Like any diagnostic method, duplex scanning has positive and negative sides. Let’s start with the pros:
- Complete safety. Medical ultrasound does not have any damaging or ugly effects on the human body, so this study can be done for young children and pregnant women.
- Painless and non-invasive. The duplex scan procedure is completely painless and does not bring any discomfort to the patient.
- High diagnostic accuracy. Considering that the doctor sees the examined vessel in two projections, simultaneously registering blood flow in it, the information content of such studies is comparable to angiography.
- The relative simplicity of the study. Ultrasound scanning takes 20 minutes on the strength, does not require bulky devices, the help of additional medical staff, but it requires the most detailed knowledge of the anatomy and physiology of blood vessels from a research doctor.
- The absence of contraindications and complications of the procedure – a study can be assigned to all categories of patients, and no serious consequences have been recorded in the entire history.
- No special preparation for the study is required, such as diet, cleansing enemas, the use of certain drugs and the introduction of solutions.
We list the disadvantages of the methodology:
- The relative high cost of the method. The fact is that for duplex studies, special ultrasound machines are needed, which are often inaccessible to small clinics and public institutions.
- The possibility of research “here and now.” This is a common drawback of all ultrasound studies, since the “picture” can only be evaluated in real time, in motion, and not by frozen pictures.
- Narrow research area. It is important to understand that scanning of brachiocephalic vessels only indirectly indicates blood circulation in the brain. Ultrasonic waves cannot penetrate the adult’s cranium, therefore the brain itself and its vascular system are hidden from the researcher.
Duplex of vessels located in the head is a study in which ultrasound waves are used, which determines the principle of operation of the equipment. Any medium (structures, tissues and elements of the body) is an obstacle to the propagation of ultrasonic vibrations. The effect is called acoustic resistance.
An ultrasonic wave encounters an object, partly continues to move on with a low resistance, and partially reflects with a significant compaction and elasticity of the medium under study. Ultrasound is reflected from the objects of the circulatory system with different intensity and speed of the reverse movement.
The higher the intensity of the reflected signal, the brighter and more distinct on the screen the area of the studied tissue looks. The reflected signal is interpreted and presented on the screen, where the doctor in real time sees the features of the structure and functioning of the bloodstream.
Scanning at an extracranial level involves examining the branches of the main arteries, which run outside the cranium, but supply blood to the brain structures of the head. Examination of intracranial arteries reveals abnormalities in the circulatory system of the brain.
Performing a duplex examination of vessels lying in the neck and head is not associated with the use of harmful ionizing radiation. The procedure is prescribed to patients of any age without restrictions. Other benefits of duplex scanning of blood vessels passing through the brain:
- Informational content.
- Lack of contraindications.
Unlike angiography, ultrasound diagnostics can be repeated many times over a short period, allows you to choose the exact location of the vascular wall, does not require internal intervention (intravenous administration of a contrast medium or sensor), makes it possible to determine the functional parameters of blood flow. In terms of informativeness, duplex scanning is inferior to CT (computed tomography) using a contrast medium.
Duplex scanning is an informative, safe, painless procedure that has no contraindications. Ultrasound examination allows the doctor to identify disorders that have arisen in the blood supply system of the brain structures.
Absolute safety. Given that ultrasound has no side or ugly effects, it can be used by pregnant women and young children. Non-invasiveness, painlessness. The procedure is absolutely painless and does not create discomfort for patients.
High diagnostic accuracy. Due to the fact that the studied vessels are presented in different projections, with simultaneous registration of blood flow, the information content of such a study can only be compared with angiography.
The simplicity of the procedure. The scan takes about 20 minutes in time, it does not require bulky devices and additional help from health workers. The only thing required is the deepest knowledge of a physician-researcher of the physiology and anatomy of blood vessels.
Lack of contraindications. A similar examination is prescribed to patients of all categories. It does not require special preparation – dieting, the introduction of solutions or cleansing enemas.
The disadvantages of the technique include, firstly, a rather high cost. Duplex scanning of the vessels of the head is carried out by special ultrasound machines, often inaccessible to public institutions and small clinics.
Secondly, a small area of research. The vessels hidden by the cranium are inaccessible to ultrasonic waves, so it is impossible to study the circulatory system in the brain. Examination of brachiocephalic vessels provides indirect information.
Duplex scanning is a procedure that combines the ability to visualize the gaps of the blood channels and surrounding tissues in the mode of 2-dimensional seroscale ultrasound imaging (B-mode) and the simultaneous assessment of hemodynamics using Doppler technology. In accordance with the results, an analysis of the elasticity and rigidity of the walls, the functional state of the endothelium, violation of the integrity (dissection), the presence, prevalence and nature of changes in the structure and thickness of the wall is carried out.
During the study, a specialist can identify intraluminal formations, their localization, echogenicity, extent. Duplex scanning of blood vessels allows you to assess the degree of patency of the lumen, diameter changes. During the procedure, the geometry of the blood channels is analyzed. In particular, deformations, deviations from the normal anatomical trajectory, anomalies of discharge, branching and length are revealed.
Information during transcranial and conventional scanning may look in the form of Doppler spectra or color cartograms. In the latter case, on the basis of the research data, the specialist receives qualitative information about the blood flow, its nature (turbulent, laminar), defects in filling cartograms and other things.
The spectral mode makes it possible to quantify intraluminal flows. In other words, the study makes it possible to objectify the absence or presence of hemodynamic disorders and determine the degree of their severity. The obtained diagnostic information is based on the assessment of speed indicators and various calculated indices, which indirectly characterize the degree of peripheral resistance, as well as the tone of the wall of the blood channels.
Ultrasound with Doppler is performed according to certain rules.
Ultrasound scanning does not require special preparation, there are no contraindications for it. The examination is carried out in a specially equipped room with ultrasound equipment.
The video in this article shows how to scan the vessels of the head and neck. The patient lies on the couch, a roller is placed under his head. A small amount of gel is applied to the skin of the neck, along which the transducer sensor will move.
The instruction prescribes the following sequence of actions:
- the patient is offered to relax the muscles, take a comfortable position on the couch;
- For children, the procedure is carried out according to the same technique.
- First of all, a carotid artery is examined on the right or left with a sensor;
- the patient turns his head depending on which side the scan is performed;
- pulsation of the carotid artery is checked, its location, depth;
- the doctor pinches with a finger the individual branches of the carotid artery, checks their blood flow;
- the patient is offered to move his head to the sides, forward and backward;
- advancing the sensor, check the speed of blood flow through the carotid arteries;
- the volume of blood flow and the tone of the vascular walls are measured;
- blood flow intensity is checked by venous circulation in the brain;
- arteries of the brain are viewed through the bones of the skull, placing the sensor in the temples and above the orbits;
- placing the sensor in the occipital bone area, the features of blood circulation in the depths of the brain are examined;
- reveal the degree of tortuosity of the vessels, the presence of collaterals between the veins;
- determine the degree of patency of arteries and veins, the completeness of their filling;
- according to the results of the survey, a protocol is compiled, where the decoding of the indicators is given;
- the protocol gives digital data, indicators, gives an interpretation of the results;
- a diagnosis of the disease is formulated if it is detected;
- the protocol indicates the general condition of the patient, prescribes medications and recommendations;
Doppler ultrasound differs from conventional ultrasound in that the protocol always provides digital characteristics of the state of the vessels.
This allows you to compare the data with the norm and identify the degree of disturbance or apparent pathology. A phlebologist, a specialist in dopplerography undergoes compulsory training and receives a specialist certificate with the assignment of qualifications. The method enjoys well-deserved popularity due to its diagnostic value.
- Indications for the purpose of the study
- What is ultrasound of the vessels of the neck and head
- Extracranial study: indications
- Signs of vascular pathology
- Advantages and disadvantages of the technique
- How is the diagnosis?
- Results and their interpretation
- Objectives of the study
- Duplex scan of the lower extremities: indications
- Description of the procedure
- What arteries are examined
- Features of the study
- Additional features
- Process technology
- Examination of the vertebral blood channels
- Need to scan
- Diagnostic value
- In conclusion
- How to prepare
- How do diagnostics
- Are there any contraindications
- How much is ultrasound
Indications for the purpose of the study
A study of blood vessels of a planned nature should be carried out without fail once a year. The detection of anomalies at an early stage of development helps to avoid the negative consequences associated with the progressive form of the disease, and take measures to prescribe the necessary therapy. A duplex scan of the patency of the vessels of the head and neck is often prescribed to verify the results obtained with MRI, ultrasound of the vessels of the neck and head. Indications for duplex are the following symptoms:
- numbness of the hands;
- lack of coordination;
- memory loss;
- history of strokes;
- cervical osteochondrosis;
- arterial hypertension ;
- previously identified vascular dystonia;
- family ties with hypertensive or diabetic;
- vasculitis (vascular inflammation).
Diagnosis is used to study vascular pathologies
It is recommended that all people be examined without exception. Such a diagnosis should be carried out 1 time in 12 months. Detection of the development of the disease in the early stages of formation will allow the appointment of effective treatment. Therapy will avoid possible negative consequences.
Duplex scanning of the vessels of the neck in most cases is required to confirm the established diagnosis by means of magnetic resonance imaging or ultrasound of the neck.
It is recommended to undergo an examination if the following symptoms are detected:
- Dizziness, fainting and sudden fainting, severe headaches, tinnitus.
- A history of previous strokes.
- Inflammatory processes on the walls of the capillaries (vasculitis).
- Lack of coordination and loss of balance.
- Memory loss, hearing loss.
- The presence in the family of hypertensive patients or patients with diabetes mellitus.
- The occurrence of situations with numbness of the limbs.
- Cervical osteochondrosis.
- Developing earlier vegetative-vascular dystonia.
If you constantly identify signs with an increase in their effect on the body, it is recommended to consult a general practitioner. He will collect a complete history of the symptoms and, if necessary, refer them to a highly specialized specialist.
Drinking coffee before the test is prohibited!
Examination of the cervical capillaries does not require specific preparation. You should not adhere to a certain diet or affect the body with physical activity.
To effectively undergo the procedure, excessive use of certain drugs that increase the tone of capillaries should be avoided:
- Morning coffee.
- Saturation of the body with toxins from nicotine.
- Strong tea.
Before undergoing the procedure, it is necessary to remove all the additional accessories from the neck that interfere with the examination – chains, scarves, hairpins, neck scarves.
The study is implemented according to the standard scheme. The patient is placed on a prepared couch. A foam roller or a hard pillow is placed under the head. The head should be turned away from the apparatus, turning the neck as far as possible.
Before the sensor touches the surface of the skin of the neck, a special gel is applied to the epidermis. It allows you to more accurately diagnose, eliminating the possibility of air entering the cavity of the sent ultrasonic rays, which entails data distortion.
During the event, the doctor may ask the patient to change the tilt of the head or position on the pillows, as well as strain, cough or hold your breath.
The duration of a simple effect on the body to obtain data on the state of the circulatory system located on the neck does not exceed 30 minutes. The examination is not prohibited for children of different ages, or for pregnant women, as well as for mothers during breastfeeding.
What is ultrasound of the vessels of the neck and head
Duplex scanning of cerebral vessels allows you to get information about the speed of blood movement, abnormalities of the development of capillaries and the presence of defects. With the help of the study, the sizes of the vessels are determined, their patency is clarified, a forming thrombus is detected. The results obtained during diagnosis are compared with the prescribed standards:
- the presence of stenosis – 0%;
- systolic arterial blood flow velocity – above 0.9;
- the thickness of the arterial wall is not more than 1.1 mm;
- complete absence of neoplasms in the lumens (blood clots);
- peak speed of movement into diastole is more than 0.5.
If a thickening of the vascular walls with an uneven narrowing of the lumen is determined, non-stenotic atherosclerosis is diagnosed. With pathological changes in the walls of the capillaries, reduced echogenicity and altered layers of the epithelium, we can talk about the inflammatory process preceding vasculitis.
Doppler ultrasound is an instrumental method of research using ultrasound.
Ultrasonic waves are able to penetrate into the tissues of the body and reflected from structures of various densities, which is recorded by a special sensor. The signals from the sensor are processed by a computer and the doctor sees on the monitor an image of organs and internal environments.
Dopplerography is an additional function of ultrasound diagnostics, which allows you to evaluate the nature and speed of blood flow in arteries and veins.
If the blood moves toward the sensor, the computer turns it red in the image. If in the opposite direction, then blue.
Duplex scanning, also called vascular ultrasound scan, is prescribed by a doctor if there is a suspicion of a violation of cerebral circulation. The following symptoms indicate this pathology:
- bursting pain in the head;
- dizziness, especially when changing the position of the body and throwing the head back;
- periodic darkening and flickering of flies before the eyes;
- progressive impairment of memory, attention, thinking;
- noise in ears;
- paroxysmal numbness, weakness in the limbs.
Some systemic diseases occur with vascular damage and poor circulation. Therefore, to assess their progression and treatment effectiveness, the doctor prescribes an ultrasound examination of the vessels. It is shown with:
- diabetes mellitus;
- after a stroke of the brain;
- elevated blood cholesterol (hypercholesterolemia);
- cervical osteochondrosis;
- systemic vasculitis;
- heart defects;
- neurocirculatory dystonia;
- long history of smoking tobacco;
- arterial hypertension;
- head and neck injuries;
- coronary heart disease.
All people over 55 years of age should have an ultrasound scan of blood vessels once a year if their immediate family has had a heart attack, stroke, coronary heart disease, atherosclerosis, or hypertension. This indicates a hereditary predisposition and a high risk of developing such conditions.
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The study does not violate the integrity of the tissues, painlessly and does not adversely affect the body. Therefore, there are no absolute contraindications to its implementation.
Difficulties arise only if a person for some reason cannot take the position necessary for research.
An ultrasound scan is mandatory for all infants aged 1 month. This allows you to identify a violation of the blood supply to the brain at the earliest stages and correct it. Without timely diagnosis and treatment, this condition will lead to serious neurological problems and impaired intelligence in the child.
Older children are prescribed ultrasound vessels for complaints of pain in the head, fatigue, mental retardation, decreased attention and memory. The study allows you to prescribe appropriate therapy and improve the condition of the child.
During the study, the doctor can determine the narrowing of the vessels, the condition of their walls, the direction of blood flow and its speed. With atherosclerosis, you can identify the location of cholesterol plaques, the presence of a blood clot on them. Thickening of the walls of arteries and a decrease in their elasticity occurs with hypertension.
A change in the direction of blood flow occurs with various obstacles in its path, stratification of the artery wall, the formation of an aneurysm – saccular protrusion of the vessel.
If there is a violation of the outflow of blood from the brain, dilated veins will be detected in which the blood flow velocity is significantly reduced.
The examination procedure is simple and painless.
As the examination is conducted, the specialist receives data on the velocity of blood flow, as well as on the presence or absence of defects and abnormal development of capillaries.
Duplex scanning allows you to accurately determine the size of blood vessels, to clarify their patency, to identify a developing blood clot and to detect a congenital abnormal arrangement of capillaries.
When diagnosing, the carotid artery is determined, the detected results are compared with the norm. The following normal level of indicators of the carotid artery is distinguished:
- The percentage of stenosis is 0%.
- The thickness of the artery wall is up to 1,1 mm.
- The systolic blood flow velocity in the artery at the maximum level is not less than 0,9.
- There should not be any neoplasms (blood clots) inside the lumen.
- Peak speed of movement in diastole is not less than 0,5.
A thickening of the walls of the blood vessels of the circulatory system is diagnosed with an uneven nature of the increase in the surface, while at the same time, the vein is narrowed by 20%. This indicates atherosclerosis of the non-stenotic type of the studied artery.
In the case of pathological changes in the walls of the capillaries, with deterioration in echogenicity, as well as changes in the differentiation of the layers of the epithelium of the walls, the inflammatory process preceding vasculitis is revealed.
This type of study is prescribed if:
- A duplex scan of the brachiocephalic blood channels revealed an occlusive or stenotic pathology – a potential source of cerebral blood flow disorders.
- Signs of chronic or acute cerebral ischemia were >
To determine the functional and anatomical features of the arteries, ultrasound of the vessels of the head is used. At the heart of TKDS is the determination of the state of the vessels of the brain. Arteries and veins of the neck are assessed, if necessary, in parallel, since the blood supply to the head and blood vessels of the brain begins outside the cranium and the problem may be there.
The option of studying arteries and veins of the brain inside the skull is called intracranial, and the neck is called extracranial. The brachiocephalic arteries (BCA) are partially visualized extracranially: the vertebral arteries feed the posterior parts of the brain, and the carotid ones – the anterior ones.
The choice of the type of Doppler examination is up to the doctor, given the pathology of the main arteries of the head (MAG). The attachment of an atherosclerotic plaque to the endothelium due to elevated blood cholesterol disrupts the smooth flow of blood. This leads to turbulence, narrowing of the lumen, the formation of a blood clot.
- Doppler ultrasound (Doppler ultrasound);
- duplex scanning;
- triplex scanning.
The most informative is the last option.
As a result of transcranial dopplerography, a number of indicators are assessed related to the anatomy of the arteries and veins of the brain, as well as their functional state.
Technical capabilities of various brain TCD methods:
- The non-duplex mode with conventional ultrasonic dopplerography determines the parameters of blood flow: speed, acceleration, pulsation.
- The V-mode of the duplex additionally reveals the geometry, patency, pulsation force, diameter of the vessel, the state of its wall, lumen, and tissues around.
- When choosing a triplex, color Doppler mapping shows zones of eddies of the blood flow, impaired filling, and the presence of filling defects in the color chart.
On the monitor of the ultrasound machine, the doctor does not see a color image of the studied arteries. He hears the sound of blood pulsation and a graph with peaks of blood pressure on the wall of the blood tube.
The doctor, using the ultrasound scan method, receives:
- peak systolic blood flow velocity (Vs);
- final diastolic blood speed (Vd);
- systolic acceleration of blood flow;
- ripple index (PI);
- time-averaged maximum speed (Vmean).
These are the basic parameters of blood flow, allowing to evaluate the blood flow, but not the state of the vessel and vascular wall.
This research method is more advanced than ultrasound. It additionally uses the B-mode, which visualizes the arteries required for analysis and displays a color image on the monitor screen.
- the direction of blood flow relative to the probe when registering blood flow velocity;
- the cross section of the study area, which allows you to determine the artery depending on the anatomical positions.
Duplex examination of arteries and veins of the brain visualizes patency, geometry, state of the vascular wall, lumen, and the value of the pulsation of the wall.
This research method combines the B-mode, the Doppler effect of conventional USG and color Doppler mapping (CDC).
When color mapping on the monitor, arteries and veins are easily detected, since they are distributed into red and blue depending on the direction of blood flow. The method allows you to quickly distinguish arterial sites from venous, to evaluate their branching, blood supply and location.
The main advantage of the triplex option is the ability for the doctor to determine the zones of change in the smooth flow of blood over a flow with turbulences, as well as defects in blood filling. Thus, the doctor will quickly establish the location of the thrombus, atherosclerotic plaque, embolism or narrowing of the vessel.
Extracranial study: indications
Duplex scanning of the vessels of the head is prescribed for:
- Clinical signs of chronic or acute cerebrovascular insufficiency. They include, among others, a headache.
- Planning operations for different types of cardiac pathology. This primarily relates to coronary heart disease. In particular, duplex scanning of arteries is prescribed before stenting.
- The presence of risk factors for cerebrovascular pathologies. These include smoking, arterial hypertension, obesity, hyperlip >
Duplex scanning of veins is carried out in the presence of clinical signs of thrombosis.
Signs of vascular pathology
Intracranial duplex, which involves the study of veins and arteries located in the cranial cavity, is indicated for patients who have the following complaints:
- Regular pains in the head;
- Noise in the head or ears;
The doctor for ultrasound diagnostics Murat Medzhidovich Nagaplev tells about the indications for the examination:
- Manifestations of inappropriate behavior;
- Weakness and numbness of the limbs;
- Visual impairment;
- Lack of coordination in combination with a shaky, uncertain gait;
- Deviations in the reproduction of speech or its understanding.
TKDS reveals circulatory disorders in the head. It is prescribed when the following pathologies are detected:
- Intracranial hypertension;
- Lesions of intracranial vascular canals.
Scanning of extracranial vessels located outside the skull and supplying blood to the brain is carried out with the following pathological signs that appear in the patient:
- Impaired ability to remember information;
- Inability to concentrate on anything;
- Dizziness, intense headaches;
- Coordination disorders.
Duplex scanning of the vessels of the brain and cervical spine is a procedure that should be performed as planned (once a year), even in the absence of any complaints, in the following cases:
- If the patient is older than 40 years (men) or 45 years (women);
- In the presence of close relatives who have diseases such as diabetes mellitus, hypertension, coronary disease;
- If the patient is a smoker with experience;
- With previous surgical interventions on the spinal cord or brain;
- With a stroke or a violation of cerebral circulation in the anamnesis;
- In the presence of .
Ultrasonic duplex scanning is used to diagnose the following pathologies:
- Vein thrombosis, thrombophlebitis, pulmonary thromboembolism;
- Anomalies and injuries of veins;
- Varicose veins;
In more detail about the aneurysm of the brain, the doctor-rehabilitologist Sergei Nikolaevich Agapkin tells:
- Degree of blood flow deficiency;
Such a method as ultrasound testing is characterized by high information content, painlessness, and the absence of harmful effects on the body, since the equipment does not require radiation during the manipulation.
Ultrasound helps to identify pathological changes in the venous system, give it an accurate diagnosis. Most often identified:
- Arteriovenous malformations
- Varicose veins
If there is a non-stenotic atherosclerosis, violations of the main arteries, a decrease in the lumen, and thickening of the walls of the arteries are detected.
Identification of plaques indicates stenotic atherosclerosis.
Ultrasound can detect an inflammatory process, a change in the thickness of the walls of blood vessels, the appearance of vasculitis.
Temporal arthritis is characterized by diffuse thickening of arteries located in the temporal region, low echogenicity is determined. In the case of a prolonged inflammatory process, the appearance of an atherosclerotic lesion is possible.
For diabetes, the appearance of signs of macroangiopathy is characteristic.
Very often abnormal phenomena occur in the region of the vertebral arteries, the so-called hypoplasia. In other words, there is a decrease in the diameter of the artery. Sometimes it becomes less than 2 millimeters.
Ultrasonic symptoms of hypoplasia depend on its severity. Ultrasound detects the appearance of abnormal phenomena at the junction of the vertebral main artery with the vessels of the cervical vertebrae. Typically, such an anomaly does not affect hemodynamics.
Ultrasound shows the available extravasal compression, that is, squeezing the walls of the vessel. The reason for this compression of the vessels of the neck is:
- Thyroid inflammation
- Highly enlarged lymph nodes
Advantages and disadvantages of the technique
When such a procedure is carried out, it is determined:
- The state of blood flow in the vessels of the brain
- Early stages of changes in the structure of blood vessels, such as atherosclerosis, are detected
- Vascular patency
The main advantage of duplex scanning is the ability to diagnose the early signs of a disease when characteristic clinical symptoms have not yet manifested.
Such a scan helps to identify existing pathologies associated with the functional work of the bloodstream. Verification by ultrasound diagnostics is done without the use of an X-ray unit, radiation is completely absent, such diagnostics can be carried out many times.
Ultrasound refers to a non-invasive method. In other words, there is no need to undergo a procedural examination, the use of special medicines is not required. The occurrence of allergic reactions is completely eliminated, there are no various side effects.
Today, duplex scanning of the vessels of the brain and neck is considered the most effective method of research, allowing the doctor to obtain maximum information about the condition in which the blood vessels of a person are.
For a long time this type of examination of the human body, its blood vessels in the brain, has been considered the most objective and completely safe. Of course, the result of the study largely depends on the qualifications of the specialist deciphering the study. Errors during such verification are not allowed.
Thanks to duplex scanning, many patients avoided the occurrence of dangerous diseases, were able to improve the condition of their vessels in time.
After a duplex scan, the doctor can prescribe the most suitable treatment, after which the person can live a normal full life.
Medicine constantly presents to society new methods for diagnosing serious pathologies. The success of treatment of various diseases depends on their timely detection, the appointment of the necessary therapy. Duplex scanning of the vessels of the head and neck is an innovative research method that allows you to see the smallest tubular hollow formations of the human body in a two-dimensional projection. The non-invasive nature of the technique facilitates the procedure, does not require recovery after the manipulation.
Duplex scanning is notable for its high resolution, non-invasiveness and the ability to conduct multiple repeat procedures. Thanks to this, the study is considered an indispensable tool in clinical neurology. Duplex scanning allows for complete preventive screening in an asymptomatic population.
Using this research method, the possibilities of differential diagnosis are greatly expanded. Duplex scanning of the neck vessels allows you to identify medium and small stenosis of the carotid canals. Based on this, it can be stated that the study can be used as a basic screening method in individuals without clinical signs of cerebrovascular disease.
How is the diagnosis?
Diagnosis of the main arteries of the head is a safe measure, which, if necessary, can be prescribed to pregnant women or a child. A relative contraindication to the procedure is the general serious condition of the patient or the presence of diseases that make it impossible for the patient to accept the horizontal position in which the procedure is performed.
Examination of the large cervical arteries
The examination lasts no more than half an hour. No prior preparation for scanning is required. Only one thing will be required from the examinee – not to take on the eve of substances or preparations that affect the vascular tone and distort the overall picture of their condition. These include caffeine, nicotine-containing substances, energy and alcoholic drinks. Do not visit the sauna and bathhouse before duplex scanning.
Duplex scanning is performed as follows:
- The patient is in a supine position. The specialist fixes the head so that it is in an elevated position, for which they put a roller under the neck. The head is turned in the direction opposite to that in the region of which the study is being carried out;
- A specialist with a sensor conducts along the area of the location of the vessels. Previously, to facilitate the examination, a gel with a special composition is applied to the surface of the skin. The resulting image is fed to the monitor;
- The examination begins with the diagnosis of the carotid artery before entering the skull, examining it in different planes;
- When examining the brain, such areas as the occipital bone, temporal and infraorbital areas, the junction of the occipital bone with the spine are examined.
During the duplex of vessels of the head and neck, functional tests can be performed to study autonomic regulation. For these purposes, the specialist may ask the subject to hold their breath, cough, slightly change the position of the body.
The procedure for duplex scanning of the vessels of the head and neck is quite simple and takes no more than 30 minutes:
- The patient arrives at the appointed time and settles down on the couch. The study can be carried out in the position of the patient lying on his back or side, sitting or half-sitting. Special special preparation for the procedure is not required.
- The doctor applies a special gel to the sensor and the neck of the patient.
- Further, the doctor easily leads the sensor along the lateral surface of the neck. Sometimes a diagnostic specialist may ask the patient to change the position of the body, cough, strain, hold his breath.
Duplex scanning of the vessels of the head enables the specialist to analyze the condition of the blood arteries and their geometry. The procedure makes it possible to investigate the existing deformations, to detect transcranial deviation, branching of arteries, their length.
After passing the examination, it is determined:
- Wall thickness
- Structural disorders
- Intraluminal formations
- Change in diameter of arteries
Duplex scanning of cerebral vessels makes it possible to establish an accurate diagnosis when the patient was diagnosed with:
- Capillary inflammation
- Artery injury
- Vascular wall diseases
- Varieties of angiopathy
- Vascular dystonia
- Encephalopathy discirculatory
Duplex scanning is prescribed for diseases:
- Vascular injury
Duplex scanning can be done in the direction of the attending physician in the neurological departments of large city hospitals or go to the clinic according to the area of residence. The manipulation is carried out as a general rule. The patient is placed on a couch, a firm pillow or a roller is placed under his head, his head is turned away from the sensor.
Before starting the procedure, the doctor applies a little special gel to the studied area, with which you can easily “drive” the transducer over the skin surface, analyzing arterial and venous channels. The vessels of the brain are checked through the bones of the skull. Previously, the skin is treated with a water-soluble gel, then the doctor places the sensors in the following areas:
- over the eye sockets;
- alignment of the occipital bone with the spine;
- the occipital bone.
Results and their interpretation
Assessment of the state of arteries and veins of the head and cervical spine is carried out according to such indicators as the thickness of the walls of blood vessels, the nature and speed of blood flow, the ratio between the minimum and maximum speeds.
The level of Doppler indicators of the state of arterial vessels is expressed in numbers. So, the norm for artery wall thickness is from 0,9 to 1,1. The normal maximum systolic rate should not exceed 0,9, the peak speed in diastole should be less than 0,5.
Deciphering the results allows you to obtain such signs of vascular pathology:
- An increase in wall thickness and narrowing of the artery by less than 20% indicates atherosclerosis;
- A diffuse change in wall thickness indicates vasculitis;
- The presence of a fistula between veins and arteries is a sign of malformations.
The examination protocol allows the specialist to determine the earliest signs of the disease, even before the onset of clinical symptoms.
The advantages of duplex scanning of the vessels of the head and neck are that it is a reliable method, which does not require the introduction of any substances into the patient’s blood, as well as exposure to x-rays, which can adversely affect health. The diagnostic method has no contraindications.
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Duplex scanning of vessels of the head and neck (SPL)
– This is a study of the main vessels supplying blood to the brain using two modes: two-dimensional ultrasound and ultrasound dopplerography. During the diagnosis, a black-and-white image of the main vessels of the neck and head is created on the monitor screen, and a linear graph is formed that shows the speed and direction of blood flow in them.
With the help of ultrasound, it is possible to determine the exact anatomy of the vessel, the presence of constrictions, deformations, obstructions to the blood flow both inside the arteries and veins and outside (for example, compression by bone spikes or a tumor). Duplex of the head and neck provides comprehensive information about the presence of blood clots or atherosclerotic plaques, their size, the extent of circulatory disorders and the degree of compensation beyond the obstacle.
Indications for study
An ultrasound duplex scan of the vessels of the head and neck is recommended for children and adults with complaints of dizziness, headaches, tinnitus, a sharp decrease in vision, flies in front of the eyes, shaky gait, episodes of loss of consciousness, as well as those suffering from neurological diseases, high arterial pressure, vegetative-vascular dystonia or preparing for vascular surgery.
How is ultrasound of the vessels of the head and neck performed?
Special preparation before diagnosis is not required. At the first stage, the doctor makes a duplex scan of the brachiocephalic vessels of the neck – this is the part of the arteries and veins that is located on the neck, in the thickness of soft tissues. These vessels are clearly visible through the skin throughout. Then the doctor proceeds to transcranial duplex scanning of the vessels of the head, that is, he examines the blood circulation already inside the cranium.
Since the bones practically do not pass ultrasound, this part of the study is carried out through the thinnest places in the skull: temples, occipital region, and also above the eyes. The doctor first puts the gel on these areas, so after the procedure the hair will be dirty. All diagnostics take about 20 minutes and are completely painless.
Duplex scanning of the vessels of the head and neck is one of the most modern techniques for the study of blood vessels. From this article you will learn about the essence of the procedure, indications for its purpose and informational content.
Vascular duplex scanning or vascular duplex scanning is a special type of ultrasound or sonographic examination designed specifically to study vascular structures and the nature of blood flow in them. This method differs from conventional ultrasound in a combination of two main techniques:
- The usual B-mode of ultrasound is the same gray-white picture depicting organs and tissues in a planar mode. In duplex mode, the vessels, depending on the tilt and rotation of the sensor, look like longitudinal or transverse sections. In this mode, you can consider their course, measure the diameter, evaluate the clearance, the presence of blood clots or other inclusions in them. State-of-the-art sensors can even help to examine a layered image of the vascular wall – like a microscope section.
- Doppler mode is a type of ultrasound based on the registration of flows of moving blood particles in vessels. Using the Doppler effect, you can record the fact of blood flow, evaluate its intensity, the direction of blood flow, measure its speed, resistance indices and other important indicators.
Duplex neck vessels procedure
By similar principles, a duplex study of all the vessels of the human body occurs. Of greatest importance in modern medicine is the duplex scan of arteries and veins of the lower extremities, the heart and its large vessels, as well as the vessels of the head and neck. It is about the latest study that we will discuss in more detail below.
Why do duplex vessels of the head and neck? The fact is that the brain, its structures and the vascular system have always been a stumbling block in diagnosis. The brain is reliably covered by a skull box, therefore, several decades ago, the only objective method of research was X-ray studies.
In addition to x-rays, various neurological tests came to the rescue, evaluating brain function and indirect signs of cerebrovascular accident. Modern techniques have successfully studied the vessels of the head and neck that feed the brain, which are accessible to research. Thus, by evaluating the blood flow in these supply trunks, one can indirectly judge a similar blood flow in the brain tissues.
The brain is supplied with blood from the branches of the carotid artery, vertebral arteries, subclavian arteries and the brachiocephalic trunk, which mutually replace each other and form the Willis circle. The more traditional and common name for all of these arteries is the brachiocephalic arteries, or BCA. Accordingly, duplex scanning of the vessels of the head and vessels of the neck is often called. It is prescribed by neurologists or therapists, and is performed by doctors of ultrasound diagnostics.
At the end of the examination, the doctor receives comprehensive information about the condition of the arteries and veins. The analysis of the venous bed practically does not contain digital data, but includes parameters:
- blood speed;
- the presence of abnormal formations inside the lumen.
Dopplerography of arterial vessels collects digital data that are compared with normal values. The satisfactory condition of the common and carotid arteries can be considered the presence of the following indicators:
- the limiting speed of blood flow in the artery is less than 0,9;
- the percentage of stenosis is 0;
- peak speed in diastole is less than 0,5;
- lack of formations within the lumen;
- wall thickness – 0,9-1,1.
The normal results of an ultrasound examination of the vessels of the neck and head are as follows:
- common carotid artery (OCA) on the left departs from the aorta, on the right – from the brachiocephalic trunk;
- spectral wave in the common carotid artery (OCA): the rate of diastolic blood flow is the same in the external and internal branches of the carotid artery (HCA and ICA, respectively);
- the internal branch of the carotid artery has no branches until the entrance to the skull;
- a large number of additional branches depart from the external branch of the OSA;
- the waveform in the internal branch of the OCA: monophasic, the speed of blood flow during diastole is greater than in the OCA;
- waveform in the external carotid artery: three-phase, blood flow during diastole is less than in the OSA;
- the thickness of the vascular wall is not more than 0,12 cm
A thickening of the vascular wall indicates incipient atherosclerosis. With obvious atherosclerosis, the doctor sees plaques, indicates their location and size. Vasculitis (vascular inflammation) leads to diffuse thickening of the vessel wall and blurring of its layers.
The presence of messages between the venous and arterial beds is called arteriovenous malformation. Damage to blood vessels in the presence of diabetes indicates its advanced stage and decompensation.
Objectives of the study
Duplex scanning of the vessels of the head not only helps to identify the occlusal and stenotic pathology of the brain, but also allows you to evaluate its hemodynamic and pathogenetic significance. The examination allows you to detect:
- A complex of disorders caused by systemic diseases of the blood channels.
- Anomalies in the development of blood vessels, aneurysms, malformations, cerebral vasospasm of anastomosis, disturbances in circulation.
- Early (preclinical) signs of systemic disease.
A duplex head scan allows you to monitor the effectiveness of therapeutic measures. In the course of the study, it is possible to assess the reserve capabilities of the circulatory system of the brain, to establish the probable etiological role of the detected pathological process or symptom complex in the genesis of the manifestation of one or more clinical syndromes for a particular patient. The examination also makes it possible to determine the functions of the central and local mechanisms of regulation of the tone of the blood channels.
Duplex scan of the lower extremities: indications
The examination is scheduled when:
- Swelling in the ankle joint.
- Discomfort and pain in the lower legs when moving and at rest.
- Convulsive twitches, pulling sensations in the fingers.
- Heaviness in the lower extremities.
- Pale or darkened skin, redness, or tightening.
- Spider veins, pronounced changes in saphenous veins.
- Trophic ulcers.
Duplex vein scanning of the lower extremities is also recommended in the absence of a pulse in the legs.
Description of the procedure
Duplex scanning of veins of the lower extremities does not require special preparation. The clothes should be chosen so that the specialist has access to the surveyed areas. Before a duplex scan of the veins of the lower extremities is performed, the patient lies on the couch. With the help of special equipment and a sensor with gel applied on it, the doctor conducts along the main blood channels of the legs. Due to the gel, the transfer of information to the device is enhanced. Additionally, duplex scanning of veins of the lower extremities can be carried out in a standing position.
What arteries are examined
Duplex scanning of cerebral vessels is done to study vascular patency. An ultrasound scan gives very accurate results about the state of the human blood arteries.
Ultrasound helps to study the condition of the main arteries, to check the speed of the blood flow. A vessel surrounded by tissues is clearly visible on the display. This diagnosis allows you to determine the causes of poor patency of the arteries. Visually you can see:
- Blood clots
Triplex research of an organism gives very good results. A colored vessel is visible on the display, and its color depends on the speed of the blood stream.
Features of the study
When conducting a duplex scan of the vessels of the head, a low radiation frequency is used. This is due to existing obstacles to the rays in the form of bone elements of the skull. When using low frequencies, it becomes impossible to visualize the vascular walls and assess the state of the lumens. The information received is indirect in nature.
The information is based on the analysis of color cartograms for flows of intracranial veins and arteries, as well as Doppler spectra. In this regard, against the background of a transcranial study, it is impossible to assess changes and diagnose processes that are not accompanied by the formation of systemic and local hemodynamic disturbances.
Due to the different thickness of the bone elements of the skull, which determines the uneven permeability of ultrasonic radiation, echolocation is performed in specific areas. They are called “ultrasonic windows.” The quality and amount of information obtained during transcranial scanning depends on their severity. The main limitations can be caused by a significant deterioration in ultrasound imaging against the background of a decrease in the acoustic ability of the bony elements of the skull.
In the process of scanning extracranial sections of the brachycephalic arteries, differential signs are revealed that are characteristic of stenosing atherosclerosis, microembolism, thrombosis, vasculitis, angiopathy. In a transcranial study, it is possible to verify occlusal or stenosing lesions with a determination of their severity without specifying morphological equivalents.
The examination also allows you to identify specific phenomena that are characteristic for the failure of autoregulation of blood flow in the brain, cerebral angiospasm, and more. If an atherosclerotic lesion of stenosing type is detected in the carotid arteries, an echostructure of the plaque and the degree of impaired lumen patency are assessed for each damaged vessel.
Dopplerographic research, as well as ultrasound, is done according to one principle. The patient should lie on his back. A solid pillow is placed under the head, it can be replaced by a roller.
The patient turns his head, opening the opportunity to examine the neck. A special gel is applied to the skin to facilitate the movement of the transducer. Thus, the doctor checks the condition of the arteries, makes the necessary measurements.
Diagnosis of extracranial vessels of the brain is carried out through the cranial bones. The sensor is located on the head, in the area of the temporal areas. These places are covered with a water-soluble gel, which helps to obtain the most objective ultrasound results.
In addition to visual inspection of the arteries, the doctor makes special functional tests, for example, asks the patient to hold his breath. Thus, he can check whether there are violations of autonomic regulation.
Examination of the vertebral blood channels
Due to the presence of anatomical features of their location, the visualization of arteries is possible only fragmentary. They are available for monoplane research. This significantly limits the ability of scanning in the diagnosis of various diseases. So, with high reliability with low quality of visualization, only stenotic lesions with narrowing of gaps of more than 40-50% in diameter, located in accessible areas, are determined.
Echostructural analysis of formations within the lumen, as a rule, is not performed. This is due to the limited ability to visualize the walls of the blood channels. Determination of functional changes in the diameter of the vessels is carried out using stress testing. There are no objective specific ultrasonic signs for extravasal compression in the vertebral blood channels in the area of the transverse processes of the vertebral elements of the upper column in the craniovertebral joint zone.
Duplex diagnostic criteria used in everyday practice are indirect in nature and must necessarily be confirmed by the methods by which visualization becomes possible. These, in particular, include angiographic examinations in the background or with load-bearing functional tests. Scanning of jugular veins (external, internal), as well as vessels in the vertebral venous plexus, is carried out in case of suspected thrombosis in them.
Need to scan
A study of the state of cerebral vessels using the duplication method is prescribed when signs of chronic cerebrovascular insufficiency appear. This also includes the occurrence of frequent headaches.
The doctor prescribes such an examination before conducting operations associated with the presence of cardiac arterial pathology. First of all, this applies to coronary heart disease.
Transcranial scanning of arteries is performed before the stenting procedure. An ultrasound examination is prescribed if there is a risk of cerebrovascular pathologies. The reason may be:
- Arterial hypertension
The results of extracranial studies of the work of the great vessels help the doctor determine the type of blood flow, available speed, and defects in the filling of arteries are revealed.
Ultrasound of the venous bed makes it possible to determine:
- Anatomical structure
- Blood speed
- Intraluminal formations
After checking the vessels, the conclusion of the ultrasound does not show any digital data. Doppler scanning of arterial vessels allows for digital analysis, it is possible to compare research data with the norms.
The clinical significance of duplex blood circulation indices obtained in the Doppler spectral mode from the gaps of the vascular collectors listed above, as well as their role in assessing pathological changes in cerebral hemodynamics in other cases, is considered very doubtful. At the same time, the variability of the blood outflow from the cranial cavity when the patient changes his body position, the inconsistency of the structure of the blood channels themselves, synchronization of flow with breathing, and light compressibility of the lumens are taken into account.
Using duplex scanning, it is possible to follow the course of blood flow and determine vascular reactions in the area of damage both against the background of selective and systemic thrombolysis. Stabilization of the flow in the affected area or its acceleration in the lumen, a decrease in intensity or the disappearance of collateralization are considered objective signs of the effectiveness of the applied therapy.
Like any other ultrasound scan, duplex scanning is an operator-dependent method. And – to a certain extent – subjective. The success of using the complex of visualization capabilities in clinical neurology, in addition to the skills and experience of a specialist operator, will largely depend on the qualitative characteristics of the equipment used in the examination.
How to prepare
The procedure of TKDG of vessels proceeds painlessly, does not require special preparation. On the eve of dopplerographic research, it is necessary to refrain from taking substances that affect vascular tone:
- vasoconstrictor or antihypertensive drugs.
Taking drugs that control blood pressure cannot be canceled due to a threat to the patient’s life. The attending physician, based on the pharmacokinetics of the drug, its peak blood concentrations, will tell you how many hours after taking the drug, you can perform the ultrasound scan.
Examination of the head and neck does not require special preparation from the patient. On the day of the procedure, it is necessary to abandon the use of drugs that increase the tone of blood vessels: coffee, nicotine, tea, energy. The abolition of drugs that can distort the results of ultrasound scan – Betaserk, Cinnazirin – requires consultation with a neurologist. Before scanning, the patient will need to remove all foreign objects in the form of chains, hairpins, etc. from the study area.
How do diagnostics
For research, a person is laid on his back on a soft couch. A roller is placed under the neck, the head lies without a pillow. The doctor applies a special gel to the sensor and skin – this is necessary for the passage of ultrasonic waves into the internal environment of the body.
The vessels of the neck are examined by pressing the sensor to its lateral surface. At this moment, you can’t move your head, talk. During the procedure, the doctor presses the sensor several times to assess the elasticity of the vessels.
The vessels of the head are examined through the thinnest areas of the cranial bones: the orbit, temporal bone, occipital bone and large occipital foramen. The sensor is installed on the closed eye, above the auricle and posterior to it. After this, the patient is seated and the neck area is examined and the place where the neck connects to the head.
Thus, the doctor examines all the vessels that bring blood to the brain and carry it back to the heart.
The procedure takes about half an hour and does not cause any discomfort. During it, the diagnostician may ask you to hold your breath, breathe often, turn your head. This is necessary for the best image accuracy and assessment of the functional state of blood vessels.
On the day of the study, you should not take medications that affect blood pressure. It is advisable to refrain from drinking strong coffee, nicotine and alcohol – all these substances change the state of the vascular bed and can distort the results of the study.
The study of duplex scanning of the vessels of the head involves the use of an ultrasound probe with a frequency of 2 MHz. The use of high-frequency probes applicable for extracranial Doppler studies is not possible for intracranial measurements during ultrasound.
High-frequency waves are not able to adequately penetrate the bones of the skull. In addition to using a low-frequency probe, ultrasound of the head vessels is only possible through thinner sections of the skull, called acoustic windows.
Areas of access zones for conducting ultrasound diagnostics:
- under the eyebrow;
- under the lower jaw;
- the back of the head.
Although each window has unique advantages for different arteries, a full examination takes place from all four windows.
Duplex or triplex scanning of veins with ultrasound scan is performed using two types of functional tests: a distal compression test, a breath-holding test.
Are there any contraindications
Doppler has virtually no restrictions on use. TCD can be performed for men, women, children of any age. Pregnancy or lactation are not a contraindication to performing ultrasound. Dopplerometry does not use x-rays, due to which it can be repeatedly used without harm to the health of the subject.
Contraindications to the procedure may include:
- injury or pathology of acoustic windows;
- inadequate patient behavior that does not allow the study.
Before conducting the study, remove glasses or contact lenses.
The advantage of duplex scanning is the absence of negative effects on the human body. The non-invasive nature of the study helps to diagnose blood vessels in an adult and a child without any restrictions. Relative contraindications can be considered a serious condition of the patient or the presence of diseases that prevent the patient from moving to a horizontal position.
How much is ultrasound
The cost of an ultrasound examination starts from 1500 and reaches 7000 rubles. It all depends on the medical institution, the need for an examination of only the head or additional neck.
Brain ultrasound scan is a relatively inexpensive but necessary measure for a comprehensive assessment of intracranial blood flow disorders. The brachiocephalic vessels test method can be used in conjunction with other tests in the clinical diagnosis of a number of cerebrovascular disorders.
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