Peripheral vascular ultrasound: how, why, and when

244 Pages·2004·9.63 MB·English

by  Abigail Thrush

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Peripheral Vascular Ultrasound
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To Wendy, Tony and June
For Elsevier:
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Peripheral Vascular
Ultrasound
HOW, WHY AND WHEN
SECOND EDITION
Abigail Thrush
MSc
Medical Physicist, Department of Clinical Physics,
St Bartholomew’s Hospital, Bart’s and the London NHS Trust, London, UK
Timothy Hartshorne
Vascular Technologist, Department of Surgery,
Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2005
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Disclaimer: Some images in the printed version of this book are not available for
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ELSEVIER
CHURCHILL
LIVINGSTONE
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First published 1999
Second edition 2005
ISBN 0 443 07283 3
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
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Notice
Knowledge and best practice in this field are constantly changing.
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v
Contents
Acknowledgments vi 9. Duplex assessment of lower limb arterial
Preface vii disease 111
10. Duplex assessment of upper extremity arterial
disease 133
1. Introduction 1
2. Ultrasound and imaging 5 11. Duplex assessment of aneurysms 145
3. Doppler ultrasound 23 12. Anatomy of the lower limb venous system and
assessment of venous insufficiency 163
4. Creation of a color flow image 35
13. Duplex assessment of deep venous thrombosis
5. Blood flow and its appearance on color flow
and upper limb venous disorders 189
imaging 49
6. Factors that influence the Doppler 14. Graft surveillance and preoperative vein
spectrum 63 mapping for bypass surgery 207
7. Optimizing the scan 75 Appendix A: Decibel scale 225
Appendix B: Sensitivity and specificity 227
8. Ultrasound assessment of the extracranial
cerebral circulation 85 Index 229
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vvii PERIPHERAL VASCULAR ULTRASOUND
Acknowledgments
We would like to thank David Evans, Hayley Handford, Pouran Khodabakhsh, Nick London, Salvatore
Luca, May Naylor, Ross Naylor, Yvonne Sensier, and Jo Walker for their help and support in the
preparation of this book.
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vii
Preface
Vascular ultrasound is a speciality in its own right sources of errors in any measurements made by
and vascular surgeons are becoming increasingly ultrasound should be understood. Specific disorders
dependent on the skills of vascular sonographers for of the arterial and venous systems are covered, and
the investigation of patients suffering from periph- the techniques for diagnosing these problems are
eral vascular disease. This book aims to provide an described. Examples of normal and abnormal
understanding of the principles and practice of vas- images and Doppler recordings are included and
cular ultrasound. the interpretation of these discussed. British readers
An introduction to some of the basic theory please note that the publishers have used American
behind the science and technology of ultrasound is spelling in this edition.
included. This will help sonographers to understand We hope this book will serve as a useful reference
the function of scanner controls and enable them to sonographers new to this field.
to obtain optimal images and Doppler recordings.
B-mode imaging, color flow and spectral Doppler
images are all prone to artefacts, and it is essential London, 2005 Abigail Thrush
that their presence be recognized. The potential Leicester, 2005 Timothy Hartshorne
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1
1
Chapter
Introduction
Since the first edition of this book there have been
significant developments in ultrasound technology,
magnetic resonance imaging (MRI) and magnetic
resonance angiography (MRA), computed tomo-
graphic (CT) scanning and vascular and endovascu-
lar surgical procedures. The latest generation of
duplex systems produce clearer images, especially
with the use of techniques such as harmonic imag-
ing and compound imaging. Scanners are more sen-
sitive to detecting flow in the arterial and venous
systems. The images produced by MRA can be visu-
ally stunning, and it has been suggested that MRA
and spiral CT may replace duplex investigations in
the future. However, duplex scanning still has many
advantages. Apart from improvements in image res-
olution, it is the ability to visualize flow in real time,
make quantitative measurements of blood velocity
and detect flow direction that will ensure duplex
scanning will remain an important imaging tech-
nique for the foreseeable future. Cost and resource
implications also are important factors. For instance,
it is not cost-effective to screen patients for carotid
disease or aortic aneurysm with MRI. However,
MRI or CT scanning is essential for planning endo-
vascular repair of an aortic aneurysm. Therefore,
each modality has its part to play in the management
of patients with vascular disorders. In many centers,
diagnostic angiography and venography have been
largely replaced by the use of duplex ultrasound
investigations. This has the advantage of allowing
surgeons and physicians to select patients for surgi-
cal treatment or conservative management without
the need for invasive investigations. In addition, vas-
cular radiologists can spend more time performing