Lower Pulsatility Index Research Articles

Doppler, ultrasonographic and endocrinological environment with regard to the number of small subcapsular follicles in polycystic ovary syndrome

The aim of this study was to evaluate how, in patients with polycystic ovary syndrome, the number of small subcapsular follicles correlates with uterine and ovarian blood flow and with specific hormonal parameters.At an ultrasonographic evaluation, 30 patients with polycystic ovary syndrome showed 5-10 (group I; n = 14) or > 10 (group II; n = 16) small follicles. These patients underwent ultrasonographic (ovarian volume and stroma echodensity; number, diameter and distribution of follicles) and color Doppler (uterine and intraovarian vessels) analyses, and hormonal assay.In group II, significantly lower pulsatility index values than in group I were observed in the ovarian stromal arteries. The Ferriman-Gallwey score, plasma androstene-dione level and luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio results were significantly higher in group II than in group I. Androstenedione plasma levels correlated with the number of small follicles. Furthermore, the LH/FSH ratio correlated with both the number of small follicles and the stromal artery pulsatility index.The combined assessment of ovarian morphology by transvaginal ultrasound and color Doppler may provide insight into the pathological state of polycystic ovary syndrome.

Uterine Evaluation in Turner Syndrome: A Preliminary Study With Doppler Ultrasound

Background Since the advent of in vitro fertilization and donor ovum technology, patients with Turner syndrome, previously infertile due to ovarian failure, now have an opportunity to conceive and carry a pregnancy. This new opportunity has refocused attention on nonnal uterine growth and development in Turner syndrome. Prior studies of the uterus in Turner syndrome have utilized ultrasound measurement of the uterus to describe uterine characteristics and, in the absence of estrogen replacement therapy (ERT) or endogenous estrogen production, have found the uterine size to be almost unifonnly prepubertal irrespective of the age of the patient. No studies to date have assessed uterine blood flow by Doppler velocimetry in patients with Turner syndrome. Uterine blood flow is regulated by many factors but primarily by gonadal sex steroid hormones. In postmenopausal women on ERT a reduction in resistance to blood flow is seen. suggesting an increase in uterine perfusion with ERT. Whether this relationship is true in the patient with Turner syndrome is unknown. Methods We studied eleven patients with Turner syndrome by transabdominal pelvic ultrasound and evaluated, by Doppler velocimetty, the uterine artery pulsatility index (PI), calculated by (systolic – diastolic)/mean. Patients ranged in age from 5–17 (median 14). Pubertal development was assessed by Tanner staging, and height, weight and karyotype was recorded for all patients. Patients were placed on estrogen replacement therapy to initiate puberty, including type and dose of ERT, at the discretion of their physician. The ultrasonographer was blinded to the presence or absence of ERT. At the time of the first ultrasound, 6 patients were taking ERT, 2 on estrogen alone, 3 on cyclic estrogen/progestin (although all studies were performed on estrogen only day) and one was on an oral contraceptive. Mean duration of estrogen exposure was 23 months. One patient had spontaneous pubertal development and 4 patients had received no estrogen treatment and were Tanner I in development. At the time of ultrasound, uterine volume, cervix/fundus ratio and the presence of visible ovaries were also recorded. Results The mean uterine artery PI of patients with estrogen exposure was 2.21(± 1.23) and the mean of the unexposed group was 3.99(± 1.04). This suggests a trend toward decreased uterine artery resistance in the patients with estrogen exposure (p = 0.07 by Mann-Whitney test). The lowest PI was seen in the patient with spontaneous pubertal development. Uterine volume was significantly larger in the estrogen exposed group, 38.7 cm3 ± 23.3 in the estrogen exposed and 1.32 cm3 ± 0.9 in the non-exposed group. (p = 0.01 by Mann-Whitney test). Conclusion In the patient with Turner syndrome, estrogen exposure is associated with a corresponding increase in uterine volume and a trend toward decreased uterine artery resistance. Further study and continued prospective follow-up will indicate whether estrogen treatment in those patients studied prior to estrogen replacement is associated with similar changes.

Color Doppler ultrasound pulsatile flow signals of thoracic lesions: comparison of lung cancers and benign lesions

Color Doppler ultrasound (US) was performed in 153 patients (including 102 with lung cancer and 51 with benign lesions) to assess pulsatile flow signals in thoracic lesions. The values of resistive index (RI) and pulsatility index (PI) of color Doppler US pulsatile flow signals in lung cancers and benign lesions were measured, analyzed, and compared. In the enrolled 153 patients with thoracic lesions, 61 lung cancers and 34 benign lesions had detectable color Doppler US pulsatile flow signals, and lung cancers had lower RI and PI values than benign lesions (RI: 0.70 ± 0.03 vs. 0.79 ± 0.04, p < 0.05; PI: 1.61 ± 0.15 vs. 2.44 ± 0.25, p < 0.005). However, overlapping RI and PI values in lung cancers and benign lesions somewhat limited color Doppler US pulsatile flow signals to differentiate lung cancers from benign lesions. Further analysis of RI and PI values in subgroups of lung cancers [squamous cell carcinoma (SCC, n = 34), adenocarcinoma (AC, n = 18), and small-cell lung cancer (SCLC, n = 6)] and benign lesions [cavitary benign lesions (CBL, n = 8), and noncavitary benign lesions (NCBL, n = 26)] revealed that all different cell types of lung cancers (SCC, AC, and SCLC), indeed, had lower RI and PI values than NCBL (for RI, all p < 0.01; for PI, all p ≤ 0.001). Moreover, the mean RI and PI values showed a significant incremental decrease from NCBL (mean RI, PI = 0.88, 2.94) toward SCC and AC (for SCC, mean RI, PI = 0.71, 1.68; for AC, mean RI, PI = 0.68, 1.67) and, finally, to SCLC (mean RI, PI = 0.62, 1.05). In contrast, CBL had relatively lower RI and PI values than AC and SCLC (for CBL, mean RI, PI = 0.53, 0.80; both p > 0.05 for RI and PI), and even a significant difference from SCC ( p < 0.05 for RI and PI). We conclude that color Doppler US pulsatile flow signal is somewhat limited to differentiate lung cancers from benign lesions, but provides a noninvasive in vivo model to assess the neovascularity intensity of lung cancers.

The Blood Flow Characteristics in Borderline Ovarian Tumors Based on Both Color Doppler Ultrasound and Histopathological Analyses

To clarify the tumor behavior in borderline ovarian tumors, we examined the characteristics of neovascularization in these tumors by using a transvaginal color Doppler ultrasound (TV-CDU). Twelve patients with borderline ovarian tumors were preoperatively evaluated for the characteristics of intratumoral blood flow by TV-CDU, using both the resistance index (RI) and pulsatility index (PI). As a control group, 100 patients with benign ovarian tumors and 31 patients with malignant ovarian tumors were also examined by TV-CDU. An intratumoral blood flow was significantly detected in both borderline (91.6%; 11/12) and malignant ovarian tumors (90.3%; 28/31), but not in benign ovarian tumors (53%; 53/100) (P< 0.01). In addition, both the mean RI and mean PI values were significantly lower in the borderline (RI; 0.45, PI; 0.67) and malignant ovarian tumors (RI; 0.39, PI; 0.58) than those in the benign ovarian tumors (RI; 0.61, PI; 1.05) (P< 0.01). In mucinous tumors, the borderline tumors showed a significantly high intratumoral vascularity (P< 0.01) and both borderline and malignant tumors significantly demonstrated a low-resistance blood flow (P< 0.01), in comparison to those of the benign tumors. Mucinous borderline tumors of the intestinal type also tended to have a lower RI as well as a lower PI value than müllerian type. Regarding neovascularization as represented by intratumoral blood flow characteristics, this study thus suggests that a close relationship exists in the tumor behavior between borderline and malignant ovarian tumors, especially in mucinous epithelial tumors.

HEMODYNAMIC CHANGES WITH PARADOXICAL BLOOD FLOW IN EXPECTANT MANAGEMENT OF ABRUPTIO PLACENTAE

In Brief Background Because the early diagnosis of abruption often is missed or misinterpreted, emergency situations frequently do not permit adequate management. Case A woman of 26-weeks' gestation was transferred with symptoms and laboratory findings typical for abruption. Ultrasound, including Doppler, revealed a subchorionic hematoma, pathologic blood flow in the uterine arteries, low pulsatility index values in the fetal cerebral and umbilical arteries (paradoxical blood flow), and high maximal velocities in the fetal aorta. Repeated Doppler and laboratory examinations revealed a gradual restoration to normal of the arterial uterine blood flow pattern, of paradoxical blood flow, aortic maximal velocities, and laboratory values. Conclusion Serial Doppler measurements considering the paradoxical pattern illustrate pathophysiologic mechanisms of abruption that may assist in deciding whether to deliver immediately or to continue intense surveillance. Detailed Doppler velocimetry revealed paradoxical blood flow patterns in a pregnancy with abruption and allowed for the evaluation of pathophysiologic changes that helped in the management of this complication of pregnancy.

Hemodynamic Changes with Paradoxical Blood Flow in Expectant Management of Abruptio Placentae

Background: Because the early diagnosis of abruption often is missed or misinterpreted, emergency situations frequently do not permit adequate management.Case: A woman of 26-weeks’ gestation was transferred with symptoms and laboratory findings typical for abruption. Ultrasound, including Doppler, revealed a subchorionic hematoma, pathologic blood flow in the uterine arteries, low pulsatility index values in the fetal cerebral and umbilical arteries (paradoxical blood flow), and high maximal velocities in the fetal aorta. Repeated Doppler and laboratory examinations revealed a gradual restoration to normal of the arterial uterine blood flow pattern, of paradoxical blood flow, aortic maximal velocities, and laboratory values.Conclusion: Serial Doppler measurements considering the paradoxical pattern illustrate pathophysiologic mechanisms of abruption that may assist in deciding whether to deliver immediately or to continue intense surveillance.

Pränatale Diagnostik einer Struma ovarii im ersten Trimenon

Fragestellung: Bedürfen solid-zystische Ovarialtumoren im ersten Trimenon der operativen Abklärung? Methoden: Wir stellen den Fall einer 28jährigen Erstgravida vor, bei der im Rahmen der üblichen Schwangerschaftsvorsorgeuntersuchung in der 12. SSW ein Ovarialtumor diagnostiziert worden war. Im Rahmen der Abklärung des Prozesses nahmen die 3D-Sonographie und die Dopplersonographie eine zentrale Rolle ein. Ergebnisse: Es erfolgte zur Abklärung der Dignität des Ovarialtumors die Laparotomie mit unilateraler Adnexektomie. Die histologische Aufarbeitung ergab eine Struma ovarii ohne Anhalt für Malignität. Schlußfolgerung: Die Struma ovarii in der Gravidität ist eine Rarität. Da die Dignität des Ovarialtumors sonographisch nicht sicher als benigne eingestuft werden konnte, ist auch in der Frühgravidität eine operative Abklärung indiziert. Bei Fehlen der typischen Klinik für eine Hyperthyreose halten wir das operative Vorgehen ohne weitere endo-krinologische Kontrollen für ausreichend.

Maternal anxiety in late pregnancy and fetal hemodynamics

The aim of this study was to investigate if fetal circulation is affected by maternal anxiety, 37 nulliparous women were studied prospectively in the third trimester of pregnancy, with self-rate tests of anxiety (STAI). Doppler ultrasound examination of the umbilical artery and fetal middle cerebral artery was performed at 37–40 gestational weeks. The pulsatility index (PI) was calculated and corrected for heart rate. The women were divided into groups of increasing levels of anxiety. The fetuses of women with high trait anxiety scores had significantly higher PI values in the umbilical artery ( p = 0.0056), significantly lower PI values in the fetal middle cerebral artery ( p = 0.0029) and significantly lower cerebro-umbilical PI ratios ( p = 0.0002), suggesting a change in blood distribution in favor of brain circulation in the fetuses. Maternal weight, weight-increase, height, age, marital status, smoking habits, drinking habits and socioeconomic factors known to affect fetal well-being did not interfere with these findings. No significant differences in birth-weight, length and head circumference were found between infants born to mothers with higher trait anxiety levels compared to mothers with lower trait anxiety levels. Our results suggest that maternal stress, in terms of trait anxiety, influences fetal cerebral circulation.

Maternal ophthalmic artery Doppler velocimetry in normotensive pregnancies and pregnancies complicated by hypertensive disorders

OBJECTIVE: Our objective was to compare maternal ophthalmic artery pulsatility index values in normotensive pregnancies and pregnancies complicated by hypertensive disorders. STUDY DESIGN: The ophthalmic artery in 17 normotensive nonpregnant women, 29 normotensive pregnant women, 9 patients with mild preeclampsia, 6 with severe preeclampsia, 6 with transient hypertension, and 9 with chronic hypertension was studied with color Doppler flow imaging and pulsed Doppler ultrasonography. The mean arterial blood pressure and the ophthalmic artery pulsatility index were calculated in each group. RESULTS: The pulsatility index (1.17 ± 0.08) in severe preeclampsia was lowest among the groupsp < 0.05), whereas that (2.92 ± 0.59) in normotensive pregnant women was highest among the groups(p < 0.05). The pulsatility index (1.47 ± 0.30) in mild preeclampsia was significantly lower than that (1.89 ± 0.27) in transient hypertension (p < 0.05). There was no significant difference in pulsatility index between mild preeclampsia and chronic hypertension (1.69 ± 0.49) or between transient hypertension and chronic hypertension. The pulsatility index inversely correlated well with the mean arterial blood pressure (R2 = 0.645, p < 0.0001). CONCLUSIONS: These results suggest that the lower pulsatility index should be interpreted as orbital vascular vasodilation, indicating orbital hyperperfusion or hyperemia. Changes in pulsatility index in the ophthalmic artery may be indicative of similar changes in other cerebral vessels. (Am J Obstet Gynecol 1997;177:174-8)

Doppler assessment of the intervillous blood flow in normal and abnormal early pregnancy

To compare resistance index (RI) and pulsatility index (PI) in the spiral and intervillous arteries, and peak systolic velocity of the continuous intervillous flow in normal and abnormal first-trimester pregnancy. Transvaginal color and pulsed Doppler were used in a prospective analysis of 60 normal (controls) and 54 abnormal (30 missed abortions and 24 anembryonic) pregnancies (6-12 weeks' gestation). Repeated-measures analysis of variance was used for comparison between groups. A gradual decrease in spiral artery RI and PI was found in women with anembryonic pregnancies. No difference in spiral artery impedance was noted in women with normal pregnancies, but there was a progressive increase in spiral artery RI and PI in women with missed abortion. A significant increase in continuous intervillous blood flow velocity was noted from the 11th week onward in the normal pregnancy group (8.0 +/- 0.9 versus 12.2 +/- 1.4 cm/second). Intervillous arterial blood flow signals did not demonstrate any difference in RI and PI with advancing gestational duration. Significantly lower PI values were obtained from the intervillous arteries in women with anembryonic pregnancy (PI 0.54 +/- 0.04) than in controls (PI 0.80 +/- 0.04) and those with missed abortions (PI 0.75 +/- 0.04). However, there was no statistically significant difference in the intervillous RI between subgroups. The new generation of sensitive Doppler units can detect intervillous flow as a continuous progressive process during the first trimester of normal and abnormal pregnancy. There is a significant difference in intervillous artery vascular impedance between normal and anembryonic pregnancies.

Transvaginal ultrasonography of pelvic masses: Evaluation of B-mode technique and Doppler ultrasonography

OBJECTIVE: The purpose of this study was to evaluate pelvic masses by B-mode and Doppler ultrasonography for identification of ovarian malignancies. STUDY DESIGN: A previously described scoring system for pelvic masses was applied in 310 women, and the lesions were classified into four groups according to the ultrasonographic structure. Pulsatility index values of vessels within the tumor and the contralateral ovary and of both uterine arteries were determined. RESULTS: A total of 259 masses were benign and 51 were malignant. The scoring system and classification into morphologic groups revealed similar sensitivity, specificity, and positive and negative predictive values. Intratumoral and opposite ovarian blood flow and ipsilateral and contralateral uterine blood flow did not differ in benign and malignant masses except in cases of benign lesions in postmenopausal women. In malignant lesions a lower pulsatility index (0.94 ± 0.4) was measured than in benign lesions (1.06 ± 0.4, p < 0.05), although a remarkable overlap was found. CONCLUSION: The results suggest that further refinement of assessment of pelvic masses with Doppler ultrasonography is needed. (Am J Obstet Gynecol 1996;175:97-104.)

Mode of delivery and perinatal cerebral blood flow.

To ascertain whether the perinatal cerebral blood flow velocity differed between vaginally delivered appropriate for gestational age (vag. AGA) term babies, AGA babies delivered by Caesarean section (C.s. AGA), and small for gestational age (C.s. SGA) babies also delivered by Caesarean section. Forty-five babies were examined by Doppler ultrasound of the middle cerebral artery prior to and immediately after delivery, and at 1 h and 24 h after birth. The pulsatility index (PI) and time-averaged maximum velocity (TAMXV) were calculated. No differences in TAMXV were found between the vag. AGA and C.s. AGA groups at any of the four recordings. A significantly higher PI value was found in the C.s. AGA group 1 h after birth. The C.s. SGA group had lower PI values before and just after birth, but did not differ significantly from the C.s. AGA group at 1 h or 24 h after birth. The results suggest mode of delivery to have a transitory effect on cerebral vascular resistance in healthy term AGA babies. The C.s. SGA group differed in the initial recording just after birth, but later manifested similar blood flow velocities in middle cerebral artery as the C.s. AGA group.

Correlation of histomorphology of ovarian masses with color Doppler sonography

This study correlates the color Doppler sonography (CDS) findings in ovarian masses according to histomorphologic groups. Sixty-two surgically excised ovarian masses (31 benign and 31 malignant) in patients who underwent CDS were retrospectively reviewed. Lowest pulsatility index (PI) was used in benign and malignant unilocular cysts, septated cysts, predominantly cystic masses with solid components, predominantly solid masses with cystic areas and solid masses. The mean of the lowest PIs of benign lesions (1.7 ± 0.7) were statistically significantly different ( p < 0.05) from malignancies (0.7 ± 0.3). The group of septated cysts (1.8 ± 0.5 vs. 0.61 ± 0.3) and predominantly cystic masses with solid areas (1.1 ± 0.1 vs. 0.6 ± 0.2) achieved statistical significance for benign vs. malignant masses. Predominantly solid masses with cystic areas (1.8 ± 0.5 vs. 0.8 ± 0.2) and solid masses (1.4 ± 1.0 vs. 0.7 ± 0.3) were not statistically significantly different. Because of a limited number of cases, statistically significant differences in the mean of the lowest PIs of benign vs. malignant unilocular cysts (2.1 ± 0.5 vs. 1.9) could not be determined. When analyzed according to histomorphology, CDS findings were of predictive value in certain morphologies and not as much in others. This fact should be taken into account when evaluating an ovarian mass for malignancy with CDS.

Discordant blood flow velocity waveforms in left and right brachial arteries in growth-retarded fetuses

To determine if the increase in cerebral blood flow ("brain-sparing" effect) with fetal hypoxemia is associated with discordant hemodynamics in the upper extremities. We studied 12 fetuses with severe growth retardation, absent or reverse end-diastolic blood flow in the umbilical artery, and low pulsatility index (PI) in the middle cerebral artery, and 12 appropriately grown control fetuses with normal fetoplacental Doppler studies. The right and left brachial arteries were identified by high-resolution color Doppler ultrasonography, and the PI was measured in each brachial artery. All growth-retarded fetuses had lower impedance indices in the right than in the left brachial artery (mean delta PI 1.0, 95% confidence interval [CI] 0.7-1.3, P < .001). No differences in the brachial artery impedance indices were found in control fetuses matched for gestational age (mean delta PI 0.0, 95% CI -0.2 to 0.2). Left and right brachial artery blood flow velocity waveforms are discordant in fetuses with growth retardation and cerebral vasodilation. Because the right arm receives its blood supply from the same source as the brain (brachiocephalic artery) and given the proximity of the left subclavian artery to the ductus arteriosus, we speculate that this might be the result of increased blood flow into the brachiocephalic circulation and/or functional differences in the distribution of left and right ventricular output within the aortic arch in response to fetal hypoxemia.

Evaluation of ovarian findings in asymptomatic postmenopausal women with color doppler ultrasound

To evaluate the prevalence and significance of abnormal ovarian findings in asymptomatic postmenopausal women, screening for ovarian cancer with color Doppler ultrasound was performed. One thousand three hundred sixty-four asymptomatic women aged 56-61 years (mean, 59 years) were examined by color Doppler sonography. Ninety-six percent of the examinations were transvaginal and 4% transabdominal. The criteria for abnormality were an ovarian volume 8 cm3 or greater, nonuniform echogenicity, and/or pulsatility index (PI) of the ovarian artery or tumor vessel, if present, 1.0 or less. Repeat sonograms were performed 1-3 months later on all patients with abnormal findings, and exploratory laparotomy was performed if a malignant tumor was suspected. Abnormal ovarian findings were detected in 160 women (12%). At the time of repeat sonogram there were 28 persisting abnormalities (2%). At that time, the ovary was regarded as normal if it still contained a small clear cyst with an unchanged greatest dimension of less than 20 mm. Three women had a low PI value but all had also abnormal ovarian sonographic morphology. Two ultrasound-guided cyst punctures were performed and three patients had surgery; one benign serous cyst, one benign serous cystadenoma, and one serous cystadenoma of borderline malignancy were detected. The remaining abnormal findings disappeared or remained unchanged during a minimum follow-up of 2 years. One case of Stage IA ovarian cancer has been reported 2 years after a negative screening and one abdominal carcinomatosis 2 1/2 years after a negative screening result. There is a high frequency of small ovarian cysts in asymptomatic postmenopausal women. A large percentage of these cysts regress spontaneously or remain unchanged. Transvaginal color Doppler ultrasound is an effective method for detecting these lesions. Color Doppler does not increase substantially the number of operations for benign reasons. However, as a primary screening modality, the conventional sonography seems to be quite sufficient.

Shear stress in cerebral arteries supplying arteriovenous malformations.

Arteries supplying cerebral arteriovenous malformations (AVMs) are known to dilate with time. These changes are reversible, and the feeders have been shown to slowly decrease in calibre after removal of the AMV. There is evidence that arteries alter their internal diameters in response to sustained changes of blood flow so that shear stress is kept constant. This implies that blood flow-induced shear stress might be the driving force for remodelling of the cerebral vascular network in the presence of an AVM, and for reversion of these changes after radical operation. The objective of this study is to examine the hypothesis that the shear stress in cerebral arteries supplying AMVs is of the same magnitude as in arteries supplying normal brain tissue in spite of larger blood flow rate. Fifteen patients with supratentorial cerebral AVMs admitted for endovascular treatment were examined with transcranial Doppler ultrasound in the distal Willisian vessels. Vessel calibres were measured in angiograms with magnification correction. Shear stress was estimated assuming a constant value for blood viscosity. Corresponding arteries in the cerebral hemisphere with AVM and in the contralateral one were compared in pairs. Thirty-four pairs of homonymous arteries were studied. The arteries on the AVM side presented larger calibres, higher axial blood flow velocities, lower pulsatility index and larger blood flow rates than the contralateral side. There was a clear positive correlation between blood flow velocities and vessel calibres. The estimates of shear stress did not differ significantly in corresponding arteries of both hemispheres (p = 0.18). The results indicate a precise adjustment of cerebral arterial calibre and blood flow-induced shear stress that presumably induces the progressive dilation of AVM feeders, and the slow regression of the vessel calibres to average dimensions after removal of the lesion. Each vessel seems to remodel itself in response to long-term changes in blood flow rate so that the vessel calibre is reshaped to maintain a constant level of wall shear stress.

Color-doppler velocimetry of uterine arteries in pregnant and nonpregnant patients during multiovulation induction for IVF

To evaluate uterine artery resistance during multiovulation induction in relation to the implantation rate in patients attending in vitro fertilization (IVF) cycles. Multiovulation induction for IVF was monitored by daily determination of the pulsatility index (PI) of the uterine arteries, obtained by a transvaginal probe (6.5 MHz) implemented with color-flow imaging. Doppler data were obtained from 5 days before hCG administration to the day of follicular aspiration. One IVF cycle was monitored in 70 patients. In 17 patients, 41 IVF cycles were monitored until a successful attempt occurred. In the 70 patients studied during one IVF attempt, the PI of the uterine arteries significantly varied (P < 0.001) in the different phases of the cycle. In the 24 patients who conceived, a significantly lower PI (P < 0.03) was found throughout the cycle. This result was mainly due to a highly significant difference of PI values observed the day after hCG administration (P < 0.005). In the 17 patients who conceived after 1 to 4 negative in vitro fertilizations, no significant difference in PI was observed in the uterine artery resistance in cycles in which implantation was or was not successful. Uterine artery resistance varies significantly during phases of the induction therapy. Uterine artery resistance is lower throughout the course of multiovulation induction in patients with higher pregnancy rates. The PI on the day after hCG administration was the best index of pregnancy rate. Low uterine artery resistance was present even in negative attempts in patients who eventually achieved a successful implantation. PI values < or = 3 can be considered a favorable prognostic factor for future IVF cycles.

Blood flow in benign ovarian tumors and normal ovaries during the follicular phase

To identify the Doppler flow characteristics of benign ovarian tumors, and to compare the variables involved with those of normal ovaries during the follicular phase. Ninety-one women comprised the study group: 43 were recruited from patients undergoing surgical exploration because of adnexal masses, and the remaining 48 were asymptomatic volunteers with normal ovaries. The ovarian volume and morphology, location of the intratumoral and intraovarian arteries, pulsatility index (PI), resistance index (RI), peak systolic velocity, and minimum diastolic velocity were assessed with transvaginal color Doppler ultrasonography. We examined patients with adnexal tumors before surgery and asymptomatic volunteers during the follicular phase of their menstrual cycles. Arterial blood flow was detected in 49 (89%) of the 55 benign tumors and in 89 (94%) of the 95 normal ovaries. The PI was less than 1.0 in 80% of the benign tumors and 94% of the normal ovaries. The RI was less than 0.4 in 43% of the benign tumors and 25% of the normal ovaries. Blood flow exhibited a lower mean PI but a higher mean peak systolic velocity and minimum diastolic velocity value in benign tumors compared with normal ovaries. There were no differences in the Doppler characteristics of the benign tumors between the follicular and luteal phases. The blood flow in benign tumors and normal ovaries may have low PIs and RIs, even during the follicular phase. Therefore, low PIs and RIs alone should not be interpreted as pathognomonic signs of malignancy.

Vascular complications in living related liver transplantation detected with intraoperative and postoperative Doppler US

Background/Aims: The purpose of this study was to clarify changes in the graft hemodynamics induced by vascular complications in living related liver transplantation. Methods: This study included 46 pediatric recipients who underwent partial liver transplantation from living rlated donors. The blood flow was evaluated in the portal system, the hepatic artery and the hepatic vein with serial intra- and post-operative Doppler ultrasound (US). Results: In 12 patients, intraoperative Dopper US showed a decrease in portal venous inflow (<9 ml · min −1 · kg −1) toward the liver graft and could act as a guide for ligation of collaterals in seven patients, portal re-construction in two, thrombectomy in one and relief of hepatic venous outflow obstruction in two for increasing the portal venous inflow. In five patients, intraoperative Doppler US showed poor arterial inflow, i.e. dampened arterial waveforms which involved both low pulsatility index (<0.90) and low peak-systolic velocity (<31 cm/s). In three of them, the waveform was more pulsatile after re-anastomosis or relief from stretching of the hepatic artery. The remaining two patients developed hepatic artery thrombosis. Most of the hepatic venous outflow obstruction (four of five patients) had flat waveforms, low flow velocity (<10 cm/s) of the hepatic vein, and poor portal inflow (flow velocity <14 cm/s). Postoperative Doppler US showed hepatic venous outflow obstruction in three patients, hepatic artery thrombosis in three (twice in one patient), portal vein stenosis in two and portal vein thrombosis in one. These complications were successfully managed with surgical procedures in three patients, transhepatic angioplasty in three and conservative treatments in four. Six patients died of non-vascular complications. Conclusions: Serial intra- and post-operative Doppler US was a useful technique for making an early diagnosis of abnormal hemodynamics of the graft circulation. Furthermore, intraoperative Doppler US could assess reconstructed vessels objectively and would reduce the incidence of vascular complications following transplantation.

Endometrial blood flow analysis in postmenopausal women: can it help differentiate benign from malignant causes of endometrial thickening?

To determine if prominent vascularity and low pulsatility index (PI) and resistive index (RI) in endometrial arteries help differentiate carcinoma from benign lesions. Forty-five postmenopausal women with at least 8-mm-thick endometrium at endovaginal ultrasound (US) underwent color duplex Doppler endovaginal US of the endometrium. PI and RI values were recorded from arterial waveforms generated in areas of increased vascularity. At color duplex Doppler endovaginal US, endometrial arterial flow was seen in 23 of 36 (64%) proved benign endometrial lesions. The range of PIs for benign lesions was 0.31-1.77 (mean, 0.72 +/- 0.33 [standard deviation]) and for RIs was 0.27-0.84 (mean, 0.48 +/- 0.13). Arterial vessels were seen in five of nine proved endometrial cancers (56%); the range of PIs was 0.42-1.17 (mean, 0.71 +/- 0.32) and for RIs was 0.34-0.69 (mean, 0.48 +/- 0.15). Differences in mean PI and RI for benign and malignant lesions were not significant. Low-impedance arterial flow is observed in various diseases of the endometrium, and there is an overlap between the PI and RI of benign and malignant lesions.