Transcranial and extracranial ultrasound assessment of cerebral hemodynamics in vascular and Alzheimer's dementia
Transcranial and extracranial ultrasound assessment of cerebral hemodynamics in vascular and Alzheimer's dementia
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DOI：
10.1179/016164106x130380
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发表时间：
2006-09-01
影响因子：
1.9
通讯作者：
Schreiber, Stephan J.
中科院分区：
文献类型：
--
作者：
Doepp, Florian;Valdueza, Jose M.;Schreiber, Stephan J.
背景：人口预期寿命的增加导致痴呆症的发病率增加。最常见的类型，血管性痴呆（VD）和阿尔茨海默氏痴呆（AD）之间的准确区分，对于新治疗策略的开发和应用至关重要。这两种情况被认为在微血管影响的程度上有很大的不同。经颅和颅外超声允许分析脑血流动力学，并应有助于区分VD和AD。我们比较了VD、AD和对照组之间的多模式超声数据，并概述了有关该主题的文献。方法：研究了20名VD和20名AD患者，并与12名年龄匹配的对照组进行了比较。经颅彩色超声检查大脑中动脉（MCA）血流速度（Vmean）和搏动指数（PI）。应用颅外双功及多普勒超声技术检测前循环血流量（颈内动脉[伊卡]）和后循环（两个椎动脉[VA]），全球脑血流量（CBF = BVFICA + BVFVA），全脑循环时间（CCT =伊卡和颈内静脉之间回声对比剂团到达的时间延迟）和全脑血容量结果：VD组（36 ± 8 cm/ s）和AD组（43 ± 13 cm/ s）的MCA V均值显著低于对照组（59 ± 13 cm/s），但VD组和AD组之间无显著差异。PI（1.1 +/- 0.2; 1 +/- 0.2; 0.9 +/- 0.2）仅在VD组和对照组之间存在显著差异。VD（570 +/- 61 ml/ min; 8.8 +/- 2.6 s）和AD（578 +/- 77 ml/ min; 8.2 +/- 1.4 s）的CBF和CCT相似，但与对照组（733 +/- 54 ml/ min; 6.4 +/- 0.8 s）有显著差异。VD组前、后循环BVF（412 +/- 62和158 +/- 38 ml/ min）和AD组（428 +/- 62和150 +/- 41 ml/ min）显著低于对照组（537 +/- 48和199 +/- 26 ml/ min），但在患者组之间没有显著差异。讨论：经颅和颅外超声无助于区分VD和AD。然而，我们的研究结果增加了对痴呆症病理生理学的了解，支持两种情况下共同的“血管”通路。
Background: Increasing life expectancy of the population leads to a higher incidence of dementia. Exact differentiation between the most common types, vascular dementia ( VD) and Alzheimer's dementia ( AD), is crucial to the development and application of new treatment strategies. Both conditions are thought to differ greatly by their extent of microvascular affection. Transcranial and extracranial ultrasound permits analysis of cerebral hemodynamics and should help to differentiate between VD and AD. We compare multimodal ultrasound data between VD, AD and controls, and give an overview of the literature on this topic.Methods: Twenty VD and 20 AD patients were studied and compared with 12 age-matched controls. Transcranial color-coded ultrasound was performed to assess blood flow velocity ( Vmean) and pulsatility indices ( PI) of the middle cerebral artery (MCA). Extracranial duplex and Doppler ultrasound techniques were used to assess the blood volume flow (BVF) in the anterior circulation ( both internal carotid arteries [ICA]) and posterior circulation ( both vertebral arteries [VA]), the global cerebral blood flow (CBF = BVFICA + BVFVA), the global cerebral circulation time (CCT = time delay of echo-contrast bolus arrival between ICA and internal jugular vein) and global cerebral blood volume (CBV = CCT 6 CBF).Results: MCA Vmean in VD ( 36 +/- 8 cm/ s) and AD ( 43 +/- 13 cm/ s) were significantly lower than in controls ( 59 +/- 13 cm/ s) but did not differ significantly between VD and AD groups. PI (1.1 +/- 0.2; 1 +/- 0.2; 0.9 +/- 0.2) only differed significantly between VD group and controls. CBF and CCT in VD ( 570 +/- 61 ml/ min; 8.8 +/- 2.6 s) and AD ( 578 +/- 77 ml/ min; 8.2 +/- 1.4 s) were similar but differed significantly from controls ( 733 +/- 54 ml/ min; 6.4 +/- 0.8 s). BVF in the anterior and posterior circulation of VD group ( 412 +/- 62 and 158 +/- 38 ml/ min) and AD group ( 428 +/- 62 and 150 +/- 41 ml/ min) were significantly lower than in controls ( 537 +/- 48 and 199 +/- 26 ml/ min) but did not differ significantly between the patient groups.Discussion: Transcranial and extracranial ultrasound does not help to distinguish between VD and AD. However, our results add insight into the pathophysiology of dementia, arguing in favor of a common 'vascular' pathway in both conditions.