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Prenatal diagnosis of cerebral arteriovenous malformation using color Doppler ultrasonography: case report and review of the literature.

Aneurysms of the vein of Galen are rare, representing less than 1% of all intracranial arteriovenous malformations. In the fetus, however, almost all cerebral arterial malformations involve the vein of Galen, usually presenting in the neonatal period with severe cardiac failure leading to neonatal death. In this report we present a case of arteriovenous malformation involving the vein of Galen detected prenatally at 35 weeks with the use of color Doppler ultrasonography. The literature is reviewed in an attempt to delineate the role of prenatal ultrasonography in the diagnosis and its impact on perinatal outcome.

Adult↗

Effects of external radiotherapy on uterine blood flow in patients with advanced cervical carcinoma assessed by color Doppler ultrasonography.

BACKGROUND: This study was designed to evaluate radiation-induced changes in tumor blood flow by color Doppler ultrasonography. METHODS: Color Doppler examination was performed on 14 patients with advanced cervical carcinoma treated with external radiotherapy. The total dose of radiation varied from 30 to 65 Gy and was given as 1.9 Gy daily fractions, 5 days/week. Tumor vascularity and blood flow impedance were measured by one pretreatment and five follow-up examinations. RESULTS: At the baseline examination, 11 of 14 patients had very low tumor blood flow impedance (< 0.70). Radiotherapy caused a significant decrease in tumor vascularity (P = 0.0001) and in presence of very low blood flow impedance. The decrease of tumor vascularity during the treatment was associated with better outcome, whereas persistence of excessive vascularity or of vessels with low blood flow impedance at the end of radiation was associated with modest therapeutic response. Eight of 10 patients with increased tumor vascularity at the end of radiation needed further treatment or died of disease. Only one of four patients with normal vasculature at the end of radiotherapy needed further treatment and all four were clinically disease free during the follow-up (mean, 13 months; range, 6-26 months). CONCLUSIONS: These results suggest that color Doppler ultrasonography may be useful in early assessment of therapeutic response during radiotherapy and in for planning individualized treatment schedules.

Adenocarcinoma↗

Color doppler ultrasonography in the diagnostic evaluation of renal allografts.

Color Doppler ultrasonography of large allograft vessels and renal parenchyma is established firmly in the diagnosis of renal allograft perfusion. While conventional color Doppler ultrasonography has proven itself to be an indispensable, rapid, highly valid and practicable method, e.g. in the diagnosis of allograft artery stenosis or allograft vein thrombosis, the diagnostic usefulness of this method with regard to allograft perfusion is considerably limited. With contrast-enhanced sonography, a simple and readily implementable method that enables the early diagnosis of chronic allograft nephropathy is now available. The timely diagnosis of vascular damage prior to a rise in S-creatinine offers the possibility of early therapeutic intervention and thus at least the potential for the improvement of allograft survival.

Blood Vessels↗

[Color Doppler ultrasonography of the thyroid gland in diagnostics of autoimmune thyroiditis].

Diagnostics of thyroid gland pathology becomes more efficient with combined use of ultrasound and Doppler Ultrasonography. The article presents Color Doppler Ultrasonography data of 91 patients with hypertrophic and atrophic form of autoimmune thyroiditis. The obtained results showed considerable increase in resistive index in patients with chronic autoimmune thyroiditis and consequently the index can be used as diagnostic criterion of chronic autoimmune thyroiditis.

Adolescent↗

Color Doppler ultrasonography findings of bladder tumors: correlation with stage and histopathologic grade.

PURPOSE: To describe color Doppler ultrasonography findings of bladder tumors and to investigate the correlation between these findings with stage and histopathological grade. MATERIAL AND METHODS: Twenty-four patients with bladder tumors were assessed with color Doppler ultrasonography for tumor size, presence of vascularity, vascular pattern, and spectral properties. All patients underwent surgery. Stage and histopathological grades of tumors were determined and compared with color Doppler ultrasonography findings. RESULTS: Presence of vascularity was related to tumor size (P<0.05) and color Doppler signal was detected when tumors reached 24 mm in size. There was no statistically significant relationship between tumor stage and histopathological grade with tumor size, presence and pattern of vascularity, and spectral color Doppler ultrasonography findings (P>0.05). CONCLUSION: The evaluation of vascularity in bladder tumors by color Doppler ultrasonography is not helpful in predicting tumor stage and histopathological grade before surgery.

Adenocarcinoma↗

Percutaneous transhepatic biliary drainage using color Doppler ultrasonography.

We performed percutaneous transhepatic biliary drainage using color Doppler ultrasonography to decrease the complications of percutaneous transhepatic biliary drainage. Thirty patients underwent this procedure. We performed this method after identifying the second and third branches of the intrahepatic bile ducts, including the portal and the hepatic veins. The success rate of percutaneous transhepatic biliary drainage using color Doppler ultrasonography was 100% with one puncture in 29 patients and with two punctures in only one patient. We never encountered severe complications, such as bleeding, infection, hemobilia, or pseudoaneurysm formation in the hepatic artery. This method was safer and easier than the usual method using B-mode ultrasonography only.

Aged↗

[Dolicho-arteriopathies (kinking, coiling, tortuoosity) of the carotid arteries: study by color Doppler ultrasonography].

BACKGROUND: This work aimed to study extracranial carotid dolichoarterial disease in outpatients using color Doppler ultrasonography. METHODS: A total of 1220 outpatients, 620 males and 600 females, aged between 25 and 89 years old, were enrolled in the study. Subjects were divided into three groups according to age: under 60, between 60 and 70, over 70. Color Doppler ultrasonography was performed on the extracranial carotid using Acuson 128 XP/5 ultrasonograph and linear 7 MHz probe. Reference was made to Weibel and Field's classification for kinking, coiling and tortuosity for the classification of dolichoarterial disease. RESULTS: Of the 1220 subjects examined, 316 (25.9%) presented dolichoarterial disease, 126 males (39.9%) and 190 females (60.1%) with a male/female ratio of 1:1.5. Of the 316 cases of dolichoarterial disease, 171 (54.1%; 14% of the patients examined) showed kinking, 36 (11.4%; 2.9% of the patients examined) showed coiling, 109 (34.5%; 8.9% of the patients examined) showed tortuosity. Females were predominantly affected by kinking (male/female ratio: 1:1.8) and coiling (male/female ratio: 1:1.8), whereas the two sexes were equally affected by tortuosity (male/female ratio: 1:1). 76 out of 387 subjects (19.6%) presented dolichoarterial disease in the under-60 group, 128 out of 441 subjects (29.3%) in the 60-70-year-old group, and 112 out of 392 subjects (28.6%) in the over-70 group. The prevalence of dolichoarterial disease remained stationary after the age of 70, as the result of different findings in the two sexes, but continued to increase in males, while it diminished in females. This trend was clearly evident for kinking and coiling, whereas the prevalence of the two sexes was comparable with regard to tortuosity, slightly higher in females under the age of 70 and slightly higher in males after the age of 70. Of the 316 cases of dolichoarterial disease diagnosed, 297 (94%) were localised at the level of the internal carotid artery, with a predominance for the left (47.8%) artery compared to the right (22.1%), 14 (4.4%) at the level of the external carotid artery and 5 (1.6%) affecting the common carotid. Dolichoarterial disease was monolateral in 239 subjects (75.6%) and bilateral in 77 (24.4%). Of the bilateral cases, only one affected the common carotid, 76 the internal carotid with much higher presence of kinking and coiling compared to tortuosity. As far as concerns the site of dolichoarterial disease, no difference was observed between the sexes. CONCLUSIONS: In conclusion, non-invasive color Doppler ultrasonography, which is easily repeatable, can provide useful data for the morphological evaluation of dolichoarterial disease. Further studies in large populations which will enable the anatomofunctional aspects obtained using color Doppler ultrasonography to be correlated with clinical symptoms and possible effects on the central nervous system are now required for an improved clinical and prognostic assessment of dolichoarterial disease.

Adult↗

Verifying complete obliteration of carotid artery-cavernous sinus fistula: role of color Doppler ultrasonography.

The purpose of this study was to evaluate the role of color Doppler ultrasonography in verifying obliteration of carotid artery-cavernous sinus fistula before and after therapeutic embolization or gamma knife radiosurgery. Before treatment, carotid artery-cavernous sinus fistula showed the following data on color Doppler ultrasonography: (1) increased blood flow in the common carotid artery (220 to 1264 ml/min with mean+/-SD of 728+/-378 ml/min); internal carotid artery (435 to 1097 ml/min with mean+/-SD of 834+/-216 ml/min) in fistulas of the direct type; and external carotid artery (85 to 257 ml/min with mean+/-SD of 170+/-75 ml/min) in fistulas of the indirect type in comparison to the contralateral side; (2) reverse pulsatile flow or spiculated wave form with turbulent flow in the engorged superior ophthalmic vein on the lesion side in all patients. All of the above abnormal hemodynamic changes became normal in six patients immediately after first embolization, in two patients with balloon embolization combined with subsequent direct embolization by direct puncture through the superior orbital fissure or internal carotid artery embolization, and in five patients after gamma knife radiosurgery at 4, 4, 8, 9, and 9 months, respectively. Color Doppler ultrasonography might be a good modality in long-term follow-up of carotid artery-cavernous sinus fistula after gamma knife radiosurgery and embolization.

Adolescent↗

Diagnostic yield of color Doppler ultrasonography in deep vein thrombosis.

OBJECTIVE: To see the diagnostic yield of color Doppler ultrasonography in patients who presented with clinical symptoms and signs of acute deep vein thrombosis of lower limb. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The study was carried out in Bolan Medical Complex Hospital, Quetta from January 2002 to December 2002. SUBJECTS AND METHODS: Twenty five patients, who presented with clinical symptoms and signs of acute deep venous thrombosis of lower limb, were selected. In all patients color Doppler ultrasound and venography was performed to compare the results. RESULTS: The age of the patients ranged from 16-82 +/- 20.33 years. The mean was 49.16, median 50.00 and mode 60.00 There were 15 females (60.00%) and 10 males (40.00%). Left lower limb involvement was seen in 12 patients (48.00% +/- 0.51), right lower limb involvement in 10 patients (40.00% +/- 0.50) and both limbs involvement in 3.0 patients (12.00% +/- 0.33). Color Doppler ultrasound was positive in 16 patients (64.00% +/- 0.48) while venography was positive in 21 patients (84.00% +/- 0.37%). Doppler ultrasonography and venography showed that 11 patients (52.38%) had distal DVT, while 10 patients (47.62%) had distal as well as proximal DVT. Ten patients (100.00%) of proximal as well as distal DVT were diagnosed by CDU and later confirmed by venography. Eleven patients (100.00%) of distal DVT only in whom 6 patients (54.54%) were diagnosed by CDU, while 5 patients (45.46%) had inconclusive findings, which were confirmed by venography. Doppler ultrasonography compared venography showed sensitivity 76.1%, specificity 100%, positive predictive value 100%, negative predictive value 44.45% and accuracy 80.00%. CONCLUSION: Color Doppler ultrasonography is a non-invasive, safe, efficient and cost-effective method in diagnosing acute deep venous thrombosis of lower limb but still it has not 100% accuracy. It is better for diagnosing proximal DVT than distal DVT. 7.

Adolescent↗

[Efficacy of contrast-enhanced color Doppler ultrasonography for the diagnosis of renal mass lesions].

We evaluated the efficacy of contrast-enhanced color Doppler ultrasonography with a galactose-based echo contrast agent, Levovist, for the diagnosis of renal mass lesions. The final pathologic diagnosis of eight renal mass lesions was renal cell carcinoma in 6 patients, transitional cell carcinoma in 1 patient and renal cyst in 1 patient (age range, 47 to 77 years; mean, 59.1). Especially in patients with renal cell carcinoma, contrast-enhanced color Doppler ultrasonography showed enhancement of mass lesion blood flow signal intensities. In all patients, contrast enhancement was demonstrated. Diagnostic capacity was improved in all patients, excluding 2 in whom mass lesion blood flow was detected by plain color Doppler ultrasonography. Furthermore, in patients with transitional cell carcinoma, the hemodynamics of mass lesions could be visualized, and diagnostic capacity was high. Contrast-enhanced color Doppler ultrasonography with Levovist, showed markedly higher mass lesion blood flow than that obtained by the plain color Doppler procedure, improving diagnostic capacity. This procedure was useful for diagnosing renal mass lesions.

Aged↗

Color Doppler ultrasonography as a routine clinical examination in male infertility.

AIM: We assessed the value of scrotal color Doppler ultrasonography as a routine examination in infertile men. METHODS: Color Doppler ultrasonography was performed in 545 infertile men with a mean age of 35.8 years to detect intrascrotal abnormalities. Findings were compared with those of physical examination. RESULTS: Intrascrotal abnormalities were detected by ultrasonography in 65.3% of patients. Of 374 abnormalities, 58.3% were undetected by physical examination. Left varicocele was found in 313 patients (57.4%); testicular microlithiasis in 30 (5.5%); epididymal cyst in 21 (3.9%); right varicocele in 4 (0.8%); and testicular cysts in 3 (0.6%). One occurrence each (0.2%) was found for testicular tumor, intrascrotal hemangioma, and hydrocele of the spermatic cord. Compared to ultrasonography, sensitivity in detecting left varicocele by physical examination was 58.4%; specificity, 79.3%; accuracy, 67.3%; and positive predictive value, 79.3%. Venous diameters in the pampiniform plexus were 3 mm or more in 61.5% of 130 subclinical left varicoceles. Of 30 patients with testicular microlithiasis, 14 had varicocele, 2 had epididymal cyst,s 3 had a history of mumps orchitis, 1 had retractile testis, and 1 had a history of orchiectomy for contralateral testicular tumor. CONCLUSIONS: The routine Color Doppler ultrasonography is valuable for diagnosing scrotal abnormalities in infertile men, frequently detecting non-palpable lesions.

Adult↗

Prenatal diagnosis of placenta accreta and percreta with ultrasonography, color Doppler, and magnetic resonance imaging.

BACKGROUND: The risk of placenta previa and accreta is increased in females with previous cesarean deliveries, and there has been an increasing number of these operations. CASES: We present 2 cases with previous cesarean and placenta previa in the following pregnancy. One patient had placenta accreta and the other, placenta percreta. In both cases, prenatal diagnosis was based on ultrasonography, where features such as loss of the hypoechoic retroplacental zone and irregular uterine serosa were found in grayscale ultrasonography. In color Doppler imaging, in both cases, increased vascularity between myometrium and placenta, as well as intraplacental lacunae, were seen. Thinning of the uterine wall, found in magnetic resonance imaging, contributed to the diagnosis of placenta percreta. CONCLUSION: Prenatal diagnosis of placenta accreta is of importance because it reduces fetal and maternal morbidity as appropriate preoperative and perioperative procedures are possible.

Adult↗

Prenatal diagnosis of an ectopic intrathoracic kidney in right-sided congenital diaphragmatic hernia using color Doppler ultrasonography.

The prenatal sonographic features of a fetus with right-sided congenital diaphragmatic hernia diagnosed at 33 weeks are presented. Color Doppler demonstrated an abnormal course of the right renal artery, arising from the aorta and feeding the intrathoracic right kidney. This case report stresses the role of color Doppler in defining which organs have herniated in fetuses with diaphragmatic hernia.

Adult↗

Tailored operative technique for Chiari type I malformation using intraoperative color Doppler ultrasonography.

OBJECTIVE: We describe an operative technique for Chiari Type I malformation that uses color Doppler ultrasonography as a guide for performing patient-specific posterior fossa decompressions. The technique has been used since 1999 in more than 300 operations. METHODS: On the basis of real-time anatomic and physiological measurements, the following goals of surgery were monitored: 1) adequate decompression of the cervicomedullary junction; 2) creation of a retrocerebellar space of 8 to 10 cm(3) volume; and 3) establishment of optimal cerebrospinal fluid flow between the cranial and spinal compartments. RESULTS: The size of the craniectomy was tailored to conform to the area of cerebellar impaction as demarcated by compressed subarachnoid spaces. A laminectomy was not performed unless the cerebellar tonsils were herniated below C1. Before opening the dura, color Doppler ultrasonography imaging was invaluable in planning operative strategies. A simple duraplasty without additional steps was found to be appropriate treatment in occasional patients with minimal tonsillar herniation (5-8 mm). In all other cases, it was necessary to perform an internal decompression that included lysis of the arachnoid and shrinkage of the cerebellar tonsils to achieve the goals of surgery. Optimal cerebrospinal fluid flow through the foramen magnum in anesthetized, prone patients was found to have the following characteristics: a peak velocity of 3 to 5 cm/s, bidirectional movement, and a waveform exhibiting vascular and respiratory variations. The attainment of surgical goals was confirmed in most patients by postoperative neuroimaging. CONCLUSION: Color Doppler ultrasonography imaging is an important technological advance that permits the neurosurgeon to tailor the steps of Chiari surgery according to patient-specific variables. The success of this technique depends on the mastery of a new and sophisticated monitoring modality.

Adult↗

[Significance of color Doppler ultrasonography in the assessment of pancreatic carcinoma vascular invasion].

BACKGROUND/AIM: It is highly appreciated to provide exact data on vascular invasion of pancreatic carcinoma relying as much as possible on non-invasive diagnostic procedures. Color Doppler ultrasonography has been proven as an efficient method for clinical staging of pancreatic carcinoma essential for therapeutic decisions. The aim of this study was to provide an analysis of the sensitivity and specificity for color Doppler ultrasonography in patients suffering from pancreatic carcinoma. METHODS: We performed color Doppler ultrasonography examination in 43 patients with pancreatic carcinoma prior to the surgery. The findings of ultrasonography on neoplasm vascular invasion were correlated to the findings obtained during the subsequent surgical procedures. An estimation of neoplastic invasion of certain blood vessels including portal vein, celiac trunk, and superior mesenteric artery and vein is critical for decision making regarding surgical treatment. The patients with metastases of pancreatic carcinoma were excluded from the study. RESULTS: Comparing color Doppler and the surgical findings we estimated the sensitivity for detection of neoplastic vascular invasion ranging from 79-93%, whereas the specificity range was from 83-93%. CONCLUSION: Color Doppler ultrasonography is a sufficiently sensitive and specific method for evaluation of vascular invasion in pancreatic carcinoma patients. Since color Doppler ultrasonography is a non-invasive, radiation free, and inexpensive diagnostic tool, considering also the results of this and similar studies we could strongly recommend its use for an initial presurgical evaluation of vascular invasion in pancreatic carcinoma patients.

Adult↗

Color Doppler ultrasonography for evaluation of internal mammary artery application in adolescent female patients with right-convex thoracic idiopathic scoliosis.

STUDY DESIGN: Prospective comparative study. OBJECTIVE: To establish the use of Color Doppler Ultrasonography to investigate internal mammary artery. SUMMARY OF BACKGROUND DATA: Breast asymmetry in female adolescents with right convex idiopathic scoliosis was supposed to be linked with anatomic and functional asymmetry of the internal mammary artery that is the main supplier to the mammary gland. However, no measurements of anatomic and hemodynamic parameters of internal mammary artery have been made to justify or to reject the hypothesis of asymmetric blood flow volume to the breasts and costosternal junction in female adolescent scoliotics. Color Doppler Ultrasonography is a well established noninvasive method to assess vessel anatomy and hemodynamics. METHODS: Twenty female adolescents with right thoracic scoliosis and 16 comparable female individuals without spine deformity were examined with Color Doppler Ultrasonography to measure at the origin of internal mammary artery lumen diameter, cross sectional area, time average mean flow and flow volume per minute and were compared each other. RESULTS: The reliability of Color Doppler Ultrasonography was high and the intraobserver variability low (ANOVA, P = 0.92-0.94). There was no statistically significant difference in the ultrasonographic parameters of the internal mammary artery between right and left side in each individual as well as between scoliotics and controls. CONCLUSIONS: Color Doppler Ultrasonography applied to assess anatomic or hemodynamic blood flow parameters at the origin of internal mammary artery was proven a highly reliable method. Color Doppler Ultrasonography disclosed no side-differences, while there were no differences between scoliotics and controls. Thus, it seems that this study cannot justify previous theories for development of right thoracic scoliosis in female adolescents.

Adolescent↗

Early detection of ovarian carcinoma with transvaginal color Doppler ultrasonography.

OBJECTIVE: Our purpose was to assess the potentials and limitations of the early detection of ovarian cancer in protocols that involve transvaginal color Doppler ultrasonography. STUDY DESIGN: Retrospective analysis was performed on the data from 206 referred patients who either had surgical or clinical follow-up of ovarian masses evaluated by transvaginal color Doppler ultrasonography. Most of the patients were referrals or had risk factors. RESULTS: In this series of 206 patients, 26 ovarian cancers were detected, > 70% of which were stage I or II. CONCLUSION: Transvaginal color Doppler ultrasonography is capable of early detection of ovarian carcinoma. An improved detection rate may be realized with better identification of high-risk patients who should be studied with transvaginal color Doppler ultrasonography.

Adolescent↗

Assessment of internal thoracic artery graft with intraoperative color Doppler ultrasonography.

BACKGROUND: Intraoperative ultrasonography has the potential to provide anatomic and functional information about internal thoracic artery (ITA) graft, but this potential has been hindered by the relatively large standard probe. In this study, we used a color Doppler microprobe to evaluate ITA grafts. METHODS: The subjects were 15 consecutive patients who underwent elective coronary artery bypass grafting either with cardiopulmonary bypass (n = 14) or without (n = 1). All patients underwent anastomosis of the left ITA to the left anterior descending artery. The ITA graft was assessed before the chest was closed, with the microprobe placed directly on the graft. RESULTS: A good-quality color Doppler image of the ITA graft was easily obtained in all 15 patients within a few minutes. The ITA graft function was assessed by analyzing the shape of the pulsed Doppler wave. All ITA grafts were patent, and the mean graft diameter was 1.8 +/- 0.04 mm. The peak systolic velocity, peak diastolic velocity, and mean velocity were 52.0 +/- 14.9 cm/s, 58.3 +/- 22.4 cm/s, and 36.5 +/- 10.9 cm/s, respectively. The ratio of peak diastolic velocity to peak systolic velocity was 1.24 +/- 0.66. The ITA graft seemed to function well when the biphasic diastolic predominant flow appeared. The mean blood flow was 55.1 +/- 22.0 mL/min. CONCLUSIONS: Intraoperative ultrasonography using the microprobe provides adequate anatomic and hemodynamic information regarding ITA grafts. As the Doppler flow evaluation has high sensitivity and specificity, we suggest that intraoperative ultrasonography is useful for the assessment of these grafts.

Anastomosis, Surgical↗