Color Doppler Ultrasound Evaluation Research Articles

Study of alteration in testicular perfusion after Lichtenstein hernia repair

Background: Inguinal hernia affects both men and women but is much more common in men who comprise over 90% of the operated patients. Considering both the operated and the non-operated inguinal hernias, the lifetime prevalence rate is 47% for men upto and including the age of 75. Repair of an inguinal hernia is one of the most common operations among adults in the western world today. Aims and objectives were to compare the alteration in testicular perfusion following Lichtenstein hernia repair. Methods: Thirty patients diagnosed with inguinal hernia admitted in our hospital with study period of 12 months were included in the study. Color Doppler ultrasound evaluation of testicular blood flow was done for all cases. Comparisons of results between groups were done using independent t test and Pearson correlation test. Results: The mean age of patients in the study was 46.10±17.27 years. Twenty three percent of patients had COPD as comorbidity. Mean peak systolic volume (PSV) of testicular artery in preop, at 24 hours, 1 week and 3 months are 18.36±2.21, 20.27±3.25, 19.21±2.31 and 18.98±2.06 respectively with a p=0.001. On further observations, no significant difference was found in the PSV of Capsular and intratesticular artery and EDV and RI of testicular, capsular and intratesticular artery. Conclusions: Testicular perfusion following hernioplasty can be easily monitored and evaluated with Duplex ultrasonography; the flow in the spermatic artery and testicular artery and its branches is of low resistance, with a relatively broad systolic part and holodiastolic flow. There is no evidence for a significant impairment of cord structures after open hernia repair using tension free techniques. It is clear that fine surgical dissection

Integrating vascularity into the pattern classification of pilomatricomas on ultrasound provides a more competent approach for discriminative evaluation.

Pilomatricoma has various manifestations on color Doppler ultrasound, and a differential diagnosis is challenging. The objective of this study was to investigate which characteristics of skin lesions on color Doppler ultrasound are effective in distinguishing pilomatricoma from epidermoid cyst and dermatofibrosarcoma protuberans. Records of patients with pilomatricomas (n=63), epidermoid cysts (n=76), and dermatofibrosarcoma protuberans (n=19) who underwent color Doppler ultrasound evaluation and surgical excision were reviewed. The anatomical distribution and color Doppler ultrasound characteristics of these lesions were analyzed. The 63 pilomatricomas were categorized into five types based on their color Doppler ultrasound characteristics, and the roles of these five types in the differential diagnosis of the aforementioned diseases were studied. Pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans exhibited some similar characteristics. Dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity were the major characteristics of pilomatricomas. The pilomatricomas could be categorized into five types, with type II having a diagnostic performance of sensitivity of 65.08%, specificity of 98.95%, area under the receiver operating characteristic curve (AUC) of 0.743, positive predictive value of 97.62%, and negative predictive value of 81.03% for the diagnosis of the aforementioned skin diseases. A combination of dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity exhibits higher diagnostic performance for the differential diagnosis of pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans.

Climatic seasons and time of the day influence thermoregulation and testicular hemodynamics in Santa Inês rams raised under humid tropical conditions

This study evaluated the possible association between the diurnal variations of climatic factors during the rainy (RS) or less rainy (LS) seasons on the testicular hemodynamics and thermoregulatory responses of hair sheep rams raised in a humid tropical climate. Santa Inês rams (n = 6) underwent evaluation of general and testicular physiological parameters (heart and respiratory rates, internal and scrotal temperatures, internal-scrotal temperature gradient, scrotal distention, and color Doppler ultrasound evaluation of the spermatic cords and spectral analyses of testicular arteries) over six consecutive weeks per season at three separate times daily (morning = 8:00 a.m., noon = 12:00 p.m., and afternoon = 5:00 p.m.) during the RS and LS. Climatic air temperature and relative humidity data were recorded, and the temperature and humidity index (THI) was calculated. Higher thermal challenge was observed in LS relative to RS (air temperature = 28.0 vs. 30.9 °C; relative humidity = 84.1 vs. 69.9%; THI = 80.0 vs. 82.5; P < 0.05). In both seasons, respiratory rate and internal temperature were normal, demonstrating the animals’ adaptability. In RS, however, a higher scrotal temperature was recorded in relation to LS (35.0 vs. 34.7 °C; P < 0.05), with a gradual increase from morning to afternoon. Lower resistivity (0.40 vs. 0.64; P < 0.05) and pulsatility (0.55 vs. 1.14; P < 0.05) indices, and a higher rate of high-velocity blood flow of testicular arteries (71.1 vs. 60.6%; P < 0.05) were observed in RS compared to LS. The lowest correlations between testicular hemodynamic, physiological variables, and environmental parameters (P < 0.05) were observed in the morning. In conclusion, testicular thermoregulation and testicular hemodynamics were influenced by the climatic seasons and time of the day, being more efficient in the LS season and with less interference from environmental factors in the morning.

Role of Color Doppler Ultrasonography in evaluation of hemodialysis AV fistula

Background: A significant percentage of the Egyptian population is affected by end-stage kidney disease, which requires long-term hemodialysis. For patients receiving regular hemodialysis, the arteriovenous fistula is now the method most frequently employed to provide vascular access. Objective: The current study's objective was to assess the role and utility of CDUS in assessing vascular access and identifying shunt complications for hemodialysis. Patients and methods: This prospective, randomized controlled trial investigation has been carried out at the Health Insurance Hospital Nasr City's radio-diagnosis department. We included a sample size of thirty patients who needed an arteriovenous fistula in the upper limb for hemodialysis. Patients ranged in age from 8 to 70 and were both male and female. Results: The majority of patients had normal vessel diameters. 6 patients (20%) have a BB fistula, 8 patients (26.7%) have an RC fistula, and 15 patients (50%) have a BC fistula. The study showed a mean age of AVF maturation occurs 2.17 ± 0.379 weeks after its 1st creation. 3 patients had an uncomplicated 10% and 27 patients had shunt complications of 90%. The investigation revealed a significant percentage of venous thrombosis (12 patients, 40%), stenosis (9 patients, 30%), aneurysmal dilatation (6 patients, 20%), pseudoaneurysmal formation (3 patients, 10%), and finally steal syndrome (3.3%, 1 patient). Conclusion: Early identification and repair of a failing hemodialysis fistula can improve the quality of hemodialysis treatment. For patients having AV dysfunction, the CDUS results from this series were useful in determining further treatment care.

Demonstration of the epigastric vessels surface anatomy with equation model: An anatomical feasibility study

Introduction: The objective of this study is to design a patient-specific model to predict the location of epigastric vessels on the abdominal surface and to show clinicians safe areas before surgical intervention. Material and Methods: A total of 200 patients who underwent color Doppler ultrasound evaluation of the deep epigastric vessel before gynecological laparoscopic surgery were recruited in the study. The deep epigastric vessels were identified at three equal levels between the xiphoid and umbilicus, and five equal levels between the umbilicus and the symphysis pubis. The distance between the epigastric vessels and the midline was measured bilaterally at each level. Linear mixed effect modeling was used to assess the anatomical location of the epigastric vessels. Results: The model with waist circumference term was found to be the model with best performance metric. This model included waist circumferences as a covariate, the region of the epigastric vessel as a categorical variable, and random effects for patients. The model that calculates the expected distance from the midline of the epigastric vessels for different regions and waist circumferences are presented as “Distance to midline (cm) = 2.57 + Region A + Region B × Waist Circumference.” Discussion and Conclusion: With the equation model, we proposed, the location of the epigastric vessels can be determined specifically for the patient and the abdominopelvic regions. This model can be a guide to prevent vascular injury.

Diagnostic accuracy of color doppler Ultrasonography and FNAC in differentiating benign and malignant cervical lymphadenopathies at Birat Medical College Teaching Hospital, Morang, Nepal

Introduction: Among various imaging modalities useful in diagnosis of cervical lymphadenopathies, Color Doppler ultrasound (CDUS) is useful to evaluate and determine the presence of vascularity, resistance, direction, and velocity of blood flow in lymph nodes. It can determine the morphological and vascular nature of lymphadenopathies which will further help in the differentiation between benign and malignant nodes. Methods: This study was conducted on 61 patients referred to the Department of radiodiagnosis and imaging of BiratMedcical College for an ultrasound of cervical lymphadenopathy. These patients had subsequently undergone FNAC examination. Color Doppler sonographic procedures were done with an 11L linear probe with a frequency of 4.5-12MHz and CDUS evaluation of lymph nodes for Resistive Index and Peak systolic velocity were carried out and correlated with FNAC findings. Results: Among 61 lymph nodes, 52 were benign and 9 were malignant in the Color Doppler study where the final diagnosis by FNAC showed 53 benign and 8 malignant nodes. RI above the cutoff value of 0.5 had 83.3% sensitivity, 79.6% specificity, 50% PPV and 95.1% NPV. PSV above the cutoff value of 16cm/sec had 66.6% sensitivity, 95.9% specificity, 80.0% PPV and 92.2% NPV with diagnostic accuracy of 91.8%. Conclusion: Morphological features of the nodes such as shape, absence of echogenic hilum, abnormal vascular pattern, and Doppler indices cutoff values of 0.5 and 16cm/s respectively for RI and PSV were sensitive and specific for the diagnosis of malignant lymph nodes.

EVALUATION OF EPIDIDYMORCHITIS BY HIGH FREQUENCY GRAY SCALE AND COLOR DOPPLER ULTRASONOGRAPHY

INTRODUCTION: Ultrasonography is extremely well suited to study of scrotum and its contents. Ultrasound is simple to perform, quick, non-invasive, low cost effective, easily reproducible, widely available and does not involve irradiation of gonads.It is very helpful in differentiating intratesticular and extratesticular pathologies. Ultrasound is the modality to differentiate solid from cystic lesions of testes and with the introduction of color Doppler, it becomes easiear to assess the viability of testis in cases of torsion and guiding the treatment accordingly. USG is helpful in differentiating torsion/ischaemia of testis from the acute inammatory pathologies. Role of other Modalities: CT and MRI have dominated imaging of other regions of the body, they have certain restrictions in evaluation of scrotal diseases. Computed Tomography delivers radiation to gonads, On the contrary, MRI imaging is expensive and not readily obtainable. Radionuclide scan helps in equivocal presentations to assess vascularity within the testis in setting of torsion but its readily availability and cost is the main set back. AIM: To assess the role of high frequency gray scale and color doppler ultrasonography in evaluation of epididymorchitis. MATERIAL &amp; METHODS: SAMPLE: 50 cases of scrotal pathology were taken using High-frequency real time gray scale ultrasonography and Color Doppler . Patients were referred to our department for scrotal ultrasonography and Doppler study by department of Urology and department of Surgery of SRMS IMS Bareilly. RESULTS: In the present study total evaluated cases of epididymoorchitis were 15,among them 11 cases were acute and 4 cases were of chronic epididymoorchitis.. Majority of cases were having unilateral involvement with 1 case of B/L involvement. USG gray scale found heterogenous echogenicity or reduced echogenicity in acute EPO while the echogenicity was reduced with calcication in chronic EPO. .Doppler study found increased vascularity in majority of cases of acute EPO with reactive hydrocele while vascularity was either normal or increased in chronic EPO without any reactive hydrocele. CONCLUSION: High-frequency gray scale USG helps in clear evaluation of anatomical structural alterations associated with acute scrotal inammatory diseases, and color Doppler USG is highly sensitive in diagnosing acute scrotal pathology. In addition, Color Doppler USG accurately differentiates between testicular ischemia and torsion from acute inammatory diseases in acute painful scrotal conditions.

Colour Doppler ultrasound study in patients with frontal fibrosing alopecia.

The sonographic characteristics of frontal fibrosing alopecia have been scarcely studied. The aim of this study was to perform a colour Doppler ultrasound evaluation in frontal fibrosing alopecia. A cross-sectional study including 99 women with frontal fibrosing alopecia and 40 control subjects was performed using ultrasound equipment with a lineal 18MHz probe. Three areas were evaluated per patient: the alopecic area (a), the hairline implantation area (b) and healthy scalp (c). The diameter (cm) and flow (m/s) of the two most significant vessels were recorded. With regard to the hairline implantation area, patients presented higher vessel diameter (0.127cm vs 0.103cm, P=.03) and vessel flow (8.183m/s vs 7.670m/s, P=.05) than the control group. Vessel diameter was higher in the healthy scalp area in patients than in the control group (0.088cm vs 0.078cm, P=.03). Patients presented higher vessel diameter and flow in the hairline implantation area compared to the control group.

Evaluation of Corpus Luteum Vascularization in Recipient Mares by Using Color Doppler Ultrasound

Background: Embryo transfer is one of the most commonly used reproductive biotechnique. The success of embryo transfer is also affected by the synchrony of estrus and ovulation between donor and recipient animals. In horse reproduction, ultrasonography has been used, among other purposes, to diagnose early pregnancy. However, only the color Doppler imaging mode makes it possible to evaluate the vascular architecture and the hemodynamic aspects of the vessels in several organs, especially the corpus luteum. The objective of this study was to evaluate, based on the color Doppler ultrasound, the corpus luteum vascularization and function from recipient mares at embryo transfer timing.Materials, Methods &amp; Results: Mangalarga Machador mares from 5 to 10-year-old and a range of live weights of between 350 to 450 kg were used for this experiment, kept in pasture-based on mombaça grass (Panicum maximum) and were given ad libitum access to water and mineral supplementation. The animals (n = 15) were gynecologically examined and uterine consistency was evaluated by rectal palpation the same operator using an ultrasound system (SonoScape®) with a linear transducer, and operating frequency ranging from 5 to 10 Mhz. The uterine tone was classified between grades 1 and 4 and subjected to ovulation induction. The objective and subjective vascular perfusion of the corpus luteum was evaluated by color Doppler ultrasound on the day of embryo transfer and endometrium. The determination progesterone concentration on the day of the embryo transfer was performed by direct chemiluminescence assay. The arcsine (√P/100) transformation was applied to the percentage data, and the results were expressed as mean (.) ± standard error of the mean (SEM). Further, the assumptions of normality and homoscedasticity were verified, respectively, based on the Shapiro-Wilk and Lilliefors tests. Regarding the parametric and non-parametric variables, were applied, respectively, analysis of variance (ANOVA) followed by Tukey’s test, and the Kruskal-Wallis test followed by Dunn’s test. Pearson’s correlation coefficient was used to evaluate the relationship between the parameters. The statistical program SPSS 16.0 was used to perform the over-mentioned analyses, and a p-value &lt; 0.05 was taken as significant. Corpus luteum vascular perfusion, based on the objective and subjective evaluation methods, and the progesterone concentration were higher in the pregnant mares (P &lt; 0.05). The objective and subjective methods for evaluation of the vascular perfusion in the corpus luteum were positively correlated between themselves as well as to progesterone concentration (P &lt; 0.05). There was no significant difference between the groups considering the uterine tonus evaluation (P &gt; 0.05).Discussion: Mares that later became pregnant showed a higher concentration of progesterone as an outcome of the higher vascularization in the corpus luteum. It can be supported by both the correlation between the progesterone concentration and the corpus luteum vascular perfusion, as well as by the higher values of the vascular perfusion in pregnant mares. Based on the results, it has been concluded that the color Doppler ultrasound evaluation is an accurate tool to determine the corpus luteum vascularization, whether considering the objective or subjective methods. Also, the vascular perfusion is the most efficient parameter to determine both the corpus luteum function and to predict the ability of the recipient mares to maintain pregnancy.

Colour Doppler Ultrasound Evaluation of Umbilical Artery and Middle Cerebral Artery in Suspected Intrauterine Growth Restriction Foetuses

Background and Aims Intrauterine growth restriction is strongly related to the dynamics of uteroplacental and fetoplacental circulation and is associated with an increased risk of perinatal mortality morbidity and impaired neurodevelopment. A prospective study was performed to establish a role of Umbilical Artery UA and Middle Cerebral Artery MCA Doppler ultrasound USG in predicting perinatal outcome in clinically suspected Intrauterine growth restriction IUGR pregnancies and to determine the role of Doppler velocimetry in clinical management of such pregnancies.Methods This prospective observational study was conducted over a period of 17 months November 2019 - March 2021 and included 50 cases. After a regular obstetric ultrasound evaluation special importance was given to measure Doppler parameters such as Pulsatility Indices PI of Umbilical Artery and Middle cerebral Artery. Colour Doppler ultrasound was performed using GE LOGIQ F8 having low frequency curvilinear transducer. Follow up Doppler studies were performed if clinically indicated to determine a favourable or a worsening pattern in the Doppler indices. However only the results of first doppler ultrasound were considered for analysis.Results The mean gestational age at the first Doppler US examination was 32.91 weeks plusmn 3.10 weeks. Forty six percent of the foetuses had at least one abnormal outcome. The mean Foetal Heart Rate FHR was 136.32 plusmn 13.5. The mean Estimated Foetal Weight EFW observed was 1.81 plusmn 0.32. Thirty five 70.0 cases were Oligohydramnios and 15 30.0 cases were with adequate amniotic fluid. Twenty three foetuses had abnormal perinatal outcome. MCA PI was most sensitive sensitivity 95.65 more than both Cerebroplacental Ratio MCAUA PI sensitivity 91.3 and UA PI sensitivity 91.3 in predicting any adverse outcome. Cerebroplacental Ratio specificity 81.48 was more specific compared to UA PI Specificity 66.6 and MCA PI Specificity 63 with highest diagnostic accuracy 86 Positive Predictive Value PPV80.8. However UA PI 94.4 had highest Negative Predictive Value followed by Cerebroplacental Ratio 91.66 and MCA PI 90.0.Conclusions The Foetal Doppler indices in particular ratios that include measurements from umbilical and middle cerebral artery help in the detection of the IUGR foetuses. Cerebroplacental ratio MCAUA is a better predictor of abnormal perinatal outcome than MCA PI and UA PI alone.nbspnbsp

Role of Grayscale and Color Doppler Ultrasonography in Evaluation of Scrotal Pathologies

ABSTRACT Aim and objective To study the spectrum of sonographic findings of various scrotal swellings and to assess the efficacy of grayscale and color Doppler sonography in the diagnosis of scrotal lesions. Materials and methods The group under study was comprised of 100 patients of all age groups with acute scrotal pain, painless, or painful scrotal swelling. All patients were scanned with the linear probe on the ultrasound machines GE Voluson S6, Toshiba Xario 100/Toshiba Acuson X 300 from January 2015 to November 2016. Results There were 128 various sonographic findings in total, at the final diagnosis, as some of the patients had more than one findings. Hydrocele was the most frequent fluid collection, one with the fluid being confined to the tunica vaginalis cavity (92.3%). Varicocele comprised 11% of the total number of cases. At the final diagnosis, there were 11 cases of orchitis (57.1%), some of the patients had more than one of the above three pathologies in different combinations. An incidence of inguinoscrotal hernia was noted in 8%. Conclusion High-resolution sonography with color Doppler imaging could reliably define the morphological features and vascularity of scrotal lesions. Sonography was highly accurate in evaluating the consistency of scrotal mass—solid or cystic. Color Doppler was found extremely sensitive in the diagnosis and differentiation of testicular torsion and inflammation especially in the case of equivocal grayscale findings. Varicoceles were accurately diagnosed using color Doppler flow imaging (CDFI). The present study concludes that high-resolution sonography should be used as a first-line investigation. CDFI adds useful information and complement grayscale sonography in reaching a quick and correct diagnosis. How to cite this article Prabha T, Singh R, Arora S. Role of Grayscale and Color Doppler Ultrasonography in Evaluation of Scrotal Pathologies. J Mahatma Gandhi Univ Med Sci Tech 2020;5(1):16–22.

Role of Color Doppler Ultrasonography in Evaluation of Extracranial Carotid Artery in Stroke Patients: A Prospective Study

Introduction: Stroke is life threatening &amp; debilitating neurological disease, defined as focal neurological deficit of sudden onset lasting &gt;24 hours &amp; vascular in origin. Significant association between ischemic type of stroke with carotid artery disease seen, more prevalent with carotid artery stenosis. &#x0D; Objectives: This study was done to show association between extracranial carotid artery disease &amp; cerebrovascular accidents (CVAs) with the help of Color Doppler Sonography (CDS). The association between carotid artery disease with associated risk factors were also assessed. &#x0D; Methodology: In this ethically approved prospective study, carotid CDS was done in 79 consecutive patients with diagnosis of acute ischemic stroke (AIS). The various parameters studied included peak systolic velocity (PSV) of internal carotid artery (ICA) &amp; common carotid artery (CCA), ICA/CCA PSV ratio &amp; plaque characteristics. The data collected was analyzed with appropriate statistical test of significance was calculated. &#x0D; Results: Total 79 patients with AIS included out of which 53 were males &amp; 26 were females. The most common presenting complains were hemiparesis (30.4%) &amp; most commonly associated risk factors included hypertension (62.02%). Right sided strokes were most common (44.3%) &amp; middle cerebral artery was most commonly involved vascular territory. Significant stenosis (≥50%) of carotid artery was seen in 27 patients with ICA most common site (45.8%) for plaque formation. Bilateral carotid artery involvement (52.1%) with hypoechoic echotexture of atheromatous plaques (46.6%) was most responsible for significant stenosis &amp; increased intima media thickness. Increased value of PSV &amp; EDV was seen in the stenotic area in the proportion of stenosis with increased PSV ICA/CCA ratio of more than three indicates &gt;60% stenosis. &#x0D; Conclusion: The present study showed well documented role of carotid doppler in detection of site &amp; extent of carotid artery stenosis due to atheromatous plaques of various characteristics playing critical role in thromboembolic phenomenon responsible for development of stroke.

Diagnosis and treatment of penile injury: ten years experience of an emergency department.

To evaluate the imaging accuracy in the diagnosis and clinical management of penile injury. From January 2010 to January 2020, 20 men (median age 40.2 years) were admitted to our Emergency Department with the diagnosis of penile injury; the penile trauma was related to sexual intercourse in 16 cases, masturbation in 3 cases and injury caused by the partner in 1 case. All the patients underwent accurate medical history, clinical examinations and diagnostic imaging. Color Doppler ultrasound (CDU) evaluation was performed by Logiq E9 ecograph (General Electric; Milwaukee, WI) supplied with a linear probe small (7.5-10 MHz); magnetic resonance image (MRI) examination was performed within 3-24 hours from the trauma using a 1.5 Tesla scanner, (ACHIEVA 3T; Philips Healthcare Best, the Netherlands) performing pre-contrast and post-contrast multi-planar turbo spin-echo T1 and T2-weighted sequences. 15/20 (75%) men with high suspicion of the tunica albuginea rupture underwent surgical exploration; conversely, 5/20 (25%) patients underwent conservative management. CDU detected 11/15 (73%) fractures of the penis and in 8 of them the length of the rupture was underestimated (more than 5 millimeters). On the contrary, MRI diagnosed all the albuginea ruptures showed by surgical exploration, but underestimated the length of the lesions in 9/15 (60%) cases. The IIEF-5 score administered six months later penile trauma demonstrated a good performance in all the patients. In our series, all the patients with a tunica albuginea rupture < 5 mm. diagnosed by MRI were submitted to conservative management with a complete functional restitutio ad integrum.

The Diagnostic Accuracy of Testicular Torsion by Doctors on Duty Using Sonographic Evaluation with Color Doppler.

As testicular torsion is a medical emergency, it requires quick diagnosis and treatment. Color Doppler ultrasound (CDUS) is useful for the diagnosis of testicular torsion. An accurate diagnosis can be difficult when CDUS indicates the preservation of blood flow in the testis. We examined the accuracy of testicular torsion diagnosis in patients with acute scrotum made by doctors on duty using CDUS. The subjects included 26 patients who visited our department between January 2016 and June 2018 presenting with acute scrotal pain. Patients were placed into one of three groups based on testicular blood flow evaluated by CDUS. The first group had no testicular blood flow, the second had diminished blood flow, and the last group had normal or increased blood flow. Patients were also diagnosed through scrotal exploration. Finally, patients were further divided into two groups identified by CDUS frequency utilized during diagnosis (12 MHz groups and ≤8 MHz groups), and the diagnostic accuracy of the two groups was compared. Characterizing torsion by either the absence of or diminished, testicular blood flow in the CDUS evaluation, the sensitivity and specificity of the CDUS performed by doctors on duty accounted for 69.2% and 53.8%, respectively. No improvement in diagnostic accuracy was evident despite the usage of a 12-MHz ultrasonic transducer. In this study, the sensitivity of CDUS performed by doctors on duty was about 70%, suggesting that scrotal exploration should be performed promptly even if testicular blood flow is observed and testicular torsion is suspected from medical history and body findings.

The clinical importance of color Doppler ultrasonography in puncture related complications of hemodialysis vascular access

BackgroundThe long-term survival of patients on hemodialysis (HD) is dependent on adequate HD which depends on quality and degree of functionality of vascular access. The aim of our study is to detect the role of color Doppler ultrasonography in evaluation of arteriovenous fistula (AVF).Materials and methodsBetween January 2017 and October 2017, 60 patients had complicated AVF at Qena General Hospital & Qena University Hospital as primary and tertiary centers respectively with the same age group between 18 and 50 years old, had no diabetes mellitus were evaluated using color duplex-Doppler ultrasound (CDUS) after AVF maturation for detection of complications and comparison between primary and tertiary centers of its incidence.ResultsThe overall results revealed that 11 patients from 30 patients that had been referred to tertiary centers have complicated AVF (36.7%), and 19 patients had no shunt complication (63.3%). Twenty-two patients from 30 patients that had been referred to primary HD centers had complicated shunts. Thrombosis at tertiary centers represents 13.3%, stenosis 3.3% (1 patient), aneurysmal formation had 6.6% for (2 patients), hematoma 6.6%(2 patients), infection 3.3% (1 patient), venous hypertension 3.3% (1 patient), thrombosis and hematoma at primary centers 16.6% (5 patients for each), aneurysmal formation and infection 13.3% for each, and stenosis 10%.ConclusionsCDUS is a readily-available, non-invasive, risk-free, bed-side technique that allows precise anatomic knowledge, qualitative, and quantitative data of the upper limb vascular system which greatly help in preoperative planning of AVF creation, assessment of prime time for puncture (maturation), early detection of complications, and choice of appropriate therapeutic procedure for their treatment.

Role of Computed Tomography Angiography (CTA) and Color Doppler Ultrasonography in Evaluation of Arterial System in Diabetic Foot

AbstractObjective: The aim of this study was to highlight the role of Computed Tomography Angiography (CTA) and color Doppler Ultrasonography (DUS) in the evaluation of patients with diabetic foot disease.Background: The risk for ulceration and amputation is much higher in diabetics compared with nondiabetics. CTA is more frequently used to assess peripheral vascular disease of the diabetic foot while Doppler ultrasonograpy is a reliable non-invasive method of investigating the lower limb arterial system provides us with hemodynamic data proximal, distal and at the site of obstruction.Patients and Methods: This prospective study included 30 diabetic patients who presented with diabetic foot vascular lesions and referred from outpatient clinics of Vascular Surgery Department to the Radiology and Medical Imaging Department, Tanta University Hospital. The present study was performed in the period between March 2017 and March 2018. Their ages ranged from 40 to 80 years; 17 of them were men and 13 were women. All cases underwent Doppler examination as a rapid, noninvasive complementary diagnostic tool, and the findings were compared with those of CTA.Results: In the present study, the number of segments were 513 for 57 limbs, and each arterial tree of one limb was divided into nine segments (common iliac,external iliac, common femoral, superficial femoral, popliteal, anterior tibial, posterior tibial, peroneal, and dorsalis pedis arteries). In this study, the number of stenotic segments was 30 and 22 on Multidetector Computed Tomography Angiography (MDCTA) and DUS, respectively. The number of segments with total occlusion was 50 and 43 on MDCTA and DUS, respectively.Conclusion: The use of CTA and DUS increases the ability to delineate vascular anatomy, localize the obstruction, assess the severity of stenosis, and detect the presence of collaterals and distal run off.

The role of color Doppler ultrasonography in evaluation of hemodialysis graft dysfunction

Objective To evaluate role of duplex Doppler ultrasound in assessing arteriovenous graft (AVG) function, detecting complications and analyzing the resistance index (RI) and flow in the afferent artery. Background End-stage renal disease causes serious health problems all over the world. The numbers of patients requiring dialysis have grown. In Egypt, it is the cause of 1.3% of all deaths, with much more incidence in later years of life. A well-functioning dialysis access is the lifeline for those patients. Patients and methods This study included 20 patients (male/female: 11/9) with end-stage renal disease and on regular hemodialysis using AVG. The prospective analyses of vascular access-related data included examination of graft morphology, shunt complications, and measurement of RI and volume of blood flow at the afferent artery. Results The most common complication seen was thrombosis (53.8%). Significant relation was found between graft function and flow volume of afferent artery (P < 0.001), with mean 1011.0 ± 135.9 ml/min in functional grafts and mean 220.8 ± 202 ml/min in dysfunctional grafts. There was a highly significant relation between graft function and afferent artery RI (P < 0.005), as 57.1% of functional grafts had their RI less than 0.5, with mean of 0.45 ± 0.05; 28.6% of complicated graft had their RI more than 0.5, with mean of 0.44 ± 0.12; and all dysfunctional graft had RI more than 0.5, with mean of 0.66 ± 0.09. Conclusion Duplex sonography has high accuracy in diagnosing and assessing most hemodialysis AVG-related complications while providing us with anatomic and hemodynamic information.

Evaluation of Split Renal Function for Children with Kidney Diseases by Renal and Vascular Color Ultrasonography

Renal dynamic imaging and radionuclide renography use radioactivity to evaluate split renal function. We aimed to investigate the use of renal vascular color Doppler ultrasonography for evaluation of split renal function in children. Thirty-five children with unilateral kidney diseases were enrolled. For patients with unilateral renal tumor, peak systolic velocity (Vmax = 113.04 ± 13.59 cm/s) and resistance index (RI = 0.73 ± 0.02) were higher on abnormal compared with normal sides (Vmax = 86.03 ± 6.49 cm/s, RI = 0.62 ± 0.01), and blood perfusion was good, indicating compensatory enhancement in split renal function. For unilateral renal cyst, Vmax (58.20 ± 7.38 cm/s) was lower on the abnormal compared with the normal (87.71 ± 14.83 cm/s) size, and perfusion was poor. For unilateral hydronephrosis and renal atrophy, the parameters were similar to those of renal cyst, suggesting a weakening of renal function. For unilateral renal agenesis, Vmax (106.07 ± 13.07 cm/s) and RI (0.71 ± 0.05) were higher, and perfusion was good. Renal vascular color Doppler ultrasonography was superior in the evaluation of split renal function in children, without being invasive or radioactive.

Distinguishing testicular torsion from torsion of the appendix testis by clinical features and signs in patients with acute scrotum.

PurposeMany physicians encounter confusion and difficulty in distinguishing testicular torsion (TT) from torsion of the appendix testis (TAT) in patients with acute scrotum because of the overlapping signs and symptoms. The objective of our study was to evaluate the clinical features and signs that can help distinguish TT from TAT.Patients and methodsWe performed a retrospective study of patients with surgically confirmed TT and TAT at our institute from January 1990 to December 2013. Clinical findings, physical examination findings, climatic conditions, laboratory data, and color Doppler ultrasound (CDUS) findings were compared between the TT and TAT groups.ResultsSeventy patients were included in this study (49 with TT and 21 with TAT). Patients with TT were significantly older than those with TAT (p < 0.001). The ambient temperature at onset was significantly lower in patients with TT than in patients with TAT (p = 0.038). Testicular swelling, high-riding testes, onset during sleep, high leukocyte counts, and high creatine phosphokinase levels were significantly more common in patients with TT than with TAT (p = 0.021, 0.032, 0.006, 0.003, and 0.043, respectively). Multivariate analysis showed that age and onset during sleep were significant independent factors for detection of TT. Eight patients (16.3%) underwent preoperative CDUS evaluation, and an absent or decreased blood signal in the involved testes was significantly correlated with the presence of TT (p = 0.018).ConclusionIn clinical features, age and onset during sleep might be helpful to distinguish TT from TAT. When supported by findings, urgent surgical exploration is warranted in patients with suspected TT based on symptoms and CDUS features.

Diagnostic efficacy of color Doppler ultrasound in evaluation of cervical lymphadenopathy.

To evaluate the efficacy of color Doppler ultrasound (CDUS) in differentiating benign and malignant cervical lymph nodes by detecting differences in blood flow patterns. In this cross-sectional prospective study, 25 untreated patients with clinical evidence of cervical lymphadenopathy were evaluated. CDUS was performed for 80 cervical lymph nodes. The gray scale parameters of the lymph node and intranodal perfusion sites were the key CDUS features used to differentiate between reactive and metastatic lymph nodes. Histopathological confirmations were obtained and compared with the results of CDUS. Initially, 53 cervical lymph nodes were evaluated by clinical examination. Twenty-seven additional lymph nodes (53 + 27 = 80) were discovered by CDUS evaluation. Gray scale parameters for lymph nodes such as size of lymph node, shape of lymph node, and presence or absence of hilum revealed highly significant results (P < 0.0001). Color Doppler flow signals revealed that central/hilar flow was characteristic for benign nodes whereas peripheral/mixed flow was characteristic for malignant nodes, the findings were highly significant (P < 0.0001). Gray scale and color Doppler features are used to differentiate benign and malignant nodes. Within the limitations of this study, CDUS evaluation was found to be highly significant with a high sensitivity and specificity over clinical evaluation CDUS examination provides a prospect to reduce the need for biopsy/fine needle aspiration cytology in reactive nodes.