Value Of Color Doppler Ultrasonography Research Articles

Diagnosis of Appendiceal Abscess in Children with Acute Appendicitis: Value of Color Doppler Sonography

Diagnosis of Appendiceal Abscess in Children with Acute Appendicitis: Value of Color Doppler Sonography

Portal Vein Thrombosis after Percutaneous Ethanol Injection for Hepatocellular Carcinoma: Value of Color Doppler Sonography in Distinguishing Chemical and Tumor Thrombi

Portal Vein Thrombosis after Percutaneous Ethanol Injection for Hepatocellular Carcinoma: Value of Color Doppler Sonography in Distinguishing Chemical and Tumor Thrombi

Portal vein thrombosis after percutaneous ethanol injection for hepatocellular carcinoma: value of color Doppler sonography in distinguishing chemical and tumor thrombi.

The distinction between benign (chemical) and tumor thromboses of the portal vein after treat,ent with percutaneous injection of ethanol for hepatocellular carcinoma is crucial for the proper management of the patient. The purpose of this study was to determine whether color Doppler sonography can be used to differentiate between the two types of thrombi. Between October 1991 and April 1994, portal vein thrombosis was detected by color Doppler sonography in 19 patients (13 men and six women 59-77 years old; mean age, 67 years) who had hepatocellular carcinomas and who had received percutaneous ethanol injection (n = 11) or percutaneous ethanol injection after transcatheter arterial embolization (n = 8). The criterion for diagnosing tumor thrombosis by color Doppler sonography was the detection of pulsatile arterial flow in the thrombus. The benign or malignant nature of the thrombosis was subsequently established by percutaneous fine-needle biopsy of the thrombus; malignant thrombosis was seen in 13 patients, and chemical thrombosis was seen in six patients. Pulsatile arterial flow in the thrombus was observed by color Doppler sonography in 12 of the 13 malignant thrombi and in none of the bland thrombi. The flow was hepatopetal in seven cases and hepatofugal in five cases. The peak systolic frequency shift ranged from 0.59 to 2.65 kHz (mean, 1.35 kHz), and the resistive index ranged from 0.37 to 0.69 (mean, 0.55). The sensitivity and the specificity of color Doppler sonography for the detection of tumor thrombosis were 92% and 100%, respectively. Our study shows that color Doppler sonography is a reliable way to differentiate between chemical and tumor thromboses of the portal vein in patients with hepatocellular carcinomas treated by ethanol injection. When the sonogram shows pulsatile arterial flow within the thrombus, percutaneous biopsy of the thrombus is unnecessary. The finding is always indicative of malignant thrombosis.

Diagnosis of appendiceal abscess in children with acute appendicitis: value of color Doppler sonography.

We performed color Doppler imaging of the right lower quadrant in children with acute appendicitis to characterize the imaging findings indicative of appendiceal perforation and to determine the value of this technique in diagnosing appendiceal abscesses. Forty-seven children with surgically proven appendicitis underwent color Doppler sonography of the right lower quadrant as an adjunct to gray-scale sonography. At pathologic examination, 27 patients had nonperforating appendicitis and 20 patients had perforating appendicitis. In the latter group, seven patients had abscesses and 10 had phlegmon. The color Doppler sonograms were evaluated for the presence or absence of appendiceal hyperemia, hyperemic periappendiceal or pelvic fluid collections, and hyperemic soft tissues in the right lower quadrant. Color Doppler sonography showed appendiceal hyperemia in 21 (78%) of the 27 patients with nonperforating appendicitis and in eight (40%) of the 20 patients with perforating appendicitis. The hyperemia was scattered in 14 (67%) of the 21 patients without perforation and in six (75%) of the eight patients with perforation. The remaining patients with blood flow identifiable on color Doppler sonography had focal appendiceal hyperemia. For seven (35%) of the 20 patients with perforating appendicitis, color Doppler examination showed hyperemic, loculated periappendiceal or pelvic fluid collections, subsequently proved to be abscesses at surgery. No patient with nonperforating appendicitis had a hyperemic, loculated periappendiceal or pelvic fluid collection. Ten patients with perforating appendicitis displayed increased color Doppler signal in the adjacent right-lower-quadrant bowel loops and soft tissues, indicating phlegmon or peritonitis. Our results indicate that the best color Doppler sonographic predictors of appendiceal perforation are a hyperemic periappendiceal or pelvic fluid collection and periappendiceal soft-tissue hyperemia. A hyperemic, loculated fluid collection appears specific for the diagnosis of abscess.

Value of color Doppler sonography in the diagnosis of venous impotence.

The gold standard in the diagnosis of venous impotence is cavernosometry. But a less invasive and time-consuming screening test for patients with a high probability of venous impotence is required. Therefore we evaluated 82 men with erectile dysfunction by color Doppler sonography after intracavernosal injection of 60 mg papaverine. 28 of them who had a poor erectile response but sufficient arterial inflow were included in this study. 6 patients who were previously found to have psychogenic impotence formed the control group. After pharmacological stimulation by papaverine, all patients were examined for 20 min by color Doppler sonography in order to detect diastolic flow velocities in the cavernosal arteries and erectile responses. Both groups of patients underwent pharmaco-cavernosometry in a blind fashion afterwards. The diagnosis of venous impotence with color Doppler sonography was confirmed by dynamic pharmaco-cavernosometry in 25 of 28 (89%) and 6 of 6 (100%) subjects of the study and control groups, respectively. Statistically, in the diagnosis of venous dysfunction, color Doppler sonography had a sensitivity of 100%, specificity of 66.6%, accuracy rate of 91% and a positive predictive value of 0.892. The gold standard in the diagnosis of venous impotence is still cavernosometry, but it seems that color Doppler sonography may provide a sensitive assessment of penile venous competence.

Femoral artery pseudoaneurysms: value of color Doppler sonography in predicting which ones will thrombose without treatment.

The purpose of this study was to evaluate the Doppler imaging characteristics of femoral artery pseudoaneurysms occurring after cardiac catheterization to determine if color Doppler sonography can be used to predict which pseudoaneurysms would ultimately thrombose spontaneously. Over a 30-month-period, 24 pseudoaneurysms were studied with serial color Doppler sonography. The color flow, B-mode, and Doppler spectral images and clinical records of patients whose pseudoaneurysms demonstrated spontaneous thrombosis were compared with those of patients who required surgical repair of the pseudoaneurysm. We found no statistically significant differences between the patients whose pseudoaneurysms demonstrated spontaneous thrombosis and those treated surgically in regard to clinical parameters or the volume of the pseudoaneurysm, percentage of flow within the pseudoaneurysm, ratio of forward to reversed flow velocity in the pseudoaneurysm neck, duration of diastolic flow in the pseudoaneurysm neck, or length of pseudoaneurysm neck. However, on color Doppler images, the volume of flow in the lumens of pseudoaneurysms that thrombosed spontaneously (1.8 +/- 3.3 ml) was significantly smaller than the volume of flow in the lumens of those treated surgically (4.4 +/- 3.2, ml, p = .02). We conclude that pseudoaneurysms with small volumes of flow in the lumen are more likely to thrombose than are those with large volumes of flow in the lumen. However, color Doppler sonographic characteristics cannot be used to predict subsequent thrombosis.

Color Doppler sonography of benign and malignant ovarian masses.

The use of transvaginal and transabdominal color Doppler sonography for the assessment of ovarian tumor vascularity was investigated in 62 cases of surgically excised and histologically examined ovarian masses. The modality was used to differentiate tumor neovascularity from normal arterioles (which contain smooth muscle in their media) on the basis of differences in the pulsatility observed in Doppler waveforms. Of the 25 malignant tumors in the series, 20 had low-impedance flow (pulsatility index of less than 1.0), and none had the diastolic notch seen in vessels in normal tissue. Three benign lesions, including two dermoid cysts and one tubo-ovarian abscess, also had low-impedance flow. The negative predictive value of color Doppler sonography was 98%, whereas the positive predictive value was 83%. Color Doppler sonography seems to be accurate for excluding malignancy, but some misdiagnosis may occur in cases of inflammatory and metabolically active benign masses.

Budd-Chiari syndrome: detection with color Doppler sonography.

The value of color Doppler sonography in evaluating newly diagnosed Budd-Chiari syndrome in five patients was studied. Hepatic venous findings included absence of vessels (one patient), flow reversal (two patients), narrowing (four patients), and tortuosity (three patients). Detected collaterals included hepatic venous to hepatic venous (four patients), hepatic venous to subcapsular systemic venous (two patients), and portosystemic (three patients). Hepatic venous spectral Doppler waveforms were flat and essentially aphasic in four patients, indicative of distal hepatic venous compression. The inferior vena cava was markedly compressed in two patients and slightly compressed in one. Color Doppler sonography allowed more reliable and confident identification of irregular, compressed, or otherwise abnormal hepatic veins than did conventional sonography. Color Doppler sonography also showed collateral vessels that were undetected with conventional sonography or other imaging techniques. Our results suggest that color Doppler sonography may be a valuable tool in the initial diagnosis and evaluation of suspected Budd-Chiari syndrome.

Screening von Nierenarterienstenosen

The value of colour Doppler sonography in the diagnosis of renal artery stenosis has been studied retrospectively. 17 patients were examined (34 main renal arteries and 7 accessory renal arteries; ages 37 to 84 years; 7 males and 10 females). We studied 1) ability to study the main renal arteries, 2) visibility of accessory renal arteries and 3) the sensitivity and specificity of colour Doppler sonography for the diagnosis of renal artery stenosis. The results were compared with intraarterial angiography. Demonstration of the main renal arteries with colour Doppler sonography was possible in 23 of the 34 vessels. Not a single of the 7 accessory renal arteries was demonstrated by colour Doppler sonography. Of 8 angiographically demonstrated stenoses (more than 50% narrowing) 2 were missed by colour Doppler sonography. One stenosis was correctly diagnosed and 5 were incorrectly evaluated by sonography. 16 out of 18 angiographically normal main renal arteries were correctly evaluated by colour Doppler sonography but 2 showed a false positive finding. This results in a sensitivity of 17% and a specificity of 89% per kidney. Colour Doppler sonography cannot be recommended as a screening method for renal artery stenosis in view of its limited accuracy.