Ultrasonography was applied to 24 carotid arteries in 22 patients prior to carotid endarterectomy (CEA) . The relationships between the histology of the plaque removed by CEA, especially the presence or absence of plaque hemorrhage (PH) and the echogenicity in B-mode imaging, and between clinical symptoms and turbulent flow (TF) around the plaque revealed by color flow imaging, were examined. The echogenicity of the plaque was divided into 3 grade based on comparison with that of the intimal layer: Low, in which echogenicity was hypoechoic relative to the intimal layer (5 plaques), Iso, in which echogenicity was the same as that of the intimal layer (6 plaques), High, in which echogenicity was hyperechoic relative to the intimal layer (13 plaques) . PH was found in 7 of the 24 plaques. All 5 of the hypoechoic plaques showed PH, whereas none of the 13 hyperechoic plaques didso. TF was detected in 11 of the 24 carotid arteries. Clinical symptoms occurred in 7 of the 11 patients with TF and 3 of those without TF. In conclusion, we have shown that this technique is capable of predicting the occurrence of PH due to its echogenicity in B-mode imaging. We also suggest that TF may play a role in the production of clinical symptoms.
We studied TCD findings in six patients with occlusion of the internal carotid artery (ICA), including two with bilateral ICA occlusion. Their ages ranged from 60 to 70 yr with mean of 64 yr. All patients had superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Mean flow velocity (MFV) and pulsatility index (PI) in the middle cerebral artery (MCA), anterior cerebral artery (ACA) and STA were measured pre-and postoperatively. Two of three patients demonstrated a decrease of MFV and a slight increase of PI in the MCA postoperatively. All three showed decreased MFV in the ACA after surgery. Five patients demonstrated a significant increase of MFV and a decrease of PI in the STA after the procedure. These results indicate that TCD is clinically useful for assessing hemodynamic changes induced by bypass surgery.
We present a case of exencephaly with amniotic band syndrome at 12 weeks of gestation. Ultrasonographic examination showed absence of the fetal cranium, and the brain appeared to be exposed in the amniotic cavity. In addition, a string-shaped structure originating from the brain and extending to the placenta was noted. At 13 weeks of gestation, induced abortion was carried out, and the diagnosis was confirmed. To our knowledge, this is the first case of its kind to be diagnosed by transvaginal ultrasonography in the first trimester of pregnancy.