Resistive Index Measurements Research Articles

Doppler sonography in acute renal obstruction and role of intra venous urography: a study in a tertial care centre

Background: Arterial RI measurements by duplex Doppler USG have been advocated for the diagnosis of obstruction. In most centres, obstruction is indicated by an RI greater than 0.70 or a difference of greater than 0.10 between the kidneys. Our aim was to evaluate and compare the Doppler waveform alterations in unilateral acute renal obstruction (UARO) with the contralateral normal kidney as a control. Methods: 100 patients presenting to the emergency medical division with symptoms of unilateral acute renal colic were subjected to USG and Doppler USG. The renal RI was calculated in comparison to the collateral normal kidney. Results: The mean resistivity index (RI) was higher in obstructed kidneys in all cases. 80% patients had complete, while 20% had partial obstruction. RI value in completely obstructed kidneys was 0.72 versus 0.71; p<0.05. However, even in partially obstructed kidneys, RI was significantly higher than in the contralateral (unobstructed) kidney. The diagnostic accuracy of the Doppler was 96% sensitive in the complete obstruction cases and 85% in patients with partial obstruction. Conclusions: Doppler USG is a useful diagnostic tool in unilateral acute renal obstruction, with RI values being significantly higher in patients with complete obstruction than in patients with partial obstruction.

Relationship Between ‘Immediate’ Resistive Index Measurement After Renal Transplantation and Renal Allograft Outcomes

BackgroundThe arterial resistive index, also referred to as the resistive index (RI) or Pourcelot Index, is a measure of pulsatile blood flow. Previous studies have demonstrated the usefulness of the RI as a predictor of allograft outcomes based on RI measurement in the later stages after transplantation. However, there is little evidence of the predictive value of “immediate” RI measurement within 24 hours after transplantation. MethodsWe performed a retrospective cohort study of 305 adult renal transplants carried out between 2003 and 2013. The associations between immediate RI measurement (within 24 hours after transplantation) and donor, recipient, and surgical factors were analyzed. In addition, the correlations between immediate RI measurement and renal allograft outcomes, including delayed graft function (DGF) and transplant failure (TF), also were evaluated. ResultsFrom a cohort of 305 patients, 52 were excluded on the basis of on confounding factors. Of the remaining 253 patients, the mean age was 48.4 years, 57.5% were male, and approximately one-third had diabetes. Two hundred twenty-six patients had an RI < 0.8, whereas only 27 had an RI ≥ 0.8. Significant associations were found between elevated RI (≥0.8) and both DGF (odds ratio = 3.22, P = .006) and TF (odds ratio = 3.54, P = .008). ConclusionsImmediate RI measurement after renal transplantation is a strong predictor of both DGF and TF.

PP.22.06] PLASMA D-DIMER LEVELS ARE RELATED TO INTRARENAL VASCULAR RESISTANCE IN NON-DIABETIC ESSENTIAL HYPERTENSIVE PATIENTS

Objective: Hypertensive nephroangiosclerosis is characterized by progressive narrowing of preglomerular arterioles that leads to increased intrarenal vascular resistance. This can be estimated by duplex ultrasound evaluation and measurement of the intrarenal resistance index (IR). In addition to high blood pressure, other factors can contribute to development and progression of nephroangiosclerosis. The aim of this study was to investigate the possible relationships between some emergent cardiovascular risk factors, such as a prothrombotic state, and presence and severity of nephroangiosclerosis, as evaluated by measurement of IR, in hypertension. Design and method: In 115 non-diabetic, essential hypertensive patients (age 46 ± 13 years; 63 males, 57 never treated with anti-hypertensive drugs, 58 studied after drug wash-out of at least 2 weeks) we measured anthropometric variables, fasting plasma glucose and insulin, HOMA-index, 24-h creatinine clearance (CrCl) and urinary protein excretion, plasma levels of fibrinogen, D-dimer, prothrombin fragment 1 + 2, plasminogen activator inhibitor-1, tissue-plasminogen activator, lipoproteina (a), and homocysteine. Patients with CrCl < 30 ml/min/1.73 m2 were excluded. In all patients, IR was calculated as the average of 4 to 6 separate measurements that were obtained in the interlobar arteries respectively in the upper, middle, and lower third of both kidneys and patients were subdivided according to tertiles of IR. Results: IR was greater in women than in men, and in patients previously treated with antihypertensive drugs. Patients in the highest tertile of IR were older and had greater body mass index, pulse pressure, D-dimer and fibrinogen levels, and lower CrCl than patients in lowest IR tertile. No differences in the other variables considered in the study were found across IR tertiles. At univariate analysis IR was significantly and directly related to age, systolic and pulse pressure, HOMA-index, urinary protein excretion, D-dimer, and inversely with CrCl. At multivariate analysis, IR was independently associated with pulse pressure, CrCl and D-dimer levels. Conclusions: In non-diabetic hypertensive patients subclinical damage of intrarenal vessels is related with an activation of the hemostatic system that could play a role in the early stages of hypertensive nephropathy.

Usefulness of colour Doppler flow imaging in the management of lacrimal gland lesions.

To assess the role of colour Doppler flow imaging (CDFI) in the diagnosis and management of lacrimal fossa lesions. Institutional ethical committee approval was obtained. Fifty-one patients with 62 lacrimal fossa lesions were retrospectively included from 2003-2015. All patients underwent conventional ultrasonography and CDFI, with a qualitative and quantitative analysis of the vascularization. All patients had lacrimal gland surgery. Definitive diagnosis was based on pathological examination. The study included 47 non-epithelial lesions (NEL) and 15 epithelial lesions (EL), with 24 (39%) malignant lesions and 38 (61%) benign lesions. NEL were significantly more likely to present with septa (p < 0.001), hypoechogenicity (p < 0.001), high vascular intensity (p < 0.001), both central and peripheral vascularization (p < 0.001), tree-shape vascularization (p < 0.05) and a low resistance index (RI) (p < 0.0001). EL were significantly more likely to present with the presence of cysts (p < 0.001), and a higher RI. Receiver operating characteristic curves identified a RI value of 0.72 as the best cut-off to differentiate NEL from EL, with a sensitivity and specificity of 100%. CDFI is a valuable tool in the differential diagnosis of lacrimal fossa lesions. Resistance index measurement enables substantial distinction between EL and NEL, thus providing crucial data for surgical management. • CDFI is a valuable tool in lacrimal fossa lesions. • Resistance Index measurement enables substantial distinction between epithelial and non-epithelial lesions. • Management of patients becomes more appropriate.

Evaluation of Carotid Intima Media Thickness and Renal Artery Resistive Index in Patients With Pseudoexfoliation Syndrome: A Prospective Case-Control Study.

To investigate the significance of renal artery resistance and carotid intima media thickness (CIMT) parameters in patients with pseudoexfoliation syndrome (PES). In this prospective case-control study, 37 patients were involved and grouped as PES (n=19) and control groups (n=18). Ophthalmological evaluation included visual acuity, intraocular pressure, central corneal thickness measurement, and optic disc evaluation. In addition, renal artery resistive index and CIMT measurements were taken for all patients and compared between the groups. The 2 groups were similar with respect to age, sex, and family history of glaucoma. The mean CIMT in the PES group was found to be significantly higher compared with the control group (0.73±0.02 vs. 0.59±0.06 mm, P=0.003). Renal artery resistive indices were found to be higher in the PES group than in the control group, however, the difference was not significant (P=0.46). A moderate positive correlation between CIMT and renal artery resistive indices was detected (r=0.447, P=0.01). However, a higher correlation rate was detected when the analysis was made in the PES group only (r=0.603, P=0.01). CIMT increases in PES patients and also the renal artery resistance index has a tendency to increase. Patients with PES should be informed about potential systemic consequences of this syndrome.

Duplex derived intrarenal resistance index correlates with invasive pressure gradient measurements in detecting relevant unilateral renal artery stenosis.

The purpose of this study was to assess the correlation between the transstenotic pressure gradient as determined by a pressure wire and the decrease in the intrarenal resistance index (RI) > 0.05 measured by duplex ultrasound in significant unilateral renal artery stenosis (RAS). Intravascular ultrasound (IVUS) was correlated to the angiographic degree of RAS. In 17 patients, transstenotic pressure gradient measurements, IVUS and RI measurements were obtained before and after stenting. After stenting, graded stenosis was created by progressive balloon catheter inflation. Stenosis severity was expressed as the ratio of the distal pressure (Pd) corrected for aortic pressure (Pa). The balloon inflation pressure was adjusted to create a stenosis with Pd/Pa ratio 1.0 to 0.7. In parallel, RI measurements were performed in the affected kidney and compared to the contralateral kidney for the calculation of the side-difference in RI. IVUS was performed to correlate the cross-sectional degree of stenosis with quantitative angiography (QA). In 60 out 68 measurements, the RI difference (decline > 0.05) correlated with a Pd/Pa ratio < 0.9; this correlation was significant by linear regression analysis (p < 0.001). The preinterventional mean degree of stenosis was 63.4 % + 16.1 (24.6 - 84.6 %) as assessed by QA and 76.7 % + 13.2 % (47 - 92 %) as assessed by IVUS, showing a significant correlation (p < 0.035). In unilateral RAS, a drop in RI > 0.05 as compared to the unaffected kidney correlates to an invasively measured Pd/Pa ratio < 0.9, which is regarded as a significant pressure gradient associated with increased renin production, which promotes renovascular hypertension. QA underestimates RAS severity as compared to IVUS.

MicroRNA Profiling and Regulation in Hypertensive Kidney

Hypertension is a major risk factor for chronic kidney disease and renal inflammation is an integral part in this pathology. In recent years, hydrogen sulfide (H2S) has emerged as an important regulator of blood pressure. Studies in spontaneously hypertensive rats have shown that endogenous hydrogen sulfide (H2S) production is impaired due to decreased CBS/CSE expression, and exogenous H2S supplementation decreased blood pressure and vascular remodeling. MicroRNAs are short, single‐stranded RNA genes that regulate post‐transcriptional gene expression by targeting messenger RNAs (mRNAs), and are associated with a broad spectrum of physiological processes. While there are several studies aimed at investigating the role of non‐coding RNA in hypertension, the roles and implications of these RNAs are not well defined. In this study, we sought to identify microRNAs that are dysregulated in response to angiotensin‐induced hypertension in the kidney and whether hydrogen sulfide donor, GYY 4137, could reverse the microRNA alteration. Wild‐type mice were treated without or with Ang‐II (1000ng/Kg/Min) and without or with GYY4137 for 4 weeks. Blood pressure, renal blood flow, renal resistive index (RI) measurements were performed. microRNA microarrays were conducted and subsequent target prediction revealed genes associated with proinflammatory response. Ang‐II treated mice showed a significant increase in blood pressure accompanied by a decrease in blood flow in the renal cortex and an increase in the resistive index. These effects were attenuated in mice treated with GYY4137. Microarrays of the kidneys revealed downregulation of miR‐129 and miR‐299b in Ang‐II treated mice and upregulation following GYY4137 treatment. In contrast, miR‐369 was upregulated in Ang‐II treatment and suppressed in Ang‐II+GYY4137 mice. Quantitation of genes involved in proinflammatory response revealed upregulation of Tnfα, Il1β, Mcp1 and Mip2 mRNA. Our data suggests that downregulation of miR‐129 and ‐299b plays a significant role in Ang‐II induced renal inflammation, and GYY4137 reduces inflammation and is associated with reversal of miR expression.Support or Funding InformationNIH: HL104103, AHA: 15SDG25840013

Diagnosis of Clinically Significant Portal Hypertension in Patients with Cirrhosis: Splenic Arterial Resistive Index versus Liver Stiffness Measurement

The purpose of the present study is to compare the diagnostic accuracy of the splenic arterial resistive index (SARI) with that of liver stiffness measurement (LSM) for identifying patients with clinically significant portal hypertension (CSPH). We included 47 patients (M:F = 37:10) who underwent Doppler ultrasonography, LSM and hepatic venous pressure gradient (HVPG) on the same day. We investigated whether the SARI and LSM were correlated with the HVPG, and compared area under the curve (AUC) values for the abilities of SARI and LSM to diagnose CSPH. We also performed a sub-group analysis. The SARI and LSM were all moderately correlated with HVPG overall in patients. The AUC of SARI and LSM were 0.873 and 0.745, respectively. In patients without splenomegaly, SARI was strongly correlated with HVPG (r = 0.830), but LSM was moderately correlated with HVPG (r = 0.601). The AUC was also higher for SARI than for LSM. Therefore, SARI is potentially an excellent non-invasive measurement method for diagnosing CSPH, especially those without splenomegaly.

MP47-10 THE COMPARISON OF ERECTILE FUNCTION BETWEEN RADICAL NEPHRECTOMY GROUP AND PARTIAL NEPHRECTOMY GROUP.

vasoactive agent. The primary aim of the study was to construct agespecific CDDU parameters for patients without organic erectile dysfunction. METHODS: A retrospective review was conducted to identify patients without organic ED who underwent in-office testing with intracavernous pharmacologic erection augmented by visual sexual stimulation and CDDU over a 5 year period. Patients were further characterized by demographic and Doppler data. Specifically, CDDU characteristics including pre and post-visual stimulation peak systolic velocity (PSV) and resistive index (RI) were identified. Patients with post-visual stimulation PSV > 35cm/s and RI > 0.9 were included in the analysis. Pearson correlation test was used to evaluate the association between ordinal age groups with PSV and RI measurements. RESULTS: 259 patients with a mean age 53.7 and a mean BMI of 27.2 were found to have normal Doppler parameters (PSV>35cm/s, RI>.90). For the entire cohort, average post-visual stimulation PSV was 59.8 (35.0-115.5) and average RI was 0.99 (.9-1.0). A majority of patients had limited medical co-morbidities, with only 29%, 7%, and 10% reporting hypertension, Diabetes, and heart disease, respectively. Priapism, as defined by needing an injectable reversible agent, occurred in 93% of patients. Doppler parameters were then analyzed across sequential decades and when age was categorized to 70, a negative correlation coefficient was obtained for pre-visual stimulation PSV (-0.09, P1⁄40.164), post-visual stimulation PSV (-0.23, P1⁄40.005) and RI (-0.005, P1⁄4.937). Pre-visual stimulation, post-visual stimulation and RI were also stratified using age as continuous variable and with a cutoff of age 1⁄4 60 (Table 1). CONCLUSIONS: No patients were diagnosed with arterial insufficiency or cavernous venous occlusive disease. There appears to be an age-related decline in post-visual stimulation PSV. Characterization of Doppler parameters in patients without organic ED can be used to construct cutoffs to further define age-specific normalcy.

MP47-09 COLOR DOPPLER DUPLEX ULTRASOUND (CDDU) PARAMETERS OF MEN WITHOUT ORGANIC ERECTILE DYSFUNCTION

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation1 Apr 2016MP47-09 COLOR DOPPLER DUPLEX ULTRASOUND (CDDU) PARAMETERS OF MEN WITHOUT ORGANIC ERECTILE DYSFUNCTION Ram Pathak, Andrew Davidiuk, Issac Effriong, Zhuo Li, and Gregory Broderick Ram PathakRam Pathak More articles by this author , Andrew DavidiukAndrew Davidiuk More articles by this author , Issac EffriongIssac Effriong More articles by this author , Zhuo LiZhuo Li More articles by this author , and Gregory BroderickGregory Broderick More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.328AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Erectile Dysfunction (ED) can be non-invasively diagnosed by Color Duplex Doppler Ultrasound (CDDU) coupled with intracavernous injection (ICI) of a penile vasoactive agent. The primary aim of the study was to construct age-specific CDDU parameters for patients without organic erectile dysfunction. METHODS A retrospective review was conducted to identify patients without organic ED who underwent in-office testing with intracavernous pharmacologic erection augmented by visual sexual stimulation and CDDU over a 5 year period. Patients were further characterized by demographic and Doppler data. Specifically, CDDU characteristics including pre and post-visual stimulation peak systolic velocity (PSV) and resistive index (RI) were identified. Patients with post-visual stimulation PSV > 35cm/s and RI > 0.9 were included in the analysis. Pearson correlation test was used to evaluate the association between ordinal age groups with PSV and RI measurements. RESULTS 259 patients with a mean age 53.7 and a mean BMI of 27.2 were found to have normal Doppler parameters (PSV>35cm/s, RI>.90). For the entire cohort, average post-visual stimulation PSV was 59.8 (35.0-115.5) and average RI was 0.99 (.9-1.0). A majority of patients had limited medical co-morbidities, with only 29%, 7%, and 10% reporting hypertension, Diabetes, and heart disease, respectively. Priapism, as defined by needing an injectable reversible agent, occurred in 93% of patients. Doppler parameters were then analyzed across sequential decades and when age was categorized to <30, 30-39, 40-49, 50-59, 60-69, and >70, a negative correlation coefficient was obtained for pre-visual stimulation PSV (-0.09, P=0.164), post-visual stimulation PSV (-0.23, P=0.005) and RI (-0.005, P=.937). Pre-visual stimulation, post-visual stimulation and RI were also stratified using age as continuous variable and with a cutoff of age = 60 (Table 1). CONCLUSIONS No patients were diagnosed with arterial insufficiency or cavernous venous occlusive disease. There appears to be an age-related decline in post-visual stimulation PSV. Characterization of Doppler parameters in patients without organic ED can be used to construct cutoffs to further define age-specific normalcy. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e629-e630 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ram Pathak More articles by this author Andrew Davidiuk More articles by this author Issac Effriong More articles by this author Zhuo Li More articles by this author Gregory Broderick More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Doppler ultrasound measurements of renal functional reserve in healthy subjects.

The aim of this study was to calculate the normal values of renal functional reserve in healthy individuals measuring the resistive index and pulsatility index using Doppler ultrasonography. Forty healthy volunteer adults were included in the study. Their basal resistive index and pulsatility index values were measured and after oral protein load at 30th, 75th and 120th minutes, resistive index and pulsatility index measurements were repeated. The maximum changes in resistive index and pulsatility index from baseline were calculated in each subject which represented the renal functional reserve. The mean values of resistive index and pulsatility index decreased significantly starting with 30 minutes and consecutively at 75 and 120 minutes (for all p<0.05). The highest decrease compared to baseline values was recorded at 75 minutes and renal functional reserve values were calculated as 22.2% for resistive index and 25.4% for pulsatility index. Renal functional reserve can be calculated through Doppler resistive index and pulsatility index measures. We consider that it may be helpful to know normal values of renal functional reserve in healthy subjects.

Doppler Assessment of the Aortic Isthmus in Intrauterine Growth-Restricted Fetuses.

We aimed to evaluate the association of fetal aortic isthmus (AoI) Doppler flow measurements in intrauterine growth-restricted (IUGR) fetuses with fetal outcome. The data presented in this prospective cohort study were obtained from 74 IUGR and 71 appropriate-for-gestational-age (AGA) fetuses of singleton pregnancies with normal medical and obstetric histories that were between 26 and 40 weeks of gestation. All AoI Doppler scans were performed by the same observer. There were no statistical differences in maternal characteristics and gestational age or between AGA and IUGR fetuses at the inclusion time. No cases of reversed flow during diastole were detected. Aortic isthmus flow index was increased in growth-restricted fetuses. Absolute end-diastolic (EDV) and time-averaged maximum velocities were decreased in the IUGR fetuses. There was an association between AoI Doppler EDV measurements and prediction of neonatal intensive care unit requirement as well as AoI Doppler isthmic flow index and resistance index measurements and low 5-minute Apgar values. Aortic isthmus EDV was found to be independently associated with IUGR status. Because the AoI Doppler flow measurements of the IUGR fetuses were different from the AGA fetuses and predicted neonatal adverse outcome, Doppler imaging of the AoI could be used as a screening tool in the clinical surveillance of fetuses with IUGR after confirmation in larger prospective studies.

Comparison of Brachial Artery Resistive Index with Intima-Media Thickness of Carotid Artery as Sonographic Markers of Atherosclerosis

Background and objective: Intima-media thickness (IMT) in common carotid artery (CCA) can be assessed during carotid arterial ultrasonography. However, it's association with resistive index (RI) in brachial artery (BA), as a useful tool to evaluate atherosclerosis progression has not been clarified well. The aim of this study was to examine the relationship between IMT in CCA and RI in BA. Material and methods: IMT and RI of CCA and BA were evaluated in 90 men with 30 control carotids, 30 mild carotid stenosis, and 30 severe stenosis using B-mode and Doppler ultrasonography. RI was measured based on the peak-systolic and different parts of diastolic velocities in Doppler spectrum in BA. Results: The intima-media thickness of the left common carotid Artery (LCCA) increased from 0.57 ± 0.14 in the control group to 0.73 ± 0.15 in the mild stenosis group and 0.90 ± 0.11 in the severe stenosis group. RId-end and RId-mean of the left brachial artery (LBA) increased from 0.85 ± 0.09 and 0.82 ± 0.05 in the control groups to 0.89 ± 0.08 and 0.85 ± 0.04 in the mild stenosis groups and 0.94 ± 0.06 and 0.89 ± 0.04 among sever groups, respectively. Conclusion: Between experimental groups, there was a significant difference in IMT of LCCA and RI of LBA, separately (p-value < 0.05). The Pearson correlation analysis showed a significant correlation between IMT of LCCA and RI of LBA. The brachial artery resistive index is associated with intima-media thickness of common carotid artery. This study showed that atherosclerosis was a generalized process that might involve the entire vasculature. Besides, we propose that RI measurements from each of the Doppler velocity spectrums of brachial artery and their averaging (RImean) may be a better index for explaining progression of atherosclerosis in brachial artery rather than RId-end alone. Due to the above-mentioned matters, it seems that RI in BA with accompaniment of IMT in CCA could be a useful tool to evaluate atherosclerosis progression. Copyright © 2015 American Scientific Publishers.

Prospective evaluation of the renal morphology and vascular resistance in patients with ankylosing spondylitis.

To evaluate renal morphology, prevalence of urinary stone disease, renal perfusion and resistance to renal blood flow in patients with ankylosing spondylitis(AS). Thirty-eight patients diagnosed with AS and with normal basal renal functions, together with 38 healthy individuals matched in terms of age, sex, blood lipid profile and body mass index, were included. Total cholesterol, triglyceride, urea, creatinine and glucose levels were measured in both groups, as well as vitamin D, erythrocyte sedimentation rate (ESR) and C-reactive protein in the AS group. Renal dimensions, parenchymal echogenicity, presence of stone and renal resistive index (RRI) from the interlobular artery level were measured, and correlations with clinical and laboratory parameters were assessed. Thirty-eight patients diagnosed with AS (age 42.4+/- 11.5, 24 male, 14 women) and a control group of 38 healthy individuals (age 41.7+/-10.8, 23 male, 15 female) were included in the study. Renal stone was present in 7 patients (18.4%) in the AS group and 4 subjects (10.5%) in the control group. There was no significant difference in prevalence of stone between the groups (p=0.516). RRI values were significantly higher in the patients with AS (0.63+/-0.06) compared with the control group (0.59+/-0.03, p=0.001). Significant correlations were determined between RRI and age, triglyceride level, body mass index and length of disease. Renal Doppler is an important examination in early diagnosis and monitoring of renal changes in AS patients since renal complications in AS develop in the chronic and follow a subclinical course.

Doppler ultrasound measurement of resistance index in the diagnosis of prostate cancer.

Prostate cancer (PCa) remains the second leading cause of cancer diagnosis worldwide. Early diagnosis and treatment of PCa is critical since the long-term prognosis is excellent in patients with tumors confined to the prostate gland. The current meta-analysis investigates the diagnostic value of resistive index (RI) measurement using color Doppler ultrasound in patients with PCa. Electronic literature databases were exhaustively searched for relevant studies published prior to May 31, 2014. Nine studies met our predetermined inclusion criteria for the present meta-analysis. The methodologic quality of the selected studies was independently assessed by 2 reviewers based on Quality Assessment of Diagnostic Accuracy Studies tool. Our meta-analysis results showed that RI values were significantly higher in malignant prostate tissues compared to normal prostate tissues (standardized mean difference [SMD] 0.42, 95% confidence interval [CI] 0.12~0.73, p = 0.007) and benign prostate tissues (SMD 0.41, 95% CI 0.26~0.56, p<0.001). Subgroup analysis based on the diagnostic instruments used revealed that RI values were accurate in diagnosis of PCa when compared between malignant tissue vs normal tissue and malignant tissue vs benign tissue (all p<0.05). Taken together, our findings support the potential clinical applications of RI values in diagnosis of PCa.

Ultrasonographic measurement of carotid artery resistive index and diastolic function of the heart in gout patients.

The aim of the study was to establish the functional disorder in the blood circulation of gout patients with a method that shows early damage of the heart and vascular structures. A total of 117 patients were examined cross-sectionally by a complex multimodal ultrasonography and were divided into four groups: 37 healthy controls, 24 asymptomatic hyperuricemia, 36 gout without tophi and 20 gouty tophi. With pulsed Doppler, common carotid artery resistive index (CCARI) and parameters of the transmitral blood flow were determined: the ratio between maximal early and late flow velocities (E/A ratio) and deceleration time (DT). With tissue Doppler imaging, mitral annular peak velocity (Em) was obtained. In the examined ultrasonographic parameters between healthy controls and the three patient groups, there was a statistically significant difference (p<0.001). Comparing asymptomatic hyperuricemia and gout without tophi, no significant difference in CCARI (p=0.656), E/A ratio (p=0.472), DT (p=0.990) and Em (p=0.488) was found. Gouty tophi in comparison with gout without tophi and asymptomatic hyperuricemia had significantly lower Em (mean±SD 0.07±0.02 vs 0.09±0.03 vs 0.13±0.17) and significantly higher CCARI (mean±SD 0.74±0.05 vs 0.70±0.05 vs 0.69±0.05). Further multiple logistic regression revealed that tophi increased subject's likelihood of having category of CCARI≥0.7 with an OR=10.91 (95% CI 1.80-66.14, p=0.009), while the category of Em<0.08m/s was influenced by renal insufficiency with an OR=3.07 (95% CI 1.17-8.02, p=0.022). Gouty tophi are associated with progression of arteriosclerotic-type vessel changes. Worsening of diastolic dysfunction of the heart is independently associated with renal insufficiency. In terms of CV risk, tophi are an indicator of its increase.

Uterine blood flow indices, antinuclear autoantibodies and unexplained recurrent miscarriage.

ObjectiveTo study the correlation between 2D and 3D uterine flow indexes and the presence or the absence of antinuclear antibodies (ANA) in women with unexplained recurrent miscarriage (uRM).MethodsFifty-two subjects (26 uRM and 26 control women) underwent 2D Doppler measurement of pulsatility index and resistance index of the uterine arteries in both the follicular and midluteal phase of the cycle. Additionally, 3D ultrasonography determination of vascularisation index, flow index, and vascularisation flow index was carried out with the aid of the VOCAL technique. Serum assay for the presence of ANA was performed in all women.ResultsPulsatility index of ANA+ uRM women was higher than that of ANA- uRM women and control ANA+ and ANAwomen, both in the follicular and in the midluteal phase of the cycle. Vascularisation index in ANA- uRM women was significantly higher than that in ANA+ control women. Flow index in uRM ANA+ women was significantly lower than that of each of the other groups.ConclusionANA might be involved in uRM by determining an impairment in uterine blood flow hemodynamic, particularly in uterine blood flow intensity and uterine artery impedance.

Intrarenal resistance index (RI) as a predictor of early renal impairment in patients with liver cirrhosis.

Despite its functional nature, hepatorenal syndrome (HRS) is associated with a poor prognosis and the only effective treatment is liver transplantation. It is very important to diagnose renal impairment in cirrhosis patients at an early stage before overt HRS develops. In patients with cirrhosis the early renal impairment or renovascular vasoconstriction can be predicted by renal arterial resistance index (RI). Our study aimed to compare RI in healthy controls versus patients with liver cirrhosis with and without ascites and assess its value for predicting subsequent renal status. Patients were divided into 2 groups with 50 patients in each group. Group 1 contained patients with cirrhosis without ascites and group 2 contained cirrhosis patients with ascites. All patients were subjected to detailed clinical examination, laboratory investigations and abdominal doppler ultrasound with renal RI measurements. Patients were followed for 6 months. RI was significantly higher in cirrhotic patients as compared to healthy controls (0.62 vs. 0.52, p< 0.01). In patients with cirrhosis, RI was significantly greater in patients with ascites than those without ascites (0.70 vs. 0.62, p < 0.01). RI >0.70 was significant independent predictor of subsequent HRS development (p = 0.006) CONCLUSIONS: Intrarenal RI measurement can be used as a predictor of HRS and may be further validated for regular monitoring of cirrhotic patients at risk of developing renal impairment.

Renal Resistive Index Measurement by Transesophageal Echocardiography: Comparison With Translumbar Ultrasonography and Relation to Acute Kidney Injury

The aim of this study was to evaluate the relationship between transesophageal ultrasonography-derived renal resistive index values (RRITEE) and a standard translumbar renal ultrasound-derived RRI (RRITLUSG). The effectiveness of each method to predict acute kidney injury (AKI) after cardiac surgery also was compared. A prospective observational study. A teaching university hospital. Sixty patients undergoing cardiac surgery. First, RRI was measured with both methods after anesthesia induction. Second, another measurement was performed with TEE after cardiopulmonary bypass and immediately following the surgery with translumbar ultrasound. To test the correlation between the 2 methods and to plot a Bland-Altman graph, preoperative RRI values measured by both techniques were used. Receiver operating characteristic curves also were plotted to compare the diagnostic values of RRI measured intraoperatively by TEE after cardiopulmonary bypass and by RRITLUSG after surgery. There was a statistically significant correlation between the 2 RRI measurement approaches (r = 0.86, p<0.0001). The Bland-Altman plot indicated good agreement between the methods. The area under the curve (AUC) of RRITEE in predicting AKI was 0.82 (95% confidence interval [CI] = 0.64-0.9, p = 0.001), and the AUC of RRITLUSG after surgery was 0.85 (95% CI = 0.7-0.98, p<0.0001). In predicting AKI, an uncertainty zone for RRITEE values between 0.68 and 0.71 was computed by the gray-zone approach. RRITEE showed clinically acceptable agreement with RRITLUSG. Indeed, RRI measured intraoperatively with TEE was comparable to RRITLUSG in terms of detecting postoperative AKI.

Is B-Flow USG superior to Color Doppler USG for evaluating blood flow patterns in ovarian torsion?

ObjectiveOvarian torsion is an uncommon gynecological emergency that most often affects women of reproductive age. Its signs and symptoms are similar to those of other abdominal conditions, which make its differential diagnosis challenging. Color Doppler (Doppler USG) and B-flow ultrasonography (B-flow USG) are used for the differential diagnosis of ovarian torsion, and in this study, we aimed to evaluate these two techniques, validate B-flow USG as the gold standard non invasive diagnostic tool in the early phase of an ovarian torsion, and show that the B-flow USG is superior to the color Doppler USG. Materials and methodsSixteen rabbits of the same age and weight were separated into 2 subgroups of 8. In Group I (sham group), right ovaries were fixated, and in Group II (torsion group), right ovaries underwent 720° torsion in a counterclockwise direction. At 1h and 2h of ischemia, both ovaries were measured by the two techniques, and an additional measurement was taken at 24h to determine any changes in the left ovary due to the right ovary ischemia. Volume flow, peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) measurements were taken both with color Doppler USG (using a 12MHz linear probe, General Electric Medical Systems Logic 7, Milwaukee, USA) and with B-flow USG. ResultsThe right Doppler RI and PI values at 1h were significantly higher than the right B-flow values (p<0.05). The difference between the left B-flow RI and PI values and the left Doppler values at 1h was not significant (p>0.05), nor was the difference between the right B-flow RI value at 2h and the right Doppler RI value at 2h (p>0.05). The right B-flow PI value at 2h was statistically different from the right Doppler PI value at 2h (p<0.05), although the differences between the left B-flow RI and PI values at 1h and 2h and the left Doppler RI and PI values were not (p>0.05). However, there was a significant difference between the RI values at 24h (p<0.05). ConclusionsIn this study, the decrease in blood reperfusion at 1h measured by B-flow USG was apparently higher than that measured by Doppler USG. However, by the end of 2h, the measurements were equal (see Fig. 3 and 4). In conclusion, B-flow USG reveals the decrease in the blood flow more distinctly in the early phase. Moreover, B-flow Doppler USG is more reliable and advantageous than color Doppler USG because it provides a more accurate preoperative evaluation of the unilateral and contralateral preoperative adnexial structures, and allows for a better assessment of blood flow in the ovarian torsion.