Color Doppler Ultrasound Imaging Research Articles

Ultrasonograms showing multiple myeloma in the skull.

areas of severe bone loss typical of osteolytic lesions (Fig. 1). A computed tomographic scan of the head showed multiple tumors in the diploe and subscalp. Ultrasonography (US) of the right temporal tumor showed a fl at, hypoechoic 2.5 × 1.0-cm mass with heterogeneous components on the surface of the skull that appeared to be lifting the pericranium (Fig. 2). Color Doppler ultrasound imaging revealed rich vascularity, and the blood fl ow passed mainly through the cranium (Fig. 3). Ultrasound examination of the tumor in the parietal region showed a hypoechoic 2.0-cm mass in the diploe of the skull, which corresponded to the punchedout lesion and showed hypertrophy of the pericranium near the tumor (Fig. 4). Ultrasound also showed part of the cerebrum through the bone defi cit area. Ultrasound-guided fi ne-needle aspiration cytology (FNAC) of the right temporal tumor showed atypical round cells of various sizes, some of which were multinucleated. The histologic fi ndings were consistent with a diagnosis of multiple myeloma.

The Effect of Caffeine on Retrobulbar Hemodynamics

Background: To investigate the acute effect of caffeine on intraocular pressure and retrobulbar blood flow velocity. Methods: In this randomized, double-masked, placebo-controlled, prospective study, we examined the effects of single 300-mg oral administration of caffeine on retrobulbar arteries' hemodynamics by using color Doppler ultrasonography imaging in healthy human volunteers. The subjects were divided into two groups; group 1 received a 300-mg caffeine tablet and group 2 received placebo. Measurements were obtained in two eyes at baseline, and 1 hr after acute ingestion of caffeine. Blood pressure, pulse rate, and intraocular pressure were monitored. Results: When compared with placebo, no significant change in mean blood pressure or intraocular pressure was observed after administration of caffeine. No significant differences were detected in the peak systolic and end diastolic velocities of retrobulbar arteries, compared with baseline values. Resistive index of ophthalmic, central retinal, and short posterior nasal ciliary artery were significantly increased after oral application of caffeine in group 1 (p < 0.05). Conclusion: The vascular resistance of the retrobulbar vessels appears to be altered by caffeine consumption. Further studies are needed to investigate the effects of caffeine on hemodynamics in patients with glaucoma.

Remitting seronegative syndrome with pitting edema as the presenting symptom in a young, male patient with sarcoidosis: A case report

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a clinical diagnosis based on an abrupt onset of pitting edema of the dorsum of the hands or feet associated with synovitis of the wrist carpus and/or ankles, small joints, and tendon sheaths. RS3PE typically occurs in elderly patients, especially in men. A specific laboratory test for RS3PE syndrome is not yet available. However, recently published data provide evidence that color Doppler ultrasound (CDUS), contrast-enhanced CDUS, and magnetic resonance imaging are valuable tools in the diagnostic evaluation of involved anatomic structures in patients with RS3PE (1,2). Although idiopathic RS3PE has a benign prognosis with rapid and sustained response to low-dose steroid therapy, RS3PE may also be associated with different rheumatic and neoplastic diseases including myelodysplastic syndrome, non-Hodgkin’s lymphoma, T cell lymphoma, and chronic lymphocytic leukemia (3–11). The coincidence of RS3PE and sarcoidosis has been suggested in only one 62-year-old patient so far (12). Sarcoidosis is a chronic multisystemic disorder histologically characterized by noncaseating epithelioid cell granuloma (13). The lung is the most frequently affected organ ( 90%), but the skin, eyes, liver, and lymph nodes are also commonly involved (14). In this report, we describe the case of a 32-year-old man presenting with RS3PE syndrome. Further examinations led to the diagnosis of underlying sarcoidosis.

A Reconstruction Method for Gappy and Noisy Arterial Flow Data

Proper orthogonal decomposition (POD), Kriging interpolation, and smoothing are applied to reconstruct gappy and noisy data of blood flow in a carotid artery. While we have applied these techniques to clinical data, in this paper in order to rigorously evaluate their effectiveness we rely on data obtained by computational fluid dynamics (CFD). Specifically, gappy data sets are generated by removing nodal values from high-resolution 3-D CFD data (at random or in a fixed area) while noisy data sets are formed by superimposing speckle noise on the CFD results. A combined POD-Kriging procedure is applied to planar data sets mimicking coarse resolution "ultrasound-like" blood flow images. A method for locating the vessel wall boundary and for calculating the wall shear stress (WSS) is also proposed. The results show good agreement with the original CFD data. The combined POD-Kriging method, enhanced by proper smoothing if needed, holds great potential in dealing effectively with gappy and noisy data reconstruction of in vivo velocity measurements based on color Doppler ultrasound (CDUS) imaging or magnetic resonance angiography (MRA).

P30.13: MRI and 3D ultrasound: a combined evaluation for placenta percreta? Case report

Congenital hemangiomas are rare solitary lesions, mostly located in the head and the limbs. Giant hemangiomas are frequently associated with life-threatening complications such as high-output heart failure, anemia, thrombocytopenia and disseminated intravascular coagulopathy (Kasabach-Merritt syndrome). Prenatal diagnosis and management is possible in the second and third trimesters of pregnancy with twoand three-dimensional sonography, color Doppler ultrasound and magnetic resonnace imaging. We present two cases of cutaneous limb hemangioma. In the first fetus, anemia and heart failure were the presenting features associated to the diagnosis of a giant hemangioma of the leg at 26 weeks of pregnancy. After full information on diagnosis and prognosis, future parents decided to terminate the pregnancy. In the second fetus, an upper limb hemangioma was diagnosed at 33 weeks of pregnancy. Delivery was anticipated because anemia was suspected. After birth, a low platelet count was descovered, pointing to a Kasabach-Merritt sequence. The female newborn was started on high dose prednisone with a rapid reduction in size of the tumor. These examples illustrate the variable outcome of seemingly similar hemangiomas and underlines the value of proper imaging studies in making accurate decisions with respect to handling.

P30.12: Prenatal diagnosis of velamentous cord insertion and vasa previa by MRI: a case report

Congenital hemangiomas are rare solitary lesions, mostly located in the head and the limbs. Giant hemangiomas are frequently associated with life-threatening complications such as high-output heart failure, anemia, thrombocytopenia and disseminated intravascular coagulopathy (Kasabach-Merritt syndrome). Prenatal diagnosis and management is possible in the second and third trimesters of pregnancy with twoand three-dimensional sonography, color Doppler ultrasound and magnetic resonnace imaging. We present two cases of cutaneous limb hemangioma. In the first fetus, anemia and heart failure were the presenting features associated to the diagnosis of a giant hemangioma of the leg at 26 weeks of pregnancy. After full information on diagnosis and prognosis, future parents decided to terminate the pregnancy. In the second fetus, an upper limb hemangioma was diagnosed at 33 weeks of pregnancy. Delivery was anticipated because anemia was suspected. After birth, a low platelet count was descovered, pointing to a Kasabach-Merritt sequence. The female newborn was started on high dose prednisone with a rapid reduction in size of the tumor. These examples illustrate the variable outcome of seemingly similar hemangiomas and underlines the value of proper imaging studies in making accurate decisions with respect to handling.

P30.11: Prenatal diagnosis and management of giant fetal limb hemangioma by two‐ and three‐dimensional sonography, color Doppler ultrasound and magnetic resonance imaging

P30.11: Prenatal diagnosis and management of giant fetal limb hemangioma by two‐ and three‐dimensional sonography, color Doppler ultrasound and magnetic resonance imaging

Differentiation of Malignant From Benign Distal Ureteral Obstructions

The purpose of this study was to evaluate the feasibility of transrectal ultrasonography (TRUS) and color Doppler ultrasonography (CDUS) in differentiating malignant from benign distal ureteral obstructions. Our study group consisted of 16 malignant distal ureteral obstructions and 12 benign distal ureteral obstructions. The 16 malignant distal ureteral obstructions were transitional cell carcinomas involving the distal ureter. The 12 benign distal ureteral obstructions consisted of benign strictures (n = 4), ureteral edema after stone passage (n = 3), tuberculosis (n = 2), a fibroepithelial polyp (n = 1), amyloidosis (n = 1), and a hematoma (n = 1). Findings from gray scale transabdominal ultrasonography, gray scale TRUS, CDUS, and duplex Doppler imaging were retrospectively evaluated. Gray scale transabdominal ultrasonography and TRUS showed no specific difference between malignant and benign distal ureteral obstructions. On CDUS, malignant distal ureteral obstructions showed dotlike blood flow in 5, moderately increased blood flow in 9, and markedly increased blood flow in 2; and benign distal ureteral obstructions showed absence of blood flow in 5 and dotlike blood flow in 7. Flow spectra could be obtained in 12 malignant distal ureteral obstructions, and they showed arterial waveforms. Duplex Doppler imaging was not tried in 4 malignant distal ureteral obstructions. In 7 benign distal ureteral obstructions with dotlike blood flow, flow spectra could not be obtained. Moderately or markedly increased blood flow within a ureteral mass on CDUS and an arterial waveform within a ureteral mass on duplex Doppler imaging may be helpful in differentiating malignant from benign distal ureteral obstructions.

Successful ultrasound‐guided laser treatment of fetal hydrops caused by pulmonary sequestration

Microcystic or solid-looking fetal lung lesions associated with hydrops are associated with a high mortality rate. The most common of these lesions are microcystic congenital cystic adenomatoid malformations and pulmonary sequestrations (PS). Performing open fetal surgery by hysterotomy and lobectomy has, until now, been the only therapeutic option available following diagnosis of these lesions in the second trimester. Here we describe a new minimally invasive technique for the treatment of PS in the second trimester. Laser coagulation of the feeding systemic artery of the sequestration was performed under ultrasound guidance. The blood flow to the lung tumor was successfully arrested and hydrops reversed. The child was born at term and, at the time of writing, was alive and well at 2 years of age. Large PS with hydrops can be treated successfully by ultrasound-guided minimally invasive laser surgery. It is therefore important to utilize color Doppler ultrasound imaging for identification of a systemic feeding blood vessel in solid fetal lung tumors. Published by John Wiley & Sons, Ltd.

Blood Flow Occlusion Via Ultrasound Image-Guided High-Intensity Focused Ultrasound and Its Effect on Tissue Perfusion

This study investigated the induction of tissue necrosis by arterial blood flow occlusion using ultrasound image-guided high-intensity focused ultrasound (HIFU). We constructed a prototype HIFU transducer in combination with an imaging probe that provided color Doppler imaging and ultrasound contrast imaging. The HIFU beam was aimed into a branch of the renal artery in vivo. The renal artery branches of eight rabbits were occluded by HIFU at an intensity of 4 kW/cm 2 (from 2 to 10 times of each sonication for 5 s). When the HIFU exposure was successful, complete cessation of blood flow was observed by color Doppler imaging with success rate of 100% (8/8). Furthermore, lack of perfusion was observed in the renal cortex with a contrast-enhanced image. Postmortem histologic evaluation showed a wedge-shaped area of infarction in six of seven cases, corresponding to the lack of the contrast medium in the ultrasound image. These results demonstrated that ultrasound image-guided HIFU can be used to induce arterial occlusion, thus producing infarction and necrosis of the perfused tissue. (E-mail: m_itihara@hotmail.com)

Achilles tendon pain intensity and level of neovascularization in athletes as determined by color Doppler ultrasound

The cause of pain in Achilles tendinopathy is thought to be related to the presence of neovascularization in the tendon as seen on color Doppler ultrasound. Asymptomatic pathology has been observed in patellar tendons of elite athletes. The purpose of this study was to examine the prevalence of Achilles tendon pain and the characteristics of Achilles tendons in a young athletic population. Sixty-four varsity athletes underwent color Doppler ultrasound imaging to determine tendon thickness, presence of degeneration and neovascularization. The presence of swelling and tenderness was determined, and Achilles tendon pain was rated on three visual analogue scales (VAS) (pain during exercise, pain at rest, pain during daily activities) as well as on the VISA-A scale. Tendon symptoms were not related to the presence of neovascularization. There was a low prevalence of Achilles tendinopathy, tenderness, and neovascularization in this population. Neovascularization was seen in both a painful and a non-painful tendon.

Differentiation of mild and severe stenosis with motion estimation in ultrasound images

Doppler ultrasound technique is now recognized as the best noninvasive screening test for carotid artery stenosis. Ultrasound does not calculate directly the degree of arterial narrowing, but relies on extrapolating the changes in blood flow parameters to an anatomical stenosis. This paper deals with the estimation of the stiffness indices of mild and severe stenosis of common carotid artery by motion estimation algorithm, focusing on their changes with the progression of atherosclerosis. 145 men with the mean age of 55 ± 12 y who were healthy or had mild stenosis or severe stenosis were studied. For each ultrasound examination, matching longitudinal views of the common carotid artery were located, the frames were grabbed and processed with motion estimation algorithm and then diameter, cross-section changes and intima-media thickness of the right common carotid artery were estimated. The blood pressure was recorded in the right brachial artery using a semiautomatic device. The arterial diameter and cross-section changes and intima-media thickness were used together with the blood pressure measurements to estimate standard arterial stiffness indices. Relative diameter changes in carotid arteries with mild and severe stenosis were decreased by 22% to 48%, respectively, compared with healthy carotid artery. Systolic blood pressure in mild stenosis was approximately 4.4% lower and in severe stenosis was 2.0% higher compared with the healthy carotid. The stiffness indices were significantly different in the group of patients with severe stenosis ( p-value < 0.05) compared with the healthy and mild stenosis subjects. It is concluded that, regarding the influence of atherosclerosis on the stiffness indices of right common carotid artery, we can differentiate mild and severe stenosis in carotid artery, through processing the sequential color Doppler ultrasound images by optical flow tracking algorithm. (E-mail: mokhtarm@modares.ac.ir)

Pictorial Essay: US Diagnosis of Urinary Tract Calculi in Children Using the 'Twinkling Sign'

Colour or power Doppler US examinations of a strongly echogenic and reflective structure can elicit the formation of an artefact distal to this structure at the site one normally expects to find an acoustic shadow. This artefact presents in colour Doppler as multi-pixel, multi-coloured, meteorite-tail-shaped configuration, commonly known as the 'twinkling sign'. Spectral Doppler at this site does not yield any flow. The two current hypotheses regarding the formation of the twinkling artefact are complex beam reflection interpreted by the Doppler as movement and intrinsic machine noise ('phase jitter'). The use of the twinkling sign as an additional diagnostic tool of concrements and calcifications has been evaluated in a number of in vitro and adult clinical studies. There is a lack of reports about the application of the twinkling sign in children. In this pictorial essay an array of colour Doppler ultrasound (US) images of urolithiasis in children is presented, featuring various facets of this US diagnostic tool. There are a number of technical parameters of an US machine that have a major influence with regards to inducing the twinkling artefact. The use of low frequency transducer combined with very high setting of the pulse repetition frequency seems to give the best result. The twinkling sign can be helpful in detecting small and obscured concrements, and may also have potential in characterization the type of stone. It is essential to gain more experience in the paediatric population on the twinkling sign and evaluate its usefulness in enhancing the sonographic diagnosis of urinary calculi thus curtailing the number of X-ray examinations, and consequently the radiation exposure.

Carotid Artery Stenting With Filter Protection in High-Risk Patients Showing Severe Electroencephalographic Alterations During Carotid Endarterectomy

To describe the results and efficacy of stent treatment in patients with carotid stenosis who had aborted carotid endarterectomy procedures due to the appearance of severe electroencephalographic (EEG) alterations. A retrospective study was conducted of 18 patients (11 men; mean age 72 years, range 62-84) with symptomatic high-grade carotid artery stenoses (> or = 70%) who experienced severe EEG alterations during carotid endarterectomy, causing the procedure to be aborted. Twelve patients had shown no hemodynamic alterations during preoperative transcranial Doppler evaluation after external compression of the common carotid artery; the remaining 6 could not be evaluated. The patients were referred for carotid artery stenting (CAS); 7 had contralateral internal carotid artery stenosis and 5 had contralateral occlusion. Endovascular intervention was carried out using standard techniques under filter protection. Follow-up was scheduled at 3, 6, and 12 months. All patients were successfully treated without immediate complications. The EEG did not display any significant alterations during the endovascular procedure. Mean follow-up was 43 months. Magnetic resonance imaging at 6 months showed no signs of cerebral ischemia. Color Doppler ultrasound imaging documented normal stent patency in all patients. Patients with symptomatic severe carotid stenosis (> or = 70%) who are considered at risk due to the appearance of severe EEG alterations during surgical treatment may benefit from CAS with respect to both major and minor complications. Larger studies are needed to confirm these findings.

3594: The experimental study of the contrast-enhanced sonography in the assessment of arterial Stenosis

Objectives: To evaluate the ability of contrast-enhanced color Doppler ultrasound (US) and contrast-enhanced real-time harmonic gray scale imaging in the diagnosis of arterial stenosis and the assessment of stenosis degree.

Femoral Pseudoaneurysm Due to Diagnostic or Interventional Angiographic Procedures

The authors investigated the incidence of, diagnostic methods for, and treatment strategies for iatrogenic femoral pseudoaneurysms in their hospital and compared the results with those in the literature. The hospital records of 25,273 patients who had coronary or peripheral angiography and angioplasty in Sani Konukoglu Medical Center from September 1997 to December 2002 were collected retrospectively. All the complications were detected and femoral pseudoaneurysm cases were selected. Diagnostic criteria and treatment strategy were documented. All results were compared with the literature. Femoral pseudoaneurysm was the second in number of complications and bleeding the first. Twenty-eight patients with pseudoaneurysm were diagnosed with color Doppler ultrasound (US) imaging (0.11%). Eleven of these closed spontaneously within 3-7 days. Image-guided compression therapy was applied to the remaining 17 and was effective in 10. The remaining 7 patients were operated on successfully. In this series the incidence of iatrogenic femoral pseudoaneurysm was comparable with the literature (0.02%-2%). Color Doppler US is the best diagnostic tool for this complication, and no other method was necessary. Eleven cases of spontaneous closure may show a rather benign prognosis, but close follow-up is advised. Image-guided compression is also an effective and noninvasive method of therapy for this complication. In late cases with a thick neck, surgery should be done immediately. It is easy to prevent rather than treat this complication. The similar incidence in the literature and in this series shows that a number of complications are to be expected, and so prompt and early diagnosis and effective treatment are very important. Application of good external compression after catheterization, selecting the thinnest introducer, use of B-mode and color Doppler US imaging for suspected cases, and image-guided compression therapy are also effective in early cases with a thin neck of the aneurysm.

Remitting seronegative symmetrical synovitis with pitting edema of the hands: Ultrasound, color doppler ultrasound, and magnetic resonance imaging findings

To assess the value of gray-scale ultrasound (US), color Doppler ultrasound (CDUS), contrast-enhanced CDUS, and magnetic resonance imaging (MRI) in the diagnostic evaluation of the hands in patients with remitting seronegative symmetrical synovitis with pitting edema (RS3PE). Eight patients (5 men, 3 women; mean +/- SD age 69.3 +/- 7.2 years) with clinical diagnosis of RS3PE syndrome underwent US, CDUS, contrast-enhanced CDUS, and MRI. US was performed with a linear array transducer operating at 12 MHz. The US contrast agent (SHU 508; Levovist, Schering, Germany) was intravenously infused in a concentration of 300 mg/ml at a rate of 1 ml/minute. All patients showed symmetric subcutaneous edema and synovitis of tendons and finger joints on both US and MRI. Vascularity was detected subcutaneously in tendon sheaths and in the joint synovia on CDUS and MRI. Detection of increased vascularity was improved after contrast administration compared with unenhanced CDUS (P < 0.01). Ultrasound, CDUS, contrast-enhanced CDUS, and MRI are valuable tools in the diagnostic evaluation of involved anatomic structures in patients with RS3PE. Contrast-enhanced CDUS is superior to CDUS in assessment of inflammatory edema, effusion, and synovitis.

Role of Grayscale and Color Doppler Ultrasonography in the Diagnosis and Outcome Analysis of Testicular Torsion

Ultrasonography (US) plays an important role in helping to differentiate acute epididymo-orchitis from testicular torsion, which is a surgical emergency. Both manifest with acute pain and swelling. Clinical differentiation of these conditions is difficult, with a false-positive rate of nearly 50%, and can result in unnecessary surgical exploration. The purpose of this study was to diagnose and analyze outcomes in patients with suspected testicular torsion by using grayscale and color Doppler US. A total of 15 patients with the final diagnosis of testicular torsion confirmed at operation were retrospectively reviewed. Eleven of the 15 underwent grayscale and color Doppler US imaging using a high frequency linear transducer. The four patients who did not undergo US were excluded. All of the US images were analyzed and compared with operating and pathologic results. Color Doppler US revealed a lack of intratesticular blood flow in the affected testis and normal flow within the contralateral testis in all 11 patients. Grayscale US findings varied, and it was found that all three salvage testes appeared homogeneous or had a slightly increased testicular echogenicity on grayscale US. Color Doppler and grayscale US accurately assesses testicular torsion and can reflect the outcome of the affected testis.

Evaluation of joint effusion in rabbits by color Doppler, power Doppler, and contrast-enhanced power Doppler ultrasonography

The aim of this prospective study was to evaluate the diagnostic value of power Doppler ultrasonography (PDUS) and contrast-enhanced PDUS (CEPDUS) in the depiction and characterization of experimentally induced arthritis in the rabbit. Thirty rabbits were divided into three groups consisting of one control group (saline injection group) and two experimental groups: a suppurative arthritis group and a chemically induced synovitis group. The same amount (1 ml) of each agent was directly injected into the right hip joint. Serial color Doppler ultrasound (CDUS), PDUS, and CEPDUS images were obtained before and after injection. We observed that all of the infected knees in the suppurative arthritis group with Staphylococcus aureus demonstrated an increased signal on PDUS after inoculation. A minimal power Doppler signal was presented in the chemically induced synovitis group with talc injection, but none of the control knees demonstrated any increased signals. CEPDUS was the most sensitive imaging modality for evaluating the increase of blood flows in suppurative arthritis and was subsequently followed by PDUS and CDUS. The increased signals obtained with PDUS represent increased local blood flows; therefore, this technique can be used for evaluating the degree of inflammation. Furthermore, using the contrast agent enhances the sensitivity of PDUS, and it can even be useful for differentiating borderline cases.

Ultrasonography of ovarian tumors: predictability of tumor type

OBJECTIVE: To determine the accuracy of ultrasonography in predicting the tumor type, so that the diagnosis of malignancy can be suggested preoperatively and appropriate treatment planned. DESIGN: Descriptive study. SETTING: Department of Gynaecology and Obstetrics, Liaquat University Hospital, Hyderabad, Pakistan from 1996-2000. PATIENTS AND METHODS: Case records of 87 patients with ovarian tumors were analyzed. All these patients had preoperative ultrasound examination. Ultrasound findings were compared with histopathological findings. RESULTS: Four patients with false positive diagnosis of ovarian tumor were excluded from this study. Out of 83 cases, 59 were benign and 24 malignant ovarian tumors. Solid component was present in 80% cases of malignant tumors and 20% of malignant tumors were cystic with septations. Solid component was also seen in 27.58% of benign tumors. Unilocular clear cysts were all benign. Dermoid cysts were all diagnosed on ultrasound. CONCLUSION: Anechoic masses have high probability of being benign and possibility of malignancy increases with the presence of solid component. Sensitivity and specificity for diagnosing malignant tumor can increase with the use of transvaginal color Doppler Ultrasound and magnetic resonance imaging.