Use Of Color Doppler Sonography Research Articles

Diagnosis of Rectal Varices via Color Doppler Ultrasonography

There has been no report on the hemodynamic evaluation of rectal varices by percutaneous color Doppler ultrasonography. Here, we report the usefulness of color Doppler ultrasonography for this purpose. Color Doppler ultrasonography was performed in 44 patients: 31 patients with portal hypertension, 7 with liver cirrhosis (LC) without portal hypertension, and 6 non-LC patients. We examined color flow images and measured velocity of blood flow in rectal varices using fast-Fourier transform (FFT) analysis. Next, we performed colonoscopy on these 44 patients as follow-up to confirm findings by color Doppler. Endoscopic findings of rectal varices were evaluated according to the grading system outlined in "The General Rules for Recording Endoscopic Findings of Esophageal Varices" prepared by the Japanese Research Committee on Portal Hypertension. Rectal varices were shown by Doppler color flow images in 27 of the 31 patients (87.1%) with portal hypertension. Blood flow velocity in those 27 rectal varices ranged from 2.0 to 11.6 cm/s (mean 6.5 +/- 2.4 cm/s). Rectal varices were observed in all 27 of these cases by colonoscopy. On the other hand, rectal varices were not observed by colonoscopy in the 7 LC patients without portal hypertension and the 6 non-LC patients not shown to have rectal variceal blood flow via color Doppler ultrasonography. Sensitivity, specificity, and accuracy were 27/27 (100%), 17/17 (100%), 44/44 (100%), respectively, for detection of rectal varices with color Doppler ultrasonography. Next, we compared velocities of rectal varices obtained by color Doppler ultrasonography with colonoscopic findings. Mean velocity (7.1 +/- 2.3 cm/s) in Cb variceal cases (N = 20) was significantly higher than that (4.9 +/- 1.7 cm/s) in the Cw rectal variceal cases (N = 7) (P < 0.05). Mean velocity (8.5 +/- 2.0 cm/s) in the RC-positive cases (N = 9) was significantly higher than that (5.4 +/- 1.8 cm/s) in RC-negative cases (N = 18) (P < 0.01). Mean velocity (9.8 +/- 1.6 cm/s) in rectal bleeding cases (N = 3) was significantly higher than that (6.1 +/- 2.1 cm/s) in patients without bleeding (N = 24) (P < 0.05). Seven days after endoscopic injection sclerotherapy (EIS) treatment, color Doppler ultrasonography showed an extreme decrease in blood flow in all three rectal varices in comparison with values before EIS. Color Doppler ultrasonography can be considered a very useful noninvasive tool for diagnosis of rectal varices.

Portal-systemic shunt through the right renal vein developing following portal tumor thrombus.

Despite the semi-routine use of color Doppler sonography for evaluating portal circulation abnormalities, there is a relative paucity of information on portal-systemic (P-S) shunt through the right renal vein (P-SR shunt). We report such a case. The patient was a 60-year-old woman with hepatocellular carcinoma on liver cirrhosis. Serial sonography showed an aggravation in findings; an increase in the size of the tumor was followed by formation of a portal tumor thrombus, and then occurrence of a P-SR shunt. We present this case, with a comparison between the patient's clinical course and the color Doppler results. To our knowledge, this is the first report to make such a comparison in a P-SR shunt case. We also briefly review the literature.

P20.04: Altered uterine perfusion in infertile women: usefulness of color Doppler sonography

P20.04: Altered uterine perfusion in infertile women: usefulness of color Doppler sonography

Does color Doppler sonography improve the clinical assessment of patients with acute scrotum?

Introduction and objectives Our experience concerning the use of color Doppler sonography (CDS) in the differential diagnosis of acute scrotum is reported. Material and methods From July 2000 to July 2005, 155 patients (median 17.2 years) were admitted with a diagnosis of acute scrotum (unilateral in 150 cases, bilateral in 5). Along with a careful anamnesis and the physical exam, all patients underwent a CDS study of the scrotal content using a sonograph GE Logiq 500 with a multifrequency (7.5–10 MHz) linear probe Small Part. The following CDS parameters were evaluated: intensity of the color-power signal on the testicular parenchyma and on the epididymis; systolic peak velocity (SPV) and telediastolic velocity (TDV) in correspondence of the gonadal hilum. Ultrasound and flowmetry parameters registered on the painful testis were compared with those registered on the healthy controlateral testis. The reduction/absence versus the increase of color-power signal in the parenchyma and the reduction/absence versus the increase of SPV and TDV in the centripetal intratesticular arteries were considered presumptive of testicular torsion versus orchiepididymitis. Results The results only refer to the 150 patients (300 testis) with acute monolateral scrotum. The clinical picture and the physical exam suggested a torsion of the spermatic cord in 40 cases, a spontaneous de-torsion in 5, an orchiepididymitis in 80, a blunt scrotal trauma in 15, a bulky epididymal cyst or a hydrocele in 4 and a testicular pain of unknown etiology in the remaining 6 cases. Standard US was pathological in 95 patients (63.3%); CDS was pathologic in 70 patients and in 42 of them suggested a testicular torsion. Fifty-three patients underwent surgical exploration: among 42 patients with a presumptive diagnosis of testicular torsion, the diagnosis was confirmed in 22 cases, no anomaly was found in 16 cases and in 4 patients a torsion of testicular appendix was found. The rupture of the tunica albuginea was present in six out of seven patients submitted to surgical exploration for previous blunt trauma and the sonographic diagnosis of hematocele was documented in all cases. The single false-negative diagnosis of testicular torsion in CDS occurred in an 18-month-old child. In presence of funicular torsion, the sensitivity and specificity of physical exam and CDS were 100% versus 95.7% and 86.5% versus 85.3%, respectively; sensitivity and specificity of SPV, TDV and color-Doppler signal on the testis were 100% and 94.8% versus 100% and 90.1% versus 95.7% and 90.8%. In the pre-operative assessment of scrotal trauma, the B-mode US showed a sensitivity and specificity of 100% and 90%, respectively; the color Doppler analysis has not supplied with additional elements for planning a surgical exploration. In presence of orchiepididymitis, the sensitivity and specificity of the physical exam in association to CDS was equal to 100%. In all patients with torsion of the testicular appendix, physical exam and CDS parameters were within normal limits. Discussion and conclusions In our experience CDS is an indispensable imaging modality for the clinical assessment of patients with acute scrotum; however, the informations it can afford are operator-dependent and have to be supported by the history and physical exam of the patient. CDS findings constitute probably an important medico-legal support when the necessity of surgical exploration is excluded; anyway, in presence of a clinical suspicion of testicular torsion, even with an apparently normal CDS, the surgical exploration is recommended.

Portal systemic shunt through the renal vein

Despite the semi-routine use of color Doppler sonography for evaluating portal circulation abnormalities, there is a relative paucity of detailed color Doppler findings of portal systemic (P-S) shunt through the renal vein (P-SR shunt). We reviewed the color Doppler findings of 18 patients with P-SR shunt to determine its clinical significance and appropriate scanning techniques for diagnosing accurately P-SR shunt. The splenorenal shunt was imaged as a highly tortuous vessel at the splenic hilum, which then coursed backward behind the spleen. Splenic vein flow was reversed or very slow. The gastrorenal shunt originated from the splenic vein, coursed backward, and joined the left renal vein. Flow direction in the splenic vein was always hepatopetal. The P-S shunt through the right renal vein originated from duodenal or jejunal varices, coursed posterolaterally, and joined the right renal vein at the renal hilum. Familiarity with these color Doppler findings will help increase the diagnostic confidence of P-SR shunt by color Doppler sonography.

Sonographie von Hals und oberem Mediastinum

Sonography of the neck and superior mediastinum is a very instructive method of investigation. However, the topographical anatomy of the region makes major demands on the investigator. In many diseases in this area, ultrasonography may be used as the first and also only imaging method (thyroid, salivary glands, lymph nodes). Pathological findings are detected with high sensitivity. The dynamic investigation with palpation, compression and observation of deglutition is especially helpful in appraising the consistency, displace-ability and topographical identification of structures. The specificity can be substantially improved by use of color Doppler sonography and ultrasound-guided biopsy. The pharyngeal and retropharyngeal space, the base of the brain and the posterior mediastinum are difficult to access by sonography. The investigator must therefore arrange for supplementary imaging procedures such as CT, MRI or thyroid scintigraphy in unclear cases, e.g. in diagnosis and staging of tumors. Mediastinal space occupations are most frequent in the anterior upper mediastinum. They can be appraised almost as reliably by transthoracic sonography as by computer tomography.

Color Doppler sonography in obstetrics and gynecology

This review aims to provide the reader with an overview of the present and future clinical applications in color Doppler sonography for the evaluation of vascularity and blood flow within the uterus (both gravid and nongravid), ovaries, fetus and placenta. The clinical use of color Doppler sonography has been demonstrated within many organ systems. Color Doppler sonography has become an integral part of cardiovascular imaging. Significant improvements have recently occurred, improving the visualization and evaluation of intraorgan vascularity, resulting from enhancements in delineation of tissue detail through electronic compounding and harmonics, as well as enhancements in signal processing of frequency- and/or amplitude-based color Doppler sonography. Spatial representation of vascularity can be improved by utilizing 3D and 4D (live 3D) processing. Greater sensitivity of color Doppler sonography to macro- and microvascular flow has provided improved anatomic and physiologic assessment throughout pregnancy and for pelvic organs. The potential use of contrast enhancement is also mentioned as a means to further differentiate benign from malignant ovarian lesions. The rapid development of these new sonographic techniques will continue to enlarge the scope of clinical applications in a variety of obstetric and gynecologic disorders.

Prenatal ultrasound diagnosis of Down syndrome. After major malformations, soft markers, nuchal translucency and skeletal signs, a new vascular sign?

Prenatal ultrasound diagnosis of Down syndrome. After major malformations, soft markers, nuchal translucency and skeletal signs, a new vascular sign?

Testicular torsion in a 68-year-old man

Testicular torsion is a rare, yet often underrecognized, cause of scrotal pain in adult men. Few reports have commented on testicular torsion in the geriatric population. We report a case of a 68-year-old man initially diagnosed with epididymo-orchitis, who, on surgical exploration, was found to have intravaginal testicular torsion. The diagnosis in this patient population is often delayed, leading to poor salvage rates. The use of color Doppler ultrasonography should be strongly considered if the history and physical examination is suggestive of testicular torsion, regardless of patient age.

Managing chronic headaches in the clinic

To the Editor: In their recent article, Managing chronic headaches in the clinic (Int J Clin Pract 2004; 58(12):1142–51), Dowson et al. suggest that some types of headaches may not be well recognized or well treated. They discuss management algorithms, and state that ‘principles can be customized to the headache subtype by the selection of appropriate therapies’. Successful personalized treatment is a highly desirable, attainable goal that is dependent on accurate evaluation of the problem. Engineers know that the type of a problem's source predicts its appropriate type of solution: chemical problems respond best to chemical solutions, and mechanical problems respond best to mechanical solutions. Many chronic daily headache (CDH) cases have a mechanical source, and as such, cannot be treated effectively with biochemical medications. Therefore, an effective management algorithm includes the directive: obtain magnetic resonance imaging (MRI) of CDH patients to identify treatable structural causes. Case in point: since 1999, with the publication of ‘Chiari 1 malformation redefined: clinical and radiographic findings for 364 symptomatic patients’ (Neurosurgery 1999; 44(5): 1005–17), a landmark study by Milhorat et al., it has become very clear that many chronic headaches are the result of compression of the hindbrain. A volumetrically small posterior fossa crowded with a normal-sized brain restricts cerebrospinal fluid flow dynamics, as measurable by both cine MRI and colour Doppler ultrasonography (CDU). Patients with such flow restrictions and tissue compression suffer from an increased intracranial pressure, and from impaired function of affected, compressed brain parts, most notably the cerebellum, occipital lobe and brainstem. (Symptoms number into the several dozen.) Additionally, many of these patients also develop subarachnoid adhesions and abnormal cranial vasculature, and a smaller subset has tonsils that are wrapped around or tethered to the brainstem or spinal cord. Hydrocephalus is not required for the diagnosis, and, in fact, is less common than other equally symptomatic manifestations. In the US, between 200,000 and 2 million people suffer from this clearly mechanical cause of CDH. The vast majority of them are undiagnosed for months or years, and typically are misdiagnosed with migraine, tension headaches, multiple sclerosis, lupus, fibromyalgia or psychiatric disturbances. This would not happen if more primary care physicians, neurologists and pain specialists were very familiar with the devastating manifestations of mechanical hindbrain compression. The treatment for severely symptomatic posterior fossa compression is physical removal of the obstruction(s), creation of adequate space for the brain and restoration of proper CSF flow dynamics. This is accomplished surgically through the widening of the cranial–cervical junction, construction of artificial cisterna magna with attention paid to establishing a 3–5 cm/second bidirectional CSF flow at the cervicomedullary junction, and a collection volume of 8–10 cc of CSF in the new cisterna magna. The recent introduction of the intraoperative use of CDU has made this feat possible and provable. See the article ‘Tailored operative technique for Chiari type I malformation using intraoperative colour Doppler ultrasonography’ (Neurosurgery 2003; 53(4): 899–906). In addition, see http://www.thechiariinstitute.com/chiari_techniques.html. In future explorations within the realm of chronic daily headache, we hope that primary care physicians, neurologists and pain specialists will join forces with their equally dedicated counterparts in the neurosurgical world, and offer a complete picture of possible causes and matching solutions to the many headache sufferers who cross their doorsteps.

Sensitivity And Specificity Of Diagnostic Imaging Techniques For Patellar Tendinopathy

PURPOSE Patellar tendinopathy (PT) is a common condition that is characterized by activity-related anterior knee pain associated with focal patellar tendon tenderness. While clinical examination forms the cornerstone of diagnosis in PT, imaging is frequently used for differential diagnosis with the techniques of choice being ultrasonography (US) and magnetic resonance imaging (MRI). The usefulness of these techniques are not established with positive US and MRI images for PT being shown in asymptomatic tendons, and symptomatic tendons having the imaging appearance of normal asymptomatic tendons. The primary aim of this study was to establish the sensitivity and specificity of US and MRI for the diagnosis of PT. A secondary aim was to assess the usefulness of color Doppler US in the diagnosis. METHODS Twenty subjects with symptomatic PT were recruited according to appropriate inclusion and exclusion criteria. A control group consisted of 20 activity- matched asymptomatic controls. All subjects had their patellar tendon imaged using US (grey-scale and color Doppler) and MRI (proton-density weighted and STIR), according to standard protocols. One investigator performed all US (ZSK) and two investigators reviewed the MRI scans (ZSK and FM). These investigators were blinded to pathology group at all times. Intra- and inter-tester reliability of MRI was performed on 10 random scans from each symptom group reviewed one week apart, and the sensitivity and specificity of each imaging techniques was determined. RESULTS Intra- and inter-tester reliability of MRI was moderate to good for most qualitative and quantitative assessments. The exceptions were for transverse width and cross-sectional area of the lesion, which had poor inter-tester reliability. US had a sensitivity and specificity of 0.79 and 0.82 for confirming symptoms of PT, respectively. The positive and negative predictive values for US were 0.75 and 0.85, respectively. In contrast, MRI had a sensitivity and specificity of 0.50 and 0.71, respectively, with positive and negative predictive values of 0.77 and 0.70, respectively. Color Doppler US was the most specific for symptomatic PT with 92%of symptomatics having a lesion. CONCLUSIONS The results of this study suggest that US should be the imaging modality of choice in the differential diagnosis of PT. It was more sensitive and specific, and is less costly, quicker and more readily available than MRI. It also allows for concurrent use of color Doppler US which seems highly specific for symptomatic PT.

Pulsatility Index of Temporal and Renal Arteries as an Early Finding of Arteriopathy in Diabetic Patients

The objective of this study was to investigate the relationship between alterations in the elasticity of the temporal and the renal arteries and the grade of arteriopathy, using the pulsatility index in type II diabetic patients and healthy volunteers. All individuals were divided into groups. Group A consisted of 15 patients without risk factors (hyperlipidemia, hypertension, obesity, and smoking) and had well-controlled diabetes mellitus as demonstrated by normal values of HbA1c. Group B had 20 patients with two risk factors (hyperlipidemia and hypertension) and normal HbA1c. Group C (25 patients) had four risk factors and high values of HbA1c, and group D consisted of 20 healthy individuals. All patients were examined by use of color Doppler ultrasonography. Pulsatility index values were measured in the temporal and renal arteries. Pulsatility indices of temporal arteries were higher in group C than in groups A and B, whereas for the renal arteries, no significant difference was detected between the four groups. In our study there seems to be strong correlation between increased values of pulsatility index, mainly in the temporal arteries, and grade of arteriopathy in type II diabetic patients.

Use of color Doppler ultrasonography in the diagnosis of anomalous connection in pancreatobiliary disease

To estimate the detectability of anomalous connection in pancreatobiliary disease (ACPBD) cases, measuring gallbladder wall blood flow (GWBF). In the retrospective study, we enrolled 42 subjects with gallbladder wall thickening. GWBF velocity was determined as an average value of the peak velocity of color signals on the gallbladder wall, three times in each case. Based on the findings on endoscopic ultrasonography (EUS) or endoscopic retrograde cholangiopancreatography (ERCP), the 42 subjects were divided into 11 cases with ACPBD and 31 cases without ACPBD. In the prospective study, the subjects were 92 cases with gallbladder wall thickening. Using the cut-off level of the flow velocity obtained in the retrospective study, the usefulness of measuring GWBF velocity in diagnosing ACPBD was evaluated. In the retrospective study, imaging of GWBF was obtained in 40 of the 42 subjects. The mean GWBF velocity of the ACPBD cases was 29.4+/-3.9 cm/s (mean+/-SD), which was significantly different (P<0.0001; 95% CI 5.48-13.2) from that of the without ACPBD cases (20.1+/-5.9 cm/s). Based on this result, we prepared a receiver operating characteristic curve, and the cut-off level appropriate for diagnosing ACPBD was estimated to be 25 cm/s. In the prospective study, GWBF was detected in 86 of the 92 subjects. Based on the EUS or ERCP findings, the 92 subjects were divided into 15 cases with ACPBD and 77 cases without ACPBD. When a cut-off level of 25 cm/s was employed, ACPBD could be diagnosed with a sensitivity of 87.0% (13/15) and a specificity of 87.3% (62/71). Measurement of GWBF velocity, which is less invasive and provides objective values, is very useful for diagnosing ACPBD prior to the development of malignant tumors in cases with gallbladder wall thickening.

Der Stellenwert von B-Mode-Sonographie und Farbdoppler-Sonographie in der Diagnose fokaler Milzläsionen

In this comparative study we determined whether the use of colour Doppler sonography (CDS) vs. B-mode ultrasound in the diagnosis of focal splenic lesions improves diagnostic accuracy. Using ultrasound scans of focal splenic lesions, diagnostic accuracy in relation to the level of sonographic experience of the examiner was also measured. Eight ultrasound examiners with different levels of sonographic experience were given clinical data and sonographic pictures (B-mode and CDS) of 63 patients in two separated sequences. After viewing the first sequence (B-mode), the examiners had to formulate a diagnosis which they could either confirm or change after viewing the second sequence (CDS). In the least experienced reviewer, diagnostic accuracy was 32 % in B-mode, compared to 35 % in CDS; the most experienced reviewer scored 72 % (B-mode) and 75 % (CDS). In none of the entities examined in this study the use of CDS resulted in a significant increase in diagnostic accuracy. The contribution of CDS in the (differential) diagnosis of focal splenic lesions is not significant. In routine ultrasound examination of the spleen, CDS is not necessary. Only with some very specific diagnostic questions CDS supplies a fast and reliable diagnosis. In focal splenic lesions, diagnostic accuracy of either B-mode and CDS is higher with experienced examiners.

Use of Color Doppler Sonography during Follicular Aspiration in Patients Undergoing In Vitro Fertilization May Reduce the Risk of Blood Vessel Injury

Use of Color Doppler Sonography during Follicular Aspiration in Patients Undergoing In Vitro Fertilization May Reduce the Risk of Blood Vessel Injury

Kidney biopsy and power Doppler imaging

Practically, all complications of kidney biopsy are connected with hemorrhage. In the last years, the use of color Doppler sonography in monitoring kidney biopsies was being described, later the possibility of using power Doppler (PD) in performing kidney biopsies was presented. PD depicts the amplitude, or power, of Doppler signals rather than the frequency shift. This allows detection of a larger range of Doppler shifts and thus better visualization of small vessels, but at the expense of directional and velocity information. Biopsy of native kidneys was performed in 144 patients. We performed real-time ultrasound-guided biopsy with an automatic biopsy device, 2-4 MHz convex probe and modified 18 G tru-cut needles were used. The vessels in the region of the biopsy were imaged with color Doppler sonography and with PD immediately before, after and the day following biopsy. Adequate tissue for histologic diagnosis was obtained in all patients with average 3.28 attempts at biopsy (range from 2-5). Average 24.15 (range from 7-58) glomeruli were obtained during each session. We observed complications in 6 (4.2%) patients, macrohematuria was presented in 4, and small hematoma with no need for intervention in 2 patients. In 138 (95.8%) patients, no complications were observed, microhematuria was present in 116 (80.6%) patients. In our study, complication rate of kidney biopsy was low and no complication requiring intervention was observed. Number of glomeruli obtained during each session was high. For better visualization of kidney vessels in biopsy path, PD was used. This additional kidney investigation itself does not essentially prolong the duration of the biopsy.

Use of color Doppler sonography during follicular aspiration in patients undergoing in vitro fertilization may reduce the risk of blood vessel injury

The use of color Doppler to identify small blood vessels (diameter: 0.68 ± 0.17 mm to 2.28 ± 0.81 mm; peak systolic velocity: 10.3 ± 4.15 cm/s to 25.15 ± 7.68 cm/s) during follicular aspiration may reduce patient's morbidity.

Detection and characterization of perianal inflammatory disease: accuracy of transperineal combined gray scale and color Doppler sonography.

To evaluate the accuracy of transperineal gray scale and color Doppler sonography for the detection and characterization of perianal inflammatory disease with surgical correlation. Eighty-seven patients with suspected perianal inflammatory disorders underwent transperineal gray scale and color Doppler sonography with a linear 4- to 7-MHz transducer that was used to scan the entire perianal region for the detection of suspected inflammatory disorders. Each detected inflammatory disorder was evaluated to determine its morphologic characteristics and extent. Color Doppler sonography was applied to assess the presence of increased vascularity in the perianal region. In comparison with surgical findings, the diagnostic performance of transperineal sonography was assessed by means of receiver operating characteristic analysis for lesion detection and the Spearman rho test for lesion characterization. Logistic regression analysis was used to assess whether increased perineal vascularity was a predictive factor of perianal inflammatory disease. Seventy-seven perianal inflammatory disorders were confirmed in 62 patients. Gray scale sonography achieved a significantly good performance in the detection (area under the curve = 0.86; P < .001) and characterization (r = 0.65; P < .001) of perianal inflammatory disease. For the detection of perianal fistulas and abscesses, sensitivity was 100% for both, and specificity was 100% and 94%, respectively. With the use of color Doppler sonography, the diagnostic confidence increased slightly (area under the curve = 0.89) but significantly (P = .002). Logistic regression analysis identified hypervascularity at the periphery of a perianal lesion as a significant independent predictor of an inflammatory disease. Combined gray scale and color Doppler sonography enables a high detectability rate and comprehensive characterization of perianal abscesses and fistulas.

Colour Doppler ultrasonography for evaluation of anterior chest blood supply: the possible role of arterial blood supply to the costosternal junction in the aetiology of idiopathic scoliosis in female adolescents.

This prospective comparative study was carried out to investigate the blood supply to the anterior chest wall by measurement of several anatomical and haemodynamic flow parameters of the internal mammary artery, with the use of colour Doppler ultrasonography, in female scoliotics with idiopathic right convex scoliosis in adolescence. Previous investigations have postulated that asymmetry of the breasts in female adolescents may be linked with the development of right convex thoracic scoliosis. This breast asymmetry is supposed to be linked with anatomical and functional asymmetry of the internal mammary artery that is the main supplier to the mammary gland. However, no measurements of anatomical and haemodynamic parameters of the internal mammary artery have been made to justify or reject the hypothesis of asymmetric blood flow volume to the breasts and costosternal junction in female adolescent scoliotics. Twenty female adolescents with right convex thoracic scoliosis and 16 comparable female individuals without spine deformity were examined with roentgenograms (scoliotics only) to measure scoliosis curve, vertebral rotation and concave and convex rib-vertebra angle at three vertebrae (the apical, one level above and one below the apical vertebra). Doppler ultrasonography was used to measure, at the origin of the internal mammary artery, its lumen diameter, cross-sectional area, time average mean flow and flow volume per minute in scoliotics and controls, which were compared with each other. The roentgenographic parameters were compared with the ultrasonographic parameters in the scoliotics to disclose any relationship. The reliability of colour Doppler ultrasonography was high and the intra-observer variability low (ANOVA, P=0.92-0.94). There was no statistically significant difference in the ultrasonographic parameters of the internal mammary artery between right and left side in each individual as well as between scoliotics and controls. In scoliotics the right mammary artery time average mean velocity increases with the convex ( P<0.05) and concave ( P<0.01) rib-vertebra angle one level above the apical vertebrae and with the apical convex rib-vertebra angle ( P<0.05). The right internal mammary artery flow volume per minute increases with convex ( P<0.01) and concave ( P<0.01) rib-vertebra angle one level above the apical vertebrae and with the apical convex rib-vertebra angle ( P<0.05). Left internal mammary artery cross-sectional area increases with convex apical rib-vertebra angle ( P<0.01) and concave rib-vertebra angle one level above the apical vertebra ( P<0.01). Conclusively, this investigation showed that haemodynamic flow parameters of the right internal mammary artery and anatomical parameters of the left internal mammary artery are significantly correlated with the magnitude of rib-vertebra angles close to the apex of right thoracic scoliosis in female adolescents. This study did not find any evidence for side-difference in vascularity of the anterior thorax wall and, thus, it could not clearly justify previous theories for development of right thoracic scoliosis in female adolescents.

Sonographic Evaluation of Fibromatosis (Aggressive Type) Using Color Doppler Interrogation

Fibromatosis refers to formation of a fibrous or tumor-like nodule or nodular swelling arising from fascia or connective tissue. The behavior of fibromatosis ranges from a self-limiting benign condition to the aggressive or recurrent type. No articles at this time have reported cases of aggressive fibromatosis emphasizing the use of color Doppler sonography for preoperative planning. The authors report two cases of aggressive fibromatosis interrogated with color Doppler imaging and magnetic resonance imaging that correlate with surgical findings.