Colour Doppler energy (power) mode ultrasound.
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Blood Flow Velocity↗
Biomedical subjects
D O Cosgrove
Publications and source records attributed to D O Cosgrove.
Renal, hepatic, and cardiac enhancement on Doppler and gray-scale sonograms obtained with EchoGen.
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Adult↗
Device to enhance visibility of needle or catheter tip at color Doppler US.
The authors tested a device that allows the tip of a needle to be visualized at color Doppler ultrasonography. The device directs an oscillating air column through a 0.016-inch inner-diameter hollow stylet, creating movement at only the needle tip. The movement is reliably and accurately displayed as a beacon of color at depths of 15 cm in vitro.
Catheterization↗
Automated quantification of color Doppler signals: a preliminary study in breast tumors.
PURPOSE: To quantify color Doppler (CD) signals reflected by breast lesions to improve differential diagnosis and serial comparisons. MATERIALS AND METHODS: Frame-grabbed color-capture scans were remapped to original velocities on a pixel-by-pixel basis for statistical analysis. Total CD area and its percentage, peak and mean velocities, standard deviation of velocity, and integral CD velocity and its percentage were calculated. These indexes were applied to scans of 44 cancers, 16 fibroadenomas, and 14 benign breast changes in 74 patients. RESULTS: With the region of interest confined to the lesion and a 5-mm margin, no CD signals were reflected by the benign breast changes. All carcinomas and 12 fibroadenomas (those that were vascular) reflected CD signals, and, except for mean and peak velocity, all scores for cancers were significantly higher than for fibroadenomas (P < .0001). Integral CD velocity was the best discriminator, with no overlap between carcinomas (range, 1,128-50,228 cm3/sec) and fibroadenomas (range, 0-1,027 cm3/sec). CONCLUSION: Automatic CD quantification improved differential diagnosis of breast masses.
Adult↗
Case report: diffuse fatty infiltration of the renal parenchyma secondary to bilateral angiomyolipomas--features on ultrasound and computed tomography.
A case is described where ultrasound demonstrated diffusely increased echogenicity in massively enlarged kidneys. Computed tomography confirmed fatty replacement of the renal parenchyma, allowing a confident diagnosis of multiple bilateral angiomyolipomas in a clinical setting of tuberous sclerosis. This is the first ultrasound demonstration of such diffusely echogenic kidneys in angiomyolipoma.
Adult↗
Adaptive speckle reduction for improving the differential diagnosis of breast lesions.
Adaptive speckle reduction could mask diagnostic features and adversely affect diagnosis of focal breast lesions. Four radiologists assessed focal breast lesions (29 malignant and 31 benign) by blind review of representative static B-mode scans before and after adaptive speckle reduction processing, scoring 14 diagnostic features for breast cancer and recording their opinions on the diagnosis and on how adaptive speckle reduction affected interpretation of each feature. No adverse affect on diagnosis of malignant (P = 0.756) or benign (P = 1.000) breast lesions was found, despite some differences in scoring of the diagnostic features after adaptive speckle reduction. Observer recognition of most diagnostic features was easier after adaptive speckle reduction (e.g., edge definition [50% of cases], edge regularity [40%], lesion texture [44%], and lesion echogenicity [35%]).
Adult↗
Effects of tamoxifen on uterus and ovaries of postmenopausal women in a randomised breast cancer prevention trial.
Randomised, double-blind controlled trials have been started to determine whether tamoxifen can prevent or delay development of breast cancer in healthy women with a family history of the disease. We recruited a randomised cohort of 111 postmenopausal women (aged 46-71 years) from the Pilot Breast Cancer Prevention Trial at the Royal Marsden Hospital to study the effect of tamoxifen on the uterus and ovaries. The main outcome measures were obtained by transvaginal ultrasonography with colour doppler imaging and microscopic examination of endometrial biopsies removed at the time of the scan. There was no significant difference between tamoxifen (20 mg/day) and placebo groups in the age of the women, or the time of the scan (and sampling) after randomisation. Women taking tamoxifen had a significantly larger uterus and a lower impedance to blood flow in the uterine arteries. 39% of women taking tamoxifen had histological evidence of an abnormal endometrium compared with 10% in the control group. 10 patients in the tamoxifen group (16%) had atypical hyperplasia and another 5 (8%) had a polyp. Women with a histological abnormality had a significantly thicker endometrium and a decreased impedance to blood flow in the uterine arteries. There was no correlation between the presence of uterine abnormalities and the age of the women, or the concentrations of tamoxifen or desmethyl tamoxifen in the peripheral blood. These findings confirm that tamoxifen can cause potentially malignant changes in the endometrium of postmenopausal women. Transvaginal ultrasonography can be used to identify those women who should have endometrial samples removed for microscopic analysis.
Aged↗
Colour Doppler demonstrates venous flow abnormalities in breast cancer patients with chronic arm swelling.
Chronic arm oedema following breast cancer treatment is traditionally attributed to lymphatic obstruction, with venous obstruction as an infrequent complicating factor. The axillo-subclavian venous systems of 81 patients with arm swelling following breast cancer treatment were examined with colour Doppler, duplex Doppler and grey scale ultrasound. Over half (57%) had evidence of venous outflow obstruction and a further 14% had signs of venous "congestion". Only 30% of the swollen arms had normal venous outflow. The venous systems of the contralateral non-swollen arms were all normal as were both arms in 28 control patients who had similar treatment but had not developed arm swelling. These findings suggest that venous outflow obstruction is an important contributory factor in the pathophysiology of arm swelling following breast cancer treatment.
Adult↗
Increased arterial inflow demonstrated by Doppler ultrasound in arm swelling following breast cancer treatment.
Doppler ultrasound was used to estimate the mean arterial flow in the arms of 50 patients with arm oedema following breast cancer treatment (oedema group). They were compared with 26 treated breast cancer patients with no arm swelling (control group). Flows on the treatment side were expressed as a percentage of the flow in the contralateral normal arm. Mean percentage blood flow was 68% higher in the swollen arms than the contralateral normal arms compared to a mean increase of 38% on the breast cancer treatment side in the control group. In both groups there was a significantly higher proportion of patients with increased (> 150%) rather than decreased (< 50%) flow on the treatment side. The ratio of increased to decreased flow was 27:4 in the oedema group and 6:0 in the control group. A neurological deficit on the treatment side was associated with an increased incidence of higher flow on the same side in the oedema group. These findings demonstrate that breast cancer treatment results in a significant increase in arterial flow in the arm on the treatment side, and that this increase is even higher in those patients with swelling. Increased blood flow is likely to contribute to arm swelling. One explanation for increased flow would be neurological deficit with loss of sympathetic vasoconstrictor control.
Adult↗
Breast carcinoma: measurement of tumor response to primary medical therapy with color Doppler flow imaging.
PURPOSE: To assess the ability of color Doppler flow imaging to help evaluate the response of breast cancer to medical therapy. MATERIALS AND METHODS: Thirty-four patients with large or centrally located breast carcinomas were studied. All tumors had been treated medically. Tumor size was assessed at clinical examination, volume at B-mode ultrasound (US), and vascularity at color Doppler flow imaging. The changes seen during the treatment course were cross compared and correlated with final tumor response. RESULTS: In 97 of the 126 treatment cycles (77%), changes in vascularity were concordant with changes in the size of the tumors (reduction in the vascularity with response to therapy and an increase in tumor size with lack of response or progression). Changes seen at color Doppler flow imaging occurred at least 4 weeks before those seen at clinical and B-mode US examination in 40% and 38% of cases, respectively. Changes in vascularity could be assessed in every patient. CONCLUSION: Color Doppler flow imaging can help assessed and predict the response of breast cancer to medical treatment.
Antineoplastic Combined Chemotherapy Protocols↗
Case report: myeloma of the breast--appearances on ultrasound and colour Doppler.
Multiple myeloma may on rare occasions involve the breast. We report a case where a predominantly echo-poor solid mass was present on breast ultrasound in a patient under treatment for multiple myeloma. There was evidence of neovascularization on colour Doppler allowing a provisional diagnosis of carcinoma to be made. Fine needle aspiration cytology, however, demonstrated numerous mononuclear cells characteristic of myeloma. The appearances on ultrasound of this lesion have not been previously described.
Breast↗
Case report: cachexia of the kidney--a cause of pseudo-hydronephrosis.
Various pitfalls in diagnosing early hydronephrosis on ultrasound (US) have been recognized. We present a case where the appearances on US mimicked bilateral hydronephrosis in a patient undergoing treatment for recurrent colonic carcinoma. Comparison with a previous ultrasound examination demonstrated marked loss of renal sinus fat. Doppler studies demonstrated normal venous flow within each portion of the "dilated collecting system". In oncology, renal cachexia should be remembered as one of the causes of pseudo-hydronephrosis.
Cachexia↗
Case report: retroperitoneal varices mimicking a mass: diagnosis on colour Doppler.
Retroperitoneal varices may occasionally resemble retroperitoneal masses on computed tomography and B-mode ultrasound. Biopsy could be disastrous in this situation and angiography has previously been required to establish the diagnosis in suspected cases. This unusual problem can nowadays be readily diagnosed by colour Doppler. We report a case in which retroperitoneal varices were initially misinterpreted on B-mode ultrasound as retroperitoneal masses, but colour Doppler established the diagnosis without the need for further investigations.
Color↗
Echo-poor periportal cuffing: ultrasonographic appearance and significance.
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Child↗
Cellular versus vascular rejection in transplant kidneys. Correlation of radionuclide and Doppler studies with histology.
The presence of two distinct subtypes of renal allograft rejection are well documented by histological studies. The differentiation between vascular rejection (VR) and cellular rejection (CR) is essential for proper management by avoiding the need for unnecessary and potentially harmful immunosuppressive treatment of VR. A histological pattern with features that are similar and confusable with some cases of rejection may be seen in cyclosporin A toxicity (CyT). To evaluate the efficiency of Guy's perfusion index (GPI) and the Doppler pulsatility index (DPI) in differentiating these two histological subtypes, a prospective study was designed in which a total of 140 radionuclide tests and 133 ultrasounds scans performed on the same day on 58 patients during the first 3 months post-transplant were analysed, and the results correlated with the histological findings of 84 renal biopsies. Results show that the GPI had a sensitivity of 86.5% and a specificity of 94% in differentiating VR and CyT from CR, while the DPI had values of 83% and 69%, respectively. Chi-squared analysis showed a higher significant association between the GPI and histology (P < 0.0001) compared to that of the DPI and histology (P < 0.005), while Youden's index (J) showed a significant difference (P < 0.05) between GPI and DPI. It is concluded that GPI is more sensitive and specific than DPI in differentiating transplants that are well perfused from those with poor perfusion (VR and CyT).
Adult↗
Breast diseases: color Doppler US in differential diagnosis.
PURPOSE: To subjectively and semiquantitatively evaluate color Doppler signals on images of breast lesions. MATERIALS AND METHODS: A 5-MHz ultrasound (US) system was used to examine 210 new breast lesions. Signals were evaluated subjectively with an analog scale. A semiquantitative scoring system involved analysis of the average number of vessels per square centimeter and average density of color pixels. RESULTS: Vessels were detected in 57 of 58 cancers (mean, 0.11 vessels per square centimeter, occupying 1.76% of the scan area). Color Doppler scores had no correlation with conventional prognostic indicators such as lymph node status or survival. Fewer vessels per square centimeter (mean, 0.06) occupying a smaller area (mean, 0.41%) were detected in the five fibroadenomas (n = 36) that showed color Doppler signals. Most cases (99 of 104 [96%]) of benign breast changes had no color Doppler signals. CONCLUSION: Color Doppler signals in a lesion otherwise thought to be benign should prompt a biopsy, while the absence of signals in an indeterminate lesion is reassuring.
Adenofibroma↗
Technical note: appearances on ultrasound of impalpable injection port in a double chamber breast prosthesis.
Breast reconstruction utilizing tissue expansion is being increasingly practised by both plastic and general surgeons. Our current experience for both immediate and delayed reconstruction is with the double chamber Becker prosthesis. The prosthesis with the resulting breast mound has on occasions rendered the injection port difficult to localize by palpation. We have found ultrasound useful in identifying impalpable ports and in facilitating needle insertion into the injection dome.
Female↗
Visual impact of adaptive speckle reduction on US B-mode images.
Adaptive speckle reduction, which is designed to improve image contrast, dramatically alters the familiar appearance of the ultrasonographic B-mode scan. The acceptability to radiologists of this alternative method of display was assessed. Four experienced radiologists selected B-mode scans from 83 liver and 71 breast examinations and graded the change in diagnostically important features after adaptive speckle reduction. There was no loss of important anatomic detail in the smoothed images and a net reduction in image artifacts. Removal of speckle noise improved definition of lesion margins in 38.3% of cases and enhanced visibility of metastases in 35.4% of liver studies and 7.7% of breast lesions. In 42.1% of cases, the textural information in the image was judged to be enhanced. Image information in general was said to be better seen in 49.5% of cases. The preliminary radiologic experience with speckle-reduced B-mode echograms is favorable and does not indicate generation of any substantial image artifacts.
Breast Neoplasms↗