Spectral Doppler Waveform Analysis Research Articles

Dialysis Treatment is an Independent Risk Factor for Foot Morbidity.

Aim: To determine the prevalence of foot morbidity among patients with ESRD on dialysis. Methods: A prospective, non-experimental, quantitative time series design was employed. Forty-seven participants were recruited in the study. Medical records were reviewed followed by non-invasive foot assessments which included: Neurological, Arterial, Biomechanical, and Dermatological Assessment. Participants were assessed twice during the study. Results: Foot morbidity was found to be high among participants with ESRD on dialysis. 95.74% of participants presented with foot deformities, 76.60% had skin and nail conditions. 15% of participants had a history of ulceration and amputation. Moreover, active ulceration and history of revascularisation were also observed. Findings demonstrated overall poor foot health and footcare behavior within this population with 40.43% of participants having inappropriate footwear. The majority of participants did not check feet regularly, did not attend to podiatry appointments, and were unable to reach their feet for self-care. The Toe Brachial Pressure Index (TBPI), Spectral Doppler Waveform Analysis, and the Quantitative Sensory Testing (QST) were re-measured at each visit. Monophasic continuous doppler waveforms increased while triphasic waveforms decreased during the study period. Protective sensation did not decrease during the study period. The mean TBPI decreased during the study period. The relationship between the TBPI and duration of dialysis was found to be significant. Both DM and dialysis duration were identified as significant predictors of reduction in TBPI. Conclusion: This study demonstrates a high prevalence of foot morbidity among patients with ESRD on dialysis. This study highlighted the importance of expanding practice by introducing a podiatry service within the renal unit to provide foot screening, foot assessments, and foot care education, with the aim to reduce severe foot complications.

Interrater Reliability of Spectral Doppler Waveform Analysis Among Podiatric Clinicians.

Spectral Doppler ultrasound examination of pedal arteries is one of the most frequently used noninvasive assessment methods by health-care professionals for the diagnosis and ongoing monitoring of people at risk for or living with peripheral arterial disease. The aim of this study was to determine the interrater reliability of the interpretation of spectral Doppler waveform analysis. An interrater reliability study was conducted among five experienced podiatric physicians at the University of Malta Research Laboratory (Msida, Malta). A researcher who was not a rater in this study randomly selected 229 printed spectral Doppler waveforms from a database held at the University of Malta. Each rater independently rated the qualitative spectral waveforms. Interrater reliability of the spectral Doppler waveform interpretation was excellent among the five experienced podiatric physicians (α = 0.98). The intraclass correlation coefficient showed a high degree of correlation in waveform interpretation across raters ( P < .001). This study demonstrates high interrater reliability in visual spectral Doppler interpretation among experienced clinicians. The current foot screening guidelines do not refer to spectral Doppler waveform analysis in their recommendations, which has been shown in studies to be an important modality for the diagnosis of peripheral arterial disease when ankle-brachial pressure indexes are falsely elevated in calcified arteries. If interpreted correctly, the information obtained can provide an indication of the presence of peripheral arterial disease and facilitate early management of this condition.

Spectral Doppler Waveform Analysis of Common Femoral Veins for the Detection of Right Ventricular Dysfunction in Acute Pulmonary Embolism

Background Changes of central and peripheral venous hemodynamics (PVH) are registered in patients with acute pulmonary embolism (PE) with right ventricular dysfunction (RVD). It can be assumed the change of PVH is detectable through spectral Doppler waveform analysis of the common femoral veins (CFV) and regular respiratory modulated (RM) flow is replaced as a function of the severity of the RVD by cardiac modulation (CM) of the velocity-time spectra. The aim of this study is to examine, through detection of CM at the CFV, whether indirect diagnostics of the RVD is possible in patients with acute PE. Methods Quantification of RVD was performed through an echocardiographic right heart score (RHS) in patients with acute PE. The RHS integrated four parameters: the size of the right ventricle, the RV kinetics, the motion of the interventricular septum and the right atrial size. The sonographic quantification of RM and CM at the CFV was performed through measurement of the flow duration directed towards the heart in the velocity-time spectrum. The results of the RHS and the respective spectral Doppler waveform at the CFV were comparatively analysed. Results In 47 acute PE-patients CM was found in 53.2%. A RHS of 1 was present in 17% and there was no CM. CM was found in 19% of patients with a RHS of 1.25, and in 92% of patients with a RHS of 1.5. All patients with a RHS of ≥ 1.75 had a CM. The sensitivity and specificity for the CM with a cut-off RHS of 1.5 amounted to 0.96 and 0.88 respectively. Conclusion The CM at the CFV is an indirect diagnostic criterion of RVD with acute PE. In the case of suspected PE, the absence of CM excludes a RVD. Disappearance of CM during the clinical course of PE indicates improvement in RV function.

Duplex Ultrasound in the Diagnosis of Lower-Extremity Deep Venous Thrombosis

A 26-year-old woman presented with progressive swelling and pain of the left leg within 2 months after switching to a different oral contraceptive preparation. On examination, she had marked edema and erythema of the leg from the calf to the thigh with significant tenderness to palpation. Pedal pulses were intact. The right leg was normal. Lower-extremity venous duplex ultrasound (VDUS) with B-mode compression maneuvers and Doppler evaluation was performed, and she was found to have an acute deep venous thrombosis (DVT) of the left leg that extended from the common iliac vein into the left calf (Figure 1A–1E). Figure 1. Acute iliofemoral deep venous thrombosis (DVT) in a 26-year-old woman with left leg swelling. A , B-mode image of a dilated external iliac vein (arrow) next to the external iliac artery (arrowhead). Intraluminal echoes are present, consistent with thrombus. B , Nearly complete loss of compressibility of the external iliac vein, consistent with acute DVT. C , Spectral Doppler waveform analysis with absent venous flow in the thrombosed and occluded external iliac vein (EIV). Lt DIST indicates left distal. D , B-mode image of acute DVT involving the profunda and femoral confluence into the common femoral vein. E , Color-flow Doppler image demonstrating absent flow in the common (CFV) and femoral (FV) vein and minimal flow in the profunda femoral vein (PFV; arrow). VDUS combines 2 components to assess for DVT: B-mode or gray-scale imaging with transducer compression maneuvers and Doppler evaluation consisting of color-flow Doppler imaging and spectral Doppler waveform analysis.1 The technique of compression B-mode ultrasonography for the diagnosis of DVT was first described by technologist Steve Talbot in 1982 and has subsequently been refined to become the diagnostic standard.2 B-mode imaging is used while the lower-extremity veins are compressed along their length with the ultrasound probe …

Femoral Pseudoaneurysm With a Communicating Arteriovenous Fistula

A 61-year-old man with acute myocardial infarction developed a painful hematoma in his groin after percutaneous coronary intervention. Ultrasonography, including color Doppler, detected a pulsatile, hypoechogenic, single compartment lesion (2.3 × 3.0 × 2.9 cm) consistent with a partially thrombosed pseudoaneurysm originating from the distal part of the common femoral artery (Figure, A). Sampling from the neck of the pseudoaneurysm connecting the pseudoaneurysm to the common femoral artery, spectral Doppler waveform analysis unexpectedly displayed flow directed toward the pseudoaneurysm cavity both in systole and diastole (Figure, B), in contrast to the characteristic to and fro–like flow pattern detected in uncomplicated pseudoaneurysms (Figure, C). The …

Evaluation of disease activity in ankylosing spondylitis; diagnostic value of color Doppler ultrasonography

Spondyloarthropathies including ankylosing spondylitis (AS) require early diagnosis to prevent irreversible changes. Sacroiliitis is a common initial manifestation of AS and is frequently diagnosed by magnetic resonance imaging (MRI). The goal of our study was to assess color Doppler ultrasonography as a potential diagnostic tool in suspected sacroiliitis in comparison with MRI representing the gold standard. Fifty-one consecutive patients with AS and sacroiliitis and 30 control subjects underwent contrast-enhanced MRI and high resolution color Doppler and duplex ultrasonography of both sacroiliac joints (SIJ) for the detection of vascularization and blood flow spectral Doppler waveform analysis. MRI demonstrated active disease in 27 and inactive disease in 24 patients. CDUS detected pulsatile monophasic wave spectral waveform flow in 22 patients with the active disease, and triphasic in 7 patients with inactive disease and in 8 control patients. The sensitivity, specificity, positive predictive value and negative predictive value for active sacroiliitis detection with CDUS were 82 % (95 % CI, 68-91 %), 92 % (95 % CI, 85-96 %), 91 % (95 % CI, 84-96 %), and 84 % (95 % CI, 70-92 %), respectively, for pulsatile monophasic wave spectral waveform Doppler sonography. MRI of SIJ was negative in all 30 (60 SIJ) control participants. Our results show that CDUS is a practical and useful tool in the diagnosis of active sacroiliitis.

Guidelines for noninvasive vascular laboratory testing: a report from the American Society of Echocardiography and the Society for Vascular Medicine and Biology

Accompanying the rapid growth of interest in percutaneous vascular interventions, there has been increasing interest among cardiologists in performing noninvasive vascular testing using ultrasound. In an attempt to provide recommendations on the best practices in vascular laboratory testing, this report has been prepared by a writing group from the American Society of Echocardiography (ASE) and the Society for Vascular Medicine and Biology. The document summarizes principles integral to vascular duplex ultrasound--including color Doppler, spectral Doppler waveform analysis, power Doppler, and the use of contrast. Appropriate indications and interpretation of carotid artery, renal artery, abdominal aorta, and peripheral artery ultrasound imaging are described. A dedicated section summarizes noninvasive techniques for physiologic vascular testing of the lower extremity arteries--including measurement of segmental pressures and pulse volume plethysmography. The use of exercise testing in the evaluation of peripheral artery disease, ultrasound evaluation of the lower extremities after percutaneous revascularization, and the diagnosis and management of iatrogenic pseudoaneurysm (PSA) is also discussed. A section on the important topic of vascular laboratory accreditation is included. Finally, additional details regarding proper technique for performance of the various vascular tests and procedures are included in the Appendix.

Guidelines for Noninvasive Vascular Laboratory Testing: A Report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology

Accompanying the rapid growth of interest inpercutaneous vascular interventions, there hasbeen increasing interest among cardiologists inperforming noninvasive vascular testing using ul-trasound. In an attempt to provide recommenda-tions on the best practices in vascular laboratorytesting, this report has been prepared by a writinggroup from the American Society of Echocardiog-raphy (ASE) and the Society of Vascular Medicineand Biology. The document summarizes principlesintegral to vascular duplex ultrasound–includingcolor Doppler, spectral Doppler waveform analy-sis, power Doppler, and the use of contrast.Appropriate indications and interpretation of ca-rotid artery, renal artery, abdominal aorta, andperipheral artery ultrasound imaging are de-scribed. A dedicated section summarizes noninva-sive techniques for physiologic vascular testing ofthe lower extremity arteries–including measure-ment of segmental pressures and pulse volumeplethysmography. The use of exercise testing inthe evaluation of peripheral artery disease, ultra-sound evaluation of the lower extremities afterpercutaneous revascularization, and the diagnosisand management of iatrogenic pseudoaneurysm(PSA) is also discussed. A section on the importanttopic of vascular laboratory accreditation is in-cluded. Finally, additional details regarding propertechnique for performance of the various vasculartests and procedures are included in the Appen-dix.

Upper-Extremity Venous Duplex Evaluation

As many as 80% of upper-extremity venous thrombosis cases develop in response to an easily identified problem, such as central venous catheter. The remaining 20% of obstructions are caused by other central venous obstruction, trauma, or Paget-Schroetter syndrome. Appropriate clinical indications for upper-extremity venous duplex evaluation include (but are not limited to) unilateral upper-extremity swelling in the presence of indwelling central venous catheter, upper-extremity erythema and tenderness, superficial palpable cord, or facial swelling. Physical examination and thorough patient history compliment the duplex findings to arrive at an accurate diagnosis. The most effective way to determine the presence or absence of thrombosis is with vein wall compressions. However, most of the upper-extremity central vein segments are located beneath bony structures, which prevent extrinsic compression with transducer pressure. Therefore, the spectral Doppler waveform analysis component of the duplex exam becomes crucial in determining venous obstruction. Common technical components and pitfalls include appropriate color and spectral Doppler settings to reliably demonstrate presence/absence of flow or accurate accounting for innominate vein and supraclavicular/infraclavicular subclavian vein versus occluded native anatomy and large patent branches. When properly executed, the aforementioned components comprise a thorough duplex evaluation of the upper extremity venous system.

Spectral doppler characterization of endoleaks following endoluminal abdominal aortic aneurysm repair

Colour Doppler ultrasound of endoluminal abdominal aortic aneurysm repair is becoming an established imaging technique in identifying endoleak. Management and treatment of endoleak is determined in part by the exact nature of the endoleak, namely its type and whether it has single or multiple vessel inflow and outflow. To date, spectral Doppler waveform analysis has provided some information about the propensity for spontaneous seal of isolated type II endoleaks, rather than assisting in their classification. We present a collection of three case reports outlining the directionality/phasicity of the Doppler waveform profile associated with endoleaks whose type and subtype (uni- /or multi-conduital) were angiographically determined. In all three cases uniconduital type II endoleak demonstrated a to-and-fro waveform on Doppler ultrasound imaging. To-and-fro Doppler waveforms may be associated with uniconduital type II endoleaks. If upon investigation of further cases this is found to be the case, this waveform classification may facilitate determination of the subtype (uni- or multi-conduital) of endoleak, thus identifying those cases which may be more amenable to percutaneous repair.

Torsion and beyond: new twists in spectral Doppler evaluation of the scrotum.

To illustrate how spectral Doppler waveform analysis plays an adjunctive but very definite role in scrotal sonography. The cases illustrate a variety of testicular disorders that were collected at a referral tertiary care center. Normal and a variety of pathologic conditions of the testes are discussed, along with their signature spectral waveforms. Analysis of the spectral waveform provides important additional information in various scrotal disorders with acute pain. Spectral waveform analysis is critical to diagnosing incomplete torsion when color and power Doppler examinations are indeterminate.

Imaging evaluation of suspected pulmonary embolism

Venous thromboembolism (VTE) is a common disorder that is difficult to diagnose clinically but carries significant morbidity and mortality if untreated. Additionally, although demonstrated to be of benefit in cases of proven deep vein thrombosis (DVT) and pulmonary embolism (PE), anticoagulation therapy is not without risk. Because the clinical exam is known to be unreliable for the detection of both DVT and PE, many imaging modalities have been used in the diagnostic imaging algorithm for the detection of VTE, including chest radiography, ventilation/perfusion (V/Q) scintigraphy, pulmonary angiography, and recently, spiral computed tomography (CT) and magnetic resonance imaging (MRI). Chest radiographic findings in acute PE include focal oligemia, vascular enlargement, atelectasis, pleural effusions, and air space opacities representing pulmonary hemorrhage or infarction. The chest radiograph can occasionally be suggestive of PE but is more often nonspecifically abnormal. The main use of the chest radiograph in the evaluation of suspected PE is to exclude entities that may simulate PE and to assist in the interpretation of V/Q scintigraphy. Lower extremity venous compression ultrasonography (CU) is both sensitive and specific for the diagnosis of femoropopliteal DVT, and the value of negative CU results has been established in outcomes studies. However, the reliability of CU for the detection of isolated calf vein thrombosis is not well established, and the clinical significance of such thrombi is debatable. Additional methods such as color and spectral Doppler analysis are also useful in the diagnostic evaluation of DVT but are best considered as adjuncts to the conventional CU examination rather than as primary diagnostic modalities themselves. Compression ultrasonography and Doppler techniques are useful in the evaluation of suspected upper extremity DVT; spectral Doppler waveform analysis is particularly useful to assess for the patency of veins that cannot be directly visualized and compressed with conventional gray-scale sonography. V/Q scintigraphy has been the initial modality obtained in patients suspected of PE for a number of years. Although many studies have investigated the role of V/Q scintigraphy in the evaluation of VTE, the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study has provided the most useful information regarding the utility of V/Q scintigraphy in this setting. A high probability scan interpretation is sufficient justification to institute anticoagulation, and a normal perfusion scan effectively excludes the diagnosis of PE. A normal/near normal scan interpretation also carries a sufficiently low prevalence of angiographically proven PE to withhold anticoagulation. Although the prevalence of PE in the setting of low probability scan interpretations is low and several outcomes studies have demonstrated a benign course in untreated patients with low probability scan results, patients with inadequate cardiopulmonary reserve do not necessarily have good outcomes. Such patients deserve more aggressive evaluation. Patients with intermediate probability scan results have a 20% to 40% prevalence of angiographically proven PE and thus require further investigation. The radionuclide investigation of DVT includes such techniques as radionuclide venography and thrombus-avid scintigraphy. Although these methods have not been as thoroughly evaluated as CU, studies thus far have indicated encouraging results, and further investigations are warranted. Pulmonary angiography has been the gold standard for the diagnosis of PE for decades. Studies have indicated that angiography has probably been underutilized by referring physicians for the evaluation of suspected PE, likely because of the perception of significant morbidity and mortality associated with the procedure. (ABSTRACT TRUNCATED)

The value of portal vein pulsatility on duplex sonograms as a sign of portal hypertension in children with liver disease.

The purpose of this study was to determine the significance of portal vein pulsatility on duplex Doppler waveforms in children with end-stage hepatic failure undergoing liver transplantation. Thirty-eight children with end-stage hepatic decompensation were examined with color-assisted spectral Doppler waveform analysis of the hepatic artery and the portal vein. Correlation was made with age, duration of illness, clinical and pathologic diagnosis, and presence of portal hypertension. Findings were compared with those for six patients with acute viral hepatitis and 12 healthy control subjects. Portal vein pulsatility was noted in all 36 patients in whom portal vein flow was detected by Doppler imaging. The majority of these (34) had clinical or sonographic evidence of portal hypertension. In two patients, no portal vein flow was identified in the liver hilum; both had a large portosystemic shunt through collaterals or surgical graft. Significantly increased pulsatility of the hepatic artery waveform (resistive index [RI] = 0.89 +/- 0.15, p < .0001) was seen in patients with end-stage liver disease. In contrast, no portal vein pulsatility and normal hepatic artery pulsatility (RI = 0.60 +/- 0.11) was noted in all patients with acute hepatitis and control subjects. Portal vein waveform pulsatility is 94% sensitive and 90% specific for portal hypertension in end-stage liver disease.