Color Doppler Ultrasound Findings Research Articles

Evaluation of calcific tendonitis of the rotator cuff: role of color Doppler ultrasonography.

To use color Doppler ultrasonography to evaluate the morphology and vascularity of calcific tendonitis and to predict the formative and resorptive phases of the calcification. Ninety-four patients with shoulder calcification on plain radiographs were enrolled in this study. Ultrasonography of the shoulder was focused on the rotator cuff. Color Doppler ultrasonography was applied in the calcific region. Patient symptoms were graded as painless, mild, moderate, and severe. The calcific plaques were classified as arc-shaped, fragmented or punctate, nodular, and cystic types. Color Doppler ultrasonographic signals were graded 0 to 3. The formative and resorptive phases of calcification were categorized by patient symptoms; acute onset of moderate or severe pain indicated the resorptive phase. The calcific plaques appeared arc shaped in 59 patients (20 painless, 19 mild, and 20 moderate), fragmented or punctate in 27 (2 painless, 3 mild, 20 moderate, and 2 severe), nodular in 6 (1 moderate and 5 severe), and cystic in 2 (severe). There was a significant difference between the morphology of the calcific plaques and clinical symptoms (P < .01). On color Doppler ultrasonography, grade 0 signals were found in 28 patients (22 painless and 6 with mild pain); grade 1 in 18 (16 mild and 2 severe); grade 2 in 41 (all moderate); and grade 3 in 7 (all severe). The correspondence between color Doppler ultrasonographic findings and clinical symptoms was excellent (P < .01). High-resolution ultrasonography with color Doppler imaging could differentiate the formative and resorptive phases of the calcification and could be used as a follow-up modality in calcific tendonitis of the shoulder.

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

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. 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. 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). 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.

Application of transarterial embolization of renal artery in rabbits with experimental hydronephrosis.

This study was performed to validate the procedure of transarterial embolization of the renal artery (TAE-RA) using iohexol-ethanol solution in rabbits with unilateral experimental hydronephrosis and to evaluate the embolized kidney and contralateral normal kidney using B-mode ultrasonography and color Doppler ultrasonography. Experimental hydronephrosis was induced at 17 days after ligation of unilateral ureter in 13 rabbits. Renal artery embolization was performed using selective catheterization in the hydronephrotic kidney of eight rabbits and electrocardiography, oxygen saturation, body temperature, pulse, and respiratory rate were within normal ranges during procedures. Iohexol-ethanol solution was used as embolic material. Average ethanol dose for renal artery embolization was 1.4 +/- 0.7 ml/kg. There were no rabbits expired after TAE-RA and no side effects associated with regurgitation of iohexol-ethanol solution. In color Doppler ultrasonographic findings, there was no blood flow into the embolized kidneys treated by TAE-RA, however, blood flow signal was found in hydronephrotic kidney not treated by TAE-RA. Ultrasonographically, the mean longitudinal length of the embolized kidney significantly decreased at 2 and 3 months after TAE-RA. No significant difference of resistive index values was found between contralateral normal kidney of rabbits treated by TAE-RA and contralateral normal kidneys of rabbits treated with nephrectomy. We may conclude that TAE-RA with iohexol-ethanol solution is a viable alternative to nephrectomy in rabbits with unilateral hydronephrosis.

Gray‐scale and color Doppler sonographic findings in intratesticular varicocele

Purpose We studied the gray-scale and color Doppler sonographic findings in intratesticular varicoceles in 7 testes in 5 patients. Methods The study group comprised 5 infertile men referred for scrotal sonography and found to have intratesticular varicocele. Patients were examined at rest and during Valsalva's maneuver in supine and standing positions. A diagnosis of intratesticular varicocele was made when intratesticular veins visible on gray-scale sonography showed retrograde flow on color Doppler sonography either spontaneously or during Valsalva's maneuver. The maximum diameter of dilated intratesticular veins and the predominant site of venous dilatation (mediastinum testis versus subcapsular) were recorded. Results Seven testes in 5 patients harbored visibly enlarged intratesticular veins that showed retrograde flow either spontaneously or during Valsalva's maneuver. The condition was bilateral in 2 patients and left-sided in 3 patients. The largest intratesticular vein measured less than 2.0 mm in diameter in 3 testes and was 2.0 mm or larger in 4 testes. In all affected testes, there was some degree of subcapsular venous dilatation, which in 3 testes was even more prominent than venous dilatation in the mediastinum testis. All intratesticular varicoceles were accompanied by extratesticular varicoceles. Conclusions A threshold value of 2.0 mm seems inadequate for the diagnosis of intratesticular varicocele because obviously variceal venous structures with retrograde flow on color Doppler sonography may be smaller than 2.0 mm in diameter. Contrary to the previous descriptions of the entity, subcapsular veins may be affected to a greater degree than mediastinal veins in intratesticular varicocele. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:369–373, 2001.

High-resolution and color Doppler ultrasonography of cervical lymphadenopathy in children.

To assess the frequency of high-resolution and color Doppler sonographic findings in the most common diseases of childhood manifested with cervical lymphadenopathy at initial presentation. High-resolution and color Doppler US were performed in 103 and 43 children respectively, with cervical lymphadenopathy at initial presentation. Sonomorphology and intranodal vascularity were assessed. Final diagnoses, based on biopsy or clinical and sonographic follow-up, included: Reactive hyperplasia (n=34), infectious mononucleosis (n=20), lymphoma (n=11), bacterial (n=28), tuberculous (n=5) and cat-scratch disease (CSD, n=5) lymphadenites. Round shape (L/S<2) was common both in lymphoma (78%), infectious mononucleosis (85%) and bacterial lymphadenitis (73%) while 91% of reactive nodes had L/S>2. Wide hilum conforming to nodal shape characterized reactive hyperplasia (94%) and infectious mononucleosis whereas absent or narrow hilum was frequent in lymphoma (100%) and bacterial lymphadenitis (60%). Central irregular hyperechogenic areas, blurred margins and central necrosis were most frequent in bacterial, tuberculous and CSD lymphadenites. On color Doppler US, hyperplastic nodes more frequently exhibited a solitary hilar vessel (48%), whereas infectious mononucleosis nodes had a central radial pattern (75%). Bacterial lymphadenitis presented with a variety of vascular patterns. Although individual sonographic signs are not specific, the categorization and combination of findings might be highly suggestive of diagnosis of the underlying disease presenting with cervical lymphadenopathy.

High-resolution and color doppler ultrasonography of cervical lymphadenopathy in children

Purpose: To assess the frequency of high-resolution and color Doppler sonographic findings in the most common diseases of childhood manifested with cervical lymphadenopathy at initial presentation. Material and Methods: High-resolution and color Doppler US were performed in 103 and 43 children respectively, with cervical lymphadenopathy at initial presentation. Sonomorphology and intranodal vascularity were assessed. Final diagnoses, based on biopsy or clinical and sonographic follow-up, included: Reactive hyperplasia (n=34), infectious mononucleosis (n=20), lymphoma (n=11), bacterial (n=28), tuberculous (n=5) and cat-scratch disease (CSD, n=5) lymphadenites. Results: Round shape (L/S&lt;2) was common both in lymphoma (78%), infectious mononucleosis (85%) and bacterial lymphadenitis (73%) while 91% of reactive nodes had L/S&gt;2. Wide hilum conforming to nodal shape characterized reactive hyperplasia (94%) and infectious mononucleosis whereas absent or narrow hilum was frequent in lymphoma (100%) and bacterial lymphadenitis (60%). Central irregular hyperechogenic areas, blurred margins and central necrosis were most frequent in bacterial, tuberculous and CSD lymphadenites. On color Doppler US, hyperplastic nodes more frequently exhibited a solitary hilar vessel (48%), whereas infectious mononucleosis nodes had a central radial pattern (75%). Bacterial lymphadenitis presented with a variety of vascular patterns. Conclusion: Although individual sonographic signs are not specific, the categorization and combination of findings might be highly suggestive of diagnosis of the underlying disease presenting with cervical lymphadenopathy.

Ultrasound of renal tumors.

Despite the limitations of US in providing a complete evaluation of renal tumors before treatment planning, initial screening, characterization of renal masses and staging of RCCs can benefit from some recent advances of the technique. One of the most relevant clinical benefits of US is the increased early detection of RCCs. Recent technical improvement of gray-scale imaging has increased US performance in the detection of small renal tumors. Combined gray-scale and color Doppler US findings may strongly suggest the histopathologic nature of a renal tumor with respect to the size, the US attenuation characteristics, and the vascular distribution of the lesion. Ultrasound contributes additional diagnostic information for differential diagnosis of some renal masses that remain equivocal at CT, including: atypical cystic lesions; solid renal tumors with poor vascularity; and angiomyolipomas with minimal fat component. Ultrasound also may provide additional diagnostic information over CT in selected cases of RCCs with venous invasion. In addition to some diagnostic and therapeutic procedures that can benefit from US guidance, intraoperative US remains the only available tool that enables to ensure renal-parenchymal-sparing surgery.

Gray-scale and color Doppler sonographic findings in intratesticular varicocele.

We studied the gray-scale and color Doppler sonographic findings in intratesticular varicoceles in 7 testes in 5 patients. The study group comprised 5 infertile men referred for scrotal sonography and found to have intratesticular varicocele. Patients were examined at rest and during Valsalva's maneuver in supine and standing positions. A diagnosis of intratesticular varicocele was made when intratesticular veins visible on gray-scale sonography showed retrograde flow on color Doppler sonography either spontaneously or during Valsalva's maneuver. The maximum diameter of dilated intratesticular veins and the predominant site of venous dilatation (mediastinum testis versus subcapsular) were recorded. Seven testes in 5 patients harbored visibly enlarged intratesticular veins that showed retrograde flow either spontaneously or during Valsalva's maneuver. The condition was bilateral in 2 patients and left-sided in 3 patients. The largest intratesticular vein measured less than 2.0 mm in diameter in 3 testes and was 2.0 mm or larger in 4 testes. In all affected testes, there was some degree of subcapsular venous dilatation, which in 3 testes was even more prominent than venous dilatation in the mediastinum testis. All intratesticular varicoceles were accompanied by extratesticular varicoceles. A threshold value of 2.0 mm seems inadequate for the diagnosis of intratesticular varicocele because obviously variceal venous structures with retrograde flow on color Doppler sonography may be smaller than 2.0 mm in diameter. Contrary to the previous descriptions of the entity, subcapsular veins may be affected to a greater degree than mediastinal veins in intratesticular varicocele.

Color Doppler and duplex sonography in 5 patients with thoracic outlet syndrome.

To evaluate the use of color Doppler sonography in the diagnosis of thoracic outlet syndrome. We studied color Doppler sonographic findings in 5 clinically suspected cases of thoracic outlet syndrome. The subclavian artery and vein were studied in varying degrees of abduction to assess the severity of the syndrome. Significant changes, i.e., stages of increased velocities, preocclusion, and occlusion in the subclavian artery in varying degrees of abduction, were noted in 4 of 5 cases. Blunted flow in the axillary artery (4 patients) and a rebound increase in velocities on release of abduction were noted in 3 patients. These changes suggested that significant narrowing was causing symptoms. Color Doppler sonography is a noninvasive, effective method compared with digital subtraction angiography in the diagnosis of thoracic outlet syndrome.

Urachal remnants in asymptomatic children: gray-scale and color Doppler sonographic findings.

We undertook this study to evaluate the frequency of visualization and the sonographic appearances of urachal remnants (URs) in asymptomatic children. One hundred eighty-two children without any urachus-related symptoms underwent sonography of the prevesical region and urinary bladder with high-frequency transducers. A UR was visualized in 180 (99%) of the children. The URs had a mean length +/- standard deviation of 13 +/- 5 mm. Most of the URs were ovoid, and most demonstrated a moderate protrusion into the bladder cavity. The URs with a central echogenic area were larger than those without central echogenicity. In 36 (61%) of the 59 URs that were evaluated with color Doppler sonography, vascular signals were demonstrated within the lesion. The URs with internal vascular signals were significantly larger than those without internal vascular signals. The gray-scale and color Doppler sonographic characteristics of URs seem to be related to their size and their degree of involution rather than to the age of the child. We think that URs are present in almost all children. URs should be considered normal findings if they are asymptomatic and their length is not significantly greater than 22.5 mm, the 95th percentile in our study.

Ovarian sclerosing stromal tumors: gray scale and color Doppler sonographic findings.

Sclerosing stromal tumors are rare benign ovarian stromal tumors, which have distinctive clinical and pathologic features. The tumors occur predominantly in the second and third decades and are histologically characterized by the pseudolobular pattern of the cellular and hypocellular areas, marked vascularity, and heterogeneity of the cellular area. We analyzed 7 cases of sclerosing stromal tumors, which showed a typical sonographic appearance. On sonograms, sclerosing stromal tumors were solid and cystic and contained multiple round or cleftlike cysts. Ascites was rare. On transvaginal color Doppler sonograms, sclerosing stromal tumors were very hypervascular in the peripheral solid area and internal intercystic space and showed low-impedance flow. We conclude that sclerosing stromal tumors should be considered in young women with menstrual irregularity who have hypervascular solid and cystic adnexal masses.

THE PREDICTION OF PAPAVERINE INDUCED PRIAPISM BY COLOR DOPPLER SONOGRAPHY

We identified color Doppler sonography findings that are useful for predicting priapism in patients after the intracavernous injection of diagnostic papaverine. We evaluated 72 men with erectile dysfunction by color Doppler sonography after the diagnostic injection of papaverine. Cavernous artery waveforms were recorded, and peak systolic and diastolic velocity of the recorded waveforms was measured. In cases of priapism color Doppler sonography findings were retrospectively evaluated to identify any finding that would predict priapism. Priapism was observed in 8 of the 72 patients (11.1%). In 6 of 8 priapism cases there was no blood flow in the cavernous artery during or after adequate erection, including after minutes 5, 10 and 20 in 3, 1 and 2, respectively. This absence of encoding was not relieved even after all stimuli were removed. In 2 patients who later presented with complaints of priapism the Doppler study was completed normally and all parameters were acquired without any cessation of blood flow in the cavernous artery. The persistent disappearance of color and pulse encoding in the cavernous artery predicted priapism with 75% sensitivity, 100% specificity, a positive and negative predictive value of 100% and 96.9%, respectively, and 97% accuracy. The persistence of absent blood flow in the cavernous artery even after the elimination of all stimuli during penile color Doppler ultrasound is a reliable predictor of priapism. The finding is accurate enough to initiate treatment for priapism to avoid further delay.

Post‐traumatic intrasplenic pseudoaneurysms with delayed rupture: Color Doppler sonographic and CT findings

Post‐traumatic intrasplenic pseudoaneurysms with delayed rupture: Color Doppler sonographic and CT findings

Color and pulsed Doppler ultrasound findings in normally functioning transjugular intrahepatic portosystemic shunts

Objective: To evaluate blood flow changes inside normally functioning transjugular intrahepatic portosystemic shunts (TIPS), using color Doppler ultrasound (CDUS) and pulsed Doppler ultrasound (PDUS). Methods: A total of 72 patients (mean age 54, range 36–78 years) underwent TIPS placement, portal angiography, CDUS and PDUS examinations. Measurements inside the stent were taken at the portal side, at the central part and at the venous end of the TIPS. Results: In well functioning TIPS the mean peak velocity (PV) on the portal side was 37 m/s (range 22–65 cm/s), in the area of the incoming intrahepatic portal branch the mean PV was 59 cm/s (range 40–95 cm/s) and at the side of the incoming hepatic vein the mean PV was 135 cm/s (range 88–220 cm/s). In the punctured hepatic and portal veins the mean PV was 25 cm/s (range 15–30 cm/s) and 18 cm/s (10–22 cm/s), respectively. The flow increase from the portal to the mid part ( P≤0.001) and to the venous side was statistically significant ( P≤0.001). Conclusion: A velocity gradient between the portal and the venous side of a TIPS is a normal finding caused by branches of the portal and hepatic vein joining the TIPS from the side and it is characteristic of a normally functioning TIPS.

Prognosis of Ischemic Colitis

The objective of this study was to compare the value of color Doppler sonography with early clinical and laboratory findings in determining the prognosis of patients with ischemic colitis. We reviewed the early clinical, laboratory, and color Doppler sonographic data of 24 patients with ischemic colitis. The patients were divided into two groups on the basis of their outcome. The first group comprised the patients with transient ischemia who recovered uneventfully, and the second group included the patients who needed surgery because of symptomatic transmural colic gangrene or colic stricture. Clinical data and laboratory values were compared with color Doppler sonographic findings including colic wall thickness, presence of stratification, and arterial flow in the bowel wall. At univariate analysis, increased age (p = 0.007), leukocyte count (p = 0.030), lactate dehydrogenase level (p = 0.030), blood lactate level (p = 0.041), and absence of vascular flow in the colic wall (p<0.001) were significantly related to complicated ischemic colitis. At multivariate analysis, absence of arterial flow was the only significant predictor of complicated ischemic colitis (p = 0.002), with a sensitivity of 82%, a specificity of 92%, a positive predictive value of 90%, and a negative predictive value of 86%. Absence of arterial flow in the wall of the ischemic colon on initial color Doppler sonography is suggestive of an unfavorable outcome and is more closely associated with outcome than early clinical and laboratory findings.

Power Doppler sonography in the diagnosis of Graves’ disease

In addition to color and pulsed Doppler sonography findings, we aimed to describe power Doppler sonography findings in Graves’ disease in this study. Twenty-three patients with Graves’ disease were imaged with gray-scale, color and power Doppler sonography. Twenty normal volunteers were examined by the same equipment and the same technique as a control group. A subjective grading system was used to categorize the vascularization in pulsed Doppler sonography images from normal to markedly increased vascularization. Power Doppler sonography exhibited diffuse hypervascularity in the thyroid gland in all patients. The flow was covering about all the parenchyma. Four patients showed mild, 12 patients moderate and seven patients marked vascularity. The intensity of power Doppler flow pattern was not correlated with the severity of the disease. This study demonstrated that power Doppler sonography is a convenient, time saving, inexpensive and noninvasive method as compared with isotope scan and some other laboratory tests for confirmation of Graves’ disease.

Hereditary haemorrhagic teleangiectasia: hepatic lesions demonstrated with colour Doppler and power Doppler sonography

Visceral vascular abnormalities in patients with hereditary haemorrhagic teleangiectasia (HHT) include teleangiectasis, arteriovenous fistula (AVF), and aneurysms. Sonographic findings and colour Doppler ultrasound (CDU) features of HHT in the liver have been described in a few reports. Presented here is the CDU finding of liver with HHT involvement in two patients, aged 52 and 29 years, respectively. Power Doppler sonography was also performed in the first patient in whom both CDU and power Doppler sonography could demonstrate the abnormal vascular channels in the liver. In the second patient, aneurysms in the left hepatic lobe and of the splenic artery were noted. Angiography was performed in both patients and confirmed the abnormal vascular lesions demonstrated by CDU and/or power Doppler sonographic findings.

Haemodynamic evaluation of the first trimester fetus with special emphasis on venous return.

Knowledge of the fetal circulation is a prerequisite for understanding the physiological behaviour of the developing fetus. In this overview dealing with Colour and Power Doppler ultrasound findings in the first trimester of pregnancy and its pathophysiological background, we aim to report on the methodological aspects, normal blood flow waveform patterns, normal reference values for haemodynamic parameters and potential clinical applications for both arterial and venous flow information (umbilical artery, descending aorta, middle cerebral artery, umbilical vein, inferior vena cava, ductus venosus) and atrioventricular valves. Particular emphasis is devoted to the venous return to the heart. Alterations in venous waveforms, particularly in the ductus venosus, are correlated with the pathophysiology of some fetal diseases and are suggested as a promising tool for the screening of cardiac impairment and as an alternative method for fetal biophysical surveillance.

Pulsed Wave and Color Doppler US Findings of Transjugular Intrahepatic Portosystemic Shunts (TIPS)

The transjugular intrahepatic portosystemic shunt (TIPS) is an effective and relatively safe and widely accepted treatment for complications arising from portal hypertension. Shunt or hepatic vein stenosis and shunt occlusion are common short- and medium-term complications arising from the procedure, though if detected early, these conditions may be treated before the recurrence of gastrointestinal bleeding or ascites. Doppler US is a relatively inexpensive, accurate, and noninvasive method for the evaluation of shunt status.

Using a logistic regression model to predict ovarian malignancy based on gray-scale and color doppler ultrasound findings combined with angiogenic cytokines serum levels

Using a logistic regression model to predict ovarian malignancy based on gray-scale and color doppler ultrasound findings combined with angiogenic cytokines serum levels