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Color Doppler Sonography (color + doppler_sonography)

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Medical Sciences	100%

Selected Abstracts

Sonographic findings in a case of scrotal lymphangioma in a 68-year-old male

JOURNAL OF CLINICAL ULTRASOUND, Issue 7 2009
Won Chan Lee MD
Abstract Lymphangiomas are benign tumors resulting from a congenital lymphatic malformation in infant and children. Most common sites are head, neck and axilla, and scrotal lymphangioma is very rare. Lymphangiomas are classified as capillary, cavernous, and cystic type and cystic type is most common. Complete surgical excision is definitive treatment and incomplete excision leads to local recurrence. We report a case of scrotal lymphangioma in 68-year-old male patient. Gray-scale sonography revealed multiseptated, hypoechoic mass abutting the upper pole of the normal right testis. Color Doppler sonography showed no remarkable blood flow in the mass. MRI demonstrated multispetated extratesticular and extraepididymal mass in the right scrotum. Surgical excision was performed and the histopathologic diagnosis was a cystic lymphangioma. In conclusion when multiseptated cystic scrotal mass was discovered in an elderly patient, scrotal lymphangioma should be included in differential diagnosis. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009 [source]

Color Doppler sonography of orbital and vertebral arteries in migraineurs without aura

JOURNAL OF CLINICAL ULTRASOUND, Issue 6 2003
Simay Altan Kara MD
Abstract Purpose The objective of this study was to investigate whether the retrobulbar hemodynamics in the ophthalmic (OA), posterior ciliary (PCA), central retinal (CRA), and vertebral (VA) arteries are affected in migraineurs without aura. Methods The eyes of migraineurs without aura and those of healthy control subjects were evaluated during both headache and headache-free periods. Retrobulbar and vertebral blood flow velocities in the OA, PCA, CRA, and the extracranial part of the VA were measured bilaterally using color Doppler sonography. The peak systolic and end-diastolic flow velocities and the pulsatility (PI) and resistance (RI) indices were determined for all arteries. Results In total, we enrolled 30 migraineurs and 31 healthy control subjects. Statistically significant differences between headache-free migraineurs and control subjects were observed in the PI and RI of both right and left PCAs and in the RI of both right and left CRAs. The PI and RI of the left VA of the migraineurs were significantly lower during both headache and headache-free periods than were those of the control subjects. Among the migraineurs, the peak systolic and end-diastolic velocities of the left VA were increased during headache periods relative to those found during the headache-free periods. Conclusions The retrobulbar circulation and flow hemodynamics in the left VA may be altered in both headache and headache-free periods in migraineurs without aura. The differences found between migraineurs and control subjects may implicate autonomic dysfunction in migraineurs. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:308,314, 2003 [source]

Correlation between microbubble contrast,enhanced color doppler sonography and immunostaining for Kupffer cells in assessing the histopathologic grade of hepatocellular carcinoma: Preliminary results

JOURNAL OF CLINICAL ULTRASOUND, Issue 8 2002
Hiroshi Kitamura MD
Abstract Purpose The aim of this study was to determine the histopathologic grades of hepatocellular carcinomas (HCCs) on the basis of the presence of Kupffer cells, using color Doppler sonography with the liver-specific microbubble contrast agent Levovist. Methods Color Doppler sonograms generated by stimulated acoustic emission were obtained 7 minutes after intravenous injection of 5 ml of Levovist (300 mg/dl) in patients with histopathologically confirmed HCCs. CT scans were also obtained and evaluated, and hematoxylin and eosin staining for morphologic examination and immunostaining (anti-CD68) for detecting Kupffer cells were performed for confirmation of the sonographic findings. Results Eighteen tumors had a defect in the color Doppler signal (color void) that corresponded with the baseline gray-scale image of the tumor. On histopathologic examination, these 18 tumors were all found to be either poorly or moderately differentiated HCCs with either a marked reduction in the number of or the absence of Kupffer cells. The remaining 2 tumors showed color signals. Histopathologic examination of these 2 tumors disclosed well-differentiated components within the tumors, with Kupffer cells in the tumor tissue. Conclusions Color Doppler sonography using a liver-specific microbubble ultrasound contrast agent appears to reflect the histopathologic features of HCCs and may thus be useful for differentiating liver tumors and determining a treatment strategy. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30:465,471, 2002; Published online in Wiley InterScience (www. interscience.wiley.com). DOI: 10.1002/jcu.10099 [source]

Color Doppler sonography of hepatic artery reconstruction in liver transplantation

JOURNAL OF CLINICAL ULTRASOUND, Issue 1 2002
Alessandro De Candia MD
Abstract Purpose The purpose of this study was to evaluate the Doppler spectral waveforms in the hepatic artery after liver transplantation and hepatic artery reconstruction by end-to-end anastomosis or aortohepatic bypass. The peak systolic velocities (PSVs), end-diastolic velocities (EDVs), and resistance indices (RIs) between the 2 reconstruction groups were compared to establish normal post-transplantation values. Methods We retrospectively reviewed the Doppler sonograms and the sonographic reports from 48 patients who had undergone liver transplantation, 30 with end-to-end arterial anastomoses and 18 with aortohepatic bypasses. All aortohepatic bypasses had been performed using the infrarenal technique. All sonographic examinations had been performed 3,6 months after transplantation in patients with no clinical sign of transplant failure and whose liver function test results more normal. We compared the mean hepatic artery PSVs, EDVs, and RIs of the 2 groups. Results Doppler spectral analysis allowed the detection of 2 types of arterial flow, a low-resistance pattern in the end-to-end anastomosis group and a high-resistance pattern with low diastolic flow in the infrarenal bypass group. The mean PSV ± standard deviation (SD) was 57 ± 16 seconds in the end-to-end anastomosis group and 62 ± 16 cm/second in the infrarenal bypass group. The mean EDV ± SD was 25 ± 14 cm/second in the end-to-end anastomosis group and 12 ± 4 cm/second in the infrarenal bypass group. The RIs ranged from 0.33 to 0.71 (mean ± SD, 0.58 ± 0.13) in the patients with end-to-end anastomoses and from 0.70 to 0.87 (mean ± SD, 0.77 ± 0.06) in those with infrarenal bypasses. The difference in the mean RIs between the 2 groups was statistically significant (p < 0.05). Conclusions Spectral waveform and RI are associated with the length and caliber of the type of hepatic artery anastomosis used. End-to-end anastomoses are short and have a uniform small caliber; aortohepatic bypasses are longer and have a progressively by smaller caliber. We must be cognizant of the method of anastomosis used when examining patients for complications after liver transplantation because the method used affects the resulting spectral waveform and RI. © 2002 John Wiley & Sons, Inc. J Clin Ultrasound 30:12,17, 2002. [source]

Correlation of color Doppler sonographic findings with pH measurements in gastroesophageal reflux in children

JOURNAL OF CLINICAL ULTRASOUND, Issue 4 2001
Hye Suk Jang MD
Abstract Purpose We conducted a prospective study of color Doppler sonography in children with suspected gastroesophageal reflux (GER). The purpose of this study was to compare the accuracy of color Doppler sonography with that of continuous 24-hour pH monitoring of the esophagus in diagnosing GER and to determine how to interpret the reflux episodes detected on color Doppler sonography in children at high risk for reflux. Methods Color Doppler sonography and 24-hour esophageal pH monitoring were performed in 54 children ranging in age from 2 months to 10 years (mean, 3 years). The stomach of each patient was filled for adequate gastric distention just before the color Doppler sonographic examination. We counted the number of reflux episodes over a period of 15 minutes. One day after the sonographic examination, the reflux was evaluated with esophageal pH monitoring, and the resultant reflux index (ReI) was obtained. The ReI was considered to be pathologic when it was equal to or greater than 11.99%. The number of refluxes on color Doppler sonography and the ReI were correlated for each patient. Results The 2 tests showed an 81.5% agreement in the detection of GER. When pH monitoring was taken as the reference test, color Doppler sonography had a high sensitivity (95.5%) for diagnosing GER but a very low specificity (11.0%), with a positive predictive value of 84.3% and a negative predictive value of 33.3%. There was no statistically significant correlation between the frequencies of GER detected on color Doppler sonography and the ReIs on pH monitoring (p = 0.1103). There was no correlation between the reflux grades on sonography and the ReI grades on pH monitoring (p = 0.422). Conclusions Color Doppler sonography is highly sensitive and easier to use than pH monitoring. Although there are no definite criteria for evaluating the severity of GER on color Doppler imaging, this modality may be useful in screening children for GER. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:212,217, 2001. [source]

Color doppler sonography for ventral hernias in patients with acute abdomen: Preliminary findings

JOURNAL OF CLINICAL ULTRASOUND, Issue 8 2001
Ren-Jow Liang MD
Abstract Purpose We assessed the usefulness of color Doppler sonography (CDUS) in evaluating the vascular status of ventral hernias and distinguishing incarcerated from nonincarcerated ventral hernias. Methods In this prospective study, 10 patients who presented with acute abdomen and had ventral hernias underwent CDUS from August 1999 to May 2000. Patient age and sex and the clinical severity, mode of therapy, and outcome in these 10 patients were evaluated in relationship to the CDUS findings. Results Five patients had readily visible flow in the bowel within the hernial sac on CDUS. Two of these 5 had spontaneous reduction under conservative treatment, and 3 had asymptomatic ventral hernias with acute abdomen caused by spontaneous bacterial peritonitis. Barely visible flow was visualized in the bowel by CDUS in 4 other patients. Three of these underwent emergency surgery because of peritoneal signs; 2 of them were found to have ischemic changes in the bowel. The fourth patient underwent a successful manual reduction. The remaining patient had absent flow in the bowel on CDUS and underwent emergency surgery, which revealed gangrenous changes in the bowel. Conclusions The intensity of the Doppler signals on CDUS appears to be a promising predictor of bowel viability in cases of ventral hernia. Thus, CDUS should impact the determination of the treatment plan, including whether to provide conservative treatment or surgery. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:435,440, 2001. [source]

Spontaneous rupture of varicocele testis associated with advanced pancreatic cancer

INTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2004
YOSHIYUKI MATSUI
Abstract, We report a rare case of strain-induced spontaneous rupture of varicocele associated with renal vein involvement by advanced pancreatic cancer. Computed tomography and color Doppler sonography yielded the correct diagnosis and the patient could maintain quality of life without surgery for acute scrotum. [source]

The effects of copper contraceptive intrauterine device on the uterine blood flow: A prospective transvaginal Doppler study

JOURNAL OF CLINICAL ULTRASOUND, Issue 7 2009
Nuray Yigit MD
Abstract Purpose. To evaluate the hemodynamic changes by transvaginal color Doppler sonography (CDS) in the uterine vascular bed after the insertion of a contraceptive intrauterine device (CIUD) and to investigate whether those CDS findings could predict potential side effects, such as dysmenorrhea and abnormal bleeding. Method. Pulsatility index (PI), resistance index, and systole/diastole ratio (S/D) were measured in the uterine artery and its myometrial branches on 28 patients before and after the insertion of copper IUD, and a correlation with dysmenorrhea and abnormal bleeding was investigated. Result. PI and S/D values in the uterine artery increased significantly after the insertion of the CIUD (p < 0.05). Patients with increased bleeding scores after insertion of CIUD had significantly lower uterine artery PI compared with those without increased bleeding scores (p < 0.05). No statistically significant difference was detected in the Doppler flow parameters regarding dysmenorrhea scores. Conclusion. Low uterine artery PI values recorded in the early phase of the menstrual cycle in patients with a CIUD were associated with an increased bleeding risk. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009 [source]

Natural course of hepatic focal nodular hyperplasia: A long-term follow-up study with sonography

JOURNAL OF CLINICAL ULTRASOUND, Issue 3 2009
Yuan-Hung Kuo MD
Abstract Purpose. We aimed to investigate the natural course of hepatic focal nodular hyperplasia (FNH) in a long-term follow-up study with sonography. Method. This study comprised 30 patients (24 women and 6 men) with 34 FNHs. Diagnosis of FNH was made using color Doppler sonography, contrast-enhanced CT, or MRI in combination with needle biopsy. Patients were followed every 3 to 6 months with sonography. Regression or progression of tumor was defined as a change of over 30% in maximal diameter. Disappearance was defined as no vizualization of the tumor on at least 3 follow-up sonographic examinations. Results. Thirty-four FNHs were followed over a mean period of 42 months (range, 7,95 months). Twenty-four lesions (70.6%) were stable in size, 1 (2.9%) progressed, and 9 (26.5%) regressed. Of those that regressed, 6 (17.6%) disappeared over a mean period of 59 ± 30 months (range, 20,95 months). Older age (OR 1.26, 95% CI 1.02,1.56; p < 0.05) and longer follow-up time (OR 1.11, 95% CI 1.01,1.21; p < 0.05) were the independent factors associated with complete regression of FNH. Conclusion. Most FNHs were stable or regressed/disappeared after a long follow-up period. Based on the benign course, conservative treatment for asymptomatic FNH should be advocated. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound 2009. [source]

Extracranial and intracranial vertebral artery dissection: Long-term clinical and duplex sonographic follow-up

JOURNAL OF CLINICAL ULTRASOUND, Issue 8 2008
Tiemo Wessels MD
Abstract Purpose. To determine the value of color Doppler sonography (CDUS) in the diagnosis and follow-up of patients with extracranial and intracranial vertebral artery (VA) dissection. Method. Thirty-three patients aged 42 ± 12 years with 40 VADS confirmed via digital subtraction angiography (DSA) (n = 37) and magnetic resonance angiography (MRA) (n = 3) were included in the study. All patients were investigated with extracranial CDUS and transcranial CDUS (TCCDUS) over a mean ± SD follow-up period of 42 ± 24 months and occurrence of new ischemic symptoms was assessed. Sonographic results were compared with initial and follow-up angiographic results. Results. At presentation, 24/33 (73%) patients had suffered an ischemic stroke, 5/33 (15%) had a transient ischemic attack (TIA), and 4/33 (12%) were asymptomatic. Two patients had a recurrent vertebrobasilar TIA; there was no recurrent stroke. The initial DSA findings consisted of 14 stenoses, 20 tapered occlusions, and 6 pseudoaneurysms. During follow-up, 63% of the vessels recanalized. Sonographic findings were consistent with angiographic findings in 80% at the initial examination and in 86% during follow-up. The main reason for discordant results was the failure of CDUS to detect pseudoaneurysms. No recurrence occurred in the vertebral arteries (VA), but 1 patient had an asymptomatic carotid artery dissection during follow-up. Conclusion. Recurrent TIA or stroke after VAD appears to be extremely rare, independent of recanalization or persistent occlusion of the affected artery. CDUS and TCCDUS provide reliable follow-up of VAD in all patients presenting with stenosis or occlusion, but do not allow for detection of pseudoaneurysms of the VA. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source]

Crohn's disease and color Doppler sonography: Response to treatment and its relationship with long-term prognosis

JOURNAL OF CLINICAL ULTRASOUND, Issue 5 2008
Tomás Ripollés
Abstract Purpose To evaluate the ability of sonography to detect changes in patients undergoing treatment for Crohn's disease and whether these findings are related to the patient's long-term outcome. Methods Twenty-eight patients with Crohn's disease were examined prospectively using gray-scale and color Doppler sonography before and during treatment. Three sonographic examinations were made: on the first day of treatment, between 3 and 8 days later, and approximately 4 weeks after starting the treatment. Sonographic examination included an evaluation of maximum bowel wall thickness and vascularity pattern. The sonographic data were compared with clinical and laboratory data, and possible relation with the patient's long-term outcome was considered. Results Initial baseline sonograms revealed at least 1 thickened segment of the bowel wall in all of the patients. In this initial examination, 18 of 22 patients (81%) with clinically active disease had moderate or marked parietal vascularity. A statistically significant reduction in the vascularity of the affected bowel was observed on the third sonographic examination (p < 0.05). Seventeen patients who were in clinical remission had relapses and were treated with immunosuppressive therapy or surgery during the follow-up. Eighty-six percent of the patients with residual hyperemia on sonographic examination after treatment had an unfavorable clinical course compared with only 30% of the patients with no, or barely visible, residual hyperemia (p < 0.01). Conclusion Sonography can identify bowel inflammation and its changes during treatment. In patients with Crohn's disease, hyperemia on color Doppler sonography during clinical remission after treatment may reflect an increased risk of relapse. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source]

Long-term effect of varicocele repair on intratesticular arterial resistance index

JOURNAL OF CLINICAL ULTRASOUND, Issue 3 2008
Ali Balci MD
Abstract Purpose To investigate the long-term effect of varicocele repair on ipsilateral intratesticular arterial resistance index (RI) using color Doppler sonography (CDS). Methods A total of 26 infertile patients with left varicocele who underwent a testicular artery and lymphatic-sparing subinguinal varicocelectomy were examined with CDS for intratesticular flow parameters before and at least 6 months after surgery. We also evaluated preoperative and postoperative semen parameters. Results The mean values of RI, end-diastolic velocity and pulsatility index decreased significantly after surgery, whereas no significant change was observed in peak systolic velocity. Repair of the varicocele resulted in a statistically significant increase in the total sperm count, motility, morphology, and total motile sperm count. However, no significant correlation was found between sperm parameters and RI values (p > 0.05). Conclusions Our data show that a significant improvement occurs in testicular blood supply and sperm parameters after surgical varicocele repair, without significant correlation between these 2 changes. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source]

Sonographic findings of mesenteric panniculitis: Correlation with CT and literature review

JOURNAL OF CLINICAL ULTRASOUND, Issue 4 2006
Nuria Rosón MD
Abstract Purpose. To evaluate the sonographic findings of mesenteric panniculitis (MP) and correlate them with CT findings. Methods. We retrospectively evaluated the clinical, CT, and sonographic findings in 26 cases of MP in our hospital between January 1997 and July 2003. We also reviewed the sonographic features of MP previously described in the literature. Results. The sonographic findings were well correlated to CT in 24 of 26 patients (92%). In these 24 cases, abdominal sonographic examination revealed a hyperechogenic, well-defined fatty mass (corresponding to the pseudocapsule CT sign) in the root of the mesentery, displacing the bowel loops. We found a clear interface between MP and normal intra abdominal fat. Examination with color Doppler sonography revealed the nondeviated mesenteric vessels within the mass. The persence of MP improved sonographic transmission in 9 obese patients and enabled the retroperitoneal vessels to be clearly visualized. Sonography was unable to demonstrate the preservation of the fat nearest the mesenteric vessels corresponding to the "fatty halo" sign on CT. Conclusions. Sonography is useful in the diagnostic workup for MP. The characteristic sonographic features of MP (well-defined mass, homogeneous hyperechogenicity of the mass, nondeviated vessels within the mass, and displaced bowel loops) correlate well with CT findings. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:169,176, 2006 [source]

Intratesticular arterial resistance and testicular volume in infertile men with subclinical varicocele

JOURNAL OF CLINICAL ULTRASOUND, Issue 8 2004
Nevbahar Akcar MD
Abstract Purpose The aim of this study was to evaluate whether intratesticular arterial resistance and testicular volume differed between infertile men with subclinical varicoceles and infertile men without varicoceles. Materials and Methods Fifty-eight infertile men were examined by gray-scale and color Doppler sonography for presence of varicocele, testicular volume, and arterial resistance. For men in the study group, mean testicular volume and resistance index (RI) in testes with varicoceles were compared with those in the contralateral testis by the paired t-test; statistical analyses between the study and control groups were performed by independent t-tests. Results Twenty-seven men had left-sided varicoceles (96% of which were subclinical), and 31 infertile men without varicoceles served as controls. Mean volumes of the right and left testes of study subjects were 14.8 ml and 14.6 ml, respectively, and in controls were 14.2 ml and 13.6 ml, respectively. Mean RI values for the right and left testes of study subjects were 0.61 and 0.58, respectively, and in controls were 0.61 and 0.58, respectively. There were no statistically significant differences in volume or RI, either between the right and left testes within patient groups or between the control and study groups' combined mean values. While the mean intertesticular volume differences for the study and control groups were 2.2 ml and 3.4 ml, respectively, the mean intertesticular RI differences were 0.04 and 0.07, respectively. These values also did not differ significantly between the 2 groups. Conclusions Subclinical varicocele is not associated with ipsilateral testicular atrophy, and does not affect the intratesticular arterial RI. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:389,393, 2004 [source]

Sonoanatomy of the Achilles tendon insertion in children

JOURNAL OF CLINICAL ULTRASOUND, Issue 7 2004
Wolfgang Grechenig MD
Abstract Purpose The aim of this study was to describe typical age-related sonographic features of the Achilles tendon and calcaneal apophysis in children, providing a reference for the assessment of heel pathologies during the growth period. Methods The calcaneal apophysis and Achilles tendon insertion of 100 children 2 months to 18 years old were examined by high-frequency gray-scale and color Doppler sonography along both the longitudinal and transverse planes. The thicknesses of the apophyseal cartilage at the calcaneal tuberosity and of the Achilles tendon were measured. Also, the sonographic appearance of the bone-cartilage interface was studied. Results In children 2 months to 3 years old, the cartilage of the calcaneal tuberosity apophysis was anechoic, with small scattered echoes. In 19 of these 25 children (76%), the echogenic areas contained at least 1 small vessel, visualized on color Doppler sonography. In 15 of 25 children (60%) 4,6 years old, a wavy interface was noted at the junction of the calcaneus and the apophyseal cartilage. Conclusions High-frequency sonography can yield reliable information about the bone-cartilage interface and the Achilles tendon insertion site at the calcaneal tuberosity in children. The sonographic features of the normal heel described here may contribute to improved assessment of pathologies in this anatomic region. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:338,343, 2004 [source]

Color Doppler sonographic signs of respiration-dependent hepatofugal portal flow

JOURNAL OF CLINICAL ULTRASOUND, Issue 2 2004
Christian Görg MD
Abstract Purpose The role of respiration in modulating blood flow in the portal vein is unclear. The aim of this study was to investigate the phenomenon of respiration-dependent periodic hepatofugal portal venous blood flow as detected on color Doppler sonography. Methods Within 1 year, we identified 13 patients with respiration-dependent reversal of blood flow in the portal vein that was diagnosed on color Doppler sonography. This phenomenon was investigated by color Doppler sonographic examination of the portal venous flow during both mid-inspiration breath-holding and a respiratory cycle including deep inspiration; evaluation of hepatic vein Doppler waveforms as normal (triphasic) or decreased (flattened); and echocardiographic examination to determine the presence or absence of tricuspid regurgitation. Results The patients' median age was 53 years (range, 26,87 years). Seven of the 13 patients had heart disease (tricuspid regurgitation) with or without liver disease, 3 had liver disease without heart disease, and 3 had other diseases with no evidence of heart or liver disease. On Doppler sonography, 10 of the 13 patients had increased portal venous pulsatility (7 of the 10 had tricuspid regurgitation; the other 3 did not); the remaining 3 patients had neither increased pulsatility nor tricuspid regurgitation. Sonographic follow-up within 4 weeks in 4 of the 13 patients revealed loss of the respiration-dependent hepatofugal portal flow. Conclusions Respiration-dependent hepatofugal portal flow is a rare finding associated with periodic portal hypertension in patients with right heart insufficiency and liver disease. Its clinical significance is unclear. Among our patients, its occurrence was predominantly associated with an increased venous pulsatility index due to tricuspid regurgitation or venous outflow obstruction. Further study is needed to investigate whether periodic respiration-dependent hepatofugal portal flow is predictive of the occurrence of continuous flow reversal. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:62,68, 2004 [source]

Reliability of intrarenal Doppler sonographic parameters of renal artery stenosis

JOURNAL OF CLINICAL ULTRASOUND, Issue 7 2003
Gülgün Demirpolat MD
Abstract Purpose The goal of this study was to retrospectively evaluate false-negative results of Doppler sonography in the diagnosis of renal artery stenosis (RAS) using intrarenal criteria. Methods We reviewed the clinical data and Doppler sonographic data for all patients in whom a diagnosis of RAS had been confirmed angiographically between November 1992 and January 2001. Mean intrarenal acceleration and acceleration time values,data obtained directly from color Doppler sonography,and findings of angiographic examination of the kidneys and stenotic renal arteries were evaluated. Results During the study period, 55 cases of RAS had been angiographically confirmed in 46 patients (25 male and 21 female; mean age, 50 ± 19 years [± standard deviation]). Intrarenal arterial acceleration, acceleration time values, or both were abnormal in 42 kidneys (76%) (group A) and normal in 13 kidneys (24%) (group B). The mean age ± standard deviation was significantly higher for patients in group B (60 ± 12 years) than for those in group A (47 ± 20 years) (p > 0.05). In group B, most of the stenotic lesions were atherosclerotic, and in all kidneys but 1, the lesions were located at the renal ostium or the proximal half of the artery. Conclusions Isolated use of intrarenal Doppler sonographic criteria for RAS may lead to an unacceptably high incidence of false-negative results in the diagnosis of this condition, especially in elderly patients. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:346,351, 2003 [source]

Color Doppler sonography of orbital and vertebral arteries in migraineurs without aura

Doppler measurement of blood flow velocities in extraocular orbital vessels in patients with obstructive sleep apnea syndrome

JOURNAL OF CLINICAL ULTRASOUND, Issue 5 2003
C. Zuhal Erdem MD
Abstract Purpose. We used color Doppler sonography to determine blood flow velocities in the extraocular orbital vessels of patients with obstructive sleep apnea syndrome (OSAS) and compared the results with those of healthy control subjects without OSAS. Methods. Patients with OSAS were classified according to the apnea-hypopnea index (AHI) as having mild OSAS (AHI < 20) or severe OSAS (AHI , 20). The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index were measured in the ophthalmic artery (OA), central retinal artery (CRA), lateral short posterior ciliary artery, and medial short posterior ciliary artery using color Doppler sonography. Only 1 eye was measured in each study participant, and right and left eyes were chosen randomly. The blood flow velocities of patients with OSAS and those of control subjects were compared with the Kruskal-Wallis test and Wilcoxon's rank-sum test. Results. The study comprised 30 patients (15 with mild and 15 with severe OSAS) and 20 healthy control subjects. Blood flow velocities were higher in most measured vessels in patients with OSAS than they were in the control subjects. Among patients with mild OSAS, the PSVs and EDVs in the posterior ciliary arteries were statistically significantly higher than those of the control group (p < 0.05), but those in the OA and CRA did not differ significantly between the mild OSAS group and the control group (p > 0.05). However, as the severity of OSAS increased, the PSVs and EDVs of the OA and CRA were also affected (p < 0.05). Conclusions. Color Doppler sonographic measurements of blood flow parameters in the orbital vessels may differ significantly between patients with OSAS and those without the syndrome. Therefore, OSAS should be considered in addition to other conditions when interpreting the results of color Doppler sonography of the extraocular orbital vessels if the clinical history points toward such a diagnosis. © 2003 Wiley Periodicals, Inc. 31:250,257, 2003 [source]

Spontaneous nontraumatic intrasplenic pseudoaneurysm: Causes, sonographic diagnosis, and prognosis

JOURNAL OF CLINICAL ULTRASOUND, Issue 3 2003
Christian Görg MD
Abstract Purpose The aim of this study was to describe the incidence, causes, sonographic features, therapy, and prognosis of nontraumatic intrasplenic pseudoaneurysms (NTISPs), a rare complication of splenic infarction or infiltration by malignant systemic disorders or infectious diseases. Methods We retrospectively reviewed the medical and sonographic records of all patients seen at our clinic from July 1985 through December 2000 to identify patients with a sonographic diagnosis of spontaneous nontraumatic splenic rupture. We then examined the features of the resulting cases to identify patients in whom NTISPs were revealed by color Doppler sonography. Results In total, 41 patients were identified. Among those patients, 5 (12%) had NTISPs. Three of those 5 patients had an underlying malignant disorder (1 case of non-Hodgkin's lymphoma and 2 cases of chronic myelogenous leukemia), and the other 2 had an inflammatory disease (1 case of endocarditis and 1 case of pancreatitis). Three of the patients also had splenic infarctions. Three patients underwent splenectomy; in 2 of them, secondary delayed splenic rupture occurred before or during splenectomy. In 2 other patients, spontaneous thrombosis of the aneurysms occurred (after 16 hours in 1 and 15 days in the other). Conclusions NTISPs may occur in about 12% of patients with sonographically detected nontraumatic spontaneous splenic rupture. NTISPs appear to be associated with an increased risk of secondary delayed splenic rupture, although spontaneous thrombosis may occur. Short-term follow-up sonographic examinations, particularly with color Doppler imaging, are recommended for early recognition of progression of NTISPs, which can guide treatment decisions. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:129,134, 2003 [source]

Cystic appearance of cervical lymph nodes is characteristic of metastatic papillary thyroid carcinoma

JOURNAL OF CLINICAL ULTRASOUND, Issue 1 2003
Ada Kessler MD
Abstract Purpose The usefulness of high-resolution sonography in diagnosing cervical lymph node metastases from papillary thyroid carcinoma was investigated. The accuracy of a particular sign, cystic change within a node, in establishing the diagnosis was assessed. Methods The sonographic findings in 63 patients with enlarged cervical lymph nodes were retrospectively reviewed. The patients had undergone high-resolution gray-scale and color Doppler sonography followed by ultrasound-guided fine-needle aspiration (FNA) in all patients and surgical excision in 27 patients. Results Abnormal sonographic features were present in the lymph nodes of all 63 patients. In 14 (70%) of 20 patients with papillary thyroid carcinoma, sonography depicted cystic changes. This pattern was not found in any of the other 43 patients, in whom FNA revealed either metastasis from another malignancy (22 patients) or benign reactive lymphadenopathy (21 patients). Among the 63 patients, there were 43 true-negative, 14 true-positive, 6 false-negative, and no false-positive results in the diagnosis of metastatic papillary thyroid carcinoma using the presence or absence of an intranodal cystic area on sonography. These results yielded a 70% sensitivity, 100% specificity, 100% positive predictive value, 88% negative predictive value, and 90% overall accuracy for this criterion. Conclusions Cystic changes within a cervical lymph node are highly suggestive of metastatic papillary thyroid carcinoma. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 31:21,25, 2003 [source]

Correlation between microbubble contrast,enhanced color doppler sonography and immunostaining for Kupffer cells in assessing the histopathologic grade of hepatocellular carcinoma: Preliminary results

Sonographically guided percutaneous sclerosis using 1% polidocanol in the treatment of vascular malformations

JOURNAL OF CLINICAL ULTRASOUND, Issue 7 2002
Rajeev Jain MD
Abstract Purpose The aim of this prospective study was to assess the safety and efficacy of sonographically guided percutaneous injection of 1% polidocanol for sclerosis of peripheral vascular malformations. Methods Patients with vascular malformations of soft tissues were invited to enroll in the study. Gray-scale and color Doppler sonography were performed to determine the texture, margins, and size of the lesions and to determine whether high-velocity blood flow was present. Using real-time sonographic guidance, lesions were punctured with a 20/21-gauge spinal needle. When possible, venous return was occluded before injection. For each injection, 1,6 ml of 1% polidocanol was injected into 1 or more sites within the lesion. The sclerosing agent was not aspirated after injection. Repeat radiography was performed 1 month after each injection session. The procedure was repeated if the patient did not have a complete response, defined as an 80% or greater decrease in the volume of the lesion or resolution of the presenting symptoms. Results Of the 15 patients enrolled, 9 had venous malformations, 3 had lymphangiomas, 1 had a recurrent aneurysmal bone cyst, 1 had a venous pseudoaneurysm, and 1 had an arteriovenous malformation of the pinna. Each patient received 1,20 injections of 1% polidocanol (mean ± standard deviation, 3.3 ± 4.8 injections). This treatment resulted in a complete response of 7 venous malformations, 3 lymphangiomas, and the arteriovenous malformation and partial response of 2 venous malformations, the recurrent aneurysmal bone cyst, and the venous pseudoaneurysm. Only minor complications occurred. Conclusions Sonographically guided percutaneous injection of 1% polidocanol for sclerosis of peripheral vascular lesions is simple, effective, and safe. This technique is especially effective in cases of soft tissue venous malformation and lymphangioma. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30:416,423, 2002 [source]

Diagnostic criteria for locating acquired arteriovenous fistulas with color doppler sonography

JOURNAL OF CLINICAL ULTRASOUND, Issue 6 2002
Jian-Chu Li MD
Abstract Purpose. The purpose of this prospective study was to evaluate and determine criteria for locating acquired arteriovenous fistulas using color Doppler sonography. Methods. We performed color Doppler sonography on 12 consecutive patients with acquired arteriovenous fistulas. We evaluated the morphologic and hemodynamic changes in the involved vessels to help locate the fistulas (10 in the extremities, 1 in the neck, and 1 in the abdomen). Results. In all cases, turbulent high-velocity flow spectrum and flow signals were present at the fistula sites, and arterialized waveforms from the draining veins were detected. In the 10 cases of acquired arteriovenous fistulas in the extremities, the resistance indices in the arteries proximal to the fistulas were all less than 1.00 (mean, 0.65), whereas the resistance indices in the arteries distal to the fistulas were all 1.00 or greater (mean, 1.17). In 70% of the cases, the diameter of the artery proximal to the fistula was at least 1.2 mm larger than that distal to the fistula. The fistula site was inferred by the point of maximal venous dilatation in 70% of the cases and by the focal perivascular color artifact in 82% of the cases. The fistula site was identified on gray-scale sonography and color flow imaging in 33% and 75% of the cases, respectively. Conclusions. Fistula sites can be located effectively and quickly by a combination of major and minor diagnostic criteria. The major diagnostic criteria are (1) junction of low- and high-resistance flow in the supplying artery, (2) a high-velocity arterialized waveform in the draining vein, and (3) a turbulent, high-velocity flow spectrum at the junction of the artery and the vein. The minor diagnostic criteria are (1) direct communication between the involved artery and vein, (2) significant change in the diameter of the supplying artery, (3) a focal point of venous dilatation, and (4) a focal perivascular color artifact. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30:336,342, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.10084 [source]

Role of color Doppler imaging in diagnosing and managing pregnancies complicated by placental chorioangioma

JOURNAL OF CLINICAL ULTRASOUND, Issue 5 2002
Yaron Zalel MD
Abstract Purpose The purpose of this study was to evaluate the role of color Doppler imaging in the diagnosis and management of placental chorioangioma. Methods The medical records, sonographic reports, and sonograms of all pregnant women who had placental masses diagnosed in our sonography unit during the years 1992 through 2000 and had been evaluated using both gray-scale and color Doppler sonography were included in this study. Subjective evaluation of the amount and distribution of intralesional vascularity by color Doppler imaging was made in all cases. Cases of chorioangioma of the placenta were compared with cases of placental hemorrhage or subchorionic hematoma. The outcomes of the pregnancies were also recorded. Results Fifteen cases of placental masses were evaluated; 8 of them were identified as placental hemorrhage or subchorionic hematoma on the basis of the sonographic findings. The other 7 cases were identified prenatally as placental chorioangioma, at a mean menstrual age of 23 weeks and a mean maternal age of 29 years. The mean size of the tumor was 6.5 cm (range, 4,13 cm). All cases of chorioangioma showed either substantial internal vascularity or a large feeding vessel within the tumor. Three infants were delivered at term with favorable outcome; 2 of them demonstrated reduction of the intratumoral blood flow during follow-up. The other 4 cases were delivered at or before 32 weeks' menstrual age (1 intrauterine fetal death, 2 terminated pregnancies, and 1 normal infant). No case of placental hematoma demonstrated blood flow within the lesion or was associated with complications of the pregnancy. Conclusions Color Doppler imaging helps differentiate placental chorioangioma from other placental lesions and may be useful in the prenatal follow-up of chorioangioma. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30:264,269, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.10072 [source]

Color doppler imaging in the sonohysterographic diagnosis of residual trophoblastic tissue

JOURNAL OF CLINICAL ULTRASOUND, Issue 4 2002
Yaron Zalel MD
Abstract Purpose The purpose of this study was to evaluate the role of color Doppler imaging during sonohysterography in the diagnosis of residual trophoblastic tissue. Methods This prospective cohort study involved 25 consecutive women with clinical and sonographic signs of an echogenic intrauterine mass who were referred to the sonography unit of our institution for evaluation. All women underwent saline infusion sonohysterography with color Doppler sonographic evaluation. An operative hysteroscopy with histologic examination was performed in 17 cases. Results Thirteen women (group A) had sonohysterographic features suggestive of residual tropho- blastic tissue (ie, an echogenic intrauterine lesion not detached from the uterine wall after introduction of saline). The initial diagnosis was confirmed by histologic analysis in all cases. Blood flow was detected within the intrauterine mass in 6 (46%) of these 13 women; the resistance indices were low in all 6 cases (mean ± standard error, 0.38 ± 0.01). Twelve women (group B) had sonohysterographic findings negative for retained tissue, and no blood flow was detected within any of the intrauterine masses in this group (p < 0.05). Conclusions Our results confirm the potential role of color Doppler sonography in the initial diagnosis of residual trophoblastic tissue. The detection of color Doppler signals, especially with low-resistance flow, within an intrauterine lesion should increase the confidence of the sonologist in the diagnosis of residual trophoblastic tissue. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30: 222,225, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.10059 [source]

Two-dimensional and three-dimensional sonography of conjoined twins

JOURNAL OF CLINICAL ULTRASOUND, Issue 2 2002
Fernando Bonilla-Musoles MD
Abstract Purpose The aim of this study was to evaluate and compare the diagnostic capabilities of 2-dimensional (2D) and 3-dimensional (3D) sonography for the study of conjoined twins. Methods Four pregnant women with an initial 2D sonographic diagnosis of conjoined twins were examined with color Doppler sonography, 3D multiplanar sonography, and orthogonal plane imaging and 3D surface rendering. Results All 4 cases of conjoined twins were initially diagnosed with either transvaginal or transabdominal 2D sonography. 3D sonography afforded more realistic views and demonstrated more clearly the linking areas and surface anomalies, but 2D and color Doppler sonography provided more definitive and specific information about shared organs. Conclusions Although 2D sonography is the primary modality for diagnosing and evaluating conjoined twins, color Doppler and 3D sonography can sometimes provide additional information that assists in the clinical management of these twins. 3D sonography also provides images that are easier for parents to understand, which can help them with decision making. © 2002 John Wiley & Sons, Inc. J Clin Ultrasound 30:68,75, 2002; DOI 10.1002/jcu.10035 [source]

Borderline cystic tumors of the ovary: Gray-scale and color Doppler sonographic findings

JOURNAL OF CLINICAL ULTRASOUND, Issue 2 2002
M. Angela Pascual MD
Abstract Purpose The aim of the study was to determine the value of gray-scale and color Doppler sonography in distinguishing borderline cystic tumors (BCTs) from benign cysts and malignant tumors of the ovary. Methods The gray-scale and color Doppler sonographic features of 383 ovarian lesions in 374 nonpregnant women were retrospectively studied. Sonography was performed transvaginally for all but 7 lesions, which were imaged suprapubically. All of the lesions were surgically resected via laparoscopy or laparotomy. Results The histopathologic diagnoses were 27 BCTs, 35 ovarian carcinomas, and 321 benign cysts. Sonography diagnosed 24 (89%) of 27 BCTs as malignant lesions. Patients with BCTs, were younger than those with ovarian cancer (p < 0.001). BCTs showed intracystic papillae in 17 cases (63%), diffuse internal echoes in 11 (41%), intracystic septa in 8 (30%), a heterogeneous echo pattern in 7 (26%), and a solid pattern in 4 (15%). BCTs showed blood flow in 24 cases (89%) and lower pulsatility and resistance indices (RI) compared with benign lesions (p < 0.001 for both). Multivariate analysis revealed intracystic papillae as the only independent predictor of BCTs (p < 0.001). Conclusions When a cystic mass has papillae, this is the only abnormal finding detected by gray-scale transvaginal sonography, and color Doppler imaging shows low RI values within the mass, a BCT should be suspected. © 2002 John Wiley & Sons, Inc. J Clin Ultrasound 30:76,82, 2002; DOI 10.1002/jcu.10028 [source]