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Neurological Surgery No Shinkei Geka Volume 20, Issue 5 （May 1992）

Neurological Surgery 脳神経外科 20巻5号（1992年5月発行）

Japanese English

研究

Transcranial Doppler Arteriographyによる脳動脈瘤の血行動態 The Hemodynamics of Intracranial Aneurysm by Transcranial Doppler Arteriography 辻本正三郎 ¹ , 竹嶋俊一 ¹ , 榊寿右 ¹ , 横山和弘 ² , 奥村嘉也 ² , 永田清 ² , 澤井冬樹 ³ Shozaburo TSUJIMOTO ¹ , Toshikazu TAKESHIMA ¹ , Toshisuke SAKAKI ¹ , Kazuhiro YOKOYAMA ² , Yoshinari OKUMURA ² , Kiyoshi NAGATA ² , Fuyuki SAWAI ³ ¹奈良県立医科大学脳神経外科 ²町立大淀病院脳神経外科 ³町立大淀病院脳神経内科 ¹Department of Neuro-surgery, Nara Medical University ²Department of Neurosurgery, Oyodo General Hospital ³Department of Internal Medicine, Oyodo General Hospital キーワード： Transcranial dopper arteriography（TCDA） , Transcraial dopplersonography（TCD） , Intracranial aneurysm , Hemodynamics , Ultrasonic diagnosis Keyword: Transcranial dopper arteriography（TCDA） , Transcraial dopplersonography（TCD） , Intracranial aneurysm , Hemodynamics , Ultrasonic diagnosis pp.541-546

発行日 1992年5月10日 Published Date 1992/5/10

DOI https://doi.org/10.11477/mf.1436900458

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Abstract 文献概要
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I．はじめに

　破裂脳動脈瘤の頻度は人口10万人当り年間16-17人といわれ71，また剖検での未破裂脳動脈瘤の頻度は2—5％8）であり，その頻度はかなり高いものである．また一旦発症するとその50-65％が死亡する^3）ためscreeningtestが非常に重要である．しかし，脳血し管撮影やDigit—al Subtraction Angiography（DSA）などの検査は侵襲的であることから，非侵襲的な補助検査法が求められている．

　1988年以来われわれは，脳血管撮影で確認された脳動脈瘤内の血流に対しTranscranial Doppler Arterio—graphy（TCDA）による検出を試みてきた．今回，脳動脈瘤の血行動態と検出率を検討した．

Abstract

The use of an ultrasonic transcranial Doppler arte-riography (TCDA) technique for noninvasive diagnosis of cerebral aneurysm is described. Twenty one patients with intracranial aneurysm previously diagnosedl byconventional angiography were evaluated with Trans-Scan (EME) . Mapping image was used as a guide to identify parent artery and aneurysm. In four patients, we could not record aneurysmal blood flow because of their poor or non existent acoustic window. Good im-ages were recorded in 17 patients.

The location of aneurysms were A-com (1 case), Dis-tal ACA (2 cases), IC (7 cases), MCA (3 cases), Basi-lar (1 case) and IC fusiform (3 cases) . Two types of Doppler spectra were obtained from the aneurysmal blood flow. One was characterized by a high density zone along the base line and the other was characte-rized by a homogeneous high density zone. In both types, Doppler sound was characterized by low fre-quency sound. The low frequency sound reflects the turbulent flow in the aneurysm.

The pattern of Doppler spectra obtained from ordi-nary arteries was characterized by a high density zone along the descending limb of the envelope. Doppler sound is characterized by high frequency sound. A homogeneous spectral pattern was obtained in both aneurysms and ordinary arteries. But it was possi-ble to differentiate them by Doppler sound. Conse-quently to be able to hear Doppler sound is very impor-tant. We were able to detect fourteen of seventeen aneurysms (A-corn 1/1, Distal ACA 1/2, IC 7/7, MCA 2/3, Basilar 1/1, and IC fusiform 2/3). The rate of de-tection was 82 percent. Aneurysm size ranged from 5mm × 4mm to 16mm × 18mm. The maximum diameter of the smallest aneurysms we could detect was 5mm in 4 cases. We expect TCDA, to become a good means, for a noninvasive examination to detect intracranial aneurysms.