來源丨《Blackwell’s Five-Minute Veterinary Consult》

翻譯丨寵物神經(jīng)科醫(yī)生高健

TYPE OF PROCEDURE
檢查類型

Ultrasonographic
超聲

PROCEDURE EXPLANATION AND RELATED PHYSIOLOGY

檢查解釋及相關(guān)生理學(xué)

Ultrasound examination of the brain requires an acoustic window through the skull. Dogs with hydrocephalus often have a persistent bregmatic fontanel that enables imaging of the brain. In these cases, an ultrasound examination is a quicker, less expensive, and more available screening tool than computed tomography (CT) or magnetic resonance imaging (MRI). Ultrasound images of the brain have relatively poor anatomic detail compared to those with CT and especially MRI. Ultrasound imaging of the brain in patients with a closed fontanel may be accomplished through the temporal window or foramen magnum, although these acoustic windows provide a more limited view of the brain in many cases. A portion of the skull can be removed surgically to provide a window for ultrasound; however, this invasive technique requires anesthesia. For these cases, CT and MRI, which are less inva- sive, provide a more complete evaluation of the brain than ultrasound will provide. Ultrasound is excellent for distinguishing fluid versus soft tissue, enabling straightforward identification of hydrocephalus, cysts, and abscesses. Intraoperative ultrasound of the brain is used mainly to aid surgical dissection by identifying nonpalpable and nonvisible le- sions. Ultrasound is used postoperatively to evaluate the completeness of removal of a lesion or look for evidence of complications.

對(duì)大腦進(jìn)行超聲檢查需要有一個(gè)通過顱骨透過超聲波的窗口。

患有腦積水的犬通常有一個(gè)永久性開放的囟門，
這使得大腦超聲檢查變得可行。

在這些情況下，
超聲檢查是一種比計(jì)算機(jī)斷層掃描CT或磁共振成像MRI更快速、更便宜、更有效的篩查工具。

但是與CT，尤其是MRI相比，
超聲圖像的大腦解剖細(xì)節(jié)相對(duì)較差。

對(duì)于囟門閉合的病患，
超聲成像可以通過顳窗或枕骨大孔來完成，
盡管在許多情況下，
這些透超聲窗提供的大腦圖像更有限。

可以通過手術(shù)切除顱骨的一部分來以提供透過超聲的窗口;
但是，手術(shù)是侵入性技術(shù)，而且需要麻醉。

對(duì)于這些病例，
CT和MRI侵入性較小，
而且能提供比超聲更全面的腦部評(píng)估。

超聲在區(qū)分液體和軟組織方面非常出色，
可以直接識(shí)別腦積水、囊腫和膿腫。

術(shù)中腦部超聲主要用于通過識(shí)別無法觸摸和肉眼不可見的病變，
用作輔助手術(shù)解剖定位。

超聲用于術(shù)后評(píng)估病變清除的完全程度，
或用作尋找并發(fā)癥的證據(jù)。

INDICATIONS
適應(yīng)癥

Suspected hydrocephalus?
Intraoperative location of brain tumor, cyst, abscess, or hemorrhage

懷疑腦積水

術(shù)中腦腫瘤、囊腫、膿腫或出血的定位

CONTRAINDICATIONS

禁忌癥

Atlantoaxial instability is a contraindication for ultrasound imaging of the brain through the foramen magnum. Hyperflexion of the head is required for imaging through the foramen magnum and could cause severe injury to the spinal cord if concurrent atlantoaxial instability?is present. To assess for possible atlantoaxial subluxation in toy-breed dogs, survey radiographs should be made prior to this ultrasound procedure.

寰樞椎不穩(wěn)（Atlantoaxial instability）是經(jīng)枕骨大孔超聲成像的禁忌癥。

因?yàn)橥ㄟ^枕骨大孔成像需要讓頭部過度屈曲，
如果同時(shí)存在寰樞椎不穩(wěn)定，
可能會(huì)對(duì)脊髓造成嚴(yán)重?fù)p傷（可能引起死亡）。

為了評(píng)估玩具品種犬寰樞椎半脫位的可能性，
應(yīng)在超聲檢查前進(jìn)行X線片檢查。

POTENTIAL COMPLICATIONS?

潛在并發(fā)癥

Excess pressure by the ultrasound probe could potentially injure the brain tissue. Judicious use of the ultrasound probe will prevent this complication.

超聲波探頭施加的過大壓力可能會(huì)潛在地?fù)p傷腦組織。

小心明智地使用超聲探頭可以防止這種并發(fā)癥。

CLIENT EDUCATION

寵主教育

The use of ultrasound to image the brain is safe, fast, and economical in screening for hydrocephalus in an animal with an open fontanel. CT or MRI of the brain is often necessary for a complete evaluation?of the brain following ultrasound.

Intraoperative ultrasound localization of a brain lesion can reduce the amount of dissection and palpation of the brain tissue, therefore reducing trauma to the brain.

Intraoperative brain ultrasound assists in identifying all abnormal tissue for removal.

超聲成像是一種安全、快速、經(jīng)濟(jì)的腦積水篩查方法。

腦部CT或MRI對(duì)于超聲后腦部的全面評(píng)估通常是必要的。

術(shù)中超聲定位腦病變可以減少腦組織的剝離和觸診，
從而減少對(duì)大腦的創(chuàng)傷。

術(shù)中腦部超聲有助于識(shí)別是否所有異常組織都進(jìn)行了切除。

BODY SYSTEMS ASSESSED

所評(píng)估的身體系統(tǒng)

Nervous
神經(jīng)系統(tǒng)

PROCEDURE

檢查方式

PATIENT PREPARATION

病患預(yù)備

Preprocedure Medication or Preparation
檢查方式所用藥物或預(yù)備

None 無

Anesthesia or Sedation 麻醉或鎮(zhèn)靜

This is required only if necessary for a surgical procedure or to assist in keeping the patient still during the ultrasound examination.

Sedation is more often required for imaging through the foramen magnum to enable sufficient flexing of the atlanto-occipital joint for imaging.

只有在外科手術(shù)或在超聲檢查中幫助病患保持靜止時(shí)才需要這樣做。

通過枕骨大孔成像時(shí)通常需要鎮(zhèn)靜，以使寰枕關(guān)節(jié)充分屈曲以便成像。

Patient Positioning

病患擺位

Patients with an open bregmatic fontanel can often be imaged with them standing or sitting.

Lateral recumbency is used in some cases, depending on the temperament of the patient.

囟門未閉的病患，
通?？梢哉局蜃M(jìn)行超聲成像。

根據(jù)病患的脾性，
在某些情況下采用側(cè)躺位。

Patient Monitoring
病患監(jiān)測(cè)
No special monitoring is needed for use of ultrasound.

使用超聲不需要特別的監(jiān)測(cè)。

Equipment or Supplies

設(shè)備或耗材

A real-time B-mode ultrasound scanner with a high-frequency transducer

A transducer with a small footprint (contact with skin area) and sector image. This allows the ultrasound beam to get through the opening in the skull and widen out to image more of the brain. A high-resolution linear array transducer may be used but will present a more restricted view of the brain.

The transducer frequency should be ≥7 MHz for the best resolution.

一臺(tái)帶有高頻探頭的實(shí)時(shí)B型超聲掃描儀。

一個(gè)小壓面（與皮膚區(qū)域接觸的面）和扇形圖像的探頭。

這可以讓超聲束穿過顱骨的未閉的開口，
并讓超聲波發(fā)散到大腦的更多區(qū)域。

可以使用高分辨率線性陣列探頭，
但所呈現(xiàn)的大腦視野將會(huì)受到更多限制。

為獲得最佳分辨率，探頭頻率應(yīng)≥7 MHz。

?

TECHNIQUE

技術(shù)

Imaging Through the Open Bregmatic Fontanel

經(jīng)未閉囟門成像

Clip or part the hair, if thick, over the fontanel. If the hair is fine, thin, or both, the transducer may be coupled sufficiently to the skin without the hair being clipped.

Place sufficient ultrasound gel on the skin surface of ultrasound transducer, and place the transducer directly over the open fontanel. Adjust the depth and gain to produce the best image of the brain.

Obtain sagittal and transverse views of the brain by sweeping slowly from side to side in the sagittal plane and rostral to caudal in the transverse plane.

如果毛發(fā)較厚，將其剃短或分開，露出囟門的位置。

如果毛發(fā)細(xì)、薄或又細(xì)又薄，
那么只要探頭可以與皮膚充分耦合，
那么就不需要剃掉毛發(fā)。

在超聲探頭和皮膚表面之間放足夠的超聲凝膠，
然后將探頭直接放置在未閉的囟門上。

調(diào)整深度和增益，以產(chǎn)生最佳的大腦圖像。

在矢狀面緩慢地從一側(cè)掃到另一側(cè)，
在橫斷面緩慢地從前側(cè)掃到后側(cè)，
獲得大腦矢狀面和橫斷面圖像。

Imaging Through the Temporal Window

經(jīng)顳窗成像

Clip or part the hair and apply acoustic gel to the skin.

The temporal window is located just dorsal to the juncture of the?zygomatic arch, with the temporal bone at the juncture of the parietal and temporal bones, where the bone can be thin enough to enable imaging through this window.

The exact location and quality of view obtained through this window vary.

Transverse and dorsal views of the brain are obtained through this window.

把毛發(fā)剃短或分開，在皮膚上涂上超聲耦合凝膠。

顳窗位于顴弓接點(diǎn)的背側(cè)，
顳骨位于頂骨和顳骨的交界處，
此處的顱骨足夠薄，
可以通過該窗口進(jìn)行成像。

通過該窗口獲得的確切位置和圖像質(zhì)量各不相同。

通過這個(gè)窗口可以獲得大腦的橫斷面和冠狀面成像。

Imaging Through the Foramen Magnum

經(jīng)枕骨大孔成像

Clip the hair and clean the skin centered on the midline occipital region of the head.

The patient is placed in lateral recumbency, and its head is hyper-flexed.

Apply ultrasound gel to the skin surface or transducer.

Place the ultrasound transducer on the patient’s skin sagittal to the?head, and point the transducer toward its nose.

Generally, only sagittal images are obtained from this acoustic window.

One advantage of this window is the ability to evaluate the blood?flow in the basilar artery with Doppler.

This view does not enable imaging of the brain rostral to the interthalamic adhesion but enables imaging of the proximal cervical spinal cord.

修剪毛發(fā)，清潔頭部枕部中線中心的皮膚。

病患側(cè)臥位，頭部需要過度屈曲。

在皮膚表面或探頭上涂抹超聲耦合凝膠。

將超聲探頭置于病患頭部矢狀面的皮膚上，并將探頭指向病患的鼻子。

一般來說，從這個(gè)方向的窗口只能獲得矢狀面圖像。

這個(gè)窗口的一個(gè)優(yōu)點(diǎn)是能夠用多普勒評(píng)估基底動(dòng)脈的血流。

這個(gè)方向的超聲不能成像丘腦間連結(jié)的前側(cè)，
但可以成像頸部近端的脊髓。

Intraoperative Imaging
術(shù)中成像

Place a sterile sleeve over the transducer and cord.

Fill the brain case with normal saline and image through the fluid or?place the transducer gently on the surface of the brain by using saline flush or sterile gel to allow sonic coupling of the transducer and brain surface.

The exact positioning of the transducer will depend on the location and size of the surgical opening in the skull. However, brain images should be obtained in at least 2 different planes. Do not agitate the saline solution by shaking it or by filling the brain case rapidly because this produces microbubbles in the solution that, throughout the fluid, produce numerous hyperechoic foci that can interfere with imaging if present in sufficient numbers.

將無菌套套在探頭和探頭線上。

用生理鹽水填充腦缺口并通過液體成像，
或使用生理鹽水沖洗或無菌凝膠將探頭輕輕放置在腦部表面，
使探頭與腦表面進(jìn)行聲波耦合。

探頭的確切位置取決于顱骨手術(shù)開口的位置和大小。

然而，大腦圖像應(yīng)該至少在兩個(gè)不同的平面上獲取。

不要搖動(dòng)鹽水溶液或快速用鹽水溶液填充腦腔隙，
因?yàn)檫@可能會(huì)在溶液中產(chǎn)生微氣泡，
在整個(gè)液體中產(chǎn)生大量高回聲灶，
如果存在足夠數(shù)量的高回聲灶，可能會(huì)干擾成像。

SAMPLE HANDLING

采樣處置

N/A 無

APPROPRIATE AFTERCARE

恰當(dāng)?shù)暮罄m(xù)護(hù)理

Postprocedure Patient Monitoring
檢查后病患監(jiān)測(cè)

None 無

Nursing Care 一般護(hù)理

Clean acoustic gel from the skin surface following the procedure.

檢查結(jié)束后，清理皮膚表面的超聲耦合凝膠。

Dietary Modification 飲食改良

None 無

Medication Requirements 藥物需求

None 無

Restrictions on Activity 活動(dòng)限制

None 無

Anticipated Recovery Time 可能得恢復(fù)時(shí)間

Immediate 立即

INTERPRETATION 判讀

NORMAL FINDINGS OR RANGE

正常發(fā)現(xiàn)或正常范圍

 The normal brain tissue is relatively hypoechoic, with some echogenic surfaces are observable that reveal the brain anatomy.

 The lateral ventricles should be observed as anechoic fluid filled structures in both hemispheres and can be imaged in both the trans- verse and the sagittal planes.

 The normal ultrasound anatomy of the brain has been described (see Hudson et al. 1989).

 Normal lateral ventricular height measured caudal to the interthalamic adhesion has a normal mean of 0.15 cm.

正常腦組織的回聲相對(duì)較低，可以觀察到一些產(chǎn)回聲表面，顯示大腦解剖結(jié)構(gòu)。

側(cè)腦室可被觀察為雙側(cè)大腦半球充滿無回聲液體的結(jié)構(gòu)，
可在橫斷面和矢狀面成像看到。

腦部的正常超聲解剖已經(jīng)有描述過（見Hudson et al. 1989）。

在丘腦間連結(jié)后側(cè)測(cè)得的正常側(cè)腦室的高度的平均值為0.15 cm。

ABNORMAL VALUES

異常值

Hydrocephalus is considered present if the height of the lateral ventricules measured caudal to the interthalamic adhesion is >0.35 cm.

如果丘腦間連結(jié)處后側(cè)的側(cè)腦室高度測(cè)得 >0.35 cm，
則認(rèn)為存在腦積水。

A ventricle/mantle ratio of >0.25 indicates hydrocephalus. The height of the lateral ventricle measured caudal to the interthalamic adhesion is divided by the cerebral mantle thickness at the same level. The cerebral mantle thickness is measured from the roof of the lateral ventricle to the dorsal brain surface.

腦室/腦幔比值（ventricle/mantle ratio）為>0.25提示腦積水。

側(cè)腦室的高度需要在丘腦間連結(jié)的后側(cè)進(jìn)行測(cè)量，
除以在同一水平面上的腦幔厚度（cerebral mantle thickness）。

腦幔厚度是從側(cè)腦室頂部到腦背側(cè)表面測(cè)量的。

 A ventricle/hemisphere ratio of >0.19 indicates hydrocephalus.

側(cè)腦室/大腦半球比值為>0.19時(shí)，
提示腦積水。

The width of the lateral ventricle is divided by the hemispheric width measured from the third ventricle (midline) to the lateral surface of the brain.

側(cè)腦室的寬度，除以，從第三腦室(中線)到大腦外側(cè)表面的大腦半球?qū)挾取?/span>

 The sizes of the lateral ventricles in hydrocephalus do not correlate well with clinical signs, with some patients having occult hydrocephalus (no clinical signs).

腦積水的側(cè)腦室的大小與臨床癥狀沒有很好的相關(guān)性，
某些病患有隱匿性腦積水（occult hydrocephalus?）(無臨床癥狀)。

 Most brain neoplasms appear as echogenic or mixed echogenic and hypoechoic masses in the relatively hypoechoic brain tissue.

大多數(shù)腦腫瘤在相對(duì)低回聲的腦組織中，
表現(xiàn)為產(chǎn)回聲（echogenic）或混合回聲（mixed?echogenic?）和低回聲（hypoechoic）腫塊。

 The sonographic appearance of abscesses and hemorrhage varies, depending on the age of the lesion.

膿腫和出血的超聲圖像，
表現(xiàn)因病變的時(shí)間長(zhǎng)短而異。

 Fluid with swirling echogenic material may indicate an exudate or hemorrhage. However, some cerebrospinal fluid in the ventricles may have sufficient protein content to show swirling material in the fluid. A sample of the fluid must be obtained for definitive diagnosis.

帶有旋流樣產(chǎn)回聲物質(zhì)的液體可能提示滲出或出血。

然而，
腦室中的一些腦脊液可能含有足夠多的蛋白質(zhì)含量，
從而使得液體中的顯現(xiàn)存在旋流物質(zhì)。

為了明確診斷，建議必須采集相關(guān)液體樣本。

CRITICAL VALUES 臨界值

None 無

INTERFERING FACTORS 干擾因素

Drugs That May Alter Results of the Procedure

可能影響檢查結(jié)果的藥物

None 無

Conditions That May Interfere with Performing the Procedure

可能影響檢查操作的狀況

A closed bregmatic fontanel, small foramen magnum, or thick bone in the temporal window requires surgical removal of bone to provide an acoustic window in order to image the brain. In these cases, it is advisable to consider alternative imaging such as CT or MRI to evaluate the brain.

已經(jīng)閉合的囟門、枕骨大孔太小，或者顳窗的顱骨太厚，
那么就需要手術(shù)切除部分顱骨，以提供腦成像的聲窗。

在這些情況下，
最好考慮使用CT或MRI等替代成像來評(píng)估大腦。

Procedure Techniques or Handling That May Alter Results

可能改變結(jié)果的檢查、技術(shù)或處理

Artifact and acoustic shadowing from a very small opening in the skull or the use of a linear array transducer may not provide a sufficient image to reasonably assess the condition of the brain.

從顱骨非常小的開口或使用線性陣列探頭產(chǎn)生的偽影和聲影可能無法提供足夠好的圖像來合理評(píng)估大腦的狀況。

Influence of Signalment on Performing and Interpreting the Procedure

動(dòng)物特征對(duì)檢查執(zhí)行和判讀的影響

Species 物種

None無

Breed 品種

Brachycephalic breeds may have slightly larger lateral ventricles without clinical signs as a breed variation.

短頭品種可能有稍大一些的側(cè)腦室，但沒有臨床癥狀，
這是一種品種相關(guān)變異。

Age 年齡

The brain of mature dogs and cats with a closed fontanel cannot be imaged by this means and must be imaged through the temporal window, through the foramen magnum, or by surgically removing a portion of the skull.

大多數(shù)成年犬貓的囟門已經(jīng)閉合，
無法進(jìn)行超聲成像，
可以嘗試通過顳窗，通過枕骨大孔，或通過手術(shù)切除一部分顱骨來成像。

Gender 性別

None 無

Pregnancy 懷孕

None 無

CLINICAL PERSPECTIVE 臨床意義

 Ultrasound is an easy, safe, and inexpensive means of evaluating the brain for hydrocephalus when an open bregmatic fontanel is present.

評(píng)估腦積水時(shí)，
當(dāng)存在開放的未閉合的囟門時(shí)，
超聲是一種簡(jiǎn)單、安全、廉價(jià)的方法。

 The lateral ventricular size does not always correlate with clinical signs in mild to moderate enlargement.

側(cè)腦室大小在輕度至中度擴(kuò)張時(shí)，
并不總是與臨床癥狀相關(guān)。

 CT and MRI are the techniques of choice for presurgical imaging of the brain for most diseases except as stated previously for hydrocephalus.

除了前面提到的腦積水外，
CT和MRI是大多數(shù)疾病術(shù)前腦成像的首選技術(shù)。

 Ultrasound can be very useful intraoperatively for locating lesions in the brain. However, surgery of the brain requires specialized training and knowledge in neurosurgery and is usually best referred to a specialist to provide the optimal outcome for patients.

術(shù)中超聲對(duì)腦部病變的定位非常有用。

然而，
腦部手術(shù)需要神經(jīng)外科方面的專業(yè)培訓(xùn)和知識(shí)，
通常最好轉(zhuǎn)診給專科醫(yī)生，
為病患提供最佳結(jié)果。

MISCELLANEOUS 其他

ANCILLARY TESTS 附加檢查

A thorough neurologic examination is required to correlate with ultrasound findings.

需要全面的神經(jīng)系統(tǒng)檢查，
再與超聲檢查結(jié)果相關(guān)聯(lián)。

SYNONYMS 同義詞

 Cranial ultrasound 顱內(nèi)超聲
 Transcranial ultrasound 經(jīng)顱超聲

SEE ALSO

Blackwell’s Five-Minute Veterinary Consult: Canine and Feline Topics
Hydrocephalus

Related Topics in this Book

 General Principles of Ultrasonography
? Computed Tomography
 Magnetic Resonance Imaging

ABBREVIATIONS 縮寫

 CT = computed tomography 計(jì)算機(jī)斷層掃描
 MRI = magnetic resonance imaging 磁共振成像

Suggested Reading 推薦閱讀

- Hudson JA, Cartee RE, Simpson ST, et al. Ultrasonographic anatomy of the canine brain. Vet Radiol 1989; 30: 13–21.

- Hudson JA, Simpson ST, Buxton DF, et al. Ultrasonographic diagno- sis of canine hydrocephalus. Vet Radiol 1990; 31: 50–58.

- Saito M, Olby NJ, Spaulding KA, et al. Identification of arachnoid cysts in the quadrigeminal cistern using ultrasonography. Vet Radiol2001; 42: 435–439.

- Saito M, Olby NJ, Spaulding KA, et al. Relationship among basilar artery resistance index, degree of ventriculomegaly, and clinical signs in hydrocephalic dogs. Vet Radiol 2003; 44: 687–694.

- Spaulding KA, Sharp NJH. Ultrasonographic imaging of the lateral cerebral ventricles in the dog. Vet Radiol 1990; 31: 59–64.

INTERNET RESOURCES 網(wǎng)絡(luò)資源

None 無

AUTHOR NAME 作者名字

George A. Henry

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