Color Doppler Ultrasound Findings Research Articles

Clinical characteristics of testicular torsion and factors influencing testicular salvage in children: A 12-year study in tertiary center

BACKGROUND Testicular torsion is the most common acute scrotum worldwide and mainly occurs in children and adolescents. Studies have demonstrated that the duration of symptoms and torsion grade lead to different outcomes in children diagnosed with testicular torsion. AIM To predict the possibility of testicular salvage (TS) in patients with testicular torsion in a tertiary center. METHODS We reviewed the charts of 75 pediatric patients with acute testicular torsion during a 12-year period from November 2011 to July 2023 at the Suzhou Hospital of Anhui Medical University. Univariate and multivariate logistic regression analyses were used to determine independent predictors of testicular torsion. The data included clinical findings, physical examinations, laboratory data, color Doppler ultrasound findings, operating results, age, presenting institution status, and follow-up results. RESULTS Our study included 75 patients. TS was possible in 57.3% of all patients; testicular torsion occurred mostly in winter, and teenagers aged 11-15 years old accounted for 60%. Univariate logistic regression analyses revealed that younger age (P = 0.09), body mass index (P = 0.004), torsion angle (P = 0.013), red blood cell count (P = 0.03), neutrophil-to-lymphocyte ratio (P = 0.009), and initial presenting institution (P < 0.001) were associated with orchiectomy. In multivariate analysis, only the initial presenting institution predicted TS (P < 0.05). CONCLUSION The initial presenting institution has a predictive value for predicting TS in patients with testicular torsion. Children with scrotal pain should be admitted to a tertiary hospital as soon as possible.

Diagnostic Accuracy of Doppler Ultrasound in Ectopic Pregnancy

Objective: To evaluate the diagnostic accuracy of Doppler ultrasound in the detection of ectopic pregnancy. Methodology: This prospective observational study was conducted at PESSI Hospital, I-12, Islamabad, in collaboration with different hospitals for data collection. The study was carried out over a period of one year from October 2021 to September 2022. All pregnant women aged >17 years presenting with symptoms of ectopic pregnancy, regardless of parity, were included. All patients underwent color Doppler ultrasound using a dedicated machine. Subsequently, the patients were followed until they underwent surgical management, and the operative findings were meticulously recorded. Data were collected using a pre-designed proforma and analyzed with SPSS version 20. Results: The mean age of the participants was 31.53 years, and the average gestational age was 6.03 weeks. 35.0% of the participants had a positive family history. According to color Doppler ultrasound findings, the majority of cases (96.7%) were identified as positive for ectopic pregnancy, while surgical findings confirmed ectopic pregnancy in 93.3% of cases. The sensitivity of color Doppler ultrasound was 100%, specificity was 60%. The positive predictive value (PPV) was 94% and negative predictive value (NPV) was 100%, suggesting that it was 100% accurate in ruling out ectopic pregnancy. Conclusion: Color Doppler ultrasound was found to be a highly sensitive, reliable, and noninvasive tool in diagnosing ectopic pregnancy. However, the findings cannot be definitively applied due to limitations, particularly the small sample size. Further large-scale studies are strongly recommended for validation and confirmation of the findings.

Ultrasonographic Findings of Cervical Lymph Nodes

Ultrasonography is an accurate and cost-effective diagnostic tool for cervical lymph node assessment. This article briefly reviews the key grayscale (size, shape, echogenicity, fatty hilum, and calcification) and color Doppler ultrasound findings to help distinguish benign and malignant lymph nodes.

The role of color doppler ultrasonography in the diagnosis of giant cell arteritis in ophthalmic patients.

In the case of ischemic optic neuropathy (ION) or retinal artery occlusion (RAO), distinguishing arteritic from non-arteritic can limit or prevent irreversible bilateral blindness. Here, the utility of color Doppler ultrasonography (CDUS) in diagnosing giant cell arteritis (GCA) was evaluated. In this retrospective analysis, a total of 38 cases diagnosed with ION or RAO were included, that presented to our department in the years 2018 up to 2021 and underwent both CDUS and temporal artery biopsy (TAB). The evaluation is based on TAB as reference standard. CDUS resulted in a sensitivity of 65.0% and a specificity of 100% (when excluding two inconclusive assessments). Therefore, when limiting TAB to only suspected cases with negative or unclear CDUS findings, the sensitivity and the specificity would remain unchanged at 100%, while reducing the need for TAB by 42.1%. Overall, the data suggest the implementation of a stepwise diagnostic algorithm to confirm or rule out GCA, in which the CDUS plays a key role, thus omitting the requirement for TAB in many cases.

High-resolution ultrasound in the evaluation of musculoskeletal infections.

Soft tissue and osseous musculoskeletal infections are common but can be difficult to diagnose clinically. Signs, symptoms, and physical examination findings may be nonspecific, and laboratory values can be inconclusive. The extent of disease may also be underestimated on physical examination. Soft tissue infections most commonly occur secondary to direct inoculation from broken skin and less frequently due to the seeding of the soft tissues from hematogenous spread, while osseous infections are more commonly due to hematogenous seeding. Infections may also be iatrogenic, following surgery or other procedural interventions. High-resolution ultrasound is an extremely useful imaging modality in the evaluation of musculoskeletal soft tissue and joint infections, and can occasionally be used to evaluate osseous infections as well. Ultrasound can aid in the early diagnosis of musculoskeletal infections, allowing for prompt treatment, decreased risk of complications, and treatment optimization. Ultrasound is sensitive and specific in evaluating soft tissue edema and hyperemia; soft tissue abscesses; joint, bursal and tendon sheath effusions/synovitis; and subperiosteal abscesses. This article describes the typical high-resolution grayscale as well as color and power Doppler ultrasound imaging findings of soft tissue infections including cellulitis, fasciitis, necrotizing deep soft tissue infection, pyomyositis, soft tissue abscess, infectious bursitis, and infectious tenosynovitis. Ultrasound findings of septic arthritis as well as osteomyelitis, such as subperiosteal spread of infection (subperiosteal abscess). are also reviewed. In addition, the use of ultrasound to guide fluid and tissue sampling is discussed.

Therapeutic outcomes and analysis of Doppler findings in 25 patients with non-ischemic priapism

Non-ischemic priapism (NiP) is painless partial tumescence caused by genital trauma and the formation of intracorporal arterio-venous fistula. This is a retrospective study of 25 men with NiP and reports the long-term erectile function and colour doppler ultrasound (CDUS) findings after treatment for NiP. Unstimulated CDUS was performed at diagnosis, 1 week and at last follow-up after treatment. CDUS traces were analysed: peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI) and mean velocity (MV) were calculated. Erectile function was assessed using the IIEF-EF questionnaire. At the last follow-up (median 24 months), 16 men had normal erectile function (64%): median IIEF-EF score 29 (IQR 28.5–30; σ2 2.78) and nine had erectile dysfunction (36%): median IIEF-EF score 17 (IQR 14–22; σ2 33.6). MV and EDV were statistically higher in those patients with erectile dysfunction at last follow-up compared to patients with normal erectile function: median MV 5.3 cm/s (IQR 2.4–10.5 cm/s; σ2 34) vs 2.95 cm/s (IQR 1.03-3.95; σ2 3.4) p < 0.002 and median EDV 4.0 cm/s (IQR 1.5–8.0; σ2 14.7) vs 0 cm/s (IQR 0–1.75; σ2 2.21) p < 0.004. Erectile dysfunction was observed in 36% of men treated for NiP and was associated with abnormal low resistance resting CDUS waveforms. Further investigation for persistent arteriovenous fistulation should be considered in these patients.

Contrast-enhanced ultrasound for the diagnosis of acute pyelonephritis in pediatric patients with urinary tract infection: A feasibility study.

This study aimed to assess the feasibility of contrast-enhanced ultrasound (CEUS) for the diagnosis of acute pyelonephritis (APN) in pediatric patients with febrile urinary tract infection (UTI). Between March 2019 and January 2021, study participants with suspected UTI were assessed for APN using ultrasound. Parenchymal echogenicity changes, renal pelvis dilatation, and the presence of a focal suspected lesion were assessed using conventional grayscale ultrasound. The presence and location of a decreased perfusion area were evaluated using color Doppler ultrasound (CDUS) and CEUS. Agreement between each ultrasound examination and a 99mTc‒dimercaptosuccinic acid (DMSA) scan was assessed using the κ value, and the most visible period of the lesion was evaluated using CEUS. This study enrolled 21 participants (median age, 8.0 months; range, 2.0-61.0 months) with isolated urinary tract pathogens. Five increased parenchymal echotextures (11.9%) and 14 renal pelvic dilatations (33.3%) were confirmed, but no focal lesions were detected on the grayscale images. CDUS and CEUS showed decreased local perfusion suggestive of APN in two and five kidneys, respectively. DMSA scan showed substantial agreement with CEUS findings (κ = 0.80, P = 0.010), but other grayscale and CDUS findings did not agree with DMSA scan results (P > 0.05). All lesions were best observed in the late parenchymal phase on CEUS. CEUS can reveal renal perfusion defects in pediatric patients with suspected APN without radiation exposure or sedation; therefore, CEUS may be a feasible and valuable diagnostic technique.

The Role of Demographic and Clinical Characteristics in Distinguishing Testicular Torsion from Torsion of the Appendix Testis: A Single-center Retrospective Study.

The acute scrotum (AS) in the pediatric population is a medical emergency. AS is usually caused by testicular torsion (TT) and torsion of the appendix testis (TAT). The current study explored which demographic and clinical characteristics can help distinguish between TT and TAT. We analyzed all children ≤16 years who underwent surgical exploration for AS. The patients were divided into Group 1/TT and Group 2/TAT. Ninety patients were included in the study (24 with TT and 66 with TAT). The peak incidence of TT was significantly higher than in the TAT group (p&lt;0.001). Scrotal pain was more prevalent in the TAT group (p=0.02), whereas systemic signs (nausea/vomiting and abdominal pain) affected more frequently the TT patients (p=0.003 and p&lt;0.001, respectively). The duration of symptoms was significantly longer in the TAT group (p&lt;0.001). The duration of symptoms in the TT cohort significantly impacted the testicular salvage (p=0.008). Color Doppler ultrasound (CDUS) findings of absent/decreased testicular blood flow in the affected testis strongly favored the diagnosis of TT (p&lt;0.001). The older age, shorter duration of symptoms, systemic signs, and CDUS findings can help distinguish between the two most common acute scrotum causes.

The ultrasonography, colour Doppler ultrasonography and sonoelastography findings of scar endometriosis in comparison with menstrual phases

We aimed to evaluate ultrasonography (US), colour Doppler US (CDUS) and sonoelastography (SEL) findings of histopathologically proven abdominal wall scar endometriosis in comparison with menstrual phases. A total of 24 female patients with scar endometriosis were included. Lesion size, volume, echogenicity, solid/cystic or complex appearance, contour and location on US, vascularisation on CDUS, and elasticity on SEL were recorded in both menstrual and ovulatory phases. Hypoechoic heterogeneous lesions with increased peripheral echogenicity were observed in all lesions. The mean ± standard deviation (SD) volume of the lesions in the menstrual and ovulatory phases of the lesions was 4.36 ± 3.01 cm3 and 4.63 ± 7.61 cm3 (p = .316). The mean ± SD resistive index values on CDUS in the menstrual and ovulatory phases were 0.96 ± 0.09 and 0.97 ± 0.07, respectively (p = .667). The SEL examination demonstrated a hard coding pattern in all cases with no statistically significant difference between menstrual and ovulatory phases (p = .176). We found no significant difference in terms of US, CDUS and SEL findings of scar endometriosis in comparison with menstrual phases which suggests there is no need to evaluate the patient in a specific menstrual phase. Impact Statement What is already known on this subject? Scar endometriosis is the endometriosis located at the abdominal wall around the scar area with a very rare incidence. The typical sonographic findings of scar endometriosis are a hypoechoic solid mass with irregular contours. High resistive index on colour Doppler ultrasonography (CDUS) and hard coding pattern on sonoelastography (SEL) are seen in the lesion. What do the results of this study add? This is the first study that evaluates sonographic features of scar endometriosis lesions in the menstrual phase. We found that scar endometriosis lesions did not have a significant difference in terms of B-mode US, CDUS and SEL in menstrual and ovulatory phases. What are the implications of these findings for clinical practice and/or further research? Our findings suggest that there is no need to evaluate the patient in a specific menstrual phase.

Validation of testicular workup for ischemia and suspected torsion score in patients with acute scrotum

The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score was created to help physicians in the clinical evaluation of acute scrotum in which testicular torsion (TT) is suspected. There have been only a few reports on validation of the TWIST score since the original study was published. To validate the TWIST score as a scoring system. We reviewed the records of 106 patients with acute scrotum in our prospectively maintained database. The patients were divided into two groups by the final diagnosis: testicular torsion (group TT) or non-testicular torsion (group NTT). We retrospectively calculated the TWIST score of the patients. Patients were divided into low (0-2), intermediate (3-4), or high (5-7) risk groups according to the total score. Fifteen patients (14%) had TT. The median age at presentation was 13.3 years (range 1.6-16.2) in group TT and 10.4 years (range 0.25-18.9) in group NTT, respectively. The sensitivity of clinical and Color Doppler ultrasonography (CDUS) findings to diagnose TT was 100%, whereas the specificity was 93.4%. Positive predictive value (PPV) and negative predictive value (NPV) were 71.4% and 100%, respectively. According to the calculated TWIST score, 65, 23, and 18 patients belonged to low, intermediate, and high risk groups, respectively. TT was found in 1(1.3%), 3(13%), and 11 (61%) patients of low, intermediate, and high risk groups, respectively. The NPV of the TWIST score for the low risk group was 98.5%, whereas the PPV of the TWIST score for the high risk group was 61.1%. Among the four patients with TT in low risk and intermediate risk groups, three patients presented to our institutions within 6h after the onset. The torsion was 180° in two of the three patients. The TWIST score can be useful for clinical diagnosis of testicular torsion, but is inferior to clinical findings along with CDUS. We should consider the possibility that a TWIST score could be underestimated when patients present with acute scrotum immediately after onset or the affected testis is mildly twisted.

“Comparison the Amniotic Fluid Index (AFI) Obtained with Gray-Scale Ultrasound and Color Doppler”

This cross sectional study was done to find out the correlation between gray scale &amp; color Doppler sonographic finding of amniotic fluid index, in the department of Radiology &amp; Imaging, Mymensingh Medical College &amp; Hospital from July 2012 to June 2014. Total 120 pregnant women ages in between 18-40 yrs with gestational age between 28 to 40 weeks from OPD or indoor patient was purposively selected. Statistical analysis was done by using SPSS version 20 windows &amp; the significant differences were measured by paired t test &amp; Kappa test for evaluation of AFI in both gray scale &amp; color Doppler Ultrasonography findings. The mean AFI in case of gray scale was 12±4.6 cm (mean±SD) varied from 3.7-38 cm &amp; 10.2±4.4 cm (mean±SD) varied from 2.6-35 cm measured by color Doppler. The mean difference was 1.8±1.2 cm varied from 0-10 cm. The mean AFI was significantly higher (p&lt; 0.05) in gray scale. The level of agreement in 75.8% and comparison of the results shows significant but reliable difference between two modalities. Also a significant positive correlation (r=0.915, p&lt;0.001) was found. So color Doppler Ultrasonography also enhances the detection of oligohydramnios and help in the management of high risk pregnancy.

Sonoelastography findings of the patellar tendon in Osgood-Schlatter disease

Objectives: There are ultrasonographic findings defined in Osgood-Schlatter disease. However, sonoelastographic findings of the disease have not been previously defined. The aim of this study was to evaluate the B-mode ultrasonography (US), Color Doppler ultrasonography (CDUS), and sonoelastography (SEL) findings of the patellar tendon in patients with Osgood-Schlatter disease (OSD) and compare it with healthy individuals. Methods: A total of 36 patellar tendons were evaluated in 12 patients with OSD and 10 healthy individuals by US, CDUS, and SEL. Thickness, echogenicity, CDUS, and SEL findings of the distal patellar tendon in each group were evaluated. Results: A total of 22 individuals (19 males, 3 females) and 36 tendons (9 with acute OSD, 7 with chronic OSD and 20 control healthy tendons) were included in this study. The patellar tendons were statistically significantly thicker in OSD patients in comparison with healthy volunteers (5.68±2.32 mm versus 3.42±0.55 mm) (p=0.001). According to the SEL evaluation, all of the patellar tendons in patients with OSD were of type 2 in contrast with all of the patellar tendons in healthy volunteers were of type 1 (p&lt;0.001). Conclusion: Distal patellar tendon in patients with OSD was thicker and softer in comparison with healthy volunteers. The intratendinous and/or peritendinous vascularity on CDUS was increased in patients with acute OSD. We suggest that these findings could be associated with tendon degeneration in OSD patients and can be useful in the evaluation of the disease.

Evaluation of portal venous system in post splenectomised beta-thalassemic children: A prospective study in a tertiary care hospital

BackgroundSplenectomy is a palliative management technique in children with β-thalassemia. Portal thrombosis is the most dreaded complication after splenectomy that requires fast diagnosis, effective therapy, and good follow-up to prevent protal hypertension. Thus, there is the importance of constant evaluation of portal venous system through Color Doppler Ultrasound. This cohort study aimed to observe the changes in the portal venous system in post-splenectomised β-thalassemic children. Material and methodsThis is a prospective observational cohort study carried out on all the pediatric patients who have undergone splenectomy in Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh from 2017 to 2019 for β-thalassemia. The color doppler of the portal venous system was done within the 7th to 10th post-operative day and after 3 months. Outcomes like mean the caliber of the portal vein, mean velocity within the portal vein, and color Doppler findings like Portal Vein Thrombosis (PVT) and Pathological change in Mean Volume (PMV) were calculated and compared in two headings: pre-operative period and postoperative period (7–10 POD and 3 months) with the help of paired t-test. ResultsTwenty-Eight β-thalassemia patients with a mean age of 10.43 ± 3.91 years planned to undergo splenectomy were included in our study. The pre-operative mean caliber and mean velocity of the portal vein were not statistically significant when compared after the postoperative period (7–10 POD and 3 months). But, continuous changes in portal vein were seen that could lead to normalization or pathological changes. ConclusionThere are physiological and pathological changes in portal vein following splenectomy that could lead to varied complications like portal vein thrombosis and portal hypertension. Color Doppler Ultrasound findings along with close follow-up help in minimizing the pathological changes and complications.

The ultrasound elastography findings in lateral epicondylitis in comparison with healthy individuals

Objectives: To evaluate the ability of strain sonoelastography (SEL) in diagnosing lateral epicondylitis (LE) and to asses clinical and diagnostic efficacy of strain SEL in patients with clinically confirmed LE and in healthy volunteers. Methods: Strain SEL was performed on 110 patients with clinical symptoms of LE and on 56 healthy participants. The common extensor tendon (CET) was evaluated with gray-scale and color Doppler ultrasonography (CDUS). The stiffness and the elasticity of the CET was divided into 2 main types and 2 subtypes as a spectrum ranging from hard for 1a to soft for 2b. Results: The thickness of the CET in patients with LE (6.3±1.06 mm) were remarkably thicker than in healthy participants (3.8±0.62 mm) (p&lt;0.001). There were negative significant correlations between the thickness of the CET and lower and mean strain ratios (SR) (rs= [–0.666], p&lt;0.001 for lower SR and rs= [–0.358], p&lt;0.001 for mean SR). Thickness of the CET varied between the groups of elastographic patterns (p&lt;0.001). The SR of tendon in patients with LE (6.68±2.49 mm) were remarkably lower than in healthy participants (11.16±4.88 mm) (p&lt;0.001). The SR of tendon in patients with LE also varied significantly between the groups of elastographic patterns (p&lt;0.001). Conclusion: Strain SEL is a promising sonographic technique for musculoskeletal imaging to differentiate thickening and softening of CET in LE. SR and SEL pattern findings are compatible with gray scale ultrasound and CDUS findings.

Basilar artery flow characteristics and color Doppler sonography findings in healthy infants

Aim: Transcranial​ ​Doppler​ ​(TCD)​ is a widely used method for the evaluation of vertebrobasilar system. There is not neither a consensus nor significant number of publications about normal spectral Doppler waveform and resistance index (RI), peak systolic velocity (PSV), and end diastolic velocity (EDV) values of basilar artery (BA). We aim to define normal PSV, EDV, RI values of BA via TCD in healthy infants. &#x0D; Material and Method: BA was evaluated from anterior fontanelle by creating sagittal and coronal images. Color doppler ultrasonography (CDUS) and spectral Doppler examinations were performed by placing the cursor in the middle portion of BA. PSV, EDV, and RI values were recorded. Patients were divided into 4 subgroups to analyze the change of normal values according to age groups: (1) 0-120 days, (2) 121-180 days, (3) 181-270 days, (4) &gt;271 days.&#x0D; Results: 115 healthy infants were included into the study. A weak positive correlation was found between PSV, EDV values and age; meanwhile a weak but significant negative correlation was present between age and RI values. We cannot find any correlation between sex and CDUS parameters. &#x0D; Conclusion: BA PSV, EDV and RI values change by age. No correlation is present between CDUS characteristics and sex. BA pathologies are rare in pediatric population, nevertheless knowing normal CDUS characteristics can help radiologists for an appropriate assessment.

Role of Sonoelastography for Differentiating Benign and Malignant Cervical Lymph Nodes: A Cross-sectional Study

Introduction: Cervical nodes form one of the major groups of Lymph Nodes (LN) that are frequently involved in inflammatory and neoplastic diseases. Metastasis causes the most apparent change in consistency of the node among the various nodal pathologies. Ultrasound elastography provides an estimate of tissue consistency by measuring the degree of distortion under the application of an external force. Aim: To estimate the diagnostic accuracy of sonoelastography in the differentiation of malignant and benign cervical LN with fine needle aspiration cytology/biopsy considered as a gold standard. Materials and Methods: A cross-sectional study was carried out from March 2020 to January 2021 in a tertiary care hospital in south India, a total of 50 patients with cervical lymphadenopathy underwent ultrasonography followed by elastography of superficial neck LN using high frequency linear transducer by freehand technique. The ultrasound characteristics of selected LN were determined and colour elastogram pattern was assessed using colour mapping elastography. The chi-square test was performed. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were obtained. The results were then compared to the fine needle aspiration cytology. Results: A total of 50 subjects(median age of 40.5±18.71 years ; 19 (38%) males and 31 (62%) females). The grayscale and colour Doppler features of cervical LN which helped predict malignancy were short axis ≥8 mm, S:L axis ratio ≥0.5, absence of normal central fatty hilum, abnormal echogenicity, lobulated border, presence of calcification and peripheral/mixed vascularity. With reference to the above variables of cervical LN characterisation on grayscale, colour doppler ultrasound and sonoelastography findings, elastography pattern was the most promising variable to differentiate malignant from benign cervical LN with 95.2% sensitivity, 75.0% specificity, 95.2% PPV, 75.0% NPV and 92.0% accuracy. Conclusion: Sonoelastography is useful in the assessment of elastic properties of cervical LN with short examination time required, real-time display, immediate interpretation and limited cost. Sonoelastography had higher diagnostic accuracy than gray scale and doppler ultrasound in differentiating benign from malignant cervical LN. Sonoelastography is an effective supplement to conventional gray scale and colour doppler ultrasound and that the combination is clinically recommended for a more accurate diagnosis of metastatic LN.

The diagnosis and treatment of retrograde intussusception: a single-centre experience

Background/PurposeTo investigate the clinical manifestations, treatments of retrograde intussusception and summarize the experience.MethodsChildren with retrograde intussusception treated in our hospital from January 2011 to January 2021 were retrospectively analysed. Demographics, clinical manifestations, preoperative colour Doppler ultrasound (CDU) findings, findings during surgery and follow-up results were collected.ResultsA total of 4719 cases of intussusception were treated in our department, including 12 cases of retrograde intussusception (0.25%). There were 8 males and 4 females.The age ranged from 4.1 to 14.3 months, with an average of (8.3 ± 2.8) months.; The weight ranged from 5.5 to 12.6 kg, with an average of (9.4 ± 2.3) kg; The onset time ranged from 6 to 15 h, with an average of (10.0 ± 2.4) h. All the children received CDU examination before surgery, and in one case, the possibility of 2 intussusception masses was considered. Emergency surgical exploration was performed after the failure of air enema reduction. During the operation, multiple types of intussusception were found (coincidence of anterograde and retrograde intussusception). The pattern of anterograde intussusception was all ileo-ileo-colic variety and the retrograde intussusception was proximal sigmoid colon into descending colon. All the children were successfully reduced by manual reduction without intestinal necrosis or intestinal malformation. All children were discharged 6–7 days after surgery, and had no recurrence after 3–6 months of follow-up.ConclusionsRetrograde intussusception is easily misdiagnosed before surgery. During air enema, if the intussusception mass was fixed and did not move with increasing pressure, we should be aware of the possibility of retrograde intussusception, and the enema pressure should not be too large to avoid intestinal perforation. If the intraoperative position of the intussusception mass was not consistent with that of the preoperative enema, it was recommended to use bimanual examination to explore whether there was still a mass in the abdominal cavity to avoid misdiagnosis.

Correlation of N-Ras Gene Expression in Hepatocellular Carcinoma with Color Doppler Ultrasound Findings

Objective: This study aims to study the N-ras gene expression in hepatocellular carcinoma (HCC) and its correlation with color Doppler imaging manifestations. Methods: The tumors of 145 HCC patients were evaluated via color Doppler ultrasonography before operation and N-ras level in tissue specimens obtained after operation were detected via RT-PCR, Western blotting and immunohistochemistry along with correlation analysis. Results: N-ras mRNA in para-carcinoma tissues was significantly reduced compared with carcinoma tissues (P &lt; 0.05). Western blotting and immunohistochemistry showed a significant difference of N-ras protein level between para-carcinoma tissues and carcinoma tissues (P &lt; 0.05). Moreover, N-ras gene expression was siginificantly correlated with the number of tumor nodules, the integrity of tumor capsule, vascular invasion, blood flow classification, RI (P &lt; 0.05). Conclusion: Our data demonstrate the elevation of N-ras in the carcinoma tissues of HCC patients and its correlation with color Doppler imaging manifestations, which lays foundation for the development of the diagnosis of hepatocellular carcinoma.

Associations of serum soluble klotho and fibroblast growth factor 23 with carotid artery calcification in patients undergoing continuous ambulatory peritoneal dialysis: A retrospective study.

This study aimed to assess the associations of serum soluble klotho and fibroblast growth factor 23 (FGF-23) with the occurrence of carotid artery calcification. Peritoneal dialysis patients treated from June 2018 to June 2019 were retrospectively analyzed. They were divided into the carotid artery calcification and non-carotid artery calcification groups according to color Doppler ultrasound findings. Basic indicators in both groups were compared, and the influencing factors of carotid artery calcification were analyzed by logistic regression. Among the 73 continuous ambulatory peritoneal dialysis (CAPD) patients enrolled, 40 (54.8%) had carotid artery calcification. Significant differences were found in age (68.85 ± 7.45 vs 46.62 ± 5.51 years), dialysis time (8.15 ± 1.42 vs 6.02 ± 1.14 months), klotho amounts (325.56 ± 41.15 vs 436.65 ± 45.58 pg/mL) and FGF-23 levels (114.45 ± 15.56 vs 70.15 ± 12.23 pg/mL) between the carotid artery calcification and non-carotid artery calcification groups (all P < .001). The above factors were associated with carotid artery calcification occurrence in univariate analysis. Multivariate analysis showed that elevated age (odds ratio [OR] = 1.55, 95% confidence interval [CI] 1.13–1.74; P = .025) and FGF-23 (OR = 2.16, 95% CI 2.01–2.44; P = .042), and lower klotho (OR = 0.66, 95% CI 0.47–0.85; P = .036) were independent risk factors for carotid artery calcification in CAPD. Serum FGF-23 and age are risk factors for carotid artery calcification in patients with CAPD, whereas klotho is a protective factor.

Color Doppler ultrasonography findings of vertebral arteries: A correlation with 64-slice CTA

Background/Aim: Although normal Color Doppler US (CDU) findings of the carotid system were described by many studies, normal findings of the vertebral system have not been studied extensively. This study aimed to evaluate vertebral artery CDU hemodynamic and morphologic findings in patients with normal vertebral arteries (VAs) on 64-slice Computed Tomography Angiography (CTA) and investigate the correlation between RDUS and CTA in evaluating the VA anatomy. Methods: In this retrospective cohort analysis, the patients referred to our radiology department for CTA who had normal VA anatomy underwent a CDU for visualization of the orifice and segments (V1-V2) of the VA. Peak systolic velocity (PSV), and end-diastolic velocity (EDV) were measured in V1 while PSV, EDV were measured and resistive index and FV were calculated in V2. The presence of hypoplasia and dominance were noted. Results: A total of 77 patients who had normal vertebral arteries on CTA were included in this study. CDU findings were highly consistent with multislice CTA findings regarding the measurement of VA diameter (ICC=0.856, ICC=0.830), hypoplasia (kappa=0.488), and dominance (kappa=0.752). No consistency was found between the two modalities in the visualization of the orifice and V1 segment of the VAs on both sides. CTA was able to show the orifice and the V1 segment in all cases, while the success rate was lower in CDU, especially in terms of visualizing the orifice of VA. VA FV was not significantly different between the patients with and without vertebrobasilar insufficiency (P=0.300). Conclusion: CDU findings were consistent with 64-slice CTA findings in VA diameter measurement and the diagnosis of hypoplasia and dominance. However, CTA is more successful than RDUS in evaluating the vertebral artery orifice and V1 segment, the most common sites of atherosclerotic involvement. There was no significant difference between the patients with and without VBI symptoms in evaluating FV.