Colour Doppler-guided spectral analysis of gall-bladder wall flow

For the purpose of the present study to diagnose gall-bladder cancers, which cannot be detected or are only partly visible by conventional ultrasonography (US), we attempted differential diagnoses of 69 patients with gall-bladder diseases (12 with gall-bladder cancer, five with acute cholecystitis, 11 with chronic cholecystitis, 27 with cholesterol polyp and 14 with adenomyomatosis) using the evaluation of gall-bladder wall blood flow (GWBF). GWBF was evaluated by colour Doppler-guided spectral analysis (CDSA). Thirty-three healthy volunteers were selected as controls at random. Two parameters of GWBF, namely flow velocity and resistive index (RI), were compared between patients with gall-bladder diseases and healthy volunteers. GWBF could be ultrasonically evaluated in 92 (90%) of 102 subjects. All 12 patients with gall-bladder cancer had a significantly rapid blood flow value compared with other patients and healthy volunteers. There was no significant difference in RI among patients and healthy volunteers. When cut-off level of the flow velocity was set at 30 cm/s, gall-bladder cancer could be diagnosed by flow velocity with 100% sensitivity (12/12) and 96% specificity (50/52). Using the same cut-off level of the flow velocity, 17 patients were analysed prospectively. In four asymptomatic gall-bladder cancers and two acute cholecystitis cases with some symptoms, the flow velocity was over 30 cm/s. In two of four patients with gall-bladder cancer, only a part of the tumour was visualized on conventional abdominal US. In conclusion, CDSA was more useful for diagnosing gall-bladder lesions than the conventional abdominal US due to estimation of arterial flow velocity in the gall-bladder wall.     

Contrast‐enhanced power Doppler of the intestinal wall in the evaluation of patients with Crohn disease

Background: Crohn disease (CD) manifests with highly variable signs and symptoms, and assessment of the status of the disease in the single patient can be difficult. This study was conducted to evaluate the efficacy of power colour Doppler ultrasonography, with and without echo‐enhancement, in distinguishing active from quiescent CD. Methods: Resistance Index (RI) of the superior mesenteric artery (SMA), bowel thickness of the affected loops and the presence of colour signals at power Doppler analysis prior to and after ultrasonography contrast agent injection (Levovist®) were evaluated in 48 patients with CD. Results: In our series, 26/48 patients had active and 22/48 had quiescent CD. A CDAI score ≥150 and a pathological (>5?mg/dL) C reactive protein were significantly correlated with active disease (P?P?=?0.004, respectively). Intestinal wall thickness showed no significant correlation with disease status (7.5?±?1.3?mm in active disease versus 6.8?±?1.3?mm in quiescent disease; P?=?0.11). Vascular signals in the affected loops were revealed in 11/22 patients (50%) with active disease and in 5/26 (20%) with quiescent disease (P?=?0.052). After Levovist injection, colour signals were found in 22/22 with active and in 8/26 with quiescent CD (P?P?=?0.001). Conclusions: Our data suggest that in patients with CD a finding of a SMA RI?≤?0.81, or the presence of a colour signal in the wall of the affected loops, at power Doppler sonography, is indicative of active disease. Utilization of echo‐enhancer media can greatly improve the diagnostic sensitivity of intestinal wall power Doppler scan. A finding of intestinal wall thickening is not associated with active disease in our series.     

Resistance index in differential diagnosis of liver lesions by color doppler ultrasonography

AIM: To investigate the specific value of resistance index (RI) in color Doppler ultrasonography in the diagnosis of focal hepatic lesions. METHODS: Eight hundred patients with 893 hepatic solid lesions were studied with color Doppler flow imagimg (CDFI) and pulsed Doppler, induding 644 malignant cases (596 primary malignant liver tumors, and 48 metastatic liver tumors), 156 benign cases. All were confirmed by operation and pathology. RESULTS: The detection rate of arterial flow in malignant tumors was 92%, and 52% in benign lesions. Doppler spectrum analysis showed that the resistance index in primary malignant tumors was 0.75±0.12, 0.73±0.09 in metastatic tumors, and was below 0.6 in benign lesions. The difference was significant (P<0.001). This difference was related with its histopathologic structure. CONCLUSION: The arterial flow with RI≥0.6 identified by CDFI within the liver lesion can be regarded as a criterion of malignant tumors, RI<0.6 can be regarded as benign disorders. RI is useful in differential diagnosis of liver neoplasms.     

Diagnosis of thyroid follicular carcinoma by the vascular pattern and velocimetric parameters using high resolution pulsed and power Doppler ultrasonography

The aim of this study was to define the preoperative diagnosis of thyroid follicular carcinoma by the vascular pattern and velocimetric parameters using high resolution pulsed and power Doppler ultrasonography (US). We compared the vascular pattern and the velocimetric parameters, such as peak systolic velocity (Vmax), end-diastolic velocity (Vmin), pulsatility index (PI), or resistance index (RI) between follicular adenoma (FA, n = 25) and follicular carcinoma (FC, n = 10) and analysed them by means of receiver characteristics curves (ROC). Of 10 patients with FC, 8 (80%) patients presented a moderate increase of intranodular vascularization using power Doppler US. In contrast, the majority (84%, 21 out of 25 cases) of FA cases showed only a peripheral rim of color flow even by power Doppler US. These color flow imagings by power Doppler US were suggested to be a reliable tool for the differential diagnosis of thyroid follicular tumor with a sensitivity of 87.5% and a specificity of 92%. In velocimetric analyses, the Vmax/Vmin ratios, PI, and RI were significantly higher in the patients with FC than those with FA (p<0.001, p<0.005, and p<0.001, respectively). By means of ROC, FC could be diagnosed with a cutoff value of ratio of PI (>1.35), RI (>0.78), and Vmax/Vmin (>3.79). The diagnostic efficiency evaluated by ROC curves were 0.898 for PI, 0.876 for RI, and 0.888 for Vmax/Vmin, respectively. In conclusion, the evaluation of the vascular pattern and the velocimetric parameters using pulsed and power Doppler ultrasound may provide important information that is useful in making correct differential diagnosis of malignant or benign thyroid follicular tumor preoperatively.     

Contrast-enhanced power doppler of the intestinal wall in the evaluation of patients with Crohn disease

BACKGROUND: Crohn disease (CD) manifests with highly variable signs and symptoms, and assessment of the status of the disease in the single patient can be difficult. This study was conducted to evaluate the efficacy of power colour Doppler ultrasonography, with and without echo-enhancement, in distinguishing active from quiescent CD. METHODS: Resistance Index (RI) of the superior mesenteric artery (SMA), bowel thickness of the affected loops and the presence of colour signals at power Doppler analysis prior to and after ultrasonography contrast agent injection (Levovist) were evaluated in 48 patients with CD. RESULTS: In our series, 26/48 patients had active and 22/48 had quiescent CD. A CDAI score > or = 150 and a pathological (> 5 mg/dL) C reactive protein were significantly correlated with active disease (P < 0.001 and P = 0.004, respectively). Intestinal wall thickness showed no significant correlation with disease status (7.5 +/- 1.3 mm in active disease versus 6.8 +/- 1.3 mm in quiescent disease; P = 0.11). Vascular signals in the affected loops were revealed in 11/22 patients (50%) with active disease and in 5/26 (20%) with quiescent disease (P = 0.052). After Levovist injection, colour signals were found in 22/22 with active and in 8/26 with quiescent CD (P < 0.001). SMA RI was significantly lower in active CD patients (0.81 +/- 0.01 versus 0.83 +/- 0.02; P = 0.001). CONCLUSIONS: Our data suggest that in patients with CD a finding of a SMA RI < or = 0.81, or the presence of a colour signal in the wall of the affected loops, at power Doppler sonography, is indicative of active disease. Utilization of echo-enhancer media can greatly improve the diagnostic sensitivity of intestinal wall power Doppler scan. A finding of intestinal wall thickening is not associated with active disease in our series.     

Limitations of the zero crossing detector in the analysis of intracoronary doppler: A comparison with fast fourier transform analysis of basal,hyperemic, and transstenotic blood flow velocity measurements in patients with coronary artery disease

The current clinical standard for the analysis of intracoronary Doppler signals is the application of a zero-crossing (ZC) detector. However, the accuracy of the method is questionable, especially in areas of disturbed flow, as confirmed by in vitro studies, animal experiments, and intraoperative observations. The aim of this study is the comparison of a conventional ZC detector and a custom-designed spectral analyzer (fast Fourier transform, FFT) in the analysis of intracoronary Doppler signals obtained in 19 patients undergoing coronary angioplasty. A 3F catheter with an end-mounted Doppler ceramic crystal was placed over an 0.014″ guidewire in a normal or near-normal segment proximal to the lesion to be dilated. The Doppler signal was recorded before and after intracoronary infusion of 12.5 mg of papaverine. In 9 patients high flow velocities could be recorded when the catheter was advanced across the stenosis. The blood flow velocity measurements obtained with ZC were significantly lower than the maximal FFT flow velocity measurements (16±12 cm/s vs. 29±18 cm/s, p < .001). In all the conditions of Doppler signal acquisition (baseline, hyperemia, stenosis) a large scattering of the signed differences between corresponding measurements was observed. The standard deviation of the difference ZC-FFT was ±11 cm/s and ±5 cm/s for the maximal and mean FFT flow velocity, corresponding in both cases to ±37% of the mean of the ZC and FFT measurements. Large differences were also observed in the values of coronary flow reserve (CFR) calculated as the ratio between ZC and FFT flow velocity measurements 30 s after papaverine intracoronary and at baseline. The standard deviation of the difference ZC-FFT based CFR was ±1.3 and ±1.2 for the values derived from the maximal and mean FFT flow velocities (percent difference ±32% and ±37%, respectively). In conclusion, the measurements obtained from the same intracoronary Doppler signal analyzed with a ZC detector and an FFT technique showed large differences in various conditions of flow and also in the assessment of relative flow velocity derived indices such as CFR. Spectral analysis should replace the current use of a ZC detector for the evaluation of coronary Doppler signals, even for the assessment of relative flow velocity changes. © 1993 Wiley-Liss, Inc.     

Vascular endothelial growth factor and colour Doppler ultrasonography in knee osteoarthritis: Relation to pain and physical function

Aim of the workTo investigate the vascular endothelial growth factor (VEGF) levels in serum and synovial fluid of patients with knee osteoarthritis (KOA) and to determine the relationship of VEGF levels with clinical manifestation, physical function, radiographic grading and ultrasonography (US) findings.Patients and methods45 patients with KOA and 15 matched control subjects were enrolled. Western Ontario McMaster Osteoarthritis index (WOMAC) was scored, knee X-rays assessed using Kellgren and Lawrence (KL) scale and superficial gray scale and colour Doppler US were done. Serum and synovial VEGF levels were analyzed.ResultsThe 45 patients mean age was 56.5 ± 11.2 years; 39 females and 6 males (F:M 6.5:1). 30 (66.7%) patients had bilateral symptomatic KOA. Knee effusion was mild in 4, moderate in 26 and severe in 21. The mean WOMAC score was 70.9 ± 10.7; pain (14.7 ± 3.4); stiffness (6.2 ± 1.4) and disability (49.2 ± 12.4). The serum VEGF level was 0.29 ± 1.02 pg/ml and the synovial 0.48 ± 0.1 pg/ml both significantly increased compared to the control (0.14 ± 0.7 pg/ml and 0.33 ± 0.1 respectively, p < 0.0001). Levels in grade 3 KL were significantly increased compared to those with grades 1 or 2 (p < 0.0001) and between colour Doppler US grades 1 and 2 (p < 0.0001). A strong correlation was present between serum and synovial VEGF with X-ray and colour Doppler US grading as well as the WOMAC index (p < 0.0001).ConclusionSerum and synovial VEGF correlated with clinical, functional, radiographic and US severity in KOA patients. Both VEGF and musculoskeletal ultrasound may serve as promising potential tools for evaluating disease severity in KOA.     

Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography

OBJECTIVE: To determine the usefulness of computed tomography (CT), magnetic resonance imaging (MRI), and Doppler ultrasonography (US) in providing specific images of gouty tophi. METHODS: Four male patients with chronic gout with tophi affecting the knee joints (three cases) or the olecranon processes of the elbows (one case) were assessed. Crystallographic analyses of the synovial fluid or tissue aspirates of the areas of interest were made with polarising light microscopy, alizarin red staining, and x ray diffraction. CT was performed with a GE scanner, MR imaging was obtained with a 1.5 T Magneton (Siemens), and ultrasonography with colour Doppler was carried out by standard technique. RESULTS: Crystallographic analyses showed monosodium urate (MSU) crystals in the specimens of the four patients; hydroxyapatite and calcium pyrophosphate dihydrate (CPPD) crystals were not found. A diffuse soft tissue thickening was seen on plain radiographs but no calcifications or ossifications of the tophi. CT disclosed lesions containing round and oval opacities, with a mean density of about 160 Hounsfield units (HU). With MRI, lesions were of low to intermediate signal intensity on T(1) and T(2) weighting. After contrast injection in two cases, enhancement of the tophus was seen in one. Colour Doppler US showed the tophi to be hypoechogenic with peripheral increase of the blood flow in three cases. CONCLUSION: The MR and colour Doppler US images showed the tophi as masses surrounded by a hypervascular area, which cannot be considered as specific for gout. But on CT images, masses of about 160 HU density were clearly seen, which correspond to MSU crystal deposits.     

Gall-bladder wall thickening in patients with liver cirrhosis

Gall-bladder wall thickening is commonly seen in patients with cirrhosis, but its exact causes have not been well established. We evaluated clinical, biochemical and haemodynamic data of patients with cirrhosis with respect to the presence of thickening of the gall-bladder wall. After excluding patients who presented with gallstones, acute or chronic cholecystitis, heart failure, a serum creatinine level greater than 2 mg/dL and/or a serum alanine aminotransferase level greater than 400 U/L, 77 patients with cirrhosis (75 male, two female; mean age 58±8 years) were enrolled in the study. Clinical, biochemical, ultrasound and haemodynamic data were obtained in every patient. Fortyone (53%) of 77 patients with cirrhosis had gall-bladder wall thickening (>4mm). Compared with patients with a normal gall-bladder wall, patients with gall-bladder wall thickening had significantly lower serum albumin levels (3.6±0.6 vs 2.9±0.7 gm/dL, respectively; P< 0.05), a longer prothrombin time (13±6 vs 16±6s, respectively; P<0.05), more patients with Child-Pugh class C (6 vs 37%, respectively; P<0.05) and more patients with ascites (8 vs 50%, respectively; P<0.05). In addition, compared with patients with a normal gall-bladder wall, those patients with gall-bladder wall thickening had a higher hepatic venous pressure gradient (13.9±4.5 vs 17.1±4.1 mmHg, respectively; P<0.01) and a lower systemic vascular resistance (SVR; 1144±332 vs 1010±318 dyn.s/cm⁵, respectively; P< 0.05). Using a multivariate analysis, the presence of ascites and SVR lower than 900 dyn.s/cm⁵, were independently correlated with the presence of gall-bladder wall thickening, while a hepatic vein pressure gradient greater than 10 mmHg had only a marginally significant association. The presence of ascites, decreased SVR and portal hypertension are related to the occurrence of gall-bladder wall thickening in patients with cirrhosis, indicating that the development of gall-bladder wall thickening may be multifactorial.     

Effects of treatment with etanercept (Enbrel,TNRF:Fc) on rheumatoid arthritis evaluated by Doppler ultrasonography

OBJECTIVE: to estimate and visualise the efficacy of treatment with etanercept (Enbrel) in patients with rheumatoid arthritis (RA) using colour Doppler and spectral Doppler ultrasonography to determine the possible changes in synovial perfusion during a one year observation period. METHODS: Eleven patients from the European multicentre trial of the efficacy and safety of etanercept were included in this study when transferred into the open label, long term safety, and efficacy study. Before a scheduled dosage increase to 50 mg/week they were examined clinically, serologically, and by ultrasonography using the colour Doppler pixels and the spectral Doppler resistance index (RI) as indicators of inflammation. The patients were re-examined at two weeks and at one year follow up RESULTS: The clinical activity decreased significantly from baseline to week 2, but no significant changes were seen from baseline to one year. The number of coloured pixels in each region of interest decreased from baseline to week 2 with a median reduction of 60% (p=0.005). This effect on the perfusion in the synovium could not be found after one year of treatment. During the initial treatment we detected an increase in synovial RI by spectral Doppler. The median increase in peripheral resistance from baseline to week 2 as estimated by the mean RI was 22.6% (p=0.005). The increase in peripheral resistance was maintained to some extent after one year (mean RI increased by 18.8% p=0.074). CONCLUSION: Ultrasonography seems to be a promising tool for the detection of treatment response using spectral Doppler and pixel estimation.     

Improved Doppler signal intensity in coronary arteries after intravenous peripheral injection of a lung-crossing contrast agent (SHU 508A)

Objectives. We tested the hypothesis that SHU 508A, a new lung-crossing contrast agent capable of increasing the Doppler signal to noise ratio in the right heart as well as left heart cavities after intravenous injection, could increase Doppler signal intensity in coronary arteries, thus improving the feasibility and quality of transesophageal Doppler echocardiographic evaluation of coronary blood flow velocity.Background. Coronary blood flow velocity can be evaluated by transesophageal Doppler echocardiography. However, an adequate Doppler tracing is obtainable in a relatively low percent of patients.Methods. Transesophageal Doppler echocardiography of coronary arteries was performed in 35 patients before and after SHU 508A injection at four different dosages (200 mg/ml in 5 ml, 200 mg/ml in 10 ml, 300 mg/ml in 5 ml and 300 mg/ml in 10 ml). Color Doppler mapping of coronary flow and pulsed wave Doppler measurement of coronary blood flow velocity were attempted in all patients.Results. Color Doppler flow mapping of 105 evaluated coronary segments (left main, left anterior descending and circumflex in 35 patients) was not detectable or was weak in 88% of patients before and 33% of patients after echo contrast injection (p < 0.0001); it was optimal (that is, well with complete flow mapping of the explored vessel) in only 11% of patients before and 67% after echo contrast injection (p < 0.0001). In addition, pulsed wave Doppler signal quality improved after echo contrast injection: Pulsed wave Doppler recording of coronary blood flow velocity was not obtainable or was weak in 78% of cases before and 34% after echo contrast injection (p < 0.0001); pulsed wave Doppler recording of coronary blood flow velocity was optimal (that is, there was a complete and well defined outline of diastolic coronary blood flow velocity in 23% of cases before and 66% after echo contrast injection [p < 0.0001]. Both length and width of color Doppler mapping in the left anterior descending coronary artery increased after SHU 508A injection (from 5.75 ± 532 and 1.51 ± 1.17 to 17.04 ± 8.76 and 4.21 ± 1.78 mm, respectively, mean ± SD, p < 0.0001).Conclusions. The feasibility and quality of recording coronary blood flow velocity by transesophageal Doppler echocardiograply are considerably improved by intravenous injection of SHU 508A. The improved feasibility of this new semi-invasive method for evaluating coronary blood flow velocity and flow reserve can considerably increase its research and clinical utilization.     

Gallbladder polyps: epidemiology, natural history and management.

Polypoid lesions of the gallbladder affect approximately 5% of the adult population. Most affected individuals are asymptomatic, and their gallbladder polyps are detected during abdominal ultrasonography performed for unrelated conditions. Although the majority of gallbladder polyps are benign, most commonly cholesterol polyps, malignant transformation is a concern. The differentiation of benign from malignant lesions can be challenging. Several features, including patient age, polyp size and number, and rapid growth of polyps, are important discriminating features between benign and malignant polyps. Based on the evidence highlighted in this review, the authors recommend resection in symptomatic patients, as well as in asymptomatic individuals over 50 years of age, or those whose polyps are solitary, greater than 10 mm in diameter, or associated with gallstones or polyp growth on serial ultrasonography. Novel imaging techniques, including endoscopic ultrasonography and enhanced computed tomography, may aid in the differential diagnosis of these lesions and permit expectant management.     

Comparison of transesophageal coronary sinus and left anterior descending coronary artery doppler measurements for the assessment of coronary row reserve

Background: Currently used methods for assessment of coronary flow reserve are invasive and require extensive laboratory equipment. Recently, noninvasive assessment of coronary flow reserve by transesophageal Doppler evaluation of coronary sinus (CS) or left anterior descending coronary artery (LAD) flow has been proposed. Direct comparison between these two techniques is lacking. Methods: Doppler recordings of CS and LAD flow velocity were obtained before and after 0.6 mg/kg/5 min dipyridamole in 16 patients with significant stenosis of the LAD (Group A) and in 14 control patients (Group B). Flow recordings and all measurements were performed in a blinded manner. For assessment of coronary flow reserve, Doppler measurements after dipyridamole were divided by the respective baseline values. Results: Doppler studies of the CS and LAD were feasible in 30 of 30 (100%) and 23 of 30 (71%) patients, respectively. Analyzing the maximum flow velocities, coronary flow reserve in Groups A and B was 1.18 ± 0.28 and 1.68 ± 0.53 with CS recordings and 1.78 ± 0.83 and 2.51 ± 0.76 with LAD recordings, respectively. Analyzing the velocity time integrals, coronary flow reserve in Groups A and B was 1.53 ± 0.68 and 2.59 ± 0.74 with CS recordings and 1.77 ± 0.38 and 2.68 ± 0.93 with LAD recordings, respectively. Correlation between LAD and CS recordings was 0.69 (p<0.001), when coronary flow reserve was calculated from the velocity time integral and 0.68 (p<0.001) when the maximum flow velocities were used. Conclusion: Both transesophageal Doppler techniques might be useful for noninvasive assessment of coronary flow reserve.     

Ultrasound characterization and quantification of carotid atherosclerosis lesions.

The development of ultrasonography in vascular applications has entailed research of ultrasound parameters leading to precise the diagnosis and quantification of carotid lesions in routine. The use of recent colour Doppler imaging techniques (velocity or power encoding) is recommended as they allow a better definition of the lesions and recesses. At present, features of plaque that could be related to increased incidence of stroke are: echogenicity, with a more frequent observation of anechoic or hypoechoic lesions in the case of clinical signs; texture, with frequent haemorrhage; surface contour, with a high rate of ulcerations which were accompanied by stroke; plaque motion, with a significant alteration in plaque motility in symptomatic patients; progression or regression in size, with a faster progression of anechoic and hypoechoic plaques; an increase in plaque volume is associated with a greater risk of stroke; a significant relationship between the presence of "ulcers" and embolic activity. The quantification of stenosis degree could be made using velocity criteria and/or morphological criteria. Velocity criteria could be obtained at the site of the stenosis (direct criteria) or downstream the carotid stenosis using Duplex systems. Morphological criteria could be obtained using B-mode imaging or colour Doppler but this quantification remains difficult in case of diffuse carotid stenoses or very severe stenoses.     

Kidney resistive index relates to variations of home blood pressure in chronic kidney diseases

Background: Kidney resistive index (RI) correlates with tubulointerstitial changes and predicts renal prognosis. Most patients with chronic kidney diseases (CKDs) manifest high blood pressure and atherosclerotic cardiovascular diseases. In addition, various atherosclerotic indexes relate to variations in blood pressure.Methods: Subjects were 70 CKD patients, who visited our office and agreed to measure home blood pressure and receive renal ultrasonography. Cross-sectional analyses were performed.Results: Patient age was averaged 61 ± 15 (SD) y/o and 60% were male. Mean serum creatinine and proteinuria were 1.2 ± 0.5 mg/dl and 0.2 ± 0.5 g/gCr, respectively. Office blood pressure and kidney RI were 128 ± 17/75 ± 11 mmHg and 0.66 ± 0.08, respectively. Multivariate regression analysis revealed that age and office blood pressure independently correlated to kidney RI (p < 0.05 for each). Home blood pressure was averaged 122 ± 7/70 ± 6 mmHg. Both standard deviation and the maximal–minimal difference in home systolic blood pressure related to kidney RI (p < 0.05).Conclusions: The present results indicate that office blood pressure correlates to kidney RI, which predicts renal prognosis. In addition, our data implicate that kidney RI relates to variations in home systolic blood pressure, and suggest that kidney RI may be a good index for atherosclerosis in CKD patients.     

高频超声对甲状腺肿块良恶性的临床诊断价值

目的 分析甲状腺肿块的二维声像图特点及多普勒检查中的血流峰值变化,探讨高频超声对甲状腺肿块的良恶性诊断价值.方法 收集80例病人的104个甲状腺肿块声像图,根据二维声像图中肿块的形态、边界、侧壁回声失落或后方回声衰减、内部回声、微小钙化及多普勒检查中的收缩期血流峰值(Vmax)和阻力指数(RI),将肿块预期分为良性和恶性两组,将高频超声预期结果与术后病理结果进行对比,比较二者的符合率和误差率.结果 高频超声预测良性肿块66个,病理检查为61个,二者的符合率为92.4%;预测恶性肿块为38个,病理检查为32个,二者的符合率为84.2%;预测总符合率为89.4%(93/104),误差率为11.6%(11/104).结论 根据高频超声检测甲状腺肿块的声像图特点,能对甲状腺肿块的良恶性进行初步判断,对患者及临床治疗有重要的意义.

Abstract：

Objective To detect and analyze thyroid tumor by two-dimensional sonogram and Doppler parameter, and evaluate the value of high-frequency ultrasound in diagnosing thyroid benign and malignant tumors. Methods The ultrasonic images of 104 thyroid tumor from 80 patients with typical features were collected. Thyroid tumor was classified into benign and malignant nodules, based on the shape, border, or the rear wall echo, echo attenuation loss, internal echo, and microcalcifications in two-dimensional sonogram and systolic blood peak velocity (Vmax) and resistant index (RI) in Doppler examination. The expected results of high frequency ultrasound were compared with pathological results on consistency and error rate. Results Prediction of benign tumor by high frequency ultrasound was 66, and pathology 61, consistency rate of the two was 92.4%. Prediction of malignant lesions was 38, and pathological examination 32, consistency rate of the two was 84.2%. The total coincidence rate was 89.4%(93/104) and the error rate was 11.6%( 11/104). Conclusions The typical features of thyroid tumor on high-frequency ultrasound are helpful in diagnosis of benign or malignant nodules, which is valuable in guiding clinical treatment.     

Estimation of mitral valve area in patients with mitral stenosis by the flow convergence region method: Selection of aliasing velocity

Objectives. We attempted to determine the most suitable aliasing velocity for applying the hemispheric flow convergence equation to calculate the mitral valve area in mitral stenosis using a continuity equation.Background. The flow convergence region method has been used for calculating mitral valve area in patients with mitral stenosis. However, the effect of varying aliasing velocity on the accuracy of this method has not been investigated fully.Methods. We studied 42 patients with mitral stenosis using imaging and Doppler echocardiography. Aliasing velocities of 17, 21, 28, 34, 40 and 45 cm/s were used. The transmitral maximal flow rate (Q [ml/s]) was calculated using the hemispheric flow convergence equation Q = 2 × π × R²× AV × α/180, where R (cm) is the maximal radius of the flow convergence region, AV is the aliasing velocity, and α/180 is a factor accounting for the inflow angle (α). Mitral valve area (A [cm²]) was calculated according to the continuity equation A = Q/V, where V (cm/s) is the peak transmitral velocity by the continuous wave Doppler method.Results. Mitral valve area was progressively underestimated with increasing aliasing velocity. The actual and percent differences noted between the mitral valve area by the flow convergence region method and that by two-dimensional echocardiographic planimetry were −0.06 ± 0.23 cm²(mean ± SD) and 0.09 ± 15.7% at an aliasing velocity of 21 cm/s, increasing gradually with increasing aliasing velocity, and were −1.24 ± 0.9 cm²and −72.56 ± 16.4% at an aliasing velocity of 45 cm/s. Mitral valve areas estimated by the flow convergence region method at an aliasing velocity of 21 cm/s in 11 patients with associated > 2+ mitral regurgitation (2.12 ± 1.17 cm²) and 8 with associated > 2+ aortic regurgitation (1.28 ± 0.71 cm²) were not significantly different using planimetry (2.24 ± 1.39 cm², p > 0.05 and 1.27 ± 0.74 cm², p > 0.05, respectively) but were significantly different by the pressure half-time method (1.59 ± 1.12 cm², p < 0.001 and 1.63 ± 0.93 cm², p < 0.01, respectively).Conclusions. This study indicated the most appropriate aliasing velocity for the accurate estimation of mitral valve area in patients with mitral stenosis.     

Doppler evaluation of patients with constrictive pericarditis: Use of tricuspid regurgitation velocity curves to determine enhanced ventricular interaction

Objectives. This study sought to examine the value of analyzing Doppler echocardiographically derived tricuspid regurgitation signals during respiration in relation to the diagnosis of constrictive pericarditis.Background. A physiologic hallmark of constrictive pericarditis is enhanced ventricular interdependence, which produces reciprocal changes in right and left ventricular filling and ejection dynamics during the respiratory cycle. It was hypothesized that these changes could be detected noninvasively by analyzing Doppler echocardiographically derived tricuspid regurgitation signals and that this information could assist in noninvasively diagnosing constrictive pericarditis.Methods. Simultaneous Doppler echocardiography and catheterization studies of the right and left sides of the heart with high fidelity pressure manometers were performed in 5 patients with surgically confirmed constrictive pericarditis and 12 patients (control subjects) with heart failure due to other causes.Results. Changes observed in tricuspid regurgitation Doppler echocardiographic variables from onset to peak inspiration in patients with constrictive pericarditis were significantly different from those in control subjects. Mean (±SD) percent change in maximal tricuspid regurgitation velocity was 13% ± 6% and −8% ± 7% in the constrictive pericarditis and control groups, respectively (p < 0.0001); mean percent change in tricupsid regurgitation signal duration was 18% ± 2% and −2% ± 7%, respectively (p < 0.0001); mean percent change in tricuspid regurgitation time velocity integral was 27% ± 15% and −10% ± 12%, respectively (p < 0.0001).Conclusions. Respiratory changes in Doppler echocardiographically derived tricuspid regurgitation peak velocity and velocity duration are increased in patients with constrictive pericarditis and may be helpful in diagnosing this condition noninvasively.     

Laparoscopic segmental colectomy for colonic lymphangiomas: A definitive,minimally invasive surgical option

Colonic lymphangioma is an unusual benign malformation. We herein describe two cases. A 36-year-old woman was admitted with one year of intermittent abdominal pain; colonoscopy, abdominopelvic computed tomography and endoscopic ultrasonography (EUS) revealed enlarged cystic masses at the ascending colon. In another 40-year-old man, colonoscopy and EUS revealed an asymptomatic lobulated cystic mass with four small sessile polyps at the sigmoid colon. Both patients underwent laparoscopic segmental colectomy. Both masses were histologically confirmed as cystic lymphangiomas, and the patients were discharged without complications. The management of colonic lymphangioma depends on the individual situation; close surveillance or endoscopic therapy may be appropriate for asymptomatic lesions smaller than 2.5 cm in diameter. Surgical intervention can be considered for larger lesions or in patients who develop complication risks. Laparoscopic segmental colon resection may be recommended to excise relatively large submucosal lesions because it is a definitive, minimally invasive intervention with a fast postoperative recovery.     

Chrome congestive heart failure: Abnormalities of left ventricular filling in patients with coronary artery disease: assessment by colour M-mode Doppler technique

In 54 healthy individuals and 107 patients with coronary arterydisease, intraventricular early filling velocities were recordedby colour M-mode Doppler. The time difference between the occurrenceof peak velocity in the apical region and at the mitral tipwas calculated, and normalized by dividing it by the mitralto apical distance. Transmitral velocities were determined bythe single pulsed Doppler technique. The patients were dividedinto groups according to systolic function as assessed by leftventriculography. The normalized time difference was similar in the referencegroup (12±8 ms. cm^–1) and the patient group withno electrocardiographical signs of previous infarction and normalventriculography (16±16 ms. cm^–1) It increasedsignificantly in the group with infarction and/or regional systolicdysfunction (43±21 ms. cm^–1), and a further increasewas present in the group with severely impaired ventricles (53±14ms. cm^–1). The ratio between peak early and late traiismitralvelocity fell significantly in the group with infarction and/orregional systolic dysfunction, but was normalized in the groupwith severely impaired ventricles. Colour M-mode Doppler shows that apical filling is delayed inpatients with injured left ventricles due to coronary arterydisease. This delay increases with progression of ventricularinjury. The technique may be an important addition to transmitralpulsed Doppler in assessing left ventricular filling.