Use Of Color Doppler Sonography Research Articles

Preoperative Assessment for Coronary Artery Bypass Graft: Going Back to the Basics

As doctors increasingly rely on technological advancements, ever-improving laboratory techniques, and imaging modalities, the importance of a thorough physical evaluation and bedside manner has been noticeably diminished. When it comes to patients scheduled for coronary artery bypass graft (CABG), the preoperative bilateral arm blood pressure (BP) measurement is often omitted; thus, sinister signs of atherosclerotic disease like the brachial gradient are neglected and the surgical plan is jeopardized. We present the case of a 72-year-old male listed for CABG, stressing the necessity of meticulous clinical examination and the routine use of color Doppler ultrasonography (CDUS), prior to surgery. This case aims to highlight the major role of thorough preoperative clinical assessment. The bilateral BP measurement and CDUS are two reliable, expeditious, noninvasive preoperative screening methods, which can detect patients with generalized atherosclerosis, altering, if necessary, the surgical plan, and aiming for the best possible outcome, without complications.

Cystic ovarian disease in dairy cattle: Diagnostic accuracy when using B-mode and color Doppler ultrasound

The most frequently reported definition of cystic ovarian disease in cattle is an abnormally persistent follicle (>7 to 10 d) with a diameter >25 mm. Discrimination between luteal and follicular ovarian cystic structures has traditionally been conducted by measuring the rim width of luteal tissue. The most common practice used in the field for diagnosis of cystic ovarian disease is examination by rectal palpation with or without the use of a B-mode ultrasound. Color Doppler ultrasound technology allows assessment of blood flow area measurements in the ovary, which has been proposed as a potential indirect measure for plasma progesterone (P4) concentrations. The objective of this study was to compare the diagnostic accuracy of differentiating luteal structures from follicular ovarian cysts using measures collected with B-mode and color Doppler transrectal ultrasonography. The definition of an ovarian cyst was a follicle greater than 20 mm in diameter in the absence of a corpus luteum that persisted for at least 10 d. A 3-mm luteal rim width was used to differentiate follicular and luteal cysts. A total of 36 cows were enrolled in the study during routine herd reproductive examination visits, with 26 and 10 having follicular and luteal cysts, respectively. Cows enrolled in the study were examined using a Mini-ExaPad mini ultrasound with color Doppler capabilities (IMV Imaging Ltd.). Blood samples were collected from each cow to measure P4 serum concentrations. History and signalment of each cow, including days in milk, lactation, times bred, days since last heat, milk composition, and somatic cell counts, were retrieved from an online database (DairyComp 305, Valley Agricultural Software). The accuracy of diagnosing follicular from luteal cysts based on luteal rim thickness was analyzed by receiver operating characteristic (ROC) curve using P4 as the gold standard, where P4 concentrations exceeding 1 ng/mL was defined as luteal, and all other structures with less P4 were considered follicular. Luteal rim and blood flow area were selected for further analysis because they presented the best ROC curves for differentiating cystic ovarian structures, with areas under the curve of 0.80 and 0.76, respectively. Luteal rim width of 3 mm was used as the cutoff standard in the study, resulting in sensitivity and specificity of 50% and 86%, respectively. Blood flow area of 0.19 cm2 was used as the cutoff standard in the study, resulting in sensitivity and specificity of 79% and 86%, respectively. When combining the use of luteal rim width and blood flow area to differentiate cystic ovarian structures, a parallel approach resulted in sensitivity and specificity of 73% and 93%, respectively, whereas an in-series approach resulted in sensitivity and specificity of 35% and 100%, respectively. In conclusion, the use of color Doppler ultrasonography when discriminating between luteal and follicular ovarian cysts in dairy cattle resulted in higher diagnostic accuracy compared with using B-mode ultrasonography alone.

Clinical use of color Doppler ultrasonography to predict and evaluate the collateral development of two common revascularizations in patients with moyamoya disease.

To explore the value of color Doppler ultrasonography (CDU) to predict preoperatively and evaluate postoperatively the collateral development of two common revascularizations in patients with moyamoya disease (MMD). We prospectively enrolled 49 patients with MMD who underwent unilateral superficial temporal artery (STA) -middle cerebral artery (MCA) anastomosis or encephalo-duro-arterio-synangiosis (EDAS). The parameters of the extracranial arteries, including STA, internal carotid artery (ICA), external carotid artery (ECA), and vertebral artery (VA), were performed before and at 3-6 months after surgery. DSA results were used to assess surgical collateral development. To predict good collateral development before STA-MCA anastomosis, the preoperative D > 1.75 mm in the STA had the highest area under the Receiver Operating Characteristic curve (AUC). To predict good collateral development before EDAS, the preoperative EDV > 12.00 cm/s in the STA had the highest AUC. To evaluate the good collateral development after STA-MCA anastomosis, the postoperative EDV > 16.50 cm/s in the STA had the highest AUC. To evaluate the good collateral development after EDAS, an increase of D of 0.15 mm in the STA had the highest AUC. Logistic regression analysis showed that the preoperative RI and EDV in the STA were highly correlated with collateral development. Besides, the preoperative RI was an independent risk factor for collateral development. CDU could predict preoperatively and evaluate postoperatively the collateral development of STA-MCA anastomosis and EDAS surgery postoperatively by detecting ultrasound parameters of the STA.

ROLE OF COLOUR DOPPLER STUDY FOR EVALUATION OF LOWER LIMB DEEP VEIN THROMBOSIS

Introduction- Deep vein thrombosis is a common clinical problem. It can endanger life of a person by producing pulmonary embolism and may cause venous hypertension. and chronic venous insufciency. Evaluation of patients wi Aim- th suspected deep vein thrombosis by using color Doppler ultrasonography. After obtaining clearance from Institute's ethical commit Method- tee, all the patients fullling the inclusion criteria were selected and written consent is obtained. They will be investigated with color Doppler using GE logic P9 and P5 ultrasound machine's high frequency linear transducer. The protocol begins with the patient in supine position from upper thigh till foot with longitudinal and transverse scanning to examine the veins from the common iliac veins down to calf veins. Results- In our study 50 patients with clinically suspicion of lower limb deep vein thrombosis were subjected for Doppler examination. Out of all the patients the maximum incidences of deep vein thrombosis were noted in the age group of 31-50 yrs. i.e. 48%, and minimum incidence in the age group of 11-30 yrs. i.e. 14%. The age group of 51-70 yrs. had 22% of patients and that of 71-90 yrs. of age group had 16% of patients out of total patients in the study. Out of all the patients it was found that majority of the patients were male 78% while incidence in female patients is 22%. Out of 50 suspected patients of deep vein thrombosis 60% of them were found to be positive or presence of deep vein thrombosis and 40% of them had negative or absence of deep vein thrombosis.Deep vein thrombosis was more common in right extremity i.e. 50% then left extremity i.e. 46%. Only 4% of patients had bilateral involvement. Deep vein Conclusionthrombosis of lower limbs can be detected reliably, non-invasively and rapidly by the use of colour doppler ultrasonography. Gray scale ndings together with colour doppler helps in qualitative evaluation of the venous system of lower limbs and early detection of deep vein thrombosis in clinically suspected Thus it can be concluded that keeping in mind the limitations. and the advantages offered by the colour doppler ultrasonography, it is a good, reliable, inexpensive and rapid method of investigation for deep vein thrombosis of lower limbs.

Applied Use of Doppler Ultrasonography in Bovine Reproduction

The use of Doppler ultrasonography to quantify blood vascularization in reproductive organs has increased over the past decade. Doppler technology has predominantly been explored in research settings to evaluate uterine blood flow and to assess follicular and luteal blood perfusion. Recent research has also explored the use of Doppler technology in applied reproductive management for both the beef and dairy industries and has focused on the use of luteal color Doppler ultrasonography to evaluate embryo transfer recipients and perform early pregnancy diagnosis. Although significant progress has been made and current literature indicates a strong potential for the applied use of Doppler ultrasonography to increase reproductive efficiency in the cattle industry, uptake of this technology is still currently limited. This review summarizes the recent developments in the applied use of color Doppler ultrasonography for reproductive management in both beef and dairy cattle herds.

Technical Report of Color Doppler Ultrasonography-Assisted Lumbar Spinal Interventions.

Ultrasonography (US) has recently been used more frequently during interventions involving the lumbar spine. However, physicians who are more familiar with musculoskeletal US targeting muscles, tendons, and nerves may find it challenging to perform US-guided lumbar spine interventions using only bony landmarks. This study described the use of color Doppler US for the visualization of the lumbar spinal blood supply to identify vascular landmarks in addition to bony landmarks and thus more easily and accurately perform lumbar spine interventions.

Usefulness of Color Doppler Ultrasonography for the Preoperative Evaluation of Thin Anterolateral Thigh Flap Perforators

Purpose: The anterolateral thigh flap is commonly applied to various body sites for reconstruction. However, surgeons often struggle against unexpected locations and the nature of perforator vessels during surgery. Thus, this study aimed to assess the accuracy and usefulness of color Doppler ultrasonography as a preoperative tool for the perforator position and course of anterolateral thigh flaps.Methods: A prospective study involving 77 anterolateral thigh flaps was conducted between March 2016 and February 2021. Among them, 37 perforators (group A) were detected using the preoperative color Doppler ultrasound, and the other 40 perforators (group B) were tested using a hand-held Doppler only. All patients in group A underwent color Doppler ultrasonography performed by a radiologist at our institution. The nature and course of the perforator vessels were recorded, and their precise locations were plotted in an orthonormal coordinate system.Results: A total of 37 anterolateral thigh perforator flaps (group A) were successfully dissected. The median distance between the preoperative color Doppler ultrasonography and the real location during surgery of the perforators was 7.50 mm, which was statistically smaller than 10 mm (p<0.001). This preoperative ultrasound test also had a success rate of 94.6% to determine the nature of the perforators (musculocutaneous type vs. septocutaneous type).Conclusion: Preoperative color Doppler ultrasonography provides a harmless, reliable, and accurate technique for visualizing the vascular anatomy of anterolateral thigh flaps. It has a high correlation with surgical findings, allowing surgeons to cope with variable vascular anatomy.

Is color Doppler ultrasonography reliable in diagnosing adnexal torsion? A large cohort analysis

Introduction Color Doppler ultrasonography (CDU) is widely used to diagnose adnexal torsion (AT). However, its validity remains questionable due to its low sensitivity. Our study aimed to evaluate the accuracy of CDU for the preoperative diagnosis of AT. Material and methods The electronic medical records of patients who were taken to the operating room with the diagnosis of suspected AT were reviewed. Patients having surgically/pathologically-proven AT were compared with patients who were found to have a different pathology at the time of surgery. CDU validity was assessed using a 2 × 2 table and compared with a diagnostic model that consists of the Doppler findings, patient’s age, and previous surgical history. Results AT was diagnosed correctly in 74.6% of cases. Absent Doppler flow was seen in only 18.6% of cases. Although its specificity and positive predictive value were high, CDU had very low sensitivity and negative predictive value. The combined diagnostic model exceeded CDU alone in terms of diagnostic accuracy. Conclusions The use of CDU alone is not a reliable modality to exclude AT. Absent Doppler flow is a sign of ovarian necrosis. Clinical correlation between CDU findings and the patient’s symptoms makes the diagnosis of AT more timely and accurate.

122 Colour-Doppler ultrasonography as a tool for oocyte donor selection

Colour-Doppler ultrasonography (CDU) has been applied for a more detailed examination of the ovary and uterus, mainly local blood flow in ovarian follicles and the corpus luteum (CL). The main use of CDU is for the diagnosis of early pregnancy or the selection of recipients for embryo transfer in cattle; however, this tool can also be used to select oocyte donors according to blood flow to the ovary. The concept is that more blood flow in the ovary is conducive to a healthier intraovarian environment (e.g. higher progesterone levels and removal of reactive oxygen species), yielding higher quality oocytes. The objective of this research was to evaluate invitro embryo production (IVP) after selection of oocyte donors, considering ovary irrigation before ovum pickup (OPU). The research was carried out in the reproduction laboratory at the Palominos Ranch (Jalisco, México). The oocyte donors (n=15) were synchronized before each round of OPU using an intravaginal device (1.9g of progesterone) with oestradiol benzoate (2mg) and cloprostenol sodium (500µg) on Day 0, to avoid the presence of a corpus luteum and to synchronize the follicular wave. On Day 6, the intravaginal device was removed and OPU was performed. All Angus breed donors between 3 and 5 years old with a body condition score between 5–6 (scale 1–9, where 1 is extremely thin and 9 is very obese) and were evaluated with transrectal CDU (Sonoscape S2™) with a linear-array probe (7.5MHz) before the first OPU session only. The oocyte donors were classified subjectively into three categories: low blood flow (LBF, ∼30% ovarian area), median blood flow (MBF, ∼50% ovarian area), and high blood flow (HBF, ∼70% ovarian area) and were submitted to 3 cycles of IVP each (45 total cycles). Semen from a proven bull for IVF was used during all IVP cycles. All oocytes collected from each donor were used in IVF with the same semen in all IVP cycles. The total oocytes collected, and percentages of viable oocytes, cleavage, and blastocysts on Day 7 of culture were evaluated. Statistical analysis was carried out using the GLM procedure of SAS software (version 9.3; SAS Institute Inc.) to evaluate the results of LBF, MBF, and HBF (P-value=0.05). Total oocyte recovery was 11.28±1.92, 10.06±1.31, and 15.52±1.05 for HBF, MBF, and LBF, respectively, being significantly higher for LBF (P<0.05). There were no differences in viable oocytes among groups. Cleavage rates were 53.04%±3.43 for HBF, 43.18%±2.34 for MBF, and 43.69%±1.89 for LBF, being significantly higher for HBF (P<0.05). Percentage of blastocysts on Day 7 was 38.16%±3.80 for HBF, 30.11%±2.60 for MBF, and 17.78%±2.10 for LBF. This value tended to be significantly higher for HBF than MBF, and both were significantly superior to LBF (P<0.05). In conclusion, under the conditions of this research, although LBF donors had more total recovered oocytes, blastocyst rates were increased in HBF and MBF donors. Therefore, based on the results of the present study, CDU can be a useful tool for the selection of oocyte donors.

Usefulness of Color Doppler Ultrasonography in the Risk Stratification of Thyroid Nodules

Introduction: Thyroid ultrasound (US) is crucial for clinical decision in the management of thyroid nodules. In this cross-sectional study, we aimed to test if the evaluation of thyroid nodules’ vascularization could improve the risk stratification ability of the American College of Radiology (ACR) TI-RADS classification system. Methods: A total of 873 thyroid nodules undergoing fine-needle aspiration were classified according to ACR TI-RADS US classification. Three types of vascularization were identified: type 0, no vascular signals; type 1, peripheral vascular signals; type 2, peripheral and intralesional vascular signals. Cytology specimens were evaluated conforming to the Italian Reporting System for Thyroid Cytology, and TIR3b, TIR4, and TIR5 were defined as high risk for malignancy. Odds ratios (ORs) with 95% confidence intervals (CI) and the areas under the receiver operating characteristic curves (ROC-AUC) for high-risk cytology categories were calculated. Results: The 3 vascular patterns were differently distributed within the cytology categories: 52.4% of TIR1c, 15.9% of TIR2, 5.9% of TIR3a, 6.7% of TIR3b, 12.5% of TIR4, and 28.9% of TIR5 nodules had no vascular signals (p < 0.001). Nodule vascularity alone was not associated with a higher risk of malignant cytology (OR [95% CI] 0.75 [0.43–1.32], p = 0.32), without differences between peripheral (OR [95% CI] 0.65 [0.35–1.20]) and intranodular (OR [95% CI] 0.88 [0.48–1.62]) vascularization (p = 0.22). The ROC-AUC (95% CI) for the diagnosis of malignant cytology was similar when considering TI-RADS classification alone (0.736 [0.684–0.786]) and when considering TI-RADS classification plus the presence/absence of vascular signals (0.736 [0.683–0.789], p value for differences between the ROC-AUCs: 0.91). Among TR1, TR2, and TR3 TI-RADS classes, no nodules without vascular signals showed a malignant cytology, allowing the identification of nodules with benign cytology with 100% specificity within these US classes. Conclusions: Color Doppler study of thyroid nodules does not improve the risk stratification ability of the ACR TI-RADS US classification system.

Early Prediction of Corpus Luteum Functionality Using an Imaging Software.

The present study aimed to assess the applicability of luteal blood flow data acquired through the use of color Doppler ultrasonography and a post-processing analysis tool (ImageJ) for predicting pregnancy in buffaloes (Bubalus bubalis). The experiment was carried out on 59 multiparous Italian Mediterranean buffaloes that underwent synchronization of estrus and fixed-time artificial insemination (TAI). Corpus luteum features (size: CLS and blood flow: BFA) were taken from Day 5 to 10 after TAI and retrospectively measured with ImageJ. In the same period, blood samples were taken to assess progesterone (P4) concentrations. Pregnancy diagnosis was carried out on Day 45 by ultrasound and confirmed on Day 70 post-TAI. Differences in CLS, BFA, and P4 concentrations from Day 5 to 10 after TAI measured between groups were analyzed by ANOVA repeated measures as were differences within each day of measuring. Buffaloes that established a pregnancy (n = 29; 55%) had larger CLS (2.2 ± 0.1 vs. 1.9 ± 0.1 cm2; P < 0.01), higher BFA (0.6 ± 0.0 vs. 0.4 ± 0.0 cm2; P < 0.01), and higher P4 blood level (1.8 ± 0.1 vs. 1.4 ± 0.1; P < 0.01) during Day 5–10 as compared to not-pregnant buffaloes (n = 22). Throughout the entire period, the first feature that changed between groups was P4 blood concentration at Day 7 (1.7 ± 0.1 vs. 1.2 ± 0.1; P < 0.05) followed by BFA at Day 8 (0.6 ± 0.0 vs. 0.5 ± 0.0; P < 0.05), respectively, in pregnant and not-pregnant animals. The ROC analyses indicated that P4 was able to predict pregnancy since Day 5 (P < 0.05) although a more reliable result could be obtained from Day 8 (P < 0.01). At Day 10, it was possible to set a cutoff value for every parameter taken into account. The logistic regression analysis showed that pregnancy was positively influenced by P4 concentration (odds ratio 534.127; P < 0.01) and BFA (odds ratio 744.893; P < 0.01). In conclusion, the use of color Doppler ultrasonography, together with ImageJ, identified different patterns of BFA between pregnant and not-pregnant buffaloes starting from Day 8 post-TAI.

Use of color-Doppler ultrasonography for selection of recipients in timed-embryo transfer programs in beef cattle

We aimed to study the association between CL characteristics assessed by color-Doppler ultrasonography (Doppler-US) at the time of embryo transfer (ET) and pregnancy rate (P/ET) in beef recipients. Estrous cycles of crossbred beef recipients were synchronized for timed-ET. On the day of ET (Day 7), CL area, proportion of luteal blood perfusion (BP), and the relationship between the largest dominant follicle (DF) and CL (ipsilateral or contralateral) were determined. Animals (n = 444) received an in vitro produced embryo from Nelore donors, placed in the uterine horn ipsilateral to the CL. Recipients were split retrospectively in three subgroups according to CL area [small (<3 cm2), medium (3–4 cm2), or large (>4 cm2)] and three subgroups according to luteal signals of BP [low (≤40%), medium (45–50%) or high (≥55%)]. Pregnancy was detected on Days 30–45 by transrectal ultrasonography and P/ET was analyzed considering the effects of cow's category (suckling or non-suckling), CL area, luteal BP and side of DF. P/ET increased along with BP category [low, 45.9%B, (62/135); medium, 54.1%AB (93/172); and high, 58.4%A (80/137)]. When luteal BP was evaluated as a continuous variable, a significant (P < 0.05) linear and positive effect was observed on P/ET. A greater (P < 0.05) CL area and serum progesterone concentrations were observed in the medium and high BP than in the low BP category. Although an effect of luteal size category was not significant on P/ET [small, 49% (76/155); medium, 59.7% (83/139); and large, 50.7% (75/148); P > 0.1], when CL area was evaluated as a continuous variable, a quadratic effect (P < 0.05) indicated a positive relationship between P/ET and CL area until luteal tissue reached 4.07 cm2, followed by a negative relationship. The location of the first-wave DF in relation to the CL did not affect P/ET (P > 0.1). In conclusion, Doppler-US is an innovative tool that has the potential to be used for selection of suitable embryo recipients based on luteal BP. Selection of recipients that have a greater chance of maintaining pregnancy will increase the success of timed-ET programs.

Feasibility of transabdominal Doppler ultrasonography for studying ovarian blood flow characteristics in cycling gilts.

The aim of this study was to assess ovarian blood flow characteristics by applying transabdominal color Doppler ultrasonography during the course of the estrous cycle in gilts. Estrus and ovulation were synchronized in 15 pubertal gilts. During their consecutive spontaneous estrous cycle the gilts were sonographically scanned daily and ovarian blood flow was determined by imaging perfused areas of the ovarian hilus and the ovarian tissue. Recorded video clips were then analyzed for the parameters perfused area (Amix), blood flow velocity (vmix) as well as resistance (RIvmix) and pulsatility index (PIvmix) using the software PixelFlux®. All blood flow parameters showed an estrous cycle dependent course, with Amix and vmix being highest in diestrus, followed by proestrus, while RIvmix and PIvmix patterns were inversely proportional. Transabdominal color Doppler ultrasonography proved feasible to study ovarian perfusion characteristics in pubertal gilts. The ovarian blood flow was dependent on the stage of estrous cycle and highest in diestrus. The results of this study encourage the use of color Doppler ultrasonography to also investigate reasons of ovary-caused infertility including corpus luteum insufficiency or seasonal effects on ovary function.

Effectiveness of Color-Coded Doppler Ultrasonography for Detecting the Trajectory in the Surgical Management of Distal ACA Aneurysms

Distal anterior cerebral artery(DACA)aneurysms are relatively rare. The detection of the surgical trajectory of DACA aneurysmal clipping is difficult because DACA aneurysms are located at various sites in the ACA. The purpose of this study was to evaluate the effectiveness of intraoperative use of color Doppler ultrasonography for the surgery of DACA aneurysms. DACA aneurysms of ten patients(three men, seven women;64.5 years old on median)were examined using intraoperative color Doppler imaging(CDI), which was performed before microscopic procedures, to detect the location of the aneurysms. Among them, six patients had ruptured aneurysms with diameters ranging from 2.5 to 10.8mm, and four of them had intracerebral hematomas. All the aneurysms and surrounding arteries were clearly detected using CDI. Moreover, in larger aneurysms, blood flow dynamics inside the aneurysm were also observed using CDI. As a result, we concluded that the intraoperative use of color Doppler ultrasonography was effective of detecting the trajectory for the DACA aneurysms without causing any damage to the brain by redundant dissections.

16 False-positive rate after anticipation of early pregnancy diagnosis for resynchronization of ovulation in Bos indicus heifers

The objective was to determine the incidence of false-positive pregnancy diagnosis following the use of colour Doppler ultrasonography 20 and 22 days after fixed-time AI (FTAI) in Bos indicus heifers submitted to resynchronization 14 days after first FTAI. In the study, 512 Nellore heifers at 24.5±0.8 months of age and body condition score of 3.4±0.1 were used beginning 14 days after FTAI. On Day 14, heifers received 50mg of short-acting progesterone (Afisterone®, CEVA, São Paulo, Brazil) and a progesterone device (Prociclar®, CEVA). Eight days later (Day 22), the progesterone device was removed. A duplex B-mode (grayscale) and pulse-wave colour Doppler ultrasound instrument (M5, Mindray, Shenzhen, China) equipped with a multifrequency linear transducer was used for the examination of luteal blood flow on Days 20 and 22. The percentage of luteal area with colour Doppler signals of blood flow at each examination was determined as previously described (Ginther 2007) and was classified as low [corpus luteum (CL) with less than 25% vascularized area], intermediate (CL with 25-75% vascularized area), or high (CL with more than 75% vascularized area). Heifers with intermediate and high luteal blood flow were diagnosed as pregnant by Doppler ultrasonography, and heifers with low luteal blood flow were diagnosed as nonpregnant. Heifers diagnosed as pregnant by Doppler ultrasonography were examined 30 days after FTAI by B-mode ultrasound examination for pregnancy diagnosis and to determine the number of false positives (heifers pregnant by Doppler ultrasonography and nonpregnant by B-mode ultrasonography). Statistical analysis was performed by the GLIMMIX procedure of SAS (SAS Institute Inc., Cary, NC, USA). Pregnancy rate by Doppler ultrasonography [Day 20=60.5% (310/512), Day 22=55.3% (283/512); P=0.10] and false-positive percentage [Day 20=29.7% (92/310), Day 22=23.0% (65/2830); P=0.06] were similar on pregnancy diagnoses by Doppler ultrasonography performed 20 and 22 days after FTAI. Furthermore, in the period from 20 to 22 days after FTAI, luteolysis was verified in 5.8% (30/512) of heifers. In conclusion, anticipation of pregnancy diagnosis in 2 days by evaluation of luteal blood flow with colour Doppler ultrasonography (20 days after FTAI) does not interfere with pregnancy rate by Doppler ultrasound and percentage of false positives in Bos indicus heifers.

Feasibility of transabdominal Doppler sonography for studying uterine blood flow characteristics in cycling gilts.

To test for the feasibility of transabdominal Doppler sonography (color, power, pulse wave) to define uterine perfusion characteristics throughout the estrous cycle in gilts. A total of 15 gilts were synchronized for estrus and scanned in their following spontaneous cycle while being restrained in a purpose-designed mobile crate. To define uterine perfusion characteristics, vessels in between and within uterine cross-sections were imaged and recorded as video sequences to be analyzed by PixelFlux® software for perfused area (Amix), blood flow velocity (vmix) and intensity (Imix) as well as resistance (RIvmix) and pulsatility index (PIvmix). Color Doppler sonography proved to be the only feasible technique, as it was less affected by animal movements than power and pulse wave sonography. As determined by color Doppler sonography, all five parameters determined showed specific patterns through the estrous cycle, i. e. Amix, vmix, Imix were high in proestrus, decreased in estrus and remained low in midestrus and most parts of diestrus; RIvmix and PIvmix with inversely paralleled patterns. This study has demonstrated that transabdominal color Doppler but not power and pulse wave Doppler sonography is feasible to be performed in crate-restrained gilts for studying uterine perfusion characteristics during the estrous cycle, and that changes of uterine perfusion over the course of the estrous cycle can be clearly followed by color Doppler sonography. Results encourage the use of color Doppler sonography for studying i. e. uterine capacity or uterus related infertility such as for cases of clinically unapparent endometritis.

Color Doppler Ultrasonography Is a Useful Tool for Diagnosis of Peripheral Artery Disease in Type 2 Diabetes Mellitus Patients with Ankle-Brachial Index 0.91 to 1.40.

BackgroundThe clinical utility of ankle-brachial index (ABI) is not clear in subjects with less severe or calcified vessel. Therefore, we investigated the usefulness of color Doppler ultrasonography for diagnosing peripheral artery disease (PAD) in type 2 diabetes mellitus (T2DM) subjects.MethodsWe analyzed 324 T2DM patients who concurrently underwent ABI and carotid intima-media thickness (CIMT) measurements and color Doppler ultrasonography from 2003 to 2006. The degree of stenosis in patients with PAD was determined according to Jager's criteria, and PAD was defined as grade III (50% to 99% stenosis) or IV stenosis (100% stenosis) by color Doppler ultrasonography. Logistic regression analysis and receiver operating characteristic curve analysis were performed to evaluate the risk factors for PAD in patients with ABI 0.91 to 1.40.ResultsAmong the 324 patients, 77 (23.8%) had ABI 0.91 to 1.40 but were diagnosed with PAD. Color Doppler ultrasonography demonstrated that suprapopliteal arterial stenosis, bilateral lesions, and multivessel involvement were less common in PAD patients with ABI 0.91 to 1.40 than in those with ABI ≤0.90. A multivariate logistic regression analysis demonstrated that older age, current smoking status, presence of leg symptoms, and high CIMT were significantly associated with the presence of PAD in patients with ABI 0.91 to 1.40 after adjusting for conventional risk factors. CIMT showed significant power in predicting the presence of PAD in patients with ABI 0.91 to 1.40.ConclusionColor Doppler ultrasonography is a useful tool for the detection of PAD in T2DM patients with ABI 0.91 to 1.40 but a high CIMT.

Intraosseous Needle Placement Confirmation by Doppler Ultrasonography

SESSION TITLE: Rapid Session: Bedside Imaging SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, November 1, 2017 at 07:30 AM - 08:30 AM PURPOSE: The 2015 guidelines for advanced cardiac life support (ACLS) recommend intraosseous (IO) access, if intravenous (IV) access is not readily attainable. The safety record for IO access is excellent. However, serious complications have been reported in the literature. In our institution, we experienced a limb threatening complication from a dislodged IO line despite standard confirmation. A properly placed IO line must be through the cortex of the bone and situated within the marrow cavity. Standard methods for confirmation of IO placement include aspiration of bone marrow, firm placement of the IO needle into the bone, and no evidence of extravasation. The traditional confirmation methods have as high as a 60% false positive rate for IOs that have incorrect penetrating placement, and a 10% false positive rate for incorrect subcutaneous placement. An alternative method to confirm IO placement is the use of color Doppler ultrasonography, which provides a noninvasive method for verification of correct IO placement. METHODS: Confirmation of correct IO placement was performed in a series of patients who received IO access during emergent resuscitation. Confirmation of IO placement with color Doppler was accomplished using a 7.5 MHz linear ultrasound probe placed adjacent to the IO site with the tomographic plane placed to intersect with the tip of the IO needle and the color Doppler map adjusted to target the needle tip area. Injection of 10 cc of agitated saline through the IO needle confirmed appropriate placement if the color signal showed subperiosteal color Doppler velocity pattern. The results of the color Doppler studies were compared to results of standard indices of IO placement. RESULTS: A total of 15 IO needle placements were studied. All were confirmed to be in appropriate subperiosteal position place using the three standard confirmation methods. The color Doppler technique confirmed placement in all 15 cases, indicating a perfect correlation between the methods. CONCLUSIONS: From this preliminary study, color Doppler ultrasonography may be a useful adjunct to standard confirmation techniques for intraosseous needle placement, as it allows for rapid identification of incorrect placement of IO lines, which in turn may prevent serious limb injury. The limitation of the technique is the requirement of operator training and machine availability. CLINICAL IMPLICATIONS: Using point-of-care color doppler ultrasonography helps quickly identify incorrect placement of IO lines. This, in turn, may help prevent serious, limb threatening injuries. DISCLOSURE: The following authors have nothing to disclose: Zubair Hasan, Karan Singh, Atul Palkar, Yonatan Greenstein, Paul Mayo No Product/Research Disclosure Information

Increased Ratio of Superficial Temporal Artery Flow Rate After Superficial Temporal Artery-to-Middle Cerebral Artery Anastomosis: Can It Reflect the Extent of Collateral Flow?

There are several ways to identify donor artery patency and success of surgery after an anastomosis of the superficial temporal artery (STA) to the middle cerebral artery (MCA). The purpose of this study was to evaluate the ratio of bilateral STA mean flow rate (MFR) with the use of color Doppler ultrasonography (CDUS) after bypass surgery and to confirm the possibility of this value as a predictor of the extent of collateral flow. Eleven consecutive patients who had undergone STA-MCA anastomosis were included. In every case, bilateral STA MFR, mean velocity, and cross-sectional diameter were measured preoperatively and postoperatively at 1 week, 1 month, and 2 months via CDUS. We measured the bilateral STA MFR ratio changes to compensate for systemic hemodynamic variables. One month after surgery, 9 of the 11 patients who underwent STA-MCA anastomosis had good patency on DSA. In patients with good patency, there was a significant increase in the baseline STA MFR ratio compared with those at 1 week, 1 month, and 2 months postoperatively (2.88, 3.07, and 4.38, respectively, P < 0.05). The mean STA cross-sectional diameter ratio also was significantly increased postoperatively in the good patency group (1.35, 1.41, and 1.49, respectively, P= 0.044). In addition, the mean STA mean velocity ratio was increased postoperatively in the good patency group (1.48, 1.40, and 1.67, respectively, P= 0.042). We conclude that using CDUS to measure both STA MFR ratio is a potential method to predict the extent of collateral flow through an STA-MCA anastomosis.

Addition of Color Doppler Sonography for Detection of Amniotic Fluid Disturbances and Its Implications on Perinatal Outcomes.

To determine whether color Doppler sonography increases the detection of pregnancies at risk for adverse outcomes. Participants admitted to labor and delivery with the anticipation of a vaginal delivery underwent measurements of amniotic fluid volume (AFV) using amniotic fluid index (AFI) and single deepest pocket (SDP) techniques by grayscale followed by color Doppler sonography. Oligohydramnios was defined as an AFI of less than 5 cm or an SDP of less than 2 cm. Intrapartum and perinatal outcomes were compared between participants with a diagnosis of a low AFV by grayscale and color Doppler sonography. Over 42 months, 428 women were enrolled in the study. Color Doppler sonography resulted in lower AFV estimates (mean ± SD by the AFI, 10.7 ± 3.7 cm by grayscale sonography and 8.6 ± 3.6cm by color Doppler sonography; P < .0001). For the SDP, the mean AFVs were 4.6 ± 2.0 cm by grayscale sonography and 3.4 ± 1.4 cm by color Doppler sonography (P < .0001). The level of agreement between grayscale and color Doppler sonography in estimating the AFV was fair, with κ = 0.32 for the AFI and 0.28 for the SDP. Outcome measures of AFVs classified as low based on color Doppler sonography (normal by grayscale sonography) and those classified as low by grayscale sonography (low by color Doppler sonography) were compared. There was no difference in composite perinatal complications, mode of delivery, or composite neonatal complications. The use of color Doppler sonography leads to the overdiagnosis of low AFVs and does not appear to increase the detection of pregnancies destined for adverse intrapartum or perinatal outcomes.