High Frequency Color Doppler Ultrasonography Research Articles

Early hemodynamics after tibial transverse transport in patients with nonarterial stenosis and arterial stenosis diabetic foot.

The diagnosis of peripheral arteriopathy in the diabetic foot is complicated by diabetes and its advanced complications. It has been found that diabetic foot can be categorized into arterial stenosis and non-arterial stenosis, both of which have significant differences in hemodynamic characteristics. To evaluate the early hemodynamic changes in diabetic foot patients with nonarterial stenosis and arterial stenosis treated by tibial transverse transport (TTT) using high-frequency color Doppler ultrasonography (HFCDU) and a laser Doppler flowmeter. Twenty-five patients with Wagner grades 3-5 diabetic foot ulcers were treated with TTT, and the wound healing time and rate were recorded. Patients were grouped according to the results of preoperative lower-extremity ultrasonography. Cases with ≥ 50% stenosis in any of the femoral, popliteal, posterior tibial, anterior tibial, and peroneal arteries of the affected limb were classified as the arterial stenosis group (n = 16); otherwise, they were classified as the nonarterial stenosis group (n = 9). Before and one month after surgery, HFCDU was used to evaluate the degree of lower limb artery lesions and hemodynamic changes in patients. The degree of femoral-popliteal atherosclerotic stenosis, the degree of vascular stenosis and occlusion of the lower-knee outflow tract, and the degree of medial arterial calcification were scored; the three scores were added together to obtain the total score of lower extremity arteriopathy. PeriScanPIM3, a laser Doppler flowmeter system, was used to detect alterations in plantar microcirculation before and 1 mo after surgery. Wound healing and hemodynamic indices were compared between the two groups. The wound healing time of the diabetic foot was significantly shorter in the nonarterial stenosis group than in the arterial stenosis group (47.8 ± 13 vs 85.8 ± 26, P < 0.05), and the wound healing rate of both groups was 100%. The preoperative total lower extremity arteriopathy scores were lower in the nonarterial stenosis group than those in the arterial stenosis group (18.89 ± 8.87 vs 24.63 ± 3.52, P < 0.05). The nonarterial stenosis group showed higher preoperative popliteal artery (POA) blood flow than the arterial stenosis group (204.89 ± 80.76 cc/min vs 76.75 ± 48.49 cc/min, P < 0.05). Compared with the baseline (before surgery), the postoperative POA blood flow of the affected limb in the nonarterial stenosis group decreased one month after surgery (134.11 ± 47.84 cc/min vs 204.89 ± 80.76 cc/min, P < 0.05), while that in the arterial stenosis group increased (98.44 ± 30.73 cc/min vs 61.69 ± 21.70 cc/min, P < 0.05). Although the POA blood flow in the arterial stenosis group was obviously improved one month after surgery, it was still lower than that in the nonarterial stenosis group (98.44 ± 30.73 cc/min vs 134.11 ± 47.84 cc/min, P < 0.05). The nonarterial stenosis group had higher preoperative plantar microcirculation than the arterial stenosis group (56.1 ± 9.2 vs 33.2 ± 7.5, P < 0.05); compared with the baseline, the plantar microcirculation in the arterial stenosis group was significantly improved one month after surgery (51.9 ± 7.2, P < 0.05), while that in the nonarterial stenosis group was reduced (35.9 ± 7.2, P < 0.05). Based on preoperative HFCDU findings, diabetic foot patients can be divided into two categories: Those with nonarterial stenosis and those with arterial stenosis, with obvious differences in hemodynamic changes in the early postoperative period between them. In the early stage after TTT, the blood flow volume and velocity and the plantar microcirculation perfusion of the affected limb of the diabetic foot with nonarterial stenosis decreased compared with the baseline, while those of the diabetic foot with arterial stenosis improved significantly compared with the baseline, although both had smoothly healed diabetic foot ulcers.

Value of High Frequency Color Doppler Ultrasonography Combined with Elastography in Differential Diagnosis of Breast Cancer and Benign Nodules

Value of High Frequency Color Doppler Ultrasonography Combined with Elastography in Differential Diagnosis of Breast Cancer and Benign Nodules

Application of high frequency color Doppler ultrasonography combined with microvascular stapler in maxillofacial defect repair

Objective:To evaluate the clinical application value of high frequency color Doppler ultrasound（HFCUS） combined with microvascular stapler in the repair of oral and maxillofacial defects with the anterolateral thigh perforator flap. Method:Forty maxillofacial malignant tumor patients were divided into HFCUS+stapler group（23 cases） and control group（17 cases）. All of cases used anterolateral thigh flap without fascia lata to repair the soft tissue defect in the operative area. One artery and two veins were anastomosed during the operation. The flaps were harvested from 6.0 cm×7.0 cm to 10.0 cm×12.0 cm, and the donor sites were closed and sutured at the same time. In group HFCUS+stapler, HFCUS was used to locate the perforating vessels and mark the location on the body surface the operation, and the vein was anastomosed intraoperatively with a stapler. In the control group, only iliac patella line was fixed before operation, and the vein was manually sutured during operation. The clinical data of 2 groups was evaluated by comparing the time consumption of flap harvest, the vascular anastomosis, the incidence of postoperative venous crisis, and the long-term survival rate of flap. Result:In the HFCUS+stapler group, a total of 27 perforators were found before the operation, 24 perforators within 1.0 cm from the preoperative marker were actually detected during the operation, and the remaining 3 perforators were about 1.7 cm, 2.0 cm and 2.5 cm from the marker respectively, with an accuracy rate of 88.9%. HFCUS+stapler group used （63.17±7.80） min to harvest the flap, while the control group used （85.47±7.41） min HFCUS+stapler group took significantly less time than the control group（P<0.001）. The arterial anastomat time in the HFCUS+stapler group was （9.48±1.20） min and it was （9.18±1.13） min in the control group. The difference between the two groups was not statistically significant（P=0.426）. The total anastomosis time of the two veins was （14.87±2.62） min in the HFCUS+stapler group and （33.06±3.86） min in the control group. The HFCUS+stapler group had significantly less anastomosing time than the control group（P<0.001）. In HFCUS+stapler group, no arteriovenous crisis occurred after operation, and all flaps survived well 15 days after operation. In the control group, 2 cases had venous crisis after operation（P=0.091）. Conclusion:HFCUS combined with iliac patellar line can improve the accuracy of anatomical perforated vessels, reduce the time of flap harvesting, and reduce the possibility of accidental injury of perforated vessels. The use of microvascular stapler for vein anastomosis can reduce the operation time and improve the survival rate of flap. The combination of the two can significantly reduce the operation time of microsurgical repairing maxillofacial soft tissue defect, improve the operation quality, and has higher clinical application value.

PSY36 THE CORRELATION STUDY BETWEEN HIGH-FREQUENCY ULTRASONOGRAPHY OF KNEE JOINT`S LESIONS IN RHEUMATOID AND VARIETY OF SERUM MARKERS INPATIENTS WITH EARLY AND NON-EARLY

The serum levels of CRP,ESR,RF,anti-CCP and the knee joint high-frequency color Doppler ultrasonography were detected in patients of ERA and NERA,respectively.The correlation between ultrasonographic (US) knee abnormalities in patients with rheumatoid arthritis (RA) and levels of CRP,ESR were investigated. 60 RA patients were divided into two groups, 24 cases in ERA group and 36 cases in NERA group were enrolled in this study. Demographical and Clinical data were recorded, including aging、sex、duration、positive signs of limited shoulder movement、DAS28、serum markers,such as RF、anti-CCP、CRP and ESR. 1. The level of CRP and ESR were significantly higher in NERA group than that in ERA group（P=0.002，0.001）Positive rate of RF was significantly higher in NERA group（0.028）,Positive rate of anti-CCP was not significantly different between NERA and ERA group;2. In the ERA patients, the proportion of suprapatellar bursa effusion was higher than the NERA group,while that of synovitis in NERA was higher than ERA group; 3. Synovitis and synovial blood flow score in NERA group were significantly correlated with DAS28,CRP and ESR.None of the ultrasonography in ERA group was significantly correlated with DAS 28,CRP and ESR. High-frequency color Doppler ultrasonography detected accurately the abnormalities of knee joint,it was valuable in the diagnosis of knee in RA patients.

Screening of parathyroid gland by high frequency ultrasound and the relationship between recurrent urinary calculi and primary hyperparathyroidism.

To understand the value of high frequency ultrasound in the clinical screening of parathyroid gland, and to summarize the intrinsic relationship between primary hyperparathyroidism and recurrent urinary calculi. 98 cases of urinary calculi were randomly selected, and the patients were admitted to our hospital from March 2014 to August 2017. A total of 100 healthy subjects were selected as group B in the same period. High frequency color Doppler ultrasonography scan recorded the results. Among the subjects in group A, 67 (68.37%) showed parathyroid gland, 14 cases (14.29%) had tumor mass in the parathyroid system, 40 cases more than those in group B (40.00%) and 2 cases (2.00%), (p <0.05). There were 10 cases (10.20%) of primary hyperparathyroidism in group A and no cases of primary hyperparathyroidism in group B (p < 0.05). The occurrence of primary hyperparathyroidism was 26.92% (7/26) in the number of cases, with 3 and more cases of urinary calculi, which was higher than that in the first recurrent cases (3/72), (p<0.005). One of the key causes of recurrent episodes of urinary calculi is primary hyperparathyroidism, which can be applied to high frequency ultrasonography to develop professional screening of parathyroid gland in cases of urinary calculi.

High-Frequency Color Doppler Ultrasound in Diagnosis, Treatment, and Rehabilitation of Achilles Tendon Injury.

BackgroundThis study evaluated the clinical application of high-frequency color Doppler ultrasonography (HFCDU) in the diagnosis, treatment, and rehabilitation of Achilles tendon injury.Material/MethodsA total of 68 patients with suspected Achilles tendon injury were examined by HFCDU. There were 42 Achilles tendon injury patients who underwent surgery, and they were randomly divided into a routine treatment group (n=21) and a rehabilitation group (n=21). HFCDU was performed at weeks 1, 3, 6, and 9, and months 3, 6, 9, 12, and 24 after the operation. The thickness of the injured Achilles tendon, echo, blood flow, and tissue adhesion were compared to those of the uninjured side.ResultsOf the 68 patients, 14 had normal ultrasound presentation with strong echo; 7 had laceration, presenting as swelling and decreased echo; 26 had partial tear, presenting as discontinued rupture with no or low echo; 19 had complete rupture, presenting as discontinued fibers with hypoechoic hemorrhage and hyperechoic fat tissue between ends; 1 had plantar tendon rupture and periapical hemorrhage; and 1 had acute Achilles tendonitis. The postoperative tendon thickness decreased over time, echo turned homogeneous, blood flow and adhesions decreased, and these results were consistent with clinical symptoms. Patient condition and ultrasound recovery were better in the rehabilitation group, and the diameter of the injured tendon increased compared with the uninjured side.ConclusionsHFCDU can determine the types and extent of tendon injuries, and can help in the diagnosis, treatment, and rehabilitation of Achilles tendon injury.

Diagnostic value of high-frequency color Doppler ultrasonography examination in combination with anti-cyclic citrullinated peptide antibody testing in rheumatoid arthritis patients.

We studied the diagnostic value of high-frequency color Doppler ultrasonography (HCDU) examination in combination with anti-cyclic citrullinated peptide (anti-CCP) antibody testing in rheumatoid arthritis (RA) patients with finger joint damage. From January 2015 to December 2015, 80 patients diagnosed with RA with finger joints damage were enrolled in this study. Patients were examined with HCDU. Serum anti-CCP antibody level was tested using ELISA, and results were compared with the healthy control group. Results obtained by ELISA demonstrated that the positive rate of anti-CCP antibodies was 73.8% in the study group, and 10% in the control group. The negative rate was 26.2% in the study group, and 90% in the control group. HCDU examination suggested that the predominantly affected joint by bone erosion of RA with finger joint damage was MCP3 (16.7%), followed by PIP3 (14.1%), MCP2 (13.5%) and PIP2 (12.8%). The slightest affected joint was thumb metacarpophalangeal joint, followed by thumb, little finger metacarpophalangeal joint and proximal interphalangeal joint. The sensitivity of diagnosis of RA with finger joints damage with both HCDU and CCP antibody examination showed a significantly lower level compared with examination with each one of the methods alone, while specificity showed a significantly higher level. Thus, a combination of HCDU examination and anti-CCP antibody testing can be considered useful to improve the early diagnostic rate of RA. HCDU examination is a sensitive, secure, atraumatic and easily-operated diagnostic method for early RA patients with finger joint damage. When combined with anti-CCP antibody testing, it will provide a better chance for RA patients, and give them hope for a better treatment and improved prognosis.

Significance of clearing differentiated thyroid carcinoma lymph node by high-frequency color Doppler ultrasonography.

We compared the clinical effects and prognosis of patients receiving lymph node dissection after surgical removal of the thyroid tissues and those not receiving it after the removal. A total of 80 patients diagnosed with differentiated thyroid carcinoma (DTC) by our hospital from March 2012 to March 2014 were successively included in the study. The cases were divided into the control group (n=36 cases) and observation group (n=44 cases), and the two groups underwent total or subtotal resection of the thyroid. In the control group, patients underwent preoperative high-frequency color ultrasonography, and the most suspicious lymph node was removed. In the observation group, patients underwent preoperative high-frequency color ultrasonography, and the surgeons cleared the lymph node of the widest range. Difference in clinical effects and prognosis of the two groups were compared. After nearly a year's follow-up observation, the tumor recurrence rate of the observation group was significantly lower than that of the control group and the survival rate of the observation group was significantly higher than that of the control group (P<0.05). The rate of surgery complications and comparative difference of the two patient groups had no statistical significance (P>0.05). When comparing the data of lymphatic metastasis tested by preoperative high-frequency color ultrasonography with intraoperative diagnosed figures, sensitivity was 97.4%, specificity 33.3%, positive predictive value 90.2% and the negative predictive value 66.7%. In conclusion, removal of the lymph node for DTC patients having undergone thyroid tissue excision with preoperative high-frequency color ultrasonography can be beneficial to improve the effects along with reduction in the recurrence rate.

Differential diagnosis of isolated calf muscle vein thrombosis and gastrocnemius hematoma by high-frequency ultrasound

Background Differential diagnosis of isolated calf muscle vein thrombosis (ICMVT) and gastrocnemius hematoma is essential for early identification of deep vein thrombosis (DVT). This study aimed to investigate the diagnostic value of high-frequency color Doppler ultrasound for differential diagnosis of ICMVT and gastrocnemius hematoma. Methods A retrospective case series of 35 ICMVT (M:F, 21:14; mean age (64.5±10.6) years) and 23 gastrocnemius hematoma (M:F, 16:7; mean age (75.4±11.8) years) patients with bilateral/unilateral lower limb pain was conducted between January 2006 and September 2012. Characteristics and the morphology of high-frequency color Doppler ultrasonography of the lower limb deep vein, great saphenous vein, calf muscles, skin, and soft tissue were examined. Results ICMVT hypoechoic signals were characterized by long, tube-like masses on longitudinal sections and oval masses on transverse sections, with apparent muscle thrombosis boundaries, distal and proximal venous connections, and, often, lower limb DVT. Gastrocnemius hematoma hypoechoic signals were characterized by large volumes, enhanced posterior hematoma echo, hyperechoic muscle boundaries, no hematoma blood flow, and no DVT, and clear differences in trauma/exercise- and oral anticoagulant-induced hematomas were readily apparent. According to the measurement, the ratio of long diameter/transverse diameter (D/T) in ICMVT patients was about less than 2.0, whereas in gastrocnemius hematoma patients the ratio was more than 2.0. Early stage isoechoic and hypoechoic signals were detected with gradually increasing ovular anechoic areas. Partial muscle fibers in the hematoma due to muscle fractures were apparent. Conclusion High-frequency color Doppler ultrasound was found to be a sensitive and reliable method for differential diagnosis of ICMVT and gastrocnemius hematoma due to trauma and exercise or prolonged oral anticoagulant use.

High frequency color Doppler ultrasonography for peripheral superficial hemangioma

Objective To explore the diagnostic value of high frequency color Doppler ultrasonography for peripheral superficial hemangioma.Methods The data on imaging features of ultrasonography and postoperative pathological findings were retrospectively analyzed in 56 patients with hemangioma confirmed by pathological examinations.The data were compared.Results Ultrasound findings revealed that of 56 patients with hemangioma,18 patients developed solid hemangioma,10 developed cystic cavernous hemangioma,and 28 developed mixed hemangioma.Pathological typing showed capillary hemangioma was in 15 patients,cavernous hemangioma in 29,and cirsoid hemangioma in 12.Conclusions High frequency color Doppler ultrasonogranphy has important value in the diagnosis of peripheral superficial hemangioma. Key words: High frequency color Doppler ultrasongraphy; Hemangioma; Diagnostic value

Value of high-frequency color doppler ultrasound in the diagnosis of early breast cancer

Objective To explore the value of high-frequency color Doppler ultrasound in the early diagnosis of breast cancer. Methods 46 cases of pathologically confirmed by surgery for breast cancer after preoperative high-frequency color Doppler ultrasound diagnosis were retrospectively analyzed. Results Among preoperative ultrasound diagnosis of breast cancer(41 cases) ,5 cases was fibroadenoma and ultrasound diagnosis and pathology diagnosis consistent rate was 89. 1%. Two-dimensional sonographic features of breast cancer were lumps form less rules,no capsule, the border less clear,and some was like or Crab-like glitches,and Aspect ratio was greater than 1,internal had the non-uniform weak echo,some showed the sand-like calcification,rear echo attenuation,Color Doppler flow characteristics :mass flow signals could be seen around and inside, Vmax value range was 6. 6 cm / s ～ 45. 1 cm / s, Vmean(21.50 ± 10.62) cm/s,RI:0.59 ～ 1.0,an average of(0.74 ±0.1). Conclusion High frequency color Doppler ultrasonography in early diagnosis of breast cancer had a high value. Key words: Breast neoplasms; Ultrasound,doppler,color; Diagnosis

Sonographic diagnosis of an ovary‐containing inguinal hernia with the formation of a corpus luteum in an adult female

Ovary-containing inguinal hernia is a rare condition in women of reproductive age. It is occasionally found in young females, with sonography used to make the diagnosis1, 2. We report a case in which high-frequency ultrasonography was used to diagnose an inguinal hernia containing the left ovary in an adult female. A 28-year-old woman, who was otherwise healthy, presented with a palpable painless mass in her left groin. The mass had been present for 20 years but had recently dramatically increased in size. On physical examination a 5 × 3-cm non-reducible mass was noted in her left groin. Sonographic examination using a linear probe (7.5 MHz) showed a heterogeneous mass with multiple small sonolucent cysts (Figure 1), indicating that it was one of the ovaries. In addition, a hyperechoic portion of the mass surrounded by an arterial flow with a low resistance index of 0.45 (Figure 2) was observed on color Doppler ultrasonography, consistent with the presence of a corpus luteum. Further transabdominal sonographic scans (transvesical view) of the pelvis revealed the absence of the left ovary in the left lower pelvis, with a normal uterus and right ovary in their normal anatomic locations. It was concluded that the left ovary was located in the left inguinal canal, a diagnosis that was confirmed by surgical exploration. Gray-scale ultrasound image showing a heterogeneous mass—the left ovary—in the left inguinal region. The hyperechoic structure (arrows) is a corpus luteum. (a) Color Doppler ultrasound image demonstrating blood flow inside the ovary located in the inguinal hernia. (b) Pulsed wave Doppler ultrasound image showing a flow velocity waveform from the corpus luteum, with a low resistance index of 0.45. The presence of an inguinal hernia containing genital organs in females is usually due to an incomplete closure of the processus vaginalis of the peritoneum during embryogenesis2, when the processus vaginalis along with the round ligament of the uterus pass through the inguinal canal towards the labia majora. The contents of this type of hernia can include unilateral or bilateral ovaries, Fallopian tubes and even the uterus3, 4. There is evidence that the presence of this condition in female infants or teenagers might warrant subsequent surgical management. However, it is seldom reported in adult females. The morphological characteristics of the ovary in the hernia sac in our case, as assessed on sonographic examination, are exceptional because of the formation of a corpus luteum after ovulation according to the menstrual cycle of the patient, which provided ovarian functional information that could not be obtained in the young females described in previous reports. Clinically, different types of masses in the inguinal area have various characteristics5, 6. Therefore, the differential diagnosis of masses in the inguinal region is broad. Physical examination alone will not always provide a definitive diagnosis, and sonography can add valuable information to clinical diagnosis7, 8. In adult females cystic masses in the groin area are sometimes misdiagnosed owing to similarities in the morphological characteristics of the cystic portions of lesions. Mesothelial cyst of the round ligament, endometriosis and ovary-containing hernia are rare conditions in the inguinal area, and should be included in the differential diagnosis. Using color Doppler imaging in our case we detected vascular characteristics indicating herniation of the ovary, which can be differentiated from a round ligament cyst that shows minimal vascularity in the cyst wall or septa9. In addition, a history of groin pain during menstruation10 might be helpful in identifying inguinal endometriosis rather than herniated ovary or round ligament cyst. In summary, although ovary-containing inguinal hernia is seldom encountered by sonographers in adult females, in this case high-frequency color Doppler ultrasonography coupled with clinical information allowed a definitive diagnosis of this unusual condition. L. Yao*, Y. Mou*, H.-X. Wang*, * Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79, Qingchun Road, Hangzhou 310003, People's Republic of China

High-Frequency Color Doppler Ultrasonography of the Spermatic Cord Arteries

The purpose of this study was to determine the normal range of Doppler ultrasonographic measurements of spermatic cord arteries in a cohort of healthy men. The spermatic cord arteries of 51 men were interrogated with color Doppler ultrasonography. The resistive index (RI) of each artery was measured for the entire cohort; peak systolic and end-diastolic velocity values were obtained in a smaller subgroup (n = 31). The artery with the lowest RI was labeled A; the other 2 arteries were identified as B and C. Three separate arteries were identified within the spermatic cord in all individuals. The median RI values for arteries A, B, and C were 0.70 (range, 0.48-0.82), 0.84 (0.67-0.90), and 0.84 (0.72-0.92), respectively. One-way analysis of variance showed a significant difference between the mean RIs of arteries A and B (P < .0001) and arteries A and artery C (P < .0001) but not between B and C (P = .49). Peak systolic and end-diastolic velocity values differed significantly between arteries A and B (P < .0001) and arteries A and C (P < .0001) but not between B and C (P = .31). No age effect was shown for the RI measurements of the cohort. Color Doppler ultrasonography enables the objective quantification of Doppler measurements of arteries within the spermatic cord. Knowledge of the normal range of Doppler measurements for spermatic cord arteries that supply the testes may be a useful adjunct to the assessment of the testes.