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KMID : 0378019710140040107
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New Medical Journal
1971 Volume.14 No. 4 p.107 ~ p.110
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A-Scan Echoencephalography in the Diagnosis of Intracranial Lesions
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Abstract
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The use of ultrasound in medical diagnosis goes back to the brothers Dussik, who attempted to outline the cerebral structures with aid of the ultrasonic transmission technique as early as 1942. Unfortunately this method, called "hyperphonographv", did not lead to the hoped-for success.
In 1950 French, et al. reported that they were able to diagnose the brain tumor by using ultrasound reflection method on the exposed brain. On the next year they used direct cortical application of this method for localization of brain tumors during operation.
Leksell in 1955 introduced the echo pulse method on the intact skull for the detection of space-occupying intracranial lesions. Echoencephalography is the term coined by Leksell for a new technique by which the position of the midline structures of the brain can be determined by passing a beam of pulsed ultrasound into the head and recording the returning echoes. This technique, used increasingly in Europe and Japan since 1956 and a little later in United States, has been little used in Korea.
The purpose of this report is to present our experiences with A-scan echoencephalography in 80 normal persons and 395 patients with intracranial lesions in the last 26 months. An Aloka SSD-9B ultrasonic analyzer (A-scope) was used. The machine is basically an ultrasound generator and receiver, displaying the echoes on an oscilloscope with camera attachment for permanent recording. The 1 and 2.25 Mc. /sec. crystals are made of barium titanate, whereas the 5 and 10 Mc. /sec. crystals are made of piezoelectric quartz. For investigations through the intact skull usually used 2. 25 Mc. /sec. transducer, but 1 Mc. /sec. transdurcer was used when the skull is thick or when the passage of sound in otherwise attenuated. The 5 and 10 Mc. /sec. transducers were used for dural or cortical echoencephalgraphy.
1. All normal persons showed normal pulsating midline echo, however mild shift (2-3 mm.) of midline
etho was observed in about 10 per cent of theni
2. In 231 acute craniocerebral injuries, midline echo shift (2 mm.) was found in 19 of 141 cerebral contusion cases, 23 of 26 unilateral epidural hematomas, 40 of 54 unilateral subdural hematomas, 1 of 5 bilateral subdural hematomas and in all of 2 unilateral epi- and subdural hematomas and 3 traumatic intra￢cerebral hematomas.
3. In 62 acute cerebrovascular disease cases, midline echo shift (>2 mm.) was found in 3 of 28 cerebral infarction cases, 9 of 12 intracerebral hematoma cases and 4 of 22 spontaneous subarachnoid hemorrhage
cases. In 10 of 12 intracerebral hematoma cases, however, evident hematoma echoes were observed.
4. In surgically verified 42 intracranial tumors, midline echo shift was found in only 17 cases (52 per cent) and in 15 suspected intracranial tumors only 6 cases (40 per cent). However in 17 cases of cerebral hemispheric tumors, midline echo shift was found in 14 cases (82 per cent). In 5 cases of craniopharyngioma
all showed cystic tumor echoes and corresponding midline echo shift in 3 cases, in 3 cases of pineal tumor also showed tumor echoes in all cases with midline echo shift in 2 cases, and all cases of 2 thalamic tumors
and 1 cerebral paragonimiasis showed midline echo shift. So the diagnostic value of A-scan in intracranial tumors was 90 per cent when excluded posterior fossa tumors and pituitary adenomas.
5. Midline echo shift was observed in 4 of 32 epilepsy cases, 5 of 7 infantile cerebral atrophy cases and
all of 3 brain abscesses. In three of typical hydrocephalic patients no midline echo shift was found but double midline echoes were observed.
In conclusion it can be stated that the A-scan echoencephalography is a relibale, harmless and rapid method for the exclusion or confirmation of various space-occupying intracranial lesions and hydrocephalus, when the extent of midline echo shift, special reflexions from hematoma, tumor and ventricles, etc. and variation in sound attenuation are taken into consideration.
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