RU2381749C1 - Method for duplex scanning of infraorbital artery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ultrasonic diagnostics, and aims at duplex scanning of infraorbital artery. The duplex scanning performed involves the V-mode study and Doppler frequency shift in a pulse-wave scanning mode of, Doppler sonography of the infraorbital foramen artery. The blood flow parametres are evaluated in Doppler colour mode, qualitative and quantitative spectrum characteristics.

EFFECT: method allows estimating an anatomic arrangement and vascular structure, its hemodynamics, eliminates radiation exposure of the patient, gives possibility for multiple study for cause.

3 dwg, 1 tbl, 3 ex

Description

The present invention relates to medicine, namely to radiation diagnostics, and can be used to assess blood flow in the artery of the infraorbital foramen.

A known method of x-ray diagnostics of blood vessels - angiography, which determines the location, course of blood vessels, determines the diameter, contours, patency, stenosis, occlusion (General Guide to Radiology. Institute of NICER 1995. Polyaev Yu.A., Shafranov V.V., Konstantinov K.V., 1999), however, according to angiography, it is impossible to judge hemodynamics.

The prototype of the invention is a method for studying the blood supply to the maxillofacial region using the functional method - rheography (Fedoreev G.A. Hemangiomas. - M., 1974. - 262 S.). However, with the help of rheography, the blood circulation of a certain region, but not a specific artery, is estimated.

The objective of the invention is to develop a technique for Doppler study of the artery of the infraorbital foramen.

The technical result when using the invention is to obtain spectral qualitative and quantitative characteristics of the artery of the infraorbital foramen, assessment of the anatomical location and structure of the vessel, as well as the state of hemodynamics.

The invention is illustrated by the following figures: figure 1 shows the zygomatic bone in the form of a thin hyperechoic curvilinear structure with a thickness of 1-2 mm, figure 2 - color locus in the projection of the zygomatic bone, figure 3 - spectrum of the Doppler frequency shift in a pulse-wave mode .

The proposed method is carried out in the following way.

Indications: diseases of the orbit and maxillofacial region.

Contraindications: no.

Preparation for the study of the patient is not required.

Technique: the patient is placed on a couch in a supine position. Alternately, in the area of the right and left half of the upper jaw, an ultrasonic linear sensor is installed with a frequency of 5 to 10 MHz with an individual selection of frequency depending on age and constitutional features. The higher the age, the lower the frequency of the sensor used. With hypersthenic type of addition, the frequency of the sensor used is reduced.

Stage 1: determine the condition of the soft tissues of the face (skin, subcutaneous fat, muscle) in the upper jaw area on the right and left in B-mode (Clinical Guide to Ultrasound Diagnostics (in 2 volumes). Edited by V.V. .Mitkova. - M .: Vidar, 1996 .-- 336 p.).

2nd stage: after determining the state of soft tissues in the B-mode, Doppler study is started in the color Doppler mapping (CCC) mode. To determine the localization of the vessel, the reference point is the image of the zygomatic bone in the B-mode in the form of a thin hyperechoic curvilinear structure with a thickness of 1-2 mm (figure 1).

The color locus is determined in the projection of the zygomatic bone at a distance from the skin surface (1.6 cm ± 0.2 cm) (FIG. 2), the diameter of the vessel is determined, the contours are evaluated.

3rd stage: after assessing the state of the vessel and blood flow in the CCC mode, they switch to an analysis of the hemodynamic state in the pulse-wave Doppler (PW) mode. The control volume is set to ⅔ of the diameter of the vessel, the insonation angle does not exceed 60 degrees (Lelyuk V.G., Lelyuk S.E. Ultrasound angiology. 1st edition. - M .: Realnoe Vremya, 1999. - 287 p.). The spectrum of the Doppler shift of blood flow frequencies in this vessel is recorded. When assessing the spectrum of the Doppler frequency shift, quantitative and qualitative parameters are determined. Among the qualitative parameters, the shape of the Doppler curve indicating the arterial type of blood flow in the vessel is evaluated, the type of Doppler spectrum, its frequency and belonging to arteries with high or low peripheral resistance, the presence of a spectral window are determined. After determining the qualitative characteristics of the spectrum, quantitative parameters are evaluated: peak systolic blood flow velocity (Vmax), final diastolic blood flow velocity (Vmin), peripheral blood flow resistance index (resistance index, RI), pulsation index (PI).

We conducted studies in 20 healthy patients, the age composition of which ranged from 8 years to 16 years, the average age was 11.6 ± 0.5 years.

The results obtained have the following characteristics.

The qualitative characteristics of the spectrum along the artery of the infraorbital foramen are:

1. The shape of the Doppler curve corresponds to the arterial type of blood flow with high systolic and pronounced diastolic components of the spectrum.

2. The spectrum refers to vessels with low peripheral resistance (S / Dav = 10.9 ± 1.3), having high systolic and high diastolic components.

3. The presence of a spectral window indicates the laminar nature of the blood flow in the vessel.

Quantitative characteristics of the spectrum in the artery of the infraorbital foramen:

1. The peak systolic blood flow velocity (Vmax) is 0.305 ± 0.250 (FIG. 3).

2. The final diastolic velocity (Vmin) of blood flow is 0.035 ± 0.005.

3. The resistance index (RI) is 0.893 ± 0.011.

4. The ripple index (PI) is 4.123 ± 0.209.

The average values of the quantitative parameters of blood flow through the artery of the infraorbital foramen are presented in the table.

When abnormalities of spectral qualitative and quantitative characteristics are detected, the change in blood flow in the artery of the infraorbital foramen is determined in the presence of pathology in the vascular wall or pathology of the hemodynamics of the organs supplying it with blood (soft tissues and bone structures of the maxillofacial region, orbit, etc.).

Advantages of the proposed method

Duplex scanning is designed to study the vessels of the abdominal cavity, limbs, main vessels of the head and neck / common carotid artery, vertebral artery / (Kuntsevich G.I. Ultrasonic methods for studying the branches of the aortic arch. / G.I. Kuntsevich. - Minsk: Aversev, 2006 . - 208 p.). The proposed method allows for the first time to examine the blood flow in the artery of the infraorbital foramen non-invasively.

Non-invasiveness of the method (vascular puncture is not performed, a catheter is not inserted; no contrast agent is used, which excludes allergic reactions to iodine-containing preparations).

Accessibility. The technique allows the assessment of blood flow in the artery of the infraorbital foramen on ultrasound devices of the middle class by the duplex (triplex) scan method. The patient under study does not bear radiation exposure and, as a consequence of this moment, this is the possibility of conducting an examination repeatedly. The method is used to determine the state of the vessel and blood flow in the artery of the infraorbital opening in normal, it allows on the basis of analysis of changes from the norm to carry out differential diagnostics with diseases of the maxillofacial region, proceeding with a violation of blood supply in the corresponding parts of the skull.

We give examples of clinical use of the proposed method.

Example 1: patient, 8 years old. Ultrasonic picture: in B-mode, the projection of the body and the angle of the lower jaw on the left determines an irregular formation with uneven contours, a hypoechoic structure with more echogenic components along the distant contour, dimensions 3.0 * 2.1 * 1.8 cm. Contour of the lower jaw interrupted (bone destruction). Artery of the infraorbital foramen (left): the color locus in the CDC mode is determined along the contour of the zygomatic bone at a distance of 1.54 cm from the skin surface, with a diameter of 0.2 cm. In the pulse-wave mode, the Doppler frequency shift spectrum is represented by the formula characteristic of arterial blood flow (expressed systole and diastole), there was a spectral window indicating a laminar flow, the spectrum is classified as typical for arteries with low peripheral resistance. The quantitative characteristics were as follows: Vmax = 0.670, Vmin = 0.180, RI = 0.800, PI = 3.350, S / D = 10.430. Artery of the infraorbital foramen on the right: in B-mode, soft tissues of the face are normal. In the CDC mode, the color locus is determined by the contour of the zygomatic bone at a depth of 1.64 cm from the skin surface. In the pulse-wave mode, the shape of the spectrum of the Doppler frequency shift is characterized by a high systole and high diastole, which determined the arterial type of blood flow. There was a spectral window; the spectrum was characteristic of arteries with low peripheral resistance. Quantitative parameters of blood flow: Vmax = 0.290, Vmin = 0.036, RI = 0.790, PI = 4.0, S / D = 9.4.

Conclusion: the anatomical location and blood flow parameters of the right infraorbital artery within normal limits. In the usually located left infraorbital artery, there is a change in blood flow in the form of an increase (which in the given example, along with an increase in blood flow in the facial artery and chin artery of the same name, may indicate a vascular genesis of formation in the lower jaw). The patient underwent surgery, the histological conclusion: osteoblastoclastoma.

Example 2. Patient M., 16 years old. When examining the infraorbital foramen when installing a linear sensor on the region of the upper jaw, to the left along the contour of the zygomatic bone, which is defined as a hyperechoic strip 1.2 mm thick, at a depth of 1.15 cm from the skin surface, the color locus is determined in the CCC mode. In the pulse-wave mode of the Doppler study, the following qualitative characteristics of the spectrum of the Doppler frequency shift were determined: the spectrum is represented by the form characteristic of the arterial type of blood flow with a pronounced systal and diastolic component, which indicated the study of arteries with low peripheral resistance. There was a spectral window. The quantitative characteristics of the spectrum were as follows: Vmax = 0.310, Vmin = 0.023, RI = 0.90, PI = 4.1, S / D = 10.8, which corresponded to normal values. When examining the artery of the infraorbital foramen to the right along the contour of the zygomatic bone, the color locus in the CDC mode is not detected. In the history of 2 years ago, the patient had a traumatic injury to the middle zone of the face on the right with a fracture of the zygomatic bone and damage to the lower orbital nerve and displacement of the eyeball, which indicated damage to the lower orbital opening. Conclusion of duplex scanning of the infraorbital foramen artery: the location of the left infraorbital artery corresponds to normal anatomical parameters, qualitative and quantitative indicators of blood flow within normal limits. Lack of blood flow in the right infraorbital artery - post-traumatic sclerosis.

Example 3. Patient G., 13 years old. Clinical diagnosis: endocrine ophthalmopathy. An ultrasound of both orbits revealed signs of pseudotumor with a change in the acoustic density of retrobulbar fiber and a thickening of the oculomotor muscles. When duplex scanning of the vessels of the infraorbital foramen on both sides along the zygomatic bone contour, color loci were determined at a depth of 1.6 cm from the right of the skin surface and 1.53 cm from the left. The qualitative parameters of the spectrum were characterized by a decrease in the systolic component of the spectrum of the Doppler frequency shift and disappearance of the diastolic component , which corresponded to a transitional type of blood flow with signs of collaterilization and did not correspond to the arterial type of blood flow in normal. The quantitative parameters of the spectrum in the infraorbital artery were: on the right - Vmax = 0.15, Vmin = 0.002, RI = 0.98, PI = 16.8, S / D = 19.8, on the left - Vmax = 0.10, Vmin = 0.01, RI = 0.94, PI = 14.4, S / D = 20.1.

Conclusion: a pathological change in blood flow in both infraorbital arteries (most likely due to spasm - stenosis of the lumen of the vessel with endocrine ophthalmopathy).

Profitability of a method. The average cost of aortography is 4500 rubles, for duplex scanning is in the range of 600-800 rubles, depending on the class of ultrasound scanner used for the study.

Quantitative blood flow in the infraorbital artery (n = 20) Options N20 Right Vmax 0.326 ± 0.034 Vmin 0.039 ± 0.004 Ri 0.882 ± 0.013 PI 3.914 ± 0.253 S / d 9.648 ± 1.074 Left Vmax 0.284 ± 0.024 Vmin 0.025 ± 0.002 Ri 0.904 ± 0.011 PI 4.331 ± 0.219 S / d 12,078 ± 1,343

Claims (1)

The method of ultrasound examination of the artery of the infraorbital foramen (APO), characterized in that they perform duplex scanning of the maxillofacial region, including ultrasound in the B mode and ultrasound dopplerography, display in the B mode soft tissues of the face in the region of the upper jaw on the right and left, find images of the zygomatic bone in the form of a curved thin hyperechoic structure, after which color Doppler mapping is performed and the color locus of the vessel is revealed in the projection of the zygomatic bone at a distance 1.6 ± 0.2 cm from the surface of the skin, thus determining the affiliation of the blood flow to the vessels of the infraorbital foramen, assessing the diameter, then conducting studies in the mode of a pulse-wave Doppler, investigate qualitative indicators: determine the shape of the Doppler curve corresponding to the arterial type of blood flow , confirm the belonging of the vessel to the artery of the infraorbital foramen, determine by the high systolic and high diastolic component the type of Doppler spectrum related to vessels with low n by the peripheral resistance, the laminar nature of the blood flow in the vessel is determined by the presence of a spectral window, quantitative blood flow indicators are studied, which are normally determined in the intervals: peak systolic velocity 0.305 ± 0.250, final diastolic velocity 0.035 ± 0.005, resistance index 0.893 ± 0.011, pulsation index 4.123 ± 0.209; and if a systolic-diastolic ratio of 10.9 ± 1.3 is detected, APO is assessed as an artery with low peripheral resistance, and if there is no detection of a vessel with a blood flow along the zygomatic bone in color Doppler mapping, an anomaly in the development of the artery of the infraorbital foramen is determined or the absence of blood flow in it as a result of sclerosis, thrombosis, if a deviation from the norm of spectral qualitative and quantitative characteristics is detected, the absence of blood flow in the artery of the infraorbital response is determined rstia, or the presence of pathology in the vascular wall, or the pathology of hemodynamics of the organs that supply it with blood (soft tissues and bone structures of the maxillofacial region, orbit, etc.).

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