Ultrasonography in Vascular Diagnosis (eBook)

Ultrasonography in Vascular Diagnosis 2
Preface to the Second Englishand Third German Edition 5
Preface to the First English Edition 7
Preface to the Second German Edition 8
Preface to the First German Edition 10
Contents 12
1: Fundamental Principles 18
1.1 Technical Principles of Diagnostic Ultrasound 18
1.1.1 Gray-Scale Ultrasonography (B-Mode) 18
1.1.1.1 Historical Milestones 18
1.1.1.2 Sound Waves 18
1.1.1.3 Generating Ultrasound Waves 19
1.1.1.4 Physical Factors Affecting the Ultrasound Scan 19
1.1.1.4.1 Reflection and Refraction 20
1.1.1.4.2 Scattering 20
1.1.1.4.3 Interference 21
1.1.1.4.4 Diffraction 21
1.1.1.4.5 Attenuation and Absorption 21
1.1.1.5 Generating an Ultrasound Image 21
1.1.1.5.1 Pulse-Echo Technique 21
1.1.1.5.2 Time-Gain Compensation 21
1.1.1.5.3 A-Mode 22
1.1.1.5.4 B-Mode 22
1.1.1.5.5 M-Mode 22
1.1.1.6 Resolution 23
1.1.1.7 Beam Focusing 23
1.1.1.8 Types of Transducers 24
1.1.1.8.1 Principle of Operation 24
1.1.1.8.2 Linear Arrays 24
1.1.1.8.3 Curved or Convex Arrays 25
1.1.1.8.4 Sector Scanners 25
1.1.1.8.5 Phased Arrays 25
1.1.1.8.6 Mechanical Sector Scanners 25
1.1.1.8.7 Annular Phased Arrays 26
1.1.1.8.8 Disadvantages of Mechanical Transducers 26
1.1.1.9 Ultrasound Artifacts 26
1.1.1.9.1 Posterior Shadowing 26
1.1.1.9.2 Acoustic Enhancement 26
1.1.1.9.3 Edge Effect 26
1.1.1.9.4 Side Lobes 27
1.1.1.9.5 Reverberation Artifact 27
1.1.1.9.6 Geometric Distortion 28
1.1.2 Basic Physics of Doppler Ultrasound 28
1.1.2.1 Continuous Wave Doppler Ultrasound 29
1.1.2.2 Pulsed Wave Doppler Ultrasound/Duplex Ultrasound 30
1.1.2.3 Frequency Processing 30
1.1.2.4 Blood Flow Measurement 31
1.1.3 Physical Principles of Color-Coded Duplex Ultrasound 35
1.1.3.1 Velocity Mode 35
1.1.3.2 Power (Angio) Mode 37
1.1.3.3 B-Flow Mode (Brightness Flow) 38
1.1.3.4 Intravascular Ultrasound 39
1.1.3.5 Three-Dimensional/Four-Dimensional Ultrasound 40
1.1.4 Factors Affecting (Color) Duplex Imaging – Pitfalls 40
1.1.4.1 Scattering, Acoustic Shadowing 40
1.1.4.2 Mirror Artifact 41
1.1.4.3 Maximum Flow Velocity Detectable – Pulse Repetition Frequency 41
1.1.4.4 Minimum Flow Velocity Detectable – Wall Filter, Frame Rate 44
1.1.4.5 Transmit and Receive Gain 45
1.1.4.6 Doppler Angle 45
1.1.4.7 Physical Limitations of Color Duplex Ultrasound 45
1.1.5 Ultrasound Contrast Agents 47
1.1.6 Safety of Diagnostic Ultrasound 49
1.1.6.1 Thermal Effects 49
1.1.6.2 Mechanical Effects 50
1.1.6.3 Specific Risks of Individual Ultrasound Techniques 50
1.2 Hemodynamic Principles 51
1.2.1 Laminar Flow 51
1.2.2 Flow Profiles and Perfusion Regulation 53
1.2.2.1 Low-Resistance Flow 53
1.2.2.2 High-Resistance Flow 53
1.2.2.3 Blood Flow Regulation 54
1.2.3 Determining the Degree of Stenosis 55
1.3 Machine Settings 59
2: Peripheral Arteries 62
2.1 Pelvic and Leg Arteries 62
2.1.1 Vascular Anatomy 62
2.1.1.1 Pelvic Arteries 62
2.1.1.2 Leg Arteries 62
2.1.2 Examination Protocol and Technique 64
2.1.2.1 Pelvic Arteries 64
2.1.2.2 Leg Arteries 65
2.1.3 Specific Aspects of the Examination from the Perspective of the Angiographer and Vascular Surgeon 66
2.1.4 Interpretation and Documentation 72
2.1.5 Normal Duplex Ultrasound of Pelvic and Leg Arteries 72
2.1.6 Abnormal Findings: Clinically Oriented Ultrasound Examination, Ultrasound Findings and Measurement Parameters, Diagnost 73
2.1.6.1 Atherosclerotic Occlusive Disease 73
2.1.6.1.1 Pelvic Arteries 74
2.1.6.1.2 Leg Arteries 77
Gray-Scale Imaging 77
(Color) Duplex Imaging 77
Spectral Doppler Assessment of Calf Arteries 84
Role of Ultrasound Contrast Agents 85
Effects of Collaterals on the Doppler Waveform 85
Multilevel Obstruction 85
Vascular Occlusion 86
2.1.6.2 Arterial Embolism 88
2.1.6.3 Aneurysm 89
2.1.6.4 Rare Stenosing Arterial Diseases of Nonatherosclerotic Origin 90
2.1.6.4.1 Adventitial Cystic Disease 92
2.1.6.4.2 Popliteal Entrapment Syndrome 93
2.1.6.4.3 Raynaud’s Disease 94
2.1.6.4.4 Paraneoplastic Disturbance of Acral Perfusion 96
2.1.6.4.5 Buerger’s Disease 96
2.1.6.4.6 Inflammatory Conditions 97
2.1.6.4.7 Chronic Recurrent Compartment Syndrome of the Calf 98
2.1.7 Follow-up After Surgical and Interventional Treatment 98
2.1.7.1 Thromboendarterectomy 98
2.1.7.2 Percutaneous Transluminal Angioplasty and Stenting 98
2.1.7.3 Bypass Graft Surveillance 100
2.1.7.3.1 Methodological Considerations and Stenosis Criteria 100
2.1.7.3.2 Controversy About the Benefit of Duplex Bypass Graft Surveillance Programs 103
2.1.7.4 Ultrasound Vein Mapping Prior to Peripheral Bypass Surgery 105
2.1.8 Role of (Color) Duplex Ultrasound Compared with Other Modalities: Problems and Pitfalls 106
2.2 Arm Arteries 109
2.2.1 Vascular Anatomy 109
2.2.2 Examination Protocol and Technique 110
2.2.3 Clinical Role of Duplex Ultrasound 111
2.2.3.1 Atherosclerosis 111
2.2.3.2 Compression Syndromes 111
2.2.4 Documentation 112
2.2.5 Normal Findings 112
2.2.6 Abnormal Findings, Duplex Ultrasound Measurements, and Clinical Role 112
2.2.6.1 Atherosclerosis 112
2.2.6.2 Compression Syndromes 112
2.3 Atlas: Peripheral Arteries 114
3: Peripheral Veins 181
3.1 Pelvic and Leg Veins 181
3.1.1 Vascular Anatomy 181
3.1.2 Examination Protocol 183
3.1.2.1 Thrombosis 183
3.1.2.2 Chronic Venous Insufficiency and Varicosis 186
3.1.3 Normal Findings 189
3.1.4 Documentation 190
3.1.4.1 Deep Vein Thrombosis of the Leg 190
3.1.4.2 Chronic Venous Insufficiency and Varicosis 190
3.1.5 Clinical Role of Duplex Ultrasound 190
3.1.5.1 Thrombosis and Postthrombotic Syndrome 190
3.1.5.2 Varicosis 194
3.1.6 Duplex Ultrasound – Diagnostic Criteria, Indications, and Role 197
3.1.6.1 Thrombosis 197
3.1.6.2 Chronic Venous Insufficiency 208
3.1.6.3 Varicosis 211
3.1.6.4 Varicophlebitis 214
3.1.7 Rare Venous Abnormalities 215
3.1.7.1 Venous Aneurysm 215
3.1.7.2 Tumors of the Venous Wall 217
3.1.7.3 Venous Compression 217
3.1.7.4 Adventitial Cystic Disease of Veins 217
3.1.7.5 Differential Diagnosis: Lymphedema, Lipedema 217
3.1.8 Vein Mapping 218
3.1.9 Diagnostic Role of Ultrasound 218
3.1.9.1 Thrombosis 218
3.1.9.2 Chronic Venous Insufficiency 222
3.1.9.3 Varicosis 224
3.2 Arm Veins and Jugular Vein 225
3.2.1 Vascular Anatomy 225
3.2.2 Examination Protocol and Technique 225
3.2.3 Normal Findings 225
3.2.4 Documentation 225
3.2.5 Clinical Role 226
3.2.6 Duplex Ultrasound Findings and Their Diagnostic Significance 226
3.2.7 Diagnostic Role of Duplex Ultrasound Compared with Other Modalities 227
3.3 Atlas: Peripheral Veins 228
4: Shunts 282
4.1 Clinical Role of Shunt Diagnosis 282
4.1.1 Background 282
4.1.2 Diagnostic Tasks in Patients with Spontaneous and Therapeutic Shunts 282
4.2 Examination Protocol, Technique, and Diagnostic Role 284
4.2.1 Congenital and Acquired Fistulae 284
4.2.2 Dialysis Access 284
4.3 Typical Shunt-Related Changes in the Doppler Waveform 286
4.4 Shunt Maturation and Flow Volume Measurement 286
4.5 Documentation 287
4.6 Vascular Mapping Prior to AV Fistula Creation 287
4.7 Abnormal Findings (Inadequate Dialysis) 288
4.7.1 Shunt Stenosis 288
4.7.2 Peripheral Ischemia 290
4.7.3 Shunt Aneurysm 290
4.7.4 Abnormal Shunt Flow 291
4.8 Diagnostic Role of Duplex Ultrasound Compared with Other Modalities 291
4.9 Atlas:Shunts 293
5: Extracranial Cerebral Arteries 306
5.1 Normal Vascular Anatomy and Important Variants 306
5.2 Examination Technique and Protocol 309
5.2.1 Carotid Arteries 309
5.2.2 Vertebral Arteries 312
5.3 Documentation 314
5.4 Normal Findings 314
5.4.1 Carotid Arteries 314
5.4.2 Vertebral Arteries 314
5.5 Clinical Role of Duplex Ultrasound 314
5.5.1 Carotid Arteries 314
5.5.1.1 Defining the Degree of Stenosis 316
5.5.1.2 Plaque Morphology 320
5.5.2 Vertebral Arteries 321
5.6 Ultrasound Criteria, Measurement Parameters, and Diagnostic Role 321
5.6.1 Carotid Arteries 321
5.6.1.1 Plaque Evaluation and Morphology 321
5.6.1.2 Stenosis Quantification/Stenosis Grading 329
5.6.1.3 Occlusion 339
5.6.1.4 Postoperative Follow-Up 341
5.6.2 Vertebral Arteries 345
5.6.2.1 Stenosis 345
5.6.2.2 Occlusion 345
5.6.2.3 Dissection 345
5.6.2.4 Subclavian Steal Syndrome 346
5.7 Diagnosis of Brain Death 347
5.8 Rare (Nonatherosclerotic) Vascular Diseases of the Carotid Territory 347
5.8.1 Dissection 347
5.8.2 Inflammatory Vascular Diseases (Takayasu’s Arteritis) 349
5.8.3 Fibromuscular Dysplasia 350
5.8.4 Aneurysm 350
5.8.5 Arteriovenous Fistula 351
5.8.6 Idiopathic Carotidynia 351
5.8.7 Vasospasm 351
5.8.8 Compression by Tumor, Carotid Body Tumor 352
5.9 Diagnostic Role of Duplex Ultrasound in Evaluating the Extracranial Cerebral Arteries 352
5.10 Atlas:Extracranial Cerebral Arteries 356
6: Visceral and Retroperitoneal Vessels 391
6.1 Abdominal Aorta, Visceral and Renal Arteries 391
6.1.1 Vascular Anatomy 391
6.1.1.1 Aorta 391
6.1.1.2 Visceral Arteries 391
6.1.1.3 Renal Arteries 392
6.1.2 Examination Protocol and Technique 392
6.1.2.1 Aorta 392
6.1.2.2 Visceral Arteries 392
6.1.2.3 Renal Arteries 394
6.1.3 Normal Findings 394
6.1.3.1 Aorta 394
6.1.3.2 Visceral Arteries 394
6.1.3.3 Renal Arteries 396
6.1.4 Interpretation and Documentation 397
6.1.5 Clinical Role of Duplex Ultrasound 397
6.1.5.1 Aorta 397
6.1.5.2 Visceral Arteries 399
6.1.5.3 Renal Arteries 400
6.1.6 Measurement Parameters, Diagnostic Criteria, and Role of Ultrasound 401
6.1.6.1 Renal Arteries 401
6.1.6.1.1 Renal Artery Occlusion 406
6.1.6.1.2 Transplant Kidney 406
6.1.6.2 Visceral Arteries 408
6.1.6.3 Aorta 413
6.2 Visceral and Retroperitoneal Veins 418
6.2.1 Vascular Anatomy 418
6.2.1.1 Vena Cava 418
6.2.1.2 Renal Veins 418
6.2.1.3 Portal Venous System and Hepatic Veins 419
6.2.2 Examination Technique 419
6.2.2.1 Vena Cava 419
6.2.2.2 Renal Veins 420
6.2.2.3 Portal Vein and Superior Mesenteric Vein 420
6.2.3 Clinical Role of Duplex Ultrasound 421
6.2.3.1 Renal Veins 421
6.2.3.2 Portal Venous System 421
6.2.4 Normal Findings 422
6.2.4.1 Vena Cava and Renal Veins 422
6.2.4.2 Portal Venous System 422
6.2.5 Documentation 422
6.2.6 Abnormal Ultrasound Findings, Measurement Parameters, and Diagnostic Role 422
6.2.6.1 Vena Cava 422
6.2.6.2 Renal Veins 423
6.2.6.3 Superior Mesenteric Vein 424
6.2.6.4 Portal and Hepatic Veins 425
6.3 Atlas: Visceral and Retroperitoneal Vessels 429
7: Penile and Scrotal Vessels 486
7.1 Vascular Anatomy 486
7.1.1 Penile Vessels 486
7.1.2 Scrotal Vessels 486
7.2 Examination Technique 487
7.2.1 Erectile Dysfunction 487
7.2.2 Scrotal Vessels 488
7.3 Normal Findings 488
7.3.1 Penile Vessels 488
7.3.2 Scrotal Vessels 488
7.4 Documentation 488
7.5 Clinical Role of Duplex Ultrasound 489
7.5.1 Erectile Dysfunction 489
7.5.2 Acute Scrotum 489
7.5.3 Varicocele 490
7.6 Abnormal Findings: Role of Duplex Ultrasound Parameters 490
7.6.1 Erectile Dysfunction 490
7.6.2 Acute Scrotum 491
7.6.3 Varicocele 492
References 497
Subject Index 524