"People only see what they are prepared to see.

" Ralph Waldo Emerson

NGUYN L V K THUT SIU M DOPPLER

BS. NGUYN QUANG TRNG (Update 10/03/2009)

KHOA CHN ON HNH NH

26/03/2009

BNH VIN AN BNH TP.HCM 1

NI DUNG
Hiu ng Doppler. Cc h thng Doppler. Hin tng vt ngng. K thut siu m Doppler. Phn tch ph Doppler. Kt lun.

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HIU NG DOPPLER
Hiu ng Doppler c tm ra vo nm 1842 bi Christian Johann Doppler (1803-1853). Lc ng dng n gii thch hin tng lch mu sc ca cc ngi sao ang chuyn ng: Khi ngi sao tin li gn qu t th nh sng ca n s chuyn thnh mu xanh (tc l bc sng gim v tn s ca sng nh sng tng ln). Ngc li, khi ngi sao i xa qu t th nh sng ca n chuyn thnh mu (tc l bc sng tng ln v tn s gim xung).

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nh ngha: l s thay i tn s ca sng khi c s dch chuyn tng quan gia ngun pht sng v ngi quan st, tn s sng phn hi tng ln khi ngun pht sng v/hoc ngi quan st tin li gn nhau, tn s ny s gim xung trong trng hp ngc li.

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 Mt hnh nh quen thuc l khi ta nghe ting ci xe cp cu xa vi m trm (do tn s thp), khi xe chy li gn th ta nghe m bng (do tn s cao). Hoc l khi ta nghe ting tu ha t xa chy li ri chy qua:

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 Nm 1959, Satomura (Nht) ln u tin ng dng hiu ng Doppler vo Y hc nhm kho st timmch. Sau Pourcelot (Php) v Franklin (M) pht trin tip k thut ny. Khc vi siu m B-mode, my khng x l tn hiu sng phn hi thnh hnh nh, m ch ghi nhn s thay i tn s do hiu ng Doppler xy ra khi chm sng siu m pht ra gp cc hng cu chuyn ng trong mch mu ang tin li gn u d hoc i xa u d.
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 Sng m gm c hai thnh phn: tn s (frequency) v bin (amplitude). Tn s (f) sng m lin quan n di bc sng (wavelength) theo cng thc: f = V(velocity) / (wavelength) Vn tc sng m i qua hu ht cc m trong c th vi vn tc 1.540m/giy. Do vy khi thay i di bc sng th tn s sng m cng thay i. Bin biu hin cng ca sng m.
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Arthur Fleischer, MD et al. Color Power Doppler Ultrasound. 1999

 Sng m c truyn i (transmitted-T) t mt u d Doppler xung vi mt tn s hoc bc sng c nh. Tn s ca sng m s khng thay i nu nh cc cu trc m n gp trn ng i khng chuyn ng.

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Arthur Fleischer, MD et al. Color Power Doppler Ultrasound. 1999

 Chuyn ng ca cc t bo mu lm thay i tn s ca sng phn hi tr v (reflected-R) u d. Nu chuyn ng ca dng mu hng v u d th tn s sng phn hi s tng ln v bc sng ngn li. Ngc li, nu dng mu chuyn ng xa u d th tn s sng phn hi s gim v di bc sng tng.

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Arthur Fleischer, MD et al. Color Power Doppler Ultrasound. 1999

 Do vy tn s ca sng truyn i v tr v khc nhau, chng s lch pha vi nhau. Hiu s ca hai tn s ny chnh l tn s Doppler (F ).

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Arthur Fleischer, MD et al. Color Power Doppler Ultrasound. 1999

10

- F: tn s Doppler. - Fo: tn s ca sng pht i. - Fr: tn s ca sng phn hi. - v: vn tc ca dng mu. - c : tc ca sng m truyn trong c th (#1540m/s). - : gc gia chm tia siu m v mch mu.

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W. Schaberle. Ultrasonography in Vascular Diseases. p1-27. 2005

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 T cng thc trn ta rt ra: - Tn s Doppler F t l thun vi vn tc dng chy. - F c tr s ln nht khi chm tia song song vi dng chy (cos =1). Khi chm tia vung gc vi dng chy th s khng c tn hiu Doppler (cos = 0). - Vi u d pht vi tn s 2-8MHz th F thu c nm trong phm vi tn s m tai ngi nghe c (50Hz-15KHz). - Vn tc dng chy c tnh theo cng thc:

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W. Schaberle. Ultrasonography in Vascular Diseases. p1-27. 2005

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C. M. Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005

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CC H THNG DOPPLER

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Doppler lin tc (continuous wave-CW). Doppler xung (pulsed wave-PW). Duplex sonography. Tn hiu Doppler xung. Doppler mu (color Doppler). Tn hiu Doppler mu. Doppler nng lng (power Doppler).
14

CC H THNG DOPPLER
DOPPLER LIN TC Doppler lin tc (continuous wave-CW) vi u d c hai tinh th, mt c chc nng pht sng lin tc v mt c chc nng nhn sng phn hi lin tc.

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W. Schaberle. Ultrasonography in Vascular Diseases. p1-27. 2005

15

 u im: Doppler lin tc o c vn tc dng mu rt ln (m iu ny thng thy trong tnh trng bnh l). Nhc im: N khng ghi c tc ti 1 im xc nh m n ch ghi c tc trung bnh ca nhiu im chuyn ng m chm sng m pht ra gp trn ng i ca n.

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 Khi chm sng m xuyn qua hai mch mu cnh nhau (hai ng mch hoc mt ng mch v mt tnh mch) th tc ghi c l tc trung bnh ca cc tc hai mch mu.

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C. M. Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005

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CC H THNG DOPPLER
DOPPLER XUNG Pht sng dng xung c dng trong Doppler xung (pulsed wave-PW) vi u d c mt tinh th va c chc nng pht v nhn sng phn hi.

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W. Schaberle. Ultrasonography in Vascular Diseases. p1-27. 2005

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 Sng m c pht i theo tng chui xung dc theo hng qut ca u d, song ch nhng xung phn hi t v tr t ca s (gate, sample volume) l c ghi nhn v x l.

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CC H THNG DOPPLER
DUPLEX SONOGRAPHY S kt hp hnh nh siu m hai chiu (cung cp thng tin v cu trc gii phu, v tr t ca s, gc ) v Doppler xung (cung cp thng tin v dng chy) c gi l Duplex sonography.

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21

TN HIU DOPPLER XUNG

Tn hiu Doppler thu nhn c th hin di dng m thanh, dng ph v hnh nh. Di dng m thanh, ta c th phn bit c dng chy m du, lin tc ca tnh mch; dng chy pht gn, cch khong ca ng mch; dng chy pht ko di, th rp ca ng mch b hp.

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22

 Ph Doppler gm c 3 thnh phn: Thi gian (time): c m t theo trc X. Tn s (frequency): c m t theo trc Y. Bin (amplitude): c m t bng sng (brightness) ca ph.
Arthur Fleischer, MD et al. Color Power Doppler Ultrasound. 1999

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 Ta phng i mt ph Doppler phn tch: Hp xanh ch mt im thi gian trong chu k tim. Nhng hp mu vng biu hin ln ca cc tn s ring bit.

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Arthur Fleischer, MD et al. Color Power Doppler Ultrasound. 1999

24

 Vo mt thi im xc nh (hp hng) cc tn hiu Doppler c tn s khc nhau c biu hin bng nhng v tr khc nhau trn ph Doppler (cc mi tn).

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Arthur Fleischer, MD et al. Color Power Doppler Ultrasound. 1999

25

 S khc nhau v bin biu hin bng sng trn thang xm. Vi cng mt tn s, bin sng cng cao th ph cng sng.

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Arthur Fleischer, MD et al. Color Power Doppler Ultrasound. 1999

26

 Theo qui c, khi dng mu i v pha u d th ta c ph dng (pha trn trc X); ngc li, khi dng mu i xa u d th ta c ph m (pha di trc X).

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27

Tuy vy, cn lu rng ph Doppler c th o ngc hon ton nu ta n vo nt invert trn bn phm my siu m!
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 hiu c cc dng chy ta cn phi phn bit dng chy lp (laminar flow) v dng chy cun xoy (turbulent flow). Dng chy lp thy c cc mch mu c vch song song v nhn (smooth), nh vy cc hng cu cng mt vng s chuyn ng vi cng mt vn tc v cng hng. Tuy vy, do c s ma st vi thnh mch, dng chy cnh thnh mch lun lun hi thp hn dng chy trung tm. Phn ln dng chy ca h tim-mch (bao gm tim v cc mch mu ln) l dng chy lp v him khi c vn tc > 1,5m/s.

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 Dng chy cun xoy (turbulent flow) xut hin khi c s tc nghn ngn chn dng chy lp. iu ny khin cho cc hng cu chuyn ng hn lon, khng cng hng v to nn v s dng xoy. Nu tc nghn nng, hng cu c th chuyn ng vi vn tc 7m/s.

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-Dng chy lp bnh thng qua van MC th tm thu vi vn tc kh ng u. -Dng chy cun xoy qua van MC th tm trng vi nhiu vn tc khc nhau.
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CC H THNG DOPPLER
DOPPLER MU (COLOR DOPPLER)

l tn hiu Doppler xung c m ha mu sc ph ln hnh siu m hai chiu. Nhng trong khi Doppler xung ch c 1 v tr t ca s (gate), th y c rt nhiu v tr t ca s k cn nhau trn vng kho st.

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 Thng tin Doppler thu nhn c t mi v tr t ca s c phn tch xc nh hng dng chy v tc trung bnh. Nhng thng tin ny c chuyn i thnh tn hiu mu chng ln hnh nh siu m hai chiu.

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 Thng thng th trn mi ng to nh c khong 32 n 128 v tr ly mu, do vy c c thng tin chnh xc, ta khng nn hp mu (color box, sample volume) qu ln.

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34

 Vi u d convex, vng xa u d, cc v tr ly mu s tha ra do s phn k ca chm tia siu m, do vy s c nhng v tr khng c thng tin Doppler. khc phc hin tng ny my s lm php tnh trung bnh ca 2 v tr ly mu cnh nhau to thng tin Doppler cho vng khuyt chen gia.

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 Dng chy hng v u d c m ha mu ; ngc li, chy xa u d c m ha mu xanh.

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Tuy vy, cn lu rng mu sc c m ha ny c th o ngc hon ton nu ta n vo nt invert trn bn phm my siu m!
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38

TN HIU DOPPLER MU
Vi dng chy lp th vn tc kh ng nht, trong khi vi dng chy cun xoy th c nhiu vn tc v hng chy khc nhau; do nu ch m ha hai mu xanh- th s b st thng tin m tn hiu Doppler em li. khc phc iu ny ngi ta m ha thm cc mu th hin bng s di y:

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 V Doppler mu ch s dng tn s trung bnh, n c th biu hin c hng (nh mu-color) v tn s trung bnh (nh sc mu-hue) ca dng chy trong cng mt vung (pixel).

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Arthur Fleischer,M.D et al. Color Power Doppler Ultrasound.1999.

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 V vn tc trung bnh gia dng (B) lun lun cao hn vn tc cnh thnh mch (A v C), sc mu (hue) gia dng sng hn hai bn tng ng vi vn tc hoc tn s trung bnh cao hn.

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41

CC H THNG DOPPLER
DOPPLER NNG LNG (POWER DOPPLER)

Doppler mu nh gi tt s hin din v chiu ca dng chy, tuy vy n khng th nh gi c cc mch mu nh li ti (mao mch). Do khng th nh gi tt s ti mu ti cc m. Doppler nng lng ra i, ch kho st ln ca tn hiu Doppler m khng quan tm n chiu ca dng chy.

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42

 Vi Doppler mu, trong hp mu (color box, sample volume) hin din ng thi cc vector vn tc ngc hng nhau, do vy gi tr trung bnh ca vn tc s nh i, thm ch b trit tiu. Vi Doppler nng lng th hon ton khng ph thuc vo cc vector vn tc, do vy n c nhy cao hn nhiu so vi Doppler mu, ng thi n cng d c so nh do chuyn ng.

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43

 Khc vi Doppler xung th hin tt c cc bin , Doppler nng lng ch th hin bin trung bnh (MEAN amplitude) v cho mu hng trn hnh thu c bt k dng mu n hay i xa u d.

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Arthur Fleischer,M.D et al. Color Power Doppler Ultrasound.1999.

44

 Vi Doppler nng lng, mu c m ha biu hin c hay khng c dng chy. N khng cho bit hng ca dng chy.

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45

HIN TNG VT NGNG

(ALIASING PHENOMENON)

Trong Doppler xung c mt yu t gi l tn s lp li xung (Pulse Repetition Frequency-PRF): PRF=C/2d +C: Tc sng siu m trong c th. +d: Chiu su ca mch mu. Nh vy PRF l s ln mi giy m chm siu m i-v gia u d v mch mu.
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 PRF c tnh bng kHz. Cc tn hiu Doppler xung ch thu nhn tt khi c tn s bng hoc thp hn PRF/2. Tn s gii hn ny gi l tn s NYQUIST. Khi tn hiu Doppler c tn s vt tn s NYQUIST th s xy ra hin tng vt ngng. Lc ny ph Doppler xung s b ct ct, Doppler mu s xut hin thm sc vng ngoi hai mu xanh-.

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47

26/03/2009

Joseph A.Kisslo,MD. Basic Echo-Doppler

48

Aliasing ph

Aliasing mu

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49

 Hin tng ny c gii thch nh sau: V nh ta c 1 bnh xe, trn bnh xe c nh du 1 im. Ta quay bnh xe theo chiu kim ng h vi tc vng/giy. Nu ta ghi nhn hnh nh mt ln mi giy (tng ng vi tn s lp li xung PRF) th im nh du s chuyn ng theo chiu kim ng h, cch nhau 900 .

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50

 Nu ta ghi nhn hnh nh vi tn sut chm hn, ch mt ln cho mi 3 giy (tng ng vi tn s lp li xung PRF) th s c hin tng l xy ra: Trong lc bnh xe quay theo chiu kim ng h th im nh du li chuyn ng ngc chiu kim ng h, cch nhau 900.

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51

K THUT SIU M DOPPLER

c mt kt qu siu m Doppler ng tin cy, cc BS lm siu m Doppler cn phi bit cch iu chnh cc nt chc nng ca my cho ra kt qu tt nht. Ngoi ra, cht lng ca my cng l im ng lu v n nh hng khng t n kt qu siu m. Tuy vy, ta cn phi nm vng k thut siu m Doppler cho ra kt qu tt nht.

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52

 Cc k thut bao gm: K thut trnh hin tng vt ngng. iu chnh thang tc mu. iu chnh lc thnh. iu chnh gc . iu chnh kch thc v hng ca s. iu chnh kch thc v hng ca hp mu. iu chnh gain ph v gain mu.

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53

K THUT TRNH HIN TNG VT NGNG 1. Chuyn dch ng nn ln trn hoc xung di ty thuc ph thu c. 2. Tng PRF: my thu tn hiu nhiu ln trn ng i v ca sng m. 3. Gim F bng cch gim tn s u d (vi u d a tn s), i u d c tn s thp hn.

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57

Jonathan B. Kruskal, MD, PhD et al. Optimizing Doppler and Color Flow US: Application to Hepatic 26/03/2009 58 Sonography. RadioGraphics 2004;24:657-675

Chnh color baseline trnh aliasing mu.

Jonathan B. Kruskal, MD, PhD et al. Optimizing Doppler and Color Flow US: Application to Hepatic 26/03/2009 59 Sonography. RadioGraphics 2004;24:657-675

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60

PRF=3,731Hz

PRF=14,286Hz
Jonathan B. Kruskal, MD, PhD et al. Optimizing Doppler and Color Flow US: Application to Hepatic 26/03/2009 61 Sonography. RadioGraphics 2004;24:657-675

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62

PRF = 04 kHz

PRF = 06 kHz, di chuyn ng nn

63

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PRF = 04 kHz

PRF = 10 kHz

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64

PRF qu thp: Aliasing

PRF ng

PRF qu cao: b st tn hiu mu cnh thnh mch

Abigail Thrush et al. Peripheral Vascular Ultrasound How, Why and When. 2nd Edi. 2005
26/03/2009 65

M chy sau, on xa, PRF=2500 Hz

PRF c iu chnh gim xung 1000 Hz Doppler xung cho thy dng chy c PSV rt thp, 10,3 cm/s
Abigail Thrush et al. Peripheral Vascular Ultrasound How, Why and When. 2nd Edi. 2005 26/03/2009 66

u d 7-7,5 MHz

u d 2,8-3,5 MHz

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67

IU CHNH THANG TC MU (color velocity scale): - N khng ng ngha vi PRF, nhng PRF lin quan vi thang tc mu v rng tng tc mu cng tng PRF v ngc li. - Nu thang tc mu t di vn tc trung bnh ca dng mu th ta khng th phn bit c u l dng bnh thng u l dng cun xoy tc cao. - Nu thang tc mu t cao hn vn tc trung bnh ca dng mu th hin tng aliasing c th bin mt, lc ta s b st ch hp. - ch mch mu gn tc, tc dng mu c th thp hn thang tc mu, to nn dng tnh gi ca tc mch. Lc ny ta cn gim thang tc mu xung tht thp (c my c th gim n 1 cm/s). Nu vn khng thy c dng chy th cn phi lm thm CTA, MRA hoc Angiography trc khi kt lun tc mch hon ton.
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69

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70

Thang tc mu: 69,2cm/s

Thang tc mu: 2,3cm/s

Thang tc mu: 30,7cm/s

26/03/2009 71 Jonathan B. Kruskal, MD, PhD et al. Optimizing Doppler and Color Flow US: Application to Hepatic Sonography. RadioGraphics 2004;24:657-675

Huyt khi tnh mch ca ? (cc u mi tn)

Sau khi iu chnh thang tc mu t 20cm/s xung 7cm/s, ta thy xut hin ph mu trong lng TMC (cc u mi tn)
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Chnh thang tc mu qu cao (maximum velocity=77cm/s)

Chnh thang tc mu va phi (maximum velocity=32cm/s)

Chnh thang tc mu qu thp (maximum velocity=08cm/s)

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Paul L Allan et al. Clinical Doppler Ultrasound. 2nd Edi. 2006

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74

26/03/2009

H.R.Tahmasebpour et al. Sonographic Examination of the Carotid Arteries. Radiographics.2005;25:1561-1575.

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Thang tc mu cao b st dng chy vn tc thp ?

Thang tc mu thp thy c dng chy hp, ngon ngoo Chn on chnh xc l gn tc ch khng phi l tc hon ton.

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H.R.Tahmasebpour et al. Sonographic Examination of the Carotid Arteries. Radiographics.2005;25:1561-1575.

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IU CHNH LC THNH (wall filter): - Khi lc thnh t qu cao, dng chy gn thnh c tc thp s b b st. - lc thnh c th c biu th vng gia thang tc mu. - Trn my, lc thnh c th kt hp cng vi PRF trn mt nt chc nng (khi c cng chung mt nt chc nng, th khi ta gim PRF, lc thnh cng t ng gim theo v ngc li). - cc my tt hn, ngoi nt chc nng PRF, lc thnh cn c iu chnh ring bit: +Vi cc my ny, khi ta gim PRF th lc thnh cng t ng gim theo. + Nhng khi ta chn iu chnh ring lc thnh th PRF khng b nh hng.
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My c nt chc nng chung cho PRF v lc thnh, ta xoay nt theo chiu kim ng h nu mun iu chnh tng PRF v wall filter v ngc li.
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My c nt chc nng PRF v nt chc nng ring cho lc thnh My ang hin th nt o chc nng PRF, ta xoay nt theo chiu kim ng h nu mun iu chnh tng PRF v ngc li.

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79

iu chnh PRF t 3.4kHz xung 1,7kHz, vn tc mu gim t 25cm/s xung 12cm/s, ng thi lc thnh cng gim t 262Hz xung cn 135Hz.

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80

 iu chnh ring lc thnh, ta nhn nt iu chnh, my s chuyn sang iu chnh lc thnh (wall filter). Ta xoay nt theo chiu kim ng h nu mun iu chnh tng v ngc li.
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iu chnh lc thnh (wall filter) t 790Hz xung 262Hz, PRF v vn tc mu khng thay i.

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82

Ph hp van MC, wall filter c iu chnh (mi tn) loi b cc tn hiu c vn tc thp.
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84

Ph o dng TMC do tng p lc TMC. Huyt khi TMC (cc mi tn) ?

Gim vn tc mu, gim lc thnh xung thp xut hin dng chy trong TMC khng c huyt khi.

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85

IU CHNH GC tnh chnh xc vn tc dng chy th gc lun lun < 600 ( sai s chp nhn c).

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Hnh di y minh ha tm quan trng ca vic ly gc : c bit vn tc thc s ca dng mu qua van MC l 2m/s. Khi gc = 100, vn tc o c l 1,97m/s. Khi gc = 300, vn tc o c l 1,73m/s. Khi gc = 600, vn tc o c l 1,00m/s.

26/03/2009

Joseph A.Kisslo,MD. Basic Echo-Doppler

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88

IU CHNH KCH THC V HNG CA CA S - Ca s qu nh s b st tn hiu Doppler. - Ca s qu ln s ly nhiu tn hiu dng chy thp hai bn thnh. - Ca s l tng chim 1/3 ng knh mch mu v t 1/3 gia ca lng mch. - Chnh hng ca ca s song song vi hng dng chy.

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89

Ca s l tng chim 1/3 ng knh mch mu v t 1/3 gia ca lng mch.

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91

Chnh hng ca ca s song song vi hng dng chy.

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Vn tc dng chy trc khi chnh gc: 18cm/s

Chnh gc qu thp (300) vn tc dng chy thp hn so vi thc t.

Jonathan B. Kruskal, MD, PhD et al. Optimizing Doppler and Color Flow US: Application to Hepatic 26/03/2009 94 Sonography. RadioGraphics 2004;24:657-675

Vn tc dng chy trc khi chnh gc: 18cm/s

Chnh gc qu cao (700) vn tc dng chy cao hn so vi thc t.

Jonathan B. Kruskal, MD, PhD et al. Optimizing Doppler and Color Flow US: Application to Hepatic 26/03/2009 95 Sonography. RadioGraphics 2004;24:657-675

Vn tc dng chy trc khi chnh gc: 18cm/s

Vn tc dng chy sau khi chnh gc ng (song song vi hng dng chy): 29,3cm/s
Jonathan B. Kruskal, MD, PhD et al. Optimizing Doppler and Color Flow US: Application to Hepatic 26/03/2009 96 Sonography. RadioGraphics 2004;24:657-675

Gc ca ca s khng song song vi hng dng chy, PSV=356cm/s (sai)

Gc ca ca s song song vi hng dng chy, PSV=155cm/s (ng)

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97

Gc ca ca s song song vi thnh mch, PSV=198cm/s (sai).

Gc ca ca s song song vi hng dng chy, PSV=376cm/s (ng).

26/03/2009

Paul L Allan et al. Clinical Doppler Ultrasound. 2nd Edi. 2006

98

SV: sample volume (ca s). Gc ca SV song song vi thnh mch cho kt qu PSV ca ICA l 229cm/s, tng ng vi hp > 70% (khng chnh xc).

Gc ca SV song song vi hng ca dng chy cho kt qu PSV ca ICA l 161cm/s, tng ng vi hp > 50-69% (chnh xc).

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H.R.Tahmasebpour et al. Sonographic Examination of the Carotid Arteries. Radiographics.2005;25:1561-1575.

99

SV t ng v tr (A) trn mt M cnh trong ngon ngoo.

H.R.Tahmasebpour et al. Sonographic Examination of the Carotid Arteries. Radiographics.2005;25:1561-1575.

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IU CHNH KCH THC V HNG HP MU - Hp mu cng su s c PRF thp hn, do vy cng d b hin tng vt ngng. - Hp mu cng ln th hnh nh thu c c phn gii dc cng km, do vy chnh hp mu va bao trm vng cn kho st. - Chnh hng hp mu to gc < 600 so vi hng ca dng chy.

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Hp mu qu ln

Hp mu va

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hng ca hp mu hng dng chy

hng ca hp mu hng dng chy

Hng ca hp mu vung gc vi hng dng chy Khng ng.

Hng ca hp mu to mt gc < 600 vi hng dng chy ng.

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Hng ca hp mu (cng chnh l hng ca chm tia) vung gc vi dng chy Khng ng.

Hng ca hp mu (cng chnh l hng ca chm tia) to mt gc < 600 vi dng chy ng.

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Hng ca hp mu (cng chnh l hng ca chm tia) vung gc vi dng chy Khng ng.

Hng ca hp mu (cng chnh l hng ca chm tia) to mt gc < 600 vi dng chy ng.
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IU CHNH GAIN PH V GAIN MU Nu gain ph hoc gain mu qu thp s b st tn hiu, nu qu cao s b hin tng soi gng (Doppler ph) hoc lem mu (Doppler mu).

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Ph h van 3 l, gain qu thp

Ph van MC, gain qu cao

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Chnh gain ph

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Nhng khi gain ph c chnh qu cao s xut hin hnh nh soi gng qua ng nn.

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Gain mu qu cao

Gain mu qu thp

Gain mu va
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Gain mu qu cao: khng thy ch hp

Gain mu va : pht hin ch hp

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PHN TCH PH DOPPLER

Ph Doppler phn nh huyt ng ca dng chy. Th tm thu, do lc co bp ca qu tim, vn tc dng chy tng cao. o vn tc ti a ca dng mu t c, ngi ta dng khi nim nh tm thu (peak systolic velocity-PSV). Th tm trng, tuy rng tim khng co bp, nhng dng chy vn c duy tr do s co bp ca thnh mch, dng chy c vn tc thp hn. nh gi dng chy trong th tm trng, ngi ta o vn tc cui tm trng (end diastolic velocity).
W. Schaberle. Ultrasonography in Vascular Diseases. 2005

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 Ngi ta tnh ch s khng (resistance index) nh gi khng lc ca mch mu. RI = (A-B)/A

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 Dng chy tr khng thp (low-resistance low): M cung cp mu cho cc c quan trong c th (M gan, lch, thn, M cnh trong, M ct sng) l nhng dng chy tr khng thp vi ph gim dn t nh tm thu ko di sut k tm trng.

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 Dng chy tr khng cao (high-resistance low): M cung cp mu cho cc chi l nhng dng chy tr khng cao vi ph o ngc tin tm trng, dng chy thp gia tm trng v khng c dng chy cui tm trng, to nn sng 3 pha.

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Da vo phng trnh lin tc, ta suy ra rng: khi din tch dng chy cng gim th vn tc dng chy cng tng

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 dng chy khng b hp, ta c dng chy lp vi vn tc kh ng u. iu ny khin cho ph Doppler c bin kh ng u, to nn ng vin ph (spectral envelope) mng, cho hnh nh ph trng chn hay cn gi l c ca s ph (spectral window)
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 dng chy khng b hp, ta c dng chy lp vi vn tc kh ng u. iu ny khin cho ph Doppler c bin kh ng u, cho hnh nh ph trng chn hay cn gi l c ca s ph (cc mi tn)
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 dng chy b hp nh, ta c dng chy ri vi vn tc khng ng u. iu ny khin cho ph Doppler c bin khng ng u, to nn ng vin ph (spectral envelope) dy, lm gim hnh nh ph trng chn (gim kch thc ca s ph).
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 dng chy b hp va v nng, ta c dng chy ri vi vn tc rt khng ng u. iu ny khin cho ph Doppler c bin rt khng ng u, , to nn ng vin ph (spectral envelope) rt dy, lm mt hnh nh ph trng chn (mt ca s ph), ng thi PSV tng cao.
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 dng chy b hp va v nng, ta c dng chy ri vi vn tc rt khng ng u. iu ny khin cho ph Doppler c bin rt khng ng u, , to nn ng vin ph (spectral envelope) rt dy, lm mt hnh nh ph trng chn (mt ca s ph), ng thi PSV tng cao.
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Khi t ca s ngay sau ch hp nng, ta ng thi ly c ph Doppler c b trn hnh rng ca biu hin ca dng chy cun xoy (turbulent) (cc mi tn), ng thi cng xut hin ph o ngc dng chy (flow reversal) (mi tn ln).

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S biu din s tiu hao nng lng ca dng chy khi i qua mt ch hp.
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S biu din cho thy vn tc dng chy tng ln khi i qua ch hp. Nhng khi dng chy qu hp th vn tc s nhanh chng gim xung v tiu hao qu nhiu nng lng.

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Ph Doppler bnh thng trc hp (1), tng cao PSV khi qua ch hp (2), ngay sau ch hp, PSV vn cn cao ng thi xut hin ph o ngc (flow reversal) (3), h lu ch hp PSV thp hn trc hp v b tiu hao nng lng nhiu khi i qua ch hp (4,5).

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Ngay trc hp

Ngay sau hp: PSV tng cao, xut hin dng cun xoy (cc mi tn) v ph o ngc (flow reversal-mi tn ln). Sau hp: PSV thp hn trc hp v b tiu hao nng lng 133

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PH TARDUS-PARVUS
Vi dng chy b hp nng thng lu, ta c ph tardus parvus (ph mch chm) h lu dng chy. Ph ny cn gp dng chy do tun hon bng h hnh thnh. c trng ca ph ny l thi gian gia tc (AT) ko di, PSV thp v trn. Ta cn nhn bit c dng sng ny trnh b st chn on. Ph ny c th bt gp bt c ng mch no trong c th. Nhng d hnh dung, ta ly trng hp hp M thn lm v d:
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PH TARDUS-PARVUS
AT

Hp > 75% vi tng PSV > 150cm/s, AT (acceleration time thi gian gia tc) > 0,07s on gn M thn (P) v ph tardus-parvus trong nhu m thn (P) vi AT ko di, PSV thp v trn.
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So snh ph M cnh chung, cnh trong bnh thng v ph tardus-parvus h lu ch hp.

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Ph bnh thng M cnh chung (P) ? Sng tardus-parvus MCC (P) Angiography: Hp nng thn M cnh u.
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KT LUN
c th lm tt siu m Doppler th vic u tin l phi hiu c nguyn l ca siu m Doppler. N c xem nh nn mng ca ngi nh. Vic nm vng nguyn l ny cng gip ta bit cch iu chnh cc yu t k thut sao cho t c kt qu chnh xc nht. Phi bit phn tch ph Doppler, t ph Doppler ta c th chn on c cc thay i huyt ng ca dng chy.
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TI LIU THAM KHO

W. Schaberle. Ultrasonography in Vascular Diseases. 2005 Abigail Thrush et al. Peripheral Vascular Ultrasound How, Why and When. 2nd Edi. 2005 Paul L Allan et al. Clinical Doppler Ultrasound. 2nd Edi. 2006 C. M. Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005 Jonathan B. Kruskal, MD, PhD et al. Optimizing Doppler and Color Flow US: Application to Hepatic Sonography. RadioGraphics 2004;24:657-675 H.R.Tahmasebpour et al. Sonographic Examination of the Carotid Arteries. Radiographics.2005;25:1561-1575. Joseph A.Kisslo,MD. Basic Echo-Doppler

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