Color Duplex Doppler Ultrasonography Research Articles

Hemodynamic assessment of femoropopliteal venous reflux in patients with primary varicose veins.

The aim of this study was to assess the anatomic distribution and extent of deep venous reflux in patients with primary varicose veins (PVVs) and to investigate its influence on venous hemodynamics. Femoropopliteal venous reflux was examined using duplex color Doppler ultrasonography in 356 limbs with PVVs in 240 patients. Photoplethysmography (PPG) was performed using above-knee and below-knee tourniquets to determine the contributions of deep and superficial venous insufficiency. Of 356 limbs with PVVs, 61 (17.1%) had femoropopliteal venous reflux, 42 (11.8%) had superficial femoral venous reflux alone, and 57 (16.0%) had popliteal venous reflux alone. Femoropopliteal venous reflux was associated significantly with clinical symptoms and shortened the half venous refilling time measured by PPG, especially in the presence of incompetent perforating veins. These findings were obtained regardless of the presence of long saphenous vein reflux. Femoropopliteal venous reflux associated with PVVs plays an important role in the pathophysiologic mechanism of venous stasis and influences venous hemodynamics in the presence of incompetent perforating veins and short saphenous vein.

The Correlation of Cavernous Systolic Occlusion Pressure With Peak Velocity Flow Using Color Duplex Doppler Ultrasound

This prospective study involved 27 patients who underwent dynamic infusion cavernosometry/cavernosography and color duplex Doppler ultrasound. Phase III dynamic infusion cavernosometry/cavernosography determination of cavernous artery systolic occlusion pressure and color duplex Doppler measurements of peak velocity flow were performed. Four subpopulations were defined: 1) normal cavernous artery systolic occlusion pressure and peak velocity flow, 2) abnormal systolic occlusion pressure and normal peak velocity flow, 3) normal systolic occlusion pressure and abnormal peak velocity flow, and 4) abnormal systolic occlusion pressure and peak velocity flow. Peak velocity flow significantly correlated with cavernous artery systolic occlusion pressure and, using a normal value of greater than 25 cm. per second, resulted in a sensitivity and specificity of 95%. The positive predictive value of an abnormal peak velocity flow was calculated to be 95%. We conclude that peak velocity flow is an effective, reliable and noninvasive means of evaluating corporeal arterial function in an office setting.

Is avoidance of surgery possible in patients with perimenopausal ovarian tumors using transvaginal ultrasound and duplex color Doppler sonography?

A total of 108 cases of small perimenopausal ovarian tumors (largest diameter, less than 7 cm) were evaluated by transvaginal sonography and duplex color Doppler sonography; 101 had criteria for benignity and 7 for malignancy. All cysts were punctured and aspirated to avoid unnecessary surgery (benign cases) and establish the cytologic diagnosis as well as to avoid the risk of leakage (malignant cases). Recurrence rate of benign punctured cysts was 25% within 1 year of follow up. No difference in recurrent rate was seen between pre- and postmenopausal patients (19 of 56 cases in the premenopausal group, and five of 28 cases in the postmenopausal group). The larger the cyst, the greater the risk of recurrence. Puncture and aspiration of seven sonographically established malignant tumors allowed cytologic diagnosis before surgery, and no evidence of leakage was noted at the time of surgery. No significant differences were observed between cytologic and histopathologic findings in cases that went to surgery. Puncture and aspiration of small endometriomas (17 cases) was found to be inefficient for therapeutic purposes. Finally, owing to the high percentage of unsatisfactory cytologic results (20%) with cyst aspiration, vaginal and color Doppler sonography seemed more efficient in distinguishing between benignity and malignancy.

Duplex Doppler ultrasonography: Noninvasive assessment of penile anatomy and function

E RECTION is a complex hemodynamic event regulated by the tone of smooth muscle composing the cavernous arterioles, venules, and sinusoids. In the flaccid penis baseline ot-adrenergic stimulation maintains the smooth muscle of the cavernous arterioles and corporal sinusoids contracted. Although vascular resistance to inflow is elevated in the flaccid state, venular outflow is unrestricted. Regulation of venous outflow from the penis appears to be a passive phenomenon; venules draining the sinusoidal spaces coallesce into a plexus below the outer fibroelastic tunica of the paired corporal bodies. Egress from the subtunical venular plexus is via emissary veins exiting perpendicularly through the tunica albuginea into the deep dorsal vein or directly via the cavernous and crural veins at the base of the corporal bodies. 1 Erection is initiated by at least three welldocumented neuropharmacologic stimulants2-5: 1. Inhibition or decrease in excitation of postsynaptic or-1 receptors on cavernous and arteriolar muscle. 2. Increasing cholinergic transmission: Acetylcholine acting on postganglionic adrenergic fibers inhibits norepinephrine release. Acetylcholine mediates the release of endothelial relaxant factor, which rapidly diffuses to the smooth muscle of arteriolar walls. 3. Direct nonadrenergic noncholinergic (NANC) transmission: Several substances have previously been considered to be the NANC erection transmitter (vasoactive intestinal peptide, substance P, prostaglandin E, adenosine triphosphate). Nitric oxide is currently believed to be the principal regulator of NANC corporal relaxation; penile smooth muscle relaxation is initiated by intracellular accumulation of cyclic guanosine monophosphate (cGMP). Tumescence follows a decrease in corporal smooth muscle tone and vascular resistance; arterial inflow increases and the corpora sinusoids distend with oxygenated blood. The expanding sinusoids compress the subtunical plexus and restrict venous outflow. Approximately 90% of systemic arterial pressure is transmitted to the corporal bodies as a result of increased arterial inflow and veno-occlusion. Observations of pudendal and cavernous arterial inflows and intracorporal pressures in the animal model reveal that erection can be divided into six phases: flaccid, latent, tumescence, full erection, rigid erection, and detumescence. 6 Figure 1 shows that cavernous nerve stimulation produces erection with intracorporal pressure reaching 100 mmHg during full erection and transiently exceeding 100 mmHg during the rigid phase. Contemporary clinical studies using intracavernous agents (papaverine, phentolamine, prostaglandin El, and vasoactive intestinal peptide) have revealed that impotence is most often organic in origin and predominantly vasculogenic in etiology 7-11 We believe that color duplex Doppler ultrasound (CDDU) following intracorporal vasoactive stimulation is the most reliable and least invasive means of screening for vasculogenic erectile failure and for selecting patients for more invasive tests of pathologic corporal inflow or outflow. The principles, techniques, and most recent criteria for duplex Doppler penile blood flow are reviewed.

The value of Doppler sonography in the detection of major vessel thrombosis in the neonatal abdomen

Duplex spectral or color Doppler sonography demonstrated major abdominal vessel blocks affecting 18 vessels in 16 infants aged between 23 and 56 weeks postconceptional age. The portal vein was affected in 8 infants, the renal vein in 3, the renal vein and inferior vena cava in 1, the renal artery in 1, the inferior vena cava and hepatic vein in 1, and the aorta in 2 infants. Doppler sonography confirmed the grey-scale findings and often demonstrated the extent of vascular flow, providing functional information not available from the grey-scale scan. It facilitated the follow-up of thrombosis during therapy. Most important of all, in many instances it enabled a rapid and reliable specific diagnosis often not possible on the grey-scale study alone and hence altered patient management.