Doppler Mode Research Articles

Compact Point of Care Ultrasound Reveals Hemodynamic Abnormalities in Children with Sickle Cell Disease

In sickle cell disease (SCD), kidney related morbidity and mortality are significant, with ~80% of patients displaying signs of chronic kidney disease (CKD) by age 401 and kidney related mortality being the third leading cause of death (16.4%)2. Children with SCD are also prone to kidney disease with 20% of 12 years-old displaying microalbuminuria4 and enuresis and hyposthenuria commonly observed in infants4. Current clinical guidelines are insufficient as they ignore pediatric disease until the development of late signs like proteinuria or large drops in eGFR have occurred5. A major limitation in the assessment of kidney disease in children with SCD is the incomplete understanding of disease progression and the lack of suitable biomarkers to discriminate health and disease. Serum creatinine based eGFR is the most common biomarker of kidney function but is poorly validated and relatively insensitive in SCD patients due low muscle mass and hyperfiltration6. Point of care ultrasound (POCUS) offers a non-invasive alternative to blood based biomarkers. POCUS has proven clinical utility in decreasing primary and secondary stroke7. Additionally, POCUS technology now offers compact, cartless systems, with tablet and smartphone compatibility, multiprobe functionality in a single probe and an economical price point (<3000$)8. Therefore, the goals of this study were two-fold. 1) Determine the feasibility of renal assessment using compact POCUS in children with SCD in a clinical setting. 2) Establish normative values for possible compact POCUS biomarkers that could supplement existing biomarkers of kidney disease in SCD. Methods: Studies were performed with informed consent under an IRB approved protocol. 18 patients with SCD were recruited during their routine clinical visit to undergo a 10-20 minute ultrasound examination. All POCUS exams were performed in supine position, on the right kidney by an experienced imaging researcher (AB, +10 years). Images were acquired with a Butterfly IQ+ (Burlington, MA, USA) system and an Apple Smartphone (Cupertino, CA, USA). The abdominal preset and B-mode imaging was used to determine the long axis renal length and echogenicity of the renal/liver parenchyma. The cardiac preset, pulsed Doppler mode was used to determine the peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI = (PSV-EDV)/PSV) of the main right renal artery. Images were saved to a cloud based, HIPPA protected database, downloaded to a local workstation and processed using custom MATLAB scripts. An angle correction of 1/cos(60°) was applied to the uncorrected velocity values. Results: Renal length and serum creatinine was measured in 18 patients with SCD (3 HbSC, 15 HbSS) and pulsed Doppler estimates were obtained in 14 of 18 subjects (hemoglobin 9.9±2.3,12 male). The average renal length was 8.7±1.3 cms and serum creatinine was 0.69±0.16 and showed a statistically significant increase with respect to age (Figure 1). The average angle corrected main renal artery PSV was 74.5±64.4 cm/s and RI was 0.49±0.33 and both decreased with respect to age (Figure 1). The average echogenicity ratio between kidney and liver parenchyma was 0.64±0.14 and was uncorrelated with age. Discussion: This work demonstrates that high quality structural and hemodynamic images can be acquired with low cost, compact POCUS in a clinical setting. The age dependent increase in serum creatinine9 and kidney length10 were in good agreement with prior cart-based sonography work in healthy children. Conversely, the age dependent drop in main renal artery PSV and RI was in opposition to work in healthy children that showed no change11 or an increase with age12. The clinical significance of abnormally elevated velocity in young children with SCD and its impact on the development of sickle nephropathy should be studied in more detail. Future work comparing cross-sectional and longitudinal variability in compact POCUS and physiologic biomarkers of kidney function in both pediatric and adult subjects with and without SCD is ongoing.

The effects of aging and gestational month on uteroplacental vascular perfusion, and umbilical artery hemodynamics in pregnant jennies

This study aimed to correlate the pulsed wave spectral indices of the middle uterine artery at both sides with placental development in jenny within mid-late pregnancies, and establish umbilical Doppler values for different ages and different gestational months. Twenty Equus Asinus pregnant jennies 260–450 kg (average, 320 ± 10 kg) were examined from 5 to 9 months of pregnancy with different ages (4–14 years). Monthly B-mode ultrasound examination was performed on both the combined thickness of the uterus and placenta (CTUP; mm) and umbilical artery cross-sectional diameter, and Doppler mode examination was performed on both the middle uterine (MUA at right [R] and left [L] sides) and umbilical arteries to measure both Doppler indices that expressed by resistance (RI) and pulsatility indices (PI), and blood flow rate. CTUP was elevated within pregnancy time at different ages (P < 0.05). L. PI was significantly declined throughout different ages (P < 0.05), but this declining trend was not observed in L. RI. The L. blood flow rate (R; bpm) was elevated among different ages and different months (P < 0.05). Both RI and PI were significantly decreased from 5 to 9 month of gestation period in jennies (P < 0.05).. The umbilical arteries cross-sectional diameter (Umb A; mm), was elevated among different ages and different months, while both Doppler indices were declined. A positive correlation was found (between both Doppler indices of both umbilical and uterine arteries P < 0.001). There was elevated vascular perfusion in uterine and umbilical arteries associated with reduced both Doppler indices along the course of pregnancy at different ages.

Towards a Low-Cost Monitor-Based Augmented Reality Training Platform for At-Home Ultrasound Skill Development.

Ultrasound education traditionally involves theoretical and practical training on patients or on simulators; however, difficulty accessing training equipment during the COVID-19 pandemic has highlighted the need for home-based training systems. Due to the prohibitive cost of ultrasound probes, few medical students have access to the equipment required for at home training. Our proof of concept study focused on the development and assessment of the technical feasibility and training performance of an at-home training solution to teach the basics of interpreting and generating ultrasound data. The training solution relies on monitor-based augmented reality for displaying virtual content and requires only a marker printed on paper and a computer with webcam. With input webcam video, we performed body pose estimation to track the student's limbs and used surface tracking of printed fiducials to track the position of a simulated ultrasound probe. The novelty of our work is in its combination of printed markers with marker-free body pose tracking. In a small user study, four ultrasound lecturers evaluated the training quality with a questionnaire and indicated the potential of our system. The strength of our method is that it allows students to learn the manipulation of an ultrasound probe through the simulated probe combined with the tracking system and to learn how to read ultrasounds in B-mode and Doppler mode.

Evaluations of Ovarian and Luteal Blood Flow Waveform Patterns in Buffalos Subjected to OvSynch Protocol in Cold and Hot Seasons

This current study aimed to determine ovarian and luteal blood flow waveform patterns in buffalos synchronized using OvSynch protocol in cold and hot seasons. Six cyclic buffalo cows aged 6±0.5 years old, having a weight of 400 ± 50 kg, were scanned daily along three successive estrous cycles transrectally by Doppler ultrasonography to evaluate the normal ovarian hemodynamic during the normal spontaneous ovulation and before the start of experiments. Buffaloes were synchronized with gonadotropin[GnRH] –prostaglandin[P] –gonadotropin (GPG) protocol in which animals received 10μg of GnRH on day ??, 0.250μg of PGF2α on day 7, and another dose of 10μg of GnRH was administered 48h after the PGF2α injection. Blood sampling and ovarian ultrasound examinations (color and spectral Doppler modes) were conducted on the day of the estrous and luteal phases. Results revealed that peak systolic velocity waveform (PSV) was significantly (P&lt;0.05) increased in the cold season compared to the hot season. The Luteal blood flow after the end of OvSynch protocol on days (5,7,9, and 11) was significantly increased in the cold season than that in the hot one. The serum levels of estradiol (E2) and nitric oxide (NO) after the second GnRH injection in the OvSynch protocol were significantly (P&lt;0.05) elevated in the cold season as compared to the hot one.&#x0D; Moreover, the progesterone (P4) levels had risen in OvSynch-treated buffaloes on days 5,7,9, and 11 of the cycle in the cold season compared to the hot one. Conclusion: In the cold season, ovarian hemodynamics was significantly improved compared to the hot one; this may influence the reproductive efficiency of buffaloes. Further studies were needed to prove it.

Clinical course, laboratory and instrumental markers of vascular inflammation in the Kyrgyz cohort of patients with Takayasu's arteritis

Lack of highly sensitive and specific methods of laboratory and instrumental diagnostics leads to difficulties in timely verification of Takayasu's arteritis (AT).Objective: to analyze the clinical course, laboratory and instrumental markers of vascular inflammation in the Kyrgyz cohort of patients with AT.Patients and methods. The study included 75 patients with a reliable diagnosis of AT, who were hospitalized and observed on an outpatient basis at the clinic of the National Center for Cardiology and Therapy named after acad. Mirsaida Mirrakhimova from January 2011 to April 2022. Patients were examined using clinical, laboratory and instrumental methods once every 2 years. The follow-up period was 1–5 years in 45 (60%) patients and 6–15 years in the remaining 30 (40%) patients. All patients underwent a clinical and standard laboratory work-up with CRP and interleukin 6 levels assessment, as well as ultrasound Dopplerography of peripheral arteries in the color Doppler mapping mode and multislice computed tomography-panaortography.Results and discussion. Lesions of the common carotid (85.33%) and subclavian (84%) arteries were detected more often. Involvement of the abdominal aorta was noted in 60% of patients and was accompanied by stenosis of the renal arteries in 100% of cases. The clinical picture of the disease was mainly represented by cardiac pathology in the form of arterial hypertension (84%) and aortic regurgitation (68%) with the development of decompensated chronic heart failure in 15% of patients. During the dynamic observation, significant improvement in the course of the disease, clinical symptoms, decrease in the severity of vascular changes were not revealed, with the exception of a decrease in the clinical activity of AT (p&lt;0.05) in one third of patients (37.4%). Conclusion. The severity of clinical manifestations and the course of AT in the Kyrgyz cohort was due to cardiovascular pathology. As dynamic observation showed, the lack of significant improvement in the course of the disease was largely due to the long duration of chronic inflammation, late diagnosis, development of irreversible stenotic, occlusive and aneurysmal changes, as well as the fact that patients did not receive adequate pathogenetic therapy at the onset of the disease. Keywords: &lt;0.05) in one third of patients (37.4%).Conclusion. The severity of clinical manifestations and the course of AT in the Kyrgyz cohort was due to cardiovascular pathology. As dynamic observation showed, the lack of significant improvement in the course of the disease was largely due to the long duration of chronic inflammation, late diagnosis, development of irreversible stenotic, occlusive and aneurysmal changes, as well as the fact that patients did not receive adequate pathogenetic therapy at the onset of the disease.

RELATIONSHIP BETWEEN ULTRASOUND CHANGES IN THE LIVER AND HYPOTHYROIDISM IN PATIENTS WITH AUTOIMMUNE THYROIDITIS

Hashimoto's autoimmune thyroiditis (AIT) is one of the most frequent causes of hypothyroidism, which leads to the development of dysfunctions of various body systems. Since the hepatobiliary system is closely related to the thyroid gland, a decrease in thyroid function is considered one of the factors in the development of non-alcoholic fatty liver disease. Early detection of changes in the liver in patients with hypothyroidism makes it possible to start therapy in time and prevent the development of complications, such as fatty dystrophy, inflammation, damage to hepatocytes, fibrosis, cirrhosis.&#x0D; The aim. Determine the relationship between hypothyroidism and ultrasound changes in the liver in patients with AIT.&#x0D; Methods. 62 patients with AIT and hypothyroidism were examined. The first group included 32 patients with a history of AIT up to two years, the second group included 30 patients with a history of the disease for more than two years, and the control group included 30 patients without signs of thyroid pathology. Thyroid function was assessed based on the results of a hormone levels blood test. Multiparametric ultrasound examination of the liver and thyroid gland was performed on Siemens Acuson S2000 and S3000 devices in B-mode, color doppler mapping, pulse-wave doppler and shear-wave elastography (SWE) modes.&#x0D; Results. Ultrasound changes in the liver were more often observed in patients with subclinical hypothyroidism on the background of AIT. It was found that the number of patients with sonographic signs of liver damage is greater in the second group than in the first. Sonographic signs of the hepatobiliary system damage included an increase in the size of the liver, an increase in the echogenicity of its parenchyma, not homogeneous structure and dilatation of the portal vein.&#x0D; The analysis of the level of shear wave speed in the parenchyma of the thyroid gland showed that it was higher in second groups and its increase was also noted in patients with subclinical and clinical hypothyroidism.&#x0D; The results of SWE of the liver demonstrated a positive correlation between the stiffness of the liver parenchyma and the duration of AIT. Also, significantly higher values of SWE were observed in patients who, at the time of examination, had laboratory signs of thyroid dysfunction and the high level of shear wave velocity in the thyroid gland parenchyma. The analysis of the number of cases of liver fibrosis in two groups showed that it is more often detected during the long course of the disease. The percentage of patients with F1-F2 in the first group was 32% and in the second group - 53%.&#x0D; Conclusions. The established relationship between sonographic signs of diffuse changes in the liver parenchyma and hypothyroidism determines the expediency of using multiparametric ultrasound examination of the hepatobiliary system in patients with AIT to assess its condition, early diagnosis of fibrosis and determine the need for correction of treatment tactics.

Maternal pre-existing diabetes and gestational diabetes and the prevalence of septal defects in the offspring

Abstract Background and introduction Maternal pre-existing and gestational diabetes affect approximately 6% of all pregnancies in Denmark and are well known risk factors for congenital heart disease (CHD). Worldwide, CHD is the most common congenital defect and a leading cause of infant death. The association between maternal diabetes, and CHD in the offspring has previously been studied, however, these studies have been limited by small study cohorts and/or registry studies without systematic transthoracic echocardiography (TTE) of the children. Purpose To assess the prevalence of atrial and ventricular septal defects (ASD and VSD) in children born to mothers with pre-existing or gestational diabetes by systematic TTE, in a large, population-based cohort of neonates. Method Systematic, standardized TTE was performed in neonates included in a population-based cohort study between 2016 and 2018. For the present study, the prevalence of VSD in cases and controls was assessed in the entire cohort of neonates who underwent TTE within 30 days of birth, and in whom information regarding maternal diabetes was available (n=24,921). The prevalence of ASD was assessed in a sub-cohort of neonates (n=12,682) with the same inclusion criteria and in whom an interatrial communication had been classified as ASD or patent oval foramen according to a validated algorithm. ASD was defined as an interatrial communication with a defect size ≥4mm, a location in the inferior 1/3 of septum, or multiple communications. VSD was defined as flow across the interventricular septum in colour Doppler mode in one or more views. VSDs were classified as either muscular, perimembranous, or subarterial. Information about maternal pre-existing and gestational diabetes was collected from review of the mother's medical records and from an Obstetrical Database maintained by the participating hospitals. Cases were compared with controls, which here consists of the full cohort for VSD and sub-cohort for ASD, respectively, after excluding cases. Results The median age at examination of the entire cohort was 11 days [interquartile range (IQR) 7; 14] and 48% were female. The prevalence of VSD in children with maternal diabetes was 3.1% compared with 3.3% among children of mothers without maternal diabetes, RR 1.00 (95% CI 0.99–1.01, p=0.771). There was no difference between cases and controls when comparing the prevalence of subtypes of VSD (table 1). In the sub-cohort of 12,682 neonates assessed for ASD (median age at examination 12 days [IQR, 8; 15], 48% female), the presence of an ASD was found in 7.3% of cases compared to 5.9% among controls, RR 0.81 (95% CI 0.59–1.13, p=0.214). Conclusion In a large population-based cohort of infants, we did not find an increased risk for ASD or VSD, nor any of the subtypes of VSD, among children born to mothers with pre-existing or gestational diabetes as compared to controls. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): The Capital Region of Denmarks Research Fund.The Research Council of Herlev and Gentofte Hospital.

Reliability of the Pediatric Specific Musculoskeletal Ultrasound Scoring Systems for the Elbow, Wrist, and Finger Joints.

Musculoskeletal ultrasound (MSUS) is increasingly being used in the evaluation of pediatric musculoskeletal diseases. In order to provide objective assessments of arthritis, reliable MSUS scoring systems are needed. Recently, joint-specific scoring systems for arthritis of the pediatric elbow, wrist, and finger joints were proposed by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) MSUS workgroup. This study aimed to assess the reliability of these scoring systems when used by sonographers with different levels of expertise. Members of the CARRA MSUS workgroup attended training sessions for scoring the elbow, wrist, and finger. Subsequently, scoring exercises of B mode and power Doppler (PD) mode still images for each joint were performed. Interreader reliability was determined using 2-way single-score intraclass correlation coefficients (ICCs) for synovitis and Cohen [Formula: see text] for tenosynovitis. Seventeen pediatric rheumatologists with different levels of MSUS expertise (1-15 yrs) completed a 2-hour training session and calibration exercise for each joint. Excellent reliability (ICC > 0.75) was found after the first scoring exercise for all the finger and elbow views evaluated on B mode and PD mode, and for all of the wrist views on B mode. After a second training session and a scoring exercise, the wrist PD mode views reached excellent reliability as well. The preliminary CARRA MSUS scoring systems for assessing arthritis of the pediatric elbow, wrist, and finger joints demonstrate excellent reliability among pediatric MSUS sonographers with different levels of expertise. With further validation, this reliable joint-specific scoring system could serve as a clinical tool and scientific outcome measure.

Right and left ventricular structures and functions in acute HFpEF: comparing the hypertensive pulmonary edema and worsening heart failure phenotypes.

Limited data are available on right (RV) and left (LV) ventricular structures and functions in acute heart failure with preserved ejection fraction (AHF-pEF) presenting with hypertensive pulmonary edema (APE) versus predominant peripheral edema (peHF). In a prospective study of consecutive patients with AHF-pEF, 80 patients met inclusion and not exclusion criteria, and underwent echocardiographic and laboratory examination in the emergency ward. The survived (94%) were re-evaluated at the discharge. At admission, systolic, diastolic, pulse blood pressure (BP), and high sensitivity troponin I were higher (all P < 0.05) with APE than with peHF while brain-type natriuretic peptide (BNP), hemoglobin and estimated glomerular filtration rate (eGFR) did not differ between the two phenotypes. LV volumes and EF were comparable between APE and peHF, but APE showed lower relative wall thickness (RWT), smaller left atrial (LA) volume, higher pulse pressure/stroke volume (PP/SV), and higher ratio between the peak velocities of the early diastolic waves sampled by traditional and tissue Doppler modality (mitral E/e', all P < 0.05). Right ventricular and atrial (RA) areas were smaller, tricuspid anular plane systolic excursion (TAPSE) and estimated pulmonary artery peak systolic pressure (sPAP) were higher with APE than with peHF (all P < 0.05) while averaged degree of severity of tricuspid insufficiency was greater with peHF than with APE. At discharge, PP/SV, mitral E/e', sPAP, RV sizes were reduced from admission in both phenotypes (all P < 0.05) and did not differ anymore between phenotypes, whereas LV EF and TAPSE did not show significant changes over time and treatments. In AHF-pEF, at comparable BNP and LV EF, hypertensive APE showed eccentric LV geometry but smaller RV and RA sizes, and higher RV systolic function, increased LV ventricular filling and systemic arterial loads. AHF resolution abolished the differences in PP/SV and LV diastolic load between APE and peHF whereas APE remained associated with more eccentric RV and higher TAPSE.

DIFFICULTIES IN DIFFERENTIAL DIAGNOSIS OF THYROID NODULAR PATHOLOGY. A CASE REPORT

This paper presents a clinical case of follicular thyroid cancer, the importance of multiparametric ultrasound in the early detection of thyroid cancer is shown. To diagnose follicular thyroid cancer, multiparametric ultrasound examination was performed in B-mode, color Doppler mapping mode, sonoelastography and in contrast enhancement mode. Based on the results, indications for fine needle aspiration puncture biopsy were determined and further management tactics for the patient with follicular thyroid cancer were determined. Thus, a timely diagnosis and a correct chosen tactics for treating follicular thyroid cancer resulted in a favorable disease outcome.

COMPARATIVE ANALYSIS OF MULTIPARAMETRIC ULTRASOUND TECHNIQUES IN THE DIFFERENTIAL DIAGNOSIS OF THYROID CANCER

The aim of the study is to determine the value of multiparametric ultrasound examination in the differential diagnosis of thyroid cancer. The results of a multiparametric ultrasound examination performed in 219 patients with thyroid cancer at the stage of preoperative assessment are analyzed. There were 123 patients with papillary thyroid cancer, 96 patients with follicular thyroid cancer. All patients underwent multiparametric ultrasound examination in grey-scale mode, color Doppler mapping mode and elastography mode: compression elastography and shear wave elastography. In papillary thyroid cancer, two–color staining was found in 13.4% of cases, three–color staining – in 19.3%, four-color staining – in 28.7%, five-color staining – in 26.4%, six–color staining – in 12.2%. The pattern was dominated by "cold" tones. The velocity of the shear wave was 4.61±1.33 m/s (95% CI), Young's modulus was 63.3±14.7 kPa (95% CI), the elasticity index (strain ratio) was 4.89±1.65 (95% CI) c.u. The color scheme of follicular thyroid cancer was characterized by patchiness, the presence of both rigid and elastic areas. In 2 cases (14.3%) there was two-color staining, in 4 (28.6%) – three-color staining, in 8 (57.1%) – four-color and five-color staining. The velocity of the shear wave was 4,53±1,25 m/s (95% CI), Young's modulus was 62,1±12,1 kPa (95% CI), the elasticity index (strain ratio) was 3,76±0,76 (95% CI) c.u. Thus, the study showed that the complex use of multiparametric ultrasound examination techniques (B-mode, color Doppler mapping, compression elastography, shear wave elastography) is highly informative and should be used in the differential diagnosis of thyroid cancer in the preoperative assessment. Thus, the performed examination showed that the complex application of multiparametric ultrasound techniques (V, mode, CDM, CEG, ESP) is highly informative and should be used in the differential diagnosis of thyroid cancer in the preoperative period.

Estradiol and follicle-stimulating hormone imbalance associated with mineral-bone metabolism disturbances and cardiovascular complications in women on hemodialysis

BACKGROUND. The influence of female sex hormones on the regulation of the processes of formation and resorption of bone tissue, as well as the effect of excess or deficiency of sex hormones on renal function is associated with the development of cardiovascular complications in patients at different stages of chronic kidney disease. THE AIM : to study the relationship between estradiol deficiency and excess FSH content with disorders of mineral and bone metabolism and cardiovascular complications in postmenopausal women on hemodialysis. PATIENTS AND METHODS. 119 women from 34 to 57 years old on hemodialysis were examined. The concentration of follicle-stimulating hormone (FSH) and estradiol2, sclerostin, and fibroblast growth factor 23 (FGF-23) was determined using a sandwich-variant solid-phase ELISA on a «Multiscan EX analyzer» («ThermoFisher Scientific Inc.», Finland) with kits of «Alkor-Bio Company» (Russian Federation) and sets of "sandwich" type manufactured by Cloud-Clone Corp., USA. Echocardiography was performed using an «ALOKA 4000 Aplio» (Toshiba, Japan) in Doppler mode. Determined the left ventricular ejection fraction (LVEF), peak systolic velocity in the aortic arch (Vps – peak systolic velocity); LV myocardial mass index (LVMI). Left ventricular hypertrophy (LVH) was defined with LVMI greater than 95 g /m 2 in women. RESULTS. There was a direct correlation between high levels of FSH and high levels of sclerostin, FSH, and FGF23, an inverse correlation between low levels of estradiol2 and sclerostin, estradiol2 and FGF23, expressed in groups of patients with more severe changes in LVMI and Vps. CONCLUSION. In women on hemodialysis, bone mineral and cardiovascular abnormalities are associated with both renal failure proper and changes in the system of female sex hormones. A decrease in estradiol levels causes an increase in the nephrotoxic FSH and contributes to the excessive synthesis of sclerostin, a key factor in bone-mineral and cardiovascular complications in CKD.

Reference Values and Repeatability of Pulsed Wave Doppler Echocardiography Parameters in Normal Donkeys.

Simple SummaryCardiovascular disease is underreported in donkeys, possibly related to their limited athletic posture and frequent poor performance-related examinations. Reports on treatments for cardiovascular disease are anecdotal in donkey. Normal echocardiographic parameters have been reported in healthy donkeys. The aim of the present study was to establish the reference values and repeatability for Pulsed Wave Doppler echocardiographic variables of the mitral valve, aortic valve and myocardial performance. Two-dimensional Color flow mapping and spectral Doppler modes were performed. For the mitral valve, the mean velocity, pressure gradient and duration of E-wave were 57.7 ± 12.5 cm/s, 1.4 ± 0.7 mmHg and 0.4 ± 0.13 s, respectively. The results of the present study provide the reference values of PW echocardiographic parameters measurements in normal adult donkeys. Such reference values are helpful, especially when confronted with clinical cases with cardiovascular disorders.In the present study, thirty clinically healthy donkeys were used to establish the reference values and repeatability for Pulsed Wave Doppler echocardiographic variables of the mitral valve, aortic valve and myocardial performance. 2-dimensional Color flow mapping and spectral Doppler modes were performed. For the mitral valve, the mean velocity, pressure gradient and duration of E-wave were 57.7 ± 12.5 cm/s, 1.4 ± 0.7 mmHg and 0.4 ± 0.13 s, respectively. The velocity, pressure gradient and duration of the A-wave were 32.3 ± 9.1 cm/s, 0.3 ± 0.04 mmHg and 0.3 ± 0.1 s, respectively. The mitral valve area, pressure half time, pulsatility index (PI), resistance index (RI) and velocity time integral (VTI) were 1.8 ± 0.5 cm2, 66 ± 17 ms, 2.8 ± 1.4, 0.9 ± 0.03 and 19.1 ± 5.7 cm, respectively. For the aortic valve, the mean velocity was 64.9 ± 10.4 cm/s, pressure gradient was 1.8 ± 0.4 mmHg, pulsatility index was 1.4 ± 0.3, resistance index was 0.9 ± 0.02, VTI was 25.02 ± 6.2 cm, systolic/diastolic was 19 ± 4.7 and heart rate was 95.7 ± 28.9 per minute. For Myocardial Performance Index (LV)–Tei Index, the mean ejection, isovolumic relaxation, isovolumic contraction time and myocardial performance index were 0.24 ± 0.01, 0.14 ± 0.01, 0.14 ± 0.02 and 1.2 ± 0.1 s, respectively. The results of the present study provide the reference values of PW echocardiographic parameter measurements in normal adult donkeys. Such reference values are helpful, especially when confronted with clinical cases with cardiovascular disorders.

Determination of Doppler velocimetric measurements of the median artery in horses

Considering the importance of equine culture for the northeast region, the objective was to determine the median artery Doppler velocimetry measurements in horses through Doppler ultrasonography and to correlate changes in these measurements with possible risk factors for laminitis and / or other foot diseases. The project was approved for its execution through protocol N°. 3769100419 granted by the UFPB Ethics Committee. The analyzes were performed at Horse Training Centers and at the Veterinary Hospital - CCA / UFPB, in Areia, Paraíba State. Fourteen animals were used, which were trichotomized at the time of the third metacarpal bone, medial face of both thoracic limbs. The sonoscape S2V ultrasound device with color Doppler coupled to a 7 MHz linear probe was placed at the height of the median artery, in which B was measured. Then, the color Doppler mode was used to determine the doppler velocimeter measurements. Thus, with a 95% confidence interval in mode B 0,509 ± 0,133 of the median artery diameter was determined and in Doppler mode 2,198 ± 1,451 of the pulsatility index and 0,734 ± 0,906 of the resistivity index (non-parametric data). as reference values ​​for normality of median artery vascularization. It is concluded that more studies need to be developed to attest to the reliability of these values. Moreover, they may help in the early diagnosis, improving the prognosis of these animals prone to laminitis and other foot diseases.

THE ROLE OF DOPPLER REGIMES IN THE DETECTION OF VOLUME OVARIAN FORMATIONS

In order to increase the diagnostic value of ultrasound diagnostics, qualitative and quantitative Doppler indicators in the detection of bulky ovarian tumors were determined. A comprehensive examination of 149 patients with additional ovarian tumors, which consisted of three groups of patients. The control group included 30 women who did not have large ovarian tumors. Detailed qualitative assessment of blood flow loci was determined using energy Doppler, and quantitative – pulse. The main parameters that were evaluated were maximum blood flow velocity (Vmax), resistance index (IR), pulsation index (PI).Studies have shown that color Doppler showed neovascularity in 46 (95.8%) malignant tumors in contrast to only 35 (68.6%) benign tumors. Malignant tumors are characterized by a change in vascular velocity with an increase in peak systolic velocity and a decrease in the resistance index. Vmax and PI values increase slightly in tumor-like and benign tumors, but in malignant tumors they increase almost twice as much as in the control group (p &lt;0.05), and RI on the contrary - halves in malignant pathology (p &lt;0.05). In 33 (68.8%) cases of ovarian malignancies, the RI was &lt;0.5 and none of the benign tumors had an RI &lt;0.4. Most benign tumors (82.4%) had an RI&gt; 0.6 (p &lt;0.0001).The results of research show that Doppler imaging is an indispensable component of ultrasound in the differential diagnosis of bulky ovarian tumors, as neoangiogenesis has its own characteristics that can be effectively detected using Doppler modes.

Intra-operative Transoesophageal Echocardiography Detecting Intramural Haematoma During Thoracic Endovascular Aortic Repair

A 49 year old man with type B aortic dissection underwent thoracic endovascular aortic repair (TEVAR) with left carotid and subclavian artery fenestrations. After stent graft deployment, intra-operative transoesophageal echocardiography detected hypoechoic, well defined, crescent shaped wall thickening without a dissection flap in the ascending aorta via the short axis (A, white arrow). The M mode showed that the aortic wall thickening remained constant during the cardiac cycle. Doppler mode showed no communication between the aortic lumen and the thickening aortic wall (B).

Tips for carotid ultrasound in the intensive care unit.

The ultrasonography of carotid arteries plays a key role in evaluating cerebrovascular disease. There are some useful considerations to perform it correctly in the intensive care unit, such as using different kind of transducer, Doppler mode optimization, and the correct interpretation of the findings.

Fetal intrahepatic Umbilical-Porto-Systemic venous shunts (IHUPSVS): In-utero anatomic classification

ObjectiveCongenital intrahepatic shunts divert highly oxygen and nutrients rich placental blood flow from the liver into the systemic flow having a negative influence on normal fetal growth and postnatal development. The ability to recognize this anomaly helps assess the possible clinical impact, counseling, and management of pregnancy. The present study aimed to propose in utero classification for the Intrahepatic Umbilical-Porto-Systemic Venous Shunt (IHUPSVS) based on our experience. Study DesignA prospective study. Grayscale ultrasound with two and three-dimensional high-definition Doppler modalities was used. IHUPSVS was defined as a diversion of blood from the liver tissue by abnormal communication between a branch of the intrahepatic Umbilical vein or the Portal veins with the systemic circulation (the Hepatic veins or the Sub-Diaphragmatic Vestibulum). ResultsTwenty-five fetuses were diagnosed with IHUPSVS. We identified three main anatomic types: I) Porto-hepatic shunt which was divided into Ia) regular single shunt (15/25, 60%) and Ib) regular multiple shunts, (6/25, 24%) II) Umbilical-Porto-Hepatic shunt divided into a) Umbilical or b) Umbilical combined with Portal hepatic shunt (2/25, 8%) and III) Cavernous- aneurysmatic shunt (2/25, 8%). All the shunts were verified by postnatal targeted sonography. ConclusionsThis study creates the anatomic basis for common nomenclature and future probable updating for this anomaly.

Advances in the ultrasound diagnosis in equine reproductive medicine: New approaches.

Ultrasound technology has led to new lines of research in equine reproduction, and it has helped to greatly improve clinical diagnosis and reproductive outcomes in equine practice. This review aims to discuss the potential clinical uses and new approaches of ultrasonography in equine reproduction. Doppler modalities are usually used to evaluate the vascularization of the follicles, corpus luteum (CL), and the uterus in the mare for diagnostic purposes. Inclusion of Doppler ultrasound in artificial insemination and embryo transfer programs could improve the reproductive outcome of these techniques. Better selection of recipients based on CL functionality, early pregnancy diagnosis 7-8 days postovulation of the donor before flushing or diagnosis of mares with endometritis with pathological increases of blood flow are examples of clinical applications in the mare. In the stallion, colour Doppler ultrasound has improved the diagnostic potential of B-mode ultrasound, improving the differential diagnosis of pathologies such as testicular torsion (decrease or absence of blood flow in the cord) and orchitis (increased blood flow in the cord). The incorporation of pulsed Doppler ultrasound into the reproductive evaluation of the stallion has enabled early identification of stallions with testicular dysfunction, thus allowing administration of timely treatment and subsequent improvements of the fertility prognosis for these animals. In addition, this technique has been used in the monitoring of patients undergoing medical and surgical treatments, thus verifying their efficacy. Recently, computer-assisted pixel analysis using specific software has been performed in research work in order to semi-quantitatively evaluate the vascularization (colour and power Doppler) and echotexture of different organs. These softwares are now being developed for clinical purposes, as is the case with Ecotext, a computer program developed for the evaluation of testicular echotexture, providing information on testicular functionality.

Streaming technology: from games to tele-ultrasound

BACKGROUND: Due to the gaming industrys rapid development, a large number of technical tools and technologies with unique characteristics have emerged. One of these technologies, which can be potentially used in medical diagnostics, is streaming (online streaming). By connecting an ultrasound scanner to a video capture system, it is possible to significantly expand the diagnostic devices functionality.&#x0D; AIM: To investigate the possibility of applying the gaming industrys information technology in telemedicine, like tele-ultrasound.&#x0D; MATERIALS AND METHODS: In this study, an ultrasound video image was captured using a video capture system developed for gamers. The video was obtained during brachycephalic arteries ultrasound in the following modes: greyscale B-mode, color duplex, and pulse Doppler mode. The examination was broadcast to a video streaming service in real time.&#x0D; RESULTS: An expert sonologist obtained optimal video image parameters and determined the minimum required video streaming settings for an adequate remote evaluation. The following video capture workstation settings are recommended: video, 1280720; 24 fps; H.264 encoder; bitrate, at least 350 Kbps.&#x0D; CONCLUSIONS: Using technical and software tools developed for video game streaming to provide tele-ultrasound is possible.