Color Doppler Flow Imaging Research Articles

Effects of two dimensional gray-scale blood flow imaging combined with color Doppler flow imaging in guiding arterial puncture and catheterization through wounds in patients with large burns

Objective: To explore the effects of two dimensional gray-scale blood flow imaging (hereinafter referred to as " B-flow" ) combined with color Doppler flow imaging (CDFI) in guiding arterial puncture and catheterization through wounds in patients with large burns. Methods: Sixty-seven patients with large burns who met the inclusion criteria and hospitalized in the First Hospital of Jilin University from January 2017 to January 2019 were enrolled in the prospectively randomized control study. According to the random number table, CDFI alone group was allocated with 35 patients (23 males and 12 females) and B-flow+ CDFI group with 32 patients (22 males and 10 females), aged 19-60 and 18-58 years, respectively. According to the progress of the disease, arterial puncture and catheterization were performed in the right time. During the operation, CDFI was used alone for guidance in patients of CDFI alone group, while B-flow and CDFI were used together for guidance in patients of B-flow+ CDIF group. Based on the first time of catheterization, the catheterization location, one-time catheterization success rate, post-back stitching re-catheterization success rate, catheterization failure rate, catheterization duration, and incidences of wound sepsis, catheter-related bloodstream infection, and arterial thrombosis within post catheterization day (PCD) 3 of patients in the two groups were recorded. Data were statistically analyzed with the independent-sample t test, chi-square test or Fisher's exact probability test. Results: (1) All the patients underwent catheterization through wounds, and there was no statistically significant difference in catheterization location of patients between the two groups (χ(2)=0.574, P>0.05). The one-time catheterization success rate of patients in B-flow+ CDFI group was 81.25% (26/32), which was obviously higher than 51.43% (18/35) in CDFI alone group (χ(2)=6.594, P<0.05). The catheterization failure rate of patients in B-flow+ CDFI group was 3.12% (1/32), which was obviously lower than 20.00% (7/35) in CDFI alone group (P<0.05). The post-back stitching re-catheterization success rate of patients was similar between the two groups (χ(2)=1.029, P>0.05). (3) The catheterization duration of patients was (15.7±1.1) min in B-flow+ CDFI group, which was obviously shorter than (17.1±2.2) min in CDFI alone group (t=11.316, P<0.01). (4) Within PCD 3, the incidences of wound sepsis and catheter-related bloodstream infection of patients in CDFI alone group were 2.86% (1/35) and 0, close to 0 and 3.12% (1/32) in B-flow+ CDFI group (P>0.05); the incidence of arterial thrombosis of patients in B-flow+ CDFI group was 0, which was obviously lower than 20.00% (7/35) in CDFI alone group (P<0.05). Conclusions: Compared with CDFI alone, B-flow combined with CDFI can improve the success rate of arterial puncture and catheterization through wounds in large area burn patients, shorten the catheterization duration, and effectively reduce the incidence of arterial thrombosis after catheterization, with a good clinical application value.

Diagnostic value of mitral regurgitant jet volume in the assessment of mitral regurgitation severity by general imaging three-dimensional quantification

Accurate quantification of mitral regurgitation (MR) severity is critical for appropriate clinical decision making regarding surgical intervention. General imaging three-dimensional quantification (GI3DQ) method allows for direct measurement of mitral regurgitant jet volume (MRJvol) with the help of three-dimensional (3D) color flow Doppler imaging. The aim of this study was to evaluate diagnostic value of MRJvol by GI3DQ for MR grading severity, using the guideline recommended integrated approach as a reference. The study included ninety-seven patients with varying degree of MR, and all MR cases were divided into central MR group (n = 44) and eccentric MR group (n = 53). The MRJvol was measured by GI3DQ. The severity of MR was graded on the basis of recommended integrated approach as mild, moderate, or severe. As assessed by receiver operating characteristic analysis, MRJvol by GI3DQ at a cutoff value of 43.4ml yielded 76.9% of sensitivity and 86.9% of specificity to differentiate moderate from severe MR in all cases, a cutoff value of 47.5ml yielded 98.9% of sensitivity and 94.4% of specificity to differentiate moderate from severe MR in central MR, and a cutoff value of 40.7ml yielded 80.0% of sensitivity and 78.6% of specificity to differentiate moderate from severe MR in eccentric MR. MRJvol measured by GI3DQ could assess MR severity, especially in central MR group, which has higher sensitivity and specificity to differentiate moderate from severe MR.

Diagnostic Value of Superb Microvascular Imaging in Parotid Tumors

BackgroundThe aim of this study was to evaluate the clinical diagnostic value of superb microvascular imaging (SMI) in assessing vascular distribution, vascularity, and vessel morphology of parotid tumors (PTs).Material/MethodsPT patients confirmed by postoperative histopathological detection and who underwent color Doppler flow imaging (CDFI), microvascular imaging (MVI), and SMI examination were recruited. PTs were classified into 3 groups: pleomorphic adenoma (PA), Warthin tumor (WT), and malignant PT (MT). The tumor vascular distribution, vascularity, and vessel morphology recorded by CDFI, MVI, and SMI were compared among PA, WT, and MT group. PT diagnosis was performed using histopathological detection. Fisher’s exact test was used to compare the diagnostic sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy between SMI and MVI examination in PTs.ResultsWe enrolled 198 PTs consisting of 114 PAs, 56 WTs, and 28 MTs into our study. CDFI examination found no significant differences in vascular distribution and vascularity among the PA, WT, and WT groups. SMI examination found significant differences in vascular distribution and vascularity among the 3 groups. MVI found significant differences in vessel morphology, including uneven distribution of blood flow, arborization, and irregular blood flow among the PA, WT, and MT groups. SMI found significant differences in arborization and irregular blood flow, but none of the differences in uneven distribution of blood flow among the 3 groups were significant. The diagnostic sensitivity, specificity, and accuracy of SMI and MVI in PTs showed no significant differences.ConclusionsSMI more accurately evaluated the vascular distribution and vascularity of PTs than CDFI. SMI might be a potential non-invasive diagnostic method for PTs in clinical practice.

Role of Combining Colour Doppler and Grey Scale Ultrasound in Differentiating Benign from Malignant Ovarian Masses

Abstract The aim of this study was to evaluate ovarian masses with conventional grey scale ultrasonography and colour Doppler flow imaging and to assess the diagnostic reliability of these methods in differentiating benign and malignant ovarian masses. We assessed 56 patients with an ovarian mass. Morphological characterisation of the mass was performed utilising the Sassone score. Colour Doppler parameters were recorded for each patient, and the Caruso vascular score was also applied. The results were compared with surgical/pathological and/or follow-up scans. Using the Sassone score, overall reliability in differentiating ovarian masses had a sensitivity of 89.5% and a specificity of 78.4%. Using the Caruso score alone, we found a sensitivity of 89.5% and a specificity of 86.5%. Using the Sassone and Caruso scores together, we found a sensitivity of 94.7% and a specificity of 89.1%. Combining both morphological and colour Doppler scores in the evaluation of ovarian masses obtained higher specificity, sensitivity, and accuracy than was obtained using a single score only.

Evaluation of hemodynamic characteristics in posterior circulation infarction patients with vertebral artery dominance by color doppler flow imaging and transcranial doppler sonography

Purpose The aim of this study was to investigate the hemodynamic characteristics of posterior circulation infarction (PCI) patients with the vertebral artery dominance (VAD) using Color Doppler flow imaging (CDFI) and Transcranial Doppler sonography (TCD) and to explore the pathogenesis of PCI caused by VAD. Materials and methods A total of 186 consecutive PCI patients were enrolled. All the patients underwent magnetic resonance (MR) examination and the clinical data were collected. According to the brain magnetic resonance angiography (MRA), the patients were divided into VAD and non-VAD groups. CDFI and TCD were performed to identify the hemodynamic parameters of the vertebral artery (VA) and basilar artery (BA). Results The male population was significantly more frequent in the VAD group (71.3%) as compared to the non-VAD group (53.1%). The significant difference in hemodynamic parameters was observed between VAD and non-VAD groups. Resistance index (RI) of extracranial and intracranial VA was different as well. There were also differences in the VA side-to-side diameter difference-value, peak velocity (Vp), mean velocity (Vm) and pulsatility index (PI) with varying degrees of BA curvature. Conclusions VA and BA hemodynamic changes caused by VAD may be an important risk factor in the process of occurrence of PCI. The combination of CDFI and TCD can help to detect the hemodynamic changes in the intracranial and extracranial segments of VA and BA. This can have important clinical value in understanding the pathogenesis of PCI.

Evaluation of Ultrasound Biomicroscopy Combined with Color Doppler Flow Imaging in the Diagnosis of Primary Lacrimal Canaliculitis

ABSTRACT Purpose: To explore the performance of ultrasound biomicroscopy (UBM) and color Doppler flow imaging (CDFI) in the diagnosis of primary lacrimal canaliculitis. Methods: Subjects with relevant symptoms of canaliculitis were prospectively recruited. UBM and CDFI were performed for presumptive diagnosis. Microbiology and histopathology were performed for definitive diagnosis. Results: A total of 37 cases were recruited, including 25 cases of canaliculitis and 12 cases of non-canaliculitis. Pathogens were isolated in 13 canaliculitis cases, and the leading pathogens were Actinomyces (4 cases) and Streptococcus (4 cases). UBM and CDFI identified 24 canaliculitis cases (sensitivity = 96%) and 11 non-canaliculitis cases (specificity = 92%). The predictive factors for canaliculitis were lumen wall thickness >0.25 mm (P = .019) and intracanalicular concretions (P = .010). Other typical features were enlarged lumen (2.16 ± 0.25 mm) and hot-wheel sign-on CDFI (84%). These image findings were congruent with histopathologic changes. Conclusion: Ultrasonography is a valuable tool to assist the diagnosis of canaliculitis. (Clinical trial registration number: ChiCTR1900025411)

Effects of high-intensity focused ultrasound treatment on peripancreatic arterial and venous blood vessels in pancreatic cancer.

The present study aimed to evaluate the safety of high-intensity focused ultrasound (HIFU) treatment on peripancreatic arterial and venous blood vessels in patients with pancreatic cancer. This trial included 15 patients with pancreatic cancer (9 females and 6 males; age, 39–81 years; median age, 62 years). All patients underwent preoperative computed tomography (CT) or magnetic resonance imaging (MRI) and color Doppler flow imaging (CDFI) to assess the vascular hemodynamics of peripancreatic arterial and venous blood vessels pre-treatment. These patients were re-examined within 1 week post-HIFU treatment. Then, vascular adverse events were observed and followed up clinically. Prior to HIFU treatment, vessel involvement was recorded in 13 patients, including tumor lesions invading 19 veins and 14 arteries, which refers to the growth of pancreatic tumor lesions surrounding blood vessels, or tumor growth into blood vessels. In addition, 9 veins and 13 arteries were <1 cm from the lesions. The hemodynamic parameters of peripancreatic vessels were measured using CDFI, including mean blood flow velocity, peak systolic blood flow velocity, vascular resistance index, vascular pulsatility index, vascular diameter, vascular blood flow and other indicators, to assess vascular perfusion in CT/MRI. There were no significant differences in preoperative and postoperative hemodynamic data (P>0.05). Overall, HIFU demonstrated no negative effects on peripancreatic arterial and venous blood vessels in patients with pancreatic cancer, even with tumor lesions wrapped in blood vessels. In addition, no complications of vascular stenosis and vascular adverse events were observed in the present study.

Prenatal diagnosis and treatment of intrahepatic arteriovenous fistulas: case reports and the literature review

Background Congenital arteriovenous intrahepatic fistulas, which are hepatic hemangiomas and arteriovenous malformations (AVMs) are rare and they confused with each other. Knowledge of prenatal medical treatment of AVMs is insufficient. Objectives First is to emphasize the distinction between hepatic hemangioma and AVMs. Second is discussion of the first case of hepatic AVM that responded well to steroid-propranolol treatment in the prenatal period. Methods Color Doppler ultrasonography, fetal and postnatal MR were used for diagnosis. Results The first case is a giant hepatic hemangioma diagnosed and progressively growing in the prenatal period and gradually shrinking in the postnatal period. The second case was hepatic AVM with no signs of heart failure during the prenatal period and postnatal right extended hepatectomy was performed as the anastomosis was enlarged and intraportal collateral vessels were developed. The third case is the first hepatic AVM which reaches a term that was prenatally diagnosed and responded to treatment with marked reduction. Conclusion Color flow and pulse Doppler imaging have a key role in the prenatal diagnosis of arteriovenous fistulas. Intrahepatic AVM are abnormal intrahepatic vascular network formation primarily fed by the hepatic artery or its branches and drained by the hepatic venous system. This vascular region looks like a mass, but it does not contain a solid area, which allows the separation of hepatic AVMs from hepatic hemangiomas. Steroid and propranolol therapy should be considered in management.

The independent indicators for differentiating renal cell carcinoma from renal angiomyolipoma by contrast-enhanced ultrasound

BackgroundThe value of contrast-enhanced ultrasound (CEUS) in differentiating between renal cell carcinoma (RCC) and angiomyolipoma (AML) was analyzed. The purpose of this study was to identify the independent indicators of CEUS for predicting RCC.MethodsA total of 172 renal tumors (150 RCCs, 22 AMLs) in 165 patients underwent conventional ultrasound (CUS) and CEUS examinations before radical or partial nephrectomy, and the features on CUS and CEUS were analyzed.ResultsThere were significant differences in echogenicity, blood flow signals in color Doppler flow imaging (CDFI), peak intensity, homogeneity of enhancement, wash in, wash out, and perilesional rim-like enhancement between RCC and AML (P < 0.05 for all). Multivariate analysis indicated that perilesional rim-like enhancement (P = 0.035, odds ratio [OR] = 9.907, 95% confidence interval [CI]: 1.169–83.971) and fast wash out (P = 0.001, OR = 9.755, 95%[CI]: 2.497–38.115) were independent indicators for predicting RCC. The area under the receiver operating characteristic (ROC) curve (AUC) for perilesional rim-like enhancement was 0.838 (95% CI: 0.774–0.890) with 76.7% sensitivity and 90.9% specificity, while the AUC of fast wash out was 0.833 (95% CI:0.768–0.885) with 74.7% sensitivity and 81.8% specificity.ConclusionsThis study indicated that CEUS has value in differentiating RCC and AML. Present perilesional rim-like enhancement and fast wash out may be important indicators for predicting RCC.

Updated Information for Neuro-anesthesia：The Indication of Transcranial Doppler and Transcranial Color Flow Imaging for Neuro-anesthesia and Intensive Care

Updated Information for Neuro-anesthesia：The Indication of Transcranial Doppler and Transcranial Color Flow Imaging for Neuro-anesthesia and Intensive Care

Association of von Willebrand factor (vWF) expression with lymph node metastasis and hemodynamics in papillary thyroid carcinoma.

The purpose of this study was to analyze the relationship between von Willebrand factor (vWF) expression and lymph node metastasis or hemodynamics parameters in PTC. This work will provide a novel biomarker for the diagnosis of papillary thyroid carcinoma (PTC). A total of 156 PTC patients were divided into metastatic and non-metastatic groups based on the presence or absence of lymph node metastasis. The Adler blood flow grading, color doppler flow imaging (CDFI), and blood flow index (PSV, PI, RI, AT) were measured and analyzed between the two groups. The expression of vWF was examined by immunocytochemical assay and quantitative Real-Time Polymerase Chain Reaction (qRT-PCR). The function of vWF was investigated by methyl thiazolyl tetrazolium (MTT) and the transwell assays. Both metastatic and non-metastatic groups with the major Adler grades as 0-1 had abundant blood flows. There was a significant difference in the rate of lymph node metastasis between Adler 2-3 and Adler 0-1. Moreover, the expression of vWF was found to be associated with lymph node metastasis or Adler blood flow grade in PTC. Significant differences in peak systolic velocity (PSV), systolic acceleration time (AT), and resistance index (RI) were detected in metastatic and non-metastatic groups. In addition, the upregulation of vWF was positively correlated with PSV, RI, and PI in PTC. Functionally, the knockdown of vWF inhibited the development of PTC by suppressing cell proliferation, migration, and invasion. Abnormal expression of vWF is closely related to lymph node metastasis and hemodynamics parameters in PTC patients. Furthermore, vWF plays an oncogene role in PTC progression.

Breast non-mass-like lesions on contrast-enhanced ultrasonography: Feature analysis, breast image reporting and data system classification assessment

BACKGROUNDBreast non-mass-like lesions (NMLs) account for 9.2% of all breast lesions. The specificity of the ultrasound diagnosis of NMLs is low, and it cannot be objectively classified according to the 5th Edition of the Breast Imaging Reporting and Data System (BI-RADS). Contrast-enhanced ultrasound (CEUS) can help to differentiate and classify breast lesions but there are few studies on NMLs alone.AIMTo analyze the features of benign and malignant breast NMLs in grayscale ultrasonography (US), color Doppler flow imaging (CDFI) and CEUS, and to explore the efficacy of the combined diagnosis of NMLs and the effect of CEUS on the BI-RADS classification of NMLs.METHODSA total of 51 breast NMLs verified by pathology were analyzed in our hospital from January 2017 to April 2019. All lesions were examined by US, CDFI and CEUS, and their features from those examinations were analyzed. With pathology as the gold standard, binary logic regression was used to analyze the independent risk factors for malignant breast NMLs, and a regression equation was established to calculate the efficiency of combined diagnosis. Based on the regression equation, the combined diagnostic efficiency of US combined with CEUS (US + CEUS) was determined. The initial BI-RADS-US classification of NMLs was adjusted according to the independent risk factors identified by CEUS, and the diagnostic efficiency of CEUS combined with BI-RADS (CEUS + BI-RADS) was calculated based on the results. ROC curves were drawn to compare the diagnostic values of the three methods, including US, US + CEUS, and CEUS + BI-RADS, for benign and malignant NMLs.RESULTSMicrocalcification, enhancement time, enhancement intensity, lesion scope, and peripheral blood vessels were significantly different between benign and malignant NMLs. Among these features, microcalcification, higher enhancement, and lesion scope were identified as independent risk factors for malignant breast NMLs. When US, US + CEUS, and CEUS + BI-RADS were used to identify the benign and malignant breast NMLs, their sensitivity rates were 82.6%, 91.3%, and 87.0%, respectively; their specificity rates were 71.4%, 89.2%, and 92.9%, respectively; their positive predictive values were 70.4%, 87.5%, and 90.9%, respectively; their negative predictive values were 83.3%, 92.6%, and 89.7%, respectively; their accuracy rates were 76.5%, 90.2%, and 90.2%, respectively; and their corresponding areas under ROC curves were 0.752, 0.877 and 0.903, respectively. Z tests showed that the area under the ROC curve of US was statistically smaller than that of US + CEUS and CEUS + BI-RADS, and there was no statistical difference between US + CEUS and CEUS + BI-RADS.CONCLUSIONUS combined with CEUS can improve diagnostic efficiency for NMLs. The adjustment of the BI-RADS classification according to the features of contrast-enhanced US of NMLs enables the diagnostic results to be simple and intuitive, facilitates the management of NMLs, and effectively reduces the incidence of unnecessary biopsy.

The value of color Doppler ultrasound in the detection of macular diseases in age-related cataract patients

Objective To observe the application value with color Doppler flow imaging (CDFI) in the detection of macular diseases in senile cataract. Methods A cross-sectional descriptive study. From December 1 to December 30, 2017, 720 senile cataract patients (1380 eyes) diagnosed in Beijing Tongren Eye Center were included in this study. There were 330 males (629 eyes) and 390 females (751 eyes), with the mean age of 70.35±19.05 years. There were 716 right eyes and 664 left eyes, with the visual acuity 0.05-0.8. The fundus of all the patients can be observed. All patients were examined by OCT using Cirrus HD-Model 5000 produced by German Carl Zeiss company and CDFI using MyLab90 color Doppler ultrasound system produced by ESAOTE S.P.A. Comparing the detection rate of macular lesions between the two methods by using χ2 test. Using statistical methods to evaluate diagnostic tests, a crosstabulation was made to compare the consistency of frequency-domain OCT and CDFI in the diagnosis of macular lesions. Logistic regression analysis of correlation between detection of CDFI macular lesions and central foveal thickness (CFT), average thickness (AT), with or without macular anterior membrane, retinal folds, retinal cystoid edema, hard exudation, macular hole or lamellar macular hole, superficial detachment of neuroepithelium, detachment of pigment epithelium, vitreous macular traction. Results Two hundreds and thirty-nine eyes (17.3%) showed macular disease by OCT, and 161 eyes (11.7%) showed the abnormal echo in the macular region by CDFI. The detection rate of the macular disease between two methods were statistically significant (χ2=851.661, P<0.001), however, the consistency was well (κ=0.766, P=0.000). Logistic analysis showed that the detection rate of macular lesions was related to retinal folds, cysts in retina and CFT (r=1.396, 1.041, 0.12; P<0.01). Conclusion CDFI can effectively detect macular lesions that affect the visual prognosis of senile cataract patients. Key words: Ultrasonography, doppler, color; Macular degeneration; Cataract

Comparative study on ultrasonic diagnosis and pathological anatomy of congenital absent semilunar valve in first trimester

Objective To investigate the echocardiographic characteristics, pathological anatomy and genetic abnormality of congenital absent semilunar valves in first trimester. Methods Eleven cases of congenital absent semilunar valve fetus diagnosed at 11-13+ 6 weeks of gestation in Guangxi Magernity & Child Healthcare Hospital from December 2014 to December 2018 were analyzed. The characteristics of echocardiography and the abnormal microanatomy of cardiac tissue after labor induction was compared. Results The crown-lump length of the 11 fetus was 46-74(62.0±9.2)mm, and nuchal translucency thickness(NT) was 2.4-10.4 (6.4±2.6)mm. The NT of 10 cases were greater than 3.0 mm. Color Doppler flow imaging revealed that biphasic bidirectional flow in the aortic arch and/or pulmonary artery at the 3VT view( to-and-fro ) in those 11 cases, and pansystolic turbulence and pandiastolic reflux spectrum were showed on spectral Doppler. Among them, there were 10 cases of stealing type , including 2 cases of isolate absent aortic valves, 3 cases of absent pulmonary valves and 5 cases of absent both aortic and pulmonary valves; and all the 10 cases had secondary ultrasonic manifestations of fetal heart failure. Chromosome analysis and detection of genes showed that 4 cases with Trisomy 13 syndrome, 3 cases with Trisomy 18 syndrome, 1 case with 22q11.2 deletion, 1 case with 12q24.32q24.33 deletion and 1 case was normal. Pathological anatomy revealed enlarged heart in 8 cases, isolate absent aortic valves in 2 cases (1 case complicated with pulmonary atresia, absence of ductus arteriosus and thymus), absent pulmonary valves in 3 cases, absent both aortic and pulmonary valves in 3 cases, relics of semilunar valves in 3 cases. And 2 cases of absent pulmonary valves and 3 cases of absent both aortic and pulmonary valves with short and thick ductus arteriosus. Only 1 case was congenital absent semilunar valve in non-stealing type without secondary ultrasonic manifestations of fetal heart failure. Chromosome analysis and detection of genes showed 22q11.2 deletion, and there were relics of semilunar valves in the pathological anatomy. It also combined with tetralogy of Fallot and absence of ductus arteriosus. Conclusions In first trimester, congenital absent semilunar valves are more common as stealing type . The echocardiographic features of congenital absent semilunar valves are the in-out sign of aorta arch and/or pulmonary artery and biphasic spectrum in spectral Doppler. Trisomy 13 syndrome and trisomy 18 syndrome significantly increased the risk of congenital absent semilunar valves in stealing type in first trimester. Key words: Echocardiography; Congenital absentsemilunar valve; First trimester; Pathologic diagnosis

High Accuracy Thyroid Tumor Image Recognition Based on Hybrid Multiple Models Optimization

With the development of computer vision recognition technology, more and more researchers apply this technology to the recognition of tumor images. But for cost reasons, many hospitals still use low-cost ultrasound and other cheap equipment, resulting in ambiguity, artifacts and many similar tumor noise areas images. Recent related studies have high precision in clear image recognition, such as face and number recognition in color images. However, they showed low accuracy and unstable results in ultrasonic image due to its fuzziness. The straight reason may be that many existing algorithms are not suitable for the fuzzy and noise image, and easily to misjudge the real objects and noise areas. In this paper, we proposed an approach based on R-CNN and RPN to distinguish the real objects from noise areas after data enhancement and morphological filtering with the optimization of a series of hyper-parameters and the combination of Color Doppler Flow Imaging (CDFI) blood flow signal model. We found that the key features of high-noise ultrasound images can be obtained quickly and accurately. From the experimental results, the accuracy and stability of our proposed method outperforms the state-of-the-art approaches on the real world thyroid tumor image data set.

419 Revisiting cardiac Doppler index with single heart beat 4D ultrafast echocardiography

Abstract Funding Acknowledgements European Research Council under the European Union’s Seventh Framework Programme (FP/2007-2013) / ERC Grant Agreement n° 311025 and the ANR-10-IDEX-00 Background 4D echocardiography has the strong potential to improve cardiac index quantification by providing reproducible and user independent measurements. Quantification of left ventricle volume and ejection fraction, for instance, have been shown to be more reliable using 4D echocardiography. However, Doppler index evaluation has not yet benefited from it, due to limited volume rates and single location estimation when assessing spectral Doppler. Purpose In this study, we propose to demonstrate the feasibility of performing semi-automatic evaluation of cardiac Doppler indices within a single heartbeat on three human hearts by performing 4D ultrafast echocardiography, a new technique allowing a drastic volume rate increase. Methods A 4D ultrafast echocardiography scanner prototype connected to a matrix probe was developed to image the human heart. The probe was positioned on the apical 4-chamber view of N = 3 volunteers. High volume rate (5200 volume/s) acquisitions were performed three times by two different trained cardiologists. 4D color flow and tissue Doppler imaging were computed from the each single heartbeat acquisition. Spectral Doppler were derived at each voxel of the volumes. Region of interest such as LV outflow tract, mitral inflow or basal inferoseptal locations were automatically detected. Doppler index were derived from Doppler spectra and tissue velocity curves at these locations, and were compared against indices obtained using a clinical procedure based on 2D echocardiography. Results For each acquisition and the three volunteers, major Doppler indices: E, A, E/A, S, e’, a’, e’/a’, s’, E/e’, cardiac output were successfully assessed during a single heartbeat. A high degree of similarity between the indices assessed by 4D ultrafast echocardiography and clinical 2D measurements were found.(p &amp;gt; 0.05 for each index). Conclusions 4D ultrafast echocardiography can quantify the major cardiac Doppler indices in a single heart beat acquisition. It promises to improve patient care by accelerating examination time and to improve results reproducibility by removing most of the operator dependency. It also offers a unique feature by enabling E/e’ index assessment in the same heart beat which could be of a great interest for atrial fibrillation patients. Abstract 419 Figure.

Diagnosis and Treatment of Early Transplant Renal Artery Stenosis: Experience From a Center in Eastern China

Few studies have focused on the clinical characteristics of transplant renal artery stenosis (TRAS) with early onset. Sixteen cases diagnosed with TRAS in our center from January 2014 to August 2018 were retrospectively analyzed. Sixteen transplant patients without TRAS were selected as controls. The median diagnostic time for TRAS was 47.5 days after transplantation. No significant difference was observed between the TRAS group and the control group. The serum creatinine level (Scr), estimated glomerular filtration rate, systolic/diastolic blood pressure, graft artery peak systolic velocity (PSV), and resistive index of intersegmental artery (RI-ISA) between the 2 groups were (5.55 ± 3.49) and (1.89 ± 0.85) mg/dL; (17.83 ± 14.94) and (49.39 ± 19.96) mL/min; (143.50 ± 9.49)/(86.14 ± 7.38) and (130.38 ± 18.86)/(82.81 ± 12.52) mm Hg; (3.39 ± 1.57) and (1.31 ± 0.51) m/s; and (0.51 ± 0.10) and (0.67 ± 0.13), respectively. All showed statistical significance except the diastolic blood pressure. The Scr, estimated glomerular filtration rate, systolic/diastolic blood pressure, graft artery PSV, and RI-ISA in the TRAS group prior and after treatment were (5.55 ± 3.49) and (3.20 ± 1.50) mg/dL; (17.83 ± 14.94) and (25.60 ± 13.29) mL/min; (143.50 ± 9.49)/(86.14 ± 7.38) and (128.07 ± 16.16)/(75.71 ± 7.56) mm Hg; (3.39 ± 1.57) and (2.00 ± 1.04) m/s; and (0.51 ± 0.10) and (0.61 ± 0.10); all showed statistical significance. Receiver operating characteristic analysis showed an area under curve of 0.8616 for PSV and 0.8535 for RI-ISA in diagnosing TRAS. Patients with TRAS in our center showed a unique characteristic of early onset. The most prominent clinical symptom of TRAS is increasing Scr level instead of refractory hypertension. Screening of color Doppler flow imaging with a graft artery PSV >2.5 m/s and RI-ISA <0.5 could yield a preliminary diagnosis of TRAS. Percutaneous transluminal angioplasty/stenting could effectively improve allograft function as well as color Doppler flow imaging indexes.

Ultrasound Diagnosis of Breast Lymphoma and the Identification of Breast Infiltrating Ductal Carcinoma.

By analyzing the B-mode ultrasound and color Doppler flow imaging characteristics of breast lymphoma (BL) and breast infiltrating ductal carcinoma (BIDC), we expected to discriminate these diseases. Thirty-two patients with BL and 30 with BIDC confirmed pathologically were selected. The BL group was divided into nodular and diffuse groups. We analyzed and compared the general and imaging characteristics of the BL subgroups and the BIDC group. The mean maximum diameter of BL was 54.93 ± 43.74 cm, and that of BIDC was 23.90 ± 6.79 cm (P < .05). The differences between the nodular BL and BIDC groups in a circumscribed margin (60.00% versus 20.00%), calcification (20.00% versus 53.33%), aggregation characteristics (0.00% versus 53.33%), and density (73.33% versus 10.00%) were statistically significant (P < .05). The differences between the diffuse BL and BIDC groups in calcification (6.67% versus 53.33%), aggregation characteristics (6.67% versus 53.33%) and density (40.00% versus 10.00%) were statistically significant (P < .05). The difference in a circumscribed margin (60% versus 13.33%) between the BL subgroups was statistically significant (P < .05). The blood flow signal in BL lesions was richer than that in BIDC lesions (P < .05). Extrasuperior-quadrant single lesions in the BL group were larger than those in the BIDC group. The edges of the lesions in the nodular BL group were circumscribed and dense. Lesions in the diffuse BL group did not have a circumscribed margin, calcification, aggregation characteristics, or density. The blood flow signal in BL lesions was richer than that in BIDC lesions.

Characteristic analysis of Zenker’s diverticulum incidentally detected on multimodal neck ultrasound

Zenker's diverticulum (ZD) incidentally detected on neck ultrasound (US) could be easily misdiagnosed as a thyroid nodule and unnecessarily removed by surgical operation. It is a critical issue to identify the characteristics of ZD in clinical practice. We reported 10 cases of ZD diagnosed using multimodal US, and discussed the features of its multimodal US images extracted from grayscale sonograms, color Doppler flow imaging (CDFI), three-dimensional US (3D-US), and contrast-enhanced US (CEUS). All lesions were heterogeneous in the posterior of the left thyroid. CDFI showed no blood flow within the lesions. The shapes and internal echoes of the masses changed when patients swallowed or drank. Performing CEUS or 3D-US for those with atypical US findings was complementary to make the final diagnosis. Importantly, multimodal US helped to diagnose suspected small lesions in three cases in which the barium esophagram tests proved negative. The US features of ZD detected by multiple modes of US can help in the collection of comprehensive imaging information on ZD, which should be used proactively to facilitate the correct diagnosis and to avoid misdiagnosis of ZD.

Superb microvascular imaging technique in depicting vascularity in focal liver lesions: more hypervascular supply patterns were depicted in hepatocellular carcinoma

PurposeTo investigate the capacity of Superb Microvascular Imaging (SMI) to detect microvascular details and to explore the different SMI features in various focal liver lesions (FLLs) and the correlation between SMI and microvessel density (MVD).Method: Eighty-three liver lesions were enrolled in our study, including 35 hepatocellular carcinomas (HCCs) and 48 non-HCCs. All patients underwent color Doppler flow imaging (CDFI) and SMI examination and were categorized into subgroups according to Adler semiquantitative grading (grade 0–3) or the microvascular morphologic patterns (pattern a-f). The correlation between SMI blood flow signal percentage and MVD was assessed.ResultsCompared with CDFI, SMI detected more high-level blood flow signals (grade 2–3) and more hypervascular supply patterns (pattern e-f) in HCCs (p < 0.05). Furthermore, more hypervascular supply patterns and fewer hypovascular supply patterns were detected in HCC compared with non-HCC (p < 0.05). Based on Adler’s grading or microvascular morphologic patterns, the areas under the receiver operating characteristic curve were 0.696 and 0.760 for SMI, 0.583 and 0.563 for CDFI. The modality of “SMI-microvascular morphologic pattern” showed the best diagnostic performance. There was significant correlation between MVD and the SMI blood flow signal percentage (vascular index, VI) in malignant lesions (r = 0.675, p < 0.05).ConclusionSMI was superior to CDFI in detecting microvascular blood flow signals. More hypervascular supply patterns were depicted in HCC than in non-HCC, suggesting a promising diagnostic value for SMI in the differentiation between HCC and non-HCC. Meanwhile, we were the first to demonstrate that SMI blood flow signal percentage (VI) was correlated with MVD in malignant lesions.