kaps M, Tegeler CH. Practice Standards for Transcranial Doppler Ultrasound: Part I-Test Performance. J Neuroimaging 2007; 17:11-8. [PMID: 17238867 DOI: 10.1111/j.1552-6569.2006.00088.x] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Indications for the clinical use of transcranial Doppler (TCD) continue to expand while scanning protocols and quality of reporting vary between institutions. Based on literature analysis and extensive personal experience, an international expert panel started the development of guidelines for TCD performance, interpretation, and competence. The first part describes complete diagnostic spectral TCD examination for patients with cerebrovascular diseases. Cranial temporal bone windows are used for the detection of the middle cerebral arteries (MCA), anterior cerebral arteries (ACA), posterior cerebral arteries (PCA), C1 segment of the internal carotid arteries (ICA), and collateralization of flow via the anterior (AComA) and posterior (PComA) communicating arteries; orbital windows-for the ophthalmic artery (OA) and ICA siphon; the foraminal window-for the terminal vertebral (VA) and basilar (BA) arteries. Although there is a significant individual variability of the circle of Willis with and without disease, the complete diagnostic TCD examination should include bilateral assessment of the M2 (arbitrarily located at 30-40 mm depth), M1 (40-65 mm) MCA [with M1 MCA mid-point at 50 mm (range 45-55 mm), average length 16 mm (range 5-24 mm), A1 ACA (60-75 mm), C1 ICA (60-70 mm), P1-P2 PCA (average depth 63 mm (range 55-75 mm), AComA (70-80 mm), PComA (58-65 mm), OA (40-50 mm), ICA siphons (55-65 mm), terminal VA (40-75 mm), proximal (75-80), mid (80-90 mm), and distal (90-110 mm) BA]. The distal ICA on the neck (40-60 mm) can be located via submandibular windows to calculate the VMCA/VICA index, or the Lindegaard ratio for vasospasm grading after subarachnoid hemorrhage. Performance goals of diagnostic TCD are to detect and optimize arterial segment-specific spectral waveforms, determine flow direction, measure cerebral blood flow velocities and flow pulsatility in the above-mentioned arteries. These practice standards will assist laboratory accreditation processes by providing a standard scanning protocol with transducer positioning and orientation, depth selection and vessel identification for ultrasound devices equipped with spectral Doppler and power motion Doppler.
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Keech AC, Grieve SM, Patel A, Griffiths K, Skilton M, Watts GF, Marwick TH, Groshens M, Celermajer DS. Urinary albumin levels in the normal range determine arterial wall thickness in adults with Type 2 diabetes: a FIELD substudy. Diabet Med 2005; 22:1558-65. [PMID: 16241922 DOI: 10.1111/j.1464-5491.2005.01688.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Cardiovascular disease (CVD) rates are substantially higher among patients with Type 2 diabetes than in the general population. The objective of this study was to identify the determinants of carotid intima media thickness (IMT) in patients with Type 2 diabetes. METHODS We measured the thickness of the intima media layer of the carotid artery, a strong predictor of the risk of future vascular events, in 397 Type 2 diabetic patients drawn from the Fenofibrate Intervention and Event Lowering in Diabetes study, prior to treatment allocation. RESULTS The mean IMT was 0.78 mm [interquartile range (IQR) 0.23 mm], and the maximum IMT was 1.17 mm (IQR 0.36 mm). By multivariate analysis, age, sex, duration of diabetes, triglycerides, and total cholesterol were independently correlated with IMT, as was urine albumin-creatinine ratio (ACR) (P < 0.001). The effect of ACR on IMT was further examined by tertile. Clinically significant differences in IMT were associated with ACR > 0.65 mg/mmol, approximately one-fifth the standard clinical threshold for microalbuminuria (P < 0.01). Long-term diabetes, independent of other parameters, was associated with a 50% increase in age-related thickening. CONCLUSIONS IMT in people with Type 2 diabetes is independently and continuously related to urine albumin levels and to the duration of diabetes. These results support previous data linking urine albumin measurements within the normal range with increased ischaemic cardiac mortality in the setting of Type 2 diabetes, and strongly suggest that urine albumin levels within this range should trigger a formal evaluation for CVD.
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Affiliation(s)
- A C Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney NSW 2006, Australia.
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Kern R, Perren F, Kreisel S, Szabo K, Hennerici M, Meairs S. Multiplanar transcranial ultrasound imaging: standards, landmarks and correlation with magnetic resonance imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2005; 31:311-315. [PMID: 15749552 DOI: 10.1016/j.ultrasmedbio.2004.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Revised: 11/24/2004] [Accepted: 12/02/2004] [Indexed: 05/24/2023]
Abstract
The purpose of this study was to define a standardized multiplanar approach for transcranial ultrasound (US) imaging of brain parenchyma based on matched data from 3-D US and 3-D magnetic resonance imaging (MRI). The potential and limitations of multiple insonation planes in transverse and coronal orientation were evaluated for the visualization of intracranial landmarks in 60 healthy individuals (18 to 83 years old, mean 41.4 years) with sufficient temporal bone windows. Landmarks regularly visualized even in moderate sonographic conditions with identification rates of >75% were mesencephalon, pons, third ventricle, lateral ventricles, falx, thalamus, basal ganglia, pineal gland and temporal lobe. Identification of medulla oblongata, fourth ventricle, cerebellar structures, hippocampus, insula, frontal, parietal and occipital lobes was more difficult (<75%). We hypothesize that multiplanar transcranial US images, with standardized specification of tilt angles and orientation, not only allow comparison with other neuroimaging modalities, but may also provide a more objective framework for US monitoring of cerebral disease than freehand scanning.
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Affiliation(s)
- Rolf Kern
- Department of Neurology, Universitätsklinikum Mannheim, University of Heidelberg, Mannheim, Germany
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16
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Meairs S, Hennerici M, Mohr J. Ultrasonography. Stroke 2004. [DOI: 10.1016/b0-44-306600-0/50026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Schreiber SJ, Stolz E, Valdueza JM. Transcranial ultrasonography of cerebral veins and sinuses. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 2002; 16:59-72. [PMID: 12470851 DOI: 10.1016/s0929-8266(02)00051-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Transcranial ultrasonography has become a valuable diagnostic tool for the bed-side evaluation of cerebral hemodynamics. While the assessment of arterial blood flow is well established, analysis of venous hemodynamics by transcranial ultrasonography is a new application of the method. The present review summarises the current state of transcranial venous ultrasound in adults by means of transcranial Doppler (TCD) and transcranial colour-coded duplex sonography (TCCS). It gives a critical overview regarding current and possible future clinical applications of the techniques.
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Affiliation(s)
- S J Schreiber
- Department of Neurology, University Hospital Charité, Schumannstr 20/21, 10098, Berlin, Germany
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18
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Wang HS, Kuo MF. Using the supraorbital window routinely in transcranial sonography. J Neuroimaging 2002; 12:375; author reply 375. [PMID: 12380487 DOI: 10.1111/j.1552-6569.2002.tb00149.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Stolz E. Response. J Neuroimaging 2002. [DOI: 10.1111/j.1552-6569.2002.tb00150.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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20
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Stolz E, Mendes I, Gerriets T, Kaps M. Assessment of intracranial collateral flow by transcranial color-coded duplex sonography using a temporal and frontal axial insonation plane. J Neuroimaging 2002; 12:136-43. [PMID: 11977908 DOI: 10.1111/j.1552-6569.2002.tb00110.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE The insonation of the posterior communicating artery (PcomA) is often hampered by the unfavorable insonation angle when the temporal acoustic bone window (TBW) is used. This problem may be ameliorated by a lateral frontal bone window (LFBW). This study evaluated the TBW and LFBW for the assessment of collateral intracranial flow conditions and aimed at defining diagnostic transcranial color-coded duplex sonography (TCCS) criteria that do not need compression maneuvers. METHODS The A1 segment of the anterior cerebral artery (ACA), the PcomA, and the P1 segment of the posterior cerebral artery (PCA) were insonated by TCCS in 40 controls and 20 patients (16 internal carotid artery [ICA] occlusions or high grade stenoses, 3 middle cerebral artery stenoses or occlusions, 1 PCA stenosis). RESULTS Detection rates for the A1 ACA and P1 PCA were higher for the TBW (94%, 98%) compared to the LFBW (86%, 81%) in controls. The PcomA was identified more frequently through the LFBW (86%) compared to the TBW (80%). Through the LFBW angle, corrected flow velocity (FV) measurements were possible for the PcomA with an average correction of 6.5 degrees. In controls, in > 80% of identified PcomAs, flow was directed towards the ICA. Side to side differences were below 7% for peak systolic FVs. In the patients with ICA disease, a flow reversal in the ipsilateral A1 ACA and a FV difference of > 30% seemed feasible for diagnosis of anterior communicating artery crossflow. Criteria for PcomA crossflow were side differences of FVs in the PcomA of > or = 30% and in the P1 PCA of > or = 20%. CONCLUSIONS The LFBW proved useful as a complementary insonation plane to assess intracranial crossflow conditions, especially via the PcomA. We were able to define TCCS criteria for functional relevant collateralization without the need of compression maneuvers.
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Affiliation(s)
- Erwin Stolz
- Department of Neurology, Justus-Liebig-University, Am Steg 14, D-35385 Giessen, Germany.
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Abstract
Transcranial colour-coded duplex sonography (TCCS) is a new and non-invasive ultrasound application that combines both imaging of intracranial vessels and parenchymal structures at a high spatial resolution. This manuscript reviews the clinical applications of TCCS with focus on its diagnostic abilities in acute stroke patients. Furthermore, new experimental imaging techniques are discussed.
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Affiliation(s)
- Stephan G Zipper
- Neurological Department of the St Katharinenkrankenhaus, Frankfurt/Main, Germany.
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