Color Flow Doppler Sonography Research Articles

Urological evaluation of Behçet patients and the effect of colchicine on fertility.

Behçet's disease is a multisystem disorder in which urogenital involvement mainly consists of genital aphthous ulcers, epididymitis, urethritis and recurrent cystitis. Colchicine is commonly used in these patients for the prevention of arthritic episodes. In this prospective study, 62 male patients under colchicine therapy for Behçet's disease underwent a complete urogenital evaluation. 33 (53.2%) had no urologic complaints. Physical examination revealed genital aphthous ulcers in 42 patients (67.7%) and epididymitis in 5 (8.1%). Analysis of urine specimens demonstrated proteinuria in 54.8% and hematuria in 30.6%. To establish any possible adverse effects of colchicine administration on male fertility, sperm analysis was performed: 23 patients (37.1%) had oligonecrospermia, 2 patients (3.2%) had azoospermia. Penile color flow Doppler sonography revealed arterial insufficiency in 17 patients (27.4%). Other urological findings were interpreted as coincidental. Our results indicate that urologic manifestations of Behçet's disease, and especially the possible adverse effects of colchicine administration on the reproductive potential of the treated patients should be carefully monitored.

Post-Radical Prostatectomy Penile Blood Flow: Assessment with Color Flow Doppler Ultrasound

Cadaveric dissections have revealed that accessory blood vessels to the penis often arise near or through the apex of the prostate. These accessory vessels may be easily injured during radical prostatectomy. Increasing attention since the 1980s has focused on preserving potency after radical prostatectomy with a nerve sparing technique. However, many patients are impotent even after a nerve sparing procedure. An arterial, venous or psychological mechanism may be involved. A prospective study was designed to assess cavernous artery diameter, peak systolic flow velocity, penile blood flow, end diastolic flow velocity and resistance index preoperatively and postoperatively in patients undergoing radical prostatectomy. Ten patients with a mean age of 60 years were evaluated, of whom 8 underwent a unilateral nerve sparing procedure, 1 bilateral nerve sparing procedure and 1 bilateral nonnerve sparing procedure. Mean penile blood flow as calculated by the formula penile blood flow = peak systolic flow velocity × π (diameter/2)2 increased 0.33ml. per second (+26%) on the nerve spared side, while diminishing 0.68ml. per second (−41%) on the nonspared side. Overall penile blood flow was diminished. End diastolic flow velocity increased on spared and nonspared sides after surgery. The resistance index for all radical prostatectomy patients diminished 7% from 0.83 preoperatively to 0.77 postoperatively (p = 0.16). While these findings were not statistically significant, they suggest that arterial insufficiency and corporeal venous occlusive dysfunction may be involved in sexual dysfunction after nerve sparing radical prostatectomy.

Percutaneous transhepatic embolization of a spontaneous mesocaval shunt after liver transplantation

A preoperatively undetected spontaneous mesocaval shunt lead to impairment of organ function after liver transplantation. Ischemia of the graft due to partial hepatofugal portal flow was demonstrated by color-flow Doppler sonography and angiography. The successful catheter embolization of the mesocaval shunt via a transhepatic approach is presented.

Cerebrospinal fluid dynamics in infants evaluated with echographic color-coded flow imaging.

To use color Doppler flow ultrasonography (US) for investigation of rapid regional motion of cerebrospinal fluid (CSF) in infants with subarachnoid hemorrhage or meningitis. Sixty-four transfontanellar and transcranial color Doppler US scans of the cerebral aqueduct, ventricles, and basal cerebral and spinal subarachnoid spaces were obtained in 19 infants (12 male and seven female infants, aged 1-81 days). Abdominal palpation or periods of straining or crying were used to increase velocity of CSF motion. In all 19 infants, rapid to-and-fro color CSF flow was observed in the aqueduct. Color-coded CSF flow signals were seen in the aqueduct in 19 infants, in the third (n = 17 with jetlike flow) and fourth (n = 7 with jets) ventricles in 17, at the foramen of Magendie in 11 (n = 4 with jets), and in the spinal compartment in 14. In the presence of scattering particles or cells, regional CSF flow can be investigated with transfontanellar, transcranial, and spinal color flow imaging. Results of regional echographic CSF flow investigation can indicate recent subarachnoid hemorrhage or exclude obstruction. Jetlike CSF flow might stimulate new concepts of rapid CSF dynamics.

Transabdominal color Doppler ultrasonography of the painful adolescent ovary.

The objective of this study was to determine if color flow Doppler ultrasonography based on patterns of perfusion can aid in providing a specific diagnosis of ovarian masses associated with pelvic pain. Color flow Doppler images of 42 ovarian lesions in 42 adolescent girls (age range, 10 to 17 years) were analyzed prospectively. The color flow patterns were classified into three main categories: lesions with no vascularity; lesions with peripheral vascularity; and lesions with internal vascularity. The diagnoses included 22 hemorrhagic ovarian cysts, seven simple cysts, three cystadenomas, seven inflamed ovaries (five with microabscesses and two with dominant cystic abscesses), and three ovarian torsions. A peripheral pattern of flow was observed in 29 of 34 (85%) cystic lesions, including 18 hemorrhagic and six simple cysts, three cystadenomas and two abscesses. Peripheral flow was also identified in four enlarged ovaries, two with inflammatory disease and two with torsion. Internal flow was noted in five patients with enlarged ovaries due to inflammatory disease. Intraovarian flow was absent in three patients with torsion and in five of 34 cystic lesions. Internal ovarian flow was identified in 90% of normal ovaries. Resistive indices, obtained in 33 abnormal ovaries, were higher in cystic lesions than in inflammatory lesions, although the values overlapped. Our findings showed that internal ovarian flow can be found in inflammatory processes and normal ovaries, but the absence of flow also is nonspecific and can be found in a variety of ovarian cystic lesions as well as in torsion. This overlap limits the usefulness of color Doppler ultrasonography for differentiating cystic ovarian lesions associated with pain in adolescent girls.

Prenatal diagnosis of sirenomelus with color Doppler ultrasonography

Sirenomelus is an invariably lethal congenital anomaly characterized by complete or nearly complete fusion of the lower extremities that occurs in 1 of 60,000 births. In about 50% of cases this condition cannot be diagnosed prenatally because of the associated oligohydramnios that precludes a detailed examination of the fetus. We present a case of sirenomelus in which prenatal diagnosis was aided by color Doppler ultrasonography; visualization of the vitelline artery as a single, large intraabdominal vessel that did not branch in the fetal pelvis but rather coursed ventrally into the umbilical cord proved to be diagnostic of this rare condition. Color Doppler flow ultrasonography is a valuable tool for the prenatal diagnosis of sirenomelus. Sirenomelus is an invariably lethal congenital anomaly characterized by complete or nearly complete fusion of the lower extremities that occurs in 1 of 60,000 births. In about 50% of cases this condition cannot be diagnosed prenatally because of the associated oligohydramnios that precludes a detailed examination of the fetus. We present a case of sirenomelus in which prenatal diagnosis was aided by color Doppler ultrasonography; visualization of the vitelline artery as a single, large intraabdominal vessel that did not branch in the fetal pelvis but rather coursed ventrally into the umbilical cord proved to be diagnostic of this rare condition. Color Doppler flow ultrasonography is a valuable tool for the prenatal diagnosis of sirenomelus.

The effect of erythropoietin treatment on arteriovenous haemodialysis fistula/graft: A prospective study with colour flow doppler ultrasonography

To determine the effect of erythropoietin (EPO) on patency the haemodynamics and morphology in haemodialysis fistula/graft were prospectively assessed using ultrasonographic two-dimensional imaging and colour flow Doppler together with pulsed Doppler, prior to and during partial correction of anaemia with EPO. Nineteen radiocephalic fistula and 11 loop grafts in 30 patients on routine maintenance haemodialysis were investigated prior to EPO treatment. A significant stenosis defined as a localised 100% increase in flow velocity was found in the arterial inflow in seven (23%) patients, in the loop graft in seven (64% of loop grafts) patients, and in the venous segments in 23 (77%) patients. Fourteen patients were rescanned after more than 200 days of EPO therapy. There was a significant increase in haemoglobin (84 +/- 14 g/l to 104 +/- 18 g/l) and haematocrit (24 +/- 4 to 31 +/- 5%) during this time. One arterial, four loop grafts and two venous stenoses appeared or increased in severity, and one venous return flow segment had occluded. Blood flow according to ultrasonography was unchanged. Of the 16 patients lost to follow-up, three underwent surgical intervention (clinical failure rate 0.20 access/year). EPO therapy may contribute to minor changes in access haemodynamics but does not seem to be detrimental to patency.

Prenatal diagnosis of sirenomelus with color Doppler ultrasonography

Sirenomelus is an invariably lethal congenital anomaly characterized by complete or nearly complete fusion of the lower extremities that occurs in 1 of 60,000 births. In about 50% of cases this condition cannot be diagnosed prenatally because of the associated oligohydramnios that precludes a detailed examination of the fetus. We present a case of sirenomelus in which prenatal diagnosis was aided by color Doppler ultrasonography; visualization of the vitelline artery as a single, large intraabdominal vessel that did not branch in the fetal pelvis but rather coursed ventrally into the umbilical cord proved to be diagnostic of this rare condition. Color Doppler flow ultrasonography is a valuable tool for the prenatal diagnosis of sirenomelus. (AM J OBSTET GYNECOL 1994;170:1377-9.)

The diagnosis of obstruction

The accuracy of ultrasonographical diagnosis of obstructive hydronephrosis has been improved by the validation of the use of intrarenal artery Doppler interrogation with measurement of the resistance index and by the detection of asymmetrical ureteric jets by colour flow Doppler ultrasonography.

Surveillance of infrainguinal vein grafts with duplex sonography.

This review considers the relative roles of traditional noninvasive vascular tests and conventional duplex and color flow Doppler sonography in the surveillance of infrainguinal autologous vein grafts. The purpose of surveillance is to identify significant anatomic or flow abnormalities that predispose to thrombosis, but can be repaired before graft thrombosis occurs. Although a few authors believe that serial measurements of the ankle-brachial index and other noninvasive vascular tests can serve as the primary method of surveillance for infrainguinal grafts, most authors do not concur. After the first postoperative month, stenosis caused by intimal hyperplasia is the most common cause of graft failure, usually occurring within 18 months after placement. Duplex sonography is both highly sensitive and specific for detection of such stenoses. Specific duplex sonographic criteria have been established for grading of stenoses and for the diagnosis and classification of arteriovenous fistulas. A large body of evidence suggests that graft thrombosis can occur without prior warning symptoms and that long-term graft patency improves if the asymptomatic lesions detected with duplex sonography are repaired before symptoms develop.

Metastatic colonic adenocarcinoma simulating primary ovarian neoplasm in transvaginal Doppler sonography

Transvaginal color flow and pulsed Doppler sonography has shown promise in the evaluation and characterization of adnexal masses and may ultimately play a role in ovarian cancer screening.',' A relative increase in the diastolic flow in malignant lesions has been previously reported. Pathologic evidence suggests that this phenomenon reflects the paucity of smooth muscle within tumor vessels along with intratumoral arteriovenous We present a case of a postmenopausal woman who presented with large adnexal masses simulating primary ovarian neoplasm in gray-scale sonography that, in addition, manifested an abnormally low resistive index in the transvaginal Doppler examination. Further evaluation with computed tomography (CT) and, ultimately, laparotomy revealed metastatic spread of a mucinous adenocarcinoma of the colon to the adnexa.

Color Flow Doppler Sonography in the Diagnosis of Vesicoureteric Reflux

We describe an alternative technique using color flow Doppler sonography (CFDS) for detection of vesicoureteric reflux (VUR). Twenty-one children, ages 2-16 years, were investigated for VUR using voiding cystourethrography (VCU) and CFDS. Forty-two ureterovesical junctions were studied and a total of 27 were found to be refluxing at VCU. Five of these 21 patients were operated for VUR and they were also reevaluated 3 and 6 months after the operation. With good diuresis ureteric jets could easily be detected with CFDS and if there was a reflux of urine into the ureter this could also be displayed. Afterwards, the patient was asked to urinate and if reflux into the ureter was detected, particular attention was paid to the detection of ureteral and pelvicalyceal dilatation by conventional gray-scale sonography. Taking VCU as the gold standard, CFDS revealed reflux in all cases except 1. There were 3 patients who had only one-sided reflux at VCU and bilateral reflux at CFDS examination (false-positive: 20%). Correlation of CFDS and VCU was 90, 100 and 75% in low grade, grade III and grade IV reflux, respectively. The results of CFDS correlated well with the results of VCU during the follow-up of 5 patients who had antireflux operations. As a conclusion, CFDS could be used as an adjunct to standard ultrasonography for detection of VUR.

THE IMAGING EVALUATION OF RENAL CELL CARCINOMA: DIAGNOSIS AND STAGING

Computed tomography plays the dominant role in the pretreatment evaluation of renal carcinomas. For detection, definition (staging), and determination of resectability or recurrence, both computed tomography with dynamic intravenous contrast enhancement and magnetic resonance imaging with Gadolinium-based contrast enhancement may offer all the cross-sectional imaging information required prior to institution of appropriate therapy. Ultrasonography and color-flow Doppler ultrasonography may offer unique information about tumor vascularity and major venous vascular involvement. An oncologic imaging approach that is based on tumor staging and classification for patients with real or suspected renal carcinoma is described.

Evaluation of Renal Morphology and Vascular Function by Color Flow Doppler Sonography Immediately after Extracorporeal Shock Wave Lithotripsy

Thirteen male and seven female patients with renal calculi were evaluated by color flow Doppler sonography (CFDS) for renal morphology and function before and after receiving 1000 to 2350 shocks with the Dornier MPL 9000 lithotripter. No significant morphologic change was encountered except for renal enlargement thought to be secondary to edema induced by shock wave application. Similarly, no significant differences were recorded in the systolic and diastolic flow rates or pulsatility (PI) or resistive (RI) indices of the renal vessels before and after treatment (P > 0.05). Color flow Doppler sonography appears to be a safe, noninvasive, and reliable means of evaluating kidneys subjected to extracorporeal shock wave lithotripsy.

Refinements in the ultrasonic detection of popliteal vein reflux

Color-flow and duplex ultrasonography were used to determine the optimal method for documenting venous valvular reflux. Popliteal veins were examined in 10 normal limbs and 11 limbs with clinical evidence of chronic venous insufficiency (CVI). Peak reflux velocity (spectral) and duration of reflux (spectral and color) were measured with the patient in supine and standing positions, with manual and pneumatic compression applied sequentially to thigh and calf. Manual and pneumatic compression produced equivalent reflux velocity and duration. In normal limbs peak reflux velocity was always less than 22 cm/sec, with a mean reverse flow duration of 0.3 sec ± 0.03 (SEM). In limbs with CVI, reflux velocity varied widely among protocols. Reflux duration and velocity were greater in the supine position than in the standing position for both normal limbs and limbs with CVI (p < 0.04). Duration was significantly increased for thigh versus calf compression in normal limbs (p < 0.001) but decreased in limbs with CVI (p < 0.003). Methods that used thigh compression or supine position were less capable of discriminating normal limbs from limbs with CVI. Standing calf compression provided the greatest rates of sensitivity (91%), specificity (100%), and accuracy (95%). Compared with spectral Doppler scanning, color-flow ultrasonography produced a consistently shorter reflux duration (p < 0.001). In limbs with CVI with a mean spectral duration of 2.5 sec ± 0.2 (SEM), mean color Doppler duration was 0.7 sec shorter. Our results demonstrate that popliteal vein incompetence is identified optimally by reflux duration after standing calf compression; adequate manual compression is sufficient to identify reflux; color-flow Doppler ultrasonography may underestimate reflux duration.

Transvaginal color flow Doppler sonography in the assessment of gestational trophoblastic disease.

The aim of this study was to evaluate the blood flow characteristics of the uterine artery and intratumoral vessels in patients with GTD. Twelve patients with GTD were evaluated with TVS, and 11 also had CFD sonography performed. Spectral analysis of both uterine artery and samples intratumoral and intramyometrial vessels revealed systolic frequencies and PI that were significantly higher in the uterine artery than in sampled intratumoral vessels (P < 0.05). Uterine artery PI correlated significantly with age (P = 0.043), uterine size (P = 0.003), and beta-HCG titer (P = 0.03). Intratumoral PI correlated significantly with uterine size (P = 0.05). Intratumoral PI did not correlate with patient age, the shape or orientation of the uterus, presence or absence of subendometrial halo, endometrial thickness or echogenicity, or impression of myometrial invasion. Regression analysis of beta-HCG titers on uterine artery and intratumoral PI revealed a linear association. TVS and color flow Doppler sonography are useful in the assessment of patients with GTD. The PI is strongly associated with prognosis and correlates with beta-HCG titers.

Diagnostic utility of color flow Doppler in extracardiac causes of congestive heart failure in infants

SummarySystemic vascular malformations are a rare cause of congestive heart failure in the infant and newborn infant. Clinical diagnosis is often problematic. Accordingly, this study presents the clinical, radiographic, ultrasound imaging, pulsed and color Doppler features of systemic vascular malformations in six infants. In all cases, color Doppler provided vital information regarding size, location, source of feeding arteries and venous drainage essential for appropriate management of these patients. Color flow Doppler ultrasonography is an accurate and sensitive modality for detecting and evaluating vascular malformations.

The use of nimodipine in a patient with eclampsia: Color flow Doppler demonstration of retinal artery relaxation

Color flow Doppler ultrasonography was used to demonstrate a significant and sustained reduction in the central retinal artery pulsatility index after administration of the calcium antagonist nimodipine to a patient with eclampsia. Nimodipine is an effective cerebral vasodilator and may be useful in the management of eclamptic patients with severe vasospasm.

Characterisation of Renal Masses with Colour Flow Doppler Ultrasonography

Colour flow Doppler ultrasonography (US) was used in 24 renal masses (12 benign, 12 malignant) to investigate the vascularity of the lesion and thus to characterise the mass. A colour flow Doppler US device (Toshiba 270 A) with a convex probe of 3.75 MHz was used. Colour flow and the peak-systolic Doppler shift frequency obtained from the renal mass were used to distinguish between benign and malignant lesions. Ten of 12 malignant lesions demonstrated colour flow together with Doppler signals greater than 2.5 kHz (mean 3.5 kHz). None of the 12 benign renal masses demonstrated colour flow or tumour signals. The majority of malignant lesions give rise to neovascularisation and so high frequency Doppler-shifted signals. Thus colour flow Doppler sonography is the most reliable means of differentiating benign from malignant renal masses.

Transvaginal color Doppler sonography of adnexal masses: differences in blood flow impedance in benign and malignant lesions.

The purpose of this study was to assess the blood flow characteristics of adnexal masses before surgical excision and to determine whether color flow Doppler sonography is useful for distinguishing benign from malignant masses. Thirty-one adnexal masses were evaluated with color flow Doppler transvaginal sonography. The pulsatility index and resistive index were calculated from the waveforms generated from blood flow within the ovary. Twenty-five lesions were benign and six were malignant on pathologic examination. Benign lesions included six endometriomas, six mesothelial cysts, three serous and one mucinous cystadenoma, three mature cystic teratomas, two hemorrhagic corpus luteum cysts, one cystadenofibroma, one sclerosing stromal cell tumor, one paratubal cyst, and one ovary that had undergone torsion with infarction. The malignant lesions consisted of three papillary serous cystadenocarcinomas, one granulosatheca cell tumor, one immature teratoma, and one metastasis of colon cancer to the ovaries. Benign tumors and cysts had a significantly higher pulsatility index (mean, 1.93 +/- 1.02; range, 0.23-3.99) and resistive index (mean, 0.77 +/- 0.22; range, 0.2-1.0) than did malignant tumors (pulsatility index: mean, 0.77 +/- 0.33; range, 0.31-1.09; resistive index: mean, 0.5 +/- 0.17; range, 0.27-0.67). However, some overlap in individual values for benign and malignant lesions was found. Our preliminary data suggest that high pulsatility and resistive indexes indicate benign adnexal processes; however, considerable overlap in pulsatility and resistive indexes between benign and malignant lesions was noted, and further work is needed before the validity of these factors is proved.