Use Of Color Flow Doppler Research Articles

Use of colour flow Doppler in locating the optimum donor site for perforator free flap reconstruction

Introduction: With an increasing number of donor site options at the disposal of the operator, we have found that perforator flaps offer an excellent low morbidity alternative to the radial fore arm free flap. They also increase patient choice. Anatomical landmarks and the handheld doppler probe are not entirely reliable for locating perforators and do not assess the calibre of the vessels, or indeed where the most suitable perforator is. Perforator flaps might be underutilised because of these issues.

Estudio preoperatorio de colgajo peroneo: ecografía doppler color versus angiografía o angio-TC

AimTo evaluate the use of colour flow doppler (CFD) in the pre-operative study of a fibula flap. Material and methodsA retrospective study was conducted on 78 lower limbs with CFD and angio-CT and/or angiography. The results of arterial flow and vessel morphology of infrapopliteal vessels were obtained and compared. CFD sensitivity, CFD specificity, and kappa index were calculated. ResultsCFD showed 100% specificity, 77% sensitivity, and a kappa index of 0.84. Three false negative results of CFD according to angio-CT were excluded from surgery. ConclusionsThe CFD sensitivity in our series implies that this test alone cannot replace CT angiography/arteriography, unless it is combined with a correct anamnesis and physical examination.The routine use of the CFD identifies vascular disorders that contraindicate the fibula free flap elevation, avoiding the need for additional radiological tests.

Retour veineux pulmonaire total isolé : y a-t-il des clés pour le dépistage prénatal ?

Total anomalous pulmonary venous connection (TAPVC) is a serious congenital anomaly. TAPVC with obstruction of pulmonary venous return is an emergency requiring urgent intervention. Before 2010, very few isolated TAPVC were diagnosed prenatally. It has been suggested in the past literature that the use of Color flow Doppler is particularly useful for the screening of TAPVC prenatally. In fact, although color-Doppler is often useful to confirm a TAPVC diagnosis, it can be quite misleading in the screening process of the condition. Looking at data of missed TAPVC, we describe how to identify TAPVC during routine cardiac screening. Since 2010, our isolated TAPVC prenatal diagnosis rate is more than 40%.

PFM.59 Foetal Cardiac Anomalies: Antenatal detection rate following introduction of Outflow Tract Views and their perinatal outcomes

ObjectivesTo ascertain the antenatal detection rate for cardiac anomalies at Birmingham Heartlands and Solihull Hospitals after the implementation of the FASP guidelines on obtaining outflow tract views.MethodsData was collected retrospectively...

Evaluation of valvular regurgitation severity using digital acquisition of echocardiographic images

Background: Digital acquisition is a technique for storing echocardiographic data that offers advantages over conventional videotape (VT); however, limited information is available on its accuracy for the evaluation of valvular regurgitation. Methods: We evaluated 102 patients with at least 1 regurgitant lesion. Data were obtained on VT and in 1 cardiac cycle stored digitally (1C). To assess for incremental improvement with acquisition of multiple cycles, digital images were also acquired with 2 (2C) or 3 cardiac cycles (3C). Both digital and VT images were graded for regurgitant severity as absent, trivial, mild, moderate, or severe. Kappa statistics were used to assess agreement. Results: A total of 171 valvular regurgitant lesions (mild or greater) were evaluated. The overall agreement between 1C and VT images was κ = 0.61. With multiple cycle acquisition, there was no improvement in agreement (κ = 0.56 and 0.57 for 2C and 3C, respectively). When subgrouped, the level of agreement between 1C and VT was slightly lower for the aortic valve than for the mitral or tricuspid valves (κ = 0.49, 0.63, 0.64, respectively). Conclusion: The 1C technique has substantial agreement and correlation with standard VT for the evaluation of regurgitant lesions with the use of color flow Doppler. The acquisition of multiple cardiac cycles does not provide incremental improvement over single beat acquisition. (J Am Soc Echocardiogr 2002;15:241-6.)

Bedside balloon atrial septostomy is safe, efficacious, and cost-effective compared with septostomy performed in the cardiac catheterization laboratory

Balloon atrial septostomy (BAS) is a life-saving palliative procedure for patients with d-transposition of the great arteries (d-TGA). 1 Rashkind W.J. Miller W.W. Creation of an atrial septal defect without thoracotomy a palliative approach to complete transposition of the great arteries. JAMA. 1966; 196: 991-992 Crossref PubMed Scopus (599) Google Scholar , 2 Hijazi Z.M. Abu A.ta I. Kuhn M.A. Cheatham J.P. Latson L. Geggel R.L. Balloon atrial septostomy using a new low-profile balloon catheter initial clinical results. Cathet Cardiovasc Diagn. 1997; 40: 187-190 Crossref PubMed Scopus (18) Google Scholar Typically performed in the cardiac catheterization laboratory under fluoroscopic guidance with hemodynamic monitoring, this procedure involves transport of a sick, cyanotic infant to the cardiac catheterization laboratory, often with some time delay from diagnosis to the start of BAS. The anatomy of the atrial septum, however, is well seen by 2-dimensional echocardiography, and the site of the restrictive atrial septal defect can be precisely located by imaging and the use of color flow Doppler. In addition, the balloon of the balloon septostomy catheter can be seen within the cardiac structures using echocardiography, making echocardiography an ideal imaging tool for this procedure. 3 Jamjureeruk V. Sangtawesin C. Layangool T. Balloon atrial septostomy under two-dimensional echocardiographic control a new outlook. Pediatr Cardiol. 1997; 18: 197-200 Crossref PubMed Scopus (15) Google Scholar , 4 Allan L.D. Leanage R. Wainwright R. Joseph M.C. Tynan M. Balloon atrial septostomy under two-dimensional echocardiographic control. Br Heart J. 1982; 47: 41-43 Crossref PubMed Scopus (52) Google Scholar Although the concept of bedside BAS was first discussed in 1984, 5 Baker E.J. Allan L.D. Tynan M.J. Jones O.D. Joseph M.C. Deverall P.B. Balloon atrial septostomy in the neonatal intensive care unit. Br Heart J. 1984; 51: 377-378 Crossref PubMed Scopus (28) Google Scholar cardiac catheterization remained an integral part of the evaluation of d-TGA in the early era of the arterial switch operation, and in patients who still have unanswered critical questions after full echocardiographic evaluation. We hypothesized that bedside BAS would significantly reduce the cost to the patient without a change in efficacy and might be safer by obviating the need for transport of a sick infant to the cardiac catheterization laboratory. In this report, we compare our results with BAS performed in the cardiac catheterization laboratory with those performed at the bedside over the past 4 years, with emphasis on the change in cost to the patient, efficacy, safety, and any change in morbidity or mortality.

Vertebral artery injuries

Vertebral artery injuries are identified more frequently now than in the past for both penetrating and blunt trauma. This is as a result of increased suspicion and awareness, liberal use of color flow Doppler, CT angiography, and traditional four-vessel angiography. The vast majority of patients who are not exsanguinating at the time of presentation can be managed nonoperatively or by angiographic embolization. Operative management should be reserved only for patients with severe active bleeding or when interventional radiology fails. The surgical exposure is complex and demands excellent knowledge of the local anatomy.

Newer diagnostic modalities for vascular injuries: The way we were, the way we are

The article discusses the role of modalities in diagnosing vascular injuries starting with angiography and tracing the evolution of the use of color flow Doppler, CT, and CT angiography. It also addresses the controversy of minimal vascular injury and outlines vascular injuries that may be safely observed and followed-up. Finally, the evolution from angiography to the use of helical CT for the diagnosis of thoracic aortic injuries is reviewed in detail.

The possible use of colour flow Doppler in planning treatment in early invasive carcinoma of the cervix.

To investigate the pathological significance of intra-tumoural blood flow signals detected by colour Doppler ultrasound and their association with angiogenesis in cervical carcinoma. A prospective cross-sectional study. University hospital. One hundred and four women with Stage IB-IIA cervical carcinoma. All women underwent radical hysterectomy and pelvic lymph node dissection. Transvaginal colour Doppler ultrasound was performed before surgery to search for arterial blood flow signals within the tumours. Tumours with a measurable intra-tumoural resistance index were defined as tumour with detectable blood flow and the others as tumour with undetectable blood flow. The microvessel density of the excised tumour was assessed immunohistochemically. The women's clinical and pathologic data were recorded. There were 60 tumours (58%) exhibiting detectable intra-tumoural blood flow signals. Tumours with detectable blood flow were larger, had deeper cervical stromal invasion, a higher incidence of parametrial invasion and pelvic lymph node metastases, and a higher microvessel density, when compared with those without detectable blood flow. Cervical cancers with deep cervical stromal invasion, parametrial invasion, and pelvic lymph node metastasis had higher microvessel density than those with superficial stromal invasion, no parametrial invasion, or no lymph node metastasis. Microvessel density correlated well with lymph node metastases and parametrial invasion by multiple regression analysis, while intra-tumoural blood signals only showed correlation with parametrial invasion. In the prediction of pelvic lymph node metastases and parametrial invasion, colour flow Doppler had a sensitivity of 0.80 and specificity of 0.48 in predicting lymph node metastases, and sensitivity of 0.91 and specificity of 0.57 in predicting parametrial invasion. The characteristics of blood flow signals in cervical carcinoma detected by colour Doppler ultrasound are associated with tumour angiogenesis and could reflect the likelihood of parametrial invasion and lymph node metastases in cervical carcinoma. The intra-tumoural blood flow signals might be used as a screening test in predicting parametrial invasion and pelvic lymph node metastases. These findings may be helpful in planning treatment for women with Stage I and II cervical carcinoma.

A comparison of color flow Doppler and serum CA 125 measurement in the preoperative evaluation of a complex pelvic mass

Ferrier AJ, Picker RH, Sinosich M. A comparison of color flow Doppler and serum CA 125 measurement in the preoperative evaluation of a complex pelvic mass. Int J Gynecol Cancer 1998; 8:113–118. Preoperative diagnosis of a malignant pelvic mass is frequently missed, resulting in suboptimal surgical management. This study evaluated the diagnostic properties of color flow Doppler and a single preoperative serum CA 125 measurement in discriminating malignant from benign pelvic tumors. Sixty-two patients were assessed, 32 with an histologically proven ovarian malignancy. Using an upper cutpoint of 0.40 for the resistance index (RI), the likelihood ratio (LR) for the diagnosis of a malignant tumor was 1.72 (95% CI 0.73–4.07). The associated probability of a malignant pelvic mass was 0.63 (95% CI 0.42–0.80). The LRs for CA 125 at the lower cutpoints of 35 U/ml and 65 U/ml were 3.62 (95% CI 1.86–7.04) and 4.50 (95% CI 1.97–10.27), respectively. The corresponding probability estimates were 0.78 (95% CI 0.065–0. 88) and 0.82 (95% CI 0.66–0.91), respectively. Combining the RI (cutpoint 0.40) and CA 125 (cutpoint 35 U/ml) resulted in a LR of 5 (95% CI 1.62–15.4) and a probability estimate of 0.83. This is only a marginal increase over CA 125 measurement alone. This study does not support the use of color flow Doppler in the diagnostic assessment of a suspicious pelvic mass.

ULTRASONOGRAPHIC DIAGNOSIS OF CONGENITAL PORTOSYSTEMIC SHUNTS IN DOGS: RESULTS OF A PROSPECTIVE STUDY

The aims of this study were to determine if accurate diagnosis of congenital portosystemic shunt was possible using two dimensional, grey‐scale ultrasonography, duplex‐Doppler, and color‐flow Doppler ultrasonography in combination, and to determine if dogs with congenital portosystemic shunts have increased or variable mean portal blood flow velocity. Eighty‐two dogs with clinical and/or clinicopathologic signs compatible with portosystemic shunting were examined prospectively. Diagnosis of congenital portosystemic shunt was subsequently confirmed in 38 of these dogs using operative mesenteric portography: 14(37%) dogs had an intrahepatic shunt and 24(63%) had an extrahepatic shunt. Ultrasonography had a sensitivity of 95%, specificity of 98%, and accuracy of 94%. Ultrasonographic signs in dogs with congenital portosystemic shunts included small liver, reduced visibility of intrahepatic portal vessels, and anomalous blood vessel draining into the caudal vena cava. Correct determination of intra ‐ versus extrahepatic shunt was made ultrasonographically in 35/38 (92%) dogs. Increased and/or variable portal blood flow velocity was present in 21/30 (70%) dogs with congenital portosystemic shunts. In one dog with an intrahepatic shunt the ultrasonographic diagnosis was based partly on finding increased mean portal blood flow velocity because the shunting vessel was not visible. Detection of the shunting vessel and placement of duplex‐Doppler sample volumes were facilitated by use of color‐flow Doppler. Two‐dimensional, grey‐scale ultrasonography alone is sufficient to detect most intrahepatic and extrahepatic shunts; sensitivity is increased by additional use of duplex‐Doppler and color‐flow Doppler. Increased and/or variable portal blood flow velocity occurs in the majority of dogs with congenital portosystemic shunts.

Usefulness of transesophageal echocardiography in the early diagnosis of penetrating stab wounds to the heart

Cardiac injury by a penetrating instrument is not always limited to the free wall of the heart or the great arteries, but may also involve the interventricular and interatrial septae, as well as the cardiac valves, coronary arteries and conduction system. 1 Rapid and accurate diagnosis is essential in these patients, because mortality is high. 1 The use of color flow Doppler in conjunction with 2-dimensional echocardiographic imaging has greatly expanded our ability for noninvasive investigation of these patients. More recently, transesophageal echocardiography (TEE), with its higher resolution and definition of cardiac structures, has proved to be an excellent imaging modality. In the present study, we summarize our experience with penetrating cardiac injuries and emphasize the role of TEE in the early diagnosis of complex cases.

The use of color flow Doppler in the diagnosis of fetal hepatic hemangioma

The use of color flow Doppler in the diagnosis of fetal hepatic hemangioma

Doppler ultrasound color flow imaging in the study of breast cancer: Preliminary findings

A prospective study of the Doppler color flow features of 55 proved breast cancers was performed. On a three-level scale of low to marked vascularity, visual assessment of the color flow images classified 82% of the cancers as moderately or markedly vascular (minimal: 14%, moderate: 29%, marked: 53%). Four percent of the cancers had no detectable flow. In 29 women, a volume of tissue comparable to the cancer was scanned in the contralateral normal breast. Sixty-nine percent of the normal breasts had moderate or marked vascularity (minimal: 28%, moderate: 41%, marked: 28%), and 3% were avascular. There was poor distinction between normal tissues and cancer which suggests that more sensitive Doppler methods than were employed in this study may be needed in order to detect the small vessel flow reported to be rather specific for malignancy. The high, 82%, detection rate of tumor vessels in this study suggests the potential use of color flow Doppler for directing more specific but lengthy Doppler procedures.

Behaviour disorders and pattern of crime among XYY males identified at a maximum security hospital.

<h3>Objectives</h3> To ascertain the antenatal detection rate for cardiac anomalies at Birmingham Heartlands and Solihull Hospitals after the implementation of the FASP guidelines on obtaining outflow tract views. <h3>Methods</h3> Data was collected retrospectively from multiple sources including foetal medicine, maternity information system and neonatal databases. Cases were identified via local foetal medicine referral criteria and cross-referenced against The West Midlands anomaly register. Perinatal data was retrieved locally and from the tertiary referral centre, Birmingham Children’s Hospital. <h3>Results</h3> Fifty seven patients were identified between July 2011 and December 2012 with cardiac abnormalities diagnosed both antenatally and postnatally. The incidence of cardiac anomalies including minor anomalies in this time period was 5.4/1000 births. The antenatal detection rate was 71% which is higher than the national predicted detection rate of 50%. The percentage of live births was 69%, termination of pregnancy and still birth were 26% and neonatal death was 4%. In the postnatal group, 20% babies were managed conservatively and the remaining underwent surgical repair. <h3>Conclusion</h3> Following the implementation of FASP guidelines, our detection rates are higher than the national average. This audit further emphasises the need for routine examination of outflow tract view to achieve better detection rates antenatally. Though the use of Colour Flow Doppler is not a mandatory requirement for screening, its use may provide additional information which could lead to improved detection of Congenital Heart Diseases.