SIU M DOPPLERKHOA KHOA HC NG DNGB mn vt l k thut y sinhMn thit b chn on hnh nh y hc 2

Siu m DopplerGVGD: PGS.TS Hunh Quang LinhSVTH:Trn Th nh MinhNguyn Hong Kim KhnhH V Quc AnhL Th Thy Dinh

121. Gii Thiu2. Cu To Ca My Siu m Doppler3. Cc Loi Siu m Doppler4. ng Dng Ca Siu m Doppler Trong Y Hc

Siu m Doppler

21. Gii Thiu2. Cu To Ca My Siu m Doppler3. Cc Loi Siu m Doppler4. ng Dng Ca Siu m Doppler Trong Y Hc

Siu m Doppler

3Hiu ng Doppler:Hiu ng Doppler c tm ra vo nm 1842 nh ton hc ngi o Christian Johann Doppler (1803-1853).Hiu ng c pht biu nh sau:Nu sng c pht ra t ngun pht c nh n mt u thu c nh th tn s thu bng tn s pht.Nu khong cch gia u thu v u pht thay i trong khong thi gian thu sng (thi gian sng truyn n u thu) th bc sng s di ra trong trng hp ra xa nhau.

Siu m Doppler

4khi 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).

5

Hiu ng Doppler:Siu m Doppler

5Hiu ng Doppler s dng trong phng php siu m Doppler xy ra khi sng siu m c phn hi t cc vt th chuyn ng nh cc t bo hng cu, thnh mch, c co khi tn s ca sng phn hi s khc vi tn s ca sng ti, v hiu ca hai tn s gi l lch Doppler hay tn s Doppler.

6Cng thc Doppler: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)/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.

Siu m Doppler

6Chuyn ng ca cc t bo mu lm thay i tn s ca sng phn hi tr v (reflected-R) u d. 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 ).

Siu m DopplerCng Thc Doppler:

- Vn tc dng chy c tnh theo cng thc:7F: tn s Doppler. Fo: tn sca sng pht i.Fr: tn sca sng phn hi.v: vn tc ca dng mu.c : tc ca sng m truyn trong c th (~540m/s).: gc gia chm tia siu m v mch mu.

8Cc H Thng Doppler:C 2 k thut Doppler p dng lin quan n cch thc to ra sng m: Sng lin tc (Continuous wave-cw)Xung (Pulsed wave-pw)

Siu m Doppler

81. Gii Thiu2. Cu To Ca My Siu m Doppler3. Cc Loi Siu m Doppler4. ng Dng Ca Siu m Doppler Trong Y Hc

Siu m Doppler

9Cu To Ca My Siu m Doppler

H thng x l nh ca my Siu m. [1] Doppler l 1 mod ca siu m. K thut siu m Doppler dng chn on cc thnh phn chuyn ng nh mch mu, tim thai,

Siu m Doppler[1] P. Perry Sprawls, Ultrasound Production and Interactions, in Physical Principles of Medical Imaging, Medical Physics Publishing, 1995.

10u d [2]:Chuyn i dao ng in thnh cc dao ng c hc v ngc li bng cc vt liu p in.Vt liu ph bin dng trong siu m y t gm p in nh PZT (Chi-Zirconate-Titanate). dy ca cc tinh th thng bng bc sng siu m.u d ngoi tinh th p in cn c: lp phu hp m, lp sao lu, lp hi tu hay phn ki ng kinh , phn thn u do gm kim loai, nha, cao su silicon, hoc epoxy, dy dn va cng kt ni.

Siu m Doppler[2] James Moore,George Zouridakis, "Ultrasonic Blood Flow and Velocity Measurement," in Biomedical Technology and Devices Handbook, CRC Press, August 1, 2003.

11B x l nh [2]Siu m Doppler

[2] James Moore,George Zouridakis, "Ultrasonic Blood Flow and Velocity Measurement," in Biomedical Technology and Devices Handbook, CRC Press, August 1, 2003.

121. Gii Thiu2. Cu To Ca My Siu m Doppler3. Cc Loi Siu m Doppler4. ng Dng Ca Siu m Doppler Trong Y Hc

Siu m Doppler

13Doppler lin tc(continuous wave-CW) [3]

Siu m Doppler[3] J. Williams, "Vascular Imaging Techniques - Module 5 Doppler Imaging," in CIHR Strategic Training Program in Vascular Research.

+ 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. 14Doppler 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. 15Siu m Doppler[6] Bs. Nguyn Quang Trng , Nguyn l v k thut siu m Doppler , TP.HCM , 26/03/2009

+ u im: o c vn tc dng mu rt ln + 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.Doppler lin tc(continuous wave-CW) [6]

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.16Siu m Doppler

Khi chm sng m xuyn qua hai mch mu cnh nhau th tc ghi c l tc trung bnh ca cc tc hai mch mu.[6] Bs. Nguyn Quang Trng , Nguyn l v k thut siu m Doppler , TP.HCM , 26/03/2009Doppler lin tc(continuous wave-CW) [3]

16Khi 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.17Ph siu m thng c th hin nh sau [4]:=> Siu m Doppler lin tc ch c th xc nh chiu dng chy, khng th xc nh su. Do vy, siu m Doppler lin tc dng siu m mch mu nng.

[4] K. K. Shung, "Doppler Flow Measurements," in Diagnostic Ultrasound - Imaging and Blood Flow Measurement, CRC Press, 2006.

Siu m Doppler

17Doppler xung (pulsed wave-PW)[3]

Siu m Doppler[3] J. Williams, "Vascular Imaging Techniques - Module 5 Doppler Imaging," in CIHR Strategic Training Program in Vascular Research.

Pht sng dng xung c dng vi u d c mt tinh th va c chc nng pht v nhn sng phn hi.

18Pht 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.19Siu m Doppler[3] J. Williams, "Vascular Imaging Techniques - Module 5 Doppler Imaging," in CIHR Strategic Training Program in Vascular Research.

u d s pht 1 xung ngn, sau , ch nhn c kch hot thu li sng phn x, sau xc nh thi gian

Doppler xung (pulsed wave-PW)[3]

1920S Khi Ca Doppler xung [4]:

[4] K. K. Shung, "Doppler Flow Measurements," in Diagnostic Ultrasound - Imaging and Blood Flow Measurement, CRC Press, 2006. Siu m Doppler

20Tn hiu Doppler Xung :[6]

Siu m Doppler

Tn hiu Doppler thu nhn c th hin di dng m thanh, dng ph v hnh nh.[6] Bs. Nguyn Quang Trng , Nguyn l v k thut siu m Doppler , TP.HCM , 26/03/20092122Siu m Doppler

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.Tn hiu Doppler Xung :

2223Siu m Doppler

Ph Doppler gm c 3 thnh phn:[7]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.

[7] Arthur Fleischer, MD et al. Color Power Doppler Ultrasound. 1999Tn hiu Doppler Xung :

2324Siu m Doppler

Tn hiu Doppler Xung :

2425Doppler mu :[6] + 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 ly mu th y c rt nhiu v tr ly mu k cn nhau trn vng kho st.

Siu m Doppler

[6] Bs. Nguyn Quang Trng , Nguyn l v k thut siu m Doppler , TP.HCM , 26/03/200925Pht 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.26Doppler mu :+Dng chy hng v u d c m ha mu ; +Ngc li, chy xa u d c m ha mu xanh.Siu m Doppler

26Pht 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.27Doppler nng lng :ch kho st ln ca tn hiu Doppler m khng quan tm n chiu ca dng chy.V cho mu hng trn hnh thu c bt k dng mu n hay i xa u d. Siu m Doppler

27Pht 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.281. Gii Thiu2. Cu To Ca My Siu m Doppler3. Cc Loi Siu m Doppler4. ng Dng Ca Siu m Doppler Trong Y Hc

Siu m Doppler

28ng Dng Siu m Doppler Trong Y Hc [5]Trong Nhi KhoaTrong Ung ThTrong Sn KhoaTrong Bnh ng Tiu HaTrong Niu HcTrong Tun Hon Mch Mu No

Siu m Doppler[5] A.Rogun, "Christian Doppler: the man behind the effect," in British Journal of Radiology, 2002

29Trong Nhi Khoa:Siu m Doppler c s dng tr s sinh kho st bnh tim bm sinh, lung thng tri - phi qua tn ti ng ng mch, cung lng tim v huyt ng hc no.Siu m Doppler co ch trong trng hp thng lin tht nho, hep eo ng mach chu, hp van hoc lung phun ngc, thng thng khc thng hay tn thng lu lng hn ch khc.Hnh nh siu m ca no tr s sinh hin l mt k thut c gi tr pht hin xut huyt trong nao tht. Cc mch no c th tip cn thun tin bng khao sat Doppler tre s sinh l cc ng mch no trc v gia v cc ng mch cnh c.Siu m Doppler

30

Siu m DopplerTrong Nhi Khoa:Thng lin nh l nh trn siu m mu

31Siu m mu gip ch rt nhiu trong vic xc nh l thng lin nh ph mu o kch thc l thng chnh xc hn l o trn siu m 2D.Thng trn cc mt ct ca siu m 2D nhn r l thng hoc nhng mt ct c ph mu r nht. Ngoi ra, siu m mu cn gip ta nh gi chiu ca shunt, nu c 2 mu v xanh trn siu m mu 2D v TM th l shunt 2 chiu.

32Trong Ung Th: K thut Doppler c ng dng tt trong chn oan khi u khng xm ln. Kt qu u tin la do Wells va ctv (1977) phat hin hin tng tn sinh mach mau ca tn thng c tnh. Taylor et al (1988b) pht hin bt thng tn hiu Doppler trong 44 /47 bnh nhn vi khi u c tnh nguyn phat ca gan, thn, tuyn thng thn va tuyn ty.Siu m Doppler c th khng phn bit c gia cu truc cc tn thng lnh tnh v c tnh cua tuyn gip, nhng pht hin c tn hiu tn s Doppler cao t ng mch tuyn gip trn l mt chi s ng tin cy ca tinh trang cng giap.Khi pht trin ky thut tao hnh nh dong chay mu, ng dng k thut Doppler cho khi u c tnh bi gii hn bi kh khn ca mt lng ln m vi chum siu m n.Siu m Doppler

32V d, so sanh vi ng mch v bnh thng v tn thng lnh tnh, tn thng vu c tnh tng tn hiu Doppler vi tn s cao hn v bin cao hn, v dng chy lin tc trong sut ky tm trng.So vi chup ng mach, siu m Doppler nhy vi thng ng-tinh mach hn.

33

Siu m Doppler

Hnh nh ung th gan ngi bnh x gan.U mch mu dng xoang, khng ph mch mu trong u, ch c ngoi.

Hnh nh u x tuyn tin lit v s chi phi mch mu trong u.33Trong Ung Th: ng dng Doppler trong chn on Polyp ti mt: Trong polyp c tn sinh mch, siu m doppler cho thy dng chy ca mch mu, pht hin dc du hiu tn sinh mch v c hin tng thng ng tnh mch.S thay i dng chy trong u v bt thng mch mu qua siu m doppler mu l du hiu quan trng ca u c tnh ti mt.S khc nhau v tn hiu dng chy gia vn tc v ch s tr khng o c trn siu m l im quan trng phn bit polyp lnh v polyp c tnh.Trong polyp lnh tnh th tn hiu mu thp v khng lan ta.

Siu m Doppler

34Trong ung th biu m tuyn, vn tc dng chy cao > 20 cm/s (39 12,4 cm) v ch s tr khng < 0,65 (0,62 0,12). Ngc li trong polyp lnh tnh thng ch s tr khng cao (0,75 0,03) v vn tc dng chy thp (11,4 2,5).

35Hnh nh ct dc ti mt vi Doppler mu.Hnh nh ct dc ti mt vi Doppler xung.Siu m Doppler

35Chn on phn bit :Polyp ti mtCarcinoma ti mtCn lng ti mt c tnh cht gy u.U c tuyn cc b

36Trong Sn Khoa v Khung Chu N:

Siu m Doppler thng c s dng anh gia khng xm hi nhp tim thai.Tnh trng lm sng ca bo thai c phn tch qua dng sng Doppler ca bo thai. Chn on bnh tim bm sinh trc sinh ca siu m Doppler hin nay c thc hin rng ri.Tn hiu dng chy Doppler mu c th d dng c ly ng mch chu ngoai va trong t b m, thng thng, t cc ng mch t cungv bung trng. ng dng siu m Doppler ng Mch T Cung:

Siu m Doppler

36Nhp tim thai l mt ch s tt ca tnh trng ca bo thai, c bit l trong giai oan chuyn da.

37

Kim sot tnh trng suy yu thai vo tun 18-22, bnh thng vn thy ch khuyt (notch) giai on tm trng, sau tun th 22, ch khuyt ny mt i tng ng vi t xm ln th 2 ca t bo nui vo thnh ng mch. Nu ch khuyt cn tn ti chng t xm ln khng y , nguy c thai b IUGR hoc ngi m b cao huyt p thai k.Siu m Doppler

37Siu m Doppler

- Sau tun 26, ph Doppler ng mch t cung khng cn khuyt tm trng, S/D ratio 2,5.

38T thp nin 1980, cc nghin cu Doppler bng pht trin, tp trung ch ch yu vo tnh mch Ca, cp mu cho rut v ghep gan. Vn tc dng mu chy trung binh c o bng mt h thng Doppler xung vi khi lng mu bao gm mu trung tm long mach ma khng phi tt c mu cn li nn c xu hng nh gi cao t l khi lng lu lng mu.Beckly (1984) a ra k thut ni soi Doppler th v vi d bo xut huyt tronglot da day. S hin din ca tn hiu ng mch mnh trong ay lot l mt du hiu cnh bo.

Trong Bnh ng Tiu Ha:Siu m Doppler

39

Hnh nh rut tha ph n v sung huyt gi th 10 sau au.Trong Bnh ng Tiu Ha:

Phnh ng mch ch bng: tin cy qua S t 98-100%.Siu m Doppler

40Mt trong cc ng dng lm sng sm nht ca hiu ng siu m Doppler la nh gi mch cp mu ghep thn (Sampson, 1969).

Hnh nh ti mu ch m b gin on trong trng hp c khi chon ch trong thn (nh u thn, nang thn).

Phnh dng mch ch bng on di thn.Trong Niu HcSiu m Doppler

41Trong Niu Hc

Nghin cu siu m Doppler ng mch thn gip pht hin ra hp ng mch thn giai on cha c biu hin lm sng.Siu m Doppler l mt trong cc phng tin chn on khng xm ln c la chn trong chn on, sng lc, theo di tng huyt p ng mch thn.Siu m Doppler

42Sng Doppler xung bnh thng ca ng mch thn. (A) Ph Doppler ng mch thy thn trong nhu m cho thy nh tm thu nhn v dong chy tm thu tin ln lin tc. Trong trng hp ny im PSV trng vi phc hp nh tm thu sm. (B) Ph Doppler ng mch thn bnh thng mt bnh nhn khc cho thy kha hnh ch V tm thu sm hay phc hp tm thu sm (mi tn) trc PSV (+). (C) o thi gian tng tc bnh thng 20ms.

43Trong Tun Hon Mch Mu No:

- Siu m Doppler xuyn s: Da trn nguyn l cc sng siu m s phn chiu li khi xuyn qua mt vt th chuyn ng trong dng mu (hng cu) v s to nn s thay i v tn s, thay i v tc ca hng cu chuyn ng trong dng mu. Cc tn hiu ghi c qua thm d vng thi dng, u d t v tr pha trn cung g m cho bit tc dng mu ca ng mch no gia, ng mch cnh trong on trong s (khc tn ch chun b chia nhnh thnh ng mch no trc v ng mch no gia), cc ng mch no trc v ng mch no sau. u d t v tr mt cho bit tc dng mu ca ng mch cnh trong on siphon v ng mch mt. u d t v tr di chm ghi c tc dng mu ca cc ng mch sng v ng mch nn.Siu m Doppler

43TCD cho bit c cc thng s sau y:+ Tc dng mu th tm thu (SFV).+ Tc dng mu cui th tm trng (DFV).+ Tc trung bnh: MFV = (SFV + 2DFV)/3.+ Ch s mch: PI = (SFV - DFV)/MFV.+ Ch s cn: RI= (SFV- DFV)/SFV.

44Thm d vng thi dng

Hnh nh siu m Doppler cc ng mch no bnh thngSiu m Doppler

44ng mch no gia l ng mch ln nht trong no. ng mch ny tng i d tm thy v tc dng chy cng ln nht.ng mch no trc, vi su t 75 - 80mm trong nhng iu kin bnh thng hng dng chy ngc chiu vi u d v tc dng chy ca ng mch no trc s yu hn so vi ng mch no gia.Tn hiu ca ng mch no sau c xc nh ti su t 65 - 75mm.45Thm d vng di chm

Hnh nh siu m Doppler ng mch thn nn v ng mch t sng bnh thngSiu m Doppler

45C 2 ng mch sng i vo s qua l chm v i ln n hnh no v cu no (rnh hnh - cu) th tp hp li thnh ng mch nn. y l hnh thi gii phu duy nht, trong 2 ng mch nh hp li to thnh mt ng mch ln hn. Dng u d t vng di chm, vi su l 55 - 65mm. Hng dng chy ca ng mch sng l ngc chiu vi hng u d. Ti v tr ca hnh no trn, dng sng siu m c th thay i biu hin l 2 ng mch sng chp li thnh ng mch nn.; ti v tr ny tc dng mu tng nh. su xc nh ng mch nn t 80 - 85mm, c khi phi t mc 120mm. Hng ca dng chy cng nh ng mch sng l ngc chiu vi hng u d.

46Thm d qua mt

Hnh nh siu m Doppler ng mch cnh trong v ng mch mt bnh thngSiu m Doppler

46Thm d vng ny xc nh ng mch mt v ng mch cnh trong on siphon. Ngi khm cn hng dn ngi bnh nhn vo pha i din trong khi khm hn ch s vn ng ca nhn cu. u d c t pha trn mi mt vi mt p lc nh cho cht gel tip xc vi mt da. ng mch mt c xc nh su t 35 - 50mm v ng mch cnh trong on siphon mc 55 - 80mm. Hng dng chy ca ng mch cnhc trong l cng hng vi u d. ng mch mt c sc cn cao v dng chy thp th tm trng, ng mch cnh trong c sc cn thp, v dng chy th tm trng l lin tc. Hng dng chy ca ng mch cnh trong th khc nhau trn tng v tr, ch gi ca ng mch cnh trong tn hiu xut hin c hai hng.

47[1] P. Perry Sprawls, Ultrasound Production and Interactions, in Physical Principles of Medical Imaging, Medical Physics Publishing, 1995. [2] James Moore,George Zouridakis, "Ultrasonic Blood Flow and Velocity Measurement," in Biomedical Technology and Devices Handbook, CRC Press, August 1, 2003. [3] J. Williams, "Vascular Imaging Techniques - Module 5 Doppler Imaging," in CIHR Strategic Training Program in Vascular Research.[4] K. K. Shung, "Doppler Flow Measurements," in Diagnostic Ultrasound - Imaging and Blood Flow Measurement, CRC Press, 2006. [5] A.Rogun, "Christian Doppler: the man behind the effect," in British Journal of Radiology, 2002[6] Bs. Nguyn Quang Trng , Nguyn l v k thut siu m Doppler , TP.HCM , 26/03/2009[7] Arthur Fleischer, MD et al. Color Power Doppler Ultrasound. 1999

Siu m Doppler

47Cm n Ch Lng Nghe!!!