Duplex Sonographic Examination Research Articles

Ultrasound assessment of brain supplying arteries (transcranial).

Ultrasonography of intracranial arteries is a non-invasive and highly efficient method for the diagnosis and follow-up of patients with cerebrovascular diseases, also in the bedside setting of the critically ill. For reliable assessment and interpretation of sonographic findings, the technique requires - apart from dedicated anatomic and pathophysiological knowledge of cerebral arteries and their hemodynamics - the comprehension of alternative imaging modalities such as CT or MR angiography. This article reviews the transcranial color-coded duplex sonographic (TCCS) examination technique including the transcranial Doppler sonography (TCD) for a standardized ultrasound assessment of the intracranial arteries and typical pathological cases. As a complementary tool, transorbital ultrasound for the assessment of the optic nerve sheath diameter and adjacent structures is also described in this article.

Dissektion einer Shuntprothese – Eine Blickdiagnose im Duplex

The diagnostic procedure and treatment strategy for The following case report describes the diagnostic procedure and the treatment strategy based on it for an acute loop shunt closure on the thigh, based on astemming from dissection of the an early shunt puncturable prosthesis, in a complex case is described in a complex case. with a loop shunt on the thigh made of prosthesis material that can be punctured. This rare cause of occlusion could bewas preoperatively identified preoperatively by a precise duplex sonographic examination. Based on this result, an optimal therapeutic approach could bewas planned and implemented. Due to a lack of suitable vein materialIn a 38-year-old dialysis patient, an arteriovenous prosthetic loop shunt (GORE® ACUSEAL Vascular Graft, 6 mm, W. L. Gore & Associates Inc., Flagstaff, Arizona, USA) was implanted on in the right thigh of a 38-year-old dialysis patient with a prosthesis (GORE® ACUSEAL Vascular Graft, 6 mm, W. L. Gore & Associates Inc., Flagstaff, Arizona, USA) due to a lack of suitable veins. Because of a shunt closure due to material fatigue, the prostheses prosthesis had to berequired partially replacedreplacement after only 20 months. Six weeks postoperatively The the patient presented again 6 weeks postoperatively with a new shunt closure. Using duplex sonography A a 4 cm long longitudinal dissection of the prosthesis was detected in the arterial part section of the new portion of the prosthesis portion using duplex sonography. This was confirmed intraoperatively. The remaining parts of the prosthesis were normal and intact. Dialysis had to be performed preoperatively, so that the patient received a left inguinal Shaldon catheter the day before the operationrevision of the loop shunt. At revisionFor this reason, dissection was confirmed. This part of and an early puncturable prosthesis the was resected and replaced not inserted as replacement. Instead theimplantation of early puncturable prostheses was dispensed with intraoperatively. A new prosthesis segment was inserted replaced (with a not early puncturable prosthesis (BARD VENAFLO® ll Vascular Graft, Straight, 6 mm, Bard Peripheral Vascular Inc., Tempe, USA)). The postoperative course was straightforward and discharge the patient was discharged on timetimely. This was confirmed intraoperatively. Dissection of an early-puncturable cannulation trilayered Shunt shunt prosthesesprosthesis , which allow early cannulation, is a rare complication and has not of such trilayered prostheses. such a problem has notpreviously been described in the literature. In the case ofShould occlusion occur in an early-cannulablecannulation trilayered shunt prosthesis occlusion and the presence of early cannulable trilayered prostheses a,dissection must be excluded. For this Reason, dDuplex sonography is the an appropriateexaminationdiagnostic procedure.

Incidence and Prevention of Deep Vein Thrombosis in Patients with Popliteal Vein Aneurysm

Introduction: Venous popliteal aneurysms are associated with high risk for deep vein thrombosis (DVT) and pulmonary embolism (PE). The goal of this study was to report the incidence and prevention options of DVT in patients with popliteal vein aneurysm. Methods: All patients between 06/1993 and 03/2019 with diagnosed popliteal venous aneurysm were enrolled in this study and analyzed retrospectively. Data were collected prospectively in an institutional database (M1, CompuGroup Medical) throughout the observation period by trained staff. The patients related variables were documented in a standardized manner. They received regular surveillance alone or treatment. Patients were offered aneurysm resection or lifelong anticoagulation if they had aneurysm size twice of normal vein diameter. Compression stockings were recommended in all cases. Clinical exam and duplex ultrasound were performed 3-6 months after operation or primary diagnosis and annually thereafter. In case of incompliance of wearing compression stockings, patients received instructions of the importance of compression and help for dressing them. Results: In a total of 58 patients 60 popliteal vein aneurysms (aneurysm size mean 20.3 mm) were diagnosed. Two patients had popliteal vein aneurysm on both legs (mean 1.5 mm). 33 patients had aneurysm size >20 mm in diameter. They had a significantly higher incidence of turbulent flow in duplex sonographic examination with higher risk for development of DVT (7/33; p=.006). Out of them, 30/33 (91%) preferred aneurysm resection, while 3/33 (9%) patients were treated with lifelong anticoagulation and compression. Patients with aneurysm size < 20 mm were treated with compression stockings alone. No DVT occured after treatment or in patients with small popliteal vein aneurysm size. Mean follow up was 39.5±8.7 months. Conclusion: Patients with large popliteal venous aneurysms experience DVT more frequently. Therefore, popliteal vein aneurysms >20 mm should be considered for surgical treatment or lifelong anticoagulation, depending on patient's preference. In patients with small aneurysm size regular control and compression stockings in risk situations are adequate. Disclosure: Nothing to disclose

Vascular Age as a Predictor of Side Effects After Facial Lipofilling.

Vascular age (VA) represents chronological age adjusted for an individual's atherosclerotic burden. Keeping in mind the fact that facial vascularization could influence the success of esthetic interventions, we aimed to investigate the predictive value of VA in development of side effects following facial lipofilling. In the period from October 1, 2014, to October 1, 2015, 106 consecutive subjects who underwent a facial lipofilling were included in the study. The VA was calculated using two approaches: Systematic Coronary Risk Evaluation (SCORE) project equations and means of vascular parameters assessed by color duplex sonographic examinations. The data regarding facial lipofilling-related complications (pain, edema and/or hematoma) have been collected during the regular checkups over 2weeks after intervention. The average chronological age of the participants was 50.9±9.4years. Estimation of VA using vascular sonographic parameters revealed the value of 45.4±29.1years, whereas the assessment of VA using SCORE equations showed that the mean age was 53.7±12.7 (p=0.006). The total frequency of these complications was as follows: 6.6% for hematoma, 15.1% for edema (13.2% mild edema and 1.9% severe edema) and 20.8% for local facial pain (17.0% mild pain and 3.8% severe pain). The multivariate logistic regression models showed that VA had statistically significant (p<0.01) independent prognostic value for facial lipofilling-related appearance of hematoma and pain. The results of our study revealed that advanced VA has an independent predictive role in the appearance of complications following facial plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Carotid replacement with Dacron graft in 292 patients.

In case of highly atherosclerotic carotid process, carotid graft replacement might be a potential solution for successful procedure. Many studies evaluated the results of vein and polytetrafluorethilen (PTFE) graft usage at the carotid bifurcation, while the experience on the Dacron graft due to extensive atherosclerotic process is missing. The aim of our study was to evaluate 30-day and long-term results of the Dacron graft on carotid artery used in patients with extensive atherosclerotic disease. This retrospective study analysed early and long-term neurological outcome as well as Dacron graft patency in patients operated with carotid reconstruction. Early results were confirmed by follow-up clinical examination, whereas late results were assessed by follow-up clinical examination as well as duplex sonographic examination at least 1 year after the surgery. As for statistical methods we used descriptive analysis tests, Chi-square test, and logistic regression. Carotid graft replacement was performed in 292 patients, before endarterectomy in 155 (53.09%), or after already attempted unsuccessful eversion endarterectomy in 137 (46.91%). Nineteen (6.5%) patients had a stroke due to ipsilateral and contralateral ischaemia or haemorrhagic in 17 (5.8%), 1 (0.3%) and 1 (0.3%) patients, respectively. Significantly higher rate of strokes occurred when the graft reconstruction was used after the failure of endarterectomy (8.5% vs. 3.5%, p = 0.029). Stroke and death rate was 7.19%. Factors that increased risk of early stroke were the length of plaque in the internal carotid artery measured intraoperatively (p = 0.025) and the surgical tactic to perform graft reconstruction after attempted extensive endarterectomy (p = 0.029). Low number of patients with carotid stenosis has extensive atherosclerotic process longer than 4 cm that might jeopardise eversion endarterectomy. Carotid graft replacement with Dacron graft provide early results that are comparable with other conduits; however, in such patients reconstruction should be selected individually based on surgical experience and anatomical distribution of stenotic disease. Due to high risk of stroke, only symptomatic patients with such extensive atherosclerotic disease should be operated.

Extracranial Carotid Artery Disease: Risk Factors and Outcomes in Patients With Acute Critical Hemispheric Ischemic Stroke.

The prevalence of carotid disease in stroke patients has been underestimated because most stroke patients who receive carotid sonography have already survived the acute event. Little is known about the extracranial carotid arteries of patients with acute stroke who need intensive care. This study reviewed color-coded carotid duplex sonographic examinations of the extracranial carotid arteries of patients with acute critical hemispheric ischemic stroke. We retrospectively reviewed 30 consecutive patients who had acute critical hemispheric ischemic stroke and received color-coded carotid duplex sonography in the intensive care unit. The presence of occlusive carotid artery disease was correlated with clinical features, vascular risk factors, and outcomes. Overall, 57% of the patients (17 of 30) had an occlusive internal carotid artery, and 44% of patients with atrial fibrillation (7 of 16) also had occlusive carotid disease. Eventually, 73% of the patients (21 of 30) had poor outcomes, and 57% (17 of 30) died. The contributing factors to a poor outcome were older age, an initial conscious disturbance, endotracheal intubation, and occlusive carotid disease, with the most significant factor being older age (P = .022; odds ratio, 27.76). The factors contributing to death were endotracheal intubation, occlusive carotid disease, and reversed ophthalmic flow, with the most significant factor being occlusive carotid disease (P = .014; odds ratio, 11.38). Soft homogeneously echogenic thrombi filling the lumen of the internal carotid artery and moving forward and backward with the carotid pulse were found in 3 patients. A small segment of ruptured plaque that was floating forward and backward with pulsation was found in 1 patient. Occlusive carotid artery disease is not uncommon among Chinese patients who have had an acute critical hemispheric infarction. Older age is the factor most significantly correlated with a poor outcome, and occlusive carotid disease is the factor most significantly correlated with death.

Jatrogene povrede perifernih arterija tokom interventnih kardioloških procedura

The aim of this review article is to highlight the clinical presentation, diagnostic and therapeutic modalities for the treatment of postcatheteric cardiac complications, with reference to the experience of the Clinic for Vascular and Endovascular Surgery, Clinical center of Serbia in their treatment. The number of poscatetheric complications that can present in the form of hematoma, pseduoaneurysms, arteriovenous fistula, ischemia or infection is constantly increasing. Diagnosis is usually made on the basis of clinical and physical examination and confirmed or complemented by additional duplex sonographic examination. Treatment can be surgical and non-surgical. Despite the fact that minor artery laceration is the most frequent postcatheteric cardiac complication, its treatment still requires prolonged hospitalization. In addition, accompanying comorbidity in these patients contributes to their high mortality rate. Therefore, one should always keep in mind the possibility of their occurrence in order to reduce their number and perform the appropriate treatment.

Traumatic pseudoaneurysm of superficial temporal artery: A case report

We report a case of a 36-year-old male who presented with a pulsatile mass at the left temporal region after a head injury. Duplex sonographic examination confirmed the diagnosis of traumatic pseudoaneurysm of the superficial temporal artery. Imaging showed the pseudoaneurysm was partially thrombosed.

Doppler ultrasound determination of average blood flow velocity and flow volume in transjugular intrahepatic portosystemic shunt (TIPS)

To determine if duplex sonographic measured Time Average Motion (TAM) is an effective parameter for screening examination in routine follow-up after TIPS implantation. 35 patients underwent duplex sonographic examination by a 3.5 MHz transducer with a follow-up for 12.4 months. A reduction of TAM about 60% from baseline proved with a sensitivity of 90% and a specificity of 93.7% the presence of a hemodynamic relevant stenosis, which was confirmed with angiography. We failed to establish a threshold which pointed out with acceptable accuracy the presence of shunt dysfunction. TAM is a good parameter in colour-duplex sonography which permits an objective view of TIPS-function. Angiography should be performed only in patients with suspect duplex-results or clinical worsening. A secondary sign of shunt dysfunction is increasing ascites.

Value of Doppler and duplex sonography studies of the extracranial carotid system performed by technical assistants

The results of Doppler sonographic and Duplex sonographic examinations of the extracranial carotid artery carried out in 100 patients by two sonographers were compared with angiographic findings. The accuracy and quality of the ultrasonic examinations did not differ from those of documented examinations performed by physicians. The percentage of error due to mistakes on the part of sonographer vas 1.3%. We conclude that sonographers are qualified for performing carotid Doppler and duplex sonography, provided that they are well-trained, experienced and supervised.

Celiac Artery Compression Syndrome in Children, Adolescents, and Young Adults

Abdominal pain is one of the most common conditions in childhood and adolescence. Celiac artery compression syndrome (CACS) is rarely suspected in this population. We present clinical and sonographic features from a series of 59 patients with this disorder. A total of 3449 patients from 0 to 18 years were investigated with 7639 abdominal color duplex sonographic examinations. Celiac artery flow velocity was measured at the branching off from the aorta in inspiration, expiration, and in between. Diagnosis of CACS was made if a greater than 2-fold acceleration of peak systolic flow in the celiac artery compared to the abdominal aorta or a peak systolic velocity greater than 200 cm/s was measured in the mid position and if a variation of flow velocity occurred during respiration. In 22 cases, angiography (21 magnetic resonance angiography and 1 digital subtraction angiography) was used to prove sonographic diagnosis. Fifty-nine patients (among them 81% female) from 22 months to 19 years (clustering between 14 and 17 years) fulfilling color Doppler sonographic criteria of CACS were found, for a prevalence of 1.7%. Their symptoms included, among others, abdominal pain (71%), nausea (29%), thoracic pain (22%), heartburn (17%), weight loss (15%), vomiting (15%), systolic murmur (15%), postprandial accentuation of symptoms (15%), diarrhea (14%), respiratory discomfort (14%), and syncope (12%). Celiac artery compression syndrome is more prevalent than expected, and conditions not usually connected to the disease were found. Alertness to CACS is recommended, especially in patients with a combination of characteristic symptoms. Color Doppler sonography is the modality of choice for diagnosing CACS.

Femoral pseudoaneurysms: management with percutaneous thrombin injections--success rates and effects on systemic coagulation.

To determine the success rate of percutaneous ultrasonographically (US) guided thrombin injection in the treatment of femoral pseudoaneurysms and to evaluate the effects of thrombin injection on systemic coagulation parameters. Fifty femoral pseudoaneurysms (37 simple pseudoaneurysms with one lobe and 13 complex pseudoaneurysms with two or three lobes) were treated with US-guided percutaneous thrombin injections. Pseudoaneurysm size, neck length and width, thrombin dose, outcome of therapy, and complications were documented prospectively. Duplex sonographic follow-up examinations were performed at 12-24 hours and 5-7 and 21-25 days. In 25 patients, activated thromboplastin time, Quick test (prothrombin time), thrombin time, fibrinogen, D-dimer, antithrombin III, thrombin-antithrombin III complex, and prothrombin fragments 1 and 2 were determined before and at 2, 5, and 10 minutes after thrombin injection. Differences in results before and those after thrombin injection were evaluated by means of the one-sample t test. Mean volume of pseudoaneurysms was 5.84 cm(3) +/- 4.89 (SD). Fifty-eight thrombin injections were performed. Mean thrombin dose was 357 IU +/- 291 in simple and 638 IU +/- 549 in complex pseudoaneurysms. Primary success rate was 36 of 37 (97%) for simple and eight of 13 (61%) for complex pseudoaneurysms. Reperfusion occurred in four complex pseudoaneurysms (none in simple ones). Secondary success rate was 100%. No thromboembolic, infectious, or allergic complications occurred. During follow-up, reperfusion was detected in one patient with a complex pseudoaneurysm. Levels of thrombin-antithrombin III complex increased significantly (P <.05) after thrombin injection, whereas changes in all other laboratory tests were not significant. US-guided percutaneous injection of thrombin is successful and safe in the management of femoral pseudoaneurysms. The increase of thrombin-antithrombin III complex indicates the possibility of thrombin passage into the arterial circulation.

Hepatic Venous Pressure Gradients Measured by Duplex Ultrasound

AIMS: The hepatic venous pressure gradient is a major prognostic factor in portal hypertension but its measurement is complex and requires invasive angiography. This study investigated the relationship between the hepatic venous pressure gradient and a number of Doppler measurements, including the arterial acceleration index. METHOD: We measured the hepatic venous pressure gradient in 50 fasting patients at hepatic venography. Immediately afterwards, a duplex sonographic examination of the liver was performed at which multiple measurements and indices of the venous and arterial hepatic vasculature were made. RESULTS: Hepatic arterial acceleration was correlated directly with the hepatic venous pressure gradient (r=0.83, P<0.0001) and with the Child–Pugh score (r=0.63, P<0.0001). An acceleration index cut-off value of 1m.s−2 provided a positive predictive value of 95%, a sensitivity of 65% and a specificity of 95% for detecting patients with severe portal hypertension (hepatic venous pressure gradient>12mmHg). A correlation between the hepatic venous pressure gradient and the congestion index of the portal vein velocity (r=0.45,P=0.01) and portal vein velocity (r=0.40,P=0.044), was also noted. CONCLUSION: Measuring the hepatic arterial acceleration index may help in the non-invasive evaluation of portal hypertension. Tasu, J-P. etal. (2002). Clinical Radiology57, 746–752.

Role of penile vascular insufficiency in erectile dysfunction in renal transplant recipients.

The objectives of this study were to define the role and haemodynamic features of penile vascular insufficiency in impotent renal transplant recipients (RTR) as well as to establish the possible vascular risk factors for impotence in these patients. A total of 54 RTR (35 impotent and 19 potent) and 21 potent healthy subjects were included in this study. All patients were assessed clinically and by measurement of serum creatinine, serum bilirubin, cyclosporine blood levels, haemoglobin and total serum cholesterol. All subjects were subjected to intracavernous injection of 20 microg prostaglandin E1 followed by colour Duplex sonographic examination. Our results showed that impotent RTR were significantly more likely than potent RTR to have hypertension, diabetes and hypercholesterolaemia (P<0.05). Arterial occlusive disease was identified in 42.9% of impotent RTR. Findings suggestive of veno-occlusive dysfunction were found in 68.6% and 26.3% of impotent and potent RTR, respectively (P=0.003). Unilateral ligation of the internal iliac artery has a negative role on haemodynamic parameters compared to unilateral end-to-side anastomosis to external iliac artery in impotent RTR (P<0.05). Impotent RTR receiving more than one antihypertensive drug showed significant decrease in basal peak systolic velocity (PSV), dynamic PSV, erectile angle and cavernosal artery diameter compared to those receiving one drug (P<0.05). In conclusion, penile vascular insufficiency appears to play a substantial role in the pathogenesis of impotence in transplant patients. Anastomosis of the graft to external iliac artery could preserve the potency to some degree. Antihypertensives should be reduced as much as possible to avoid their negative effects on erectile function.

Color flow Doppler versus power Doppler imaging in the examination of vertebral arteries

Objective: Power Doppler imaging (PDI) is a newly introduced ultrasound method which visualizes the integrated power of the Doppler signal instead of its frequency shift. We compared this technique with the conventional color flow Doppler (CFD) in the examination of extracranial vertebral arteries. Methods: In the present study, 195 patients with normal findings of the vertebral arteries and 35 with vertebral hypoplasia, stenosis or occlusion, who were referred because of suspected disorders of cerebral circulation, were examined. Using an electronic 7.5 MHz linear probe, the vertebral arteries were examined with conventional CFD and PDI at the V 2-segment and at the origin from the subclavian artery (V 0-segment). Results: In 286 vertebral arteries of 195 normal persons, the visualized diameter of the blood-flow signal was 3.32 ± 0.54 mm (mean ± S.D.) using CFD vs. 3.63 ± 0.55 mm using PDI (correlation 0.78; P < 0.001) on the left side and 3.23 ± 0.56 mm using CFD vs. 3.51 ± 0.64 mm using PDI (correlation 0.78; P < 0.001) on the right side. PDI revealed 9.5% larger diameter on both sides when compared to conventional CFD. In distally stenosed or occluded vertebral arteries where a signal could be obtained using both methods, the difference between diameters was similar to that of normal vertebral arteries, with 2.40 ± 0.52 mm (CFD) vs. 2.63 ± 0.71 mm (PDI; correlation 0.81; P < 0.01). In vertebral hypoplasia, CFD revealed a signal of 1.50 ± 0.52 mm vs. 1.73 ± 0.71 mm with PDI; (correlation 0.79, P < 0.01). In the proximally stenosed vessels, PDI visualized morphological details more clearly by overcoming artifacts such as aliasing and echoshadowing. In one case of distal occlusion, CFD failed to show a blood flow signal, whereas PDI demonstrated continuous perfusion. Conclusions: PDI is a useful additional color-coding technique in duplex sonographic examination, particularly of hypoplastic and stenosed vertebral arteries.

Gallbladder varices: diagnosis in children with portal hypertension on duplex sonography.

We established the prevalence of gallbladder varices (GBVs) as seen on duplex sonogram of children with portal hypertension. Fifty-five consecutive children with portal hypertension underwent duplex sonographic examination by an experienced sonologist who was blinded to clinical presentation. Forty children had extrahepatic portovenous obstruction (EHPVO), 12 had cirrhosis, and three had noncirrhotic portal hypertension. GBVs were seen on sonography in 10 of 40 children with EHPVO (25%), two of 12 children with cirrhosis (16.6%), and no children with noncirrhotic portal hypertension. Sonographic findings of GBVs were confirmed on duplex sonographic imaging. Among patients with EHPVO, GBVs did not correlate with size of esophageal varices, number of sessions of sclerotherapy, presence or absence of gastric varices, portal gastropathy, or splenorenal shunt placement. In cirrhotic patients, GBVs did not correlate with Child Pugh grade. Children with EHPVO have a higher incidence of developing GBVs. The clinical significance of GBVs is their propensity to bleed during biliary surgery; thus, the operating surgeon should be made aware of them.

The value of duplex sonography after peripheral artery angioplasty in predicting subacute restenosis.

The purpose of this study was to determine if abnormal findings on duplex sonographic examination after peripheral artery angioplasty correlate with the subsequent recurrence of a stenosis. We used duplex sonography to examine 35 stenoses in 23 patients within 48 hr after the patients had angioplasty to treat these stenoses. Patients were followed up for 3 years by using one or more of the following: assessment of signs and symptoms, monitoring of peripheral pulses, pulse volume recordings, and angiography. Life tables were constructed to compare long-term patency with the presence of abnormal findings seen on duplex sonograms. Abnormal findings at the dilated segment included a blood-flow velocity greater than 120 cm/sec or a residual elevated velocity ratio greater than 1.4 or 2.0 immediately after angioplasty. Twelve (34%) of 35 angioplasty sites showed recurrent stenosis before 36 months. Patency at 24 months was calculated for velocities less than 120 cm/sec vs velocities of 120 cm/sec or greater (41% vs 68%), for velocity ratios less than 1.4 vs ratios of 1.4 or greater (63% vs 57%), and for velocity ratios less than 2.0 vs ratios of 2.0 or greater (54% vs 74%). We found no significant difference in patency between those patients with normal findings and those with abnormal findings on duplex sonographic examination after angioplasty. Abnormal findings on duplex sonograms obtained immediately after peripheral angioplasty cannot be used to predict subacute restenosis.

Transcranial color duplex sonography in childhood and adolescence. Age dependence of flow velocities and waveform parameters.

Transcranial color duplex sonographic examinations in children and adolescents without cerebrovascular disease were evaluated retrospectively. Flow velocities and waveform parameters were determined and their side-to-side differences and age dependence analyzed and, finally, compared with analogous data of a previously described group of healthy adults. With a 2.0-MHz sector transducer of a computed sonographic system, the anterior, middle, and posterior cerebral arteries were examined in 64 children and adolescents between 1.5 and 17.5 years of age. Angle-corrected systolic peak, end-diastolic maximum, time-averaged, and time-averaged maximum velocities, and the resistance, pulsatility, and spectral broadening indexes were determined in all vessels. Mean +/- SD values for time-averaged maximum velocity (and time-averaged velocity) were 92.2 +/- 13.0, 79.9 +/- 17.7, and 63.9 +/- 13.6 (55.3 +/- 11.7, 40.4 +/- 10.4, and 34.2 +/- 9.2) cm/s, respectively, in the middle, anterior, and posterior cerebral arteries in children under 10 years of age; values were 83.2 +/- 11.9, 69.4 +/- 13.8, and 55.6 +/- 10.1 (50.8 +/- 9.0, 39.9 +/- 10.5, and 33.1 +/- 6.3) cm/s, respectively, in children 10 years of age and older. Time-averaged maximum velocity decreased significantly with age in all vessels (P < .001). Although time-averaged velocity did not change significantly during childhood and adolescence, a clear decline occurred from adolescence to adulthood (P < .0001 in the middle and posterior cerebral arteries; P < .01 in the anterior cerebral artery). The spectral broadening index decreased significantly from childhood to adolescence in the anterior and posterior cerebral arteries (P < .0001). The resistance and pulsatility indexes remained stable throughout childhood. Transcranial color duplex sonography allows angle-corrected measurements of "true" flow velocities in basal cerebral arteries. Additional determination of time-averaged velocity permits more detailed evaluation of flow characteristics for all age groups. The transcranial color duplex technique may provide deeper insights on normal cerebral perfusion and its disorders.

Duplex ultrasonography of superior mesenteric artery: interobserver variability.

The aim of this study was to evaluate the interobserver variability during duplex ultrasonographic investigation of the SMA. Eleven healthy volunteers were examined twice under the same conditions by two independent observers. Three basic Doppler wave parameters were assessed for the SMA: pV, edV, and rT. The tD was recorded for SMA and abdominal aorta (AotD) with B-mode imaging. The interobserver variability was very low for all parameters: pV = 13.5 cm/s; edV = 3.4 cm/s; rT = 0.01 s; tD = 0.3 mm; AotD = 0.5 mm, with corresponding 95% confidence intervals as follows: pV = 19 cm/s; edV = 4.7 cm/s; rT = 0.015 s; tD = 0.4 mm; and AotD = 0.75 mm. Coefficients of variation also showed very low dispersion for results obtained. Under the appropriate standard conditions for duplex sonographic examination of the mesenteric artery, assessments of basic Doppler wave parameters do not differ significantly between independent investigators. Reliable evaluation of B-mode distances can be obtained by replication of measurements.

Color-Coded Duplex Sonography for Diagnosis of Testicular Torsion

By color-coded duplex sonography moving structures are visualized as red or blue colors within a normal gray-scale B-mode ultrasound image. Thus, blood flow even within small vessels can be visualized clearly. Color-coded duplex sonographic examination was performed in 11 patients who presented with scrotal pain. This method proved to be reliable to differentiate between testicular torsion and testicular inflammation. By clearly demonstrating a lack of intratesticular blood flow in testicular torsion, while avoiding flow in scrotal skin vessels being misinterpreted as intratesticular blood flow, this method significantly decreases the number of patients in whom surgical evaluation is necessary to exclude testicular torsion.