Color Doppler Flow Research Articles

Venous Leak Embolization Results in Clinical Improvement of Patients with Mixed Arterio-Venous Erectile Dysfunction Not Responding to Arterial Revascularization Alone.

To analyze the safety and efficacy of additional venous leak embolization after an initial arterial revascularization to treat patients with combined arteriogenic and venogenic erectile dysfunction (ED). Single-center observational study from October 1, 2019, to September 30, 2022, including 26 patients with ED resistant to phosphodiesterase-5-inhibitors (PDE5i) and without significant clinical benefit after arterial revascularization of erection-related arteries. Additional treatment with venous leak embolization was performed 458 ± 424daysafter arterial revascularization. Arterial obstruction and venous leak were verified based on color Doppler flow analysis, computed tomography angiography, and computed tomography cavernosography. The primary safety endpoint was any major adverse event 6weeks after the procedure. The primary feasibility endpoint was defined as an IIEF-6 (International Index of Erectile Function-6) score improvement of ≥ 4 points at 6-week follow-up post intervention. Procedural success was achieved in all patients with no major adverse events on follow-up. The primary feasibility endpoint at 6-week follow-up was reached with 3/26 (11.5%) of patients following arterial revascularization only. Six weeks after additional venous embolization, the primary feasibility endpoint was reached in 17/26 (65.4%) of patients. Venous leak embolization yields additional clinical improvement and treatment potential in patients with vasculogenic ED not responding to PDE5i due to mixed arterio-venous disease and insufficient clinical improvement after arterial revascularization alone.

Using ultrafast angio planewave ultrasensitive and conventional doppler imaging techniques to assess intramuscular blood perfusion in older adults

BackgroundMicrovascular ultrasound imaging techniques such as Angio PLanewave UltraSensitive (Angio-PL.U.S.) have been used to detect microvascular blood flow in various organs and tissues. However, the advantage of Angio-PL.U.S. for assessing muscle microvascularity over other non-invasive imaging modalities has not been investigated. This cross-sectional study compared ultrafast Angio-PL.U.S. and conventional color Doppler flow imaging (CDFI) techniques for assessing intramuscular blood perfusion.MethodsForty-five older adults participated (age = 59.1 ± 7.6). The vascularity index (VI) was used to quantify intramuscular blood flow of the bilateral biceps brachii (BB) and medial gastrocnemius (MG). Intra-limb (difference in VI between CDFI and Angio-PL.U.S. techniques) and inter-limb differences [percent side-to-side differences (%SSD) in VI between dominant and non-dominant sides] were compared using Wilcoxon Signed Ranks and Mann-Whitney U tests, respectively. Associations between techniques were assessed using Spearman’s rho (ρ).ResultsNo significant differences were observed between dominant and non-dominant BB (p ≥ 0.053) and MG (p ≥ 0.756) for both CDFI-VI and Angio-PL.U.S.-VI. Only VI measures for the non-dominant BB demonstrated significant intra-limb difference between techniques (p = 0.002). A significant %SSD between techniques was observed for BB (p = 0.022) but not MG (p = 0.225). Strong to very strong correlations were observed between CDFI-VI and Angio-PL.U.S.-VI across all muscles (ρ = 0.616–0.814, p ≤ 0.001).ConclusionUltrafast Angio-PL.U.S. and conventional ultrasound imaging techniques were comparable when used in conjunction with the VI for quantifying resting intramuscular blood flow. Angio-PL.U.S. appeared to be more sensitive in detecting bilateral disparities in upper extremity muscles. However, further research is needed to validate these findings and investigate the potential clinical utility of this technique for characterizing disease progression in populations with global or unilateral musculoskeletal tissue alterations.

Visual grading of valvular regurgitation is inferior to measurement – results from the VIAVA-study (VIsual Assessment of VAlvular Regurgitation)

While the visual estimation of systolic left ventricular function by experienced examiners closely aligns with quantitative methodologies, the accuracy of visual estimation in determining the severity of valvular regurgitation using colour flow Doppler assessment of native heart valves remains largely unexplored. This study analysed the ability of 262 physicians to visually estimate the severity of 12 native valve regurgitations by grading colour Doppler transthoracic echocardiography loops in an online questionnaire. The assessments of the participants were compared to standardized quantitative evaluations conducted by certified echocardiography experts. Of the three valves to assess, evaluations by the participants showed the best correlation (Rs = 0.75, p < 0.0001) and agreement (percent agreement: 66.4%) with those of the experts in mitral valve regurgitation (MR). High agreement was observed for mild regurgitation across all valves (MR 94.5%, AR 80.3% and TR 88.7%), while consensus diminished in moderate (MR 55.9%, AR 49.5% and TR 55.0%) and severe regurgitation (MR 57.6%, AR 67.4%, TR 14.6%). The study underscores the potential utility of visual estimation of valvular regurgitation in clinical settings for identifying clinically relevant regurgitations. However, our findings also highlight the importance of integrating visual estimation with quantitative methods, particularly in moderate and severe cases of regurgitation.

Significance of myeloperoxidase, pentraxin-3 and soluble urokinase plasminogen activator receptor determination in patients with moderate carotid artery stenosis

We investigated serum concentrations of specific inflammatory parameters in patients with significant carotid artery stenosis (CAS) of 50–99%, with an additional focus on patients with moderate stenosis (50–69%), in terms of both symptomatic status and plaque morphology, to determine whether there are certain parameters that can be associated with plaque instability before the progression of CAS to a high degree. The study included 119 CAS patients, 29 of whom had moderate stenosis, and 46 controls. Ultrasonography of the carotid arteries was performed using color flow Doppler and B-mode duplex ultrasound, and serum inflammatory parameters were measured using commercially available enzyme immunoassays. When comparing patients with 50–99% stenosis, only serum amyloid A (SAA) was higher in symptomatic patients, while in the group of patients with 50–69% stenosis, myeloperoxidase (MPO) was higher and pentraxin-3 (PTX-3) was lower in symptomatic compared to asymptomatic patients, and soluble urokinase plasminogen activator receptor (suPAR) was higher in patients with carotid plaque of unstable compared to stable morphology. Our results suggest that the importance of different inflammatory parameters in patients with moderate CAS is not the same as in CAS patients in general, and therefore their separate investigation in patients with high and moderate stenosis may be beneficial. SAA has the potential to be further considered in research to predict CAS symptom risk. There is a possibility that MPO and PTX-3 play a role in the development of CAS symptoms originating from less stenotic plaques and that suPAR is involved in the destabilisation of such plaques.

A case report of patent ductus arteriosus in a Brazilian longhair female kitten

Among the congenital cardiac alterations observed in small pets, the persistence of the right aortic arch has been described as a rare anomaly in cats. The ductus arteriosus corresponds to a normal fetal vascular structure derived from the distal portion of the sixth left aortic arch that connects the pulmonary artery to the dorsal aorta. During fetal life, this structure has the function of transporting oxygenated blood from the maternal placenta to the aorta, bypassing the collapsed lungs of the fetus. At birth, the increase of O2 partial pressure dissolved in arterial blood (PaO2) and the decline in prostaglandin concentration cause the closure of the ductus arteriosus in the first hours of life, giving rise to the ligamentum arteriosus. If this process does not occur, the ductus arteriosus will remain patent. In this case report, a 4-month-old longhair female kitten was treated, and, during auscultation, a heart murmur was found. After performing a Doppler echocardiogram and color flow mapping, the presence of continuous turbulent flow in the pulmonary artery was demonstrated, characteristic of patent ductus arteriosus persistence. The animal was sent for surgery, and in the post-surgical Doppler echocardiogram, correction of patent ductus arteriosus was verified, demonstrating the absence of continuous turbulent flow in the pulmonary artery.

Analyses of gingival papilla blood flow via color doppler flow imaging and micro-flow imaging in patients with advanced periodontitis: a clinical pilot study

BackgroundResearch investigating the potential link between gingival microvascular blood flow and inflammatory status is scarce. This study aims to assess color doppler flow imaging (CDFI) and micro-flow imaging (MFI) as tools for the assessment of gingival papilla blood flow (GPBF) and to examine their diagnostic utility as a noninvasive means of detecting gingival bleeding.MethodsCDFI and MFI were used to assess the GPBF grade (0–4) of 140 anterior gingival papilla sites in advanced periodontitis patients. Correlations between GPBF grades and periodontal characteristics were examined, and diagnostic performance as a means of predicting bleeding on probing (BOP) was examined using receiver operating characteristic curves.ResultsGPBF grades 0 and 1 assessed by the MFI were 14.29% and 15.71% respectively, lower than the 28.57% and 24.29% assessed by the CDFI. In contrast, MFI detected a higher frequency of GPBF grade 2 sites (40.71%) relative to CDFI (22.14%). The CDFI and MFI provided consistent results in 62.14% of the sites, while the MFI demonstrated higher ratings in rest 37.86% of the sites. A significant positive correlation was detected between GPBF grade and the modified gingival index (MGI), bleeding index (BI), BOP, and probing depth (PD). It showed high accuracy for CDFI or MFI to diagnosing BOP with a sensitivity of 80.51% and 96.43% and a specificity of 77.27% and 57.14%, respectively. Area under the receiver operator characteristic curve values when predicting BOP based on the GPBF grade determined using CDFI and MFI approaches 0.887 (95% CI 0.833–0.942) and 0.917 (95% CI 0.862–0.972), respectively, and there were no significant differences between these values (Z = − 1.502, p = 0.133).ConclusionsBoth MFI and CDFI can be employed for the evaluation of GPBF, and MFI is better suited to detecting mild inflammation.Trial registration ChiCTR2200066021 (Date of registration: 22/11/2022).

Improving microvascular sensitivity of color Doppler using phase mask based flow recycling algorithm

&#xD;Blood flow sensitivity is a crucial metric for appraising the effectiveness of color Doppler flow imaging (CDFI). Color Doppler velocity maps based on classic autocorrelation techniques are widely used in clinical practice. However, these techniques often produce twinkling artifacts in noisy regions due to the inherent randomness of noise phases. To mitigate artifacts and improve image quality, Power Mask (PoM) technology becomes imperative. Nevertheless, PoM technology unintentionally filters out small flow signals that have similar power and frequency characteristics to noise signals, thereby reducing the imaging system's sensitivity to flow. &#xD;Approach:&#xD;To address this issue, a novel Flow Recycling Algorithm (FRA) based on phase anomaly is introduced in this study. This algorithm, excavating small flow signals from noise, aims to enhance the small flow signals with low-velocity by the phase characteristics of the color Doppler flow information. &#xD;Main results: &#xD;Experiments in multi-organ imaging have shown that the FRA-CDFI approach is more effective in suppressing twinkling artifacts in noisy regions, preserving intricate small flow signals, and markedly improving small blood flow sensitivity. This novel approach provides adequate technical support for clinical ultrasound imaging of organs with dense small blood vessels, such as the brain, kidneys, liver, and more. &#xD;Significance: &#xD;As a novel post-processing method, FRA-CDFI holds significant potential for future deployment in clinical high-frame-rate ultrasound imaging devices.

Qualitative and quantitative analysis of solid renal tumors by high-frame-rate contrast-enhanced ultrasound

ObjectiveTo analyze the characteristics of high-frame-rate contrast-enhanced ultrasound (H-CEUS) in solid renal tumors using qualitative and quantitative methods.MethodsSeventy-five patients who underwent preoperative conventional ultrasound (US), conventional contrast-enhanced ultrasound (C-CEUS), and H-CEUS examination of renal tumors were retrospectively analyzed, with a total of 89 renal masses. The masses were divided into the benign (30 masses) and malignant groups (59 masses) based on the results of enhanced computer tomography and pathology. The location, diameter, shape, border, calcification, and color doppler blood flow imaging (CDFI) of the lesions were observed by US, and the characteristics of the C-CEUS and H-CEUS images were qualitatively and quantitatively analyzed. The χ² test or Fisher’s exact probability method was used to compare the US image characteristics between the benign and malignant groups, and the image characteristics of C-CEUS and H-CEUS between the benign and malignant groups. Moreover, the nonparametric Mann-Whitney test was used to compare the differences in C-CEUS and H-CEUS time-intensity curve (TIC) parameters.ResultsSignificant differences in gender, surgical approach, echogenicity, and CDFI were observed between the malignant and benign groups (p = 0.003, < 0.001, < 0.001, = 0003). Qualitative analysis also revealed significant differences in the mode of wash-out and fill-in direction between C-CEUS and H-CEUS in the malignant group (p = 0.041, 0.002). In addition, the homogeneity of enhancement showed significant differences between the two contrast models in the benign group (p = 0.009). Quantitative analysis indicated that the TIC parameters peak intensity (PI), deceleration time (DT) /2, area under the curve (AUC), and mean transition time (MTT) were significantly lower in the H-CEUS model compared to the C-CEUS model in both the benign and malignant groups. (all p < 0.001). In contrast, ascending slope of rise curve (AS) was significantly higher in the H-CEUS model compared to the C-CEUS model in the malignant group (p = 0.048).ConclusionsIn renal tumors, H-CEUS shows clearer internal enhancement of the mass and the changes in the wash-out period. The quantitative TIC parameters PI, DT/2, AUC, and MTT were lower in H-CEUS compared to C-CEUS. Both the quantitative and qualitative analyses indicated that H-CEUS better displays the characteristics of solid renal masses compared with C-CEUS.

Encapsulated papillary carcinoma of breast: Comparative study of multimodal ultrasound manifestations and pathological features.

To investigate the conventional ultrasound (US), contrast-enhanced ultrasound (CEUS) manifestations and the corresponding histopathological characteristics of patients diagnosed with breast encapsulated papillary carcinoma (EPC) and to explore the value of CEUS in diagnosis of EPC. The clinical, pathological, US, and CEUS features of 16 patients (17 lesions) with EPC confirmed by postoperative histopathology were retrospectively analyzed. EPC was prevalent in the postmenopausal women. The majority of conventional US images of EPC showed complex cystic and solid masses with circumscribed margins (70.6%), enhanced posterior echo (94.1%), no sonographic calcification (88.2%), rich blood flow in the solid components within lesions (70.6%) on Color Doppler flow imaging, and high resistance index of blood flow (94.1%). Moreover, CEUS showed mainly centripetal hyperenhancement of the solid components within the lesions with irregular outline, and the enhancement area of the whole masses was essentially the same as the B-mode US area. EPC typically presents as a complex cystic and solid mass. CEUS is helpful to clarify the extent of the solid component and facilitate preoperative core-needle biopsy. A comprehensive evaluation by CEUS is valuable for diagnosing EPC and combining it with clinical features are helpful to further improve the diagnosis of this rare kind of breast cancer.

Diagnosis and Analysis of Vasa Previa Types With Flow HD Glass Body.

To explore the value of applying flow high definition (HD) glass body in prenatal diagnosis of vasa previa and to preliminarily discuss the types of vasa previa. Two-dimensional ultrasound, flow HD, and flow HD glass body were used to image the umbilical cord insertion site and placenta, observe the cervical internal os and surrounding areas, and retrospectively analyze cases of vasa previa. There were 15 cases of vasa previa, including 14 cases of singleton pregnancies and 1 case of twin pregnancy, with a total of 22 vasa previa, including 10 veins and 12 arteries. There was 1 case with 3 vessels, 5 cases with 2 vessels, and 9 cases with a single vessel. Among them, in 3 cases of vasa previa detected at 12, 14, and 24 weeks, respectively, the vasa previa were relocated to a normal position at 24, 29, and 35 weeks of gestation when re-examined. Routine 2-dimensional ultrasound examination in this group showed tubular or circular hypoechoic areas near the cervical internal os, but vasa previa could not be confirmed. Flow HD could display color blood flow at and near the cervical internal os in 15 cases, but it was difficult to continuously show the course and source of the blood vessels under the chorion. Flow HD glass body from multiple angles could display the relationship between 15 cases of 22 vasa previa and the placenta and cervix. Combined with color Doppler blood flow spectra, flow HD glass body could determine the types of vasa previa. Flow HD glass body imaging can clearly display vasa previa, showing their origin and the spatial relationship with the cervix and placenta in a 3-dimensional manner, displaying the course and attachment points of umbilical vessels under the chorion. It can observe the area of interest at any angle, and combined with color Doppler blood flow spectra, it can judge the vasa previa of the umbilical vein, providing a more definite imaging basis for clinical management.

The treatment response evaluation through the combination of contrast-enhanced ultrasound and squamous cell carcinoma antigen in cervical cancer.

The evaluation of the treatment response after concurrent chemotherapy and radiotherapy (CCRT) for locally advanced cervical cancer is closely related to the formulation of treatment strategies. Magnetic resonance imaging (MRI) is a recommended method for efficacy evaluation; however, a unified consensus has not yet been reached on its use, and it has its limitations. This study aimed to evaluate the diagnostic value of a combination of contrast-enhanced ultrasound (CEUS) parameters and the squamous cell carcinoma antigen (SCC-Ag) to establish another efficient and feasible examination method. The data of 94 patients with cervical cancer who underwent transvaginal contrast-enhanced ultrasound (TV-CEUS) from October 2020 to March 2023 were retrospectively collected. Based on the inclusion and exclusion criteria, 70 patients diagnosed with cervical squamous cell carcinoma (SCC) who underwent CCRT were selected for inclusion in the study. The patients were divided into the residual disease (RD) group (comprising 26 patients) and the complete response (CR) group (comprising 44 patients) according to the diagnostic standard. Data on the grayscale echogenicity, color Doppler flow imaging (CDFI), CEUS parameters, and the SCC-Ag of all the patients were collected by two experienced radiologists. Inter-observer reliability was assessed using the intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) curves were created based on the non-parametric U-test or t-test results for the two groups. Delong's test was used to compare the area under the curve (AUC) between different ROC curves. A subgroup analysis was conducted based on the patient's age, tumor diameter, and disease stage. The ICCs between the two observers ranged from 0.915 and 0.947. Hypervascular hyper-enhancement in the arterial phase, hypo-enhancement in the venous phase, and the SCC-Ag differed significantly between the RD and CR groups (P<0.05). The AUC of the ROC curve combining these indicators was 0.890 [95% confidence interval (CI): 0.792-0.989], which was higher than the AUC of any indicator alone (P<0.05). The subgroup analysis showed that the AUCs of the patients aged ≥53 and <53 years were 0.922 (95% CI: 0.816-1.00) and 0.896 (95% CI: 0.782-1.00), respectively, those of the patients with stage II, III, and IV were 0.881 (95% CI: 0.732-1.00), 0.955 (95% CI: 0.894-1.00), and 1.000 (95% CI: 1.00-1.00), respectively, and those of the patients with a tumor diameter ≤10 mm, 10 mm < tumor diameter (post) <20 mm, and tumor diameter (post) ≥20 mm were 0.976 (95% CI: 0.910-1.00), 0.883 (95% CI: 0.763-1.00), and 1.00 (95% CI: 1.00-1.00) respectively. Transvaginal ultrasound (TVUS), TV-CEUS, and the SCC-Ag can be used in combination to evaluate the patient response to CCRT in locally advanced cervical SCC. This integrated approach enhanced the accuracy of the diagnosis of residual lesions and may be helpful in treatment plan optimization.

Development and Assessment of a Predictive Model for Ki-67 Expression Using Ultrasound Indicators and Non-Morphological Magnetic Resonance Imaging Parameters Before Breast Cancer Therapy.

To formulate a predictive model for assessing Ki-67 expression in breast cancer by integrating pre-treatment ultrasound features with non-morphological magnetic resonance imaging (MRI) parameters, encompassing functional and hemodynamic indicators. A retrospective study was conducted on 167 patients. All patients underwent a breast mass biopsy for histopathological and Ki-67 analysis prior to neoadjuvant chemotherapy (NAC) treatment. Additionally, all patients underwent ultrasonography and MRI examinations prior to the biopsy. The recorded variables were Ki-67, apparent diffusion coefficient (ADC) values, Max Slope, time to peak (TTP), signal enhancement ratio (SER), early enhancement rate (EER), time-signal intensity curve (TIC), tumor maximum diameter, tumor margins and boundaries, aspect ratio, microcalcification, color Doppler flow imaging grading, resistance index (RI), and axillary lymph node metastasis. Statistical analysis was performed using the R software package. Normally distributed continuous data are presented as mean ± standard deviation (SD), skewed continuous data as median, and categorical variables as frequency or percentage. The dataset was randomly divided into a modeling group and a validation group following a 7:3 ratio, employing a predetermined random seed. The selection of variables was conducted using the random forest algorithm. Specifically, in the initial analysis, we trained a random forest model using all available variables. By evaluating the Gini importance scores of each variable, we identified those that contributed the most to predicting Ki-67 expression. The predictive model for Ki-67 expression was constructed using selected variables: Maximum Diameter, ADC value, SER value, Max Slope value, TTP value, and EER value. Within the validation group, the evaluation metrics demonstrated an Area under the curve of 0.961 with a 95% confidence interval ranging from 0.865 to 0.995. The model achieved a kappa score of 1.00, precision of 0.949, recall of 1, an F1 score of 0.974, sensitivity of 100%, specificity of 85.71%, a positive predictive value of 94.87%, and a negative predictive value of 100%. The combination of non-morphological MRI parameters and pre-treatment ultrasound features in a breast cancer prediction model powered by RF machine learning demonstrated favorable clinical outcomes and improved diagnostic performance.

Diagnostic value of lung ultrasound, clinical examination, and colourflow Doppler compared with fiberoptic bronchoscopy to predict appropriate lung exclusion in thoracic surgery: A cohort study.

Diagnostic value of lung ultrasound, clinical examination, and colourflow Doppler compared with fiberoptic bronchoscopy to predict appropriate lung exclusion in thoracic surgery: A cohort study.

Abstract P450: A dual probe ultrasound vector Doppler method for a robust and reliable estimation of blood flow volume and pulse wave velocity on the carotid artery

Background: The arterial pulse wave velocity (PWV) is a strong marker of cardiovascular risk and hypertension. The development of devices enabling a robust and reliable assessment of PWV could play an important role in the early diagnosis and monitoring of those diseases. In this work, we propose an ultrasound technique to estimate blood flow volume (BFV) and PWV by simultaneously using two probes. Methods: Two linear arrays, held by a handle, image two cross-sections of the artery, on two planes intersecting at 40° at the vessel center (A). B-mode and color flow Doppler (CFD) images are reconstructed at high frame rate (HFR): the cross-section HFR CFDs, providing vector-Doppler imaging, avoid any assumptions on flow velocity direction and profile, thus enabling reliable BFV estimates; the HFR B-mode allows tracking the arterial wall, thus enabling robust and time-resolved estimates of the lumen area (B). PWV is estimated as the ratio between the change in flow and cross-sectional area during the early systole (C). The method was preliminary verified by repeating 12 times the BFV and PWV estimation on the carotid artery of 8 healthy volunteers. Results: PWV and BFV measures were in the physiological range of 4.0-6.6 m/s (D) and 4.2-10.8 cm 3 /s, respectively. Measures were repeatable as proved by narrow interquartile ranges and low average standard deviations (1.4 m/s and 1.1 cm 3 /s, for PWV and BFV), which confirm the method's robustness. Conclusions: The proposed technique is suitable for BFV and PWV estimations. Since it is robust to probe repositioning and does not rely on any assumption of flow direction and profile, it could be implemented on wearable cardio-vascular wellness monitoring devices.

A Study of Mechanical Scanning High-frequency Ultrasonic Color Flow Imaging

Abstract High-frequency Ultrasonic imaging can promote high-resolution images and detailed diagnostic information, which has great clinical application prospects. However, due to the difficulty and high cost of high-frequency multi-channel ultrasound systems and multi-array element transducers, it is not conducive to popularization. Mechanical scanning high-frequency ultrasound imaging system is an alternative and low-cost method. However, current mechanical scanning systems cannot perform ultrasound flow imaging, and hemodynamic information is clinically important. Therefore, an improved high-frequency, miniaturized mechanical scanning system for color flow imaging was designed and developed. The system uses a crank linkage structure to drive a miniature transducer with a center frequency of 12 MHz for reciprocating scanning imaging within a range of 15 mm. By optimizing the clutter filter and dynamic domain flow imaging process, two methods are realized: real-time rapid ultrasound imaging and highly sensitive ultrasound flow imaging. The two optimized methods used power Doppler and color flow Doppler for flow phantom imaging, and the final measured blood flow error was less than 5%, which indicates that the mechanical scanning high-frequency ultrasonic color flow imaging system has a good application prospect.

Predictors of left ventricular outflow tract obstruction after biventricular repair in interrupted aortic arch or aortic coarctation

BackgroundLeft ventricular outflow tract obstruction (LVOTO) re-intervention is a significant cause of morbidity and mortality in patients with coarctation of the aorta (CoA) or interrupted aortic arch (IAA) after aortoplasty. MethodsThis retrospective study analyzed data from neonates with IAA/CoA who underwent biventricular repair between 2012 and 2022. LVOTO events were defined by the detection of color Doppler flow acceleration ≥3.0 m/s at the valvular, subvalvular, or supravalvular regions via transthoracic echocardiography, and the necessity for surgical or catheter intervention to relieve the obstruction. ResultsAmong 121 neonates with CoA/IAA, 16 (13.7%) primary aortoplasty patients developed LVOTO. Additionally, one patient (25%) who underwent a staged Yasui operation developed LVOTO due to a narrowed ventricular septal defect–pulmonary atresia tunnel. During follow-up, 58% of patients with a bicuspid valve and 25% of patients with a subaortic ridge developed LVOTO. The combination of either a bicuspid valve, subaortic ridge, or an aortic valve annulus Z-score < −3.0 predicted a high re-intervention rate (7/8 [87.5%]). ConclusionsIn patients with IAA/CoA, the presence of multiple risk factors, including a bicuspid valve, subaortic ridge, and an aortic valve annulus Z-score < −3.0, is associated with a significantly increased rate of re-intervention for LVOTO.

Enhancing Quality of Life in Venous Ulcer Patient with Irsal-e-Alaq (Hirudotherapy): A Case Report

Background: In general practice, venous ulcers (stasis ulcers) are the most common and recurrent leg ulcers. Ignorance of it can have a severe detrimental effect on one's quality of life, cause gangrene, and even the limb amputation. Venous ulcers are the most dangerous and disabling side effect of chronic venous insufficiency. Leech therapy seems to be effective for the treatment of varicose ulcers due to its salivary secretions which it injects during bloodsucking. The saliva of leeches contains certain biochemical with vaso-dilating, anticoagulant, anesthetic, thrombolytic, antibiotic, analgesic, and anti-inflammatory properties. As a result, Irsal-e-Alaq (Hirudotherapy), one of the Unani regimens, can effectively control it. Objective: The purpose of this case report is to provide insight into the effects of Irsal-e-Alaq (Hirudotherapy) on venous ulcers. Intervention: A 60-year-old male has a complaint of ulceration in his left lower leg near the medial malleolus with swelling, pain, discharge, and darkening of the skin of the left lower limb. Four leeches were applied once every week for 2 months. Efficacy of leech therapy was assessed on every 15th day by pain /leg discomfort on 4 point scale ranging from 0-3, limb girth at calf, ankle &amp; foot, pigmentation color on 4 point scale, pigmentation area, pain in ulcer on 4 point scale from 0-3, ulcer depth, PUSH Score. Hb% was assessed every 15th day to check anemia, colour flow Doppler was done to assess any change in vein anatomy. Result: In this case report, the ulcers were completely healed, and also showed remarkable improvement in other variables. Conclusion: Irsal-e-Alaq has been proven beneficial in treating venous ulcers and enhancing patient’s quality of life. Keywords: Venous ulcer, Hirudotherapy, Unani Medicine, Pain, Pigmentation.

Clinical Diagnostic Value of Shear-Wave Elastography in Detecting Malignant Nipple Retraction.

In recent years, the use of shear-wave elastography (SWE) as a diagnostic tool for detecting malignant breast lesions has shown promising results. This study aims to determine the clinical diagnostic value of SWE in detecting malignant nipple retraction. Both US and SWE (Philips EPIQ7 system) were performed for 41 consecutive patients with nipple retraction (56 nipples). The mean, median, and maximum tissue elasticity values (in kilopascals) were determined for each nipple by using SWE. The sensitivity, specificity, and overall accuracy of each measurement was determined by using the surgical pathology results or clinical diagnosis as the gold standard. Of the 56 retracted nipples, 32 were due to benign lesions, and 24 were due to malignant lesions. No significant differences in dimensions or echo features were found between the benign and malignant groups. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the color Doppler flow imaging (CDFI) pattern were 63.89% (23/36), 95% (19/20), 95.83 (23/24), 59.38 (19/32), and 75% (42/56), respectively; the corresponding values for median elasticity on SWE were 88.46% (23/26), 96.67% (29/30), 95.83 (23/24), 90.63 (29/32), and 92.85 (52/56), respectively. The addition of SWE to conventional US could help differentiate benign from malignant lesions associated with nipple retraction.

Comparative Study of Carotid Artery Disease in Hypertensive Versus Non-Hypertensive Patients Using Color Doppler Flow Imaging

Comparative Study of Carotid Artery Disease in Hypertensive Versus Non-Hypertensive Patients Using Color Doppler Flow Imaging

Ultrasound super-resolution imaging for the assessment of renal allograft dysfunction: A pilot study

BackgroundThe purpose of this study was to examine the feasibility and practical application of ultrasound (US) super-resolution imaging (SRI) in evaluating microvasculature and measuring renal allograft function. MethodsSixteen consecutive patients who received kidney transplants were prospectively enrolled. The patients were assigned as: normal allograft function (n = 6), and allograft malfunction (n = 10). Localizing each potential contrast signal resulted in super-resolution images (SRI). SRI was utilized to assess micro-vessel density (MVD) and microvascular flow rate, whereas contrast-enhanced (CE) US images were statistically processed to get the time to peak (TTP) and peak intensity. Logistic regression was utilized to evaluate their relationship. ResultsUS SRI may be utilized effectively on allografts to show microvasculature with significantly higher resolution than typical color Doppler flow and CEUS pictures. In the multivariate analysis, MVD and TTP were significant US markers of renal allograft failure (p = 0.031 and p = 0.045). The combination of MVD and TTP produced an AUC of 0.783 (p < 0.05) for allograft dysfunction. ConclusionsSRI can accurately portray the microvasculature of renal allografts, while MVD and TTP are appropriate US markers for assessing renal allograft failure.