Александр Павлович Речмедин
Врач УЗИ – Эксперт
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Шмарин Алексей Николаевич
УЗДГ и УЗДС – отличия допплерографии и дуплексного сканирования
Вопрос о профилактике и лечении сосудистых заболеваний на сегодняшний день остаётся одним из самых актуальных. В области ангиохирургии разработано немало способов лечения сосудистых патологий, но, как известно, для врача-ангиохирурга самым важным в постановке диагноза и назначении лечения является предварительная ультразвуковая диагностика сосудов.
УЗИ – очень распространённый термин в современном мире. Но, говоря об УЗИ сосудов, существует много непонятных терминов, которые порождают заблуждения у пациентов, напрямую с ними не связанных. Для диагностики сосудистых заболеваний используют несколько методов: УЗДГ (метод ультразвуковой допплерографии), УЗДС (метод ультразвукового дуплексного сканирования) и ЦДК (метод цветного допплеровского картирования). Данные исследования не приносят вред организму и считаются безопасным видом диагностики.
В этой статье мы попробуем разобраться, чем отличается УЗДГ от УЗИ, и какая разница между допплерографией (УЗДГ) и методом дуплексного сканирования (УЗДС).
ДИАГНОСТИКА МЕТОДОМ УЗДГ
Одним из простых и доступных способов исследования венозной и артериальной проходимости является ультразвуковая допплерография. В основе УЗДГ лежит эффект Допплера, то есть для получения необходимых данных производится фиксирование изменений отражаемых звуковых волн от движущихся кровяных телец. УЗИ метод допплерографии назначается при необходимости определения сосудистой проходимости, либо для получения оценки тока крови, либо для выявления патологий венозного клапана.
При проведении Доплер-УЗИ, вены и артерии не видны, оценка скорости тока крови и проходимости осуществляется на основании получаемых значений Доплер-эффекта. По результатам обследования УЗДГ успешно диагностируются головные боли, гипертоническая болезнь, варикозное расширение вен. Но если выявление нарушенной проходимости сосудов делается с легкостью, то устранение причин такой патологии методом Доплер-УЗИ весьма затруднительно. Это связано с тем, что такой способ диагностики не позволяет визуализировать сосудистые стенки и возможные их искривления, влияющие на скорость и качество кровотока.
Изначально, показываемые ультразвуковым аппаратом изображения, были выполнены в плоской и тонкой проекции исследуемого органа. В современной диагностической медицине используется оборудование, позволяющее получать трехмерное изображение органов в реальном времени и в движении.
Метод ультразвуковой допплерографии является одним из самых распространённых способов диагностики заболеваний артерий и вен. Как правило, УЗДГ назначают пациентам с подозрением на непроходимость сосудов или недостаточность венозных клапанов. Разобраться в этой патологии позволяет эффект Допплера, давший начало ультразвуковой допплерографии. С его помощью фиксируется перемена отражения звуковой волны от перемещения кровяных телец, что позволяет впоследствии диагностировать скорость тока крови, варикозное расширение вен, выявить причину головных болей и гипертонической болезни.
Обращаем Ваше внимание: УЗДГ с лёгкостью выявляет нарушения кровотока, но установить его причину не так просто! Как уже было сказано, метод УЗДГ не визуализирует стенки сосудов и их патологические изгибы, а именно они воздействуют на скорость тока крови и его качество.
Метод диагностики УЗДС
УЗДС представляет собой дуплексное сканирование и является более «глубокой» формой исследования и, естественно, более эффективной. В отличии от допплерографии, УЗДС сочетает эффект Доплера с В-режимом или «режимом яркости». Такое сочетание даёт возможность визуализировать стенки вен и артерий, а также проверить состояние рядом располагающихся тканей. Обследование кровотока сосудов выполняется при помощи Доплер-метода (цветовое картирование) или техники спектро-анализа.
При использовании метода УЗДС на экране монитора мы можем увидеть изображение исследуемого сосуда, зрительно оценить венозную или артериальную проходимость и выявить причину слабого кровотока.
Метод диагностики УЗДС обладает рядом неоспоримых преимуществ. С помощью УЗДС не составит проблем обнаружить, например, деформацию сосудов или их просветов, выявить образование холестериновых бляшек и наличие тромбов, оценить кровоток всей сосудистой системы. При исследовании УЗДС крупных вен и артерий можно обнаружить патологические состояния на самых ранних стадиях развития. В чём заключаются преимущества диагностики УЗДС?
Процедура дуплексного сканирования, естественно, абсолютно безболезненна. В среднем время проведения диагностики занимает 30-40 минут, в зависимости от исследуемой области тела, и, как правило, не вызывает дискомфорта у пациента. После проведения УЗДС пациент может сразу же вернуться к привычному образу жизни без ограничений.
Метод ультразвукового дуплексного сканирования является высокоточным методом исследования и не вызывает каких-либо осложнений после проведения процедуры.
В отличии от допплерографии (УЗДГ), в дуплексном сканировании сочетаются две исследовательские функции. С помощью УЗИ-Доплера характеризуется кровоток сосудов, а на ряду с В-режимом данное исследование даёт ещё и возможность визуализировать особенность структуры артерий и вен. Это даёт право называть УЗДС более точным методом исследования.
Дуплексное сканирование сосудов головы и шеи — высокоинформативный и безопасный метод, который основан на ультразвуковой технологии. Волны ультразвука «проявляют» артерии и сосуды головы и шеи и позволяют оценить состояние кровотока по нескольким основным признакам, а также исследовать просвет сосуда на наличие широкого спектра патологий. К ним относятся аневризмы, тромбы, изменение толщины стенки и ее выпячивание, бляшки, извитости сосудов. При сравнительной диагностике дуплексное сканирование выявляет изменения состояния стенок и скорости кровотока, что помогает корректировать лечение или принимать решение о его начале, если пациент ранее был под наблюдением.
УЗДГ-обследование неинвазивна, безболезненна, не требует предварительной подготовки. Процедура повторяется нужное количество раз без ограничений для подтверждения сложного диагноза.
Общее описание исследования
Суть метода дуплексного сканирования заключается в совмещении возможностей ультразвуковых волн, которые визуализируют строение сосудистых стенок, и доплеровского эффекта, отражающего характер движения крови при помощи кодирования несколькими цветами (для наглядности).
Программное обеспечение соединяет два изображения и в понятной форме выводит данные для врачебного анализа.
Таким образом сканирование проводится в 2 режимах:
- двумерный (В-режим) — просматриваются сосуды и прилежащие ткани, полных данных о кровоснабжении в этом режиме не получают;
- дуплексный (допплерография) — строится двумерный цветной рисунок, по которому можно сделать расширенное описание состояния сосудов.
Эффект Доплера отражает изменение длины волны для наблюдателя при отражении сигнала от движущегося объекта, которым являются разные виды кровяных телец. Ультразвук отражается от них, помогая оценить направление кровотока и вычислить его скорость и динамику. О патологиях в данном случае будут свидетельствовать завихрения, ретроградное движение, замедление.
В исследованиях выделяются 3 основных направления:
- транскраниальное УЗДГ — исследуются сосуды мозга;
- УЗДГ брахиоцефальных сосудов — область исследования лежит в районе шеи;
- УЗДГ МАГ — обследование магистральных артерий головы, к которым относятся две позвоночные и две сонные, образовывающие круг в основании мозга (их изменение отражается на всем организме).
Кому назначают подобное исследование
Исследование назначается для выявления причин головной боли, при повышенном уровне холестерина в анализах, для ранней диагностики атеросклероза, при патологиях позвоночника, подозрениях на извитость питающих мозг сосудов, частых головокружениях. Для составления полноценного диагноза проводится ультразвуковое исследование сосудов как на уровне шеи, так и внутри черепа.
Симптоматика, при которой показано дуплексное сканирование:
- боль в голове, появляющаяся с тревожащей и заметной периодичностью;
- потеря памяти на небольшое количество времени;
- головокружения;
- истечение крови из носа без видимой причины;
- повышенный холестерин;
- механические повреждения в области шеи;
- шум в ушах;
- наличие определенных заболеваний — инсульт, инфаркт, ТИА, заболевания, вызванные нарушением кровообращения, ослаблением тока крови, сахарный диабет.
Оценивая результаты дуплексного исследования, специалист рассматривает массу характеристик и данных, сравнивая их с нормальными показателями. Для врача важна толщина стенки сосуда (в норме 0,12см), расположение артерий относительно друг друга, окружающих тканей и органов, скорость крови в разных ветвях, характер и наличие разветвлений в определенных участках и т.д.
Дуплексное сканирование не только выявляет патологические процессы, когда симптоматика уже проявилась, но и показывает сосудистые патологи на ранней стадии их развития. Это позволяет вовремя предупредить болезнь и быстро начать лечение.
Если стенка утолщена, можно сделать предположение о скапливании на ней жира и разрастании соединительной ткани. Если при утолщенной стенке сосудистые слои плохо различимы, это указывает на васкулит. При наблюдении характерных бляшек в сосудах можно говорить об атеросклерозе (данные о расположении и размере бляшек имеют большое значение для проведения лечения).
Что обычно выявляют в ходе исследования
Дуплекс затрагивает в основном экстракраниальные сосуды, в меньшей степени интракраниальные. Врач особое внимание уделяет следующим сосудам шеи — общие сонные артерии (и области бифуркации), экстракраниальная часть сонных артерий, часть плечеголовного ствола, наружные сонные артерии, вены рядом с черепом, венозное позвоночное сплетение, височные артерии и т.д.
Для транскраниального дуплексного сканирования делать УЗИ с учётом доступа сквозь черепные кости — они подавляют большое количество ультразвуковых волн. Доступ осуществляется через естественные отверстия — большое затылочное, височные кости, глазницы. УЗИ сканирование мозга грудничка можно проводить через роднички — они дают значительный обзор и помогают собрать больше информации. В процессе этого вида дуплексного сканирования осматриваются сонные и позвоночные артерии внутри черепа, основная и мозговые артерии.
Дуплексное сканирование — метод, который выявляет широкий спектр патологий артерий вен в голове и шее. Если диагноз уже известен, врач получает возможность контролировать состояние пациента (после операции, инсульта, травм головы и шеи).
У пациентов с патологиями УЗИ головы и шеи обнаруживает:
- атеросклероз;
- артериовенозную мальформацию головного мозга;
- сдавливание сосудов новообразованиями;
- заболевания центральной нервной системы;
- тромбы;
- эндартериит;
- стенозы и расширения;
- аневризмы;
- бляшки у людей с повышенным холестерином в анализах
- изгибы, петли.
Атеросклероз можно подозревать при избыточном весе, высоком показателе холестерина и триглицеридов в анализах, предрасполагающейся наследственности. Эндартериит имеет аутоиммунные причины, при нем повреждается стенка артерии, и повреждение видно на экране. Аневризмы обнаруживаются впервые (при характерных жалобах пациента) или подтверждаются, если они уже были замечены на предыдущем УЗИ, КТ или ангиографии. На дуплексе они выглядят как истонченные и растянутые стенки артерий (реже вены), выпяченные наружу.
Некоторым пациентам необходим регулярный мониторинг сосудов. Раз в год для оценки эффективности лечения и составления индивидуального прогноза дуплекс рекомендуется пациентам с сахарным диабетом, скачками артериального давления, дистрофическими изменениями дисков в шейном отделе, инсультами в прошлом.
Помимо пациентов с болезнями регулярная диагностика показана курильщикам, лицам старше 40 лет (для мужчин) и старше 45 (для женщин). При наличии родственников с сосудистыми патологиями и заболеваниями, их провоцирующими, так же следует регулярно обследоваться.
Как проходит процедура
Подготовка к дуплексному сканированию не проводится. Перед диагностикой достаточно снять одежду или украшения в области, где будет использоваться аппарат. Пациент удобно укладывается на кушетке и расслабляется. Врач наносит на кожу специальный проводящий гель, обеспечивающий лучший контакт датчика с кожей, и прикладывает датчик к телу. На экране появляются непрерывно меняющиеся срезы, которые специалист изучает в режиме реального времени.
Как правило, датчик прикладывается в область ультразвукового окна (например, на 2-3см выше скуловой кости). В этом месте твердые ткани наименьшим образом поглощают ультразвуковые волны, что помогает исследовать кровоток в нескольких артериях. После окончания дуплексного сканирования гель легко стирается с кожи головы и шеи.
УЗДГ сосудов шеи и головы занимает около 30 минут, пациент при этом ощущает себя спокойно и не испытывает дискомфорта.
В процессе исследования пациент не испытывает боли. По ощущениям метод дуплексного сканирования практически не отличается от обычного УЗИ. По ощущениям метод дуплексного сканирования сравним с обычным УЗИ. Результаты вводятся в электронную базу пациента, если он лечится в нашей клинике, либо выдаются на руки и виде распечатанной копии. Специальных рекомендаций после проведения дуплекса не выдается — пациент может сразу же возвращаться к своему привычному ритму жизни.
Распространенные преимущества и недостатки представленного метода
Дуплексное сканирование имеет ряд очевидных преимуществ:
- обладает высокой информативностью;
- не требует использования ионизирующего излучения;
- более дешевый и доступный метод исследования, чем альтернативные;
- проводится в реальном времени, не требует ожидания заключения;
- помогает отразить состояние мягких тканей, которые недостаточно визуализируются на рентгене;
- неинвазивен, проводится без контраста (на который иногда встречается аллергия), не приносит никаких неприятных ощущений;
- подходит детям и беременным женщинам.
Любой метод наряду с положительными имеет и негативные стороны, и в некоторых случаях имеет смысл выбрать другие типы исследований. Решение принимает врач в индивидуальном порядке, оценив результаты других диагностических процедур и анализов, осмотра, опроса пациента.
К недостаткам метода относятся:
- трудность в рассмотрении мелких сосудов;
- возможность диагностики только в процессе исследования, а не после него уже по результатам;
- узкая исследуемая область, поскольку кости черепа взрослого человека препятствуют прохождению ультразвука.
Немаловажную роль в качестве проведённой диагностики играет уровень оборудования и профессионализм врача. Это один из методов диагностики, к которому применяются повышенные требования в профессионализме врачей, поэтому выбирать клинику для дуплексного сканирования следует особенно тщательно, потому что результат может существенно отличаться.
Ценовая политика
Стоимость дуплекса зависит от:
- профильности клиники;
- расположения;
- рейтинга;
- квалификации персонала;
- технической оснащенности диагностического кабинета.
От качества и опыта врача зависит точность диагноза и своевременность обнаружения даже незначительных повреждений. Не экономьте на дуплексном сканировании головы и шеи, даже если стоимость может отличаться, мы гарантируем результат и качество выполняемого обследования.
В стоимость исследования при необходимости может быть добавлена консультация невролога, флеболога и других профильных специалистов. Наш медицинский центр располагает лучшими врачами, и мы в том числе занимаемся обучением и повышением квалификации персонала из других клиник.
В нашей клинике вы получите один из лучших сервисов и высокое качество исследования. Здесь же вы можете пройти лечение. Стоимость дуплексного сканирования головы и шеи найдете в разделе «Прайс-лист». Услуга оказывается по предварительной записи и 100%-ой предоплате.
Заключение и выводы
Дуплекс (УЗДГ) головы и шеи делается по показаниям для лиц с жалобами, реже установленные врачом промежутки времени для пациентов, проходящих лечение, и раз в год для лиц, находящихся в группе риска. Обращаться к врачу рекомендуется при головных болях, головокружениях, шуме в ушах, кровотечении из носа и другой симптоматике. Раннее УЗИ поможет предотвратить инсульт, отрыв тромба, развитие новообразований, истончение или утолщение стенок сосудов, серьезных болезненных последствий вплоть до летального исхода.
Автор: Надежда · Опубликовано 22.10.2018 · Обновлено 28.10.2018
Согласно медицинской статистике, сосудистые заболевания в настоящее время занимают одну из лидирующих позиций среди патологий других органов. Для диагностирования нарушений в данном случае обычного УЗИ бывает недостаточно, и требуются специфические диагностические процедуры. В связи с этим у пациентов нередко возникает вопрос, что такое УЗДГ БЦА? Чем отличается ультразвуковое дуплексное сканирование от допплерографии? В чем заключаются отличия между обычным ультразвуковым исследованием и УЗИ с доплером?
Что такое УЗДГ?
Эта аббревиатура расшифровывается, как ультразвуковая допплерография. Данная диагностическая методика основана на эффекте Доплера. В ходе процедуры используются безопасные для человеческого организма звуковые волны, которые при воздействии на ткани и клетки не нарушают их целостность. Эту манипуляцию назначают даже беременным пациенткам. В отличие от первого планового УЗИ на 11-14 неделе гестации, УЗДГ рекомендуется делать не позднее 16-недельного срока.
Данная методика является наиболее быстрым и безболезненным способом оценки состояния кровеносных сосудов. С помощью УЗДГ можно выявить:
- отклонение от нормы скорости кровообращения;
- повышенное внутричерепное давление;
- аномальные процессы в кровеносных сосудах воспалительного или атеросклеротического генеза;
- аномалии, окклюзию и патологическую извитость сосудов.
Что такое ультразвуковое дуплексное сканирование?
Ультразвуковое дуплексное сканирование или УЗДС – это один из наиболее информативных способов диагностики состояния сосудов головы и шеи. Данная методика основана на способности отражения ультразвука от эритроцитов, входящих в состав крови. Такой эффект дает врачу возможность увидеть изображение необходимого участка кровообращения.
Ультразвуковое дуплексное сканирование позволяет визуализировать не только находящиеся за границами черепа сосуды шеи, но и те, что расположены внутри черепной коробки. В основе данной методики лежит совмещение ультразвукового излучения и эффекта Доплера. В результате этого можно получить изображение движущейся крови на различных участках кровеносной артерии или вены. Отличие УЗДС от других разновидностей диагностических процедур заключается в возможности отслеживания исследуемых участков в динамике.
При отражении ультразвуковых волн от эритроцитов крови и их возвращении на экране аппарата на основе полученных данных образуется изображение обследуемой области в продольном и поперечном виде. Оценка состояния внутричерепных сосудов позволяет выявить патологические изменения, обнаружить очаги стеноза или аневризмы. Благодаря регулярному обследованию брахиоцефальных артерий (БЦА) — сосудов, отвечающих за кровоснабжение головного мозга, тканей головы, плечевого пояса и рук — можно контролировать возникающие изменения и в случае необходимости своевременно принимать хирургические меры.
УЗДС используется для:
- определения состояния артерий и вен головного мозга;
- анализа сосудистой ткани;
- диагностирования стеноза артерий, степени влияния этой патологии на кровообращение и снабжение кровью тканей;
- мониторинга нарушения движения крови в других органах;
- выявления аномалий строения шейных и церебральных артерий;
- диагностирования и изучения артериальных и венозных новообразований;
- исследования характера нарушений, обусловленных недостатком снабжения кровью области, обеспечиваемой определенным сосудом.
Каковы различия и сходства между УЗДГ и УЗДС?
Эти методы исследования сосудистой системы имеют как схожие, так и различные черты. По сравнению с ультразвуковой допплерографией, дуплексное сканирование считается более развернутым. Оно предоставляет врачу функциональной диагностики наиболее полную информацию, чем УЗДГ. В таблице размещены сведения о том, чем отчаются и в чем схожи данные диагностические способы.
Различия | Сходства | |
УЗДГ | УЗДС | |
Нет возможности установить датчик на исследуемые участки, это происходит вслепую | Датчик крепится в необходимую область исследования | Использование эффекта Доплера |
Выявление проблемы без возможности определения первопричины | Установление конкретной причины патологического процесса | Осуществление процедуры неинвазивным путем |
Используется для первичной диагностики сосудов | Показано для детального изучения органа | Полная безопасность |
Позволяет увидеть только те клапаны, которые расположены в стандартных местах | Предоставляет сведения обо всех имеющихся клапанах | Отсутствие у пациента дискомфортных ощущений в процессе обследования |
Визуализирует исключительно вены-перфоранты с типичным расположением | Мониторит состояние перфорантных вен вне зависимости от их расположения | Быстрота проведения |
Не в состоянии определить источник рецидива варикоза или тромбоза после проведенного лечения | Выявляет очаг варикозной или тромбозной болезни на посттерапевтическом этапе | Высокая диагностическая точность |
Не показывает стадию тромбоза сосудов | Определяет характер закупорки сосудов | Широкая распространенность |
Определяет только скорость движения крови в целом по определенному сосуду | Оценивает диаметр сосуда, состояние его стенок, выявляет холестериновые бляшки, сужения, врожденные аномалии. | Относительно доступная цена |
Как проводятся исследования?
Данные процедуры занимают от 20 до 60 минут и требуют предварительной подготовки. О том, как нужно готовиться к исследованию, врач информирует пациента отдельно. Во время диагностических манипуляций он не испытывает никаких дискомфортных ощущений. Подробные сведения о том, как проводится УЗДГ и УЗДС, размещены в таблице.
Проведение исследования | Подготовка к обследованию | Продолжительность процедуры, минуты | Особые указания | |
УЗДГ | Пациент укладывается на кушетку с вытянутыми вдоль тела руками и сведенными ногами, его взгляд направлен вверх, а мышцы спины расслаблены. Врач наносит на исследуемые области специальный гель и устанавливает датчики, считывающие информацию о работе сердца и дыхании. Получаемые данные отображаются на мониторе в виде изображения. | Процедура проводится на голодный желудок. Если она назначена на вторую половину дня, следует ограничить употребление продуктов, богатых глюкозой. За 7 дней до предполагаемого исследования нужно полностью отказаться от употребления алкоголя и табакокурения. За сутки до проведения УЗДГ прекратить прием сосудистых, снотворных и седативных препаратов. | 20-60 | Повязки и гипсовые лонгеты перед процедурой необходимо снять. |
УЗДС | Пациент укладывается на кушетку на спину. Врач фиксирует его голову в необходимом положении, подкладывая под шею валик. Она повернута в сторону, противоположную исследуемой области тела. Нанеся на обследуемые участки гель, специалист проводит датчиком по шее. Полученные сведения транслируется на монитор в виде изображения. Пациента могут попросить покашлять, поменять положение головы или туловища. | Накануне процедуры нужно прекратить использование медикаментов, влияющих на тонус мозговых артерий. Также следует отказаться от посещения бани и сауны, табакокурения, употребления кофе и алкоголя. | ≤ 30 | Перед обследованием нужно снять все металлические предметы ( серьги, заколки, шпильки, цепочки). |
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