Use Of Color Doppler Sonography Research Articles

Differential Diagnosis of Cervical Lymphadenopathy: Usefulness of Color Doppler Sonography

Differential Diagnosis of Cervical Lymphadenopathy: Usefulness of Color Doppler Sonography

Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography.

The purpose of this study was to evaluate the usefulness of color Doppler sonography in differentiating benign from malignant cervical lymphadenopathy. We used color Doppler sonography to evaluate 117 lymph nodes in 105 patients. The patients were pathologically and clinically confirmed to have benign reactive lymphadenitis (n = 28), tuberculosis (n = 17), lymphoma (n = 14), and metastasis (n = 46). The patterns of hilar vascularity, central nodal vascularity, and peripheral vascularity were assessed. The highest resistive index and pulsatility index in 116 lymph nodes were measured from spectral waveforms. Histologic findings of nodal vessels were analyzed in 14 nodes and compared with findings on color Doppler sonograms. Thirty-two (94%) of 34 nodes with benign reactive disease showed normal patterns of nodal vascularity; central hilar vascularity, radial symmetric central vascularity, and no peripheral vascularity. At least one of six abnormal patterns of vascularity (eccentric or absent hilar vascularity; deformed radial, aberrant multifocal, or absent central vascularity; and peripheral vascularity) was observed in 98% (65/66) of nodes with malignant disease and in all tuberculous nodes. We established cutoff values of 0.8 for the resistive index and 1.5 for the pulsatility index that were 100% specific for malignancy. However, sensitivities for these cutoff values were 47% and 55%, respectively. Also, histologic examinations showed that most flow signals in nodes with malignant disease represented arterioles or veins in the septa between tumor nests or near the capsule. Unlike nodes with benign reactive disease, 98% of nodes with malignant disease and 100% of tuberculous nodes showed abnormal patterns of nodal vascularity. Also, high values for the resistive and pulsatility indexes were highly specific for malignant lymphadenopathy. Color Doppler sonography combined with analysis of spectral waveforms was useful in differentiating benign from malignant cervical lymphadenopathy.

Portal vein aneurysm: report of six cases and review of the literature.

Portal vein aneurysm is very rare, and its relation to portal hypertension has been emphasized. We report six cases of portal vein aneurysm (five extrahepatic and one intrahepatic). All patients were asymptomatic and had no signs suggestive of portal hypertension; the lesion was incidentally detected by ultrasound. Color Doppler sonography showed a constant hepatopetal flow along the aneurysmal wall, which immediately led to the diagnosis. We stress the usefulness of color Doppler sonography for studying the hemodynamics of this vascular anomaly and briefly review the literature.

The Usefulness of Color Doppler Ultrasonography In the Evaluation of Breast Mass

The Usefulness of Color Doppler Ultrasonography In the Evaluation of Breast Mass

Color Doppler sonography in Graves' disease: value in assessing activity of disease and predicting outcome.

The aims of the study were to establish the usefulness of color Doppler sonography in assessing changes in thyroid blood flow during the course of Graves' disease and to investigate which of several variables (thyroid volume, number of intraparenchymal vessels, and blood flow in the thyroid artery) were best related to thyroid hyperfunction and therefore could be used to evaluate the course of the disease. Fifty-six patients with Graves' disease were selected and divided on the basis of clinical and laboratory data into four groups: patients untreated at first diagnosis, patients undergoing antithyroid drug treatment, patients in remission after withdrawal of therapy, and patients having a relapse of hyperthyroidism. Ten healthy subjects served as controls. Patients with active hyperthyroidism (at first diagnosis, during treatment, or at relapse) had a significantly enlarged thyroid (p = .005); intrathyroid vascularization, evaluated as number of vessels per square centimeter (p < .0001); and blood flow in the thyroid artery (p < .0001) compared with control subjects and with patients in remission after withdrawal of therapy. During treatment, sonographic values were slightly lower but not significantly different from those registered in patients at the onset of hyperthyroidism, indicating that normalization of vascularity does not parallel the drug-induced decrease of hormonal synthesis. Among 21 patients in remission, the nine patients who had a relapse shortly after the examination had a higher number of vessels per square centimeter (2.18 +/- 0.34 versus 1.03 +/- 0.16, p = .03) and higher flow in the thyroid artery (80.3 +/- 19.1 versus 10.6 +/- 2.3 ml/min, p = .01) than did the other 12 patients who remained in stable remission, despite normal hormonal levels in both groups. Our results suggest that color Doppler sonography can be used to assess activity of Graves' disease and to predict the outcome of the disease after withdrawal of medical therapy.

Color Doppler sonography of the cystic artery: comparison of normal controls and patients with acute cholecystitis.

Color Doppler sonography was used to evaluate the length and distribution of the cystic artery in the gallbladder wall in 115 normal adults and in 54 patients with surgically proved cholecystitis. All patients were scanned with a 5 MHz curved array transducer optimized for low volume color sensitivity. A specific attempt was made to visualize the cystic artery throughout its course. Spectral Doppler waveforms were obtained to document arterial flow. The length of the cystic artery visualized was analyzed as a quartile percentage length of the anterior gallbladder wall. The distribution of the cystic artery flow also was analyzed in specific quartiles. Of 54 patients with acute cholecystitis, 26% had cystic artery length greater than half of the anterior gallbladder wall, compared with 2% of 115 normal controls (P < 0.001); 19% of patients with cholecystitis had flow in the distal (fundal) quartile, compared to 0% of normal controls (P < 0.0001). Although the presence or absence of flow in the gallbladder is not a reliable finding to establish the diagnosis of acute cholecystitis, length of cystic artery visualized is a potentially useful criterion to suggest the diagnosis of acute cholecystitis, especially in cases in which flow in the distal fundal quartile of the gallbladder. The usefulness of color Doppler sonography in acute cholecystitis is limited owing to the fact that it is insensitive, and many patients with cholecystitis have no detectable flow or have normal flow patterns.

Maturational changes in arterial impedance of the normal testis in boys: Doppler sonographic study.

The use of color Doppler sonography to diagnose scrotal disorders in children has been hampered by the small size of the vessels and the slow blood flow compared with those in adults. Spectral analysis is the best means available of confirming the vascular origin of questionable color-flow signals arising from testes of small volume. The range of normal and abnormal Doppler sonographic arterial waveforms arising from the testis in boys, as distinct from those in adults, has never been described. The purpose of our study was to establish the normal range of testicular arterial impedance, measured as resistive index (RI), in both prepubertal and pubertal/post pubertal boys. Bilateral scrotal color Doppler sonography was performed in 33 healthy boys aged 3 days to 17.5 years. The mean RI in the parenchymal artery was measured in 44 testes and plotted against testicular volume. Chi-square statistics were used to test differences in mean RI, testicular volume, and age between testes with volumes of 4 cm3 or less and testes with volumes greater than 4 cm3. In testes with volumes of 4 cm3 or less, the mean RI ranged from 0.39 to 1.00 (mean, 0.87), and in testes with volumes greater than 4 cm3, the RI ranged from 0.43 to 0.75 (mean, 0.57). In 20 of 30 testes with volumes of 4 cm3 or less, the RI of parenchymal arteries was equal to 1.00 (i.e., diastolic flow was undetectable). Mean RI, testicular volume, and age were significantly different between testes with volumes of 4 cm3 or less and testes with volumes greater than 4 cm3 (p < .001 for all variables). Mean testicular RI in our samples of pubertal and postpubertal boys is decreased compared with the mean RI in prepubertal boys. Diastolic arterial flow may not be detectable in normal testes with volumes of 4 cm3 or less. Despite the existence of a statistically significant difference in mean RI between prepubertal and pubertal/postpubertal testes, substantial variability exists within each group, particularly among the prepubertal testes. Norms of testicular flow previously established for adults are therefore not routinely applicable to prepubertal boys with testicular volumes less than 4 cm3. However, RI values in normal pubertal and postpubertal boys where testicular volumes exceed 4 cm3 are comparable to those previously described in adults.

Imaging techniques in the diagnosis of urinary tract infection.

In terms of future morbidity and mortality, one of the most important considerations in urinary tract infection is the age of the patient. In adults, only those with complications or illnesses that fail to respond to treatment require investigation to exclude underlying pathology. In contrast, the young are at risk of future hypertensive and renal disease; imaging techniques are therefore of paramount importance to identify those with renal parenchymal disease at an early stage and permit appropriate and adequate treatment. 99mTc-dimercaptosuccinic acid scintigraphy is emerging as the method of choice for this purpose, because it combines high specificity and sensitivity with convenience, repeatability, and acceptable radiation doses. Voiding cystourethrography will also be required in many cases to exclude bladder pathology. New developments include the use of color Doppler ultrasonography and the nuclear magnetic resonance technique of rapid acquisition recall echo urography, both of which may become of value for the detection of scarring.

Assessment of reducibility of ileocolic intussusception in children: Usefulness of color doppler sonography: Lim HK, Bae SH, Lee KH, et al Radiology 191:781–785 Jun 1994

Assessment of reducibility of ileocolic intussusception in children: Usefulness of color doppler sonography: Lim HK, Bae SH, Lee KH, et al Radiology 191:781–785 Jun 1994

Color Doppler sonography of the scrotum in children.

Color Doppler sonography is a well-accepted method for evaluating abnormalities of the scrotum and testes in children. The use of color Doppler sonography is especially important in acute diseases, allowing the evaluation of both perfusion and morphology. Most previous reports of the use of color Doppler sonography in the scrotum have been in adults [1-4]. In this pictorial essay, we illustrate normal and abnormal findings on color Doppler sonograms of the scrotum in children, particularly in prepubertal patients. Experience with vascular anatomy, inflammatory processes, testicular torsion, and tumors is emphasized.

Percutaneous vascular and nonvascular puncture under US guidance: role of color Doppler imaging.

Although ultrasound guidance is extensively used in percutaneous interventional procedures, the limitations of B-mode, gray-scale sonographic guidance can restrict clinical use. Little attention has been paid to the use of color Doppler sonography during such procedures. There are several ways in which color Doppler sonography can facilitate percutaneous procedures that involve insertion of a needle or catheter. The advantages of color Doppler sonography include the following: (a) better visualization of the shaft and tip of the needle, especially in solid, echogenic lesions, when the needle is moving, or when the beam-needle angle is narrow; (b) improved targeting of either vessels or non-vascular structures (ie, biliary ducts) to be punctured; (c) avoidance of interposed vascular structures and highly vascular areas during puncture of lesions; (d) improved visualization of poorly echogenic catheters, allowing proper placement; and (e) prompt detection of complications, including active bleeding, after withdrawal of the needle.

Transabdominal color Doppler ultrasonography of the painful adolescent ovary.

The objective of this study was to determine if color flow Doppler ultrasonography based on patterns of perfusion can aid in providing a specific diagnosis of ovarian masses associated with pelvic pain. Color flow Doppler images of 42 ovarian lesions in 42 adolescent girls (age range, 10 to 17 years) were analyzed prospectively. The color flow patterns were classified into three main categories: lesions with no vascularity; lesions with peripheral vascularity; and lesions with internal vascularity. The diagnoses included 22 hemorrhagic ovarian cysts, seven simple cysts, three cystadenomas, seven inflamed ovaries (five with microabscesses and two with dominant cystic abscesses), and three ovarian torsions. A peripheral pattern of flow was observed in 29 of 34 (85%) cystic lesions, including 18 hemorrhagic and six simple cysts, three cystadenomas and two abscesses. Peripheral flow was also identified in four enlarged ovaries, two with inflammatory disease and two with torsion. Internal flow was noted in five patients with enlarged ovaries due to inflammatory disease. Intraovarian flow was absent in three patients with torsion and in five of 34 cystic lesions. Internal ovarian flow was identified in 90% of normal ovaries. Resistive indices, obtained in 33 abnormal ovaries, were higher in cystic lesions than in inflammatory lesions, although the values overlapped. Our findings showed that internal ovarian flow can be found in inflammatory processes and normal ovaries, but the absence of flow also is nonspecific and can be found in a variety of ovarian cystic lesions as well as in torsion. This overlap limits the usefulness of color Doppler ultrasonography for differentiating cystic ovarian lesions associated with pain in adolescent girls.

Assessment of Reducibility of Ileocolic Intussusception in Children: Usefulness of Color Doppler Sonography

Assessment of Reducibility of Ileocolic Intussusception in Children: Usefulness of Color Doppler Sonography

Use of color Doppler sonography for detection of thyroid nodules.

Use of color Doppler sonography for detection of thyroid nodules.

Assessment of reducibility of ileocolic intussusception in children: usefulness of color Doppler sonography.

To assess the diagnostic usefulness of ultrasonography (US) in intussusception in children and determine whether color Doppler sonography (CDS) can indicate bowel viability and help in prediction of reducibility. US was used to examine 176 children in whom the presence of intussusception was clinically suspected. CDS was performed in 64 patients with 65 cases of intussusception proved with US. The positive US findings were confirmed with air enema; the negative findings, with air enema in 46 patients and clinical follow-up in 66 patients (100% specificity and sensitivity). CDS indicated blood flow in 62 of 65 cases of intussusception; pneumatic reduction was achieved in 58 (94%) of these 62 cases. Four patients (6%) underwent manual reduction of viable bowel; three patients (5%) who had no color Doppler signal underwent segmental resection. The difference in reduction rates based on blood flow was statistically significant (P = .0008). US is sensitive and specific in the diagnosis of intussusception, and CDS is a promising predictor of bowel viability.

Assessment of catheter placement and patency by color Doppler ultrasonography.

Catheter placement and follow-up, including patency check, usually is required in patients with serious conditions, who often cannot be brought to the Radiology Department for the procedure. In a series of 24 consecutive patients, we show the usefulness of color Doppler ultrasonography with its advantages of portable equipment, lack of ionizing radiation, improved catheter visualization, and ability to determine patency.

Alterations in regional cerebral blood flow in neonatal stroke: preliminary findings with color Doppler sonography.

Little information is available regarding alterations in regional cerebral blood flow and vascularity on cranial sonography in infants with focal ischemic brain injury. This study describes the use of color Doppler sonography in the characterization of these changes following acute neonatal stroke. Color Doppler examinations were performed as part of the series of clinically indicated cranial sonograms in eight infants with clinical, sonographic, and CT evidence of acute cerebral infarction. The cerebral vascularity of each hemisphere was assessed for symmetry and for presence of abnormal blood vessels. Initial Doppler study in four infants with hypoxic-ischemic infarcts showed increased size and number of visible vessels in the periphery of the infarct and increased mean blood flow velocity in vessels supplying or draining the infarcted areas. Diminished vessel number and size and frequency shifts suggestive of decreased hemispheric perfusion was identified in one infant with middle cerebral artery insufficiency. Repeat Doppler studies were performed on two infants. These showed the development of multiple small, irregular blood vessels in the periphery of the infarct. Focal abnormalities in regional cerebral blood flow may be present as part of the normal healing process following neonatal stroke, and can be demonstrated with color Doppler sonography.

Colour Doppler demonstration of pseudoaneurysms complicating pancreatic pseudocysts

The great morbidity and mortality associated with pseudoaneurysms complicating pancreatic pseudocysts stress the need for their early detection. The authors report the use of colour Doppler sonography in the detection of pseudoaneurysms within pancreatic pseudocysts, emphasizing not only the value of this modality in the initial diagnosis, but also its value in monitoring the success of transcatheter embolization. Colour Doppler should be used systematically in the evaluation of pancreatic pseudocysts.

Color Flow Doppler Sonography for Extracorporeal Shock Wave Lithotripsy

This report documents the usefulness of color Doppler sonography for early verification of urinary stone fragmentation during extracorporeal shock wave lithotripsy with ultrasonographic focusing. In the experimental study lithotripsy was performed on human urinary stones placed in pig kidneys. Increasing color flow within the stone mass created by movement of small fragments indicated fragmentation earlier than pixel movement on the standard gray scale sonogram. The success of treatment was demonstrated macroscopically. In the clinical study 25 patients with radiopaque kidney stones were treated by color Doppler guided shock wave lithotripsy and compared to a control group of 32 patients with similar stone characteristics in whom the end point of treatment was chosen based on B-mode sonography alone. The amount of color flow within the stone reflex determined the end point of treatment. The degree of fragmentation was confirmed by fluoroscopy immediately after treatment. Disintegration was successful in all cases and fragments passed spontaneously.Color Doppler imaging during shock wave lithotripsy provides reliable information on the spatial and temporal characteristics of stone fragmentation, and is superior to B-mode sonography by providing more immediate, objective information on stone fragmentation and allowing better evaluation of the focal zone. With the help of this technique, the number of applied shock waves could be reduced by 20% compared with the control group.

Antenatal diagnosis of vasa previa by transvaginal color Doppler sonography.

Vasa previa is a rare complication of pregnancy with a high perinatal mortality, which has virtually not changed over the last 200 years. In this case report we describe the use of color Doppler ultrasonography to make a correct antepartum diagnosis of vasa previa. The baby was delivered by Cesarean section. A strategy is presented which may reduce the high mortality rate from this condition.