Accuracy Of Doppler Ultrasonography Research Articles

Diagnostic failures in ovarian torsion during childhood: The effect of ovarian cyst size on the diagnostic accuracy of Doppler ultrasonography.

AbstractPurposeTo determine the diagnostic accuracy of Doppler ultrasonography (US) in pediatric ovarian torsion (OT) and the effect of ovarian cyst size on the effectiveness of Doppler US in pediatric OT.MethodsWe retrospectively reviewed of the data of 84 patients (4–17 years) operated with the preliminary diagnosis of OT from January 2007 to December 2019. Patients' demographic characteristics, clinical signs and symptoms, laboratory and radiologic findings, operative management, histopathological results, and postoperative complications were recorded.ResultsOT was surgically confirmed in 53 (63%) patients. In 30 patients without ovarian cyst, Doppler US suggested OT in 16 out of 22 patients with surgically confirmed OT. In 12 patients with ovarian cysts <5 cm, Doppler US suggested OT in 7 out of 8 patients with surgically confirmed OT. In 42 patients with ovarian cysts ≥5 cm, Doppler US suggested OT in 13 out of 23 patients with surgically confirmed OT. Accuracy of Doppler US in these groups were found to be 73%, 83%, and 47%, respectively.ConclusionGray scale and Doppler US have better performance in patients without ovarian cysts and with cysts smaller than 5 cm and help improve the diagnosis of OT. In patients with ovarian cyst ≥5 cm, accuracy of Doppler US is low. Thus, in the presence of ovarian cyst ≥5 cm and the clinical findings compatible with OT, laparoscopy must be strongly considered.

Accuracy of Doppler Ultrasonography in Assessment of Lower Extremity Peripheral Arterial Diseases

Doppler ultrasound scan is a non-invasive, cheap and convenient tool and it complements angiography, Computed tomography angiography (CTA), magnetic resonance angiography (MRA) and catheter digital subtraction angiography (DSA) in screening, diagnosis, treatment and follow-up of peripheral vascular diseases. Symptoms of peripheral vascular diseases are becoming more common due to rise in incidence of diseases and risk factors (diabetes mellitus, dyslipidemias, smoking, sedentary lifestyle). Due to limited availability of highly specific tools such as CT angiography, magnetic resonance angiography (MRA) and DSA (digital subtraction angiography) in many developing countries, doppler ultrasound is gaining more importance. Early determination of peripheral arterial diseases is beneficial in prevention of complications as severity increases may cause intermittent claudication, pain, tissue loss, including ulceration and gangrene (as the diseases progresses) and early management of arteriosclerosis will be beneficial to prevent these complications.

Middle Cerebral Artery Spasm after Subarachnoid Hemorrhage: Detection with Transcranial Color-coded Duplex US

To prospectively determine the accuracy of transcranial color-coded duplex ultrasonography (US) used alone and in conjunction with carotid artery US for diagnosis of middle cerebral artery (MCA) spasm, with intraarterial digital subtraction angiography (DSA) used as the reference standard. The institutional ethics committee approved the study. Each patient, or members of the patient's family, gave informed consent. One hundred twenty consecutive patients (64 women, 56 men; mean age, 45.5 years +/- 13.6 [standard deviation]) were routinely referred for DSA after subarachnoid hemorrhage. Vasospasm was graded as mild (< or =25% reduction in vessel diameter), moderate (>25% to 50% reduction), or severe (>50% reduction). US was performed 2 hours or less before angiography. The ratio of flow velocity in the middle cerebral artery (V(MCA)) to flow velocity in the ipsilateral extracranial internal carotid artery (V(ICA)) was calculated. Diagnostic accuracy was evaluated by calculating the area under the receiver operating characteristic curve (Az). The significance of the difference between the two Az values (for US vs DSA) was determined by using the z test with correction for correlated data. Nine of 120 patients were excluded because of inadequacy of acoustic windows in the squama of temporal bones. Spasm was mild in 17, moderate in 16, and severe in only nine of 222 arteries studied. Arteries with moderate or severe vasospasm were combined in one group. The best-performing parameters were peak systolic velocity and V(MCA)/V(ICA) ratio. Az values for these two parameters in diagnosis of moderate-to-severe vasospasm were 0.93 and 0.95, and in diagnosis of mild vasospasm, 0.90 and 0.91. Accuracy of the V(MCA)/V(ICA) ratio calculated on the basis of end-diastolic velocity for diagnosis of mild MCA narrowing was significantly better than that of end-diastolic MCA velocity alone (Az = 0.88 vs 0.84, P < .05). The stepwise approach with use of the V(MCA)/V(ICA) ratio after flow velocity measurements in the MCA resulted in a decreased number of false-negative findings in both vasospasm subgroups. The thresholds of highest efficiency were at a mean velocity of 94 and 108 cm/sec and a peak systolic V(MCA)/V(ICA) ratio of 3.6 and 3.9 for diagnosis of mild and moderate-to-severe vasospasm, respectively. Transcranial color-coded duplex US alone or in conjunction with carotid artery US has excellent accuracy for angiographic detection of vasospasm. Use of MCA velocity measurements and V(MCA)/V(ICA) ratio can increase the accuracy of Doppler US.

Collateral Capacity of the Circle of Willis in Patients with Planned Sacrifice of the Internal Carotid Artery

To evaluate the accuracy of Doppler sonography compared with angiography, temporary test occlusion of the internal carotid artery (ICA) was performed as paramenter for prediction of tolerance in case of sacrifice of the ICA. The vessel occlusion was done in 67 patients by manual compression over 10 seconds and by twenty minutes lasting balloon insufflation.The results (table 1) show a good correlation between dopplersonographic and angiographic testing in terms of collateral circulation. However, Doppler sonography proved to be more indicative for predicting clinically insufficient collateral supply.

Doppler sonography findings associated with transjugular intrahepatic portosystemic shunt malfunction.

Our purpose was to determine the overall accuracy of Doppler sonography and the accuracy of specific Doppler parameters associated with a compromised transjugular intrahepatic portosystemic shunt (TIPS). For 43 patients who had undergone TIPS, 64 correlated sonogram-venogram paired examinations were analyzed. Sonographic parameters assessed included absolute velocities plus absolute and percentage changes in velocities measured in the main portal vein (MPV) and in several intrashunt locations (including peak and minimum velocity). Direction of flow and change in direction of flow in the left and right portal veins were also examined. TIPS malfunction was defined as any shunt with greater than or equal to 50% stenosis or any stenosis with a portosystemic gradient greater than 15 mm Hg. The prospective interpretation of the sonograms using all available parameters resulted in a sensitivity of 92% and a specificity of 72% for detecting TIPS malfunction. Peak shunt velocity (absolute velocity and velocity change), distal shunt velocity, MPV velocity (absolute velocity and percentage change in velocity), change in minimum shunt velocity, and direction of flow in branch portal veins were found to have statistically significant differences between normal and abnormal shunts. Sensitivities for these individual parameters ranged from 64% to 84%, and specificities ranged from 70% to 100%. When either the MPV velocity or the distal shunt velocity was abnormal, the sensitivity was 94%. When both parameters were abnormal, the specificity for detecting TIPS malfunction was 100%. Doppler sonography is a sensitive and relatively specific means of revealing TIPS malfunction. Accuracy depends on analysis of multiple sonographic parameters.

Transjugular intrahepatic portosystemic shunts: accuracy of Doppler US in determination of patency and detection of stenoses.

To evaluate the accuracy of Doppler ultrasonography (US) in determination of patency and detection of stenosis in transjugular intrahepatic portosystemic shunts (TIPS). Retrospective review was performed of 251 Doppler sonograms obtained in 79 patients who underwent TIPS placement. Sonograms were evaluated for (a) the presence of a spectral waveform or color flow signal within the shunt, (b) the maximum peak flow velocity (Vmax) measured at the midportion of the TIPS, and (c) the direction of intraparenchymal portal venous flow. Independent review was performed of 116 transjugular portal venograms obtained after TIPS placement. Doppler US showed TIPS occlusion in 25 of 26 (96%) cases and confirmed patency in 192 of 193 (99%) cases. Low Vmax within the TIPS (< 50 cm/sec) correlated to a diameter stenosis of 50% or greater at angiography in 25 of 32 (78%) stenotic cases and was not present in 71 of 72 (99%) cases in which no hemodynamically significant stenosis was seen. An interval change in direction of intraparenchymal portal venous flow from hepatofugal to hepatopetal was seen in association with TIPS stenoses in all stenotic cases and was not found in 24 of 26 (92%) cases in which stenosis was not seen. Doppler US allows accurate determination of TIPS patency. A Vmax of 50 cm/sec or less within the shunt and interval change from hepatofugal to hepatopetal intraparenchymal portal venous flow are reliable indicators of stenosis.

Accuracy of doppler sonography in the evaluation of acute conditions of the scrotum in children

During a 12-month period, 65 boys (newborn to 18 years of age) with acute scrotal pain or swelling underwent Doppler sonography of both testes, followed by scintigraphy (15) and/or surgery (34) and close clinical follow-up for at least 4 months (23). Pulsed Doppler was performed with an ATL UM8 or Quantum II apparatus, using 7.5- or 10-MHz transducers. In 25 patients, color Doppler was also used. The testicular artery was deemed patent if Doppler shifts from branches within the parenchyma could be found. (Doppler signals from scrotal or marginal arteries were considered nondiagnostic). Through surgery, 19 testicular torsions were noted. Seventeen were diagnosed as such with Doppler. Two boys with torsion were deemed normal at the time of both Doppler and scintigraphy evaluation. One boy had a second Doppler examination 13 hours later, which showed no flow. The testicle was necrotic at the time of surgery. The second boy had had 8 hours of symptoms and had a viable testis at the time of surgery. This probably represented intermittent torsion. In six of the 65 cases, no signals could be found on either side, and they were deemed technical failures of the test. Doppler sonography was technically successful in 59 of the 65 patients (91%) and yielded a sensitivity of 89% and specificity of 100%. Comparing the normal and painful side helped to define technical failures. Pulsed Doppler with mechanical sector scanners was more sensitive than color Doppler. Intermittent torsion was missed with both Doppler sonography and scintigraphy. Although ultrasonography cannot replace clinical judgement, it may be very helpful in unclear cases.

Testicular torsion in infants and children: diagnosis with Doppler sonography.

The accuracy of Doppler sonography in the evaluation of testicular torsion was tested in 65 boys (aged 0-18 years) with acute scrotal pain or swelling. All patients underwent pulsed Doppler sonography of both testes, followed by scintigraphy (n = 16) and/or surgery (n = 34) and a close clinical follow-up for 4-8 months (n = 31). Color Doppler sonography was performed in 29 patients. The testicular artery was deemed patent if Doppler shifts from branches within the parenchyma could be found. Surgery revealed 19 cases of testicular torsion, 17 of which were diagnosed with Doppler sonography. There were six technical failures, in which no signals could be found on either side. In four boys, no color signals were obtained in either testis but subsequent examination with a mechanical sector scanner and pulsed Doppler sonography yielded arterial signals. Doppler sonography was successful in 59 of 65 boys (91%) and yielded a sensitivity of 89% and specificity of 100%. Pulsed Doppler sonography with mechanical sector scanners was more sensitive than color Doppler sonography. Intermittent torsion was missed both with Doppler sonography and scintigraphy.

A prospective study of hand-held Doppler ultrasonography by emergency physicians in the evaluation of suspected deep-vein thrombosis

A prospective study was conducted in the emergency departments of two community hospitals to assess the accuracy of Doppler ultrasonography performed by emergency physicians in the evaluation of patients with symptoms suggestive of deep-vein thrombosis. Seventy-eight extremities in 76 patients were evaluated by both Doppler ultrasonography and contrast venography. Thirty-six Doppler examinations were normal, 26 were abnormal, and 15 were equivocal. Of the unequivocal examinations, three were false-negative and nine were false-positive. These data represent a sensitivity of 85%, specificity of 79%, negative predictive value of 92%, and positive predictive value of 65%. Negative predictive value improved to 100% among a subgroup of low-risk patients, and positive predictive value improved to 80% among a subgroup of high-risk patients. Our study suggests that Doppler ultrasonography is highly predictive of a negative venogram, particularly in the low-risk patient. Further study with a larger population is needed. The availability and noninvasiveness of Doppler ultrasonography make it a useful adjunct in the evaluation of suspected deep-vein thrombosis in the ED.