Vascular diagnosis with ultrasound/ 1, Cerebral and peripheral vessels: 49 tables. / Michael G. Hennerici; Doris Neuerburg-Heusler

381 Pages·2006·27.53 MB·English

by  Doris Neuerburg-Heusler

Hennerici_Vasc_103832 11.10.2005 11:48 Uhr Seite 1
N H Vascular Diagnosis
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Vascular Diagnosis with Ultrasound e Clinical Reference with Case Studies
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One of the most powerful non-invasive diagnostic tools available to clinicians, vascular V Volume 1: Cerebral and Peripheral Vessels
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ultrasound technology has undergone dramatic changes in recent years, creating exciting
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new diagnostic and treatment options for a growing array of disorders. The completely c
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Michael G. Hennerici
revised new edition of Vascular Diagnosis of Ultrasound offers the most comprehensive l
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and up-to-date information on the broad spectrum of vascular ultrasound applications. r
Doris Neuerburg-Heusler
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Now in two volumes—1: Cerebral and Peripheral Vessels and 2: Abdominal and Renal ia
Vessels—this edition retains the accessible design and logical structure of the first edition g and
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and adds a new team of expert contributors and more than 500 illustrations and images. o Michael Daffertshofer
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Volume 1 features: s Thomas Karasch

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Stephen Meairs
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• Comprehensive coverage of vascular ultrasonography in the arteries and veins t
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of the cerebral circulation and the peripheral upper and lower limb circulation.
U 2nd revised edition
• Systematic presentation of all available ultrasound technologies—including l
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continuous and pulsed-wave Doppler mode, B-mode, conventional and color- ra
coded duplex analysis in frequency and amplitude power modes. s
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• In-depth chapters on anatomy and physiology, normal and abnormal findings,
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test accuracy and sensitivity. d
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• Helpful comparison with data from other diagnostic methods (e.g., conventional V
and noninvasive MR angiography) used in each region, as well as authoritative o
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assessments of recent developments in ultrasound technology, such as tissue u
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perfusion studies, 3D and 4D imaging, contrast enhancement, and microbubble
applications, and their diagnostic and therapeutic implications (sonothrombolysis e

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and thrombus micro-fragmentation).
• A revised section with many new, challenging case studies for review both for the
novice and the expert in the field.
Praise for the first edition of Vascular Diagnosis with Ultrasound:
“A huge asset to the library of the ultrasound department…will be the first source of
information for any vascular ultrasound questions. Highly recommended.”—RAD Magazine
“An exhaustive review of vascular diagnosis… I recommend it to any physician in training
or practice… vivid illustrations and high-quality color images complement the excellent 2
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discussions.”—Journal of Vascular Surgery d
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The Americas ISBN 3-13-103832-2 (GTV) Rest of World
ISBN 1-58890-144-0 (TNY)
ISBN 1-58890-144-0 ISBN 3-13-103832-2
,!7IB5I8-jabeeg! ,!7ID1D1-adidcg!
www.thieme.com
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Vascular Diagnosis with Ultrasound
Clinical Reference with Case Studies
Volume 1: Cerebral and Peripheral Vessels
Michael G. Hennerici, M.D., Ph.D. Doris Neuerburg-Heusler, M.D.
Professor and Chairman Former Director of the Department
Department of Neurology of Noninvasive Diagnostics
University of Heidelberg Aggertalklinik, Engelskirchen
Klinikum Mannheim Cologne, Germany
Mannheim, Germany
With contributions by
Michael Daffertshofer, M.D, Ph.D. Thomas Karasch, M.D. Stephen Meairs, M.D., Ph.D.
Associate Professor Department of Associate Professor
Department of Neurology Cardiology/Angiology Department of Neurology
University of Heidelberg University of Cologne University of Heidelberg
Klinikum Mannheim Cologne, Germany Klinikum Mannheim
Mannheim, Germany Mannheim, Germany
2nd revised edition
532 illustrations
49 tables
Thieme
Stuttgart · New York
IV
LibraryofCongressCataloging-in-PublicationData Important note: Medicine is an ever-changing science
Hennerici,M.(Michael)G. undergoing continual development. Research and clini-
[GefässdiagnostikmitUltraschall.English] calexperiencearecontinuallyexpandingourknowledge,
Vasculardiagnosiswithultrasound:clinicalreferences in particular our knowledge of proper treatment and
with case studies / Michael G. Hennerici, Doris Neuer- drugtherapy.Insofarasthisbookmentionsanydosageor
burg-Heusler ; with contributions by Michael Dafferts- application, readers may rest assured that the authors,
hofer,ThomasKarasch,StephenMeairs. editors,andpublishershavemadeeveryefforttoensure
p.cm. thatsuchreferencesareinaccordancewiththestateof
Rev.translationof:GefässdiagnostikmitUltraschall.2. knowledgeatthetimeofproductionofthebook.
Aufl.1995. Nevertheless,thisdoesnotinvolve,imply,orexpressany
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ISBN 3−13-103832−2 (alk. paper) −- ISBN 1−58890- inrespecttoanydosageinstructionsandformsofappli-
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1.Blood-vessels-−Ultrasonic imaging. 2.Blood-vessels-− aminecarefullythemanufacturers’leafletsaccompany-
Ultrasonicimaging-−Casestudies. ingeachdrugandtocheck,ifnecessaryinconsultation
[DNLM: 1.Vascular Diseases-−ultrasonography.WG withaphysicianorspecialist,whetherthedosagesched-
500 H515g 2005a]I. Neuerburg-Heusler, Doris. II. Hen- ules mentioned therein or the contraindications stated
nerici, M. (Michael) Gefässdiagnostik mit Ultraschall. bythemanufacturersdifferfromthestatementsmadein
EnglishIII.Title. the present book. Such examination is particularly im-
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V
Preface
Diagnosisandtreatmentofvasculardiseaseshavemade largestudytrialsandbasicresearch.Italsointroduced
tremendousprogresssincetheintroductionofnon-in- experimental techniques just investigated in research
vasiveultrasoundtechnologiesinclinicalpracticeinthe laboratories at that time (harmonic imaging, 3-D and
early1970s.Todayultrasoundiscapableofmonitoring 4-Dimaging,flowvolumemeasurements,intra-arterial
the early silent stages of atherogenesis as well as the and interventional applications, functional and moni-
morphological features of advanced atherosclerosis toringstudies,etc.).AthirdGermaneditionwaspub-
duringitsprogressionandregressioninallmajorarter- lished very soon thereafter in 1999; due to the fast
ies of the body. The ability of ultrasound to visualize developmentofultrasound,thiseditionincludednew
botharterialandvenousthrombusformationhasbeen dataonimagingofperfusionindifferentorgansandin-
expanded to include detection and quantification of vestigationsofsmallvesselnetworksbymeansofnew
circulating microemboli. Vascular ultrasound studies echocontrastmedia.
areimportanttoolsinindividualpatientdiagnosisand Sincetheamountofmaterialtobeincludedinthe
duringfollow-up,andnotablyinrandomized,prospec- newsecondEnglisheditionof"VascularDiagnosiswith
tive clinical trials that serve to strengthen evidence- Ultrasound"hasbeengrowingsorapidlyandbecause
basedmedicineforclinicalpractice.Therecentuseof wedidnotwanttomissthebroadspectrumofvascular
state-of-the-artultrasoundmonitoringinsuchstudies ultrasoundapplicationsaddressingalargecommunity
hashelpedtointroducenewpathwaysforthemanage- ofbothinvestigatorsandclinicians(whoarenowcon-
ment of our patients, both in modern industrialized fronted with results of ultrasound studies from
societies and in developing countries. Increasing age throughout the world using different instruments,
combinedwiththeunfortunatelyremaininghighprev- differenttechnologies,anddifferenteconomicrestric-
alencesandincidencesofmyocardialinfarction,stroke, tions),wedecidedtocompletelyrevisethetextandsplit
andperipheralvasculardiseaseunderlinetheneedfor thebookintotwovolumes.Thefirstvolumedealswith
earlyidentificationofsubjectsathighriskfortreatment cerebral and peripheral vessels. The second volume
inayetasymptomaticperiodwithpotentialtherapeutic addresses the abdominal vessels, small parts vessels,
impactinprimaryprevention,andformeanstoimprove andtopicssuchastumorvascularization,whichhasbe-
monitoring for secondary prevention. Ultrasound will come a fascinating area of vascular ultrasound. The
continuetoplayamajorroleinrealizingtheseimpor- completerevisionincludesbothdiagnosticandthera-
tantgoalsofpreventivemedicine;asitisnon-invasive, peuticaspectsofultrasoundthataddress,particularlyin
alwaysavailable,andeconomicallyviable,ithasdistinct theatlas,theadvantagesofrecentneurosonologictech-
advantagesoverallothervasculardiagnostictools. nologies and applications. This edition also provides
The first German edition of this book (1988) was newinformationonultrasoundproceduresinperiph-
welcomed by both novice and experienced sono- eral angiology, reflecting the results of recent ultra-
graphers due to its strict illustrative composition. A sound studies that provide normative parameters for
majorrevisionpublishedin1994wasnecessaryforin- therapeuticdecisions.Newerhorizonsinvascularsono-
clusionofrapidlydevelopingtechnologies.Thisedition graphy,suchassonothrombolysisinstroke,peripheral
firstintroducedacollectionofindividualcasehistories artery thrombolysis using intra-arterial ultrasound to
andvascularfindings,whichbecameofmajorinterestto causemicro-fragmentationofthrombi,andmolecular
manyreadersofthebook.Theatlasillustratedfromthe imaging for non-invasive detection of diseases using
very beginning the combined use of ultrasound tech- microbubblestargetedtodisease-associatedmolecular
nologieswithclinicaldataandothermethodsappliedin structures,areonlyafewofthefascinatingperspectives
clinicalpracticeandwasparticularlyusefulandwellac- addressedinthisnewvolume.
cepted both by the specialized collaborations in the Thefirstvolumeofthisnewsecondeditionhascon-
vascularlaboratory,aswellasbycliniciansunfamiliar tinuedtobewrittenbyM.G.HennericiandD.Neuer-
withspecificultrasoundtestsbutusingtheirreports.In burg-Heusler. However, this would not have been
1997whenthefirstEnglisheditionwaspublished,rare possiblewithoutthehelpandcooperationofnewco-
findingsandspecificproblemswereonlyoccasionally workers, such as Michael Daffertshofer and Stephen
includedandselectedrepetitionswereintentionalfor MeairsfromtheDepartmentofNeurology,Universityof
educationalpurposes.Thiseditionwasalsoacomplete Heidelberg,UniversitätsklinikumMannheimandongo-
revisionofthesecondGermanmonographandincluded ingcooperationwithThomasKarasch,Departmentof
advancedultrasoundapplicationsaswellasdatafrom InternalMedicine(Cardiology/Angiology),Universityof
VI Preface
Cologne,whoseexpertisewassowellacknowledgedal- volume,withthesupportofourteamfromThiemepub-
ready for previous editions. We are grateful to our lishers headed by Cliff Bergman. We are especially
vasculartechniciansandsecretarieswhohelpeduswith grateful for the continuous support of our families,
the enormous work on the manuscript, including the Marion Hennerici, and the late Helmut Neuerburg;
continuous preparation of the abundant literature in withouttheirloveandsupportwewouldhavefailed.
thisexcitinganddevelopingfield.Ittookuslongerthan
expected but we finally managed to finish the first MichaelG.HennericiandDorisNeuerburg-Heusler
VII
Table of Contents
1 Physics and Technology of Ultrasound 1
BasicUltrasoundPhysics ..................... 1 Time-IntervalHistograms ................... 13
PropertiesofWaves ........................... 1 SpectralAnalysis ........................... 13
Reflection ..................................... 1 Three-DimensionalUltrasound ................. 14
Refraction..................................... 2 ImageAcquisition .......................... 15
ScatteringandDiffraction ...................... 2 MonitoringSpatialPosition............... 15
Attenuation ................................... 2 ComputerizedMotor-DrivenSystems ..... 15
IntensityandPower ........................... 2 SemiregistrationTechniques ............. 15
TheDopplerEffect............................. 2 POMScanheadTracking.................. 16
ReconstructionTechniques .................. 16
UltrasoundTechnology ....................... 3
VisualizationTechniques .................... 16
DopplerSystems .............................. 3
Four-DimensionalApplications ................. 17
Continuous-WaveDopplerSonography ...... 3
Pulsed-WaveDopplerSonography ........... 3 ContrastImaging ............................. 18
B-ModeImaging............................... 6 NonlinearCharacteristicsofMicrobubbles ...... 18
ColorDopplerFlowImaging ................... 7 MicrobubbleDestruction....................... 18
PowerDopplerImaging ........................ 9 LowMechanicalIndexImaging................. 19
DuplexSystems ............................... 9 StimulatedAcousticEmission .................. 19
CompoundImaging............................ 10 HarmonicImaging............................. 19
B-FlowImaging ............................... 10 PulseInversionHarmonicImaging ............. 20
Transducers ................................... 11 PowerPulseInversionImaging ................. 20
SignalAnalysis ................................ 12 MicrovascularImaging......................... 20
AudioSignalAnalysis ....................... 12 MicrobubbleRefillKinetics..................... 21
Zero-CrossingCounter ...................... 12 References .................................... 22
2 Extracranial Cerebral Arteries 27
Examination.................................. 27 AnatomyandFindings ...................... 36
SpecialEquipmentandDocumentation ......... 27 Anatomy ................................ 36
ExaminationConditions ....................... 27 Findings................................. 37
PatientandExaminer ....................... 27 Evaluation .................................... 37
ConductingtheExamination ................ 27 SourcesofError ............................... 37
ExaminationSequence ...................... 29 NeckArteries ................................. 38
OrbitalArteries................................ 29 Principle ................................... 38
NeckArteries ................................. 29 AnatomyandFindings ...................... 39
CommonCarotidArtery .................. 29 CarotidSystem .......................... 39
InternalandExternalCarotidArteries..... 31 Anatomy ............................. 39
Vertebral−SubclavianSystem ............. 33 CommonCarotidArtery ............... 39
VertebralArtery ...................... 33 InternalCarotidArtery ................ 41
SubclavianArtery ..................... 36 ExternalCarotidArtery................ 43
InnominateArtery(Brachiocephalic Vertebral−SubclavianSystem ............. 44
Trunk) .................................. 36 Anatomy ............................. 44
ThoracicAorta ........................... 36 VertebralArtery ...................... 44
SubclavianArtery ..................... 45
NormalFindings.............................. 36
InnominateArtery−AorticArch ........... 46
OrbitalArteries................................ 36
Evaluation ................................. 46
Principle ................................... 36
VIII TableofContents
SourcesofError ............................ 47 SequentialIpsilateralStenosesinthe
UltrasoundIncidentAngle................ 47 CarotidSystem ....................... 72
CardiacArrhythmia ...................... 47 MultivesselDisease ................... 73
VascularWidth .......................... 47 CarotidArteryDissection .............. 73
AnomaliesintheVascularCourse......... 47 PostoperativeFindings ................ 73
VenousSuperimposition ................. 47 PostinterventionalFindings(Stenting) . 73
Echogenicity............................. 48 SourcesofError ............................ 73
Postintervention ......................... 48 DiagnosticEffectiveness..................... 74
DiagnosticEffectiveness..................... 50 VertebralArterySystem ....................... 75
Principle ................................... 75
PathologicalFindings ......................... 52
Findings ................................... 75
OrbitalArteries................................ 52
IncreasedFlowVelocities.............. 76
Principle ................................... 52
DecreasedFlowVelocities ............. 76
Findings ................................... 52
SloshPhenomenon.................... 77
Evaluation ................................. 53
IntermediateBloodFlow .............. 77
SourcesofError ............................ 53
AbsentSignal ......................... 77
DiagnosticEffectiveness..................... 54
RetrogradeBloodFlow ................ 78
CarotidSystem ................................ 55
Evaluation ................................. 78
Principle ................................... 55
SourcesofError ............................ 78
Findings ................................... 62
DiagnosticEffectiveness..................... 79
CommonCarotidArtery ............... 62
Supra-AorticSystem ........................... 80
InternalCarotidArtery ................ 65
Principle ................................... 80
ExternalCarotidArtery................ 69
Findings ................................... 80
Evaluation ................................. 71
SubclavianArtery ..................... 80
VascularDegenerationandAthero-
ObstructionProximaltotheOrigin
genesis ............................... 71
oftheVertebralArtery ................ 81
InternalCarotidArteryStenosis........ 71
ObstructionDistaltotheOriginofthe
InternalCarotidArteryOcclusion ...... 71
VertebralArtery ...................... 81
CarotidBifurcationStenosis ........... 72
InnominateArtery .................... 81
InternalCarotidArteryOcclusionand
AorticArch ........................... 81
IpsilateralExternalCarotidArtery
Evaluation ................................. 82
Stenosis .............................. 72
SourcesofError ............................ 82
ExternalCarotidArteryOcclusionand
DiagnosticEffectiveness..................... 82
InternalCarotidArteryStenosis........ 72
References .................................... 82
3 Intracranial Cerebral Arteries 89
Examination.................................. 89 CO ReactivityTest.................... 97
2
SpecialEquipmentandDocumentation ......... 89 AutoregulationTests .................. 98
ExaminationConditions ....................... 90 VasoneuralCoupling .................. 101
PatientandExaminer ....................... 90 PosteriorCerebralArteryStimulation .. 101
ConductingtheExamination ................ 91 MiddleCerebralArteryStimulation .... 102
UltrasoundApplicationandProbePosition ... 91 Techniques ........................... 103
TranstemporalUltrasound............. 91 TranscranialMonitoring(TCM) ........ 103
TransorbitalUltrasound ............... 91 UltrasoundContrastAdministration.... 104
TransnuchalUltrasound ............... 92
NormalFindings.............................. 105
OphthalmicArteryandInternalCarotid
Principle ...................................... 105
Artery(Siphon) .......................... 92
AnatomyandFindings ......................... 106
MiddleCerebralArtery(MCA) ............ 92
CarotidSiphon—OphthalmicArtery ....... 106
AnteriorCerebralArtery(ACA) ........... 94
Anatomy ............................. 106
IntracranialInternalCarotidArtery
Findings .............................. 106
andT-Junction........................... 94
MiddleCerebralArtery................... 107
PosteriorCerebralArtery(PCA) ........... 94
Anatomy ............................. 107
VertebralArtery(VA) .................... 94
Findings .............................. 107
BasilarArtery(BA) ....................... 95
AnteriorCerebralArteryandAnterior
FunctionalTests ............................ 96
CommunicatingArtery ................... 108
CompressionTests .................... 96
Anatomy ............................. 108
VasomotorReactivityTests ............ 97
TableofContents IX
Findings .............................. 108 Evaluation .................................... 121
NormalValues ........................ 109 DilativeArteriopathy ....................... 121
PosteriorCerebralArteryandPosterior CarotidCavernousFistula ................... 121
CommunicatingArtery ................... 109 ArteriovenousMalformation ................ 121
Anatomy ............................. 109 SpasmsandAneurysms ..................... 122
Findings .............................. 109 Extracranial−IntracranialBypass ............. 123
VertebralArteryandBasilarArtery ....... 109 IncreasedIntracranialPressureandCerebral
Anatomy ............................. 109 CirculatoryArrest........................... 124
Findings .............................. 109 IntracranialFindingsinStealPhenomena .... 125
FunctionalTests ......................... 110 FunctionalDisturbances .................... 125
CompressionTests .................... 110 Monitoring ................................. 126
VasomotorReactivityTest ............. 110 AcuteStroke.......................... 126
CO ReactivityTests ................... 111 SpontaneousMicroemboli(MES)
2
AutoregulationTests .................. 112 andHigh-IntensitySignals(HITS) ...... 128
VasoneuralCoupling .................. 112 MonitoringDuringInterventional
Monitoring ........................... 113 Procedures ........................... 128
Evaluation .................................... 113 Right-to-LeftShuntDetection.......... 128
SourcesofError ............................... 114 TCDandMigraine..................... 129
WeakorAbsentSignals ............... 114 TCDandEpilepsy ..................... 129
AnatomicalReasonsforError .......... 114 SourcesofError ............................... 129
TechnicalArtifacts .................... 114 IncorrectAnatomicIdentification
HemodynamicCauses ................. 114 ofFlowAccelerations ................. 129
PathophysiologicalCauses ............. 114 AbsentSignal ......................... 129
IdentificationProblems................ 115 InadequateControl ................... 129
DiagnosticEffectiveness ....................... 115 NormalVariants ...................... 129
SpecialApplications ........................... 129
PathologicalFindings ......................... 115
BrainStructureImaging ............... 129
Principle ...................................... 115
Hemorrhage,MidlineShift ............ 130
Findings ...................................... 117
TissuePerfusion ...................... 130
Stenoses ................................... 117
DiagnosticEffectiveness ....................... 131
Occlusions ................................. 118
References .................................... 132
CollateralizationofExtracranialCarotid
ArteryObstructions......................... 120
4 Cerebral Veins 139
Examination.................................. 139 Findings ...................................... 143
SpecialEquipmentandDocumentation ......... 139 ExtracranialVeins .......................... 143
ExaminationConditions ....................... 139 JugularVeinThrombosis ................. 143
PatientandExaminer ....................... 139 EctasiasandAneurysms.................. 143
ConductingtheExamination ................ 139 VenousCongestion ...................... 143
FunctionalTests(ProvokedFlowSignals) .... 139 ArteriovenousFistulas ................... 143
IntracranialVeins........................... 143
NormalFindings.............................. 139
SinusThrombosis ........................ 143
AnatomyandFindings ......................... 139
CavernousSinusFistula .................. 145
ExtracranialVeins—InternalJugularVein .. 141
ArteriovenousMalformations............. 145
IntracranialVeins ........................ 142
VenousMalformations ................... 146
Evaluation .................................... 143
Evaluation .................................... 146
PathologicalFindings ......................... 143 SourcesofError ............................... 146
Principle ...................................... 143 DiagnosticEffectiveness ....................... 146
References .................................... 147