Quantified color Doppler sonography of tumor vascularity in an animal model.

This study was designed to evaluate the accuracy of a system to quantitate tumor vascularity with amplitude (power) color Doppler sonography two- and three-dimensionally. The vascularity of 20 transplanted murine tumors was determined with quantitated amplitude color Doppler sonography both two- and three-dimensionally and compared to tumor vascularity estimated by histologic examination. Serial examinations were performed 15, 30, 45, and 60 min after the injection of the exotoxin CM-101 and saline solution to assess changes in tumor vascularity. Three-dimensional amplitude color Doppler sonography best depicted the overall vascularity of tumor when compared to histologic estimation of vessel density. However, neither two- nor three-dimensional amplitude color power angiography correlated well to the microvessel count, probably a reflection of the difference in the method for vessel quantification using sonographic versus histologic techniques. Three-dimensional amplitude Doppler sonography correlated better with counts of large vessels (> 100 microm) as opposed to small vessels (> 15 microm). Time-activity curves showed no difference in tumor flow at the times measured in the experimental group injected with CM-101 or when compared to saline solutions in either the peripheral or central portions of the tumor. This three-dimensional amplitude color Doppler sonographic system affords global quantification of tumor vascularity and flow that may, in turn, be useful in determining the probability of malignancy (by determination of branching patterns and vessel regularity) or tumor response or both to treatment.     

Assessment of ovarian tumor vascularity with transvaginal color Doppler sonography

This report describes the results of transvaginal color Doppler sonography (TV-CDS) of 43 surgically proved ovarian masses. Waveform analyses of the signals arising from specific vessels (i.e., peripheral, central, septal) adjacent to and within these masses were correlated to those seen on macroscopic pathologic evaluation. The mean and standard deviation of the pulsatility indices (PI) of 32 benign lesions (1.8 +/- 0.8) were higher than 11 malignant ones (0.8 +/- 0.6) (P = 0.03). However, the range of benign (4.0 to 0.7) and malignant (1.5 to 0.4) lesions did overlap. Low PIs (less than 1.0) were found in five relatively benign lesions (one case each of dermoid cyst, cystadenoma containing a dermoid cyst, endometrioma, benign sclerosing stromal tumor, and thecoma), but also in all 11 malignant or borderline malignant lesions (nine cystadenocarcinomas, two germ cell tumors), causing an overlap between the PIs of some benign and malignant masses. With a 100% negative predictive value, our preliminary data suggest that TV-CDS can effectively exclude malignancy. However, with a positive predictive value of 73%, one in four malignant lesions diagnosed by TV-CDS will be benign.     

Transvaginal color flow Doppler sonography in the assessment of gestational trophoblastic disease

The aim of this study was to evaluate the blood flow characteristics of the uterine artery and intratumoral vessels in patients with GTD. Twelve patients with GTD were evaluated with TVS, and 11 also had CFD sonography performed. Spectral analysis of both uterine artery and samples intratumoral and intramyometrial vessels revealed systolic frequencies and PI that were significantly higher in the uterine artery than in sampled intratumoral vessels (P < 0.05). Uterine artery PI correlated significantly with age (P = 0.043), uterine size (P = 0.003), and beta-HCG titer (P = 0.03). Intratumoral PI correlated significantly with uterine size (P = 0.05). Intratumoral PI did not correlate with patient age, the shape or orientation of the uterus, presence or absence of subendometrial halo, endometrial thickness or echogenicity, or impression of myometrial invasion. Regression analysis of beta-HCG titers on uterine artery and intratumoral PI revealed a linear association. TVS and color flow Doppler sonography are useful in the assessment of patients with GTD. The PI is strongly associated with prognosis and correlates with beta-HCG titers.     

Three-dimensional power Doppler sonography of tumor vascularity.

The purpose of this study was to assess the value of routine clinical examination using three-dimensional power Doppler sonography of intratumoral blood flow. Twenty-two hepatocellular carcinomas, seven cases of hepatic metastasis, four hepatic hemangiomas, six renal cell carcinomas, two cases of hepatic focal nodular hyperplasia, and one case of splenic metastasis were included in the study. Three-dimensional images were reconstructed by maximum intensity projection method using cine-loop data on a built-in computer in a LOGIQ 500 and a LOGIQ 700 from GE Yokogawa Medical Systems. The three-dimensional images obtained were viewed multidirectionally on a monitor screen. Three-dimensional representations of intratumoral blood flow became available for all tumors approximately 5 s to 30 s after scanning. In every case, the entire vasculature of the tumor was appreciated more easily from three-dimensional images than from cross-sectional two-dimensional images. These three-dimensional images of intratumoral blood flows corresponded to the tumor vessels that could be visualized by angiography at the early arterial phase. Differential diagnosis of hepatic tumors based on distinct difference in their intratumoral vascular structures was performed. Our results suggest that three-dimensional power Doppler sonography can be used for routine clinical examination of tumor vascularity and may provide improved diagnostic information.     

乳腺癌彩色多普勒血流显像的多因素分析

目的 探讨乳腺癌彩色多普勒血流显像的相关因素。方法 前瞻性研究121例乳腺癌病变的彩色多普勒血流显像，选择患者的年龄、乳腺癌的大小、组织学分类、导管内癌和浸润性导管癌组织学分级及雌激素受体（ER）、孕酮受体（PR）、c—erbB2、P53表达状态，采用Logistic回归模型进行多因素分析。结果 121个乳腺癌中，血流丰富者68个（占56．2％），中等血流者48个（占39．7％），无血流者5个（占4．1％）。Logistic回归模型多因素分析显示：对血流程度有影响的因子，其作用从大到小依次为：肿块大小（OR=5．931）、肿块分化程度（低分化OR=4．318，中分化OR=1．681）、患者年龄（OR=0．949）。肿块病理类型、ER、PR、c-erbB2、P53对血流程度无影响。结论 乳腺癌血流显像的相关因京主要有肿块大小、肿块分化程度和患者年龄。肿块越大，血流越丰富；肿块分化越差，血流越丰富；随患者年龄增加，血流减少。但是，年龄对血流的影响较前二者弱。     

经阴道彩色多普勒对盆腔静脉血流的研究进展

盆腔静脉是一组以静脉丛为特征的静脉血管,没有瓣膜,结构较为薄弱,易受多种因素的影响而发生变化.但是到目前为止,关于盆腔静脉的研究较少,而且内容较为局限,还没有盆腔静脉相关参数正常值的报道.为此我们展开对盆腔静脉的研究,建立盆腔静脉相关参数的正常值,为临床上一些盆腔疾病的诊断提供帮助.     

Transvaginal pulsed and color Doppler sonography for the evaluation of adenomyosis.

In an earlier paper, we reported our scoring system for the diagnosis of adenomyosis by gray scale transvaginal sonography. In this study we evaluated 44 benign uterine masses (adenomyosis and myomas) and seven uterine malignancies. We used transvaginal color and pulsed Doppler imaging to determine whether this technique is useful to differentiate adenomyosis from uterine malignancies. The peak systolic velocity and the resistive index of intratumoral vessels were studied. The differences in these parameters for adenomyosis and uterine malignancies were statistically significant. Our results suggest that this technique is useful to differentiate adenomyosis from uterine malignancies.     

Transvaginal color Doppler sonography of ovarian masses with pathological correlation.

This report describes the correlation of pathological findings with transvaginal color Doppler sonography performed preoperatively on 26 ovarian masses. The pulsatility indices of benign lesions (1.9 +/- 0.7) were higher than those of malignant ones (0.7 +/- 0.2) (p = 0.03). Low pulsatility indices (< 1.0) were found in three relatively vascular benign lesions (one immature teratoma, one cystadenoma containing a dermoid cyst, one endometrioma), causing an overlap between the pulsatility indices of some benign and malignant masses. There appears to be significant potential for discrimination between benign and malignant ovarian masses with transvaginal color Doppler sonography.     

Transvaginal color Doppler sonography versus sonohysterography in the diagnosis of endometrial polyps.

OBJECTIVE: To compare the diagnostic performance of transvaginal color Doppler sonography (TVCD) and sonohysterography (SHG) in the diagnosis of endometrial polyps. METHODS: Fifty-one women (mean age, 51 years; range, 27-75 years) with clinical or B-mode sonographic suspicion of endometrial polyps were included in this prospective study. Transvaginal color Doppler sonography first and then SHG were performed in all patients. On TVCD, a polyp was suspected when a vascular pedicle penetrating the endometrium from the myometrium was identified. On SHG, a polyp was suspected when a focal polypoid lesion was seen within the endometrial cavity. All patients underwent hysteroscopy and endometrial biopsy, the findings of which were used as the criterion standard. Sensitivity and specificity for TVCD and SHG were calculated and compared by the McNemar test. RESULTS: Hysteroscopy and endometrial biopsy findings were as follows: endometrial polyps, 41; endometrial hyperplasia, 3; cystic atrophy, 4; proliferative endometrium, 2; and endometritis, 1. Sensitivity and specificity for TVCD and SHG were 95% and 80% and 100% and 80%, respectively (McNemar test, P = .5) CONCLUSIONS: Transvaginal color Doppler sonography and SHG had similar performance for diagnosing endometrial polyps.     

经阴道彩色多普勒诊断盆腔静脉曲张症

目的使用彩色多普勒超声经阴道探测、评价其在盆腔静脉曲张症中的诊断价值。方法通过二维图像及彩色多普勒显像,重点观察子宫两侧附件区域的类椭圆形网络状低回声区或无回声区,进行测量、分析。结果盆腔静脉曲张症患者曲张静脉内径最窄达4 mm,最宽达12 mm,彩色多普勒血流显像（CDFI）可显示该区域不同方向的多色彩相间、流速减低的彩色血流信号。结论经阴道超声诊断盆腔静脉曲张症具有安全、无痛、经济、准确、可靠等优点和较高的灵敏度及特异度,是诊断盆腔静脉曲张症的首选方法。     

输卵管炎性疾病超声诊断方法学研究

目的探讨输卵管炎性疾病的超声诊断方法。方法回顾性分析本院228例输卵管炎性疾病的超声诊断结果,总结输卵管结构超声显示的方法以及不同阶段输卵管炎性疾病的声像图特征,并对经腹部超声(TAS)与经阴道超声(TVS)检查结果进行对比研究。结果急性单纯性输卵管炎、急性输卵管炎伴输卵管积脓、输卵管积液分别为42例、45例、131例,TVS诊断符合率分别为100%、93.8%、98.4%,TAS诊断符合率分别为23.1%、73.4%、93.1%,诊断符合率差异均有统计学意义(P<0.05)。结论 TVS能清晰显示急性输卵管炎输卵管壁水肿、增厚、管腔轻微扩张等细微变化及丰富血供。TVS、TAS均能良好显示输卵管积液、输卵管积脓内部特征性结构,具有重要临床应用价值,但TVS优于TAS。     

Quantification of tumor vascularity and flow with amplitude color Doppler sonography in an experimental model: preliminary results.

This study was designed to evaluate a system to quantitate vascularity and tumor blood flow with amplitude (power) color Doppler sonography. The vascularity of nine transplanted murine tumors was determined with quantitated amplitude color Doppler sonography and compared to tumor vascularity estimated by histologic examination. The system used seemed to provide an accurate depiction of the vascularity of tumor vis-à-vis histologic estimation of vessel density (r = 0.80). Time-activity curves showed greater flow in the experimental group injected with an exotoxin than in the group injected with saline solution. Vascular density quantification with amplitude color Doppler sonography also was more accurate when an intravascular agent (such as an exotoxin) was used than when saline infusions were given. This quantification scheme may allow the development of a system to assess the probability of malignancy and to monitor tumor response to treatment on the basis of the vascularity of the mass.     

Mild fetal renal pelviectasis. Differentiation from hilar vascularity using color Doppler sonography

Ultrasound often detects a sonolucent region in the hilum of the fetal kidney. Although this sonolucency is usually assumed to represent mild dilatation of the fetal renal collecting system, in pediatric and adult kidneys blood vessel lumina can simulate pelviectasis. We used color Doppler ultrasound to differentiate the fetal renal collecting system from hilar blood vessels and to evaluate how often blood vessels account for the sonolucent region often demonstrated in the renal hilum during antenatal sonography. Twenty-nine kidneys in fetuses with sonolucent hilar regions greater than 2 mm in anteroposterior (AP) dimension were studied with color Doppler ultrasound. Doppler signal was demonstrated in blood vessels adjacent to, but not within, the sonolucent area in the hilum of all 29 kidneys. Based on the absence of color signal in the sonolucent hilar regions studied, with color signal seen in adjacent blood vessels, these regions were felt to represent mildly dilated collecting systems rather than renal vasculature. We conclude that color Doppler ultrasound can differentiate mild pelviectasis from hilar blood vessels in the fetal kidney. Sonolucent areas measuring 2 mm or greater in AP dimension are unlikely to be attributable to renal vasculature.     

经阴道彩色多普勒超声诊断围绝经期妇女子宫内膜病变的价值

目的探讨阴道彩色多普勒超声对围绝经期妇女子宫内膜病变的预测价值.方法对164例绝经前不规则阴道出血的患者行阴道彩色多普勒超声检查,重点观察内膜厚度及内膜血流,与当日或次日诊刮的内膜组织病理诊断对照.结果子宫内膜厚度在生理改变,良性病变,癌及癌前病变三组比较,具有极显著性差异(P＜0.01).以内膜厚度12 mm为预测绝经前妇女子宫内膜病变的临界值,其敏感性、特异性、阳性预测值、阴性预测值分别为96.2%、65.5%、83.6%、86.4%.生理改变组58例(58/164)内膜区未检测到血流信号,良性病变组2例(2/98),癌前病变组中有癌3例(3/8).结论阴道彩超可把内膜厚度12 mm做为围绝经期子宫内膜病变的临界值,但内膜形态、内部回声、边缘及内膜内血流对预测病变亦有诊断意义.     

Transvaginal color Doppler assessment of venous flow in adnexal masses.

OBJECTIVE: To analyze the usefulness of transvaginal color Doppler assessment of venous flow in the differential diagnosis of adnexal masses. MATERIAL AND METHODS: Ninety-one consecutive patients (mean age: 46.6 years, range: 16-81 years) diagnosed as having an adnexal mass were evaluated by transvaginal color Doppler sonography prior to surgery. Color Doppler was used to detect and analyze the flow velocity waveform from arterial and venous blood flow within the tumor. For arterial signals the resistance index and peak systolic velocity, and for veins the maximum venous flow velocity, were calculated. Receiver operator characteristic curves were plotted to determine the best venous flow velocity cut-off. According to our previous study using arterial Doppler, a tumor was considered as malignant when flow was detected and the lowest resistance index was < or = 0.45. Using venous Doppler a mass was considered as malignant when flow was detected and the venous flow velocity was > or = the best cut-off found on the receiver operator characteristic curve. Definitive histopathological diagnosis was obtained in all cases. Sensitivity, specificity, positive predictive value and negative predictive value for B-mode morphology (evaluation performed according to Sassone's scoring system), arterial Doppler, venous Doppler, and a combination of both arterial and venous Doppler were calculated. RESULTS: Twenty-five masses (27.5%) were malignant and 66 (72.5%) benign. Arterial and venous flow was found more frequently in malignant than in benign masses (92% vs. 41% (P < 0.001) and 72% vs. 21% (P < 0.001), respectively). The resistance index was significantly lower in malignant tumors (0.42 vs. 0.60, P = 0.0003). No differences were found in peak systolic velocity. Venous flow velocity was significantly higher in malignant masses (18.1 cm/s vs. 8.9 cm/s, P = 0.0006). The best cut-off of venous flow velocity was 10 cm/s. Sensitivity, specificity, positive predictive value and negative predictive value for morphology, arterial Doppler, venous Doppler, and the combination of both arterial and venous Doppler were 92%, 71%, 45%, 96%; 76%, 95%, 87%, 91%; 68%, 94%, 81%, 89%; and 88%, 91%, 79%, 95%, respectively. CONCLUSIONS: Our results indicate that preoperative evaluation by venous flow assessment of adnexal masses may be useful to discriminate between malignant and benign tumors.     

乳腺癌的彩色多普勒血流分布特征与组织病理学对照研究

目的探讨乳腺癌彩色多普勒血流分布类型及其在乳腺癌诊断中的价值.方法前瞻性研究104例121个乳腺癌病变的彩色多普勒血流分布类型,分析血流特征与乳腺癌病理组织学之间的关系.结果121个乳腺癌中周边型血流62个(51.2%),内部型血流31个(25.6%),穿入型血流23个(19.0%),5个(4.1%)无血流.导管内癌、浸润性小叶癌和高、中分化的浸润性导管癌的血流多位于肿块的周边;而低分化的浸润性导管癌以穿入和内部血流为主(P=0.010);特殊类型浸润癌以内部血流为主(P=0.009).肿瘤表现为内部血流者,多血流丰富(P=0.003).结论彩色多普勒血流的分布部位是乳腺癌新生血管的一个重要特征.血流分布类型与乳腺癌生长、分化之间存在一定的关系,导管内癌、浸润性小叶癌和高、中分化的浸润性导管癌的血流多位于肿块的周边,分化差的浸润性导管癌以及特殊类型浸润癌则以穿人型和内部型血流为主.血流分布类型与血流数量有一定的关系,穿入型和内部型血流往往血流比较丰富.     

Doppler ultrasound assessment of tumor vascularity in gynecologic disorders

Real-time two-dimensional and pulsed-wave Doppler ultrasonic examinations were performed on 8 normal volunteers and 97 patients with various gynecologic disorders; the objective was to assess uterine and tumor vascularities. Each arterial blood flow velocity wave-form was classified into two types. The resistance indices of normal and abnormal flows were greater than .7 and less than .7, respectively. In normal volunteers, abnormal flows were nil. In 8 of 44 patients with benign tumors (18.2%), abnormal flows were evident and all proved to be cases of leiomyoma or adenomyosis. Doppler signals were not detected in 18 of 36 patients with cervical carcinoma (50%) and abnormal flows were noted in only 6 (16.7%). In all cases of endometrial carcinoma, ovarian carcinoma, and trophoblastic disease, typically abnormal flows were noted. Moreover, in most subjects a decrease in blood flows was observed after chemotherapy by anticancer drugs or irradiation. Therefore, Doppler ultrasound is a pertinent and noninvasive tool that can be used repeatedly for assessing the tumor vascularity in gynecologic disorders.     

Three-dimensional color Doppler sonography and uterine artery arteriography of fibroids: assessment of changes in vascularity before and after embolization.

OBJECTIVE: To assess the accuracy of three-dimensional color Doppler sonography and uterine artery arteriography in depicting changes in fibroid vascularity before and after embolization. METHODS: Preembolization and postembolization three-dimensional color Doppler sonography and selective uterine artery arteriography were retrospectively compared in 15 patients who underwent uterine artery embolization for treatment of symptomatic fibroids. Three-dimensional color Doppler sonography was performed by using a scanner with color power angiographic imaging capability. Vascularity was quantified by using an estimation of power-weighted pixel density as described by our group in previously published studies. Uterine artery arteriography was performed by using a standard selective microcatheter embolization technique. For purposes of comparison, fibroids were classified as either hypervascular or hypovascular relative to myometrial vascularity before and minutes to several hours after uterine artery embolization. Changes in fibroid vascularity (i.e., from hypervascular to hypovascular) as depicted by three-dimensional color Doppler sonography were compared with those shown on uterine artery arteriography and classified as being in agreement or disagreement. RESULTS: In 13 (87%) of 15 patients there was agreement; in 2 (13%) of 15 there was disagreement. In both cases of disagreement, three-dimensional color Doppler sonography showed collateral flow not depicted by uterine artery arteriography The mean reduction in quantitated vascularity after uterine artery embolization was 44% (range, 19%-78%). CONCLUSIONS: Three-dimensional color Doppler sonography accurately depicts fibroid vascularity and in some cases can reveal collateral flow not depicted by uterine artery arteriography.