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PubMed1988

Doppler ultrasound, laser Doppler, and perfusion fluorometry in bowel ischemia.

Improved accuracy and objectivity in the evaluation of intestinal viability has been reported by some investigators using Doppler ultrasound, and more recently laser Doppler velocimetry and perfusion fluorometry. To compare the sensitivity and clinical applicability of these techniques, intestinal viability was evaluated by each method in nine 15- to 50-cm loops of small bowel prepared by division of the mesenteric vasculature in five anesthetized dogs. The sensitivity of Doppler ultrasound was 86%, of laser Doppler flow velocity 85%, of laser Doppler index 94%, and of perfusion fluorometry 95%. Though the sensitivity of Doppler ultrasound is significantly less than that of laser Doppler and perfusion fluorometry, this is not unexpected since the latter two techniques are more quantitative than Doppler ultrasound. Clinically, Doppler ultrasound compares favorably with laser Doppler and perfusion fluorometry, and its low cost and simplicity suggest its adjunctive use in the operative setting.

Animals↗
PubMed1985

Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients.

Simultaneous continuous wave Doppler echocardiography and right-sided cardiac pressure measurements were performed during cardiac catheterization in 127 patients. Tricuspid regurgitation was detected by the Doppler method in 117 patients and was of adequate quality to analyze in 111 patients. Maximal systolic pressure gradient between the right ventricle and right atrium was 11 to 136 mm Hg (mean 53 +/- 29) and simultaneously measured Doppler gradient was 9 to 127 mm Hg (mean 49 +/- 26); for these two measurements, r = 0.96 and SEE = 7 mm Hg. Right ventricular systolic pressure was estimated by three methods from the Doppler gradient. These were 1) Doppler gradient + mean jugular venous pressure; 2) using a regression equation derived from the first 63 patients (Group 1); and 3) Doppler gradient + 10. These methods were tested on the remaining 48 patients with Doppler-analyzable tricuspid regurgitation (Group 2). The correlation between Doppler-estimated and catheter-measured right ventricular systolic pressure was similar using all three methods; however, the regression equation produced a significantly better estimate (p less than 0.05). Use of continuous wave Doppler blood flow velocity of tricuspid regurgitation permitted determination of the systolic pressure gradient across the tricuspid valve and the right ventricular systolic pressure. This noninvasive technique yielded information comparable with that obtained at catheterization. Approximately 80% of patients with increased and 57% with normal right ventricular pressure had analyzable Doppler tricuspid regurgitant velocities that could be used to accurately predict right ventricular systolic pressure.

Adolescent↗
PubMed1990

Carotid artery disease assessed by color Doppler flow imaging: correlation with standard Doppler sonography and angiography.

Carotid artery disease was assessed in 180 patients by means of color Doppler flow imaging. Color Doppler findings in 360 carotid arteries were compared with the results of standard Doppler sonography, and color Doppler findings in 60 bifurcations were compared with the results of intraarterial angiography. The sensitivity of color Doppler for the detection of carotid disease was 100% when compared with angiography. The accuracy of color Doppler in classifying minor (40-60%), moderate (61-80%), and severe (81-90%) stenosis ranged from 91.3% to 97.8% vs standard Doppler sonography, and from 91.7% to 95.8% vs angiography. Whereas all occlusions were identified correctly by both color Doppler and angiography, four pseudoocclusions of the carotid artery were misdiagnosed as occluded. Characteristic features providing reliable criteria of the degree of stenosis are (1) intensity, extent, and duration of color fading; (2) postprocessed systolic peak frequency; (3) plaque extent on serial sonograms; and (4) poststenotic flow patterns. Display of hemodynamic disturbances induced by less pronounced plaques showed highly variable patterns that could not be anticipated from the plaque morphology alone. Thus, color Doppler preserves the advantages of standard Doppler and duplex sonography but provides additional information about otherwise anechoic necrotic and thrombotic material that often causes cerebral embolisms. With atherogenesis, repair mechanisms may be sustained or progression be stopped by reducing the risk factors and instituting medical treatment; thus, the application of this noninvasive technique is important.

Adult↗
PubMedDate not supplied

Carotid artery disease assessed by color Doppler flow imaging: correlation with standard Doppler sonography and angiography.

Carotid artery disease was assessed in 180 patients by means of color Doppler flow imaging. Color Doppler findings in 360 carotid arteries were compared with the results of standard Doppler sonography, and color Doppler findings in 60 bifurcations were compared with the results of intraarterial angiography. The sensitivity of color Doppler for the detection of carotid disease was 100% when compared with angiography. The accuracy of color Doppler in classifying minor (40-60%), moderate (61-80%), and severe (81-90%) stenosis ranged from 91.3% to 97.8% vs standard Doppler sonography, and from 91.7% to 95.8% vs angiography. Whereas all occlusions were identified correctly by both color Doppler and angiography, four pseudoocclusions of the carotid artery were misdiagnosed as occluded. Characteristic features providing reliable criteria of the degree of stenosis are (1) intensity, extent, and duration of color fading; (2) postprocessed systolic peak frequency; (3) plaque extent on serial sonograms; and (4) poststenotic flow patterns. Display of hemodynamic disturbances induced by less pronounced plaques showed highly variable patterns that could not be anticipated from the plaque morphology alone. Thus, color Doppler preserves the advantages of standard Doppler and duplex sonography but provides additional information about otherwise anechoic necrotic and thrombotic material that often causes cerebral embolisms. With atherogenesis, repair mechanisms may be sustained or progression be stopped by reducing the risk factors and instituting medical treatment; thus, the application of this noninvasive technique is important.

Carotid Artery Diseases↗
PubMed1989

[A comparative study of pulsed Doppler versus continuous Doppler technic without spectral analysis in obstetrics].

We conducted a study in 48 parturients in order to: --assess the possibilities of continuous Doppler examination without preliminary ultrasonographic localization and without spectral analysis, to measure the traditional hemodynamic parameters of fetal development (in particular on the umbilical cord). --to compare these results with those obtained using pulsed Doppler-scan as reference. The protocol was very strict and neither of the two practitioners was aware of the other practitioner's results. With the continuous Doppler examination, the uterine arteries were systematically localized and recorded. The technique is simple in trained hands. The material included an ultrasonograph fitted with two probes (3.5 and 5 MHz, equipped with a pulsed Doppler) and a continuous Doppler (only the 4 MHz probe was used). Because the tests were sometimes repeated, 63 measurements were obtained in 48 parturients, mean age was 29.3 years and mean gestational age was 32.9 weeks. The reason for the examination varied: intrauterine growth retardation and/or maternal hypertension, diabetes, etc. The results obtained from the cord proved to be very encouraging: 42 of the 54 measurements were comparable (77.7%) showed an index difference less than or equal to 0.05. Only 4 (7.4% of the measurements) maximum deviations were observed (exceeding 0.10). The mean Pourcelot index on the Doppler scan was 0.677. With the continuous Doppler, it was 0.676. The 13 abnormal measurements with the pulsed Doppler were also abnormal with the continuous Doppler. The uterine arteries were recorded and measured with the continuous Doppler 42 times on the right (68.8% of the cases) and 34 times on the left (55.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Evaluation of Tissue Doppler Tei index for global left ventricular function in mice after myocardial infarction: comparison with Pulsed Doppler Tei index.

AIM: The Pulsed Doppler Tei index is a parameter to evaluate combined systolic and diastolic function in humans. However, one major limitation is that the parameters of Pulsed Doppler Tei index cannot be measured within one cardiac cycle. Therefore, accuracy of the Pulsed Doppler Tei index may be affected by anesthesia induced heart rate variation in mice echocardiography. Tissue Doppler Imaging (TDI) enables us to measure both relaxation and contraction velocities simultaneously. Thus, the aim of our study was to validate TDI and Pulsed Doppler Tei index and their reproducibility in mice after experimental anterior myocardial infarction (MI). METHODS AND RESULTS: Pulsed Doppler Tei index and TDI Tei index were assessed before and 4 weeks after MI. Both parameters increased significantly after MI (Pulsed Doppler: 0.4+/-0.04 to 0.7+/-0.03; P<0.001; TDI: 0.2+/-0.03 to 0.5+/-0.04; P<0.0001). In addition, TDI Tei index showed a good correlation with ejection fraction and fractional shortening, and was indicated by better reproducibility than Pulsed Doppler Tei index. CONCLUSION: Tissue Doppler Tei index is appropriate to characterize global left ventricular function in mice after MI.

Animals↗
PubMed2002

Assessment of blood flow velocity waveforms of the pulmonary circulation by multigate spectral Doppler scanning and traditional pulsed Doppler ultrasonography.

OBJECTIVE: To assess (1) pulmonary artery and peripheral pulmonary blood flow by using a multigate spectral Doppler system and standard pulsed color Doppler ultrasonography and (2) the reproducibility of peripheral pulmonary artery blood flow velocity waveforms. METHODS: Thirty-three women were enrolled in the study Fetal pulmonary artery flow velocity waveforms were investigated by multigate spectral Doppler scanning and traditional pulsed Doppler ultrasonography plus color flow mapping. To establish the relationship between these 2 methods, we calculated the correlation coefficient, coefficient of variation, and limits of agreement. RESULTS: The 2 methods were not significantly correlated. The range of measurement agreement for these 2 methods suggests that there is a significant difference between the main and peripheral pulmonary artery blood flow, and the difference should be taken into account in the interpretation of Doppler flow velocity studies of the pulmonary artery. CONCLUSIONS: Multigate spectral Doppler scanning with power Doppler imaging may be a better way to assess the average flow impedance in a highly vascularized organ. This technique supplies a large number of Doppler signals in the region of interest and offers a quantified range of Doppler measurements, improving our understanding of fetal hemodynamics.

Blood Flow Velocity↗
PubMed2006

An improved spectral width Doppler method for estimating Doppler angles in flows with existence of velocity gradients.

Doppler angle (i.e., beam-to-flow angle) is an important parameter for quantitative flow measurements. With known Doppler angles, volumetric flows can be obtained by the mean flow velocity times the cross-section area of the vessel. The differences or changes between prestenotic and poststenotic volumetric flows have been quantified as an indicator for assessing the clinical severity of the stenosis. Therefore, several research groups have dedicated themselves to developing user-independent methods to determine automatically the Doppler angle. Nevertheless, most of these methods were developed for narrow ultrasound beam measurements. For small vessels, where the beam width is a significant fraction of the diameter of the vessel, the effect of velocity gradients plays an important role and should not be ignored in the Doppler angle estimations. Accordingly, this paper is concerned with a method for improving the estimation of Doppler angles from spectral width Doppler (SWD) method, but correcting for velocity-gradient broadening that may arise when the beam has a nonzero width. In our method, Doppler angles were firstly calculated by SWD and then were corrected by an artificial neural network (ANN) method to neutralize the contribution of velocity gradient broadening (VGB). This SWD and ANN conjoint method has been successfully applied to estimate Doppler angles from 50 degrees to 80 degrees for constant flows in 10 mm, 4 mm and 1 mm diameter tubes, whose mean flow velocities were 15.3, 19.9 and 25.5 cm/s, respectively, and the achieved mean absolute errors of the estimated Doppler angles were 1.46 degrees , 1.01 degrees and 1.3 degrees.

Blood Flow Velocity↗
PubMed1989

Validation of continuous-wave Doppler measurements of mitral valve gradients during exercise--a simultaneous Doppler-catheter study.

In patients with mitral stenosis, continuous-wave Doppler measurements of the maximal transmitral inflow velocity can be converted into transvalvular pressure gradients using the modified Bernoulli equation. Because of close correlations between Doppler- and catheter-measured gradients this method has become a valuable tool in non-invasive evaluation of mitral stenosis at rest. However, in some patients, exercise studies are necessary to determine the haemodynamic significance of the valve stenosis. The accuracy of continuous-wave Doppler in this setting has not yet been validated. Thus, in 20 selected patients with pure or predominant mitral stenosis, continuous-wave Doppler echocardiography was performed during left- and right-heart catheterization. At rest and during submaximal bicycle exercise, Doppler and pressure measurements were simultaneously performed. The Doppler gradient was calculated according to the modified Bernoulli equation while the mean manometric gradient was determined from the simultaneous pulmonary wedge and left ventricular pressure curves. Exercise caused a significant increase of cardiac output (4.8 +/- 1.3 to 5.7 +/- 1.31 min-1) and heart rate (59.7 +/- 12.0 to 95.3 +/- 14.3 beats min-1). The mean Doppler gradient increased from 6.8 +/- 2.1 to 12.2 +/- 3.2 mmHg. The manometric gradient showed a comparable increase of 9.5 +/- 2.4 to 17.2 +/- 3.7 mmHg, respectively. Correlation between Doppler and manometric data was close (y = 0.79x-0.67,r = 0.90,SEE = 0.97 mmHg) at rest and still good during exercise (y = 0.71x-0.10,r = 0.82,SEE = 1.97 mmHg). Thus, in some patients with borderline resting gradients and valve areas, exercise Doppler might allow further identification of the haemodynamic severity of mitral stenosis.

Adult↗
PubMed1996

Conventional color Doppler velocity sonography versus color Doppler energy sonography for the diagnosis of acute experimental torsion of the spermatic cord.

OBJECTIVE: We compared color Doppler velocity sonography and color Doppler energy sonography for the diagnosis of spermatic cord torsion in a canine model and determined the degree of torsion necessary to acutely halt testicular blood flow. MATERIALS AND METHODS: Spermatic cord torsion was created in five dogs by exposing and rotating the ipsilateral testis 0 degree, 180 degrees, 270 degrees, 360 degrees, 450 degrees, and 540 degrees. Detorsion followed. The testicles were scanned at each torsion stop using both color Doppler velocity sonography and color Doppler energy sonography. Doppler parameters were optimized (by phantom and test scans) and maintained at a tolerable noise level throughout the experiment. Readers who were unaware of the degree of torsion compared flow in the rotated and contralateral control testes. RESULTS: Flow became undetectable by color Doppler velocity sonography and color Doppler energy sonography at 450 degrees in four of five cases and at 540 degrees in one of five cases. We found no significant difference between the velocity and the energy techniques for detecting this absence of flow (p > .05, Wilcoxon test). We found a significant difference in degree of flow for both techniques when comparing controls and all degrees of torsion combined (p < .006, Mann-Whitney test), but significance was achieved at lesser degrees of torsion with the velocity technique than with the energy technique (180 degrees and 360 degrees, respectively, Wilcoxon test). CONCLUSION: Color Doppler energy sonography was not significantly more sensitive than color Doppler velocity sonography for the diagnosis of spermatic cord torsion in this model. Complete occlusion of arterial inflow occurred at 450-540 degrees of torsion.

Animals↗
PubMed1987

Current development in Doppler echocardiography. The real-time two-dimensional Doppler flow imaging system.

Recent advances in ultrasound instrumentations have provided a new Doppler modality capable of displaying the spatial distribution of blood flow velocities by colors on the monochromatic echo image on the real time basis, called the real-time two-dimensional Doppler flow imaging system. With this new Doppler technique, we can noninvasively relate the dynamic flow pattern to the anatomy and the motion of the cardiac structures and can further our understandings of flow dynamics in the circulatory system in health and disease. In clinical cardiology, the Doppler flow imaging technique offeres a quite sensitive approach to the detection of flow abnormalities caused by valvular insufficiency or stenosis and congenital shunt diseases. The spatial distribution of the regurgitant jet flow visualized by the Doppler flow imaging technique provides a semiquantitative approach to the evaluation of the severity of the valvular insufficiency. Furthermore, we can appreciate the spatial and angular orientation of the stenotic or regurgitant jet flow, which allows us to measure the velocity of the jet flow with the optimal beam direction. Though there are some limitations and pitfalls in the Doppler flow imaging system at present, it has provided the mapping of the dynamic distribution of flow velocities, which has never been available with the conventional Doppler technique, and has expanded Doppler capabilities and utilities in clinical cardiology. The Doppler flow imaging system is now widely used as a routine part of noninvasive cardiac examination and is improving its clinical significance.

Coronary Circulation↗
PubMed1986

Validation of continuous-wave Doppler echocardiographic measurements of mitral and tricuspid prosthetic valve gradients: a simultaneous Doppler-catheter study.

For patients with stenotic native valves, the modified Bernoulli equation (delta P = 4V2) may be applied to Doppler-measured transvalvular velocities to yield an accurate estimate of transvalvular gradients. Although it would be useful if the same approach could be used for those with stenotic prosthetic valves, no previous study has validated the Doppler technique in this setting. We therefore recorded simultaneous continuous-wave Doppler flow profiles and transvalvular manometric gradients in 12 catheterized patients in whom all atrial and ventricular pressures were directly measured (transseptal left atrial catheterization and transthoracic ventricular puncture were performed where necessary). A total of 13 prostheses were studied: 11 mitral (seven porcine, three Starr-Edwards, and one Björk-Shiley) and two tricuspid (one porcine and one Björk-Shiley). The Doppler-determined mean gradient was calculated as the mean of the instantaneous gradients (delta P = 4V2) at 10 msec intervals throughout diastole. The correlation of simultaneous Doppler (DMG) and manometric mean gradients (MG) for the whole group (n = 13) demonstrated a highly significant relationship (MG = 1.07 DMG + 0.28; r = .96, p = .0001). The correlation was equally good for porcine valves alone (n = 8) (MG = 1.06 DMG + 0.55; r = .96, p = .001) and for mechanical valves alone (n = 5) (MG = 1.06 DMG - 0.04; r = .93, p = .02). In a subset of patients without regurgitation (n = 8), prosthetic valve areas were estimated by two Doppler methods originally described by Holen and Hatle, as well as by the invasive Gorlin method. As expected from theoretical considerations, a close correlation was not demonstrated between results of the Gorlin method and those of either Hatle's Doppler method (r = .65, fp = NS) or Holen's method (r = .14, p = NS). Comparison of the results of the two Doppler methods yielded a somewhat closer correlation (r = .73, p less than or equal to .05). These results suggest that in patients with disk-occluder, ball-occluder, and porcine prosthetic valves, Doppler estimates of transvalvular gradients are virtually identical to those obtained invasively.

Aged↗
PubMed2001

[Power Doppler as a method that is better than color Doppler for evaluation of thyroid nodular lesions].

AIM: The evaluation of usefulness of color Doppler sonography and power Doppler sonography in the diagnostics of thyroid nodules with the low or absent uptake of (99m)Tc-pertechnate. Although scintigraphy is highly sensitive method in the diagnosis of cold nodules it is non-specific in the diagnostics of malignant changes of thyroid. We tried to investigate the possibility to improve the diagnostic accuracy of sonography. MATERIAL AND METHODS: 122 cold thyroid nodules were investigated with linear 7.5 Mhz Doppler probe. The flow pattern in power Doppler and color Doppler were correlated with cytologic and histopathologic examination. RESULTS: According to cytology, PD has better sensitivity and specificity than CD; consecutively-100% vs. 86.6% and 93.4% vs. 84.1%. CONCLUSIONS: 1. Power Doppler can detect low blood flow in small blood vessels, observed in thyroid cancer. 2. Power Doppler allows the best nodules selection for fine-needle biopsy than color Doppler.

Adult↗
PubMed1998

Differential diagnosis of neonatal adrenal haemorrhage and congenital neuroblastoma by colour coded Doppler sonography and power Doppler sonography.

UNLABELLED: The differentiation between neonatal neuroblastoma and adrenal haemorrhage may be very difficult in the individual case. We investigated eight neonates with adrenal haemorrhage and one patient with congenital neuroblastoma by colour coded Doppler sonography and power Doppler sonography. Six haemorrhages were cystic, whereas the neuroblastoma and four adrenal haemorrhages had a solid appearance. Colour coded Doppler sonography and power Doppler demonstrated vessels within the neuroblastoma. In none of the ten adrenal haemorrhages could flow be shown either with conventional colour coded Doppler sonography or power Doppler sonography. CONCLUSION: Conventional colour coded Doppler sonography and power Doppler sonography are useful to differentiate between neuroblastoma and adrenal haemorrhage.

Adrenal Gland Diseases↗
PubMed1999

Validation of a new noninvasive method (contrast-enhanced transthoracic second harmonic echo Doppler) for the evaluation of coronary flow reserve: comparison with intracoronary Doppler flow wire.

OBJECTIVES: We tested the hypothesis that coronary flow reserve (CFR) in the left anterior descending coronary artery (LAD) as assessed by a new noninvasive method (contrast-enhanced transthoracic second harmonic echo Doppler) is in agreement with CFR measurements assessed by intracoronary Doppler flow wire. BACKGROUND: Contrast-enhanced transthoracic second harmonic echo Doppler is a novel noninvasive method to detect blood flow velocity and reserve in the LAD. However, it has not yet been validated versus a gold-standard method. METHODS: Twenty-five patients undergoing CFR assessment in the LAD by Doppler flow wire were also evaluated by contrast-enhanced transthoracic Doppler to record blood flow in the distal LAD at rest and during hyperemia obtained by adenosine i.v. infusion. In five patients CFR was evaluated twice (before and after angioplasty). RESULTS: As a result of the combined use of i.v. contrast and second harmonic Doppler technology, feasibility in assessing coronary flow reserve equaled 100%. The agreement between the two methods was high. In fact, in all but five patients the maximum difference between the two CFR measurements was 0.38. Overall, the prediction (95%) interval of individual differences was -0.69 to +0.72. Reproducibility of CFR measurements was also high. The limits of the agreement (95%) between the two measurements were -0.32 to +0.32. CONCLUSIONS: Coronary flow reserve in the LAD as assessed by contrast-enhanced transthoracic echo Doppler along with harmonic mode concurs very closely with Doppler flow wire CFR measurements. This new noninvasive method allows feasible, reliable and reproducible assessment of CFR in the LAD.

Adenosine↗
PubMed1998

Power Doppler in breast tumours: a comparison with conventional colour Doppler imaging.

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.

Adult↗
PubMed1989

[Transthoracic color Doppler echocardiography in the diagnosis of insufficiency of heart valve prostheses. A comparison with conventional Doppler sonography].

Color-coded and conventional pulsed wave/continuous wave Doppler detection of valvular or paravalvular regurgitation in 59 patients with 67 cardiac valve prostheses were compared; 21 patients had known regurgitation determined by auscultation. Analysis of the color-coded Doppler findings was made from videotape and blinded as to patient identity and clinical findings. Conventional Doppler Sonography detected 36 instances of aortic and 3 of mitral prosthetic regurgitation. Color-coded Doppler investigation detected 27 instances of aortic and 1 of mitral prosthetic regurgitation resulting in a sensitivity of 72% and specificity of 100% as compared to conventional Doppler sonography. All 21 patients with a regurgitant murmur had pathological conventional Doppler findings, but 3 of them did not show regurgitant flow in the color-coded Doppler examination. The apical four chamber view contributed most to the colour-coded Doppler detection of regurgitant flow, followed by the parasternal long axis view.

Adult↗