Effective duplex head and neck scanning: everything you need to know. Who Should Do Ultrasound Duplex Scanning?

Ultrasound of the vessels of the head and neck- a non-invasive diagnostic method that visualizes the carotid and vertebral arteries, neck veins, and the main arteries of the brain. Used in the diagnosis of vascular atherosclerosis, stroke, stenosis, thrombosis, embolism. Ultrasound of the vessels of the head and neck consists of several procedures: transcranial dopplerography, ultrasound of the vessels of the head, ultrasound and ultrasound of the vessels of the neck. The cost depends on the scope of studies, the mode used (vessel duplex, dopplerography).

Training

Special preparation for ultrasound of the vessels of the head and neck is not required. General recommendations before scanning are as follows:

1. The day before the examination, it is worth giving up coffee, strong tea, alcoholic and energy drinks.
2. Do not smoke two hours before the procedure.
3. Warn the doctor about taking drugs that affect vascular tone (hypotensive, vasoconstrictor).

What shows

Ultrasound of the vessels of the head and neck visualizes the condition of the arteries and veins located outside and inside the skull, along the brain stem and cervical spinal cord. With transcranial dopplerography, the patency of the veins and arteries of the head is determined. Duplex examination of the vessels of the head reveals the speed of blood flow, the cause of the violation of vascular patency. Doppler ultrasound of the neck vessels provides information on the blood flow of the basilar, vertebral and carotid arteries. With ultrasound of the cervical vessels, the structure of the arterial and venous circuits is visualized, the rate of venous outflow and blood flow through the basilar artery is determined.

Normally, the thickness of the walls of the arteries is 0.9-1.1 mm, the diameter of the vertebral artery is not more than 2 mm, the lumen of the vessels is free, there is no turbulent blood flow and vascular branching, the blood flow velocity in the veins is 0.3 m/s (small deviations are acceptable) . With the help of ultrasound, the following pathologies are detected:

• Atherosclerosis. With non-stenosing atherosclerosis of the artery, an increase in the walls, uneven echogenicity, narrowing of the lumen by 20% or less is found. Another characteristic sign of an atherosclerotic lesion is the irregular course of the vessels, the presence of tortuosity and kinks.
• Vascular stenosis. The key manifestation of vascular stenosis is a decrease in the diameter of veins, arteries, narrowing of the lumen.
• The presence of thrombi. The ultrasound method determines the presence of plaques, blood clots. With complete obstruction of the vessel, the lumen is absent, with partial obturation, it narrows (the doctor assesses the degree of narrowing).
• Anomalies in the development of blood vessels. With congenital anomalies of the cerebral vessels, a change in their course, the presence of pathological tortuosity, and branches of small vessels in the pathological area are determined.
• Vasculitis. Vasculitis is characterized by a violation of the differentiation of the layers of the wall, a change in echogenicity.

The results of vascular ultrasound diagnostics are not used in isolation when making a diagnosis. Their interpretation is carried out taking into account the anamnesis, clinical picture and laboratory data. Often, ultrasound is the primary stage of imaging, which requires supplementation with MRA results.

Advantages

Ultrasound remains the best diagnostic method in terms of the ratio of information content and the cost of the procedure. It has practically no contraindications, is safe and painless, can be used to examine all categories of patients: newborns, pregnant women, the elderly, somatically debilitated people. Compared to MRA, REG or CT, sonography has a lower cost, but it does not always allow you to get a complete image of the vessel and determine the factors of patency. The information content of the study is negatively affected by the presence of an obstacle for ultrasound waves in the form of bone tissue.

What is duplex scanning of the vessels of the head and neck? What is this procedure for? What makes it possible to determine? How to behave after it? We will try to answer these and other questions in more detail.

Duplex and triplex of vessels, ultrasonic angioscanning, simply UZDAS are one and the same. This is a method that uses ultrasound. It allows you to see the vessels in a two-dimensional projection. Ultrasound is reflected from the red blood cells and thereby forms an image of the vessels. So each vessel and its surrounding tissues are visualized. At the same time, there is a unique opportunity to assess their condition, namely, to consider the condition of the walls, to assess the speed of blood flow and its nature. This is the most modern method for diagnosing vascular pathology, which is non-invasive. When scanning, the diagnostician can examine the vascular system in detail, assess whether they are narrowed. Also, at the same time, he will see if there are any blockages or areas where the vessels expand, but at the same time become thinner. He may notice the presence of plaques (atherosclerotic), blood clots, disturbances in the blood flow.

Such a study is called doppler. This is the name of the scientist who invented this unique method. A very effective method for studying blood flow is triplex scanning of the vessels of the neck and brain. In this case, sound waves with a high frequency range are used. Human hearing is absolutely immune to them. The ultrasonic sensor transmits information to a powerful computer, which converts it into a dynamic two-dimensional image. The monitor screen shows the state of the patient's vessels in the smallest detail. This technology greatly facilitates the work of diagnosticians.

The forerunner of duplex (triplex) was dopplerography. This technique used to be very popular. But her options were limited. She helped to establish only the speed of blood flow and its direction. At the same time, it was impossible to assess changes in the structure of the walls and lumen of the vessels. Accordingly, the duplex has such possibilities.

Ultrasound has a unique property to pass through the tissues of our body. It can also bounce off cells that float around in our bloodstream. In this case, a clear image of the vessel is sent to the screen. So the doctor can assess the degree of its narrowing and the characteristics of the patency.

Should I be afraid of ultrasonic waves?

Some patients are concerned about whether the ultrasound waves will harm them. Let's calm down. A number of studies have not revealed the harmful effects of ultrasound on human organs and tissues. Note that we are talking about adult patients. Scanning with duplex or triplex is one of the safest studies of the vessels of the brain and neck. At the same time, it is important to understand that the harm from vascular diseases is much greater. If a duplex examination is required for the correct diagnosis, then you should not be afraid of it. By the way, if it is necessary for diagnosis, then this study can be repeated several times in a fairly short time.

Where can duplex be used?

During duplex scanning, the diagnostician finds out the following information:

• What is the degree of elasticity of blood vessels
• What is the condition of the inner shell?
• Is the integrity of the walls of blood vessels broken?
• Are there any formations inside the veins or arteries of the head and neck
• What is the anatomy of the vessels of a particular patient
• Is there any abnormal curvature
• Does a small vessel depart in an uncharacteristic place
• Are there any changes in the course of the vein or artery

Dopplerography allows you to make a diagnosis in such diseases:

• Congenital anomalies in the branching, course or arrangement of blood vessels
• Atherosclerosis
• Injury to a vein or artery
• Inflammation of capillaries and artery walls
• Angiopathy (toxic, hypertensive or diabetic)
• Vegetative-vascular dystonia
• encephalopathy

By performing an ultrasound of the vessels of the neck and head, you can find out:

• why strokes or transient ischemic attacks recur
• how specific arteries are affected
• how vascular patency is impaired due to smoking, diabetes or atherosclerosis

When the doctor receives a complete picture of the state of the intracranial veins and arteries, he can most objectively prescribe complex treatment, as well as control how effective it is. Also, such a study will help predict how the disease will behave in the future.

The study of blood vessels using a duplex is prescribed in a number of conditions and diseases:

• Endarteritis, atherosclerosis, diabetic angiopathy of the leg vessels
• Atherosclerosis of the visceral branches of the abdominal aorta (these vessels supply blood to the spleen, liver, stomach, kidneys)
• Aneurysm in the abdominal aorta, as well as other large vessels
• Varicose veins in the legs
• Vasculitis (inflammation of blood vessels)
• Vascular disease of the neck and brain
• When monitoring the operations performed on various vessels
• With post-thrombophlebitic disease
• With the syndrome of compression (external compression) of the vessel
• Screening study (examination to identify asymptomatic forms of the disease)
• Phlebothrombosis and thrombophlebitis of veins (limbs)
• Thrombosis of vessels in the intestine
• Vascular injury and its consequences

Signs of vascular pathology

Note! If you often experience dizziness, headache, tinnitus, blurred vision, loss of consciousness, unsteady gait, or impaired coordination of movements, then these may be symptoms of vascular disease. Also, violation of understanding or reproduction of speech, weakness and numbness of the arms and legs should alert.

The following indicators may indicate that the condition of the vessels requires medical intervention:

• Thickening of the walls of blood vessels
• The echogenicity is changed, and the artery is narrowed by less than 20%. This is indicative of arteriosclerosis.
• With vasculitis, the vascular wall and its echogenicity change, the differentiation of layers in the wall is disturbed
• With plaques, a hypoechoic image appears with a thin rim or echogenicity may decrease.

Treatment is mandatory prescribed for stenosis of any cerebral artery (more than 50%).

What is better to choose - triplex scanning or duplex?

If you cannot decide which method to prefer, then we clarify that there is not much difference between them. Both are about equally informative. The triplex has one advantage - it will help to assess the condition of the vessels in different three modes of ultrasound. Duplex will allow you to scan the vessels in two types of mode. The quality of the study is primarily affected by the state of the equipment, as well as the experience of the doctor, and not the technique itself.

What is better to examine - veins or arteries?

In fact, only a specialist can adequately determine which vessels need to be examined for a particular patient. It is important to get a comprehensive consultation with a surgeon (vascular, angiosurgeon). Only he will be able to tell you exactly what procedures and to what extent you need for diagnosis. To save money, time and nerves, pay special attention to the initial examination by a specialist. Duplex or triplex scanning is not required for every patient, even with obvious vascular diseases. There are other diagnostic methods.

Do I need to prepare before a vascular scan?

Specialists most often prescribe duplex or triplex scanning for problems with the vessels of the neck or head. In this case, the arteries of the neck and head, as well as veins or arteries in the lower extremities, are examined. Whatever veins or arteries are examined, this procedure does not require any preliminary preparation.

But if a scan of the vessels of the small pelvis and abdominal cavity is performed, in particular in patients who suffer from obesity, a diet will be required. It usually lasts no more than three days. In this case, the patient will have to exclude from his diet milk, meat, cabbage, black bread, as well as plant products that are rich in fiber. Also, for a more accurate diagnosis, drugs may be prescribed that will prevent excessive formation of gases in the intestines. Espumizan is most often used.

What happens in the body during a scan?

Some patients who are scheduled for duplex scanning are afraid that this procedure will give them any discomfort. We hasten to reassure you. This procedure is completely painless and cannot adversely affect the body. Therefore, neither general nor local anesthesia is required.

Another question that interests many patients is in what position the scan will be performed. The posture will depend on which part of the body you want to examine. Scanning can be done sitting, standing or lying down. A special gel is applied to the patient's skin, and then a sensor is installed. The main function of the gel is to improve the conductivity between the body and the ultrasound signal transducer. To get a better image, the doctor may ask his patient to temporarily hold his breath, change the position of his body, or perform some other simple manipulations. Scanning takes an average of 30 to 40 minutes. At the same time, patients experience almost no discomfort.

How to behave after a duplex or triplex scan?

Once a patient undergoes one of these scans, they do not need to do anything else. You can safely return to your usual activities. There can be no restrictions after this simple procedure.

Can there be complications?

Practice has shown that there are practically no complications after scanning. This procedure is absolutely safe for adult patients. Very rarely, minor complications in well-being were observed.

Can duplex or triplex vascular scanning be considered accurate diagnostics?

Such a scan is a very accurate way of diagnosing. Due to its high accuracy, it helps to objectively and quickly diagnose many vascular diseases. But it is worth noting that the quality of the study and the accuracy of its results are affected by how serviceable and whether a sufficiently new device is used. It must be in good condition and with the correct settings. In addition, it is very important that the study was conducted by an experienced diagnostician. Even the most modern and new equipment cannot replace an experienced and talented diagnostician. Sometimes the results of a study of the same patient with different diagnosticians or with different devices can vary quite a lot.

Can such scanning be considered the final and decisive method in the study of the state of blood vessels?

Very often, it is the scanning of blood vessels that becomes decisive for the diagnosis and further treatment. After it, most often the doctor can already prescribe a specific treatment regimen. But there are times when this study is not enough. We are talking about operations on the vessels. In this case, the doctor may resort to additional research methods. For example, radiopaque, magnetic resonance, or computed angiography is often prescribed.

Duplex vascular scanning is a widely used ultrasound examination that allows visualization of the arteries, surrounding tissues and blood flow. Today it is considered the main method for diagnosing vascular diseases, it is highly informative and accessible. The method is based on the property of ultrasound to be reflected from soft tissues.

Indications

Duplex vascular scanning is prescribed for the diagnosis of the following diseases:

• atherosclerosis;
• angiopathy;
• aneurysms;
• vasculitis (inflammation of the vascular walls);
• disorders of cerebral circulation (ischemia);
• anomalies and vascular injuries;
• varicose veins;
• thrombophlebitis;
• vein thrombosis;
• thromboembolism of the pulmonary artery.

Headache syndrome is one of the indications for ultrasound of the vessels of the brain and neck

Duplex scanning of the vessels of the head and neck is prescribed when signs appear that may indicate a violation of cerebral circulation:

• fainting states;
• persistent headaches;
• dizziness;
• noise in ears;
• flies before the eyes;
• loss of balance and impaired coordination of movements;
• absent-mindedness, memory impairment, difficulty concentrating;
• hearing loss or loss;
• fears, anxiety, anxiety;
• depression.

Duplex scanning of the vessels of the neck and brain makes it possible to find out:

• causes of strokes;
• violations of the patency of the arteries in smokers, patients with diabetes mellitus, with atherosclerosis;
• the degree of vascular damage in antiphospholipid syndrome.

Types of ultrasound examination

Duplex scanning of the vessels of the brain and neck is carried out in different modes:

1. two-dimensional - shows the arteries and their surrounding tissues, except for the vessels inside the skull, gives some information about the blood flow;
2. duplex scanning (carried out in two modes - color and spectral) - gives a two-dimensional image and shows the vessel in two planes (along and across), makes it possible to obtain detailed information about the blood flow, vessel wall, its lumen, surrounding tissues.

To study the vessels inside the skull, transcranial ultrasound is used, which is less informative than CT and MRI. It is necessary:

• for the study of the medulla in lesions of the brain in the hemispheres;
• with intracerebral hematomas;
• to control previously diagnosed pathologies.

In addition, it is shown:

• if stenosis and closure of the lumen are found in the duplex of extracranial arteries;
• if there are indirect signs of vascular damage inside the skull;
• with constant headaches;
• if cerebral ischemia is detected;
• with vasculitis, diabetes, hypertension;
• with pathologies of the brain associated with a change in its structure and impaired blood circulation.

Examination of the brachiocephalic arteries

The brachiocephalic arteries are the main vessels of the head that provide blood supply to the brain. When they change, the development of serious disorders leading to a stroke is possible. These include the carotid artery, vertebral and subclavian. Duplex scanning of brachiocephalic vessels makes it possible to identify the following pathologies:

• deformations: bends, tortuosity, loops;
• cholesterol plaques;
• blood clots;
• aneurysms;
• damage due to trauma;
• stenosis or expansion;
• underdevelopment.

Pros and cons

The method has many advantages:

• informative and efficient;
• relative cheapness, availability for most people;
• painless, non-invasive, no anesthesia required;
• harmlessness due to the absence of radiation;
• there are practically no contraindications due to the fact that ultrasound does not have a negative effect on the body;
• carried out in real time.

There are also some disadvantages:

• difficulties in examining small vessels;
• the result depends on the professionalism of the doctor;
• cholesterol plaques can interfere with the passage of ultrasound.

How is it carried out

Duplex scanning of the arteries of the head and neck can be performed in almost all patients, including pregnant women and children. Preliminary preparation before the procedure is not required. The examination lasts about half an hour.

During the examination, the patient is in a supine position, the head is fixed, the doctor drives the sensor in the neck area, while an image appears on the monitor

Before the examination, the patient lies on the couch, a roller or pillow is placed under his head so that it is in an elevated position. For better contact between the sensor and the body, the skin of the neck is lubricated with a special gel. The doctor holds the sensors in the area of ​​the vessels and looks at the veins and arteries on the monitor, takes measurements.

Start the examination from the carotid artery to the entrance to the skull. It may have a different location. They examine it from different angles and in different planes. This is how wall changes and stenoses are well defined.

To examine the brain, the sensor is passed over the head in the following areas:

• supraorbital;
• temporal (on both sides);
• occipital bone;
• where the occipital bone joins the spine.

The doctor correlates the results obtained with normal values. In some cases, additional examination and consultation of other specialists may be required.

results

During the study, the doctor receives information about the speed of blood flow, vascular defects.

The duplex of the brain makes it possible to assess the veins: their anatomy, patency, diameter, tortuosity, outflow rate.

During the study, a high-quality color image appears on the monitor, allowing you to assess blood flow, changes in the arteries and their walls, surrounding tissues

During the examination, data on the carotid arteries are obtained and the indicators are compared with normal values.

Pathologies are determined by the following features:

• they talk about vasculitis if there are changes in the vessel wall and disturbances in the differentiation of its layers;
• atherosclerosis is evidenced by an increase in the thickness of the artery wall and narrowing of its lumen;
• narrowing of the arteries of the brain by 50 percent requires mandatory treatment.

Who is scheduled examination

A duplex of cerebral vessels is indicated for people at risk. These include:

• men over 40;
• women over 45;
• patients with diabetes;
• suffering from osteochondrosis of the spine (cervical);
• patients with antiphospholipid syndrome;
• smokers;
• people with vegetative-vascular dystonia;
• hypertension;
• have had a stroke;
• patients with cardiac arrhythmias;
• people with high cholesterol;
• preparing for a surgical operation on the heart;
• patients after brain surgery.

Conclusion

Duplex scanning of the arteries of the neck and head is an informative method for diagnosing vascular diseases, which allows you to detect changes in the arteries in the early stages, even before the appearance of patient complaints, which helps prevent stroke. The information obtained with the help of ultrasound allows you to choose the right treatment tactics, evaluate its effectiveness, and make a prognosis. Due to the availability, ease of implementation and relatively low cost, the ultrasonic method has become the most widely used today.

Duplex scanning of blood vessels is called an effective diagnostic method based on the principles of ultrasound and the Doppler effect. This technique reveals various pathologies at the initial stages of development, when the symptoms have not yet made themselves felt.

Duplex scanning is based on the properties of high-frequency sound reflected from different structures of the human body. The study combines classic B-mode ultrasound with Doppler ultrasound.

B-mode called two-dimensional echography, that is, a picture in various shades of gray. Due to the different density, the structures of the human body are able to absorb or reflect ultrasonic waves with different intensities. This information is captured by the sensor, and software processing produces a two-dimensional black and white picture.

dopplerography is a dynamic study that evaluates blood flow parameters at the current time. Ultrasound in this case is reflected by moving objects, that is, blood cells.

Combining the two modes provides duplex scanning with high information content.

• no invasive intervention;
• there is no need to administer a contrast agent to the patient;
• safety: there are no unpleasant sensations or side effects; after scanning, the patient returns to his usual life;
• the possibility of repeated scans;
• simplicity;
• no contraindications;
• minimal preparation.

Diagnosis can be carried out both for diagnosis in the presence of relevant symptoms, and for preventive purposes. Experts recommend undergoing such a scan annually in order to timely identify problems with the circulatory system.

Indications for examination

Scanning of vessels of the head and neck

In addition to the listed risk groups, the following symptoms indicate the need for diagnosis:

• frequent or prolonged headaches (read about the causes and methods of treating pain in the head);
• noise in ears;
• heaviness in the head;
• dizziness (repeated attacks);
• prone to fainting;
• impaired coordination of movements;
• changes in gait;
• muscle weakness.

• the skin on the legs darkened and became thicker;
• hairline is broken;
• the appearance of non-healing ulcers;
• swelling of the extremities, itching in them, a feeling of heaviness;
• increased sensitivity to cold;
• veins are dilated, protrude;
• , fatigue is felt, convulsions appear;
• development risk;
• sedentary lifestyle;
• sedentary advantage work;
• excess weight;
• diabetes;
• vascular diseases in relatives.

Duplex scanning of abdominal vessels

• abdominal trauma;
• abdominal pain;
• puffiness;
• high blood pressure;
• feeling of heaviness;
• high cholesterol;
• varicose veins of the lower extremities, rectum, stomach and other organs;
• enlargement of the spleen (splenomegaly) or liver (hepatomegaly).

Study preparation

Preparation for the diagnosis of the vessels of the abdominal cavity or small pelvis begins 3 days before the study. The main principle of preparation is diet. It is necessary to exclude products that increase flatulence:

• fresh vegetables and fruits;
• meat and fish of fatty varieties;
• dairy products;
• black bread;
• sweet products;
• whole milk;
• carbonated drinks and kvass;
• legumes.

Diagnosis must be done on an empty stomach. From the last meal to the scan, at least 6-8 hours should pass. Breakfast is only worth it if the study is scheduled after lunch.

Carrying out a scan

The patient needs to take a certain posture. For duplex scanning of vessels in different areas, the position must be special.

Diagnosis of vessels of the neck and head

When examining the neck, the head should be turned in the opposite direction from the sensor. The vessels of the brain are viewed through the cranial bones, therefore several points are scanned with a sensor - on both sides of the temporal regions, areas above the eyes, the junction of the spine and the occipital bone, the location of the latter.

About the features of such a study of the vessels of the head and neck, see this video:

Examination of the veins of the lower extremities

During the procedure, functional tests may be required. The patient is asked to change position or hold their breath.

You can see how this study is carried out in this video:

Deciphering the results

The results of the scan can be sent to the doctor who issued the referral, or handed over to the patient. In any case, a specialist will make a diagnosis and prescribe treatment. The study allows you to find out many parameters and identify all kinds of pathologies.

Examination of the vessels of the neck and head

• congenital anomaly in the location or course of blood vessels;
• injured vein or artery;
• atherosclerosis;
• vasculitis;
• angiopathy of a different nature;
• dyscirculatory encephalopathy;

• external symmetry of the arteries;
• the diameter of the vertebral arteries is 3-4 mm;
• venous blood flow up to 0.3 m/s;
• no stenosis;
• arterial wall thickness up to 1.1 mm;
• systolic blood flow velocity of the carotid artery - up to 0.9 m/s, diastolic - up to 0.5 m/s.

Scanning of vessels of the lower extremities

• thrombosis, including its degree and nature of the thrombus;
• chronic insufficiency of venous function;
• anomalies in development;
• insolvency of valves of venous collectors;
• post-thrombophlebitic syndrome.

• anechoic lumen;
• elasticity and smoothness of the walls, thickness no more than 2 mm;
• the presence of valve leaflets in the lumen;
• the deep vein is larger in diameter than the deep artery, but a maximum of 2 times.

Results of duplex scanning of the abdominal aorta

• aneurysm;
• obliterating atherosclerosis;
• occlusion (blockage);
• stenosis;
• thrombosis;
• developmental anomaly.

Contraindications

Due to the security of the scan, if necessary, it can be repeated indefinitely. Repeated research can be made even on the same day.

Duplex scanning of blood vessels is a safe non-invasive method of instrumental diagnostics. It is used not only for certain symptoms, but also for prevention. The study can reveal pathology even in the absence of its external signs.

The first one shows the vessels and adjacent tissues. It is based on sending impulse signals and their reflection from tissues of different density. From the data obtained, a two-dimensional picture of the organ is immediately built. The duplex study mode, in turn, gives a complete description of the work of the vessels. When a signal is reflected from objects moving inside the arteries, for example, red blood cells, its frequency also changes. So you can measure the speed of blood flow and get a color cartogram. Therefore, the method is called color Doppler mapping.

As a result of diagnostics, data are obtained on the state of the arteries and veins in general, as well as on each vessel separately. It becomes easier to identify the appearance of pathologies.

After receiving the results, it is possible to draw conclusions about:

• elastic characteristics of vessel walls;
• the presence of intraluminal formations;
• change in the structure and thickness of the walls;
• degree of vascular obstruction.

Indications

Such studies are prescribed for postoperative control or if a person has neck pathologies, varicose veins, aortic aneurysms, vascular injuries, thrombosis. Duplex scanning of the vessels of the head shows not only disturbances in the work of the vessels, but also various formations in the brain, for example, inflammation or tumors. Such an analysis helps cancer patients, being an accurate way to determine their current condition. Based on it, the doctor can draw conclusions about the further direction of treatment.

Scanning has no contraindications and can be applied to people of all ages. The analysis does not use drugs, which eliminates the likelihood of allergic reactions. Special preparation for the study is not required. Just do not take on the day of analysis:

• coffee;
• nicotine;
• energy drinks.