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The role of uterine receptivity and endometrial perfusion in in vitro fertilisation (IVF) remains unclear. In our prospective pilot study, we used a new dynamic tissue perfusion measurement method to evaluate this relationship in humans. A standard ovulation induction and embryo transfer method were applied to all the volunteers. On the day of embryo transfer, dynamic images of the uterus were recorded using colour Doppler ultrasound, and these images were uploaded onto PixelFlux Chameleon Software (GmbH, Munster, Germany). After determining the region of interest (ROI), the average velocity, intensity, and area values for all coloured pixels in the ROI, the tissue resistance index (RI) and the tissue pulsatility index were calculated. Endometrial thickness, morphology and dynamic endometrial perfusion parameters were compared between the clinically pregnant and non-pregnant groups. Endometrial thickness, morphology values and endometrial dynamic tissue perfusion measurements were similar between the groups. This study compared perfusion parameters between clinically pregnant and non-pregnant patients by accurately calculating endometrial tissue perfusion using standard software to establish its relationship with implantation success in IVF treatment.IMPACT STATEMENT What is already known about this subject? The relationship between IVF success, endometrial receptivity and perfusion is known. Clear valuations of endometrial receptivity require an endometrial biopsy which may cause endometrial damage to the actual IVF cycle. This problem has led researchers to conduct non-interventional studies. Studies have revealed the value of endometrial thickness, pattern and Doppler examination of endometrial uterine arteries in predicting the success of IVF treatment. What do the results of this study add? This prospective pilot study is the first one to use this programme in humans to evaluate uterine receptivity in IVF. Successful results can be obtained by using computer programmes in tissues where perfusion parameters cannot be measured using traditional colour Doppler ultrasonography. Revealing the relationship between tissue perfusion and IVF success will be more effective and accurate with the development of software technologies. What are the implications of these findings for clinical practice and/or further research? To increase the success of IVF treatment, current and new technological developments, as well as imaging methods should continue to be tested.

Arteriovenous fistula (AVF) complications are classified based on fistula outcomes. This review aims to update colour Doppler (CD) and pulse wave Doppler (PWD) roles in managing early and late complications of the native and prosthetic AVF. Vascular access (VA) failure occurs because inflow or outflow stenosis activates Wirchow’s triad inducing thrombosis. Therefore, the diagnosis of the tributary artery and outgoing vein stenosis will be the first topic considered. Post-implantation complications occur from the inability to achieve AVF maturation and dialysis suitability due to inflow/outflow stenosis. Late stenosis is usually a sequence of early defects repaired to maintain patency. Less frequently, in the mature AVF or graft, complications are acquired ‘de novo’. They derive either from incorrect management of vascular access (haematoma, pseudoaneurysm, prosthesis infection) or wall pathologies (aneurysm, myxoid valve degeneration, kinking, coiling, abnormal dilation from defects of elastic structures). High-resolution transducers (10–20 MHz) allow the characterization of the wall damage, haemodynamic dysfunctions, early and late complications even if phlebography remains the gold standard for the diagnosis for its sensitivity and specificity.

AIMS & OBJECTIVES- The aim of the study was to evaluate by duplex sonography normal appearance of deep veins of lower extremity and appearance of thrombus in clinically suspected patients of DVT. MATERIALS AND METHOD- This study was conducted on Siemens Acuson X-700 machine in the department of Radiodiagnosis at SRMSIMS Bareilly in 50 patients presented with clinical suspicion of leg pain. They were evaluated by color duplex sonography in Department of Radiodiagnosis. RESULTS- On color duplex sonography 42 patients were detected and conrmed for DVT .On sonography sensitivity for test was 82%. DISCUSSION- The diagnosis of DVT has always been troublesome. The characteristics signs and symptoms that can be associated with DVT and the fact that many thrombi are having no symptoms make it exceedingly difcult to rely on the clinical diagnosis. The management of patients with clinical presentation of DVT in the lower extremity needs precise diagnosis of thrombus, its nature, location and extent. CONCLUSION- It is conclusively accepted that Color Doppler USG is non invasive, efcient, easily, repeatable, widely available and sensitive diagnostic tool in diagnosis of lower limb DVT.

BACKGROUND Grey scale ultrasonography can be used as a first line imaging modality along with histopathology for evaluation of cervical lymphadenopathy. Morphologic features like size, shape, hilum and necrosis within the lymph node and vascularity are analysed. We wanted to identify the role of Grey scale ultrasonography and colour Doppler in characterisation of enlarged cervical lymph nodes, evaluate findings in benign and malignant cervical lymphadenopathy and assess the sensitivity, specificity, predictive value, likelihood ratios and accuracy in malignant and benign cervical lymph node enlargement. METHODS This was a cross sectional study with diagnostic test evaluation. All suspected cases of cervical lymphadenopathy referred for sonological evaluation to the Department of Radiodiagnosis of Govt. T.D. Medical College, Alappuzha were included in the study. About 75 patients included in the study, underwent Grey scale and colour Doppler sonography of cervical lymphadenopathy. RESULTS When three criteria were positive for malignancy, the sensitivity and specificity of grey scale ultrasonography and colour Doppler were 100 % and 73.80 %, and when four criteria were positive, the sensitivity and specificity were 72.73 %, and 90.48 % respectively. When we analysed individual variables, status of hilum (absence / presence) has reasonably good sensitivity and specificity, positive predictive value, negative predictive value and accuracy (90.09 %, 92.90 %, 90.09 %, 92.90 % and 92.0 % respectively). In our study the important criteria positive for malignant lymph nodes were size > / 11 mm in short axis diameter, round shape, absent hilum and peripheral and central + peripheral type of vascularity of cervical lymph nodes. For benign lymph nodes, oval shape, presence of hilum and central vascularity were the important criteria noted. CONCLUSIONS Grey scale ultrasonography can be complemented by colour Doppler ultrasonography (USG) in patients presenting with cervical lymphadenopathy to differentiate between benign and malignant lesions by reducing unnecessary biopsies by more accurate discrimination. KEY WORDS Grey Scale Ultrasonography, Malignant, Benign Lymph Nodes, Histopathology

BACKGROUND Neck swellings consists of a wide spectrum of pathological entities. These swelling can occur due to a variety of aetiologies consisting of congenital, acquired inflammatory, neoplastic, or vascular origin. It is essential to have an extensive knowledge of the anatomy and contents of each cervical compartment to achieve a diagnosis. The age of presentation and clinical findings often narrows down the differential diagnosis. Ultrasonography (USG) is helpful in differentiating the nature of the lesions and differentiating solid from cystic neck lesions. Ultrasound is often used as an initial modality for pre-treatment assessment of any neck swelling. METHODS Patients with clinically palpable / non-palpable neck swellings were scanned using 7.5 - 11 MHz transducers, excluding patients with diagnosed thyroid swellings. RESULTS In total 120 cases were studied; the mean age of patients was 34 years with a male to female ratio of 1.1:1. The age wise categorisation included paediatric population (34.2 %) and adult population (65.8 %). 96 (80 %) cases presented with painless neck swelling, 76 (63.3 %) cases were non-neoplastic and 44 (36.7 %) cases were neoplastic in nature. Cervical lymphadenopathy being the most common ultrasound finding in both paediatric and adult population. Malignant lesions were most common in adult age group. Heterogeneous echotexture, rounded nodes, intranodal necrosis, loss of echogenic hila, peripheral nodal blood flow and increased pulsatility index (PI) and resistive index (RI) were important features of malignant lymph nodes. Sensitivity and specificity of USG and Doppler in differentiating neoplastic from non-neoplastic lesions were 97.7 % and 98.3 % respectively and for differentiating benign from metastatic nodes were 97.7 % and 98.3 % respectively. CONCLUSIONS Considering the study results and observations, USG is the best initial investigation for the evaluation of inflammatory, cystic and neoplastic swellings in various age groups. It is non-invasive, cost effective readily available and repeatable technique. It is relatively easier to use and does not involve radiation hazards. Colour Doppler can evaluate the vascularity of the lesions and provide details of any vascular invasion of metastatic lesions. Ultrasound can differentiate aetiology of lymph node enlargement to a significant extent. KEYWORDS High Resolution Ultrasound, Paediatric Neck Mass, Metastatic Lymph Node, Histopathology, FNAC, Tubercular Lymph Nodes, Colour Doppler, Non-Thyroidal

Aim: To compare non-neoplastic and neoplastic scrotal masses by characterization on B-mode scan and Colour Doppler ultrasonography. Results: Of 56 cases of non-inflammatory scrotal swellings, 5 cases were neoplastic lesions, remaining 51 cases were non-neoplastic swellings. The 5 cases of neoplastic swellings were three cases of testicular neoplasm, two case of spermatic cord neoplasm which was histopathologically confirmed. Conclusion: When color Doppler sonography is supplemented with High frequency gray scale US, the sensitivity of diagnosing acute scrotal pathology will be increased.

The aim of this study was to evaluate ovarian masses with conventional grey scale ultrasonography and colour Doppler flow imaging and to assess the diagnostic reliability of these methods in differentiating benign and malignant ovarian masses. We assessed 56 patients with an ovarian mass. Morphological characterisation of the mass was performed utilising the Sassone score. Colour Doppler parameters were recorded for each patient, and the Caruso vascular score was also applied. The results were compared with surgical/pathological and/or follow-up scans. Using the Sassone score, overall reliability in differentiating ovarian masses had a sensitivity of 89.5% and a specificity of 78.4%. Using the Caruso score alone, we found a sensitivity of 89.5% and a specificity of 86.5%. Using the Sassone and Caruso scores together, we found a sensitivity of 94.7% and a specificity of 89.1%. Combining both morphological and colour Doppler scores in the evaluation of ovarian masses obtained higher specificity, sensitivity, and accuracy than was obtained using a single score only.

High-frequency ultrasonography (HFUS) represents a useful adjunct for dermatologists in the diagnosis of capillary malformation-arteriovenous malformation (CM-AVM) syndrome. We present a paediatric case series of 6 patients with confirmed RASA1 gene mutation in whom HFUS demonstrated AVM beneath cutaneous CM-like lesions greater than 1.5 cm.

Background Contrast-enhanced ultrasound (CEUS) has been used as an additional imaging technique in order to clarify testicular findings. CEUS is easy and fast to perform, overcomes the limitations of B-mode US. Objective To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the assessment of unclear testicular pathologies. Methods CEUS examinations of 45 patients with unclear testicular pathologies between 2012 and 2018 were analyzed retrospectively. Examinations were performed using B-mode, colour Doppler (CCDS) and CEUS after injection of contrast agent (SonoVue®, Bracco) and interpreted by an experienced radiologist (EFSUMB level 3). Reference standard was defined as histopathological report and clinical course. Results Overall 19 patients presented with a neoplastic lesion, whereas 14 were malignant. Matched to the histopathological report and clinical follow up, CEUS represented a sensitivity of 93% (95% -CI, 69-99), a specificity of 94% (95% -CI, 80-98), a positive predictive value (PPV) of 87% (95% -CI, 62-96) and a negative predictive value (NPV) of 97% (95% -CI, 83-99). Conclusion CEUS is an accurate additional tool to differentiate between testicular alterations when B-mode US and CCDS are uncertain. CEUS may provide additional information and detect early enhancement in small tumor lesions when CCDS comes to its limit.

Introduction Splenogonadal fusion is a rare developmental disorder that results in a gonadal or paragonadal mass due to the close proximity of the developing spleen and gonad. Case report We describe a case of splenogonadal fusion presenting as a paratesticular mass in a 25-year-old male. This was ultimately diagnosed on surgical biopsy. Discussion Splenogonadal fusion is a rare abnormality but can be managed conservatively. The sonographic features and the differential diagnosis are highlighted. Conclusion Through this case, we highlight the clinical and sonographic features of splenogonadal fusion. Awareness amongst ultrasound practitioners is important, given that it can be managed conservatively, and means of a non-invasive diagnosis are highlighted.

Background: A hernia is defined as a protrusion from a structure through the normally tissues containing it, either a focal or diffuse defects in the tissues with many types including: inguinal, femoral, umbilical and paraumbilical, epigastric and incisional hernias. Objective: This study aimed to evaluate anterior abdominal wall hernia using ultrasound and color Doppler. Patients and methods: An interventions study included (48) patients who were referred from the Surgery Department, Zagazig University Hospitals for sonographic evaluation of the abdominal wall and the abdomen when their clinical presentations were suggestive of abdominal wall hernia obstruction, either progressed or not progressed to bowl obstruction, when their physical examinations were inconclusive or when surgeons believed it was important to determine the contents of a suspected hernia preoperatively. Results: The mean age of the studied patients was 47.5 ± 21.88 years old, with a range from 3 months to 66 years old, less than ½ of the studied patients were males (41.7%) and 58.3 % were females. About 100% of the studied hernias were irreducible containing omentum, while hernias were containing bowel in 95.8% of cases, 41.7 % of cases contained free fluid in hernia sac, 47.8% of the studied patients had absent bowel peristalsis. Comparing the ultrasound finding with the operative data revealed that ultrasound had 100% sensitivity, while accuracy in diagnosis of peristalsis, bowel irreducibility, bowel thickness ranged from 93.4% to 98.8%. Conclusion: High-resolution ultrasonography (US) is an efficient tool for detecting the presence of abdominal wall hernias and accurately detecting the content, and the possible associated complications.

Major salivary gland ultrasonography (SGUS) is increasingly being recognized as having critical roles in differentiating primary Sjögren’s syndrome (pSS) from other connective tissue disorders. Contrast-enhanced ultrasonography (CEUS) has been reported to evaluate microvascularity of lesions in different tissues with objective angiographic index, eliminating the observer-dependent defect of ultrasonography. However, there are few relevant studies concentrating on the application of CEUS in the diagnosis and assessment for pSS, and their clinical utility prospect remains uncertain. In this study, a total of 227 eligible patients were enrolled, including 161 pSS and 66 non-pSS patients with comprehensive ultrasonographic evaluation of the parotid and submandibular glands, including grayscale ultrasonography, color Doppler sonography (CDS), and CEUS. Compared with non-pSS, pSS patients had significantly higher grayscale ultrasound (US) scores and CDS blood grades in the parotid gland and significantly higher grayscale US and CEUS scores in the submandibular glands. Diagnostic model combining ultrasonographic signatures, anti-SSA/Ro60, and keratoconjunctivitis sicca (KCS) tests showed a remarkable discrimination [mean area under the curve (AUC)0.963 in submandibular glands and 0.934 in parotid glands] for pSS, and the nomogram provided excellent prediction accuracy and good calibration in individualized prediction of pSS. A combination of multiple ultrasonographical examinations of the major salivary glands (SGs) is a promising technique that may be used as a practical alternative to minor SG biopsy in the detection of pSS.

Background Intestinal ultrasound [IUS] is a promising and non-invasive cross-sectional imaging modality in the diagnosis and monitoring of ulcerative colitis [UC]. Unlike endoscopy, where standardized scoring for evaluation of disease activity is widely used, scoring for UC with IUS is currently unavailable. Therefore, we conducted a study to assess the reliability of IUS in UC among expert sonographists in order to identify robust parameters. Methods Thirty patients with both clinically active [25] and quiescent [five] UC were included. Six expert sonographers first agreed upon key IUS parameters and grading, including bowel wall thickness [BWT], colour Doppler signal [CDS], inflammatory fat [i-fat], loss of bowel wall stratification [BWS], loss of haustrations and presence of lymph nodes. Thirty video-recorded cases were blindly reviewed. Results Inter-observer agreement was almost perfect for BWT (intra-class correlation coefficient [ICC]: 0.96) and substantial for CDS [κ = 0.63]. Agreement was moderate for presence of lymph nodes [κ = 0.41] and fair for presence of i-fat [κ = 0.36], BWS [κ = 0.24] and loss of haustrations [κ = 0.26]. Furthermore, there was substantial agreement for presence of disease activity on IUS [κ = 0.77] and almost perfect agreement for disease severity [ICC: 0.93]. Most individual parameters showed a strong association with IUS disease activity as measured by the six readers. Conclusion IUS is a reliable imaging modality to assess disease activity and severity in UC. Important individual parameters such as BWT and CDS are reliable and could be incorporated in a future UC scoring index. Standardized acquisition and assessment of UC utilizing IUS with established reliability is important to expand the use of IUS globally.

Bleeding is one of the complications of trans-rectal ultrasound (TRUS)-guided biopsy of the prostate. Urethral bleeding could be prevented by avoiding the trajectory on the urethra. However, rectal bleeding is difficult to predict because the peri-prostatic, intra-prostatic and rectal vessels cannot be seen on an ordinary ultrasound scan. Use of colour Doppler to map out the vessels cognitively before injection of local anaesthesia prevents puncture of the vessels, which is a key cause of rectal bleeding. Level of evidence: Not applicable.

Isolated left ventricular non-compaction (ILVNC) is a rare, congenital, idiopathic cardiomyopathy that may present in adulthood. There is no true gold standard for the diagnosis of ILVNC. Two-dimensional echocardiography with colour Doppler is the modality of choice to diagnose the condition. However, the diagnosis should be confi rmed with cardiac magnetic resonance imaging (CMRI), as well as either a positive family history, complications of ILVNC or confi rmatory genetic testing. We describe the clinical and echocardiographic features in 4 patients, each with a possible diagnosis of ILVNC, in the setting of potential alternative aetiologies for heart failure. Approval to present these cases was obtained from the institutional ethics committee and the patients also provided consent. Suffi cient transthoracic echocardiographic (TTE) evidence of ILVNC according to previously published criteria was found in all the cases, although it was not confi rmed with CMRI. This case series highlights the importance of routine echocardiography in all patients who present with heart failure – irrespective of associated risk factors. We caution against over-diagnosis of ILVNC with TTE alone, and recommend the use of CMRI as a second-line diagnostic investigation. Screening of family members and prevention of complications of confi rmed cases of ILVNC are important.

Aims : To compare the diagnostic performance of microvascular Doppler ultrasonography (MVUS) to B-mode and con- ventional colour Doppler US (CDUS) for detecting acute pyelonephritis (APN) lesions in children. Material and methods : An IRB-approved retrospective study was performed. From July 2018 to January 2019, 41 APN lesions in 28 children (15 boys, 13 girls; age range, 1-196 months; mean age, 53 months) who underwent 99m Tc‒dimercaptosuccinic acid renal scintig- raphy (DMSA) or contrast-enhanced computed tomography (CECT) and US including B-mode, CDUS, and MVUS were enrolled in this study. Three paediatric radiologists independently reviewed the B-mode, CDUS and MVUS images for the DMSA or CECT-proven APN lesions and evaluated the lesion visibility, lesion distinguishability and diagnostic confidence between the MVUS and CDUS images. Results : A total 41 of APN lesions were verified by DMSA (41 lesions) or CECT (3 lesions) during the same hospitalization period with renal US. Among 41 APN lesions, 52.8% was visible on B-mode, 85.4% on CDUS, and 94.3% on MVUS (p

Purpose of review The purpose of this review is to summarize the utilization and most recent developments with regard to the use of ultrasound when imaging the abdomen and gastrointestinal tract. Recent findings Although the use of ultrasound to assess the anatomy of the various abdominal organs is well established within radiology and critical care, its use as part of functional and physiological assessment is still evolving. Recent developments have extended the use of ultrasound beyond standard B-mode/2D imaging techniques to incorporate more functional and haemodynamic assessment. These include the use of contrast-enhanced ultrasound (CEUS), elastography, and colour Doppler techniques. Summary Whilst Doppler techniques are reasonably well established within critical care ultrasound (CCUS), especially in echocardiography, CEUS and elastography are less well known. CEUS utilizes a purely intravascular contrast agent whilst elastography measures the degree of deformation or stiffness in various organs. Whilst their use individually may be limited; they may play a role in a multiparametric assessment. Mirroring the overall trends in critical care ultrasound development, abdominal ultrasound assessment is best integrated in a holistic approach and adapted to the individual patient.

Background Portal vein aneurysm (PVA) is an uncommon vascular dilatation, showing no clear trend in sex or age predominance. Due to the low number of published cases and the lack of management guidelines, treatment of this condition remains a clinical challenge. Case summary We present three cases of asymptomatic PVA; the first and second involve an extrahepatic manifestation, of 48 mm and 42.3 mm diameter respectively, and the third involves an intrahepatic PVA of 27 mm. All were diagnosed incidentally during routine check-up, upon ultrasonography scan. Since all patients were asymptomatic, a conservative treatment strategy was chosen. Follow-up imaging demonstrated no progression in the aneurysm dimension for any case. Conclusion As PVA remains asymptomatic in many cases, recognition of its imaging features is key to favourable outcomes.

Background: Abdominal ultrasonography is a valuable tool for evaluating patients with FUO. A skilled ultrasonographer can examine most abdominal organs and often detect lesions that are not demonstrated by radiography. Aim of the work: The aim of this study is to demonstrate the diagnostic value of a complete standardized ultrasound examination of patients with fever of unknown origin. Patient and methods: We evaluate 60 patients by (ultrasound and colour Doppler) with infection in 32 patients and non-infection in 28 patients. The ultrasound and color Doppler diagnosis was confirmed by histological examination and others images. Results: In this study the US diagnosis were correlated with the final diagnosis based on laboratory examination in 44(73.3%) of the cases, US diagnosis did not correlate with final diagnosis in 16(26.7%) of the cases. Conclusion: Ultrasound is a valuable non-invasive tool in diagnosis of fever of unknown origin patients.

Objective: To determine the most discriminating two-dimensional gray-scale and colour Doppler sonographic features that allow differentiation between malignant and benign adnexal masses, and to develop a scoring model that would enable more accurate diagnosis with those features.Methods: A cross sectional prospective study was conducted on patients scheduled for surgery due to presence of adnexal masses at Gyneoncology Unit of Alshatby hospital, Alexanndria University, Egypt between1st of September 2018 to the 1st September of 2019. All patients were evaluated by 2D ultrasound for morphological features of the masses combined with colour Doppler examination of their vessels. The final diagnosis, based on histopathological analysis, was used as a gold standard.Results: Eighty four patients were recruited, 41 with benign masses, 43 with malignant masses. Features that allowed statistically significant discrimination of benignity from malignancy were; wall thickness, presence and height of the largest papillary projections septation, Echogenicity, largest diameter of the solid component, colour score ,Doppler indices; RI cutoff

Present study was to evaluate and standardize different ultrasonography techniques to predict malignancy of canine tumours. The study was conducted on 28 canine patients (20 females and 8 males) with visible tumour masses with age ranging from 5 to 13 years of age and body weight from 11 to 37 Kg, for a period of 8 months. The ultrasonographic variables for different techniques (B-mode, Colour Doppler and stress elastography) were measured and recorded. The tumour masses after excision were submitted for routine histopathological examination. Statistical analysis was performed using analysis of variance and paired “t” test using IBM SPSS statistical packages. The B-mode and Colour Doppler ultrasonography had a low to moderate sensitivity, specificity and accuracy in predicting the malignancy of canine tumours. The stress elastography was a reliable and non-invasive technique to predict the malignancy in case of canine tumours with highest level of sensitivity, specificity and accuracy.

Background: Adnexal mass lesions are very common among women of all age group but very common among reproductive age. Differential diagnosis of adnexal mass is difficult and complex. Recognition of the severity of the problem, appropriate and timely evaluation and treatment with good outcome is the goal. Ultrasound is the primary modality used for detection and characterization of adnexal masses. The purpose of this study is to evaluate the diagnostic accuracy of ultrasonography in patients suspected with adnexal masses. Objectives: Understanding the characterization of adnexal masses on ultrasonography and colour doppler,and to corelate the usg findings with histopathology where ever possible,to derive simple and clinically useful usg based IOTA rules for discriminating between benign and malignant mass. Methods: The study was conducted on 100 patients with suspected various adnexal masses in a period of 1 year from 2018-2019. Patients are selected based on Clinical history & Adnexal masses detected on pelvic ultrasound. Results of ultrasound were correlated with available histopathological findings. Results: On histopathology, out of total 50 cases studied 14(28%) were malignant and 36 (72%) were benign. Out of 45 cases where IOTA simple rules were applicable, 16(35.5%) were malignant and 29(64.4%) were benign. Conclusion: On comparing the findings of ultrasonogram versus histopathology, it was found that ultrasound had a high sensitivity of 91.66%, 84.84% specificity, 68.7% positive predictive value, 96.55% negative predictive value and 88.8% accuracy of detecting adnexal masses. Keywords: TAS – Transabdominal sonography, TVS – Transvaginal Sonography, Adnexal Masses.

BACKGROUND In adults, the normal portal venous pressure is 5-10 mmHg. Portal hypertension is defined as portal venous pressure of more than at least 5 mmHg greater than the pressure in the hepatic veins or inferior vena cava.1 Clinically significant portal hypertension, sufficient to cause serious complications and therefore requiring treatment, is defined as an increase of 12 mmHg. The objective of the study is to study the role of ultrasound and colour doppler sonography in 1. evaluation of portal hypertension, 2. identifying specific features of portal hypertension on these modalities, that permit its accurate diagnosis and 3. detecting the complications at an early stage. MATERIALS AND METHODS Forty adult patients referred to the radiodiagnosis department of Sri Lakshmi Narayana Institute of Medical Sciences with clinical diagnosis of portal hypertension were included in study. All patients included in the study underwent ultrasonography (USG) of abdomen using a curvilinear and a sector probe of 3.5-5.0 MHZ coupled with colour Doppler equipment. Statistical analysis was done using percentage and proportions. RESULTS The most common age group presenting with portal hypertension was between 51-65 years. The frequency of portal hypertension was more in males. Diameter of portal vein of >13 mm was seen in 53% and

BACKGROUND Sacroiliitis is an important feature of several spondyloarthropathies. While findings on conventional radiographs are delayed, the cost and availability of MRI are still important negative factors. The objectives of the study were- 1) to evaluate the role of ultrasound and colour doppler (CD) in the detection of sacroiliitis and 2) to compare these findings with those of normal age matched population. MATERIALS AND METHODS In this prospective study, bilateral sacroiliac joints of 25 patients with suspected sacroiliitis were studied. Radiographs were taken for all patients. MRI was performed for patients with normal or unilateral disease on radiographs. USG and CD were performed for bilateral SI joints. Presence of fluid, echogenic joint space, hypervascularity and low-resistance flow (

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.

Objective:The imaging of stones in the salivary glands and ducts poses a challenge, even to experienced ultrasound examiners. This study investigated whether the ‘twinkling artefact’, which occurs at internal calcific foci during Doppler ultrasound examinations, is useful for detecting salivary gland stones.Methods:In a model test, 20 salivary stones were analysedin vitro, via Doppler ultrasound, with regard to their representability and the triggering of the twinkling artefact. In a follow-up study, 28 patients with sialolithiasis and food-related large salivary gland swellings were examined, using both power and colour Doppler modes, with regard to the twinkling artefact. All ultrasound examinations were performed by an experienced examiner and retrospectively graded by two experienced sonographers.Results:All stones could reliably be detected using the twinkling artefact in the model test. Twenty-seven of 28 salivary stones (96 per cent) also showed twinklingin vivo, during patient assessment. The power Doppler mode showed a significantly higher intensity level of twinkling than the colour Doppler mode (p< 0.0001).Conclusion:The twinkling artefact is a very reliable sign for the diagnosis of sialolithiasis. Power Doppler is superior to colour Doppler for detection of the twinkling artefact.

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

Liver transplantation is a frequently used treatment for patients with end-stage liver disease and ultrasound is often the first-line imaging technique for detection of vascular complications after liver transplant. Although colour Doppler ultrasound is a good screening method for evaluation of post-liver transplant vasculature, it has limitations in evaluating small-calibre vessels and vessels in close proximity. Contrast-enhanced ultrasound (CEUS) has been proposed to overcome these limitations by improving visualisation of post-liver transplant vasculature and reducing the number of false-positive cases, which necessitate unnecessary additional investigations such as computed tomography or angiography. Liver transplant anatomy and the wide array of post-transplant imaging findings on colour Doppler have already been well described but literature on the use of CEUS and its image interpretation remain scarce. This review aims to discuss the indications for CEUS after liver transplant, to demonstrate CEUS technique and familiarise readers with the imaging appearances of post-transplant vascular complications on CEUS.

This research communication aims to test the hypothesis that B-Mode, colour Doppler ultrasonographic measurements and characteristics can identify mastitis in dairy cows. A total of 102 lactating cows were divided into 3 groups: cows in which all mammary quarters were CMT-negative, cows with CMT-positive mammary quarters and cows with clinical mastitis in at least one quarter. Colour Doppler ultrasonography measurements of the supramammary lymph nodes revealed that distortion-type vascular morphology, the rate of type 4 vascular densities and the incidence of mixed-type vascular distributions were highest in the clinical mastitis group, whereas the frequency of avascularity in supramammary lymph nodes was highest in the CMT-negative group. All differences were significant. In conclusion, the use of B-mode and colour Doppler ultrasonographic measurements of the supramammary lymph nodes can provide useful information about the current condition of mastitis in cows, although its diagnostic potential remains to be determined.

The superficial temporal artery (STA) is one of the terminal branches of the external carotid artery; STA pseudoaneurysms are uncommon vascular lesion, generally subsequent to blunt or penetrating trauma that could represent a trick for radiologist, especially when the only anamnestic information is "palpable superficial swelling". In this article, we describe our ultrasonographic experience about STA pseudoaneurysm reporting several cases with different etiopatogenesis.Between January 2004 and March 2015 six patients (4F and 2M; aged 15-55 years, mean 36 year) presented at our department with superficial palpable swelling in temporal region (four with trauma history, two with iatrogenic cause) underwent to ultrasonographic study to assess the presence of STA pseudoaneurysm. Ultrasonographic findings suggestive of pseudoaneurysm was a well-defined, pulsatile, anechoic mass in B-mode, a swirling or disorganized pattern of blood flow in the lesion with demonstration of direct communication between arterial lumen and pseudoaneurysm at colour-Doppler and a typical to-and-fro waveform on pseudoaneurysm neck at pulsed-Doppler.B-mode proves the presence of anechoic mass in five on six patients. Colour-Doppler demonstrates the presence of flow inside the lesion in five patients and a direct communication in all patients. To-and-fro typical waveform has been demonstrated in five patients. Ultrasound made diagnosis in all patients with a sensibility and specificity of 100 %.US is the imaging modality of choice, since it can provide detailed information about vascular anatomy without incurring the risks of invasive methods like angiography or radiation.L’arteria temporale superficiale (STA) è uno dei rami terminali della carotide esterna. Gli pseudoaneurismi dell’STA sono poco frequenti, generalmente successivi a traumi chiusi o penetranti, potendo trarre in inganno il radiologo soprattutto quando l’unica informazione anamnestica è “rigonfiamento superficiale palpabile”. In quest’articolo descriviamo la nostra esperienza ultrasonografica riguardo gli pseudoaneurismi dell’STA riportando diversi casi ad eziopatogenesi diversa.Tra il Gennaio 2004 e Marzo 2015 6 pazienti (4F E 2M; Età 15–55 anni, media 36) giunti al nostro dipartimento per un rigonfiamento superficiale palpabile in regione temporale (4 con storia di trauma, 2 per cause iatrogene) vengono sottoposti ad esame ecografico per valutare la presenza di pseudoaneurismi dell’STA. I reperti ultrasonografici suggestivi per pseudoaneurisma sono stati: una massa ben definita, anecogena e pulsatile in B-mode, un pattern di flusso turbolento all’interno della lesione con la dimostrazione di una diretta comunicazione tra il lume arterioso e lo pseudoaneurisma al color-Doppler e un tipico spettro flussimetrico “to-and-fro” in corrispondenza del collo aneurismatico.B-mode ha mostrato la presenza di una massa anecogena in 5 su 6 pazienti. Il color-Doppler ha dimostrato la presenza di flusso all’interno della lesione in 5 pazienti e una diretta comunicazione in tutti i pazienti. Lo spettro “to-and-fro” è stato dimostrato in 5 pazienti. L’ecografia ha permesso la diagnosi in tutti i pazienti con una sensibilità e specificità pari al 100 %.L’ecografia rappresenta la modalità di imaging di scelta, fornendo informazioni dettagliate sull’anatomia vascolare senza incorrere nei rischi di metodiche invasive come l’angiografia o all’utilizzo di radiazioni.

AIMS Can Doppler index–RI be a predictor of renal colics impending obstruction in acute and emergency clinical settings. To compare the results of RI in cases of obstructive, nondilated and normal kidneys. METHODS A total of 90 patients were included in this prospective study. The patients were grouped into three categories based on the clinical settings. Group 1 with acute unilateral obstruction were 44, group 2 who were presented with flank pain without stone disease were 26 and group 3 were 20 patients with sonologically normal kidneys. Grey scale ultrasonography and colour Doppler study carried out in all the groups and index – RI value were compared. RESULTS The study showed differences in RI values among the groups (0.726±0.04, 0.63±0.039 and 0.608±0.03 respectively). CONCLUSION In acute and emergency clinical setting, grey scale ultrasonography and interrogation with colour Doppler index– RI improved the assessment and detection of impending obstructive uropathy.

Extra-testicular lesions are usually benign but present with nonspecific grey-scale sonography findings. This study assesses conventional sonographic characteristics in the differentiation of extra-testicular tumoural from inflammatory lesions and whether contrast-enhanced ultrasound has a role. A retrospective database analysis was performed. All patients were examined by experienced sonographers employing standard techniques combining grey-scale, colour Doppler sonography and contrast-enhanced ultrasound. Features recorded were: clinical symptoms, size, location, echogenicity, colour Doppler sonography and contrast-enhanced ultrasound enhancement. Vascularity on colour Doppler sonography and contrast-enhanced ultrasound was graded and compared. The lesions were classified as tumoural or inflammatory. The Chi-square test was used to analyse the sonographic patterns and kappa coefficient to measure the agreement between colour Doppler sonography and contrast-enhanced ultrasound. A total of 30 lesions were reviewed (median diameter 12 mm, range 5–80 mm, median age 52 years, range 18–86 years), including 13/30 tumoural and 17/30 inflammatory lesions. Lesions were hypoechoic ( n = 12), isoechoic ( n = 6), hyperechoic ( n = 2) or mixed ( n = 10). Grey-scale characteristics of tumoural vs. inflammatory lesions differed significantly ( P = 0.026). On colour Doppler sonography, lesions had no vessels ( n = 16), 2–3 vessels ( n = 10) and ≥4 vessels ( n = 4). On contrast-enhanced ultrasound, lesions showed no vascularity ( n = 17), perfusion similar to testis ( n = 7) and higher ( n = 6). All abscesses identified ( n = 9) showed no vascularity on both colour Doppler sonography and contrast-enhanced ultrasound. There was good agreement between these techniques in evaluating vascularity ( κ = 0.719) and no significant difference between colour Doppler sonography and contrast-enhanced ultrasound of tumoural vs. inflammatory lesions ( P > 0.05). The grey-scale appearances of extra-testicular lesions are essential for characterisation. Colour Doppler sonography and contrast-enhanced ultrasound findings are not useful in that respect. Contrast-enhanced ultrasound is excellent in establishing absence of vascularity.