The vascularisation of oral cavity tumours and tumour shell tissue determined by three-dimensional power Doppler sonography

The aim of the study was to determine and quantify the vascularity of oral cavity tumours and peritumoural tissue by using 3-D power Doppler sonography (3-D PDS) and to compare the vascularity of metastatic and nonmetastatic tumours. The investigation was carried out preoperatively on 49 patients with squamous carcinoma of the tongue and floor of the mouth. Collected data were analysed with the help of virtual program of computer-aided analysis (VOCAL)-imaging program by which the borders of a structure could be defined and vascularity quantified by analysing 3D colour histograms. Vascularity was defined by three indices, VI- vascularisation index, FI- flow index and VFI- vascularisation-flow index. The vascularity of oral cavity tumours was determined in 4 mm and 7 mm shells surrounding the tumour. Modified neck dissection was performed in all of the patients and lymph nodes were examined histologically. Peritumorous tissue vascularity was significantly higher in metastatic (N+ neck) than it was in nonmetastatic (N0 neck) tumours. Indices VI and VFI in 4 mm and 7 mm shells differed significantly between N+ and N0 tumours (p < 0.01). Flow index (FI) did not show any difference between N0 and N+ necks. The difference between vascularity indices VI and VFI of peritumorous tissue and tumour was also varied significantly between N0 and N+ neck (p < 0.05) and was higher in N+ tumours. With VOCAL software and 3-D power Doppler sonography, the vascularity of peritumorous tissue could be quantified successfully. Tumours which had metastasised showed richer vascularity in their shells and a greater difference in vascularity between the shell and tumour tissue.     

Comparison of intermittent-bolus contrast imaging with conventional power Doppler sonography: quantification of tumour perfusion in small animals

Replenishment kinetics of microbubbles were adapted to a single bolus injection to investigate tumour angiogenesis in small animals with intermittent imaging, and to compare vascularisation parameters from this new approach with conventional power Doppler ultrasound (US). A reformulation of the imaging protocol and the derivation of perfusion parameters was necessary, taking into account the time-dependence of the systemic microbubble concentration after single bolus injection. Using this new method, tumour vascularisation was evaluated in 13 experimental murine tumours. Furthermore, parameters calculated with intermittent imaging after bolus injection of 100 microl Levovist were compared with parameters from the signal intensity-time curve. The results showed that quantifying tumour perfusion, blood volume and flow, as well as the assessment of the mean blood velocity (in m/s), is possible in tumours with a volume of more than 0.1 mL. In larger tumours, a lower perfusion was calculated than in smaller ones (k = -0.88; p < 0.001). Only limited correlations were found between conventional power Doppler US quantities and parameters of intermittent sonography: Perfusion correlated with the maximum signal intensity (k = 0.61, p < 0.05) and the gradient to maximum (k = 0.82, p < 0.01), full width-half maximum was associated with blood volume (k = 0.62, p < 0.05). We conclude that intermittent bolus contrast sonography allows the quantification of tumour perfusion, even in small animals, and the monitoring of basic antiangiogenic studies with perfusion parameters shows a higher significance than conventional power Doppler US.     

Three-dimensional power Doppler sonography: imaging and quantifying blood flow and vascularization.

OBJECTIVES: To assess the feasibility of imaging low-velocity blood flow in adnexal masses by transvaginal three-dimensional power Doppler sonography, to analyze three-dimensional power Doppler sonography data sets with a new computer-assisted method and to test the reproducibility of the technique. METHODS: A commercially available 5-MHz Combison 530 ultrasound system was used to perform three-dimensional power Doppler sonography transvaginally. A cube (= volume of interest) was defined enclosing the vessels of the cyst and the Cartesian characteristics were stored on a hard disk. This cube was analyzed using specially designed software. Five indices representing vascularization (the vascularization index (VI) or blood flow (the flow index (FI)) or both (the vascularization-flow index (VFI)) were calculated. The intraobserver repeatability of cube definition and scan repetition was assessed using Hartley's test for homogeneous variances. Interobserver agreement was assessed by the Pearson correlation coefficient. RESULTS: Imaging of vessels with low-velocity blood flow by three-dimensional power Doppler sonography and cube definition was possible in all adnexal massed studied. In some cases even induced non-vascular flow related to endometriosis was detected. The calculated F value with intraobserver repeated Cartesian file-saving ranged from 0 to 18.8, with intraobserver scan repetition from 4.74 to 24.8 for VI, FI 1, FI 2 and VFI 1; for VFI 2 the calculated F value was 64. The interobserver correlation coefficient ranged between 0.83 and 0.92 for VI, FI 1, FI 2 and VFI 1; for VFI 2 the correlation coefficient was less than 0.75. CONCLUSION: Vessels with low-velocity blood flow can be imaged using three-dimensional power Doppler sonography. Induced non-vascular flow was detected in endometriotic cyst fluid. Three-dimensional power Doppler sonography combined with the cube method gave reproducible information for all indices except VFI 2. These indices might prove to be a new predictor in all fields of neoangiogenesis. The clinical relevance remains to be determined.     

Reproducibility of endometrial vascular patterns in endometrial disease as assessed by transvaginal power Doppler sonography in women with postmenopausal bleeding.

OBJECTIVE: The purpose of this study was to assess the intraobserver and interobserver agreement for identifying different endometrial vascular patterns using power Doppler sonography in women with postmenopausal bleeding and a thickened endometrium. METHODS: Digitally stored sonographic images from a random sample of 65 patients with postmenopausal bleeding and a thick endometrium (>5 mm) on B-mode sonography and evaluated by transvaginal power Doppler sonography for assessment of endometrial blood flow mapping were evaluated by 5 different examiners with different levels of expertise in Doppler sonography. Intraobserver and interobserver agreement according to the level of experience were assessed by calculating the kappa index. RESULTS: Intraobserver agreement was good or very good for all experienced examiners (kappa = 0.78-0.96) and moderate (kappa = 0.52) for the inexperienced examiner. Interobserver agreement was moderate among all experienced examiners (kappa = 0.45-0.80). The inexperienced examiner showed fair or moderate interobserver agreement (kappa = 0.32-0.45). CONCLUSIONS: Our results indicate that endometrial blood flow mapping using transvaginal power Doppler sonography is acceptably reproducible. More experience was associated with better intraobserver and interobserver agreement.     

Radiosensitivity of Rat Mammary Tumors Correlates With Early Vessel Changes Assessed by Power Doppler Sonography

Objective . To investigate the changes occurring in the vascularization of tumors during irradiation, we used a model of autochthonous mammary tumors in rats and assessed early vascular changes after irradiation by power Doppler sonography. Methods . Mammary tumors were induced in 24 female Sprague Dawley rats by a single subcutaneous injection of N‐nitroso N‐methyl urea. After tumor areas reached 1 cm², the animals received a single fraction of 18‐Gy radiation or intraperitoneal saline injection. Power Doppler sonographic quantification of detected vessels was performed 1 day before irradiation and 7 days after the use of a power Doppler index of 5 different tumor imaging planes. Final tumor shrinkage was compared with early changes in the power Doppler index. Not all tumors regressed in a similar fashion. Radiosensitive tumors were defined as tumors with a greater than 50% decrease in baseline area 28 days after irradiation, whereas radioresistant tumors were tumors with a less than 50% decrease in baseline area. Statistical analysis was performed by the Mann‐Whitney U test. Results . Tumor area changes were similar in radioresistant and radiosensitive tumors 7 days after irradiation (–41% and –35%, respectively; P > .05, not significant), whereas reduction in the power Doppler index was significantly greater in radiosensitive tumors (mean value, –63%) than in radioresistant tumors (mean value, –12%) (P = .001). Late tumor regrowth was correlated with day 7 power Doppler index changes (P = .009). A 40% reduction in the power Doppler index at day 7 distinguished 8 of 9 radiosensitive tumors and 8 of 9 radioresistant tumors (P = .003). Conclusions . This study suggests that early changes in tumor perfusion as assessed by power Doppler sonography after tumor irradiation may precede the long‐term tumor regression.     

Detectability of Small Blood Vessels with High-Frequency Power Doppler and Selection of Wall Filter Cut-Off Velocity for Microvascular Imaging

Power Doppler imaging of physiologic and pathologic angiogenesis is widely used in preclinical studies to track normal development, disease progression and treatment efficacy but can be challenging given the presence of small blood vessels and slow flow velocities. Power Doppler images can be plagued with false-positive color pixels or undetected vessels, thereby complicating the interpretation of vascularity metrics such as color pixel density (CPD). As an initial step toward improved microvascular quantification, flow-phantom experiments were performed to establish relationships between vessel detection and various combinations of vessel size (160, 200, 250, 300 and 360 μm), flow velocity (4, 3, 2, 1 and 0.5 mm/s) and transducer frequency (30 and 40 MHz) while varying the wall filter cut-off velocity. Receiver operating characteristic (ROC) curves and areas under ROC curves indicate that good vessel detection performance can be achieved with a 40-MHz transducer for flow velocities ≥2 mm/s and with a 30-MHz transducer for flow velocities ≥1 mm/s. In the second part of the analysis, CPD was plotted as a function of wall filter cut-off velocity for each flow-phantom data set. Three distinct regions were observed: overestimation of CPD at low cut-offs, underestimation of CPD at high cut-offs and a plateau at intermediate cut-offs. The CPD at the plateau closely matched the phantom's vascular volume fraction and the length of the plateau corresponded with the flow-detection performance of the Doppler system assessed using ROC analysis. Color pixel density vs. wall filter cut-off curves from analogous in vivo experiments exhibited the same shape, including a distinct CPD plateau. The similar shape of the flow-phantom and in vivo curves suggests that the presence of a plateau in vivo can be used to identify the best-estimate CPD value that can be treated as a quantitative vascularity metric. The ability to identify the best CPD estimate is expected to improve quantification of angiogenesis and anti-vascular treatment responses with power Doppler. (E-mail: jlacefield@eng.uwo.ca)     

Prognostic significance of color Doppler findings in head and neck tumors

We examined whether or not the degree of tumor vascularity in lymph node metastases as depicted by color Doppler is associated with a patient's prognosis. Cervical lymph node metastases in 25 patients with head and neck cancer were examined before combined accelerated radiotherapy and chemotherapy. The findings were quantified using a computer-assisted protocol that quantitatively describes color Doppler images by the relative color pixel density (CPD) and the color hues, which are numerically expressed by the mean color value (MCV). We found that, in the patient group with a CPD below median, the median survival was 958 days and, in the group with a higher CPD, it was 423 days (p = 0.05). The time to detection of distant metastases was 18 months with a low CPD, and 6 months with a high CPD (p = 0.05). However, the time to local or nodal progression was not different between the groups. The MCV was not correlated with prognostic data. These results indicate that, in patients with metastatic head and neck cancer, highly vascularized lymph nodes detected with color Doppler sonography may indicate a shorter survival and earlier occurrence of distant metastases.     

鱼精蛋白治疗前列腺癌鼠模型引起多普勒血流变化的研究

目的　研究血管生成抑制剂治疗前列腺癌鼠模型的多普勒血流信号变化规律。方法　将人PC 3m前列腺癌块移植于 48只Balb/C雄性裸鼠皮下 ,选用鱼精蛋白作为血管生成抑制剂。随机将荷瘤裸鼠分成大剂量组、小剂量组和对照组 ,各组依据治疗和观察的不同时间段再分为A、B两个亚组。计算机辅助测定彩色多普勒能量图 (CDE)和超声造影血流信号象素网格数 ,并与肿瘤微血管密度 (MVD)对照分析。结果　在A组中 ,大剂量组、小剂量组和对照组的血流信号平均象素网格数分别为 1.44、2 .13、5 .75 (P <0 .0 1)。结论　多普勒超声能有效地显示血管生成抑制剂引起的肿瘤血流变化     

Three-dimensional power Doppler sonography in screening for carotid artery disease

PURPOSE: Color Doppler sonography has gained considerable recognition as a noninvasive method to detect carotid artery disease and to assess the degree of carotid artery stenosis. However, results are highly operator-dependent and cannot be presented as survey images. The purpose of this study was to evaluate real-time 3-dimensional (3D) power Doppler sonography as a method for screening for atherosclerosis in the carotid arteries. METHODS: We prospectively screened 75 patients for carotid artery disease using both conventional color Doppler sonography and 3D power Doppler sonography, and the results from the 2 modalities were compared. A total of 150 common carotid arteries, 150 internal carotid arteries, and 150 external carotid arteries were examined utilizing a 7.5-MHz linear-array transducer combined with tissue harmonic imaging. RESULTS: Color Doppler sonography detected 297 normal or atherosclerotic arteries without stenosis, 57 arteries with mild (1-49%) stenosis, 41 with moderate (50-69%) stenosis, 32 with severe (70-99%) stenosis, and 9 with occlusions. The degree of stenosis determined by color Doppler sonography correlated with that determined by 3D power Doppler sonography (r = 0.982-0.998). Moreover, there was a good correlation between the measurements for both the length of the lesion and its distance from the bulb as determined by the 3D volume surveys and by color Doppler sonography (r = 0.986). The interobserver variability rate was 3.7% +/- 0.5%. Generally, the acquisition and reconstruction of the 3D data took less than 5 minutes. CONCLUSIONS: 3D power Doppler sonography is easy to perform and is an accurate method in screening for atherosclerotic lesions of the carotid arteries. Moreover, it provides excellent 3D volume surveys that may be helpful in the planning of surgical treatment.     

Intraobserver and interobserver variability of ovarian volume, gray-scale and color flow indices obtained using transvaginal three-dimensional power Doppler ultrasonography.

OBJECTIVE: To assess intraobserver and interobserver variability in ovarian volume and gray-scale and color flow index measurements using transvaginal, three-dimensional, power Doppler ultrasonography. METHODS: Eleven women (22 ovaries) were examined on day 8 of controlled ovarian hyperstimulation therapy, which was part of their in vitro fertilization treatment protocol. The patients were examined twice by the first observer and once by the second observer. The acquired volume datasets were analyzed using the VOCAL imaging program, enabling the assessment of ovarian volume, vascularization index (VI), flow index (FI), vascularization flow index (VFI) and mean grayness (MG). For these parameters the intraclass (intra-CC) and interclass (inter-CC) correlation coefficients, within-observer and between-observers repeatability coefficient (r) and limits of agreement were calculated. RESULTS: Both intraobserver and interobserver repeatability of ovarian volume measurements were considered very good with an intra-CC value of 1.00 and inter-CC value of 0.99, respectively. Also VI, FI, VFI and MG measurements were repeatable by a single observer, the intra-CC ranging from 0.82 to 0.91. The interobserver reproducibility was also good for VI, VFI and MG measurements (inter-CC values 0.73, 0.70 and 0.81, respectively), but for FI measurements the reproducibility was poor (inter-CC = 0.29, r = 7.87). CONCLUSIONS: In general, the intraobserver reproducibility was better than interobserver reproducibility for all parameters. The volume assessments were reproducible both by one observer and by two separate observers. The intraobserver and interobserver variabilities were acceptable for VI, VFI and MG, whereas for FI the interobserver reproducibility was poor. Our results suggest that measurement of gray-scale and color Doppler flow indices is reproducible thus allowing them to be used in clinical practice and research.     

Influence of menopausal state on Colour Doppler flow parameters of breast tumours and healthy mammary tissue

The aim of this study was to evaluate the influence of menopausal state on the Doppler flow parameters in healthy breast and breast tumours. One hundred and fourteen patients were examined with colour and spectral Doppler sonography. The flow parameters in tumour and healthy breast tissue from postmenopausal patients under hormone replacement therapy (HRT) did not differ significantly from premenopausal women, but both groups showed a significant difference to postmenopausal patients without HRT. The difference between benign and malignant tumour groups no longer exists after stratification according to menopausal state. Menopausal state has a significant influence on breast vascularisation and should be taken into consideration when assessing malignancy.     

Correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis.

OBJECTIVE: To record the correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis. METHODS: Women with palpable breast masses scheduled for excision biopsy were scanned with two- and three-dimensional color power Doppler sonography before and after the administration of a sonographic contrast agent. Vessel counts were performed on two- and three-dimensional sonographic images before and after contrast agent administration. All tumors were surgically removed and underwent immunohistochemical analysis for microvessel density assessment. The sonographic measure of tumor vascularity was correlated with microvessel density. RESULTS: Pathologic examination showed 43 breast cancers and 14 benign breast masses. Higher microvessel density was noted in malignant than benign breast masses (P < .0005). Color power Doppler sonographic measurement of tumor vessel number showed a significant positive correlation with tumor size (P < .05) and progesterone receptor negativity (P < .05). A significant positive correlation was observed between microvessel density and the number of intratumoral blood vessels assessed by both two- and three-dimensional color power Doppler sonography (P < .05). Regression models showed three-dimensional color power Doppler sonography to have a significantly higher correlation with microvessel density when compared with two-dimensional color power Doppler sonography at baseline (P < .005). The administration of a sonographic contrast agent did not improve correlation with microvessel density. CONCLUSIONS: A significant correlation was shown between color power Doppler sonographic measurement of tumor vascularity and microvessel density by immunohistochemical analysis. Further improvement in Doppler sonographic techniques to map capillary vessel flow should be explored to improve the current association with pathologic findings.     

The different features of congenital neuroblastomas: report about the sonographic diagnosis of three cases

We report on three infants with congenital neuroblastoma. Two clinically asymptomatic infants showed a suprarenal right-sided mass, one infant had a mediastinal tumour with tracheal compression causing immediate postnatal dyspnoea. Diagnosis was established by ultrasonography showing hypoechoic tumours without significant calcifications. The two suprarenal masses were characterised by small cystic areas. Colour coded Doppler sonography revealed perfusion of the tumours distinguishing the suprarenal masses from adrenal haemorrhage. The right-sided mediastinal neuroblastoma showed infiltration of the intervertebral foramina and spinal canal without spinal cord compression. All tumours were surgically removed with favourable clinical outcome.     

Kuttner tumour (chronic sclerosing sialadenitis) of the submandibular gland: sonographic appearances

Patients with Kuttner tumours present with clinical features simulating a submandibular tumour. This article aims to familiarise sonologists with the sonographic appearances of these tumours, to help in their differentiation from other salivary lesions. In 13 patients with histologically or cytologically proven Kuttner tumours, the features evaluated on sonography included: shape and border of the gland, internal architecture, duct dilatation, presence/absence of calculi and presence and distribution of vascularity. There was diffuse involvement of the submandibular glands in 11 patients and focal involvement in 2. The majority (9 of 11) of the patients with diffuse involvement showed sonographic appearances simulating a "cirrhotic" liver; 2 showed diffuse heterogeneous involvement with duct dilatation and calculus. Doppler showed prominent intraglandular vessels, with no evidence of displacement. Focal lesions (2 of 11) were seen as hypoechoic, heterogeneous "masses," with a radial branching vascular pattern within, on Doppler. In conclusion, sonographic features may help in identifying Kuttner tumours of the submandibular glands.     

乳腺癌彩色多普勒超声的诊断及鉴别诊断

目的探讨彩色多普勒超声在乳腺癌诊断与鉴别诊断中的应用价值。方法回顾性分析经手术病理证实的68例乳腺癌患者与67例乳腺良性肿块患者声像图资料,对乳腺癌二维超声图像与彩色多普勒血流图像(CDFI)特点进行总结,并将超声与病理结果相对照。结果乳腺恶性肿块与乳腺良性肿块的二维声像图存在差别;彩色多普勒血流图检查恶性肿块血流显示率为96%,良性肿块血流显示率为48%;恶性肿块多表现为穿入性动脉血管(76%),并呈高阻血流信号(RI>0.7)。结论彩色多普勒血流的分布特点与频谱变化是反映乳腺新生血管的一个重要特征,二维超声与彩色多普勒血流图结合能进一步提高乳腺癌的诊断率。     

Contrast-enhanced power Doppler sonography in breast lesions: effect on differential diagnosis after mammography and gray scale sonography.

OBJECTIVE: To evaluate the efficacy of contrast-enhanced power Doppler sonography in the differential diagnosis of breast lesions after a mammography-gray scale sonography combination. METHODS: Sixty-eight patients with 69 breast masses underwent power Doppler sonography before and after intravenous injection of a contrast agent. The lesions were diagnosed as "highly suggestive of malignancy" (category 5; n = 32), "suspicious" (category 4; n = 21), and "probably benign" (category 3; n = 16) by mammography and gray scale sonography, modeled on the American College of Radiology Breast Imaging Reporting and Data System classification. Power Doppler findings did not affect patient treatment. The authors subjectively evaluated the estimated area of vascularity, degree of enhancement following contrast agent administration, morphologic features, and distribution of vessels within the lesions. RESULTS: The final diagnoses were malignant in 28 lesions and benign in 41. Significant enhancement after contrast agent injection was detected in both the malignant and benign groups. Only 2 criteria, estimated area of vascularity and degree of enhancement following contrast agent administration, proved to be significant diagnostic determinants for contrast-enhanced power Doppler sonography (P < .001; interobserver agreements, 74.4 and 77.8, respectively). Contrast-enhanced power Doppler sonography provided a higher specificity, positive predictive value, and negative predictive value than power Doppler sonography but a lower sensitivity and negative predictive value than mammography-gray scale sonography. Only in the category 4 lesions could the combination of mammography-gray scale sonography and contrast-enhanced power Doppler sonography accomplish a higher specificity (71%) and positive predictive value (70%) than mammography-gray scale sonography (39% and 53%, respectively). CONCLUSIONS: Power Doppler and contrast-enhanced power Doppler sonography cannot be recommended as confirmatory tests in Breast Imaging Reporting and Data System category 3 and category 5 lesions. Although contrast-enhanced power Doppler sonography may help reduce unnecessary biopsies in Breast Imaging Reporting and Data System category 4 lesions, recommendation of its use has many drawbacks, such as imperfectly established criteria, lack of absolute certainty, and high cost.     

Lipoma in the parotid gland: typical US and CT morphology

Up to 3% of all parotid tumours are lipomas. Parotid lipomas can be diagnosed almost specifically by imaging as US, CT, MRI. On ultrasound parotid lipomas are ovoid, hypoechogenic lesions with typical feathered structure. Colour Doppler sonography did not detect any signals in the tumour. CT enables the definite diagnosis by measurement of density values equivalent to fat.     

三维能量多普勒超声成像技术在早期宫颈癌血管检测中的应用

目的探讨三维能量多普勒超声定量检测早期宫颈癌肿块内血管的诊断价值及早期宫颈癌肿瘤体积与血管参数(VI、FI、VFI)的相关性。方法对25例临床诊断为早期宫颈癌(Ia～IIa期)的患者(宫颈癌组)及19例宫颈上皮内瘤变(CIN)Ⅱ～Ⅲ级的患者(宫颈上皮内瘤变组)行三维能量多普勒超声检查,测定宫颈或肿块内血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI)3项血管参数,同时观察宫颈癌组患者肿瘤体积与血管参数的相关性,并与20例正常女性(对照组)宫颈的3项血管参数检测值进行比较。结果早期宫颈癌组[VI(5.44±4.02)%、FI(41.61±3.51)及VFI(2.31±1.65)]3项血管参数平均测值明显高于宫颈上皮内瘤变组[VI(1.84±0.62)%、FI(39.17±4.12)、VFI(1.34±0.55)]和对照组[VI(0.77±0.11)%、FI(38.49±3.55)及VFI(0.47±0.33)],差异有统计学意义(P0.05);宫颈上皮内瘤变组2项血管参数测值VI、VFI亦高于对照组,差异有统计学意义(P0.05)。早期宫颈癌组患者宫颈肿瘤体积越大,宫颈肿瘤内FI测值也升高,宫颈肿瘤体积与FI测值间存在线性正相关关系,相关系数r=0.523(P=0.007)。结论三维能量多普勒超声是定量检测早期宫颈癌肿块内血流的新方法,可为早期宫颈癌患者超声检查提供更多诊断信息。     

Clinical usefulness of 3-dimensional sonography and power Doppler angiography for diagnosis of endometrial carcinoma.

OBJECTIVE: The purpose of this study was to assess whether endometrial volume (EV) and 3-dimensional (3D) power Doppler indices can discriminate between hyperplasia and endometrial carcinoma and can predict extension of the endometrial carcinoma. METHODS: Eighty-four women with uterine bleeding and a histopathologic diagnosis of endometrial hyperplasia (n = 29) or carcinoma (n = 55) were preoperatively examined by transvaginal 3D sonography and power Doppler angiography. Endometrial thickness (ET), EV, the vascularization index (VI), the flow index (FI), the vascularization-flow index (VFI), and the intratumoral resistive index (RI) were measured. A histopathologic diagnosis was made after endometrial biopsy was performed by hysteroscopy or curettage. RESULTS: The EV and 3D power Doppler indices (VI, FI, and VFI) were significantly higher in endometrial carcinoma than endometrial hyperplasia, whereas the intratumoral RI was significantly lower (P < .05). A VFI of 2.07 was the best cutoff for predicting endometrial carcinoma, with sensitivity of 76.5% and specificity of 80.8%. No significant differences were noticed for ET. The endometrial VI was significantly higher when the tumor stage was greater than I. All the 3D power Doppler indices were significantly higher when the carcinoma infiltrated more than 50% of the myometrium. The intratumoral RI was significantly lower in cases with a high histologic grade, myometrial infiltration of more than 50%, and lymph node metastases. CONCLUSIONS: The VI, 3D power Doppler indices, and the intratumoral RI are more useful than ET for differentiating between hyperplasia and endometrial carcinoma. Intratumoral blood flow evaluated by pulsed Doppler sonography and 3D power Doppler angiography can predict the spread of endometrial carcinoma.     

Vascularity change and tumor response to neoadjuvant chemotherapy for advanced breast cancer

For advanced breast cancer with severe local disease (ABC) (stage III/IV), neoadjuvant chemotherapy improves local control and surgical outcome. However, about approximately 20 to 30% of advanced cancers show either no or poor response to chemotherapy. To prevent unnecessary treatment, a capability of predicting clinical response to neoadjuvant chemotherapy of ABC is highly desirable. Vascularity index (VI) of breast cancers was derived from the quantification results in 30 ABC patients by using power Doppler sonography. Power Doppler sonography evaluation was performed every one to two weeks during chemotherapy. The overall response rate for 30 advanced patients tested was 70%, when 50% or more reduction in tumor size was the objective clinical response. Chemotherapy response was unrelated to the original tumor size (p = 0.563) or chemotherapy agents used (p = 0.657). The median VI for all 30 patients was 4.99%. The response rates for hypervascular tumors vs. hypovascular tumors, based on initial median value, were 86.7% and 53.3%, respectively (p = 0.109). The average VIs in responders and nonresponders were 7.67 +/- 4.77% and 4.01 +/- 3.82% (p = 0.052). There was a tendency for responders who have a relatively high initial vascularity. The VI change in responder group shows a pattern of initial increasing in vascularity followed by decreasing in vascularity. All patients (17/17) with a VI increment of >5% during chemotherapy had good chemotherapy response, whereas in patients with a VI increment of <5%, the response rate was 30.8% (4/13) (p < 0.001). For patients with a peak VI of >10% during chemotherapy, the response rate was 94.1% (16/17). However, in patients with a peak VI of <10%, the response rate was 38.5% (5/13) (p = 0.001). This prediction was made mostly within one month (25.47 +/- 12.96 d for VI increments >5% and 25.44 +/- 12.41 d for VI increased to >10%). In the meantime, the differences in size reduction shown in B-mode sonography were insignificant between responders and nonresponders (patient group with VI increment >5%, p = 0.308; patient group with peak VI >10%, p = 0.396). In conclusion, we propose that VI as determined by using power Doppler sonography is a good and inexpensive clinical tool for monitoring vascularity changes during neoadjuvant chemotherapy in ABC patients. Two parameters--VI increment >5% and peak VI >10%--are potential early predictors for good responses to neoadjuvant chemotherapy within one month in patients with ABC.