Neurologische Ultraschalldiagnostik – ein Update

Das Ausbildungscurriculum der neurologischen Ultraschalldiagnostik beinhaltet nicht nur die fächerübergreifenden Ausbildungsinhalte im Anwendungsbereich der extra- und intrakraniellen hirnzuführenden Arterien, sondern umfasst zusätzlich die erweiterte Diagnostik intrakranieller Gefäße mittels transkranieller Duplexsonografie, die Untersuchung der Hirnvenen, die funktionelle transkranielle Doppler-Sonografie inklusive Monitoringverfahren sowie die Hirnparenchym- und Orbitasonografie.

Abstract

The diagnostic use of ultrasonography in the field of neurology comprises not only the investigation for a stenosis or occlusion of the brain-supplying arteries but also includes a comprehensive examination of intracranial vessels using transcranial color-coded sonography, assessment of brain parenchyma or the optic nerve sheath diameter using B-mode ultrasonography, and monitoring for microembolic signals and testing for a disturbed cerebral autoregulation or a right-to-left shunt via a patent foramen ovale using transcranial Doppler sonography. This paper provides an update on recent developments in neurosonology and compiles the state-of-the-art knowledge required for certification by relevant national societies in charge for continuing education in ultrasonography.

Schlüsselwörte

Duplexsonografie - Karotisstenose - intrakranielle Gefäßstenosen - funktionelle Doppler-Sonografie - Orbitasonografie

Key words

duplex ultrasonography - carotid artery stenosis - intracranial artery stenosis - functional Doppler sonography - orbital sonography

Publication History

Article published online:
07 December 2023

• Literatur

• 1 Valaikiene J, Schlachetzki F, Azevedo E. et al. Point-of-Care Ultrasound in Neurology - Report of the EAN SPN/ESNCH/ERcNsono Neuro-POCUS Working Group. Ultraschall Med 2022; 43: 354-366 DOI: 10.1055/a-1816-8548.
• 2 DEGUM. Recommendations for documentation of neurosonographic examinations. 2023. Im Internet: https://www.degum.de/fileadmin/dokumente/sektionen/neurologie/richtlinien/DokuEmpfehlungen_Englisch_korrigiert.pdf Stand: 04.10.2023
• 3 Gray-Weale AC, Graham JC, Burnett JR. et al. Carotid artery atheroma: comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology. J Cardiovasc Surg (Torino) 1988; 29: 676-681
• 4 Schminke U, Allendörfer J. Intima-Media-Dicke und Atherosklerotische Plaques. Klin Neurophysiol 2023; 54: 87-98 DOI: 10.1055/a-1974-6585.
• 5 Touboul PJ, Hennerici MG, Meairs S. et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 2012; 34: 290-296 DOI: 10.1159/000343145.
• 6 Naylor R, Rantner B, Ancetti S. et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. Eur J Vasc Endovasc Surg 2023; 65: 7-111 DOI: 10.1016/j.ejvs.2022.04.011.
• 7 Kakkos SK, Nicolaides AN, Charalambous I. et al. Predictors and clinical significance of progression or regression of asymptomatic carotid stenosis. J Vasc Surg 2014; 59: 956-967 DOI: 10.1016/j.jvs.2013.10.073.
• 8 Arning C, Widder B, von Reutern GM. et al. [Revision of DEGUM ultrasound criteria for grading internal carotid artery stenoses and transfer to NASCET measurement]. Ultraschall Med 2010; 31: 251-257 DOI: 10.1055/s-0029-1245336.
• 9 von Reutern GM, Perren F, Alpsoy I. et al. Poststenotic Distal Caliber Reduction Predicts Very High-Grade Proximal Internal Carotid Artery Stenosis. Ultraschall Med 2023; 44: e168-e173 DOI: 10.1055/a-1798-0094.
• 10 Markus HS, King A, Shipley M. et al. Asymptomatic embolisation for prediction of stroke in the Asymptomatic Carotid Emboli Study (ACES): a prospective observational study. Lancet Neurol 2010; 9: 663-671 DOI: 10.1016/S1474-4422(10)70120-4.
• 11 Reinhard M, Schwarzer G, Briel M. et al. Cerebrovascular reactivity predicts stroke in high-grade carotid artery disease. Neurology 2014; 83: 1424-1431 DOI: 10.1212/WNL.0000000000000888.
• 12 Arning C. Ultrasound Criteria for Diagnosing Spontaneous Cervical Artery Dissections. Ultraschall Med 2023; 44: 126-150 DOI: 10.1055/a-2004-4986.
• 13 Baumgartner RW, Mattle HP, Schroth G. Assessment of≥50% and<50% intracranial stenoses by transcranial color-coded duplex sonography. Stroke 1999; 30: 87-92 DOI: 10.1161/01.str.30.1.87.
• 14 Sharma S, Lubrica RJ, Song M. et al. The Role of Transcranial Doppler in Cerebral Vasospasm: A Literature Review. Act Neurochir Suppl 2020; 127: 201-205 DOI: 10.1007/978-3-030-04615-6_32.
• 15 van Mook WN, Rennenberg RJ, Schurink GW. et al. Cerebral hyperperfusion syndrome. Lancet Neurol 2005; 4: 877-888 DOI: 10.1016/S1474-4422(05)70251-9.
• 16 Walter U, Brandt SA, Förderreuther S. et al. Empfehlungen der Deutschen Gesellschaft für Klinische Neurophysiologie und Funktionelle Bildgebung zur Diagnostik des irreversiblen Hirnfunktionsausfalls. Klin Neurophysiol 2023; 54
• 17 Bäuerle J, Nedelmann MJ. Sonographic assessment of the optic nerve sheath in idiopathic intracranial hypertension. J Neurol 2011; 258: 2014-2019 DOI: 10.1007/s00415-011-6059-0.
• 18 Ertl M, Barinka F, Torka E. et al. Ocular color-coded sonography – a promising tool for neurologists and intensive care physicians. Ultraschall Med 2014; 35: 422-431 DOI: 10.1055/s-0034-1366113.
• 19 Nedelmann M, Graef M, Weinand F. et al. Retrobulbar Spot Sign Predicts Thrombolytic Treatment Effects and Etiology in Central Retinal Artery Occlusion. Stroke 2015; 46: 2322-2324 DOI: 10.1161/STROKEAHA.115.009839.
• 20 Schlachetzky F, Nedelmann M, Eyding J. et al. Sonografisches Neuromonitoring auf der Stroke Unit und in der neurologischen Intensivmedizin. Klin Neurophysiol 2022; 53: 83-98 DOI: 10.1055/a-1810-0728.
• 21 Walter U, Behnke S. Transkranielle Sonografie des Hirnparenchyms: etablierte Anwendungen bei Erwachsenen. Klin Neurophysiol 2019; 50: 73-82 DOI: 10.1055/a-0858-1484.
• 22 Jauss M, Zanette E. Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography. Cerebrovasc Dis 2000; 10: 490-496 DOI: 10.1159/000016119.
• 23 Walter U, Berg D, Behnke S. et al Positionspapier der DEGUM, Sektion Neurologie, und der DGKN zur Untersucherqualifikation für die transkranielle B-Bild-Sonografie (TCS) des Gehirns in der Diagnostik der Parkinson-Krankheit. Klin Neurophysiol 2023; 54