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J S Pellerito

Publications and source records attributed to J S Pellerito.

11 recordsLinked to original sources
PubMed2001

Current approach to peripheral arterial sonography.

Color and pulsed Doppler imaging have assumed a prominent role for evaluating noninvasively lower-extremity arterial occlusive disease. In conjunction with indirect arterial tests, ultrasound imaging is recommended to screen for lower-extremity disease. It provides not only specific information regarding location, severity, and frequency of disease, but it can also determine the optimal therapeutic approach before more invasive procedures. Using ultrasound for graft surveillance is mandatory for identifying flow-reducing lesions that may lead to subsequent bypass failure. As new developments become perfected and clinically available, ultrasound contrast agents, three-dimensional imaging, and B-flow imaging each seem to have great potential for assessing peripheral arterial disease. In all likelihood, these additions will further improve the diagnostic capability of ultrasound and may also lead to the development of new vascular applications for this modality.

Aneurysm, False↗
PubMed1996

Suspected deep venous thrombosis: is US of both legs necessary? [ comment].

PURPOSE: The first purpose was to test the assumption that ultrasound (US) examination of the asymptomatic leg was unnecessary. The second was to confirm the absence of deep venous thrombosis (DVT) in patients with bilateral symptoms. MATERIALS AND METHODS: Four hundred eighty-eight patients were evaluated at a peripheral vascular laboratory for signs and symptoms of DVT. All patients then underwent bilateral color Doppler US of their leg veins. RESULTS: Ninety-four patients had no lower extremity symptoms. Of these, 73 had no DVT, 11 had unilateral DVT, and 10 had bilateral DVT. Of 245 patients with unilateral symptoms, 180 had no DVT, 44 had ipsilateral DVT, three had contralateral DVT, and 18 had bilateral DVT. Of 149 patients with bilateral symptoms, 114 had no DVT, 10 had unilateral DVT, and 25 had bilateral DVT. CONCLUSION: The frequent finding of bilateral DVT and unsuspected contralateral DVT in patients with unilateral symptoms, and the even more frequent finding of DVT in patients with bilateral symptoms, clearly indicates that both categories of patients need to be evaluated with bilateral US.

Female↗
PubMed1996

Doppler color flow imaging surveillance of deep vein thrombosis in high-risk trauma patients.

To determine the prevalence of upper and lower extremity deep vein thrombosis in high-risk trauma patients, 136 consecutive high-risk trauma patients were prospectively evaluated with weekly Doppler color flow imaging. Incomplete compressibility and visualized intraluminal thrombus were considered diagnostic of deep vein thrombosis. Pulmonary embolus was documented by pulmonary arteriography. Deep vein thrombosis occurred at 27 non-contiguous sites in 19 patients (14%). Eight of 27 cases of deep vein thrombosis (30%) involved the upper extremity and 19 (70%) occurred in the lower extremity. Twenty-one of 27 deep vein thromboses (78%) were partially occlusive, whereas six (22%) were occlusive. Pulmonary embolus was documented in three patients (2.2%). Doppler color flow imaging detected occult deep vein thrombosis in 14% of high-risk trauma patients (30% occurring in the upper extremity).

Adolescent↗
PubMed1995

Common pitfalls of endovaginal color Doppler flow imaging.

Endovaginal color Doppler flow imaging is a relatively new technique that combines gray-scale sonography with duplex Doppler and color Doppler flow techniques. However, such imaging is associated with multiple pitfalls. Technical errors are caused by improper setting of the color flow parameters. The color velocity scale, color priority, color gain, color sensitivity, and color wall filter should be adjusted to optimize color flow information. Technical errors may result in false diagnosis of ovarian torsion, malignancy, and ectopic pregnancy. Errors in interpretation result from an inability to identify and correctly characterize tissue vascularity. Such errors include failure to distinguish placental from luteal flow and failure to characterize adnexal masses accurately. In addition, functional ovarian cysts may demonstrate increased vascularity throughout the menstrual cycle and simulate cancer. Recognition of the common pitfalls of endovaginal color Doppler flow imaging and integration of clinical and sonographic features will reduce misinterpretation and improve diagnostic accuracy.

Artifacts↗
PubMed1995

Quantitative Doppler assessment of acute scrotal inflammation.

PURPOSE: To establish quantitative Doppler criteria for acute unilateral epididymitis and/or orchitis. MATERIALS AND METHODS: Triplex ultrasonography (US) was used to prospectively evaluate 31 patients with acute hemiscrotal pain and 15 asymptomatic control subjects. Morphology and perfusion were assessed, and peak systolic velocities (PSVs) were recorded. Ratios of PSV were calculated by using values from the right and left sides. RESULTS: PSVs in control subjects differed significantly from those in patients (P < .0001). A PSV > or = 15 cm/sec produced diagnostic accuracy of 90% for orchitis and 93% for epididymitis: Five of six false-negative findings were in patients younger than age 15 years. Epididymal PSV ratios > or = 1.7 or testicular ratios > or = 1.9 were diagnostic of acute inflammation (P < .0001). In three cases, morphologic and color Doppler findings were normal and only the PSV ratios were diagnostic. CONCLUSION: PSV and PSV ratios provide diagnostic criteria for acute unilateral epididymitis and/or orchitis that are more accurate than morphologic evaluation and color flow imaging either alone or in combination.

Acute Disease↗
PubMed1992

Ectopic pregnancy: evaluation with endovaginal color flow imaging.

Endovaginal sonography and endovaginal color flow imaging were compared in 155 patients with clinical suspicion of ectopic pregnancy. Sixty-five patients (42%) had surgically confirmed ectopic pregnancies. Thirty-six of the pregnancies were diagnosed with endovaginal sonography alone, the criteria being an extrauterine sac or ectopic fetus (sensitivity, 54%). Sixty-two ectopic pregnancies were diagnosed with endovaginal color flow imaging (sensitivity, 95%) when an ectopic fetus or sac was seen or placental flow was identified in an adnexal mass separate from the ovary and uterus. The diagnosis of ectopic pregnancy was excluded with endovaginal sonography (specificity, 98%) and endovaginal color flow imaging (specificity, 98%) by finding an intrauterine gestation, nonvisualization of an adnexal mass, and absence of placental flow. Three false-positive and three false-negative diagnoses were made with endovaginal color flow imaging (positive predictive value, 97%). The addition of color Doppler flow imaging to endovaginal sonography allows increased sensitivity in the detection of ectopic pregnancy.

Adult↗
PubMed1992

Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography.

The purpose of this study was to compare the relative accuracy of magnetic resonance (MR) imaging (n = 26), endovaginal sonography (EVS) (n = 14), and hysterosalpingography (HSG) (n = 20) in the classification of müllerian duct anomalies in 26 patients. There were 24 cases of surgically proved anomaly, and two patients had normal uteri (one with a vaginal septum). MR imaging allowed diagnosis of 24 of 24 cases (accuracy, 100%), and EVS was correct in 11 of 12 cases (accuracy, 92%). HSG was correct in only four cases. In the diagnosis of septate uterus, MR imaging demonstrated a sensitivity and specificity of 100% and EVS demonstrated a sensitivity of 100% and a specificity of 80%. Both MR imaging and EVS demonstrated a sensitivity and specificity of 100% in distinguishing those anomalies that did not require surgery. The high accuracy of MR imaging and EVS permit noninvasive differentiation of uterine anomalies and can spare women diagnostic laparoscopy, promoting cost-effective diagnosis.

Congenital Abnormalities↗
PubMed1992

Doppler color imaging. Peripheral arteries.

The impact of DCI on the evaluation of peripheral vascular disease is considerable. In essence, it is noninvasive angiography without the limitations of that modality. However, the pressure gradient can only be inferred, and pull-through pressure gradients are still the most accurate estimation of adequacy of flow. Nonetheless, segmental blood pressures and the peak velocities measured by duplex Doppler provide a noninvasive alternative for estimating pressure gradients. DCI imaging has greatly improved the perception of focal abnormalities and allows rapid appreciation of global hemodynamics. As further technical refinements improve resolution and sensitivity, color Doppler may eventually supplant angiography as the primary imaging modality in peripheral arterial diagnosis, reserving arteriography for interventional procedures.

Aneurysm↗
PubMed1992

Doppler color imaging. Obstetric and gynecologic applications.

The addition of pulsed and color Doppler has greatly added to the diagnostic potential for obstetric and gynecologic ultrasound. In addition to improved morphologic detail inherent in the use of EVUS, new information is available on perfusion and the physiologic changes associated with the menstrual cycle and early pregnancy. The absence of luteal flow strongly predicts unsuccessful pregnancy outcome in patients undergoing therapy for infertility. This introduces the possibility of more economic use of expensive treatments. Later in pregnancy, DCI aids in the efficient and accurate performance of Doppler spectral sampling and contributes to the evaluation of structural and functional abnormalities of the fetus, umbilical cord, and placenta. Applications in the evaluation of patients with suspected ectopic pregnancy, incomplete abortion, and pseudosac are welcome additions for clinical problems that currently result in many malpractice suits. Finally, the recognition of neovascular flow, especially in the ovary, raises hope for improved and earlier diagnosis of ovarian cancer.

Color↗
PubMedDate not supplied

Imaging the endometrium: disease and normal variants.

The endometrium demonstrates a wide spectrum of normal and pathologic appearances throughout menarche as well as during the prepubertal and postmenopausal years and the first trimester of pregnancy. Disease entities include hydrocolpos, hydrometrocolpos, and ovarian cysts in pediatric patients; gestational trophoblastic disease during pregnancy; endometritis and retained products of conception in the postpartum period; and bleeding caused by polyps, submucosal fibroids, endometrial hyperplasia, or endometrial adenocarcinoma. Other findings include tamoxifen-associated changes, intrauterine fluid collections, and endometrial adhesions. Although ultrasound (US) is almost always the first modality used in the radiologic work-up of endometrial disease, findings at sonohysterography, hysterosalpingography, magnetic resonance imaging, and computed tomography are often correlated with US findings. It is important to understand that the appearance of the endometrium is related to multiple factors, including the patient's age, stage in the menstrual cycle, and pregnancy status and whether she has undergone hormonal replacement therapy or tamoxifen therapy. Accurate diagnosis requires that these factors be taken into account in addition to clinical history and physical examination findings.

Adult↗