Color Doppler Ultrasound Research Articles

Impact of ovulation inducers on ovarian artery in mares: pulsatility and resistivity indexes

A failure of vascular development in reproductive organs may be the cause of several dysfunctions during the estrous cycle and gestation. Therefore, it is important to evaluate the in vivo influences of ovarian vaso- irrigation on ovulation. The ovarian follicles need an adequate blood supply for oxygen, nutrients, and hormones, besides eliminating CO2 and other metabolites (Bruno et al. Animal Reproduction. 2009; 6, 2:371-379). Transrectal ultrasonography (US) with color, power, and spectral Doppler US has been used to study blood flow and ovarian perfusion in mares (Acosta et al. Biology of Reproduction. 2004b; 71, 2: 502-507). Studies have shown a daily increase in vascularization of the wall of the dominant follicle as it approaches the day of ovulation (Gastal et al. Animal Reproduction Science. 2007; 102, 3-4: 314-321); However, a few hours before ovulation, an abrupt decrease in blood perfusion of the follicular wall has been detected (Ginther et al. Journal of Equine Veterinary Science. 2007a; 27, 1: 20-27). The drugs most used as ovulation inducers in horses are human chorionic gonadotropin (hCG) and analogues of gonadotropin-releasing hormone (GnRH), such as deslorelin (Chavatte & Palmer Equine Veterinary Education. 1998; 10, 26-30). Using different ovulation inducers, this study aimed to evaluate changes in ovarian arteryblood flow after induction of ovulation in mares with follicles ≥ 35mm diameter. Twenty-eight estrous cycles were followed, randomly and equally distributed: GI: control mares without treatment; GII: 1000 IU IV of hCG; GIII: 750µl IV of deslorelin; GIV: 250µg IM of hysterelin. The ovarian artery pulsatility and resistivity indexes (PI and RI) were measured. Thereafter, estrous cycles were followed every 12 hours from time 0 (induction) until ovulation using B-mode US and spectral mode Doppler US of ovarian arteries. Statistical analysis was performed with ANOVA, a p-value of <0.05 was considered significant. No statistical difference was found in PI between groups (p=0.1297) of at the different evaluation times. When the times of analysis were compared separately between the groups, no statistical difference was found between 0h (p= 0.7092), 12h (p= 0.5148), 24h (p=0.2642), and 36h (p=0.582). Similarly, the RI did not differ between the groups analyzed (p= 0.1397), regardless of the time of evaluation, nor between the timepoints analyzed separately between 0h (p= 0.5049), 12h (p= 0.7334), 24h (p=0.3589) and 36h (p=0.1621). It can be concluded that although an increase in vascularization of the wall of the dominant follicle occurred, the PI and RI of the ovarian artery were not influenced by any ovulation inducer of the pre-ovulatory follicles.

The Use of Conventional Lower-Frequency Color Doppler Ultrasound for Flap Planning in the Lower Extremity.

Handheld Doppler is often inaccurate in localization of perforators for pedicled and free flaps. Color Doppler ultrasound (CDU), in contrast, allows more accurate mapping and characterization of perforators to facilitate rapid flap harvest. Forty-seven flaps harvested from the lower extremity were evaluated preoperatively with CDU by a single surgeon with a conventional low-frequency ultrasound device (Philips Sparq, Cambridge, Mass). Flaps evaluated included profunda artery perforator flaps (n = 36), anterolateral thigh flaps (n = 2), pedicled propeller perforator flaps (n = 7), and toe transfers (n = 2). In all cases where a free profunda artery perforator or anterolateral thigh flap was used, the location of the dominant perforator visualized preoperatively correlated exactly with intraoperative findings. In cases where CDU was used preoperatively to locate a large perforator close to a lower extremity defect for reconstruction with a propeller perforator flap, all perforators could be used, and all flaps were successful. Preoperative CDU is particularly useful for flap planning where knowledge of the location of the dominant perforator is critical. This includes planning of thin and superthin free flaps, as well as freestyle perforator flaps. Our clinical experience suggests that this technology should be routinely adopted in certain aspects of reconstructive microsurgery.

Echopattern parameter as an aid to profile Crohn's disease patients

BackgroundIntestinal ultrasonography (US) allows for the characterization of the intestinal lesions and provides information on transmural inflammation. The aim of the study was to assess the clinical relevance of echopattern and correlation with Crohn's disease (CD) behavior and activity. MethodsWe performed a prospective study including CD patients assessed by intestinal US. The echopattern was classified as hypoechoic, hyperechoic and stratified. Color-doppler US was also performed in the thickest segment. ResultsOne hundred CD patients were enrolled. The hypoechoic echopattern was significantly correlated with penetrating behavior (r = 0.44, p<0.0001), active disease (r = 0.21, p = 0.034), C-reactive protein/Fecal Calprotectin (r = 0.31, p = 0.004; r = 0.34, p = 0.031, respectively) and steroids (r = 0.33, p = 0.0008). Hypoechoic echopattern was associated with younger age than stratified (p = 0.046) and hyperechoic (p = 0.018) echopatterns. Bowel wall thickness was greater in the hypoechoic group than in the hyperechoic/stratified groups (p = 0.011 and p<0.0001, respectively). Hypoechoic echopattern was associated with fistulas (r = 0.52, p<0.0001) and increased vascularization (r = 0.32, p = 0.001). The hyperechoic echopattern showed a significant correlation with stricturing disease and an inverse correlation with fistulas. During a follow up period of 6 months, patients with hypoechoic echopattern had an increased risk of biological therapy need or surgery. ConclusionsThe characterization of bowel wall echopattern allows for the identification of different CD behaviors.

(382) Trimodal Therapy for Erectile Dysfunction: Combination of Low-intensity Shock Waves, Platelet Rich Plasma (PRP) Injections and Vacuum Erectile Device Physiotherapy

Abstract Introduction Nowadays it is proved that low intensity shockwave therapy (LISW) have a positive effect in men with erectile dysfunction (ED). Platelet rich plasma (PRP) as well is used to treat ED. PRP contains many growth factors, such as IGF-1, BDNF and VEGF play a significant role in neural regeneration and up-regulation nNOS, as well as in the recovery of erectile function. Vacuum erectile device is used as physiotherapy to treat many penile disease. Objective The goal of our study is to investigate the efficacy of this trimodal treatment (Rigenerection ®) to treat ED Methods This prospective, randomized, controlled, interventional study enrolled 150 pts and randomly divided in two groups: Group A receiving LISW alone (1 weekly sessions) for 6 weeks and Group B receiving LISW + PRP (1 shot a week per 6 weeks) + Vacuum erectile device physiotherapy (15 minutes/daily per 3 months). Main outcome measures were: erectile function (evaluated through the IIEF5 questionnaire) and the peak systolic velocity (PSV) of the cavernosal artery (evaluated through color Doppler ultrasonography). Follow-up was at 3 months. The Mann-Whitney and Wilcoxon tests with a p&amp;lt;0.05 where used to analize the data. Results In both groups, at 3 months follow-up, mean IIEF score and mean PSV ameliorated significantly. Intergroup analysis revealed a statistically significant higher mean IIEF score and PSV increase in patients receiving the trimodal treatment (p&amp;lt;0.03; p&amp;lt;0.001 respectively). Group A: IIEF score from a baseline of 14.2 to 17.9 at 3 months. PSV from 24.4 +/− 12.4 at baseline to 33.8 +/− 8.2 at 3 months. Group B: IIEF score from a baseline of 13.8 to 21.4 at 3 months. PSV from 27.3 +/− 42.6 +/− 7.3 at 3 months. Conclusions The trimodal therapy proved to be a valid tool in the treatment od ED. The combination of these procedures leads to better outcomes compared with the only therapy with LISW. Disclosure No

Testicular ischemia secondary to acute epididymitis: A case report.

Rare side effects of acute epididymitis include testicular infarction and ischemia. Distinguishing them from testicular torsion is challenging, both clinically and radiologically. However, only a few such cases have been reported to date. A 12-year-old child presented with persistent right testicular pain for 3 days. It developed after trauma and was accompanied by gradual swelling and enlargement of the right scrotum, with nausea and vomiting. Scrotal color Doppler ultrasonography demonstrated right epididymitis, right scrotal wall swelling, and right testicular torsion. Routine blood tests revealed leukocyte and neutrophil counts were both above normal. Scrotal exploration revealed edema and adhesions in all layers of the scrotal wall. The right testicle was pale. The patient was diagnosed with testicular ischemia secondary to acute epididymitis. The patient underwent simultaneous lower spermatic cord sheath dissection and decompression, testicular sheath reversal, and right testicular fixation. Blood flow to the testicles gradually recovered after decompression, as did the color. Postoperatively, the patient's scrotal swelling and pain improved significantly. Despite the rarity of this condition, it is a potentially serious consequence of epididymitis and should be considered when patients experience sudden scrotal pain.

Precise evaluation of blood flow patterns in human carotid bifurcation based on high-frame-rate vector flow imaging.

To investigate the feasibility of high-frame-rate vector flow imaging (HiFR-VFI) compared to ultrasound color Doppler flow imaging (CDFI) for precisely evaluating flow characteristics in the carotid bifurcation (CB) of presumed healthy adults. Forty-three volunteers were assessed for flow characteristics and their extensions using HiFR-VFI and CDFI in CBs. The flow patterns were classified according to the streamlines in HiFR-VFI and quantitatively measured using an innovative turbulence index (Tur-value). Interobserver agreement was also assessed. HiFR-VFI was consistent with CDFI in detecting laminar and nonlaminar flow in 81.4% of the cases; however, in 18.6% of the cases, only HiFR-VFI identified the nonlaminar flow. HiFR-VFI showed a larger extension of complex flow (0.37 ± 0.26 cm2 ) compared to CDFI (0.22 ± 0.21 cm2 ; p < 0.05). The flow patterns were classified into four types: 3 type-I (laminar flow), 35 type-II (rotational flow), 27 type-III (reversed flow), and 5 type-IV (complex flow). The Tur-value of type-IV (50.03 ± 14.97)% is larger than type-III (44.57 ± 8.89)%, type-II (16.30 ± 8.16)%, and type-I (1.48 ± 1.43)% (p < 0.05). Two radiologists demonstrated almost perfect interobserver agreement on recognizing the change of streamlines (κ = 0.81, p < 0.001). The intraclass correlation coefficient of the Tur-value was 0.98. HiFR-VFI can reliably characterize complex hemodynamics with quantitative turbulence measurement and may be an auxiliary diagnostic tool for assessing atherosclerotic arterial disease.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

Central retinal artery occlusion diagnosed by color Doppler ultrasonography: A case report

Central retinal artery occlusion diagnosed by color Doppler ultrasonography: A case report

Thyrotoxic periodic paralysis in a Caucasian man without identifiable genetic predisposition: a case report

BackgroundThyrotoxic periodic paralysis (TPP) is a rare condition characterized by muscle paralysis, thyrotoxicosis, and hypokalemia. It presents with paralysis of both proximal and distal musculature in upper and lower limbs and may affect respiratory musculature and the cardiac conduction system. Early diagnosis is essential, as the condition is potentially reversible by oral or intravenous potassium treatment, leading to rapid resolution without lasting weakness. Overlooking the diagnosis may result in respiratory failure and cardiac arrhythmias including QT prolongation, Torsades de points, and ventricular arrhythmias.Case presentationA 19-year-old Caucasian man was admitted acutely with paralysis in upper and lower limbs and tachycardia. Over several months, he had experienced anxiousness, sweating more than usual, had daily palpitations, shortness of breath on exertion, and loose stools, and had lost 21 kg over the last year. Initial blood gas showed very low potassium of 1.4 mM, and blood tests showed decreased Thyroid-stimulating hormone (TSH) < 0.01 × 10− 3 IU/L, elevated free thyroxine (fT4) of 63.5 pM (reference interval (RI): 12.0–22.0 pM), and elevated total triiodothyronine (T3) of 8.2 nM (RI: 1.0–2.6 nM). He was diagnosed with TPP and treated with liquid oral potassium chloride (30 mmol every 30 minutes) and propylthiouracil (initial dose of 400 mg followed by 200 mg three times daily). TSH-receptor antibodies (TRAB) and thyroid-peroxidase antibodies (TPO-ab) were highly elevated. Thyroid ultrasound showed a normal-sized gland and color Doppler sonography showed increased vascularity throughout the gland, compatible with Graves’ disease. He was discharged on day 4 with a normal potassium level and followed in the outpatient clinic where he received standard care for Graves’ disease. Genetic testing using whole-genome sequencing found no genetic variants in genes previously associated with TPP.ConclusionTPP is very rare in Caucasians but more often affects young men in East Asian populations. The case presents a Caucasian man with TPP where genetic testing of CACNA1S, KCNJ18, SCN4A, KCNJ2, KCNE3, and ABCC8 shows no pathogenic variants in genes previously associated with TPP.

Uterine blood flow assessment by colour Doppler for prediction of malignant endometrial pathologies in women with abnormal uterine bleeding

Introduction: Colour Doppler has emerged as useful adjunct to transvaginal sonography in evaluation of women with AUB. This study was carried out to evaluate the role of measurement of the Resistance index (RI) and Pulsatility index (PI) of the uterine arteries by Colour Doppler sonography to discriminate between benign and malignant endometrial condition in women with abnormal bleeding.Material and Methods: This prospective analytical study was performed to evaluate 70 women (30-60 years) with AUB. Spiral arterioles flow patterns, Resistance index (with 0.81 as cut off) and Pulsatility index (with 1.83 as cut off) of uterine arteries were analysed by colour Doppler after detailed TVS. They were compared with Histopathological report of Endometrial Aspiration biopsy. Results: 10 patients (14.3%) had RI in malignancy range (> 0.81) and 9 patients (12.9%) had PI in malignancy range (< 1.83). Out of these 8 had both RI and PI in malignancy range. Thus 11 cases (15.7%) having either RI/PI or RI and PI both, in malignancy range were considered to be suspected of malignancy. Out of these 11 cases, 5 patients were diagnosed to have Hyperplasia/Malignancy on histopathology. There were no False Negative cases, making the sensitivity 100% and specificity 90.7% of TVS with colour Doppler. For the vascular patterns, both cases of hyperplasia had scattered vessel pattern and all 3 cases of carcinoma had multiple vessel pattern, making the association of vascular pattern with AUB diagnosis significant (p<0.001).Conclusion: Colour Doppler of the uterine artery and endometrial spiral arteries, improves the diagnostic accuracy of TVS for the prediction of endometrial pathologies and facilitates in screening for malignant and premalignant lesions. Therefore, it is recommended that CDTU with TVS should be used as screening modality in all AUB patient.

Evaluation of treatment response with color doppler ultrasonography in cases with primary open-angle glaucoma

Aims: Beta-blockers, the most frequently preferred drug group in glaucoma.Withcolor Doppler ultrasonography (CDU), the localization of retrobulbar vascular structures, their flow rates and directions, and the effects of the drugs used on the ocular circulation can be examined in a dynamic, reliable, and noninvasive way in less time than other techniques. The aim of our study was to compare the effects of beta-blockers, widely used in glaucoma treatment, and the additional neuroprotectant flunarizine on ocular hemodynamics using CDU. Methods: Between November 1998 and August 1999, 30 cases diagnosed with POAG in the GlaucomaUnit of the 1st EyeClinic of our center were included in the study. Patients were divided into 3 groups according to their beta-blocker treatment. Patients' CDU examinations were then examined by an experience dradiologist, and peaksys to lic flow velocity (PSFV) and end-diastolic flow velocity (EDFV) of the ophthalmicartery (OA), central retinal artery (CRA), and lateral (temporal) posterior ciliary arteries (LPCA) in the right or left eye were detected. Results: Of the 30 patients who participated in the study, 14 were male and 16 were female. Nine patients had hypertension (HT), 3 patients had diabetes (DM), and 6 patients had migraine. The mean age was similar in all three groups. There was a significant reduction in IOP in all three patient groups in whom IOP was measured after the use of topical beta-blockers (P&lt;0.01). The use of flunarizine had no effect on IOP in all three groups (P&gt;0.05). There was no statistically significant difference between groups in OA PSFVs and EDFVs at the first, second, and third measurements using the three beta-blockers (P&gt;0.05). No statistically significant difference existed between all three groups in the measurements of CRAPSFVs and EDFVs (P&gt;0.05). There were also no significant differences between groups in measurements of LPCA, PSFVs, and EDFVs at baseline and follow-up (P&gt;0.05). Conclusion: We found that the changes in hemodynamic parameters and reduction in IOP with all three beta-blockers were similar on color Doppler USG in patients using beta-blockers for the treatment of glaucoma. We observed that flunarizine had no effect on systemic hemodynamic parameters, did not affect IOP, and had no adverse effects on retrobulbar hemodynamic parameters when combined with beta-blockers. Local beta-blockers remain the mainstay of medical treatment for POAG because of their low systemic side effects and beneficial effects on the eye.

The diagnostic value of Doppler Resistive Index in the differential diagnosis of focal liver lesions.

To investigate the diagnostic value of resistance index (RI) in differentiating focal liver lesions. In this retrospective study, a total of 576 patients with histologically confirmed focal liver lesions were included. Each patient underwent B-mode ultrasound examination and color Doppler ultrasound examination. The RI values of different focal liver lesions were recorded and compared. The mean RI value of benign lesions was significantly lower than that of malignant lesions (0.54 ± 0.10 vs. 0.71 ± 0.12) (p <0.05). In malignant lesions, the RI value of intrahepatic cholangiocarcinoma was significantly lower than that of hepatocellular carcinoma lesions. Furthermore, in hepatocellular carcinoma lesions, the RI of large lesions (group 4: >10 cm) was significantly lower than that of small lesions (group 1: ≤2 cm, group 2: 2-5 cm) (p <0.05). Taken RI of 0.615 as a cutoff value to differentiate malignant and benign lesions, the sensitivity, specificity, positive predictive value and negative predictive value were 82.80%, 81.00%, 81.34% and 82.48%, respectively. Color Doppler ultrasound examination is a valuable imaging method in detecting blood flow signal within liver lesions. The RI parameter should be helpful in differentiating malignant and benign liver tumors.

Effects of electroacupuncture on pregnancy outcome in poor ovarian response patients of kidney essence deficiency and undergoing in vitro fertilization-embryo transfer

To observe the effects of electroacupuncture (EA) on ovarian reaction, egg and embryo quality, as well as pregnancy rate in poor ovarian response (POR) patients of kidney essence deficiency and undergoing in vitro fertilization-embryo transfer (IVF-ET). Ninety-six patients who met the inclusion criteria were randomly divided into an EA group and a control group, with 48 cases in each group. Before IVF-ET, the patients in the EA group received EA, once daily, 2 or 3 treatments a week for 12 weeks. Before and after the treatment, traditional Chinese medicine (TCM) syndrome score and clinical pregnancy rate were assessed in two groups. The concentrations of serum follicle-stimulating hormone (FSH), luteinsing hormone, estradiol, progesterone and anti-mullerian hormone were detected by chemiluminescence; the contents of serum insulin-like growth factor-1, serum inhibin B (INHB) and Kisspeptin in follicular fluid were determined by enzyme linked immunosorbent assay (ELISA); the antral follicle counting (AFC) was detected by color Doppler ultrasonography; and the egg and embryo conditions were observed under microscope. Fourteen days after embryo transfer, the positive rate of serum hemchoriconic gonadotropin (HCG) and clinical pregnancy rate were calculated. After the treatment, the TCM syndrome score and level of serum FSH were reduced (P<0.05); the INHB in serum and AFC were increased (P<0.05) when compared with those before the treatment in the EA group. After the treatment, in comparison with the control group, the TCM syndrome score and level of serum FSH were lower (P<0.05); and the contents of serum INHB, AFC, the numbers of MⅡ eggs and high-quality embryos, as well as serum HCG positive rate were all increased (P<0.05) in the EA group. EA can relieve the clinical symptoms of TCM in POR patients of kidney essence deficiency and undergoing IVF-ET, increase the ovarian reserve, reduce the serum FSH level, and improve the content of serum INHB, and the quality of eggs and embryos. This therapy tends to improve the clinical pregnancy rate and clinical pregnancy outcome.

Early effects of inactivated (CoronaVac) SARS-CoV-2 vaccine on retrobulbar vascular blood flow and retinal vascular density

AimsWe aimed to investigate the early effects of inactivated SARS-CoV-2 vaccine on retrobulbar vascular blood flow and retinal vascular density in healthy subjects. MethodsThirty-four eyes of 34 healthy volunteers who received the CoronaVac (Sinovac Life Sciences, China) were included in this prospective study. Resistive index (RI), pulsatility index (PI) and peak systolic velocity (PSV) of the ophthalmic artery (OA), central retinal artery (CRA), and the temporal and nasal posterior ciliary arteries (PCA) were evaluated with color Doppler ultrasonography (CDUS) before vaccination, at the 2nd and 4th weeks after vaccination. Superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density (VD), foveal avascular zone (FAZ), and choriocapillaris blood flow (CCF) measurements were made using optical coherence tomography angiography (OCTA). ResultsWhen compared to the pre-vaccination values, there was no significant change in OA-PSV, temporal-nasal PCA-PSV, CRA-EDV, temporal-nasal PCA-EDV at 2nd and 4th weeks after vaccination. However statistically significant reductions were found in the OA-RI, OA-PI, CRA-RI, CRA-PI, temporal-nasal PCA-RI, temporal-nasal PCA-PI values, CRA-PSV at post-vaccination 2nd week (p<0.05 for all). While there was sustained reduction in OA-RI, OA-PI, CRA-PSV, and nasal PCA-RI values at 4th week after vaccination, the change in CRA-RI, CRA-PI, temporal PCA-RI, temporal-nasal PCA-PI values were not significant compared to pre-vaccination values. There was no statistically significant difference in the SCP-VD, DCP-VD, FAZ and CCF measurements. ConclusionsOur findings demonstrating that CoronaVac vaccine did not affect retinal vascular density in the early period, but it caused alterations in the retrobulbar blood flow.

Tiroid Karsinomu Tanısı – Problem Çözücü Olarak Dinamik Manyetik Rezonans Görüntüleme

Objective: Comparison of the diagnostic accuracy of dynamic magnetic resonance imaging (MRI) with color Doppler US and Fine Needle Aspiration Cytology (FNAC) in the differential diagnosis of thyroid carcinoma cases.&#x0D; Materials and methods: Study group comprised 28 women and 6 men and all of them had thyroid hormone disorders in their routine examinations. 38 nodules were examined. After radiologic examinations, FNAC and thyroidectomy were applied.&#x0D; Results: The dynamic MR was found to have the highest sensitivity and specificity between the color-Doppler US, FNAC, and dynamic MR modalities for the diagnosis of carcinoma. In the dynamic MR examination, the difference between the peak-contrast signal intensity values (p = 0.018) and the minimum-contrast signal intensity values (p = 0.023) calculated at the p &lt; 0.05 level were statistically significant between the malignant and benign nodules.&#x0D; Conclusions: We consider that the differential diagnosis of thyroid nodules can be made by analyzing the dynamic MRI data. Malignant thyroid nodules show typical time-signal intensity curves, and we believe that dynamic MRI will be valuable for preoperative assessment of the thyroid nodules in certain conditions like radiology–pathology mismatch.

Superior mesenteric artery blood flow in infants of very preterm and very low birthweight and its related factors

&#x0D; Abstract&#x0D; &#x0D; Background Significant hemodynamic changes in preterm infants during early life could have consequences, especially on the intestinal blood flow. Alteration of superior mesenteric artery (SMA) blood flow may lead to impairment in gut function and feeding intolerance.&#x0D; Objectives To assess SMA blood flow velocity in very preterm and/or very low birth weight (VLBW) infants in early life and to elucidate the factors influencing them.&#x0D; Methods This is a cross-sectional study conducted in NICU at Cipto Mangunkusumo Hospital, Jakarta. Superior mesenteric artery (SMA) blood flow was evaluated by peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) measurement using Color Doppler US at &lt; 48 hours after birth. Maternal and neonatal data that could be potentially associated with SMA blood flow were obtained. Bivariate analyses were conducted with a P value of &lt; 0.05 considered significant.&#x0D; Results We examined 156 infants eligible for the study. PSV, EDV, and RI of SMA blood flow were not related to both gestational age and birth weight. Infant with small for gestational age (SGA) showed significantly lower EDV median [15.5 (range 0.0-32.8) vs 19.4 (range 0.0-113.0)] and higher RI [0.80 (range 0.58-1.00) vs 0.78 (range 0.50-1.00)] compared to appropriate for gestational age (AGA). Infants born from mother with preeclampsia showed lower PSV median [(78.2 (range 32.0-163.0) vs 89.7 (range 29.2-357.0)]) and EDV [16.2 (range 0.0-48.5) vs 19.4 (range 0.0-113.0)] compared to without PE, while absent/reverse end-diastolic velocity (AREDV) revealed a lower EDV median [16.9 (range 0.0 – 32.4) vs 19.4 (range 0.0 – 113.0)] compared to no AREDV. Furthermore, infants with hs-PDA showed lower EDV median [16.2 (range 0.0-113.0) vs 19.4 (range 0.0-71.1)] but higher RI median [0.80 (range 0.50-1.00) vs 0.78 (range 0.55-1.00)] compared to non hs-PDA. No difference in SMA blood flow across other factors was observed.

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.

Role of color Doppler ultrasonography in predicting the viability of bowel loops in children with intussusception

Abstract Background: Intussusception mainly affects infants and toddlers, though it can affect any age of the pediatric population. Intussusception has been successfully diagnosed using B-mode ultrasonography. Once, hydrostatic or pneumatic intussusception reduction under image guidance was used to treat these children. But this needs a critical assessment of the preserved bowel viability before the procedure. There are several criteria based on ultrasonography for predicting bowel reducibility during hydrostatic or pneumatic reduction. Our study aimed to demonstrate the role of color Doppler ultrasound in predicting the viability of the intestine in children with intussusception. Materials and Methods: Thirty children under 14 years of age with clinical symptoms suggestive of intussusception were evaluated on color Doppler and power Doppler ultrasonography to predict the viability of bowel loops in children with intussusception. The compression technique was used for graded compression, and the patients were followed for clinical/surgical outcomes. Sensitivity, specificity, positive predictive value, negative predictive value, the strength of agreement of trapped fluid, vascularity at apex, and power Doppler for predicting viability of bowel loops were statistically analyzed. Results: In 17 (56.67%) children, vascularity at the apex of the intussusceptum loop was absent. Vascularity at the apex was present in only 13 of 30 patients (43.33%). On the final clinical/surgical outcome, 17 (56.67%) of patients had necrosis of the bowel loop. Bowel loops were viable in only 13 of 30 patients (43.33%). Of patients who had viability of bowel loops, 76.92% of patients did not have trapped fluid. If the trapped fluid was absent, there was a 100.00% probability of viability of bowel loops; if trapped fluid was present, there was an 85.00% chance of necrosis. Among patients who had necrosis, 100.00% of patients had trapped fluid. In predicting bowel loops’ viability, vascularity’s sensitivity and specificity at the apex on color Doppler were maximum: sensitivity 100% (75.29%–100.00%) and specificity 100% (80.49%–100.00%). In predicting the viability of bowel loops, the sensitivity and specificity of power Doppler at the apex of the intussusceptum loop were maximum: sensitivity 100% (75.29%–100.00%) and specificity 100% (80.49%–100.00%) each. Excellent agreement was seen between final diagnosis and vascularity at the apex with kappa 1 and P value &lt;0.0001. Among 17 patients diagnosed with bowel necrosis, 17 had similar findings in vascularity at the apex. Among 13 patients diagnosed with viable bowel loops, 13 had similar vascularity findings at the apex. The concordance rate was 100.00%, and the discordance rate was 0.00% between the final diagnosis and vascularity at the apex. Conclusion: The presence or absence of blood flow in the intussusceptum loop on color Doppler sonography and power Doppler is a promising predictor of bowel viability. Trapped fluid within the intussusceptum loop emphasizes the possibility of no spontaneous resolution of intussusception. Color Doppler ultrasonography, which detects blood flow in the invaginated bowel, seems to be the most valuable diagnostic modality for predicting the likelihood of bowel reduction.

MP43-18 ADOLESCENT VARICOCELE: EFFECTS OF VEIN SIZE AND ARTERIAL FLOW RATE ON SEMINAL PARAMETERS

You have accessJournal of UrologyCME1 Apr 2023MP43-18 ADOLESCENT VARICOCELE: EFFECTS OF VEIN SIZE AND ARTERIAL FLOW RATE ON SEMINAL PARAMETERS Selin Ocal, Alina Sheikh, Joseph Pizzuti, Alexander Fang, Joseph Boroda, Steven Friedman, Ronnie Fine, Mark Horowitz, Ronnie Fine, Richard Sclussel, Lori Dyer, Paul Zelkovic, Jaime Freyle, Israel Franco, and Jordan Gitlin Selin OcalSelin Ocal More articles by this author , Alina SheikhAlina Sheikh More articles by this author , Joseph PizzutiJoseph Pizzuti More articles by this author , Alexander FangAlexander Fang More articles by this author , Joseph BorodaJoseph Boroda More articles by this author , Steven FriedmanSteven Friedman More articles by this author , Ronnie FineRonnie Fine More articles by this author , Mark HorowitzMark Horowitz More articles by this author , Ronnie FineRonnie Fine More articles by this author , Richard SclusselRichard Sclussel More articles by this author , Lori DyerLori Dyer More articles by this author , Paul ZelkovicPaul Zelkovic More articles by this author , Jaime FreyleJaime Freyle More articles by this author , Israel FrancoIsrael Franco More articles by this author , and Jordan GitlinJordan Gitlin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Varicocele severity has been associated with larger testicular vein size but the relationship to decreased fertility remains debatable. In clinical practice, largest vein diameter is used to screen for surgical intervention, yet more recent studies have found venous reflux patterns and total testicular volume (TTV) to be associated with total motile sperm count (TMSC). This study compares largest testicular vein size and arterial flow rates to identify patients at risk for reduced seminal parameters. METHODS: We conducted a retrospective single institution chart review over 14 years of 487 Tanner V adolescents. 148 met inclusion criteria of palpable, non-operated left sided varicoceles who underwent at least one SA and color doppler ultrasonography. Abnormal TMSC was defined by WHO 2010 criteria. Descriptive statistics, ROC analysis, univariate and multivariate logistic regression were performed using SPSS. RESULTS: Data on 148 Tanner V adolescent males with mean age 18.24±1.38 years were evaluated. Median diameter of largest left testicular vein was 3.5 mm (IQR 3.1-4.6), median peak systolic velocity (PSV) of left testicular artery was 10.4 cm/s (IQR 9.1-12.5), median end diastolic velocity (EDV) of left testicular artery was 5.1 cm/s (IQR 4.3-5.9), median value of PSV/EDV was 2.1 (IQR 1.8-2.3) and median TMSC was 37.4 million sperm/ejaculate (IQR 15.8-84.2). On ROC analysis regarding prediction of abnormal TMSC (<9 million sperm/ejaculate), left testicular PSV was found to have the greatest AUC at 0.73 (95% CI 0.62-0.85) with Youden index analysis determining cutoff of 10.22 cm/s while largest vein diameter was found to have an AUC of 0.48. On univariate logistic regression, PSV<10.22 cm/s resulted in a significantly greater likelihood of abnormal TMSC (OR: 5.51 [1.84-16.46], p=0.002), which persisted on multivariate logistic regression with adjustment for age (OR: 5.49 [1.83-16.43], p=0.002). CONCLUSIONS: Left testicular PSV was most significantly correlated to TMSC. PSV <10.22 cm/s was predictive of an abnormal TMSC. No significant association was found between larger veins and greater risk for abnormal TMSC. When assessing varicocele, left testicular artery PSV may help stratify future fertility risk, allowing for improved surveillance regarding surgical intervention. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e608 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Selin Ocal More articles by this author Alina Sheikh More articles by this author Joseph Pizzuti More articles by this author Alexander Fang More articles by this author Joseph Boroda More articles by this author Steven Friedman More articles by this author Ronnie Fine More articles by this author Mark Horowitz More articles by this author Ronnie Fine More articles by this author Richard Sclussel More articles by this author Lori Dyer More articles by this author Paul Zelkovic More articles by this author Jaime Freyle More articles by this author Israel Franco More articles by this author Jordan Gitlin More articles by this author Expand All Advertisement PDF downloadLoading ...

Case 312: Dercum Disease

A 29-year-old woman was referred for US of bilateral breasts during evaluation for noncyclical mastalgia predominantly in the left breast of 8 months duration. She had been taking selective serotonin receptor inhibitors for the past 6 months for a clinical diagnosis of generalized anxiety disorder. A detailed medical history revealed breast cancer in the patient's mother and grandmother. There was no history of weight loss or appetite loss, nor was there a history of any altered bowel or bladder habits. The patient was overweight, with a body mass index of 26.8 kg/m2, and appeared anxious during the general physical examination, with an increased pulse (102 beats per minute) and normal blood pressure (118/82 mm Hg). Local examination revealed multiple small mobile painful lesions that were palpable in all quadrants of the bilateral breasts, anterior abdominal wall, and forearm. On further questioning, the patient reported similar painful lesions were present in her mother and one brother. Laboratory investigations showed a normal hemoglobin level (12.4 g/dL; normal range, 12-15 g/dL), a total leukocyte count of 9000 cells per microliter (9 cells × 109/L) (normal range, 4500-11 000 cells per microliter [4.5-11 cells × 109/L]), a normal differential leukocyte count (74% neutrophils [normal range, 40%-80%], 24% lymphocytes [normal range, 20%-40%], and 2% eosinophils [normal range, 1%-4%]), and an erythrocyte sedimentation rate of 5 mm per hour (normal range, 0-29 mm per hour). High-frequency US of bilateral breasts was performed in conjunction with Color Doppler US and shear-wave elastography of representative lesions in the breasts. Similar lesions were also found in the subcutaneous plane of the right forearm and the anterior abdominal wall.