1.TẠO ẢNH BẰNG CỘNG HƯỞNG TỪ
Nguyên lý khiến cơ sở cho sự tạo hình của máy rất phức tạp, sở hữu thể biểu hiện tóm lược như sau: nguyên tử hydro sở hữu siêu nhiều trong các mô ở thân thể con người, hạt nhân nguyên tử này chỉ có một proton. Khi các proton của những nguyên tử hydro của các mô được đặt trong một từ trường có cường độ to và được chế tạo năng lượng dưới dạng những sóng mang tần số radio (radiofréquence) thì khi dừng sản xuất các sóng đó, hệ thống sẽ hồi trả lại năng lượng và các proton sẽ phát ra các tín hiệu. Các tín hiệu này được các phòng ban tinh vi trong máy và máy vi tính xử lý để biến thành hình ảnh.
Để mang thể hiểu rõ nguyên lý hoạt động của máy một phương pháp yếu tố hơn, với những điều ta cần phải biết như sau:
2. Hai đám proton và hiện tượng hấp thụ cộng hưởng.
Những proton của hạt nhân nguyên tử hydro lúc nào cũng quay nhanh xung quanh trục của nó gọi là quay hạt nhân (spin nucléaire) và được thể hiện bằng một mômen động (moment cinéque). Điện tích dương của proron do sự quay quành trục của nó sẽ hình thành 1 kim nam châm nhỏ và tạo bắt buộc 1 từ trường nhỏ, được biểu thị bằng một vectơ mômen từ. Tuy nhiên, do chuyển động nhiệt (agitation thermire) của các nguyên tử bắt buộc các mômen từ căn bản (moment magnétique) này có những chiều và hướng khác nhau và sẽ luôn thay đổi, tổng hợp (ressultante) của chúng =0.
Khi được đặt trong 1 từ trường Bo với cường độ to từ 0,33 Tesla tới 2 Tesla (1 Tesla = 10.000 gauss) (từ trường của trái đất khoảng 0,5 gaus) thì các proton của hydro dưới tác dụng của Bo xếp hàng theo trục của Bo và sở hữu một đi lại đồ vật hai nữa, ngoại trừ chuyển động quay quanh trục của nó, gọi là di chuyển tiến động (mouvement de précession), vẽ buộc phải 1 hình nón, có trục đồng thời sở hữu trục của từ trường to Bo.
Khi đặt trong từ trường lớn Bo, người ta thấy sở hữu hai đám proton khác nhau: một đám gọi là đám năng lượng rẻ đồng thời (paralèle) có Bo và một đám gọi là đám năng lượng cao đối song (antoparalèle) có Bo. Đám thứ 1 khá đa dạng hơn chút ít so mang đám thiết bị hai và tổng hợp những mômen từ căn bản của hai đám trên là Mo cộng chiều với Bo.
Hiệu số năng lượng A E giữa hai đám proton này xác định mức độ từ hoá của mô và tỷ lệ thuận sở hữu cường độ của Bo và thay đổi theo tuỳ từng mô: AE = aBo.
F được gọi là tần số Larmor, diễn tả bằng Herrtz Khi những sóng tần số radio được tiêu dùng để tác động vào mômen tổng hợp Mo, nghĩa là từ khi cung cấp năng lượng cho hệ thống thì ta sở hữu thể khiến Mo lệch ra khỏi của nó. Đó là hiện tượng tiếp thu cộng hưởng (absorption resonante).
A. Các Proton khi chưa có từ trường Bồi B. Sự xếp hàng của các Proton hydro trong từ trưởng Bo. Mo là tổng hợp của những mômen từ C. Chuyển động tiến động của các Proton năng lượng thấp (a) và năng lượng cao (b).
Cung cấp 1 nguồn năng lượng bằng sóng tần số radio: Mo bị lệch ra khỏi trục cũ (hấp thụ cộng hưởng từ).
Năng lượng được đưa vào hệ thống cần đáp ứng hai điều kiện căn bản sau đây:
– Nó cần được phân phối bởi 1 từ trường B1 quay quanh co Bo có một tốc độ góc tiến động ao của proton hydro. Sóng từ trường B1 do 1 máy phát ra sóng tần số radio được đặt trong 1 mặt phẳng thẳng góc mang Bo. Tần số sóng mà máy phát ra nên bằng tần số của chuyển động tiến động Larmor. Điều kiện này cực kỳ phải thiết để duy trì hiện tượng cùng hưởng. Lượng năng lượng được sản xuất cho hệ thống phải thật chuẩn xác vì nó quyết định độ lệch của Mo.
– Ở trạng thái nghỉ (không với kích thích của sóng tần số radio), Mo với thành phần dọc (composante longgitudinale) cực đại và thành phần ngang (composante transversale) bằng không.
– Khi năng lượng được chế tạo bằng AE, hai đám proton năng lượng rẻ và cao cân bằng nhau thì thành phần dọc của Mo biến mất, thành phần ngang của Mo được hình thành và vectơ Mo lệch đi 1 góc 90 độ so với Bo. Khi năng lượng được cung cấp nhỏ hơn AE, đám proton năng lượng thấp giảm đi nhưng vẫn còn trội hơn đám năng lượng cao. Vectơ Mo có vị trí trung gian, lệch một góc nhỏ hơn 90 độ.
– Khi năng lượng được cung cấp cho hệ thống bằng 2AE, đám proton có năng lượng cao trội hơn và thành phần dọc của Mo ở vị trí có chiều ngược chiều với Ba. Véc tơ Mo đã bị lệch đi một góc 180 độ.
a) Nghỉ không bị kích thích, b) Năng lượng cung cấp bằng AE.
a. Năng lượng cung cấp nhỏ hơn AE; b. Năng lượng cung cấp bằng 2AE.
Những vận động lệch đi của vectơ Mo trên thực tiễn rất phức tạp. Là vì, dưới liên quan phối hợp của các từ trường Bo và B1 mômen từ tổng hợp Mo xa dần Bo và vẽ cần 1 đường xoắn ốc nội tiếp trong một hình cầu.
Nếu dừng kích thích hệ thống bằng sóng tần số radio thì từ trường B1 không còn nữa. Mômen tổng hợp Mo lại quay trở lại trục cũ trong lúc hệ thống hoàn trả lại năng lượng đã nhận được.
Cuộn bobine phát nhận (bobine émettrice – réceptrice) được tiêu dùng để phát ra sóng tần số radio gây ra từ trường B1 (cũng được sử dụng để thu nhận lại năng lượng hoàn trả lại dưới dạng sóng tần số radio do Mo trở lại trục cũ).
Chuyển động của đầu vectơ Mo khi chịu tác dụng của hai từ trưởng Bo và B1.
Tín hiệu cộng hưởng từ hạt nhân phát hiện được ở những đầu cuộn bôbine được gọi là tín hiệu của tiến động tự do (signal de précessiolibre: free introduction decay–FID). Đó là một đường hinh sin có tần số và biên độ tỷ lệ thuận với thành phần ngang của Mo.
Sự hoàn trả năng lượng tương ứng với sự thư giãn (relaxation) của Mo biểu hiện bằng hai cách:
– Giải phóng năng lượng vào môi trường bên ngoài (tức là những mô) đấy là sự thư giãn quay màng lưới (relaxation spin réseau). – Trao đổi năng lượng giữa các proton ở trong cùng một hệ thống mà ko truyền năng lượng ra bên ngoài: đấy là sự thư giãn quay quay (relaxation spin spin).
2.1. Ý nghĩa của thời gian thư giãn T1, T2 và mật độ của proton
Lập 1 trục quy chiếu theo Bo và một mặt phẳng quy chiếu thẳng góc với trục đó, lúc nào ta cũng sở hữu thể sở hữu được góc lệch.
Lập một trục quy chiếu theo Bo và một mặt phẳng quy chiếu thẳng góc với trục đó, lúc nào ta cũng có thể có được góc lệch của Mo.
Thời gian thư giãn T1: khi với liên quan của sóng tần số radio dẫn đến mômen từ Mo nằm trong mặt phẳng thẳng góc sở hữu Bo, khi đó thành phần dọc của Mo bằng không. Khi ngừng kích thích bằng sóng tần số đó, thành phần dọc tiến dần trở lại tối đa, với 1 tốc độ khi đầu nhanh rồi sau chậm dần. Ta cũng có thể vẽ được đường cong tiến dần trở lại của thành phần dọc theo thời gian.
Thời gian thư giãn T1 của 1 mô là thời kì mà thành phần dọc của mômen tổng hợp Mo lấy lại được 63% giá trị ban đầu. Tuy nhiên, ví như tốc độ vẫn giữ được ko thay đổi từ đầu tới cuối thì thời kì T1 là thời kì mà vectơ Mo lấy lại được 100% giá trị thành phần dọc.
Tất cả các loại mô đều sở hữu giá trị T1 không giống nhau và như vậy đường cong thư giãn dọc theo cũng khác nhau. Nếu sự tiến trở lại của thành phần dọc của Mo càng nhanh bao nhiêu thì giá trị T1 của mô sẽ càng ngắn bấy nhiêu. Với những loại mô này , T1 mang giá trị từ 500 đến 2000ms.
Thời gian thư giãn T1: mang thúc đẩy đến màng lưới tức là những mô trong ấy các proton bị kích thích. T1 cho biết khả năng của các proton bị kích thích thu hồi lại năng lượng buộc phải còn gọi là thời kì thư giãn hay quay lưới (relaxation spin reseau) hay thư giãn dọc (relaxation longitudinale). Khi khả năng đó cao, T1 ngắn và cho tín hiệu cao (hypersignal) miêu tả bằng tín hiệu trắng (ví dụ như đơn vị mỡ). Ngược lại, khả năng ấy thấp, T1 sẽ dài và cho tín hiệu rẻ (hyposignal) diễn đạt trên ảnh bằng hình đen (dịch, nước tiểu, dịch não tuỷ…). Các chất như nhu mô của lách, tuy, gan hoặc cơ có T1 trung gian sẽ cho tín hiệu có cường độ ở giữa hai mẫu trên (signal intermédiaire) và diễn đạt trên ảnh bằng hình xám.
Thời gian thư giãn T2: sau lúc ngắt kích thích bằng sóng tần số radio, thành phần ngang của Mo giảm dần tiến đến triệt tiêu. chúng ta có thể vẽ được đường cong biểu diễn sự biến diễn đó, đó là đường cong hình dạng hàm số mũ được gọi là đường thư giãn ngang theo T2. Trị số T2 của 1 mô là thời gian mà thành phần ngang của trị số ban đầu. Nếu tốc độ của sự thư giãn giữ được không đổi từ đầu đến cuối thì T2 cũng là thời gian mà Mo đã mất đa số thành phần ngang. Với các loại mô, T2 có giá trị từ 50 đến 150m.
T2 là hậu quả của sự thúc đẩy tương hỗ giữa các proton ở cạnh nhau. Mỗi proton như 1 nam châm nhỏ, nó gây hỗn loàn (perturber) rộng rãi hay ít các proton bên cạnh nên T2 còn được gọi là thời kì thư giãn ngang (relaxation transversale). Khi việc gây hỗn loàn ở một mô với hậu quả to thì T2 ngắn, mô tả bằng tín hiệu rẻ và cho ảnh hình đen (mỡ). Ngược lại, ở mô sự hỗn loạn trên có hậu quả nhỏ thì T2 dài, diễn tả bằng tín hiệu cao và mang hình trắng trên ảnh (chất dịch, những mô bệnh…). Các nhu mô của gan, tuỵ, lách… có T2 làng nhàng diễn đạt bằng các tín hiệu trung gian và cho hình xám trên ảnh. Mật độ của proton miêu tả số lượng của proton trong một doanh nghiệp thể tích. Nó đóng một vai trò quan yếu đối mang vỏ xương và ko khí là nơi mật độ nguyên tử hydro vô cùng thấp. Còn đối mang những mô khác của thân thể thì sự khác biệt về mật độ khác nhau khi ta tiêu dùng tham số này trong giai đoạn tạo ảnh, trừ ở não người ta sở hữu thể phân biệt được chất trắng và chất xám. Ngoài ra, về mặt kỹ thuật ta cũng buộc phải biết thêm hai thuật ngữ nữa trong giai đoạn chọn hiểu về tạo ảnh bằng cùng hưởng từ hạt nhân. Đó là: – TR: thời kì nhắc lại (temps de répétition), thời kì giữa hai lần kích thích bằng sóng radio. TE: thời kì phúc âm (temps d’écho), thời kì giữa kích thích và thu hồi tín hiệu.
- So sánh tóm tắt T1 và T2:
Ngoài hai xung cơ bản T1 và T2, ngày nay nhờ các tiến bộ khoa học nhiều chuỗi xung chuyên biệt khác được vận dụng giúp cho sự tạo ảnh cộng hưởng từ mang nhiều ưu thế trong chẩn đoán. Ví dụ: chuỗi xung T2*, những chuỗi xung đảo/thu hồi (séquences avec inversion/récupration), những chuỗi xung mạch máu thời gian bay (séquences angio temps de vol) v.v… Cũng chính vì thế mà bên cạnh các kỹ thuật tạo ảnh thông thường, rộng rãi công nghệ cùng hưởng từ chuyên sâu được ra đời như cùng hưởng từ mạch máu, cộng hưởng từ phổ, cùng hưởng từ chức năng.
- Tóm lại, tạo ảnh bằng cùng hưởng từ là kỹ thuật tạo ảnh y khoa tiên tiến với nhiều ưu điểm. Nó mang hai đặc điểm cơ bản: ấy là kỹ thuật dùng nhiều chiều (multidimensionnele) và đa dạng thông số (multiparametrique): T1 và T2, mật độ proton… (không như X quang, Scaner chỉ tiêu dùng 1 tham số là sự tiếp nhận của tia X). Cho tới nay hình ảnh của kỹ thuật tạo ảnh này vẫn đứng hàng đầu so với các công nghệ khác.
2.2. Chỉ định và chống chỉ định của cộng hưởng từ
Chụp cộng hưởng từ được vận dụng vô cùng đa dạng trong những bệnh lý của hệ thống tâm thần (sọ não, cột sống), bệnh lý khớp, bệnh lý các cơ quan ở trong ổ bụng và sau phúc mạc,những bệnh lý tim và các mạch máu. Chống chỉ định: cho đến nay những nghiên cứu cho thấy sở hữu cường độ từ trường tiêu dùng trong chẩn đoán hiện nay ko gây các nguy cơ sinh học cũng như biến đổi gen. Các chống chỉ định bắt buộc được thực hiện khi bệnh nhân có máy tạo nhịp tim, máy kích thích thần kinh-giác quan (thính lực, tủy…), bơm tiêm có thành phần kim chiếc hay điện tử, những kẹp giải phẫu trong não, những van tim có bi kim loại. Tuy những năm gần đây các van tim với bi kim loại và kẹp giải phẫu có sắt từ không còn được tiêu dùng nữa, nhưng trên thực tế khi thực hành chụp công hưởng từ cho những bệnh nhân với những thứ trên cũng bắt buộc thận trọng. Những người bệnh có dị vật kim loại trong hố mắt hoặc nằm sát trong các mạch máu. cũng thuộc đối tượng chống chỉ định bắt buộc. Các chống chỉ định tương đối: những dị vật kim chiếc nằm sắp trường thăm khám mang thể gây nhiễu ảnh; bệnh nhân ko hợp tác; đàn bà mang thai với thể chụp cộng hưởng từ nhưng ko được tiêm gadolinium.
3. SIÊU ÂM
3.1. Vài nét về lịch sử
– 1889: D’ arsonval (Pháp) đo sự dẫn truyền của siêu âm trong mô người sống.
– 1900: P. Curie (Pháp) sắm ra hiệu ứng áp diện được áp dụng vào sự phát xạ của cực kỳ âm.
– 1914: Longevin (Pháp) nghiên cứu sự truyền của vô cùng âm trong nước.
– 1929: Sokolov (Nga) đã diễn tả một phương pháp sử dụng siêu âm để phát hiện những vết nứt trong kim loại.
– 1945: Firestone (Mỹ) cùng dùng siêu âm để dò những vết nứt trong kim loại. Trong chiến tranh thế giới lần vật dụng hai (1939 – 1945) siêu âm được áp dụng vào việc dò tàu ngầm, và được gọi là Sonar, trong nghành Y học sau chiến tranh, siêu âm được áp dụng vào điều trị sớm hơn vào chẩn đoán bệnh . Năm 1950 hội nghị ở Erlangen (CHLB Đức) đã tổng kết ra những kinh nghiệm điều trị bằng phương pháp siêu âm.
Về mặt chẩn đoán, năm 1940 Dussik (Áo) đã thử ghi hình của sọ bằng năng lượng còn lại của 1 chùm siêu âm sau lúc xuyên qua hộp sọ, nhưng không đạt kết quả mỹ mãn.
Sau đấy khởi đầu có các công trình về áp dụng vô cùng âm chẩn đoán bằng các kiểu khác nhau: rất âm kiểu A, cực kỳ âm kiểu B, siêu âm kiểu TM và rất âm Doppler, vô cùng âm 3D và 3D thời gian thực (hay còn gọi là rất âm 4D sở hữu 3 chiều không gian và 1chiều theo thời gian).
3.2. Nguồn phát sóng siêu âm
Sóng siêu âm là sóng cơ học có tần số > 20.000Hz, tai người không nghe được, có định hướng, dễ hội tụ và có bước sóng ngắn.
Chùm sóng rất âm sử dụng trong chẩn đoán được tạo ra theo cách áp điện. Một số vật liệu khi chịu ảnh hưởng của một mẫu điện biến thiên sẽ bị biến dạng cơ học và phát ra sóng rất âm. Ngược lại, nếu sóng siêu âm ảnh hưởng lên loại vật chất này sẽ sinh ra một dòng điện biến thiên có cùng tần số mang tần số của sóng siêu âm ảnh hưởng lên nó. Tích chất vật lý này được gọi là hiệu ứng áp điện thuận nghịch và đây cũng là nguyên lý cấu tạo chung của đầu dò cực kỳ âm, đầu dò vừa phát sóng vô cùng âm vừa thu sóng phản hồi trở về. Các nguyên liệu với tích chất này là thạch anh, titanat bari, titanat zirconat bari. Trong đấy những hợp chất titanat có hệ số áp điện cao hơn hệ số của thạch anh 300 lần, chỉ buộc phải một hiệu thế 100V là đủ để gây hiện tượng rung và phát ra sóng vô cùng âm.
Sóng vô cùng được phát ra theo hai cách: phát liên tiếp thường được dùng trong siêu âm Doppler liên tiếp và phát ngắt quãng theo dạng hình sin mang thời gian mỗi xung là 2 micro giây và mỗi giây mang đến 500–1000 xung được dùng trong vô cùng âm kiểu A, B, TM.
Chùm sóng siêu âm sử dụng trong chẩn đoán thường với tần số 1MHz đến 10MHz cường độ 5 – 10 milliwatt cho mỗi cm2.
Sự tạo hình siêu âm dựa trên các thuộc tính vật lý của nó ấy là: tính chất phản xạ, tán xạ và truyền qua của sóng vô cùng âm lúc tương tác có môi trường vật chất thuộc tính bị thu nạp khi truyền qua các môi trường này.
3.3. Sự dẫn truyền siêu âm
a) Tốc độ truyền âm
Trong môi trường thiên nhiên: trong ko khí tốc độ truyền là 350m/s. Như vậy, rất âm truyền trong ko khí vô cùng kém, do ấy để sóng vô cùng âm truyền được vào thân thể buộc phải với một môi trường dẫn truyền trung gian như dầu nước đặt giữa đầu dò của máy cực kỳ âm mang bề mặt da. Trong những môi trường khác siêu âm truyền tốt: parafin là 1400m/s, nước 1500m /s và thép là 5000m/s.
Trong môi trường thọ học: phần mềm và mỡ tốc độ truyền là 1400m/s, cơ 1600m/s và xương từ 3600 – 4000m/s v.v… Các phòng ban có nhiều khí như phổi, dạ dày, ruột rất âm cực kỳ khó truyền qua vì vậy, việc thăm khám siêu âm các phòng ban này là vô cùng hạn chế. Trong cơ thể tốc độ truyền âm nhàng nhàng của những đơn vị phần mềm là 1540m/s. Việc đo các khoảng phương pháp trong rất âm đều dựa vào thời gian đi và về của chùm sóng siêu âm.
b) Các định luật của truyền âm
Khi chùm sóng siêu âm truyền qua môi trường vật chất gặp môi trường thứ hai có trở kháng âm khác nhau sẽ xẩy ra các hiện tượng sau:
– Một phần chùm sóng siêu âm phản xạ quay về đầu dò ngược với hướng của chùm sóng siêu âm phát ra hệ số phản xạ:
Trong đó:
− P1 và P2 là tỷ trọng của môi trường thứ nhất và thứ hai.
Hệ số phản xạ càng lớn nếu tổng trở kháng âm giữa hai môi trường càng khác nhau và chùm sóng vô cùng âm phản xạ về đầu dò càng nhiều.
Một phần chùm sóng siêu âm truyền qua môi trường thứ hai cũng theo hướng của chùm sóng phát với hệ số truyền qua là:
T= 1-R
Trong đó: T sẽ là hệ số truyền qua, R sẽ là hệ số phản xạ. Một phần chùm sóng siêu âm nữa sẽ đổi thay hướng, tạo thành sóng cực kỳ âm khuyếch tán hay gọi là hiện tượng tán xạ. Hiện tượng tán xạ xảy ra khi đường kính những cấu trúc nhỏ hơn hoặc bằng độ dài của bước sóng chùm sóng cực kỳ âm hoặc có bề mặt ko đồng đều. Ví dụ: khi thăm dò huyết mạch sở hữu đầu dò với tần số 2,5MHz bước sóng của chùm tia 600um gần bằng đường kính hồng huyết cầu thì hiện tương tán xạ sẽ xảy ra đa dạng hơn là hiện tượng phản xạ.
c) Suy giảm năng lượng của chùm sóng siêu âm
Khi truyền qua môi trường vật chất, một phần năng lượng của chùm sóng siêu âm sẽ bị hấp thụ và biến thành nhiệt năng. Người ta có thể tính cường độ siêu âm ở tại một độ sâu nhất định, sau khi đã xuyên qua lớp mô theo công thức:
Ix = Io-2uFX
Trong đó: – Io: cường
độ bao chùm của sóng siêu âm trên bề mặt đầu dò
– Ix: cường độ chùm sóng siêu âm ở độ sâu X
− a : là hệ số hấp thụ của môi trường
– F: tần số của chùm sóng siêu âm
− X: chiều dày của mô xuyên qua, tính bằng cm Thường người ta biểu hiện điểm suy giảm bằng hai cách:
– Tính độ suy giảm bằng số đề si ben (NdB).
Trong đó: I là cường độ ở điểm đo và lo là cường độ lúc ban đầu của chùm siêu âm.
-Lớp hấp thụ 50% chùm siêu âm: Edler tính độ đâm xuyên của chùm siêu âm bằng cách tính chiều dày của lớp mô đủ làm giảm đi 50% cường độ ban đầu của chùm siêu âm. Ví dụ: với chùm siêu âm có tần số 2,25MHz và 1 MHz lớp hấp thụ của một vài mô như sau: Huyết tương: 14,4cm và 100cm, máu 15,5cm và 35cm, Mỡ 1,6cm và 3,5cm, cơ là 2,0cm và 4,7cm.
Độ hấp thụ tỷ lệ nghịch với bình phương tần số, tần số càng cao thì độ hấp thụ càng lớn, vì vậy không thể dùng đầu dò tần số cao để thăm khám các tạng sâu. Đồng thời, trong thăm khám các tạng sâu phải sử dụng kỹ thuật khuyếch đại bù theo chiều sâu (DGC- depth gain control) hay còn gọi là bù theo thời gian (TGC– time gain compensation).
Trong chẩn đoán bằng siêu âm, người ta thu chùm siêu âm phản xạ (còn gọi là âm vang) quay trở lại đầu dò và hiệu ứng áp điện thuận nghịch sẽ tạo ra những tín hiệu điện biến thiên tùy theo tần số sóng âm phản xạ. Từ tín hiệu diện này qua bộ phận xử lý sẽ chuyển thành tín hiệu quang và cuối cùng tạo nên hình ảnh siêu âm của các cấu trúc cần thăm khám. Tùy phương pháp thu tín hiệu, người ta chẩn đoán bằng siêu âm kiểu A,B,TM, Doppler mà chúng ta sẽ lần lượt nghiên cứu.
3.3. Máy và kỹ thuật siêu âm
3.3.1 Siêu âm kiểu A
Dùng 1 đầu dò phát siêu âm gián đoạn, kiểu thu rất âm phản xạ. Chùm cực kỳ âm khi xuyên qua cơ thể sẽ gặp các bộ phận sở hữu trở kháng âm (còn gọi là độ dẫn truyền) khác nhau, và sẽ cho những âm thanh phản xạ trở về tác dụng lên đầu dò siêu âm, tạo thành những tín hiệu điện, các tín hiệu này được khuyếch đại và được truyền vào màn hiện sóng của máy dao động ký, biểu đạt thành các hình xung nhọn nhô lên khỏi đường đẳng diện. Người ta gọi kiểu này là kiểu A, do lấy chữ đầu tiên của từ amplification. Trước đây, rất âm kiểu A được tiêu dùng trong: khoa sản để đo đường kính lưỡng đỉnh của thai, đo sườn chậu của sản phụ chuyên khoa mắt đo đường kính nhãn cầu, phát hiện bong võng mạc; trong chuyên khoa tâm thần để làm cho âm vang não dồ. Hiện nay, vô cùng âm kiểu A hầu như không còn được tiêu dùng trên lâm sàng.
3.3.2. Siêu âm kiểu TM
Siêu âm kiểu TM bắt nguồn từ chữ time motion hay còn gọi là rất âm di chuyển theo thời gian. Nguyên lý cũng giống như rất âm kiểu A nhưng hình ảnh được ghi lại theo sự vận động của những tổ chức thăm khám theo thời kì thực. Siêu âm kiểu TM được sử dụng đa dạng trong tim mạch để kiểm tra sự di chuyển của các van tim, những vách tim và buồng tim.
3.3.3. Siêu âm kiểu B
Siêu âm kiểu B được lấy từ chữ Bidimensionnal gọi là siêu âm hai chiều hay rất âm cắt lớp. Nguyên lý cũng giống như rất âm kiểu A, nhưng trong rất âm kiểu B các đỉnh xung của sóng phản hồi được biểu hiện bằng những điểm sáng. Cường độ của những điểm sáng này tỷ lệ thuận sở hữu cường độ của chùm sóng phản hồi về đầu dò. Nếu đi lại đầu dò trên bề mặt da vùng thăm khám và lưu hình trên màn lâu hơn thì sẽ ghi xây dựng được hình ảnh phòng ban cần thăm khám nằm trên 1 mặt phẳng quyét. Vì vậy, rất âm kiểu B còn được gọi là vô cùng âm cắt lớp (échotomographie). Hiện nay, rất âm kiểu B thời kì thực là kiểu siêu âm được tiêu dùng cốt yếu trên lâm sàng.
Siêu âm Doppler dùng hiệu ứng Doppler được sử dụng để thăm khám tim, mạch máu.
Đầu dò siêu âm hiện nay được áp dụng phương pháp quét điện tử và có nhiều loại như: đầu dò phẳng, đầu dò cong lồi, đầu dò rẻ quạt. Việc lựa chọn đầu do thích hợp cho từng bộ phận thăm khám rất quan trọng. Trong thăm khám các tạng nông (như tuyến giáp, mạch máu ngoại vi, tinh hoàn v.v…) thường sử dụng đầu dò có tần số cao (7,5 đến 10 MHz); thăm khám các tạng trong ổ bụng người lớn thường dùng đầu dò tần số từ 2,5–3,5MHz, trẻ em đầu dò tần số 5MHz; thăm khám tim thường dùng đầu dò rẻ quạt.
3.4. Triệu chứng học và chỉ định siêu âm
3.4.1. Triệu chứng học siêu âm
Người ta phân chia hình siêu âm thành hai loại cơ bản: hình đường bờ và hình cấu trúc.
Hình đường bờ là hình dừng giữa hai môi trường có tổng trở kháng âm bí quyết biệt nhiều (mạnh chuyển sang yếu) ví dụ: bờ của những tạng, thành mạch máu, thành của những nang dịch v.v…
– Hình cấu trúc trong đó cấu trúc âm đều đấy là hình nhu mô các tạng như gan, thận, tinh hoàn v.v…, cấu trúc âm không đều của các thương tổn bệnh lý như nhu mô gan xơ, những khối u ác tính v.v…
-Các dấu hiệu vô cùng âm căn bản bao gồm:
+ Dấu hiệu tăng âm (hyperéchogène) hay giàu âm: tiêu dùng để diễn tả một cấu trúc sở hữu cường độ âm phản hồi cao hơn nhu mô tạng đang thăm khám, biểu hiện ảnh sáng hơn những vùng khác trên màn hình.
+ Dấu hiệu giảm âm (hypoéchgène) hay ít âm: là những cấu trúc sở hữu cường độ phản phúc đáp tốt hơn nhu mô tạng đang được thăm khám, biểu lộ hình kém sáng hơn nhu mô thường nhật trên màn.
+ Dấu hiệu đồng âm (isoéchgène): là cấu trúc có cường độ phản hồi âm tương đương với cấu trúc nhu mô bình thường.
+ Dấu hiệu không âm (anéchogène): tương ứng với một cấu trúc hay một vùng không có âm phản hồi về đầu dò và được biểu hiện đen trên màn hình. Dấu hiệu này thường đi kèm với hình ảnh tăng âm phía sau và là biểu hiện của một cấu trúc dịch như túi mật, bàng quang, các nang dịch trong các tạng (gan, thận, tụy.v.v.)
+ Dấu hiệu âm hỗn hợp: là một cấu trúc bao gồm cấu trúc dịch và đặc xen lẫn nhau.
+ Dấu hiệu âm không đều: gồm các cấu trúc có độ phản hồi âm không đồng nhất, biểu hiện trên màn hình là hình vừa giảm, tăng âm và đồng âm hỗn hợp.
+ Dấu hiệu bóng cản âm (ombre acoustique) miêu tả của chùm sóng siêu âm bị phản hồi mọi về đầu dò. Dấu hiệu này thường đi kèm mang một hình tăng âm trước ấy (hình tăng âm kèm bóng cản) và là biểu đạt của tổn thương vội hóa nhu mô hoặc sỏi.
a. Dấu hiệu không âm; b. Tăng âm; c. Dầu giảm âm; d. Dấu hiệu âm không đều.
3.4.2. Chỉ định của siêu âm
Siêu âm là phương pháp thăm khám hình ảnh được chỉ định đầu tiên và rộng rãi để thăm khám các tạng đặc bên trong ổ bụng , sau phúc mạc (gan, tụy, lách, hệ tiết niệu v.v.); hệ thăm khám tim, mạch máu; những tạng nông (tuyến giáp, tinh hoàn, vú, phần mềm.v.v.); dò la trong sản khoa; thăm khám thành ngực và khoang màng phổi. Siêu âm Doppler được tiêu dùng trong thăm khám tim, huyết mạch những chi, mạch máu vùng đầu mặt cổ, mạch máu những tạng và kiểm tra mức độ cấp máu của các tổn thương. Ngày nay, sở hữu những máy với độ phân giải cao siêu âm cũng đã được chỉ định đa dạng trong bệnh lý ống tiêu hóa.
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