Use Of Color Doppler Sonography Research Articles

The effect of an acute decrease in serum estrogen concentration on vessel walls: determination with color and pulsed Doppler ultrasound.

The aim of this study was to determine the effects of an acute decrease in serum estrogen concentration on endothelial function in women with surgically induced menopause through the use of color Doppler ultrasonography. There were 40 women scheduled to undergo total abdominal hysterectomy and bilateral salpingo-oopherectomy who participated in the study; 15 women not undergoing surgery also participated as a control group. Color Doppler ultrasonographic examinations of each surgical patient were obtained 3 days prior to and 7 days after surgery. Baseline measurements of the brachial arteries, including peak systolic velocity, end-diastolic velocity, true mean velocity, arterial diameter, and volume flow, were obtained for each patient. After baseline measurements were established, hyperemia was induced by inflating a blood pressure cuff on each patient's upper arm to suprasystolic pressures for 5 min. To evaluate endothelium-dependent vasodilation, the ultrasonographic appearance of the brachial artery was evaluated after the cuff was deflated and removed from the arm. Measurements of peak systolic velocity, end-diastolic velocity, true mean velocity, arterial diameter, and volume flow were obtained, and were repeated at 1, 3, 5, 10, and 20 min subsequent to removal of the blood pressure cuff. The differences between baseline and maximum values of each Doppler parameter after the cuff deflation were calculated. No significant differences were identified in terms of laboratory findings or systolic and diastolic pressures in pre- and postoperative status of surgical patients, or between surgical patients and the control group. A significant difference in serum estradiol levels during pre- and postoperative periods ( P<0.001) was detected. No significant difference in serum estradiol levels was detected among preoperative surgical patients and members of the control group ( P=0.72). All net changes detected within each group during reactive hyperemia were statistically significant. No significant difference in values was detected among pre-, postoperative, and control subjects. Our study reveals that acute decrease in serum estrogen level does not appear to affect endothelial function; thus, we assume that this is mainly due to the result of postoperative surgical stress.

Color Doppler sonography of bile duct tumor thrombi in hepatocellular carcinoma.

To determine with the use of color Doppler sonography whether bile duct tumor thrombi had detectable vasculature in hepatocellular carcinoma. Among 491 patients with tissue-proven hepatocellular carcinoma, 9 (1.8%) had bile duct tumor thrombi. All 9 patients had spectral Doppler sonography guided by color Doppler sonography (3.75-MHz convex probe). All 9 patients had dilated bile ducts with isoechoic thrombi. Eight patients had tumors infiltrating into and obstructing adjacent major bile ducts. The other patient had common hepatic duct tumor emboli that were not adjacent to primary tumors. Color signals were detectable within bile duct tumor thrombi in 7 patients. All of them had pulsatile waveforms on spectral analyses. Bile duct tumor thrombosis with obstructive jaundice was a rare complication of hepatocellular carcinoma. A detectable color signal with pulsatile waveforms was shown in most cases by color Doppler sonography with spectral analyses.

Usefulness of color Doppler sonography for assessing hemodynamics of free flaps for head and neck reconstruction.

This report focuses on the monitoring of intraoperative and postoperative hemodynamics of free flaps for repair of head and neck defects by color Doppler sonography (CDS). The study group included 20 patients with head and neck cancer who underwent resection and reconstruction with free flaps. The hemodynamics in the feeding arteries of the flaps were measured during the following six stages: before surgery, immediately after microvascular anastomosis, and on postoperative days 1, 3, 5, and 7. The pulsatility index (PI) was used as the index for measuring changes in hemodynamics over time. Grafts showed the maximal PI immediately after vascular anastomosis. PI decreased over 3 to 7 days. Of the 20 patients, 1 patient in whom the hypopharynx was reconstructed with the radial forearm flap developed venous occlusion. This was diagnosed during the early stage using CDS, allowing the flap to be saved. CDS proved to be very useful for real-time observation of the hemodynamics in free flaps.

Usefulness of color doppler ultrasound in the management of a spinal arteriovenous fistula

BACKGROUND While color Doppler ultrasonography and microvascular Doppler recordings have been used intraoperatively for spinal cord vascular malformations, they have not been employed for similar spinal cord lesions preoperatively. CASE DESCRIPTION We report the usefulness of color Doppler ultrasonography through a lumbar laminectomy defect in the management of a spinal arteriovenous fistula. CONCLUSION Color Doppler ultrasonography should be considered for spinal lesions in which a laminectomy defect is present.

Color Doppler and duplex sonography in 5 patients with thoracic outlet syndrome.

To evaluate the use of color Doppler sonography in the diagnosis of thoracic outlet syndrome. We studied color Doppler sonographic findings in 5 clinically suspected cases of thoracic outlet syndrome. The subclavian artery and vein were studied in varying degrees of abduction to assess the severity of the syndrome. Significant changes, i.e., stages of increased velocities, preocclusion, and occlusion in the subclavian artery in varying degrees of abduction, were noted in 4 of 5 cases. Blunted flow in the axillary artery (4 patients) and a rebound increase in velocities on release of abduction were noted in 3 patients. These changes suggested that significant narrowing was causing symptoms. Color Doppler sonography is a noninvasive, effective method compared with digital subtraction angiography in the diagnosis of thoracic outlet syndrome.

Color doppler sonography in the follow-up of giant glutealaneurysm embolization

False aneurysm of the gluteal artery is uncommon and may develop secondary to penetrating gluteal injury or pelvic trauma. The use of color Doppler sonography may allow the initial diagnosis of gluteal pseudoaneurysms and provide information about the success of the interventional radiological procedures. In this study, color Doppler sonographic examination demonstrated the failure of the endovascular treatment of a giant superior gluteal artery pseudoaneurysm. The second intervention of super-selective coil embolization provided optimal thrombosis and eliminated the need for open surgery.

Blood flow in and around the masseter muscle: Normal and pathologic features demonstrated by color Doppler sonography

Objective: The purpose of this study was to clarify the normal findings of arteries in and around the masseter muscle and to present their pathologic changes with the use of color Doppler sonography. Study Design: The vascular appearances were examined for the 4 main arteries feeding the masseter muscle in healthy volunteers (n = 38) and patients with inflammation (n = 5) and intramuscular hemangioma (n = 3). The features of these arteries were investigated together with the flow diameter, flow velocities, and arterial resistances. The symmetry indices were also calculated to assess the pathologic changes. Results: The detection rates of the branch from the transverse facial artery, the masseter artery, and the branch from the maxillary or external carotid artery were 98.7%, 21.1%, and 84.2% in healthy volunteers, respectively. The facial artery that feeds the muscle from the inferior part represented 2 patterns according to anatomic variant: the masseteric branch (22.4%) and the main trunk itself (77.6%). The means of the flow diameter, maximum and minimum velocities, resistive index, and pulsatility index in healthy subjects were 1.8 mm, 24.6 cm/s, 5.1 cm/s, 0.80, and 2.51, respectively. In most of the patients with symptoms, the symmetry indices of all measurement values increased in comparison with those of healthy volunteers. Conclusion: Color Doppler sonography is useful in describing the arteries in and around the masseter muscle and has the potential of being used to depict the pathologic changes. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:472-82)

WS03: Infertility WS03‐01Selection of candidates for IVF based on color Doppler findings

In the last 20 years there have been numerous improvements in IVF techniques leading to an exponetial increase in pregnancy rates. In spite of these improvements the patients undergoing IVF procedure still have more chance of failure than success. This presentation will address the areas in IVF treatment in which the use of color Doppler ultrasound could improve the results of IVF. Discussion will include the appropriate assessment of ovarian reserve as well as why the determination of the initial dose of gonadotropins based solely upon the patient's chronological age or serum FSH or E2 concentrations is imprecise. Recently, baseline ultrasound scans to assess for the presence of polycystic ovaries, and the use of color Doppler sonography to assess stromal perfusion have emerged as valuable tools in the assessment of the optimal dose selection of gonadotropins required for IVF ovarian stimulation. The issue of the assessment of oocyte maturity will additionally be discussed. Traditionally, follicular size has been used to assess oocyte maturity. However, frequently very poor oocytes are obtained from optimally grown follicles. It has been suggested that the assessment of peri‐follicular flow could potentially distinguish oocyte maturity in a superior manner than size of follicles. Finally, the value of measurement of endometrial thickness and its structure, as well as uterine and subendometrial flow in the assessment of endometrial receptivity will be discussed.

The usefulness of color doppler ultrasonography for the diagnosis of gastric varices

The usefulness of color doppler ultrasonography for the diagnosis of gastric varices

Color Doppler sonographic evaluation of spontaneous portosystemic shunts and inversion of portal venous flow in patients with cirrhosis.

The aim of the study was to evaluate the usefulness of color Doppler sonography in the detection of spontaneous portosystemic shunts and abnormal blood flow direction in the portal vein in patients with cirrhosis. Patients were 67 men and 42 women (mean age, 53 +/- 14 years) with cirrhosis confirmed by liver biopsy. All patients underwent abdominal gray-scale and color Doppler sonographic evaluations to detect the presence of spontaneous portosystemic shunts and to analyze portal vein blood flow direction. Spontaneous portosystemic shunts were found in 41 patients (38%), most often as splenorenal shunts (21%) and patent umbilical veins (14%). Less frequent were gastric collaterals, gallbladder varices, collaterals to thrombotic portal veins, mesoiliac shunts, and portorenal shunts to the right kidney. The presence of shunts was associated with that of esophageal varices (p < 0.01), ascites (p < 0.01), and inversion of portal flow (p < 0. 001) but not with splenomegaly. The direction of portal venous flow was normal (hepatopetal) in 80 patients (73%), hepatofugal in 10 (9%), and bidirectional in 7 (6%); 12 patients (11%) had partial portal vein thrombosis. Portosystemic shunts and the direction of portal venous flow are important features in the sonographic diagnosis of portal hypertension.

Duplexsonographisch kontrollierte Nd:YAG-Lasertherapie von Gefäßmißbildungen

Vascular malformations can be studied in detail by colour Doppler sonography. These lesions are best treated by Nd:YAG laser therapy. The aim of the study was to improve the quality of therapy by the use of colour Doppler sonography guided Nd-YAG laser application. 17 vascular malformations/haemangiomas in 16 patients were treated by colour Doppler sonography guided Nd:YAG laser therapy. 5 children were less than one year of age, 4 children were between one and five years of age, the other patients were adults (age 22-57 years). The size of the vascular malformations (largest diameter) were 1.5-3 cm (8 cases), all others were larger than 3 cm. When using laser therapy in combination with colour Doppler sonography it is possible to adjust the treatment variables (dose, duration and energy of the laser pulse as well as the precise intralesional positioning) individually. As a result more than 80% of cases can be treated successfully during a single session. Larger lesions may be divided into functional units which can be treated subsequently. Through colour Doppler sonography it is possible to monitor the effects of laser treatment in vascular malformations. The development of smaller ultrasound probes has facilitated the application of laser therapy guided by Doppler sonography in the region of the head and neck. Colour Doppler sonography guided laser therapy increases efficiency and selectivity of the laser treatment. Early interventions prevent growth of the lesions and reduce long-term disfigurement particularly in children.

Monitoring of fracture calluses with color Doppler sonography

Fracture callus formation is closely associated with vascular invasion, and the use of color Doppler sonography has been suggested as a means to monitor, earlier than gray-scale sonography, the first stages of the healing process. We report the findings in a series of patients with tibial fractures in whom both gray-scale sonography and color Doppler imaging were employed to monitor new bone formation at the fracture site. Twenty patients with tibial fractures treated with external fixator frames were examined sonographically about 10 days after surgery and then about every 25 days until radiographic demonstration of consolidation. Eighteen of 20 patients had a well-developed callus, while the remaining 2 patients showed delayed fracture healing. In patients with normal callus development, color Doppler imaging demonstrated the progressive formation of new vessels until about 100 days from the surgery; at subsequent examinations, flow signals decreased, and bone remodeling was confirmed by conventional radiography and gray-scale sonography. The resistance indices in these patients tended to decrease in the early weeks after surgery and then slightly increased. In contrast, lack of development of flow signals and persistence of high resistance indices were observed in the 2 patients with delayed fracture healing. Color Doppler sonography seems to have the capability to predict whether the development of fracture calluses will be normal or delayed.

Diagnosis of the Nutcracker Syndrome With Color Doppler Sonography: Correlation With Flow Patterns on Retrograde Left Renal Venography

Shigeo Takebayashi1 Teiichiroh Ueki2 Naoya Ikeda2 Atsushi Fujikawa2 OBJECTIVE. Our objective was to confirm flow patterns of the left renal vein and assess the usefulness of color Doppler sonography in the diagnosis of the renal vein entrapment. or nutcracker, syndrome. SUBJECTS AND METHODS. Forty-four patients with hematuria of unknown origin underwent color Doppler sonography, renal arteriography, retrograde left renal venography. and renocaval pressure measurement. The flow patterns were classified according to the presence or absence of distended left renal veins on sonograms and collateral veins on retrograde venograms. The sensitivity and specificity of color Doppler sonography for revealing the nutcracker syndrome were assessed by analyzing pressure gradients in combination with the venograms. which were used as the gold standard. RESULTS. Twenty-one nondistended left renal veins were seen, including 19 (43%) without collateral veins or hypertension and two (5%) with collateral veins but without hypertension (long-term nutcracker syndrome). The 23 distended left renal veins included seven without collateral veins or hypertension and one with hypertension but without collateral veins (early nutcracker syndrome). The remaining 15 distended left renal veins with collateral veins included I I (25%) with borderline hypertension (partially compensatory status of the syndrome) and four (9%) with hypertension (noncompensatory status of the syndrome). The sensitivity and specificity of color Doppler sonography for revealing the nutcracker syndrome were 78% and lO()%, respectively, when color flow in collateral veins was included in the diagnostic criteria. CONCLUSION. The nutcracker syndrome can exist in either nondistended or distended left renal veins. However, normal flow also can exist in distended left renal veins. The ability of color Doppler sonography to reveal color flow in collateral veins is useful for the noninvasive diagnosis of the nutcracker syndrome.

Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography.

Our objective was to confirm flow patterns of the left renal vein and assess the usefulness of color Doppler sonography in the diagnosis of the renal vein entrapment, or nutcracker, syndrome. Forty-four patients with hematuria of unknown origin underwent color Doppler sonography, renal arteriography, retrograde left renal venography, and renocaval pressure measurement. The flow patterns were classified according to the presence or absence of distended left renal veins on sonograms and collateral veins on retrograde venograms. The sensitivity and specificity of color Doppler sonography for revealing the nutcracker syndrome were assessed by analyzing pressure gradients in combination with the venograms, which were used as the gold standard. Twenty-one nondistended left renal veins were seen, including 19 (43%) without collateral veins or hypertension and two (5%) with collateral veins but without hypertension (long-term nutcracker syndrome). The 23 distended left renal veins included seven without collateral veins or hypertension and one with hypertension but without collateral veins (early nutcracker syndrome). The remaining 15 distended left renal veins with collateral veins included 11 (25%) with borderline hypertension (partially compensatory status of the syndrome) and four (9%) with hypertension (noncompensatory status of the syndrome). The sensitivity and specificity of color Doppler sonography for revealing the nutcracker syndrome were 78% and 100%, respectively, when color flow in collateral veins was included in the diagnostic criteria. The nutcracker syndrome can exist in either nondistended or distended left renal veins. However, normal flow also can exist in distended left renal veins. The ability of color Doppler sonography to reveal color flow in collateral veins is useful for the noninvasive diagnosis of the nutcracker syndrome.

High-frequency color Doppler sonography of the submandibular gland: Relationship between salivary secretion and blood flow

Objective. The purpose of this study was to evaluate the changes of blood flow of the submandibular gland in comparison with salivary secretion after gustatory stimulation through use of color Doppler sonography. Study design. High-frequency color Doppler sonography was performed on 30 healthy volunteers, aged 22 to 31 years. The prestimulation and poststimulation arterial blood flows were evaluated with color Doppler sonography and spectral analysis. Results. The means of prestimulation maximum and minimum velocities and pulsatility index of the submandibular gland were 6.35 ± 2.57 cm/sec, 1.79 ± 0.93 cm/sex, and 1.53 ± 0.42, respectively. After the stimulation, the color signals and velocities increased and the pulsatility index decreased. There was a close correlation between the increase in minimum velocity and that of salivary secretion. Conclusion. Color Doppler sonography is useful in analyzing changes in the blood flow of the submandibular gland caused by gustatory stimulation.

Arteriovenous fistula after renal biopsy in children.

Our objective was to assess the prevalence and history of arteriovenous fistula after renal biopsy in pediatric patients by the use of color Doppler sonography. Fifty patients, aged 6 days to 18.5 years, underwent sonographically guided renal biopsy. Color Doppler sonography was performed prior to, during, and after the procedure. Postbiopsy hematoma was detected in 46 patients (92%), of whom 10 suffered clinically significant bleeds. Six patients (age range, 8 to 18.5 years) developed postbiopsy arteriovenous fistula. In three cases the arteriovenous fistula diminished spontaneously, one persisted without symptoms, and two symptomatic arteriovenous fistulas needed coil implantation. Color Doppler sonography demonstrated all arteriovenous fistulas 4 hours after the procedure and duplex Doppler sonography demonstrated the flow disturbances in the feeding and draining vessels. We conclude that color Doppler sonography allows noninvasive detection and follow-up study of postbiopsy arteriovenous fistula, thus helping to define management after interventional procedures.

Colour Doppler sonographic diagnosis of upper limb venous thromboses.

1. Upper limb venous thromboses are considered to be a rare event, but in large hospitals with a lot of patients who receive aggressive intravenous therapy the number of thromboses seem to increase. 2. We have analysed all the cases of upper limb venous thrombosis which occurred at the Essen University Hospital between the years of 1992-1996. All patients were examined using colour Doppler sonography. 3. Out of 827 patients that were examined, a thrombosis was diagnosed in 334 cases. The subclavian vein was involved in 69% of all thromboses. Isolated jugular vein thrombosis was found in 17% of the thromboses, combined thromboses of the jugular and subclavian vein in 19%. In 182 cases the patients were treated for primarily a malignant illness. In 96 cases we found an association with venous port-systems or central venous catheters. 4. More than 40,000 patients a year were treated at the university hospital. Considering this huge number of patients the thrombosis of the upper limb is still rare. The use of colour Doppler sonography allows an early and safe diagnosis of the thrombosis without straining the patients.

Diabetes: the use of color Doppler sonography for the assessment of vascular complications

The use of color Doppler sonography (CDS) for the assessment of diabetic vascular complications is not yet well established. Among the complications of the disease, retinopathy, nephropathy and peripheral arteriopathy are classically due to a vascular attack, either a micro or a macroangiopathy. The results of CDS in the assessment of retinopathy and nephropathy are correlated with the degree of the disease and the biological findings, but the diagnostic and prognostic benefit of these results remains unclear compared to the conventional tests. Doppler sonography is more helpful in peripheral arteriopathy assessment; it may take the place of arteriography in the most clinical situations. The technique is particularly useful in case of proximal atheromatous-like arteriopathy. When the arteriopathy is distal, mediacalcinosis, specific to diabetes, may interfere with the functional test like the ankle/arm pressure index measurement.

Detection of tumor thrombus in children using color Doppler ultrasonography

Color Doppler ultrasonography (CDUS), which provides information regarding both the tissue and the blood flow simultaneously in real time, is a relatively new and noninvasive technique for the evaluation of organ perfusion. The authors investigated the usefulness of CDUS in the detection of tumor thrombus in 34 children who had malignant tumor (21 neuroblastomas, 2 Wilms' tumors, 5 hepatoblastomas, 2 rhabdomyosarcomas, and 4 others) who underwent CDUS between April 1992 and March 1995 in our department. The CDUS showed tumor thrombus in four patients (11.8%). Three thrombi (in one patient each with neuroblastoma, Wilms' tumor, and hepatoblastoma) were situated in the inferior vena cava, and one (in a patient who had hepatoblastoma) in the portal vein. Each tumor thrombus was monitored and followed up using CDUS every month during the entire clinical course; two of the four thrombi remained despite intensive treatments. The authors have found CDUS to afford rapid and noninvasive detection of tumor thrombus, and it proved useful not only in the detection of tumor thrombus but also in its follow-up in these children who had malignant tumor.

Undescended Testes in Adults: Clinical Significance of Resistive Index Values of the Testicular Artery Measured by Doppler Ultrasound as a Predictor of Testicular Histology

Purpose We evaluated the clinical significance of arterial impedance as a predictor of testicular histology in adults with undescended (inguinal) testes. Materials and Methods We performed arterial impedance and testicular diameter measurements with the use of color Doppler ultrasonography on 22 adults with undescended testes. Arterial impedance of the contralateral descended testes served as controls. All patients later underwent inguinal orchiectomy and the testes were examined histologically. Results Of the 22 undescended testes, 7 had arterial impedance values below 0.50, and the other 15 had values equal to or above 0.50. All testes with arterial impedance values below 0.50 had histologic scores between 2 and 3, whereas the others had scores of 3 and 8. Arterial impedance values and testicular volumes in the contralateral testes were significantly higher than the undescended testes. Although some of the testes with arterial impedance values above 0.50 had histologic score 3, testes with arterial impedance values below 0.50 never exceeded score 3. Volume differences of the undescended testes were not statistically significant. Conclusions Arterial impedance of an undescended testis may have a predictive value and provide more accurate information about its histology than the volume measurement itself.