Table Of ContentCEREBROV ASCULAR EV ALUATION
WITH DOPPLER ULTRASOUND
DEVELOPMENTS IN
CARDIOV ASCULAR MEDICINE
VOLUME 6
1. e.T. Lancee, Echocardiology, 1979. ISBN 90-247-2209-8.
2. J. Baan, A.e. Arntzenius, E.L. Yellin, Cardiac Dynamies. 1980. ISBN
90-247-2212-8.
3. H.J.Th. Thalen, e.e. Meere, Fundamentals oI Cardiac Pacing. 1979. ISBN
90-247-2245-4.
4. H.E. Kulbertus, HJ.J. Wellens,Sudden Death. 1980. ISBN 90-247-2290-X.
5. L.S. Dreifus, A.N. Brest, Clinical Applications oI Cardiovascular Drugs. 1980.
ISBN 90-247-2295-0 (hardback), 90-247-2369-8 (paperback).
7. D.P. Zipes, J.e. Bailey, V. Elharrar (eds.), The Slow Inward Current and
Cardiac Arrhythmias. 1980. ISBN 90-247-2380-9.
8. H. Kesteloot, J.V. Joossens (eds.), Epidemiology oI Arterial Blood Pressure.
1980. ISBN 9-247-2386-8.
series ISBN 90-247-2336-1
CEREBROV ASCULAR
EVALUATION WITH
DOPPLER ULTRASOUND
by
MERRILL P. SPENCER, M.D.
JOHN M. REID, Ph.D.
With contributions by
EDWIN C. BROCKENBROUGH, M.D.
ROBERT S. RENEMAN, M.D.
GEORGE 1. THOMAS, M.D.
DONALD L. DAVIS, B.S.E.E.
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1981
MARTINUS NIJHOFF PUBLISHERS
THE HAGUE / BOSTON / LONDON
Distributors :
Jor the United States and Canada
Kluwer Boston, Inc.
190 Old Derby Street
Hingharn, MA 02043
USA
Jor all other countries
Kluwer Academic Publishers Group
Distribution Center
P.O. Box 322
3300 AH Dordrecht
The Netherlands
Library of Congress Cataloging in Publication Data
Spencer, Merrill P
Cerebrovascular evaluation with Doppler ultrasound.
(Developments in cardiovascular medicine; v. 6)
Includes bibliographical references and index.
I. Cerebrovascular disease-Diagnosis. 2. Diagnosis, Ultrasonic.
3. Head-Blood-vessels-Examination. 4. Doppler effect.
I. Reid, lohn MitchelI, joint author. 11. Brockenbrough, Edwin C.
III. Title. IV. Series.
[DNLM: \. Cerebrovascular disorders-Diagnosis. 2. Ultrasonics-Diagnostic use.
WI DE997VME v. 6/ WL355 S745c]
RC388.5.S67 616.8 '\ 07543 80-23643
ISBN-13:978-94-009-8206-2 e-ISBN-13 :978-94-009-8204-8
DOI: 10.1007/978-94-009-8204-8
Copyright © 1981 by Martinus Niiho./l Publishers by. The Hague.
Softcover reprint of the hardcover 1 st edition 1981
All rights reserved. No part oI this publication may be reproduced. stored in a retrieval system, or
transmitted in anyIorm or by any means, mechanical, photocopying. recording, or otherwise, without
the prior written permission oI the publisher,
Martinus Niiho.tr Publishers bv. P.O. Box 566. 2501 CN The Hague. The Netherlands.
TO THE MEMORY
OF
Dr. M.P. Spencer's Father
WILLIAM ARTHUR SPENCER
WHO DIED OF STROKE
.. idging the G.
~==~
I
IGRESEARCH I IGJ>EOPLGf:
Stroke Prevention
Heart Diseases
Cancer
Environment
The Institute of Applied Physiology and Medicine, 701 - 16th
Avenue, Seattle, W A, 98122 is a non-profit organization for medi
cal research and education which extends itself beyond research to
bridge the critical gap between research and major health prob
lems.
PREFACE
This book represents tangible results of the Institute of Applied Physiology
and Medicine's objectives of bringing into clinical application the concepts
and results of bioengineers and physiologists.
lt has grown out of our experience in development of original Doppler
diagnostic instrumentation and its application to more than 6,000 patients in
non-invasive diagnosis of the extracranial cerebrovascular circulation. It gath
ers together bioengineering and physiological concepts which were initially
developed for a graduate course for physicians and specialized medical tech
nicians. lt should be of particular interest to physicians and medical technol
ogists whose specialties lie in the field of neurology, vascular surgery, and
radiology.
The particular selection of techniques on our complete cerebrovascular
non-invasive evaluation was chosen primarily to provide an integrated
approach relying primarily on Doppler ultrasonic audio signals, but in addition
utilizing a pertinent history and physical examination of the patient. The
examination is performed by a specially trained physiology technician. Suffi
cient data is provided to the interpreting physician who develops a consulta
tive report for the referring physician. The ultimate objective is prevention of
stroke and symptoms of cerebrovascular insufficiency. The Doppler functional
information supplements the angiography anatomical management decisions
for angiography and surgery, anti-platelet or anti-coagulant medication, or to
follow the patient with no special treatment.
As Doppler instrumentation and experience accumulates, the answer to
many questions will co me concerning the natural history of atherosclerosis
and how it affects the cerebral circulation and patient management. As the
instrumentation improves, both the speed and accuracy of the examination
and reporting will improve. Of great potential is the new Infinite Gate Pulsed
Doppler, as weil as the advantages of real-time imaging of velocity profiles
along the carotid and vertebral circulation.
ACKNOWLEDGEMENTS
We gratefully acknowledge the encouragement of the Medical Staff of The
Providence Medical Center and the skill of physiology technicians Sheryl
Clark, Wayne Ellsworth, Gail Glassen, Lou Granado, Jane Mayfield, David
Moseley, John O'Brien and Karmann Titland. Josiane Petit-Tchoukaline pro
vided much of the medical graphics for the text.
Many grants and contracts from the United States Department of Health
and Social Services, the National Heart, Lung and Blood Institute, have
supported research from wh ich this book developed. These grants and con
tracts have included: HL 19341, HE 10248, H4670, HE08525, HE09131,
H 2630, HV 72926 and HL 15844.
T ABLE OF CONTENTS
Preface VII
A cknowledgements VIII
l. An Overview of Non-invasive Cerebrovascular Evaluation Using
Doppler Ultrasound
MERRILL P. SPENCER, M.D.
2. Sound and Ultrasound 23
JOHN M. REID, PH.D.
3. Doppler Flowmeter Systems 41
JOHN M. REID, PH.D.
4. Doppler Imaging Systems 48
JOHN M. REID, PH.D.
MERRILL P. SPENCER, M.D.
DON ALD L. DA VIS, B.S.E.E.
5. Other Ultrasonic Techniques and Current Research 57
J OHN M. REID, PH.D.
6. Technique of Doppler Examination 69
MERRILL P. SPENCER, M.D.
7. Vascular Murmurs 89
MERRILL P. SPENCER, M.D.
8. Blood Flow in the Arteries 97
MERRILL P. SPENCER, M.D.
x
9. Hemodynamics of Carotid Artery Stenosis 113
MERRILL P. SPENCER, M.D.
10. Audio Spectral Analysis 133
ROBERT S. RENEMAN, M.D.
11. The Periorbital Collateral Arteries 143
EDWIN C. BROCKENBROUGH, MD.
12. Ultrasonic Detection of the Non-Stenotic Plaque 157
MERRILL P. SPENCER, M.D.
13. Obstructive Lesions Diagnosed by Doppler Ultrasound 169
MERRILL P. SPENCER, M.D.
GEORGE 1. THOMAS, M.D.
14. Clinical Management Decisions Based on Doppler Cerebrovascular
Evaluation 193
MERRILL P. SPENCER, M.D.
15. Full Capability Doppler Diagnosis 211
MERRILL P. SPENCER, M.D.
Doppler Cerebrovascular References 223
Credit and Recognition List 238
Index of Subjects 241
