Doppler Mode Research Articles

Double Interatrial Septum and Patent Foramen Ovale in Woman With Transient Ischemic Attack.

A 47-year-old woman with a history of hypertension presented with symptoms of transient ischemic attack. Her blood pressure was normal. A 12-lead electrocardiogram and a 24-hour Holter monitor revealed sinus rhythm. Transthoracic echocardiograms showed normal left ventricular systolic function (ejection fraction, 66%), mild left ventricular hypertrophy, and a slightly enlarged left atrium. The apical 4-chamber view showed echo-free space between 2 atria in the center of the interatrial septum (IAS) with 2 parallel atrial-septal structures, raising suspicion of a persistent interatrial space (Fig. 1). With the patient in the Valsalva maneuver, we obtained a 2-dimensional transesophageal echocardiogram (TEE) with agitated saline contrast medium, which revealed a small communication from the interatrial space to the right atrium through a patent foramen ovale (PFO) at the midesophageal short-axis level of the aortic valve (Fig. 2). Real-time 3-dimensional TEE revealed a membrane, parallel to the IAS, that created a double IAS and an additional interatrial space (Figs. 3 and 4). No obstruction existed between the left atrial appendage and the normal pulmonary veins, mitral valve, or coronary sinus. A 2-dimensional TEE in color-flow Doppler mode showed flow into the additional chamber from the left atrium across the left-sided IAS. Previous reports suggest that a double IAS can cause emboli,1,2 so we considered our patient to be at high risk and the PFO to be the cause of her neurologic event. Device closure of the PFO was not attempted because of possible complications from catheter-based closure. The patient was prescribed anticoagulation therapy and was discharged from the hospital after a 5-day stay. At the 3-month follow-up visit, she had no neurologic complications; 4 years later, she remained asymptomatic.Double IAS, an extremely rare congenital cardiac anomaly, is characterized by the presence of 2 distinct interatrial septa enclosing an interatrial chamber. The accessory membrane lies parallel to the IAS, and the pulmonary veins continue to communicate freely with the mitral valve and left atrial appendage.2,3 Most patients are asymptomatic unless thromboembolic complications or cardioembolic events occur. Potential causes of double IAS are abnormal or incomplete fusion of the atrial septum primum with the septum secundum, and embryologic left venous valve derived from the embryologic sinus venosus.2,3 There is no preferred treatment or risk stratification for cardiac sources of embolism in double IAS associated with neurologic events. However, monitoring with 3-dimensional TEE is imperative.

Poster 213: Increased Vascularity might Peak at 3 to 6 Months Postoperatively on the Reconstructed Anterior Cruciate Ligament Assessed with Superb Microvascular Imaging (SMI)

Poster 213: Increased Vascularity might Peak at 3 to 6 Months Postoperatively on the Reconstructed Anterior Cruciate Ligament Assessed with Superb Microvascular Imaging (SMI)

Open volume defects in ultra-thin TiO2 layers embedded in VMCO-like samples studied with positron annihilation spectroscopy

Positron annihilation signals from VMCO-like samples grown by atomic layer deposition at different temperatures are utilized for the characterization of differences in open volume defects in TiN/TiO2/a-Si heterostructures. Doppler and coincidence Doppler mode of positron annihilation spectroscopy combined with a monoenergetic positron beam were used for this study. Differences observed in the Doppler parameters indicate differences in the positron trapping states of the TiO2 epilayers grown at different temperatures. Furthermore, the coincidence-Doppler results show that these differences cannot be due to intermixing of the TiO2 and a-Si layers and formation of thin SiO2 layers at the interface during the growth process. The results indicate that the amount of open volume defects in the TiO2 layer of the VMCO-structure seems to increase with an increase in the growth temperature.

Effects of Mid-Gestation Nutrient Restriction, Realimentation, and Parity on the Umbilical Hemodynamics of the Pregnant Ewe

Previous studies have reported that nutritional restriction from days 50 to 130 applied in young nulliparous ewes reduces umbilical blood flow (UBF). We hypothesized that during restriction, UBF and fetal and placentome dimensional measurements would decrease compared to adequately fed ewes, but upon realimentation, ewes would have similar UBF as ewes that were not restricted. We also hypothesized that multiparous ewes would be more resilient to nutrient restriction compared to nulliparous ewes. In experiment 1, second-parity Dorset ewes carrying singletons were assigned to an adequate nutrition group (CON, n = 7) or a restricted (60% of CON) group (RES, n = 8), from days 50 to 90 of gestation. In experiment 2, on day 50 of gestation, adult (15-month) nulliparous (NUL; n = 12) and multiparous (MUL; n = 16) Dorset ewes carrying singletons were randomly assigned to receive 100% of NRC recommendations (CON) or 60% of CON (RES). On day 90, all ewes were fed 100% of nutritional recommendations according to body weight. Ewe body weight and conceptus measurements via ultrasonography were recorded every 10 days from days 50 to 130 of gestation. We measured 10 random placentomes, fetal biparietal and abdominal length, and kidney length and width. Doppler mode was used to obtain UBF, pulsatility index (PI), and resistance index (RI). Lamb weight and parturition problems were recorded. In experiment 1, on day 80, UBF decreased (P ≤ 0.05 means separation of unprotected F test), placentome size tended to decrease (P ≤ 0.10), and PI and RI tended to increase in RES vs. CON ewes (P ≤ 0.10). In experiment 2, there were no three-way interactions or main effects of treatments on UBF, PI, RI, and placentome size (P ≥ 0.57). There was a parity-by-day interaction (P < 0.05) for RI, but UBF was not affected by parity or diet. After realimentation, there was no effect of treatment on ultrasound measurements in both experiments. At birth, lambs and placental measurements were not different (P ≥ 0.43). Restriction from days 50 to 90 does not seem to influence umbilical hemodynamics or conceptus growth in adult white face sheep, regardless of parity.

Function and Safety of SlowflowHD Ultrasound Doppler in Obstetrics.

SlowflowHD is a new ultrasound Doppler imaging technology that allows visualization of flow within small blood vessels. In this mode, a proprietary algorithm differentiates between low-speed flow and signals attributed to tissue motion so that microvessel vasculature can be examined. Our objectives were to describe the low-velocity Doppler mode principles, to assess the bone thermal index (TIb) safety parameter in obstetric ultrasound scans and to evaluate adherence to professional guidelines. To achieve the latter goals, we retrospectively reviewed prospectively collected ultrasound images and video clips from pregnancy ultrasound scans at >10 wk of gestation over 4 mo. We used a custom-built optical character recognition-based software to automatically identify all images and video clips using this technology and extract the TIb. Overall, a total of 185 ultrasound scans performed by three fetal medicine physicians were included, of which 60, 54 and 71 scans were first-, second- and third-trimester scans, respectively. The mean (highest recorded) TIb values were 0.32 (0.70), 0.23 (0.70) and 0.32 (0.60) in the first, second, and third trimesters, respectively. Thermal index values were within recommended values set by the World Federation for Ultrasound in Medicine and Biology American Institute of Ultrasound in Medicine and British Medical Ultrasound Society in all scans.

The possibilities of comprehensive ultrasound examination using modern methods in the diagnosis of endometrial cancer

Introduction. An urgent problem of oncogynecology is the diagnosis and treatment of patients with endometrial cancer, the steady growth of which is noted in most developed countries of the world and at the present stage occupies the 2nd place among neoplasms of the reproductive system of women.Purpose. To evaluate the informativity of complex ultrasound examination for diagnostics of endometrial cancer.Material and methods. There were examined 28 patients aged from 45 to 70 y.o. (23 menopausal women — 82,1% and 5 in reproductive status — 17,9%). The diagnosis of endometrial cancer was verified by morphologic and histologic methods. For all the patients there was performed the ultrasound examination including energy Doppler mode, ultrasound elastography, Doppler imaging of uterine and intratumoral vessels, evaluation of M-echo thickness, invasive growth index and rate of myometrial invasion. Studies were performed with ultrasound scanners «ACUSON 2000» by SIEMENS and «Aixplorer» by «SuperSonic Imagine S.A.».Results. Highly and moderately differentiated adenocarcinoma was revealed mostly in patients with Ia and Ib stages while low differentiated adenocarcinoma was revealed mostly in the III stage. The investigation performed ascertained that a complex ultrasound examination with application of dopplerography, sonoelastography, contrast enhanced sonography is highly informative for determination, staging and prediction of endometrial cancer.Conclusion. The results obtained indicate the high efficiency of the diagnostic complex used in identifying the characteristic features of intraorgan and tumor blood flow, as well as tissue stiffness, which play an important role in specifying the stage and prognosis of the disease.

C43 A CASE REPORT OF A GIANT RIGHT CORONARY ARTERY ANEURYSM: ROLE OF CONTRAST ECHOCARDIOGRAPHY

Abstract A giant coronary aneurysm is rare entity and it is defined if the diameter is 4–fold greater the reference vessel diameter or if it is > 20 mm in diameter. We report the case of a 73–years–old man without prior history of cardiac disease, admitted in Emergency Department for abdominal pain with normal ECG. Abdominal CT scan showed no pathological findings. At thoracic level it was reported a suspected pericardial cyst (75x80 mm), with partial compression of right chambers (Fig. 1). Echocardiography confirmed the presence of a giant round cystic–appearance lesion characterized by the presence of an anechoic space with internal echogenic swirling flow pattern at the level of right atrioventricular groove with mild compressive effect on right chambers. (Fig. 2). The color Doppler mode showed a faint signal, without a clear evidence of flow origin. A bubble test with agitated saline contrast medium injected through antecubital vein, shows no evidence of contrast uptake by the mass. In order to better characterize the lesion, we use echocardiographic contrast agent (SonoVue®), which showed a clear pattern of blood flow inside the mass with a probable origin at a very limited region (Fig. 2a–2b). At that level it was also possible to sample an ECG–synchronized systo–diastolic pulse–wave (PW)–Doppler pattern (peak velocity 125 cm/s), typical for a coronary artery flow. According to these echocardiographic findings, we supposed a giant right coronary aneurysm. Coronary Computed Tomography Angiography with 3D reconstruction showed a giant aneurysm of the right coronary artery at mid–level, preceded by a mild aneurysm of the proximal tract and two small aneurysms of the circumflex artery and diffuse atherosclerosis diseases with significant stenosis on mid left anterior descending artery (LAD). The coronary angiography confirmed the presence of the giant aneurysm in mild tract of right coronary artery preceded by a small one in the proximal tract andthe two small aneurysm of the circumflex artery and a critical stenosis of mid tract of LAD. The patient underwent surgical treatment of the aneurysm and coronary artery bypass graft (Fig. 3). Computed Tomography Coronary Angiography is the best method for coronary artery anatomy and coronary abnormalities. In case of giant coronary abnormalities, the use of echo contrast agent provides further important information about perfusion and/or flow assessment and it helped to clarify the diagnosis.

A 24 GHz FMCW/Doppler Dual-Mode Frequency Synthesizer With 68.8 kHz RMS FM Error and 1.25 GHz Chirp Bandwidth

This brief presents a 24 GHz dual-mode frequency synthesizer designed in a 55-nm CMOS technology supporting both Doppler and frequency modulated continuous wave (FMCW) radars. The effects of chirp linearity and delta-sigma modulation (DSM) resolution on the rms FM error is analyzed. A design procedure for the PLL loop bandwidth and time interval of the frequency step to reduce the rms FM error is proposed. A voltage-controlled oscillator (VCO) featuring a four-coil transformer load is developed providing differential local oscillation (LO) signals for the transmitter (TX) and quadrature LO signals for the 2-channel receiver (RX). The prototype is designed with a loop bandwidth of 350 kHz, a frequency step time interval of <inline-formula> <tex-math notation="LaTeX">$2 ~\mu s$ </tex-math></inline-formula>, and a VCO tuning linearity of 26&#x0025;. In the FMCW mode, it achieved an rms FM error of 68.8 kHz over a 1.25 GHz chirp bandwidth. In the Doppler mode, the VCO operates in the free-running mode to save power consumption. An 8-bit digital-to-analog converter (DAC) is used to provide the VCO control voltage compensating process and voltage variations. The free-running VCO operates at a 24.125 GHz and has a frequency error of less than 1 MHz.

Ultrasound of the Heel Improves Diagnosis-Tender Entheses in the Heel Region Rarely Corresponds to Inflammatory Enthesitis in Patients with Peripheral Spondyloarthritis.

Enthesitis is a key pathology in spondyloarthritis (SpA), but diagnosis may be clinically challenging. The objective of this study was to investigate the prevalence of ultrasound enthesitis lesions in tender entheses in the heel region in patients with peripheral SpA. In 27 patients with tenderness upon palpation at the Achilles tendon or the plantar fascia insertion, ultrasound assessment of the affected enthesis was performed using greyscale and color Doppler mode. Images were evaluated using the Outcome Measures in Rheumatology (OMERACT) scoring system for enthesitis, scoring presence/absence of hypoechogenicity, thickening, calcifications/enthesophytes, and erosions, and color Doppler activity semi quantitatively from 0 to 3. A total enthesitis sum score was calculated. A second examiner scanned 10 patients for inter-reader reliability. Ultrasound signs of inflammatory enthesitis (thickening/hypoechogenicity and/or Doppler activity) were found in 48%, and 19% showed Doppler activity—all in the Achilles enthesis. Inflammatory pathologies other than enthesitis (e.g., tendinitis, arthritis, bursitis) were identified in 26% of tender heels. The ultrasound OMERACT scoring system for enthesitis lesions showed excellent intra- and inter-reader agreement in a clinical setting. In conclusion, less than 50% of clinically tender entheses are related to inflammatory enthesitis when assessed by ultrasound. Ultrasound is useful for diagnosing other pathologies that may explain tenderness in the area.

A case of congenital capillary proliferation of the kidney (CCPK)

We report a case of congenital capillary proliferation of the kidney (CCPK) along with the multimodality imaging findings. Four-day-old boy who had managed due to his mother's gestational diabetes underwent abdominal ultrasound and a mass was detected in the right kidney. On gray scale ultrasound, the mass exhibited a hyperechoic, slight lobulated shape and a circumscribed margin. On Doppler mode, the mass showed hypervascularity in its peripheral to central zones. On MRI, the mass was hyperintense on the T2-weighted image, and no diffusion restriction was noted on DWI/ADC. On computed tomography, strong enhancement was shown at center of the mass at the post-contrast early phase; homogeneous enhancement at the entirety of the mass was observed at the delayed phase. We suspected hemangioma but did not rule out the possibility of malignancy. Surgery was performed. Pathologically, the specimen showed a proliferation of capillaries which were positive for vascular endothelial markers and negative for GLUT1 in immunohistochemistry. A small number of entrapped tubules and glomeruli were also observed. After an intensive pathological examination, the diagnosis of CCPK was finally considered. CCPK was recently described as an extremely rare childhood renal vascular lesion, and to our knowledge, only five other cases have been reported. Our patient's multimodality imaging findings well reflected the characteristics of a vascular lesion.

Automated Interpretation Of Systolic And Diastolic Function On The Echocardiogram

Background Echocardiography is the test of choice to assess cardiac function to diagnose and manage heart disease. However, manual interpretation of the echocardiogram is time-consuming and subject to human error. Therefore, we demonstrate a fully automated deep learning workflow to classify, segment, and annotate 2D videos and Doppler modalities. Methods The workflow was developed using a total of 20,828 annotated 2D and Doppler modalities images from 1,145 studies (N) from a heart failure research platform in Singapore. We validated the workflow against human measurements in a dataset from Canada (N=1,029), a 'real-world' dataset from Taiwan (N=31,241), the US-based EchoNet-Dynamic dataset (N=10,030); and in an independent prospective Singapore dataset (N=29 to 66) with repeated human expert measurements. Results In the test set, the automated workflow classified 2D videos and Doppler modalities with accuracies ranging from 0.91 to 0.99. The left ventricle and left atrium segmentation were accurate, with a mean Dice similarity coefficient >93% for all. In the external datasets, automated measurements showed good agreement with locally measured values, with a mean absolute error range of 13-25ml for left ventricular volumes, 6-10% for left ventricular ejection fraction, and 1.8-2.0 for E/e'; and reliably classified systolic dysfunction (LVEF<40%, area under the curve [AUC] range 0.90-0.92, Figure A) and diastolic dysfunction (E/e' ≥13, AUC range 0.91-0.91, Figure B). Independent prospective evaluation confirmed similar or less variance of automated compared to human expert measurements. Conclusions : Deep learning algorithms can automatically annotate 2D videos and Doppler modalities with similar accuracy compared with human measurements. Echocardiography is the test of choice to assess cardiac function to diagnose and manage heart disease. However, manual interpretation of the echocardiogram is time-consuming and subject to human error. Therefore, we demonstrate a fully automated deep learning workflow to classify, segment, and annotate 2D videos and Doppler modalities. The workflow was developed using a total of 20,828 annotated 2D and Doppler modalities images from 1,145 studies (N) from a heart failure research platform in Singapore. We validated the workflow against human measurements in a dataset from Canada (N=1,029), a 'real-world' dataset from Taiwan (N=31,241), the US-based EchoNet-Dynamic dataset (N=10,030); and in an independent prospective Singapore dataset (N=29 to 66) with repeated human expert measurements. In the test set, the automated workflow classified 2D videos and Doppler modalities with accuracies ranging from 0.91 to 0.99. The left ventricle and left atrium segmentation were accurate, with a mean Dice similarity coefficient >93% for all. In the external datasets, automated measurements showed good agreement with locally measured values, with a mean absolute error range of 13-25ml for left ventricular volumes, 6-10% for left ventricular ejection fraction, and 1.8-2.0 for E/e'; and reliably classified systolic dysfunction (LVEF<40%, area under the curve [AUC] range 0.90-0.92, Figure A) and diastolic dysfunction (E/e' ≥13, AUC range 0.91-0.91, Figure B). Independent prospective evaluation confirmed similar or less variance of automated compared to human expert measurements. : Deep learning algorithms can automatically annotate 2D videos and Doppler modalities with similar accuracy compared with human measurements.

Steering Rotating Magnetic Swimmers in 2.5 Dimensions Using Only 2D Ultrasonography for Position Sensing

Micro/millimeter-scale magnetic robots have many potential biomedical applications. However, there are major challenges in using these devices for <i>in vivo</i> tasks due to limitations of imaging technology for real-time detection and navigation inside the human body. Ultrasound is a popular sensor for localizing such robots because it is easy to use and less expensive than other imaging methods. This letter studies methods to track and control a millimeter-scale rotating magnetic swimmer to perform path following. Detection using ultrasound B-mode and Doppler mode to track the robot during navigation are compared. In addition, an algorithm to perform 2.5D closed-loop control (controlling 3 degrees of freedom for a swimmer to follow a planar path) of the swimmer using only 2D ultrasound feedback was studied and tested experimentally.

Dyspnea Declare Yourself! Decoding Doppler

AN APPRECIATION of the utility of echocardiographic Doppler spectral profile analysis in diagnosing cardiac pathology and guiding surgical intervention more than justifies an investment in obtaining proficiency in these skills. Given the relatively low incidence of significant complications associated with transesophageal echocardiographic examination, the facile use of both spectral and color Doppler principles to diagnose unusual pathology is essential. Doppler modalities are used to characterize blood flow, pressure gradients, chamber dimensions, and other anatomic and physiological parameters. The authors present a case in which several Doppler principles were used to evaluate and diagnose the etiology of dyspnea and a high aortic valve gradient.

Myxomatous Degeneration of Atrioventricular Valves in a Crab-eating fox (Cerdocyon thous) - Echodopplercardiography Diagnosis

Background: The myxomatosis degeneration is a degenerative cardiac valve disease, with a higher incidence in male and senile canids. The diagnosis is made by a doppler echocardiography exam. Although there are few reports on the occurrence of cardiopathies in wild dogs (Cerdocyon thous), some studies on their cardiological parameters can be found. Considering this, and knowing that the cardiopathies in wild canids are common post mortem findings, the objective of this study is to describe the echocardiography diagnosis of a case of myxomatous degeneration of the atrioventricular valves in 1 wild dog (Cerdocyon thous) living in captivity.Case: It was treated at the Diagnostic Imaging Department of the Veterinary Hospital of the Federal University of Mato Grosso (HOVET-UFMT), 1 wild dog (C. thous), male, living in captivity with approximately 10-year-old, directed by the Center of Medicine and Research in Wild Animals of Cuiabá, to perform echocardiography exam. The patient was submitted to anesthesia for proper examination, which was used Esaote® machine model MyLabFive VET with sector scan transducer (4.0 -7.5 MHz). The longitudinal, transverse and apical scan planes were obtained through left and right parasternal windows. The evaluation of M mode exposed ejection fraction and shortening increased, of 81% and 47%, respectively, however it showed no increase in systolic and diastolic values of left ventricle, nor in right cavities on subjective evaluation. The relation between the left atrium (LA) and the aorta (Ao) remained normal, at 1.2 mm, with dimensions of 13.4 mm from the AO and 16.3 mm from LA, compatible with species parameters or domestic canines. The atrioventricular valves showed thickening and irregularities in their cusps, with great intensity in the left atrioventricular valve (LAV). The Doppler mode analysis revealed a turbulent systolic flow into the left atrium and right atrium, constituting transvalvular LAV and right atrioventricular valve- (RAV) regurgitation, both observed through the blood flow in colored Doppler and measured through the reflux velocity of 4.02 m/s of LAV and 2.17 m/s of RAV by the continuous Doppler, showing insufficiency of intense degree of LAV and moderate degree of RAV, no evidence of pulmonary hypertension. On the other hand, the relation between wave E and wave A (E/A) was 1.0, with increased transvalvular velocities and values of 0.95 m/s for wave E and A. The isovolumetric mitral relaxation time was approximately 76 m/s. The value of the pressure derivative (dp) in relation to time (dt) dp/dt measured from the LAV reflux was 1257 mmHg, within the limit considered normal for canines. Four months after the diagnosis, the patient died due to complications of chronic renal failure.Discussion: Despite being a commonly diagnosed pathology in domestic canids, the myxomatous degeneration of atrioventricular valves is still little reported in wild canids. The evaluation of the results showed that although there was severe LAV regurgitation, there was no hypertrophy or compensatory dilation of the left cavities. However, there was a compensatory increase in the shortening fraction together with the ventricular relaxation deficit. The diagnosis of this condition in Cerdocyon thous demonstrates that the pathology can affect animals of advanced age and that its incidence needs to be determined in these captive species, in order to understand the real impact of this disease in these populations. Keywords: cardiopathies, cardiac valve disease, degenerative disease, cardiological parameters, wild dog. Título: Degeneração mixomatosa das válvulas atrioventriculares em cachorro-do-mato (Cerdocyon thous) - diagnóstico ecocardiográfico Descritores: cardiopatias, doença valvular cardíaca, doença degenerativa, parâmetros cardiológicos, canídeo selvagem.

325 The role of 2d ultrasound, 3d ultrasound and their doppler modes in the prediction of malignancy in women with adnexal masses

Introduction and aims of the study: Sonography has always been considered of great significance in gynecologic practice and 3D ultrasound is now an aspiring method not only for detecting but characterizing and classifying pathological entities as well. This systematic review aims to determine the ability of four sonographic methods to discriminate benign masses from malignant ones in women with adnexal pathology, as well as the predictive value of different variables, such as vessel morphology and localization and vascular indices.

Potential of sonography in diagnosis of tongue tumors

Purpose of the study. An analysis of sonography potential in the primary diagnosis and clinical staging of tongue cancer.Patients and methods. The study included 18 patients aged 40–70 years with tongue tumors. The majority accounted males – 14 (77.7 %). Women were represented by 4 (22.2 %) examinees. Ultrasound examinations were performed using expert-class ultrasound systems with broadband linear multifrequency transducers. Transoral examination with linear transducers required tumor location in the anterior and lateral parts of the oral tongue. During ultrasound examinations we evaluated: tumor shape, tumor invasion depth; tumor sizes – width and thickness; tumor echogenicity and structure; tumor vascularization in Doppler modes. The results were compared with the data of histological examination.Results. Transoral ultrasound examination of patients with tongue cancer allows clear visualization of the tumor and assessment of it’s spread. The study showed that the round shape of tongue tumors prevailed in 13 (72.2 %) patients, the tumor echo structure in 10 (55.5 %) was heterogeneous, the contours were even and clear in the majority of patients – 13 (72.2 %), all tumors showed a reduced acoustic density, the depth of invasion ranged from 2 to 6 mm in 8 (44.4 %) patients and exceeded 6 mm in 6 (33.3 %) patients, which corresponded to stages III and IV of the diseas. Doppler ultrasonography recorded intense intratumoral blood flow in 100 % of cases. In 8 (44.4 %) cases, metastatic lesions of the cervical lymph nodes were observed.Conclusion. Transoral ultrasound diagnosis of tongue cancer is a highly informative, safe and modern method providing surgeons with information that helps in choosing the scope of surgical treatment and in determining the disease prognosis at the preoperative stage. The accuracy of the method was 87 %, the sensitivity was 85 %, and the specificity was 86.2 %.

Cystic renal diseases: role of ultrasound. Part II, genetic cystic renal diseases.

Kidney cysts are quite common in adults. Though small simple renal cysts in an adult over 30-40 years of age are not too unusual, however, if the same cysts are seen in a child, and especially if there are additional findings, then several diagnostic possibilities may come to mind. The role of ultrasound, together with the help of intravenous contrast agents and Doppler mode, are very critical in describing the morphologic features and follow-up of the complex or multiple and bilateral renal cysts. These sonographic signs are occasionally specific for diagnosis, but in many cases sonographic clues should be evaluated together with the other genetic and clinical data to reach diagnosis.The first part of this pictorial essay included the introduction into the subject and the classification of non-genetic cystic renal diseases. The key features for the non-genetic cystic renal diseases are illustrated. In the second part, eye-catching features of genetic cystic renal diseases are demonstrated.

AGE-RELATED ADAPTATION OF PORTAL HEMODYNAMICS IN RATS DURING 75 DAY FOLLOW-UP

The age-related adaptation of portal hemodynamics was studied in young rats by ultrasound methods. In the mode of color Doppler mapping, a color signal was visualized in the projection of the portal vein, and in the spectral Doppler mode, the spectrum of blood flow in the portal vein was visualized. The diameter and cross-section of the portal vein, linear and volumetric blood flow rates were determined. The study was performed at the beginning and after 60- and 75-day follow-up. It was found that the portal hemodynamics parameters were influenced by a change in the diameter of the portal vein. With an increase in the diameter of the portal vein, the linear velocity of blood flow in the portal vein decreased, but the volumetric velocity of blood flow in the portal vein increased. Conclusions. The mechanisms of age-related adaptation of portal hemodynamics include compensation for a decrease in the linear velocity of blood flow by increasing the volumetric velocity of blood flow in the portal vein.

Flexor Tendons Sonography.

Ultrasonography is the best examination to explore the flexor tendons anatomy and disorders from the wrist to the digit. It is the only dynamic and comparative tool easily accessible for the surgeon. Indeed, ultrasonography is always available in all the departments of your hospital. Recent innovations permit to see superficially (high-frequency probes), precisely (smaller probes), and with greater softwares for an effective Doppler mode. Ultrasonography becomes a very important help at the outpatient clinic examination. In the future it can be used in the operating room to perform miniinvasive surgery under local anesthesia to control active motion of the gliding of flexor tendons.

Ratio of submucosal thickness to total bowel wall thickness as a new sonographic parameter to estimate endoscopic remission of ulcerative colitis

The development of feasible, reliable parameters and criteria for intestinal ultrasound (IUS) to estimate endoscopic remission of ulcerative colitis (UC) is a crucial clinical challenge. Such parameters must be simple, objective, and reproducible so that IUS can be widely used in daily practice. We developed a new parameter called the submucosa index (SMI), defined as a percentage of the submucosal thickness (SMT) in the total bowel wall thickness (BWT), and investigated its clinical potential. The inclusion criteria were performance of both IUS and endoscopy (sigmoidoscopy or colonoscopy) for UC and a ≤ 15-day time interval between IUS and endoscopy. Loss of stratification was defined as inability to identify the submucosa even with a BWT of > 3mm. The vascularity of the colon was assessed by the modified Limberg score (mLS) and evaluated as bowel wall flow (BWF) ( -) or ( +) using color Doppler mode. A Mayo endoscopic subscore (MES) of 0 or 1 was defined as endoscopic remission. Seventy-four colonic segments were analyzed. The SMI, mLS, and BWF could distinguish an MES of 1 versus 2 (p < 0.05, p < 0.01, and adjusted p < 0.001, respectively). The criteria using the BWT and SMI and using the BWT and BWF had the same estimating ability for endoscopic remission (sensitivity, 70.0%; specificity, 97.7%; positive predictive value, 95.5%; and negative predictive value, 82.7%). The SMI is a practical, quantitative parameter based on the bowel wall structure and may be used to estimate endoscopic remission of UC.