Doppler Technique Research Articles

Diagnostic insights into splenic pathologies: the role of multiparametric ultrasound.

Ultrasound(US) evaluation of the spleen is mandatory in the assessment of patients with chronic liver disease, and splenomegaly can be a sign of systemic diseases. However, due to the lack of distinctive ultrasound findings in specific splenic pathologies, clinical diagnosis can be very challenging. Splenomegaly, defined by increased splenic dimensions, can indicate underlying systemic conditions and is a common manifestation of portal hypertension (PH). Ultrasound and Doppler techniques help assessing splenic involvement in PH. Splenic stiffness measurement, using elastography, offers additional diagnostic accuracy, especially when liver stiffness measurements are inconclusive. CEUS enhances the diagnostic capability for focal splenic lesions, differentiating between benign and malignant lesions by their distinct enhancement patterns, and plays also a critical role in the context of splenic traumatic pathology. Overall, CEUS significantly improves the characterization of splenic pathology, reducing the need for invasive procedures and ensuring appropriate patient management. This review article describes the normal US findings of the spleen and examines the role of multiparametric US in the evaluation of the most common splenic pathologies encountered in the daily clinical practice.

Non-invasive blood pressure measurement in conscious rabbits: A comparison of Doppler ultrasonic and oscillometric devices.

This study aimed to compare Doppler (the most commonly used technique for non-invasive indirect blood pressure [NIBP] measurement in rabbits) and oscillometric devices for NIBP measurements in conscious rabbits. Blood pressure (BP) measurements were obtained for49 conscious rabbits using the Doppler and oscillometric devices. Each measurement was repeated in triplicate. Three rabbits were excluded from the study because it was not possible to obtain BP measurements using the oscillometric device. The American College of Veterinary Internal Medicine (ACVIM) guidelines were followed to compare the results obtained with the two devices. A total of 164 systolic BP measurements were obtained with the Doppler device and 182 were obtained with the oscillometric technique. The mean of the three values obtained for each animal with each device was used for statistical analysis. The analysis demonstrated a poor level of agreement between the measurements obtained with the two devices. Oscillometric devices rely on built-in software algorithms to perform calculations and produce their measurements. However, the oscillometric devices currently available only have the software for dogs and cats installed. Therefore, these conclusions should be revised when a device with software specifically for rabbits is commercialised. This study indicates that oscillometric devices should not be used as a substitute for the Doppler technique when measuring BP in rabbits.

Dynamic mode decomposition based Doppler monitoring of de novo cavitation induced by pulsed HIFU: an in vivo feasibility study

Pulsed high-intensity focused ultrasound (pHIFU) has the capability to induce de novo cavitation bubbles, offering potential applications for enhancing drug delivery and modulating tissue microenvironments. However, imaging and monitoring these cavitation bubbles during the treatment presents a challenge due to their transient nature immediately following pHIFU pulses. A planewave bubble Doppler technique demonstrated its potential, yet this Doppler technique used conventional clutter filter that was originally designed for blood flow imaging. Our recent study introduced a new approach employing dynamic mode decomposition (DMD) to address this in an ex vivo setting. This study demonstrates the feasibility of the application of DMD for in vivo Doppler monitoring of the cavitation bubbles in porcine liver and identifies the candidate monitoring metrics for pHIFU treatment. We propose a fully automated bubble mode identification method using k-means clustering and an image contrast-based algorithm, leading to the generation of DMD-filtered bubble images and corresponding Doppler power maps after each HIFU pulse. These power Doppler maps are then correlated with the extent of tissue damage determined by histological analysis. The results indicate that DMD-enhanced power Doppler map can effectively visualize the bubble distribution with high contrast, and the Doppler power level correlates with the severity of tissue damage by cavitation. Further, the temporal characteristics of the bubble modes, specifically the decay rates derived from DMD, provide information of the bubble dissolution rate, which are correlated with tissue damage level—slower rates imply more severe tissue damage.

Arterial and Venous Doppler in Evaluation of the "At-risk" Fetus.

Our practice utilizes Doppler ultrasound as one of the most objective and effective methods to assess at-risk pregnancies. This review will discuss the application of arterial and venous Doppler techniques in assessing and managing various diseases and conditions for high-risk fetuses.

Intra-ovarian Doppler artery indices values in cases with polycystic ovarian syndrome: a case control study

Background and objective: polycystic ovarian syndrome (PCOS) is the most common female endocrine disorder during their reproductive age which results in hyperandrogenism and anovulation or oligo-ovulation. Significant changes occur in ovarian vascularization at the level of the intra ovarian arteries in PCOS patients. The objective is to assess Doppler hemodynamic changes in ovarian stromal arteries in follicular phase of the cycle in both ovaries in women with PCOS compared to normal ovulatory fertile women (control) using transvaginal Color Doppler technique, by calculating intra ovarian Doppler artery indices values: Resistive index (RI) and pulsatility index (PI) of both ovaries. Methods: Two hundred women were included in the study. One hundred patients were diagnosed as PCOS (cases) according to Rotterdam’s criteria and another one hundred were normal fertile women (controls). Transvaginal color Doppler technique is used in examining the recruited cases and controls, Doppler indices values of intraovarian stromal arteries were measured. Results: in the current study, the RI and PI of the ovarian stromal artery were lower in women with PCOS (cases) compared to controls. These hemodynamic changes are a predictor for the diagnosis of PCOS. Conclusion: Doppler ultrasonography was a successful tool in assessing the hemodynamic changes in PCOS women.

Imaging of experimental venous thrombus by means of Doppler and CEUS techniques in dogs.

Venous thrombosis has been widely studied in humans, but not in dogs. This study was designed to evaluate a venous thrombus in dogs, from creation to solution, by means of various ultrasonographic techniques. Nine healthy Beagle dogs were included in the study. The venous thrombus was formatted by puncturing the lumen of the external jugular veins and then, the veins were examined with B-mode, color Doppler, pulsed-wave Doppler, and contrast-enhanced ultrasound (CEUS) techniques, at regular intervals, within 210-270min after venipuncture. Haemodynamic parameters were calculated at two different locations, before and after the site of the thrombus formation. The existence of a thrombus was confirmed by CEUS technique. Thrombus volume and echogenicity were evaluated. The results showed that the visualization of the venous thrombus by color Doppler modality was not feasible in some veins. The blood volume was the parameter that could more precisely indicate the presence or absence of a thrombus. In cases where thrombus volume was less than 0.001 cm3, it was impossible to detect its presence using haemodynamic parameters. The CEUS imaging depicted accurately the size and shape of an anechoic venous thrombus, even when its volume was 0.001cm3.

Clinical application of intraoperative ultrasound superb microvascular imaging in brain tumors resections: contributing to the achievement of total tumoral resection

BackgroundTo investigate whether the intraoperative superb microvascular imaging(SMI) technique helps evaluate lesion boundaries compared with conventional grayscale ultrasound in brain tumor surgery and to explore factors that may be associated with complete radiographic resection.MethodsThis study enrolled 57 consecutive brain tumor patients undergoing surgery. During the operation, B-mode and SMI ultrasound evaluated the boundaries of brain tumors. MRI before and within 48h after surgery was used as the gold standard to evaluate gross-total resection(GTR). The ultrasound findings and GTR results were analyzed to determine the imaging factors related to GTR.ResultsA total of 57 patients were enrolled in the study, including 32 males and 25 females, with an average age of 53.4 ± 14.1 years old(range 19 ~ 80). According to the assessment criteria of MRI, before and within 48 h after the operation, 37(63.9%) cases were classified as GTR, and 20(35.1%) cases were classified as GTR. In comparing tumor interface definition between B-mode and SMI mode, SMI improved HGG boundary recognition in 5 cases(P = 0.033). The results showed that the tumor size ≥ 5 cm and unclear ultrasonic boundary were independent risk factors for nGTR (OR>1, P<0.05).ConclusionsAs an innovative intraoperative doppler technique in neurosurgery, SMI can effectively demarcate the tumor’s boundary and help achieve GTR as much as possible.

Early Morbidities of Hypoxia-Ischemic Encephalopathy in Term Neonates With a Resistive Index as a Prognostic Indicator.

Background Acidosis, hypoxemia, and hypercarbia are symptoms of a syndrome known as perinatal asphyxia that occurs during the first and second stages of labor and shortly after delivery due to poor gas exchange. The Doppler technique is a non-invasive way to assess the risk of neurodevelopment damage in hypoxic-ischemic encephalopathy (HIE) that may be done at the patient's bedside without disturbing them. The study aims to evaluate cranial ultrasound findings in HIEand investigate the role of resistive index (RI) values assessed by color Doppler transcranial ultrasonography in predicting early morbidities in neonates with HIE within 72 hours of life. Methodology Prospective observational research was carried out at the north Karnataka region's tertiary newborn critical care unit. The study included 54 infants with HIE in total. The male-to-female ratio was 1.7:1, with 34 (63%) male and 20 (37%) female newborns. Results About 32 instances had grade I HIE, 8 had grade II HIE, and 14 had grade III HIE. In 35 instances (64.81%), the RI was normal; in 19 cases (35.19%), it was abnormal. Increased periventricular density and cerebral parenchyma echo density were common Doppler ultrasonography findings. Roughly 93% of people survived, and 7% of people died from HIE. Seizures (12.96%) and acute renal damage (33.33%) were the most frequent consequences. Conclusion In instances of HIE, the RI was revealed to be a favorable predictive indicator for newborn prognosis. Counselingand educating parents about early morbidities, anticipated long-term consequences, and the need for follow-up will all benefit from it. Additionally, color Doppler is a practical and secure diagnostic method for determining a newborn's level of HIE.

Echocardiographic Detection of Subclinical Left Ventricular Dysfunction in Asymptomatic Type Two Diabetes Mellitus

Background: Before systolic dysfunction and symptomatic heart, diabetic cardiomyopathy begins with left ventricular diastolic dysfunction (LVDD). Echocardiographic modalities were used to detect subclinical LV impairment in asymptomatic type 2 diabetics. This study aimed to identify subclinical left ventricular impairment in asymptomatic patients with type two diabetes using several echocardiographic techniques. Methods: In the present prospective cohort study, 30 adults over 18 having type II diabetes mellitus (DM) (Group I) and 20 normal controls (Group II) were studied. Transthoracic echocardiography and 12-lead ECG were performed on all individuals. Results: Pulsed wave Doppler techniques revealed significant variation in transmitral flow velocities between groups, including septal e', lateral mitral annulus early velocity (e'), septal early diastolic peak flow velocity (E)\e', Lateral E\e', and average E\e'. EF was significantly decreased in group I (P &lt; 0.001). With a p-value of 0.001, LVESD was significantly higher in group I. The septal, lateral, and average systolic mitral annulus (S') motions in group II were significantly larger than those in group I. When comparing groups, I and II, the first showed much longer myocardial performance index (MPI) and isovolumetric contraction time (IVCT). The ET for Group I was significantly lower than that of Group II. The study group exhibited significantly greater levels of fasting blood sugar, post-prandial blood sugar, and haemoglobin A1C (HBA1C) compared to the control group (P &lt;0.001). Conclusions: Patients having diabetes mellitus exhibited considerably greater levels of DM history fasting glucose levels, postprandial glucose levels, haemoglobin A1C (HBA1C), E/e´ ratio, LVESD, IVCT, and MPI, while having significantly lower EF and ET relative to the healthy group.

#2280 Kidney elastometry, X-flow algorithms to interrogate adult and pediatric number of nephrons

Abstract Background and Aims Standard ultrasound mainly provides information about structural changes in the kidney, whereas parenchymal Doppler ultrasound provides the renal resistance index (RI), which correlates with plasma creatinine levels. Unfortunately, in the case of isolated proteinuria and normal renal function/creatinine levels, these two classical approaches do not show any changes. Recent advances in ultrasound analysis, allowing the measure of kidney stiffness (sharewave elastometry) and the imaging of ultralow-flow vessels up glomeruli (such as X-Flow), might be helpful to identify kidney alterations in case of proteinuria with normal creatinine. We hypothesize that proteinuria with intact glomerular filtration may induce a measurable change in kidney stiffness and the size of low-flow microcircle, with different effects in acute and chronic conditions. We also verify whether the mismatch between creatinine, resistance index, and kidney size may suggest a specific nephrological disease. Method We conducted a transversal study on 301 patients with chronic kidney disease (CKD) and 160 kidney transplant patients (Tx), comparable for age, gender, and eGFR. For all patients, we retrieved the resistance indices of both the kidney and the spleen, clinical variables, shear wave elastrometry, and the X-Flow algorithm (Esaote) to detect the microcircle. We compared Conventional pulsed wave Doppler techniques (resistance index, RI) and ultrasensitive Doppler algorithm (Xflow, Esaote, Genoa, GE, Italy) to study the perfusion pattern and smaller angio-architecture of kidney's cortical vessels. X-Flow is a high-resolution and high-definition Doppler technology, which, with a new algorithm, makes better spatial resolution possible and maximizes Doppler signal penetration capabilities. We also identify a mismatch between creatinine and the renal RI, calculating the renal mismatch index (correlation between renal resistance index and creatinine level). The connection between the resistance index and the kidney size was tested as a significant marker of chronicity. Results The eGFR was best predicted by renal RI in Tx patients (Pearson −0.4, p &amp;lt; 0.01). At variance, the RI is a poor predictor of eGFR in CKD patients: in these subjects, the kidney longitudinal size was a better predictor of eGFR (Pearson's coefficient 0.39, p &amp;lt; 0.01). Using a large dataset from a previous study, we estimated the total number of nephrons using the following approximation: nephron number = (5270*total cortical volume – 61612)*number of kidneys. This formula is only valid for chronic patients and cannot be applied to polycystic patients. We speculated that while eGFR was proportional to the number of active glomeruli in CKD patients (thus correlating with kidney size), in TX patients, the local microcircle better explained the changes in eGFR. The consequence is that the eGFR has different meaning in CKD and Tx patients. Patients deviating from this pattern are identified as having an increased renal dissimilarity index. The multiple regression analysis revealed that RI also depended on age and cholesterol levels. The spleen resistance index correlated with cholesterol levels. The kidney mismatch index defined a subgroup of patients with tubular microcirculation abnormalities. Shearwave stiffness correlated with Resistance index (Pearson −0.3, p = 0.04) and, limited to Tx patients, to the cortical volume (Pearson = −0.446, p &amp;lt; 0.05) and number of nephrons (Pearson −0.44, p &amp;lt; 0.05), but was not associated with creatinine or eGFR. The extent of microcircle measured on X-flow images was altered in chronic forms of proteinuria with normal creatinine levels. Conclusion Kidney elastometry and kidney X-flow indices might show more sources of profitable information that can be collected from ultrasound approaches that allow the identification of a diseased kidney, even in the presence of regular architecture and average resistance index. The X-flow algorithm should be used to study the smaller vascular tree not visualizable with Doppler, such as the afferent arteriole.

IMPROVEMENT OF CAPILLAROSCOPY METHOD FOR STUDYING HUMAN MICROCIRCULATION

The human circulatory system has historically captivated researchers in the field of medicine. Modern medicine, however, has moved beyond identifying a single crucial element, such as the heart or venous system, for maintaining blood flow. Instead, it emphasizes a more analytical approach, focusing on the interconnected functioning of all components within the system. The aim of this work is to analyze the existing methods of studying blood microcirculation and to improve the technology of capillaroscopy, technical means of raster microphotography to determine the physiological state and disorders of capillary circulation. To achieve this objective, we address the following tasks: analyzing existing non-invasive methods for studying the human vascular system; enhancing the optical capillaroscopy method through the utilization of modern high-resolution digital cameras, computer, and multimedia equipment, along with appropriate software for analyzing electronic images; developing a technological scheme and equipment design for digital microphotography of capillaries in the periungual region of the upper extremities; providing software solutions for registering and analyzing digital microphotographic images obtained through capillaroscopy; conducting experimental studies to explore the structure and properties of capillaries utilizing the developed technologies and equipment. Magnetic resonance imaging (MRI) enables the comprehensive evaluation of both anatomical and functional aspects of blood flow. Magnetic resonance angiography (MRA) capitalizes on the distinction between the signal emitted by moving tissue (blood) and that of surrounding stationary tissue, facilitating the acquisition of vascular images without the need for radiopaque contrast agents. Ultrasonography integrates Doppler and conventional ultrasound techniques, providing physicians with insights into blood vessel structure and blood flow dynamics. Traditional ultrasound employs sound waves that are imperceptible to the human ear and bounce off blood vessels, while Doppler ultrasound measures the velocity of sound wave reflection from moving elements. Ophthalmoscopy constitutes a fundamental component of standard ophthalmological examinations, serving as a pivotal tool for diagnosing eye conditions and evaluating the condition of blood vessels. Additionally, ophthalmoscopy aids in diagnosing autoimmune disorders. Capillaroscopy enables comprehensive assessments of both systemic and regional microcirculation disorders, facilitating the characterization of tissue metabolism. Dysfunction in capillary function contributes to circulatory impairments, leading to blood stasis, metabolic irregularities, and compromised immunity, thereby exacerbating existing conditions and predisposing individuals to new diseases. Optical computerized capillaroscopy offers a non-invasive means of visualizing, examining, and archiving capillary images, enabling clinicians to make informed assessments regarding blood microcirculation. Experimental validation of the optimized hardware and software capillaroscopy system was conducted using nail bed capillaries of a patient with type II diabetes mellitus undergoing insulin therapy for 10 years. This study underscores the importance of refining and enhancing optical capillaroscopy methodologies by leveraging high-resolution camera sensors and modern computational tools for image processing.

Assessment of quantitative microflow Vascular Index in testicular cancer

PurposeUltrasound (US) is the primary imaging modality when a testicular tumor is suspected. Superb microvascular imaging (SMI) is a novel, highly sensitive Doppler technique that allows quantification of flow signals by determination of the Vascular Index (VI).The aim of the present study is to investigate the diagnostic significance of the SMI-derived VI in normal testicular tissue and testicular cancer. MethodsThis retrospective analysis included patients who underwent testicular US in our department from 2018 to 2022. Inclusion criteria were: i) sufficient image quality of the stored images, ii) US with standardized SMI-default setting (colour gain of 44 ± 5), iii) patient age ≥ 18 years, and iv) normal testicular findings or testicular tumor with histopathological workup. US examinations were performed as part of clinical routine using a high-end ultrasound system (Aplio i800/i900, Canon Medical Systems Corporation, Tochigi, Japan). Statistical analysis included Chi-square test and Mann-Whitney U tests and receiver operating characteristic (ROC) curve analysis. ResultsA total of 62 patients (31 each with normal findings and testicular tumors) were included. The VI differed statistically significantly (p < 0.001) between normal testis (median 2.5 %) and testicular tumors (median 17.4 %). Like vascular patterns (p < 0.001), the VI (p = 0.030) was shown to distinguish seminomas (median 14.8 %), non-seminomas (median 17.6 %) and lymphomas (median 34.5 %). ConclusionsIn conclusion, our study has shown the VI to be a quantitative tool that can add information for differentiating testicular tumor entities. While further confirmation in larger study populations is desirable, our results suggest that the VI may be a useful quantitative parameter.

Shexiang Tongxin Dropping Pill Promotes Angiogenesis through VEGF/eNOS Signaling Pathway on Diabetic Coronary Microcirculation Dysfunction.

To study the effect of Shexiang Tongxin Dropping Pill (STDP) on angiogenesis in diabetic cardiomyopathy mice with coronary microcirculation dysfunction (CMD). According to a random number table, 6 of 36 SPF male C57BL/6 mice were randomly selected as the control group, and the remaining 30 mice were injected with streptozotocin intraperitoneally to replicate the type 1 diabetes model. Mice successfully copied the diabetes model were randomly divided into the model group, STDP low-dose group [15 mg/(kg·d)], medium-dose group [30 mg/(kg·d)], high-dose group [60 mg/(kg·d)], and nicorandil group [15 mg/(kg·d)], 6 in each group. The drug was given by continuous gavage for 12 weeks. The cardiac function of mice in each group was detected at the end of the experiment, and coronary flow reserve (CFR) was detected by chest Doppler technique. Pathological changes of myocardium were observed by hematoxylin-eosin staining, collagen fiber deposition was detected by masson staining, the number of myocardial capillaries was detected by platelet endothelial cell adhesion molecule-1 staining, and the degree of myocardial hypertrophy was detected by wheat germ agglutinin staining. The expression of the vascular endothlial growth factor (VEGF)/endothelial nitric oxide synthase (eNOS) signaling pathway-related proteins in myocardial tissue was detected by Western blot. Compared with the model group, medium- and high-dose STDP significantly increased the left ventricular ejection fraction and left ventricular fraction shortening (P<0.01), obviously repaired the disordered cardiac muscle structure, reduced myocardial fibrosis, reduced myocardial cell area, increased capillary density, and increased CFR level (all P<0.01). Western blot showed that high-dose STDP could significantly increase the expression of VEGF and promote the phosphorylation of vascular endothelial growth factor receptor 2, phosphoinositide 3-kinase, protein kinase B, and eNOS (P<0.05 or P<0.01). STDP has a definite therapeutic effect on diabetic CMD, and its mechanism may be related to promoting angiogenesis through the VEGF/eNOS signaling pathway.

EFFECTS OF ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITOR (ARNI) ON HOME BLOOD PRESSURE AND BAPWV IN ESSENTIAL HYPERTENSIVE PATIENTS

Objective: Sacubitril/valsartan sodium hydrate (Entresto) is classified as an ARNI and has a novel mechanism of action that simultaneously inhibits neprilysin and angiotensin II receptors. We investigated the effects of Entresto on blood pressure (BP), baPWV, and carotid arterial intima-media thickness (IMT) and elasticity in essential hypertension. Design and method: Fifty-two hypertensive patients (twenty-six males, average age 67 years) who had insufficient BP reduction (home systolic 135 or diastolic 85 mmHg or higher) after receiving ARBs (azilsartan 26 or valsartan 26) for more than 6 months, were assigned to receive Entresto for 12 months (200-400mg/day, gradually increase depending on the condition). Changes in home BP, biochemical data, baPWV, central blood pressure (cSBP) were evaluated. The carotid arterial IMT and elastic modulus in the circumferential direction (Eθ) were simultaneously measured by the high-resolution Doppler technique, “Phased Tracking Method”. Results: Home morning BP (mmHg) after administration of Entresto significantly (p&lt;0.05) decreased from 142.9±11.3/80.0±12.1 to 125.7±7.4/70.9±12.0, and home heart rate (HR, bpm) also significantly decreased from 75.1±11.3 to 72.2±11.9. There were no differences in BP and HR changes between ARBs. Furthermore, baPWV (m/sec) significantly decreased from 1542.4±259.8 to 1438.4±222.41, and cSBP (mmHg) significantly decreased from 141.0±9.1 to 133.2±8.4. Urine protein (mg/g/Cr) decreased significantly from 319.6±473.6 to 213.1±376.4, but there were no significant changes in eGFR (45.6±14.1 to 44.5±14.5 mL/min/1.73m2) nor serum potassium (4.2±0.4 to 4.0±0.9mEq/L). Eθ (kPa) was reduced significantly from 301±141 to 163±41 without changes in IMT. The histogram analysis of the Eθ data revealed the drug decreased harder components of the elasticity distribution, suggesting improvement of endothelial dysfunction. Conclusions: These data demonstrate that the ARNI, Entresto provides potent antihypertensive and antiatherosclerotic effects.

Smart Streetlight Energy Saving System Based on mmWave Radar

Streetlights serve as fundamental infrastructure to meet the lighting needs of people on every road. However, their extensive deployment often results in unnecessary energy waste, with many streetlights maintaining high brightness despite minimal usage during the night. This study aims to develop a smart energy-efficient streetlight system that automatically adjusts lighting levels based on the absence of vehicles and pedestrians, detected after a 3-minute countdown. Specifically, the study utilizes mmWave radar to collect point cloud data, which undergoes denoising through Doppler, DBSCAN, and XYZ techniques. Additionally, the mmWave radar assists in training an LSTM model to identify pedestrian pathways. The implementation of the proposed system significantly reduces energy consumption and annual costs by automatically dimming or turning off streetlights in areas with minimal pedestrian activity during nighttime.

Prognostic value of resistive index (measured in anterior cerebral artery) in term neonates with hypoxic ischemic encephalopathy

Background: Perinatal asphyxia refers to a condition during the first and second stage of labor and soon after birth in which impaired gas exchange leads to acidosis, hypoxemia, and hypercarbia. The Doppler technique is a non-invasive method that can be used at the bed side without disturbing patients, for risk of subsequent neurodevelopment impairment in HIE. It has been proven that impaired cerebral circulation plays the main role in the pathogenesis of hypoxic ischemic brain injury in neonates. Methods: Doppler sonography conducted in all enrolled subjects. Cerebral blood flow parameters-peak systolic velocity, end diastolic velocity and resistive index were measured in anterior cerebral artery bilaterally on parasagittal planes obtaining the images through the anterior fontanelle with in first 72 hours. Results: In our study we found that death during hospital stay in neonates with normal RI and abnormal RI is 13% and 28.6% respectively (p&lt;0.01). Abnormal neurological outcome of 70.6% at 6 months and 64.7% at 12 months in patients with abnormal RI and 23.3% at 6 months and 18.6% at 12 months in patients with normal RI (p&lt;0.01). Conclusions: There is a significant correlation between neurodevelopmental disabilities and cerebral blood flow parameters in neonates with hypoxic ischemic encephalopathy. Detection of increased or decreased in cerebral blood flow velocities in neonates with in first 72 hours postpartum has a significant prognostic value related to death and long-term neurodevelopmental outcome.

Subclinical Echocardiographic Parameters and Biomarker Approach to Characterize the Pathophysiology of Carcinoid Syndrome

Introduction: Carcinoid heart disease is a rare cause of right-sided valvular dysfunction, an important complication in patients with carcinoid syndrome. Objectives: We aim to present our own experience regarding early myocardial dysfunction in patients with carcinoid syndrome. Methods: 64 patients (35-90 year old, 62,5% female, 37,5% male patients) with carcinoid syndrome were evaluated between October 2017 and June 2021. All patients underwent two-dimensional echocardiography with additional tissue Doppler and speckle-tracking techniques. For all patients there were measured urinary level of 5- hydroxyindolacetic acid, serotonin and NT-proBNP values. Results: The following echocardiographic features: global longitudinal strain of both ventricles, mean systolic velocity of the left ventricle, systolic velocity of the free wall of right ventricle, correlated with high values of specific biomarkers: serotonin, and urinary 5-hydroxyindolacetic acid, and also with the presence of hepatic metastases and poorly differentiated tumors. Discussion: In this study we identified several patients with early myocardial dysfunction due to carcinoid syndrome, representing a predictive model of poor prognosis, requiring further investigations. Conclusion: Echocardiographic assessment based on the measurement of systolic velocities, as well as the global longitudinal strain of both ventricles, together with specific biomarkers may contribute to better recognition of carcinoid heart disease in clinical practice, but this needs validation through further studies enrolling larger number of patients.

Ultrasound-Based Noncontrast Microvascular Imaging for Evaluation of Breast Lesions: Imaging Techniques and Review of Diagnostic Criteria.

Vascularity plays a pivotal role in the progression of breast lesions and may be associated with their aggressiveness and likelihood of being malignant. Contrast-enhanced imaging techniques are necessary to evaluate vascularity due to the limited sensitivity of conventional color Doppler techniques, in which motion artifacts are eliminated using wall filters. However, in this process, low-flow signals from small vessels also get removed unintentionally. Advancements in technology have revolutionized the way ultrasound images are generated, resulting in tremendous improvements in Doppler imaging techniques. The new, ultrasound-based noncontrast microvascular imaging techniques overcome the limitations of conventional Doppler, and are highly sensitive for detecting microvessels and low flow. The resultant high Doppler sensitivity leads to detection of vascularity in more breast lesions. It is important for radiologists to understand the imaging principles and the clinical implications of the new techniques, to optimally utilize them and aid correct diagnosis. Angio-PLUS is one such recent advancement, which uses unfocused or plane waves and three-dimensional wall filtering to analyze tissue motion in time, space, and amplitude domains that effectively distinguish between blood flow and tissue. The information is beneficial for assessing the lesion vascularity without using contrast. This article aims to explain the Doppler imaging techniques, their clinical applications, scanning methods, and review the common Doppler-based diagnostic criteria used in the evaluation of breast lesions.

Hepatic Artery Delineation on Ultrasound Volumes Comparing B-Flow and Color Doppler for Postoperative Monitoring of Pediatric Liver Transplants.

(1) Background: Accurate hepatic artery (HA) depiction following pediatric liver transplantation (LT) is essential for graft surveillance but challenging on ultrasound (US). This study assesses if improved HA delineation can be achieved by recording two-dimensional US volumes in Color Doppler (CD) and B-flow technique. (2) Methods: Of 42 consecutive LT, 37 cases were included, and HA delineation was retrospectively rated using a four-point score (0 = HA not detectable, 3 = HA fully detectable, separable from portal vein) within 48 h post-LT (U1) and before discharge (U2). (3) Results: Adding B-flow compared with CD alone showed superior results at neohilar (U1: 2.2 ± 1.0 vs. 1.1 ± 0.8, p < 0.0001; U2: 2.5 ± 0.8 vs. 1.5 ± 0.9, p < 0.0001) and segmental levels (U1: 2.8 ± 0.6 vs. 0.6 ± 0.8, p < 0.0001; U2: 2.8 ± 0.6 vs. 0.7 ± 0.5, p < 0.0001). (4) Conclusions: Standardized US volume recordings combining B-flow and CD can effectively delineate the HA along its vascular course in pediatric LT. The technique should be further evaluated as a standard monitoring instrument to rule out vascular complications after LT.

Associations between vitamin D status, VDR gene polymorphisms and echocardiographic markers in Polish patients with cardiovascular disease.

Aim: This work was designed to investigate the associations between vitamin D metabolites, VDR gene polymorphismsand echocardiographic markers in a population of patients with cardiovascular disease. Methods: Echocardiographic markers for 42 patients were determined with tissue Doppler techniques. PCR-restriction fragment length polymorphismanalysisidentified genetic variants ApaI, TaqI, BsmI and FokI. A validated UHPLC-MS/MS methoddetermined vitamin D metabolites. Results: Patients with the ApaI-GT genotype exhibited a lower pressure gradient across the aortic valve than ApaI-TT carriers. BMI, ApaI-GT, TaqI-TC, aortic arch diameterand maximal pressure gradient were significant univariate predictors of hypertension. Conclusion: A potential link existsbetween VDR gene polymorphisms and cardiovascular function.