末梢血管における超音波検査の進歩と現状 はじめに 超音波技術の進歩 特集 : 脈管疾患診断における非侵襲的画像診断 : 進歩と現状. real-time tissue elastography real-time virtual sonography

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1 Online publication January 22, 2010 総 説 特集 : 脈管疾患診断における非侵襲的画像診断 : 進歩と現状 末梢血管における超音波検査の進歩と現状 要旨 : real-time tissue elastography real-time virtual sonography J Jpn Coll ngiol : Key words: peripheral vascular disease, ultrasound, erastography, 3D4D, contrast enhanced US はじめに real-time tissue elastography 超音波技術の進歩 (1) 画質の向上 MHz 12 15MHz tissue harmonic imagimg THI 2mm Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 (2) 血流表示 ( 造影超音波法 ) dynamic flow -Flow 2 3 Levovist 3 Sonazoid THE JOURNL of JPNESE COLLEGE of NGIOLOGY Vol. 49,

2 Figure 1 mode images of the dorsal pedis artery. : Normal artery. : Occlusive lesion of urger disease. oth arteries are 1.5 mm in diameter. mode image shows vessel wall thickening and slightly echogenic lumen at the occlusive lesion of urger disease (). Figure 2 cute brachial artery occlusion. Thrombosis is clearly seen in the brachial artery (arrows). Figure 3 Stenting for the SF occlusion. : mode image. : -Flow image. Correlation between vessel wall and stent and intimal thickening (arrows) are clearly shown. Figure 4 DVT of the soleus vein. : mode image. : -Flow color image. DVT of the soleus vein is clearly shows (arrows). 524 脈管学 Vol. 49, 2009

3 5 Figure 5 mode images of a solitary venous aeurysm. Moya echoes are moving in the venous aneurysm in real-time observation. Figure 6 Contrast enhanced ultrasound with Sonazoid (transvers scan of the peroneal muscle). Several vessels in the peroneal muscles are shown in linear or dotty patterns. 4 7 Fig. 6 8 (3) パノラマ表示, 三次元 / 四次元表示 1 Fig Fig. 8 Figure 7 Iliac arterial aneurysm treated by stent graft. : Iliac angiography before treatment. : Iliac angiography after treatment. C: Panoramic ultrasound image after treatment. Panoramic image shows the whole aspect of stent graft (arrows) and aneurysms. (4)real-time tissue elastography real-time tissue C 脈管学 Vol. 49,

4 Figure 8 Real-time 3D image. : Longitudinal view of the brachial artery. : Transverse 3D view. Frame rate: 6Hz Figure 9 Real-time tissue elastography of deep vein thrombosis. Flouting thrombosis of the common femoral vein is not crearly visualized by mode image (right: arrows). However, thrombosis is displayed in blue (means hard) and the surrounding lumen in red (means soft). elastography Fig. 9 (5) 他画像参照機能 (real-time virtual sonography,volume navigation) MDCT MRI CT MRI MPR CT CT MRngio GPS CT Fig. 10 Figure 10 Volume navigation images of SF stenosis. : Real-time power Doppler image after balloon angioplasty. : Reference MPR image of contrast enhanced CT before treatment. (6) 高機能ポータブル装置 Tissue harmonic imaging THI 526 脈管学 Vol. 49, 2009

5 5 末梢血管領域における超音波の現状 (1) 末梢動脈エコ -の現状 1 11 CT ngio MR ngio 2 CT ngio MR ngio PSV T IVR Fig. 3 3 IVR IVR 3D 3 2 Fig. 8 6Hz IVR (2) 静脈エコーの現状 CT D DVT DVT おわりに CVT 2 文献 , Flow 2000, 40: Coli S, Magnoni M, Sangiorgi G et al: Contrast-enhanced ultrasound imaging of intraplaque neovascularization in carotid arteries: correlation with histology and plaque echogenicity. J m Coll Cardiol, 2008, 52: 脈管学 Vol. 49,

6 5 Shah F, alan P, Weinberg M et al: Contrast-enhanced ultrasound imaging of atherosclerotic carotid plaque neovascularization: a new surrogate marker of atherosclerosis? Vasc Med, 2007, 12: Feinstein S: Contrast ultrasound imaging of the carotid artery vasa vasorum and atherosclerotic plaque neovascularization. J m Coll Cardiol, 2006, 48: Vicenzini E, Giannoni MF, Puccinelli F et al: Detection of carotid adventitial vasa vasorum and plaque vascularization with ultrasound cadence contrast pulse sequencing technique and echo-contrast agent. Stroke, 2007, 38: INNERVI- SION D IVR D 3 3D Medical Technology Hirai T, Ohishi H, Kichikawa K et al: Ultrasonographic screening for arterial occlusive disease in the pelvis and lower extremities. Radiation Medicine, 1998, 16: PT IVR IVR Ultrasonography of the Peripheral Vascular Diseases Recent dvances and Clinical pplications Toshiko Hirai 1, Syouji Sakaguchi 2, Wataru Higashiura 2, Hirofumi Ito 2, Shigeo Ichihashi 2, and Kimihiko Kichikawa 2 1 Department of Endoscopy and Ultrasound, Nara Medical University, Nara, Japan 2 Department of Radiology, Nara Medical University, Nara, Japan Key words: peripheral vascular disease, ultrasound, erastography, 3D4D, contrast enhanced US Recent advances and clinical applications of ultrasound for peripheral vascular diseases are introduced. Ultrasonography delivers morphological and functional information in real time non-invasively and is used for the diagnosis of peripheral vascular diseases. In some facilities, ultrasound is used as the guide for IVR too. Recent technologies for example, real-time tissue elastography, contrast-enhanced ultrasound, real-time virtual sonography, and so on are only utilized for study in the peripheral vascular region. In the near future, we expect to see these advanced technologies become widely available for the diagnosis and follow-up of peripheral vascular diseases. (J Jpn Coll ngiol, 2009, 49: ) Online publication January 22, 脈管学 Vol. 49, 2009