Search

The aim of the present study was to evaluate the potential of colour Doppler and three-dimensional ultrasound for visualization of mammary gland structures in goats. Ten Bulgarian white milk goats, aged from 2 to 4 years, weighing 48–54 kg were used. Mammary gland scans were performed via the transcutaneous approach, using 11.0 MHz linear transducer for teat and 5.0 MHz transducer for udder parenchyma. Colour Doppler ultrasonography permitted the visualization of blood vessels in the udder parenchyma, the teat wall skin and the Furstenberg’s venous ring at the boundary between gland cistern and teat cistern. After differentiation of blood vessels, it was possible to determine the direction and velocity of blood flow. The three-dimensional (3D) ultrasonography of caprine mammary gland was capable of visualization of detailed description of the following morphological structures: papillary orifice, rosette of Furstenberg, teat wall, teat and gland cisterns, the parenchyma and the lactiferous ducts. The papillary orifice was seen as a small structure at the tip of the teat, and immediately above it, the teat canal was seen as a thin white band. The 3D image of the rosette of Furstenberg represented a clearly observable thickening at the boundary between the teat canal and the teat cistern. The 3D image of the teat wall allowed for differentiation of its three layers. In the region of the gland cistern, the lactiferous ducts and the parenchyma were distinguished, as well as the boundary between teat and gland cisterns. The analysis of results indicated that colour Doppler ultrasound permits the visualization of mammary blood vessels and their differentiation from anechoic lactiferous ducts and milk in teat and gland cisterns. The three-dimensional (3D) ultrasound check provides an opportunity for detailed observation of all morphological mammary gland structures of goats, which could serve as a background for detection of occurring pathological changes. The main advantage of 3D ultrasonography is the possibility for in-depth observation of the different udder parts, which allows for a more precise diagnostics.

This study investigated whether microvenous reflux can be detected in limbs with chronic venous disease using superb microvascular imaging (SMI) and colour Doppler imaging. Participants with venous disease (limbs, n = 26) and without venous disease (limbs, n = 10) were studied. The skin in the medial gaiter region was imaged using both SMI and colour Doppler to identify reflux in the small vessels in response to distal augmentation. The diameters and depths of responsive vessels were measured. In limbs with venous disease, reflux in response to provocation was visualised with SMI in a greater number of vessels (12/26 versus 4/26) and smaller vessels than with colour Doppler. Reflux in the superficial skin veins was demonstrated in one control participant (1/10) using SMI and in none using colour Doppler (0/10). Our study indicates that microvenous reflux is demonstrable in limbs with venous disease and that SMI is more sensitive than colour Doppler.

The anterolateral thigh flap (ALT) is often used to reconstruct the head and neck and depends on one or more skin perforators, which often present with variable anatomy. The aim of this study was to localise and evaluate the precise position of these perforators preoperatively with colour Doppler duplex ultrasound scanning (US). We detected 74 perforators in 30 patients. The mean duration of examination with colour Doppler was 29 (range 13-51) minutes. Adequate perforators and their anatomical course could be detected preoperatively extremely accurately (p

Cutaneous ultrasound carried out by dermatologists is an emerging diagnostic technique that complements the clinical diagnosis of benign cutaneous tumours by providing important information on their structure, their relation to neighbouring structures, and the degree of vascularisation. One of the main key points in the development of this technique for use in cutaneous tumours, which will be discussed in detail, is adequate surgical planning and monitoring of some minor ambulatory surgery techniques, such as drainage or infiltrations. Likewise, cutaneous ultrasound is also useful in the diagnosis of subcutaneous nodules, without clinical/dermoscopic manifestations, and in their differential diagnosis with malignant tumours.

Nail diseases are a diagnostic challenge and high-frequency ultrasound with colour Doppler is a simple and painless diagnostic test that can often be useful. Ultrasound allows real-time evaluation of the anatomical structures of the nail and its vascularisation. The present study reviews the literature on ultrasound findings in the normal nail and in inflammatory and tumoural disease.

Objective Takayasu arteritis (TA) is a chronic, granulomatous, idiopathic, inflammatory disease that primarily affects large vessels. The objective of this study was to evaluate and describe the ocular manifestations of TA, correlating the resistivity and pressure in retrobulbar vessels by colour Doppler and retinal angiography. Design Cross-sectional study. Participants Twenty-one patients with TA, 42 eyes, and 21 patients without TA (42 eyes) as control subjects. Methods This study was performed in clinical practice. Patients with TA received complete ophthalmologic examination, fluorescein and indocyanine green angiography, and colour Doppler ultrasound to evaluate blood flow in the retrobulbar vessels. Results A statistical correlation was found between peak systolic velocity (PSV) in the ophthalmic artery (OA) and Heidelberg retinal angiography (HRA) examination results ( p = 0.006), and resistivity index (RI) in the OA was abnormal in patients with long (average, 14 years) versus short (average, 5.5 years) onset time of the disease ( p = 0.035). RI in the central retinal artery (CRA) was abnormal in patients with a long time of disease onset (mean 14.4 years) versus those with a short time (mean 4.6 years) of onset ( p = 0.006). Conclusions The longer the onset of the disease, the more commonly the RI showed changes in the OA and CRA, and, to a lesser extent, in the short posterior ciliary artery. When abnormalities are observed in the HRA examination, abnormal PSV in the OA may be present. Doppler blood flow evaluation and HRA may have predictive value in all patients with TA as part of serial monitoring.

Introduction Breast elastography improves the diagnostic performance of B mode ultrasound to characterise lesions. There are many methods to use shear wave values to assess breast lesions. The aim was to assess elastography of the breast to characterise breast lesions. Assessment of the breast lesion including histological profile, tumour grade and molecular subtype. Method A prospective study, the patients were self selected into the study. The patients were routine visits to the ultrasound department and any lesions were assessed with measurements, colour doppler, vocal fremitis and elastography. The treatment pathway was not altered by this study. If they required a biopsy and were in agreeance for the pathology results and ultrasound results to be used, they were consented into the study. The lesions had the elastography value taken in radial and antiradial images. Results The elastography values in mean and maximum showed a statistically significant result. Malignant lesions had higher quantitative values then benign breast lesions. The elastography ratio of lesion:fat was statistically higher in malignant lesions. The luminal results showed that ER- and PR-negative breast cancers have a higher elastography maximum than ER- and PR-positive breast cancer. HER-2 positive and triple-negative breast cancers have higher ratios compared to ER-positive breast cancers. Conclusion The preliminary results show that elastography may be a complementary technique to conventional sonography to help characterise breast lesions. Take home message - Breast elastography improves the diagnostic performance of B mode ultrasound to characterise lesions including histological profile, tumour grade and molecular subtype.

The present study examines the relationship between reproductive and seminal characteristic with blood flow supply of the testis in male dogs by means of Doppler ultrasonography. Five male dogs were subject to a clinical examination, blood sampling, B-Mode and Doppler ultrasonography of the testis, semen evaluation at collections and after storage at 4°C for 24, 48 and 72 h in three replicates 30 days apart. Peak Systolic Velocity was positively correlated with testicular volume and negatively with live sperm at collections and after 24h. A negative correlation existed between Resistive Index and Pulsatility Index with total and progressive motility at collections and also after 24, 48 and 72 h. Resistive Index and Pulsatility Index were also negatively correlated with the percentage of membrane intact sperms with curled tails at collections while the latter was positively correlated with End Diastolic Velocity. Moreover, positive linear correlations of weight with bilateral testicular volume and total sperm concentration and also between age and abnormal sperm at collections and after 24h were established. The results suggest that the Resistive Index and Pulsatility Index seem to be potential markers of seminal quality in dogs.

Aim To investigate the accuracy of colour Doppler sonography as compared to phlebography in patients with Klippel-Trenaunay syndrome (KTS). Materials and methods From September 2004 to May 2012, 59 consecutive patients seen in Shandong medical imaging research institute with a clinical suggestion of KTS were included. Thirty-four were female and 25 were male, with a mean age of 28.4 years. Colour Doppler sonography was used to assess the lower limb veins. The main sonographic criteria for a positive diagnosis were visualization of the lateral vein or sciatic vein, capillary haemangioma, and abnormality of the deep veins. These data were compared with phlebography findings. The κ statistic was used to determine the level of agreement. The sensitivity, specificity, positive and negative predictive values, and accuracy of colour Doppler sonography as a diagnostic test were assessed. Results Colour Doppler sonography findings were positive in 21 of 59 patients with a clinical suggestion of KTS. The diagnosis was confirmed using phlebography in 22 patients. There were two false-positive results and one false-negative result by colour Doppler sonography. The κ-value was 0.892. Sensitivity, specificity, positive and negative predictive values, and accuracy for colour Doppler sonography were 95.4, 94.6, 91.3, 97.2, and 94.9%, respectively. Conclusion Colour Doppler sonography is an accurate, reliable, and non-invasive investigation in the assessment of patients with suspected KTS.

Objectives Triple-negative breast cancers generally occur in young women and they have the potential to be aggressive. It is important for this subtype of tumour to be detected early. We studied the appearance of 73 tumours on mammography, sonography and MRI in order to determine what specific features they showed on imaging. Patients and methods From July 2009 to December 2010, we retrospectively reviewed mammogram and sonogram images of 73 triple-negative cancers. Colour Doppler had been used to depict vascularisation in 34 cases and elastography score calculated in 17 cases. Sixteen patients had undergone MRI. The radiological description of these different modalities draws on the BI-RADS lexicon and categorisation. Results On mammography, triple-negative cancers often presented as a round mass (59.3%) or an oval or lobulated mass (65%), with circumscribed (15%), microlobulated (12.5%), indistinct (55%) or occasionally spiculated margins (15%). On sonography, the vast majority of these cancers appeared as masses (92.8%) with occasional posterior acoustic attenuation (22.6%). MRI showed more suspicious images than the standard examinations, notably rim-enhancement (eight out of 12 masses). Conclusion . Radiological images appear as lobulated masses more readily, while on sonography posterior enhancement is shown more often than attenuation, and MRI finds rim-enhancement.

Objective: To investigate the relationships between colour Doppler findings, infectious parameters and visual analogue scale (VAS) scores in patients with mild acute pelvic inflammatory disease (PID). Study design: Twenty-seven patients diagnosed with PID were enrolled in the study. Resistance index (RI) and pulsatility index (PI) of uterine, arcuate and utero-ovarian arteries were measured, as well as VAS score, erythrocyte sedimentation rate, C-reactive protein, white blood cell count and body temperature at hospital admission. After the initial visit, all measurements were repeated and recorded on days 7, 15 and 30. Results: PI and RI values of uterine arteries showed significant increases between days 1 and 7. However, PI and RI values of uterine arteries, RI values of arcuate arteries and RI values of utero-ovarian arteries showed significant increases between days 1 and 30. Statistically significant decreases in infectious parameters and VAS scores were observed between days 1 and 7, days 1 and 15 and days 1 and 30. Conclusion: Infectious parameters and VAS scores showed concordant changes with clinical recovery in mild PID. Significant changes were also observed in PI and RI values of uterine arteries, but Doppler measurements of arcuate and utero-ovarian arteries showed a slower and later response to treatment.

This paper presents a promising automotive technique for the classification of colour human tumour and nontumour tissues. The proposed classification algorithm is based on texture feature colour fuzzy texture spectrum and two more features from colour Doppler spectra. SOMs classify the tissues, which got a classification accuracy of 99.92%. Compared with other works, our method achieves good classification results on colour texture images, demonstrating the performance of our proposal.

Aim To assess the diagnostic performance of conventional ultrasound (US) and contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of non-palpable intratesticular tumours. Materials and methods The local ethics review board approved the protocol, and all of the patients provided written informed consent. Between December 2011 and February 2014, men with non-palpable testicular tumours and normal tumour markers who were referred for surgery were included. The tumours were analysed by conventional US, including B-mode and colour Doppler US (CDUS) as well as by CEUS. Morphological aspects and qualitative and quantitative CEUS criteria, based on visual enhancement and time–intensity curves, were assessed for each lesion. Results Forty patients were ultimately included. Based on histopathological results, the tumours were classified into three groups: benign tumours (n=16), malignant tumours (n=15), and burned-out tumours (n=9). In B-mode, the morphological aspects were significantly different between benign and malignant tumours (p-values from 0.0002 to 0.008). Qualitative and quantitative analyses of the CEUS images revealed that burned-out tumours exhibited significantly less enhancement than malignant and benign tumours: in burned-out tumours, time–intensity curves were flat, whereas in both benign and malignant tumours the curves had a bell-shaped pattern. All intensity parameters were lower for burned-out tumours compared to benign and malignant tumours (p-value from 0.0001 to 0.026). Both benign and malignant tumours enhanced strongly, however, and no significant difference between the two was noted (p-value from 0.0721 to 0.0953). Conclusion Unlike conventional US, which enable benign lesions to be differentiated from malignant or burned-out tumours, CEUS failed to enabled differentiation between benign lesions and malignant vascularised testicular tumours. CEUS appears to have the potential, however, to differentiate burned-out tumours from vascularised testicular tumours.

Objective To determine the morphology and hemodynamic characteristics of the arterial vessels of the proximal femur according to specific anatomic regions in asymptomatic neonates in 2 pediatric-based health care institutions. Methods Forty-three neonates (29 female, 14 male; age range, 2 d–3 mo; median age, 3 d) were enrolled in the study. Thirty-two (37%) of 86 hips were classified as Graf type IIA joints (mean alpha angle, 56.0° ± 2.7°), and 54 (63%) were classified as type I joints (mean alpha angle, 65.0° ± 4.6°). Results Colour and spectral Doppler imaging identified vessels running along the acetabular labrum, epiphyseal vessels, and femoral neck. We showed 4 different patterns of vascularity of the hips: radial, parallel, mixed radial–parallel, and indeterminate, however, they were not related to the hip maturity ( P = .3, coronal plane; P = .62, transverse plane) or to the amount of colour pixels identified in each region ( P = .35). The mean number of pixels in the ligamentum teres region was significantly higher than that in other regions of interest ( P = .03). Except for the acetabular labrum arteries, Doppler spectrum waveforms of proximal femur arteries presented with low resistivity. There was a tendency towards females' acetabular arteries presenting with lower peak systolic velocities than males' acetabular arteries ( P = .06). Conclusions Colour Doppler spectrum waveforms and intensity of vascularity in normal neonatal hips differ according to the anatomic region under evaluation. This observation deserves further investigation on its role on the physiopathogenesis of neonatal hip disorders.

To evaluate the correlation of grey-scale and colour Doppler sonography with colonoscopy and histology to detect bowel inflammation in children.The records of 72 patients with suspected bowel inflammation were reviewed retrospectively. Patients were included in the study if sonography had been performed up to 30 days before colonoscopy. Grey-scale and colour Doppler sonography were used to evaluate bowel wall thickness and vascularity for the detection of distal bowel inflammation. Findings were correlated with colonoscopy and histological findings. The sensitivity and specificity of sonographic wall thickness to detect inflammation was determined. Spearman's coefficient (rs) was used to determine the correlation of Doppler findings with colonoscopy/histology.Sonograms of 372 bowel segments were evaluated and results were correlated with colonoscopy and histological findings of 352 segments. The sensitivity and specificity of sonographic bowel thickness to detect inflammation in the terminal ileum and the right colon were high; in the other segments, specificity was high but sensitivity was low. The correlation of Doppler sonography with colonoscopy and histology to detect inflammation in the terminal ileum was strong (rs: 0.84; p0.001) and in the other segments, weak to moderate; when the interval between examinations was shorter than 10 days, the correlation was stronger in all segments. Of nine patients with abnormal small bowel sonograms but normal colonoscopies, three had Crohn's disease.Sensitivity and specificity of grey-scale sonography to detect inflammation in the terminal ileum and the right colon were high, and the correlation of Doppler with colonoscopy and histology was very strong in the same segments.

This article discusses the traditional and more recent echocardiographic measures that have been employed to evaluate atrial function. Conventional parameters commonly used and reported in the literature include the study of the various phases of atrial activity using atrial volume measurements, the peak A wave velocity, its velocity time integral (VTI) and the fraction of atrial contribution (all obtained from transmitral flow), as also the atrial ejection force. Newer parameters for atrial function assessment include Doppler tissue imaging (DTI) including segmental atrial contractility using colour Doppler tissue imaging (CDTI) and estimates of atrial strain and strain rate.

Objectives The aim of this study was to demonstrate the ultrasonographic features of prenatal bilateral torsion of the testis, and its histological correlation and management. Patient A newborn presented at delivery with both testes enlarged, swollen and tender. Prenatal ultrasound (US) showed enlarged, hyperechoic testes. Colour Doppler US examination was performed. Results US revealed both testes to be heterogeneous. Colour Doppler US did not reveal any flow signal. On inguinal exploration both testes appeared necrotic. Histology showed recognizable seminiferous tubules and Leydig cells. Conclusion We believe that both testes should be left in situ after bilateral detorsion even if their macroscopic appearance is necrotic.

Resume Les applications du doppler dans l'exploration de l'appareil urinaire se sont considerablement diversifiees au cours de ces dix dernieres annees. Il peut etre utilise dans le diagnostic des affections vasculaires pediculaires et intrarenales, le diagnostic de certaines nephropathies, dans l'evaluation des tumeurs renales et de certaines affections de la voie excretrice telles que la lithiase, l'obstruction aigue ou encore le reflux vesico-ureteral. Les progres technologiques recents et le developpement des agents de contraste ultrasonores en ont sensiblement ameliore les performances.

Fifty-two women with regular menses were enrolled in the study. The patients were not allowed to use non-steroidal anti-inflammatory drugs within 24 h of any examination. All patients were examined during the mid-luteal phase (6-9 days after ovulation, according to previous ultrasound record). Power Doppler energy levels were classified into five categories according to the per cent area of sub-endometrial signal: I (10%), II (10-25%), III (25-50%), IV (50-75%) and V (75%). The colour Doppler signal was considered positive when it reached at least the endometrial basal layer. The picture of the endometrium was analysed and the regions of interest were identified and marked for further analysis. Each recorded image was then independently evaluated and classified by three blinded observers. According to the power Doppler classification, age, body mass index (BMI) and endometrial thickness were analysed, and no significant differences were observed among them. The Kappa test (0.70) demonstrated an excellent agreement among examiners (P = 0.0001). This study has validated a very simple and cost-effective classification for sub-endometrial vascularization. This method of quantification may potentially be of use, and its relevance to clinical practice should be explored.

Purpose: Physical and technical artefacts of the colour Doppler method are examined with regard to their diagnostic relevance for the carotid artery. Materials and methods: After recording all diagnostic problems arising from physical and technical artefacts in 30,000 consecutively carotid arteries, the quantitative significance of relevant artefacts was determined in minor subgroups of the collective. Results: Acoustic shadowing causes diagnostic problems in morphological and haemodynamic evaluation of stenoses. Mirror image artefacts simulate flow in cases of actual vessel occlusion or mimic vessel wall ulceration in carotid plaques and stenoses. Insonation angle artefacts inhibit detection of flow or mimic flow reversal. Problems of spatial resolution lead to incorrect demonstration of the vessel lumen in stenotic findings. Aliasing, perivascular colour artefacts, and ghosting do not cause any diagnostic problems. Relevant shadowing artefacts occurred in 14.7%, and relevant mirror image artefacts in 2.5% of the pathological cases. Insonation angle artefacts occurred in 17.3% of the cases (when using standard apparatus setting). However, with an exact knowledge of the artefact phenomena, insonation angle artefacts could be eliminated and mirror image artefacts were recognized in all cases. Resolution artefacts resulted in underestimation of carotid stenoses by on average 13.3% of the degree of stenosis. Conclusion: In principle, four artefact phenomena give rise to diagnostic problems; however, with a good knowledge of the phenomena, only artefacts due to acoustic shadowing and limited spatial resolution are of diagnostic significance.

ObjectiveWe sought to quantitatively evaluate the degree of deep venous reflux of the lower extremities using colour Doppler velocity profile (CDVP) technology.MethodsDeep venous reflux volume was examined using CDVP in 79 limbs of 66 patients who were admitted to our hospital between July 1999 and July 2000 with primary, deep venous, valvular incompetence. Reflux data were statistically described and analyzed.ResultsOf 79 limbs, 20 had grade I reflux, with a mean reflux volume of 29.79 ± 5.89 mL/min; 19 had grade II reflux, mean reflux volume, 43.87 ± 4.86 mL/min; 23 had grade III reflux, mean reflux volume, 70.67 ± 5.77 mL/min; and 17 had grade IV reflux, mean reflux volume, 105.07 ± 14.8 mL/min. There were significant differences among grades I, II, III and IV (p < 0.05), except between grades I and II (p > 0.05) for analysis of variance and Student-Newman-Keuls analysis, although the 95% confidence interval (CI) of grade I was different from grade II. Every degree of reflux volume showed close correlation with the reflux index. Other indices were less sensitive.ConclusionsVenous reflux volume is a more accurate non-invasive quantitative assessment of the degree of deep venous reflux in the lower extremities than current methods.

Cooperation between paediatric nephrology/urology and paediatric radiology is essential for timely and correct diagnosis and therapy of kidney and urinary tract disorders. We need the direct contact between doctors before or after investigations, interdisciplinary discussions, and rapid access to the images. This should lead to optimal settings for investigations, a reduction of radiation burden and the number of investigations, and further improvement in the management of patients. Modern sonography including colour Doppler sonography, amplitude-coded Doppler sonography, and eventually 3D-ultrasound is and will be the method of choice as the basic, non-invasive investigation. These investigations should become the routine in all institutions. Refinement and standardisation of already established investigations are needed. Recently introduced investigations, like MRI, will have to show their impact on future diagnostic imaging. Future introduction of new non-invasive methods is welcome, e.g. to correctly diagnose vesicoureteral reflux without catheterisation/puncture of the bladder.

Objective: To describe the potential of modern sonographic techniques in paediatric uroradiology. Method: Ultrasound (US)—now being the primary imaging tool—has revolutionised imaging diagnostic in the urinary tract. Constant developments and technical refinements have secured the role of US in uroradiology. Colour Doppler Sonography (CDS) and innovative applications such as the transperineal approach or application of m-mode US to the urinary tract have helped to develop US from just a basic tool to a sophisticated and respected method. The ongoing introduction of new and even more sophisticated methods further enhance the sonographic potential, which shall be demonstrated by a more detailed discussion of these methods. Results: Harmonic imaging, extended field of view US, amplitude coded CDS, echo-enhanced US, and three-dimensional US as the most recent new sonographic techniques are successfully applicable to paediatric urinary tract disease. They improve sonographic diagnosis in many conditions, such as detection of vesico-ureteral reflux, renal parenchymal volume assessment, comprehensive visualisation of hydronephrosis and complex pathology, evaluation of renal perfusional disturbances or defects, superior documentation with improved comparability for follow-up, or simply by offering clearer tissue delineation and differentiation. Conclusion: Modern US techniques are successfully applicable to neonates, infants, and children, further boosting the value of US in the paediatric urinary tract. However, as handling became more sophisticated, and artefacts have to be considered, modern urosonography became not only a more powerful, but also a more demanding method, with the need for expert knowledge and dedicated training.

Pigmented villonodular synovitis is a rare proliferative disorder of the synovium of unknown aetiology. We present a case of pigmented villonodular synovitis in an unusual location, the interphalangeal joint of a toe, diagnosed by ultrasound with colour Doppler. The role of various imaging modalities in the diagnosis of pigmented villonodular synovitis is discussed.

In the early days, it was believed that ultrasound contrast agents (UCA) could be sufficiently detected and imaged with the conventional imaging methods nowadays referred to as fundamental imaging. Newer imaging techniques proved to be more sensitive and are based on specific properties of the UCA. In general, these new characteristics involve non-linear and transient characteristics of contrast agents that appear at the high end of the diagnostic acoustic intensity. Imaging modalities used today for UCA are, besides fundamental imaging, second harmonic imaging, power Doppler, harmonic power Doppler, pulse inversion and pulse inversion Doppler, multi-pulse imaging and subharmonic imaging. Although the results of conventional second harmonic imaging are still not optimal for perfusion imaging applications, in combination with Doppler techniques (colour Doppler, power Doppler) it is one of the most sensitive techniques currently available in terms of agent-to-tissue ratio. Further improvements in current and future detection methods demand a complete understanding of the ultrasound-UCA interaction.

AIMS/METHODS: A longitudinal study of 22 malignant lymph nodes by colour Doppler (CD) and/or colour power (CP) ultrasonography was undertaken in 12 non-Hodgkin's lymphoma patients to delineate changes in vascularity, and correlate this response with clinical outcome. RESULTS: Reduced vascularity in response to chemotherapy was shown to be a positive prognostic sign. CONCLUSIONS: More persistent nodal vascularity may signify a less favourable prognosis.Ho, S. S. (2000). Clinical Radiology 55 , 110–113.

Objective: to evaluate the accuracy of colour Doppler sonography (CDS) in the assessment of the left hepatic arterial supply in living donors before hepatic transplantation. Material and methods: Pre-operative sonographic Doppler data of the left hepatic artery (LHA) were compared retrospectively with the selective hepatic angiographic data and the intra-operative observations in 60 living donors. Results: Pre-operative Doppler data of the LHA were available in 53 cases and incomplete or absent in seven cases. In 51 cases (96%) the origin of the LHA or an accessory LHA were correctly described at Doppler sonography (44 classical LHA in anatomic position, seven accessory LHA). In 11 cases (21%), Doppler data were insufficient or incorrect to define the arterial supply of the hepatic segments II, III and IV. Doppler studies were unable to determine the length or the diameter of the LHA. Conclusion: Doppler sonography seems to be able to define the main left hepatic artery anatomy. Selective hepatic angiography is still indicated to determine the length, diameter and intra-hepatic segmental supply.

Transoesophageal echocardiography (TOE) offers real-time diagnosis and monitoring of a variety of structural and functional abnormalities of the heart in critically ill patients. It provides, in particular, useful information on cardiac contractivity, filling status and output, valvular morphology and function and the structure of the ascending and descending aorta. The anaesthetist disposes of the full range of echocardiographic modalities, including M-mode, two-dimensional and colour Doppler echocardiography. This chapter describes how different two-dimensional images can be obtained, presents a summary of the anatomical and functional information available in those images and relates this information to the clinical questions which form the indications to perform TOE.

We report the case of a 40-year-old woman with a submandibular sialocele (diagnosed by ultrasonography and magnetic resonance sialography) after sialoadenectomy for sialolithiasis. Type A botulinum toxin was injected percutaneously under colour Doppler ultrasonographic guidance into the sialocele and the residual salivary gland. Five months later the submandibular swelling had gone, and we gave a second injection of botulinum toxin to block any residual secretory activity. There were no side effects. This is, as far as we know, the first published report of the use of botulinum toxin to treat an iatrogenic submandibular sialocele.

Objective: Tumour vascularity can be assessed in-vivo using Doppler ultrasound. The purpose of this study was to determine whether Power Doppler imaging (PDI) better differentiates benign from malignant breast masses than conventional Colour Doppler imaging (CDI) on the basis of assessment of tumour vascularity. Methods: One-hundred women with solid breast lumps (51 malignant lesions, 49 benign lesions) were investigated using a Toshiba SSA-270A ultrasound machine with a 5.0 MHz (3.75 MHz Doppler reference frequency) or a 7.5 MHz (5.0 MHz Doppler reference frequency) linear array probe. The vascularity within or at the periphery of the mass was subjectively assessed from the CDI and Power Doppler images by two independent observers. It was assumed that the absence of vascularity indicated benignity and the presence of flow malignancy. Results: CDI showed sensitivities of 62 and 42% and specificities of 62 and 62% using the 5 and 7.5 MHz probes respectively. PDI showed sensitivities of 76 and 51% and specificities of 56 and 48% using the 5 and 7.5 MHz probes respectively. A comparison of images of the 59 lesions investigated with both probes on both CDI and PDI concluded that the 5 MHz (3.75 MHz DRF) probe displayed equal vascularity to the 7.5 MHz (5.0 MHz DRF) probe in 76% of cases and greater vascularity in 24% of cases on CDI, and 68 and 31% of cases respectively on PDI. Conclusion: Power Doppler imaging with a 5 MHz (3.75 MHz DRF) probe increases the sensitivity of Doppler ultrasound to malignant breast tumours but the sensitivity achieved is not high enough to propose it as a screening investigation.

Objective : Conventional transvaginal ultrasound- and transvaginal colour Doppler flow were used to assess morphology and circulation of pelvic masses. Study design : One hundred and nine adnexal masses in 101 women were examined between January 1993 and September 1994. Morphology was classified after a score published by Sassone et al. in 1991. Doppler waveforms using the lowest resistance index (RI), the pulsatility index (PI) and peak flow velocity were used for analysis. Ninety five patients underwent laparotomy. Following histopathological evaluation best cut-off values, sensitivity and specificity were calculated. Score results were compared with Doppler results and a combination of both methods. Results : A combination of Doppler sonography and conventional transvaginal sonography led to a sensitivity of 74.0% and a specificity of 73.7%. Eight out of 15 malignant masses were classified as stage I. An analysis of the false positive diagnoses showed that important information can be gained when Doppler sonography is performed. In particular, on solid appearing adnexal masses, Doppler sonography leads to a high accuracy (84.6%). Conclusion : Colour Doppler sonography is not applicable in routine clinical practice, but can give important additional information in specific cases. For solid appearing masses and in early ovarian malignancy, Doppler sonography facilitates the preoperative discrimination between benign and malignant processes.

The method of choice in the work-up of a patient with blunt abdominal trauma is contrast enhanced computed tomography (CT) as B-mode ultrasound alone is insensitive to intraparenchymal changes in the early stages. We describe a case where ultrasound together with Colour Doppler Energy (CDE) correctly diagnosed a splenic rupture/haematoma by demonstrating lack of perfusion in the upper pole of the spleen.

An automated system for measuring features of colour Doppler (CD) images has been examined for its ability to measure tissue perfusion in vivo under conditions of diffuse vascularity. Seven statistical features were extracted from CD images of human calf muscle and compared with the arterial input measured by plethysmography. It was found that, when appropriate scanning procedures are employed, good correlation is achieved with arterial input (r = 0.96 to 0.99). Ultrasound beam angle was important, even for the assessment of "colour area." A sensitive velocity scale was ideal for "percentage colour" (r = 0.979). "Mean colour velocity" correlates well with arterial input (r = 0.979) when the volocity scale was optimised for each CD scan. "Integrated colour velocity per unit area" was more responsive when using a variable velocity scale (r = 0.99) than a fixed velocity scale (r = 0.98), but was less responsive to low flow. Automated CD analysis speeds up the process of quantitative assessment of tissue vasculature and perfusion. It is therefore essential for the analysis of dynamic studies of ultrasound contrast agents and serial examinations when monitoring response to therapy.

Surveys published up to 1991 have highlighted a steady increase in the acoustic outputs from diagnostic ultrasound equipment. Since 1991 we have made measurements of the maximum peak negative pressure (p−) and spatial peak temporal average intensity (ISPTA) produced by 223 probes from 82 scanning systems in current clinical use in the Northern Region in the UK. Measurements have also been made of the maximum total acoustic power generated by 45 probes from 17 scanners. The results from these measurements are presented in this article and compared to the results of a similar survey of equipment from both the Northern and Wessex Regions in the UK and published in 1991. The comparison shows that measured ISPTA values have increased approximately sixfold in B mode and approximately threefold in colour Doppler mode. Also, measured total acoustic power values have doubled in pulsed Doppler mode. The present survey also draws attention to some particularly high ISPTA values obtained from a number of probes and scanning systems. This survey has shown that measurements of acoustic outputs from diagnostic ultrasound scanners in current clinical use are substantially higher than reported in earlier surveys and, for certain scanners, the acoustic outputs from scanned beam modes of operation can reach levels hitherto only found in pulsed Doppler mode.

The purpose of this study was to investigate the distribution of vein incompetence and the nature of venous haemodynamics accompanying the development of lower extremity primary varicose veins (LEPVV). The entire venous circulation of 77 lower extremities in 55 patients (pts) with LEPVV was evaluated, by using Duplex colour Doppler ultrasonography. The greater and lesser saphenous veins (GSV, LSV) and their branches were thoroughly scanned. The valvular integrity of the deep venous system was determined in the areas of common and superficial femoral vein, saphenofemoral junction, popliteal vein, saphenopopliteal junction, and perforating veins. Demonstration of bidirectional flow signified venous incompetence. Quantitation of venous reflux was estimated after manual calf compression with pts in a standing position. All the symptomatic legs had branch venous disease, 60% had GSV incompetence, 3% had LSV incompetence, 10% showed concurrent GSV and LSV incompetence, while 27% demonstrated no evidence of GSV, and LSV disease. Thirty per cent and 50% of the symptomatic legs demonstrated deep and perforating vein incompetence, respectively. Furthermore, 30% of the asymptomatic lower extremities had insufficiency of saphenofemoral (nine pts) and saphenopopliteal (one pt) junction. The median peak venous reflux in the incompetent GSV and popliteal vein was 0.74 ml/s (range 0.2 to 2.5 ml/s) and 3.5 ml/s (range 2.5 to 8 ml/s), respectively. In conclusion, the observed heterogeneity in anatomic and functional distribution of lower extremity venous insufficiency in pts with LEPVV support the hypothesis that this condition is probably a part of another entity that might be called "lower extremity primary venous insufficiency" whose treatment should be highly individualised. To this end, colour Doppler imaging can help.

A renal dialysis cartridge was adapted for use as a perfusion phantom for the investigation of ultrasound contrast agents. In preliminary studies using this phantom, it was possible to visualise the effects of introduction of contrast material into the system, on both real-time and colour Doppler imaging. It was also possible to make quantitative measurements relating to the backscatter and attenuation properties of the contrast material. The method of adapting the dialysis cartridge is economical and convenient, and should provide a useful in vitro model in which to evaluate and compare ultrasound contrast agents.

We have developed a system to acquire in vivo three-dimensional (3D) colour velocity images of peripheral vasculature. A clinical ultrasound system was modified by mounting the transducer on a motor-driven translation stage, allowing planar ultrasound images to be acquired along a 37 mm long stroke. A 3D velocity image is acquired by digitizing, in synchrony with the cardiac cycle, successive video images as the transducer is moved over the skin surface. 3D images require about 1 min to acquire and 10 min to reconstruct before being viewed interactively. Image acquisition at several points in the cardiac cycle permits a cine-type reconstructed image. Geometrical, temporal and velocity accuracy of the acquisition and reconstruction have been quantified and found not to degrade the image.

Early experience has suggested that colour flow Doppler ultrasound may have a diagnostic role in calf vein thrombosis. Before its accuracy within the calf can be adequately assessed, normal calf vein flow and anatomy needs to be understood. We, therefore, studied 40 normal volunteers, age range 24-75 years (mean 45.4), M:F 22:18, and assessed both flow and venous diameter in each of the three sets of calf veins in the supine and erect positions and once again in both these positions following the application of an above knee band. Paired sets of veins were present in all posterior tibial and common peroneal sets, but in only 85% of the anterior tibial group. Significant flow variations were present between different sets of veins, there being relatively less appreciable flow within the common peroneal (p0.05). Both band application and erect posture produced significant increases in venous diameter (p0.01, p0.001) in the posterior tibial and common peroneal veins, aiding visualization but at the cost of reducing flow following band application (p0.05, p0.01). The erect posture had no deleterious effect on calf vein flow. We, therefore, recommend that when the patency of calf veins is being assessed scanning should be performed in both a supine and erect position as this will help vein visualization without a reduction in flow, and thus avoid misinterpretation.

Colour Doppler imaging and cavernosometry are the optimal means for objective assessment of pharmacologically induced penile erections. 21 impotent patients were assessed by both methods independent of the information derived from the other modality. The diagnosis obtained was found to be immediately consistent in only 10 cases, 7 of which had venous leakage. 6 of the remaining 11 patients had a diagnosis of mixed arterial and venous disease in one or the other modality, but only arterial or venous disease alone in the other. The remaining 5 patients had completely inconsistent diagnoses. However, knowledge of the clinical picture and awareness of the pitfalls in the diagnostic procedures allows most of the discrepancies to be explained. Colour Doppler imaging is subject to operator error but allows selection of patients for cavernosography.

J Obstet Gynaecol Can 2015;37(8):679 A 35-year-old woman, gravida 1, para 0, underwent a placental ultrasound assessment at 22 weeks’ gestation because of her history of renal disease. This showed an anterior placenta with the umbilical cord inserted well away from the placenta on the posterior wall. Colour Doppler velocimetry confirmed velamentous cord insertion, with all the vessels encircling the internal os.

Many orthopaedic centres screen the proximal leg veins for occult deep venous thrombosis (DVT) in post-operative patients. This paper studies the practical implications of ultrasound screening. Venography and ultrasound with colour Doppler was performed in 51 patients. The time taken and results were recorded. There were seven cases (14%) of proximal DVT. The sensitivity of ultrasound was 86% with a specificity of 100%. There was one false negative (a small

This investigation involved the development of a range of Colour Doppler Twinkle Artefact phantoms to characterise and quantify the “Twinkle” artefact which is often present when an irregular structure is encountered in the imaged field of view. The artefact occurs in both colour and power Doppler ultrasound imaging and manifests as a false depiction of colour velocity information in stationary soft tissue and therefore can cause significant misdiagnosis of areas of flow within the patient. It has been hypothesised that it is generated due to a strongly reflecting medium composed of individual reflectors and therefore becomes a clinical concern when parenchymal calcifications are encountered. (Tsao et al., 2006). The aim of this study was to investigate the occurrence and magnitude of this artefact across a range of ultrasound scanners and to monitor the effects on the artefact of varying image acquisition parameters. A range of phantoms were produced that could reproducibly recreate the Twinkle artefact, the presence of which was quantified in a range of scanners (Zonare, Siemens Antares, Philips HDI and IU22). These phantoms included both fine and coarse structures as well as a flow channel in one of the phantoms, through which blood mimicking fluid was pumped. A semi-quantitative grading system was implemented and instrument controls such as pulse repetition frequency (PRF), colour write priority, greyscale gain and depth of focal zone were varied in order to determine their impact on the Twinkle artefact. Instrument control settings were found to significantly affect the intensity of this artefact, predominantly PRF showed a significant increase in the presence of this artefact. Furthermore, the extent of the artefact varied greatly across the range of scanners with Siemens Antaries and Zonare being most sensitive to the artefact. The implication of this study has shown the Twinkle artefact to be dependent on scanner specifications and instrumental parameters. With careful image optimisation, a reduction or elimination of the artefact can be achieved.

This study evaluates the potential of colour Doppler ultrasound (CDU) in prospective staging of axillary lymph node involvement by metastatic disease in breast cancer. The results of this staging were compared with histological examination of the subsequent surgically resected specimens. In this study, colour Doppler had an overall accuracy of 86.4%. The results demonstrate a potential for this technique and if confirmed in further trials, CDU might replace surgical assessment of axillary nodal status in certain breast cancer patients.

The colour Doppler signals in 35 patients with breast lumps (12 carcinomas, 23 benign lesions) were assessed subjectively. The number and location of vessels within the masses were recorded and compared with the histologic diagnosis and the lesion's size. All 12 malignancies were vascularized but only 12 23 benign lesions demonstrated vessels. All but one of the breast cancer displayed > 2 vessels compared to only 3 12 of the vascularised benign lesions. There was a relation between size of the lesion and the number of vessels observed. Colour Doppler proved more reliable in the differential diagnosis of breast masses when lesions less than 2 cm were considered.

Discussion: Despite widespread acceptance amongst experienced clinicians, the concept of intra-pelvic instability remains controversial in the wider medical community. Indeed, rheumatologists still argue it does not exist. Hence, lack of a validated objective outcome measure for intra-pelvic instability has major impacts on access to treatments for these patients and has made research in the area difficult. While our numbers are small, these early results indicate that we may, finally, have a tool that simply and reliably measures intra-pelvic instability. This early data also indicates that prolotherapy to the pelvic ligamentsmay correct this instability.