Sonographic appearance of a giant cell tumor of the humerus

The sonographic presentation of intramedullary bone tumors is rarely reported. A patient with right shoulder pain for 7 months was clinically diagnosed with shoulder impingement syndrome. Sonographic examination revealed a segment of thinning cortex with a large, heteroechoic tumor deep in the greater tuberosity of the humerus. Increased peripheral vascularity of the tumor was observed in the power Doppler mode. The definite diagnosis was a giant cell tumor, whose sonographic findings are discussed.     

Sonographic Appearances of Desmoid Tumors

The medical records of 16 patients (9 female and 7 male; age range, 5–66 years) with 24 lesions that had a histologic diagnosis of desmoid tumors were reviewed at our institution. Six cases were extra‐abdominal, 4 intra‐abdominal, and 6 in the abdominal wall. Lesions ranged from 1.5 to 18.0 cm in diameter (mean, 6.8 cm). All lesions were solid masses, which appeared hypoechoic, isoechoic, or hyperechoic with homogeneous or heterogeneous echogenicity. Posterior acoustic enhancement was seen in 18 lesions. No lesions showed central necrosis. Most lesions had substantial flow and high resistive index values (>0.70). Sonography can show a desmoid tumor's site, size, contour, margin, echogenicity, homogeneity, vascularity, and resistive index value in detail.     

肾上腺肿瘤声像图特征在判断良恶性质中的价值

目的探讨二维和彩色多普勒超声在判断肾上腺良、恶性肿瘤中的价值。 方法回顾性分析96例肾上腺良、恶性肿瘤的声像图特征,并与病理诊断对照。 结果肾上腺肿瘤声像图为;（1）低回声;（2）等回声;（3）高回声;（4）混合性回声;（5）囊性回声。 结论肾上腺肿瘤越大,其恶性的可能性也越大。超声检查对判断肾上腺良、恶性肿瘤有重要价值。较大肿瘤中探测到钙化灶或丰富的血流,应怀疑肾上腺恶性肿瘤。     

经阴道彩色多普勒超声在诊断妇科恶性肿瘤术后复发中的应用

目的探讨经阴道彩色多普勒超声(TVS-CD)对妇科恶性肿瘤术后复发病灶的诊断价值.方法对60例妇科恶性肿瘤术后复发的患者行TVS-CD检查,并与病理结果及临床对照.结果经阴道超声(TVS)检查86.7 %的复发灶为实性肿块,少数为混合性(8.3%)或囊性(5.0%).彩色多普勒能量图(CDE)显示实性及混合性病灶以II-III级血流信号为主(86.7%),少数为0-I级血流信号(8.3%),囊性病灶(5.0%)未检出血流信号.频谱多普勒(SD)测量血流阻力指数(RI)平均值为0.60,搏动指数(PI)平均值1.26.TVS-CD诊断术后复发符合率为 86.7 %,误诊13.3%.结论妇科恶性肿瘤术后复发灶的二维图像以实性低回声为主,病灶内血流多较丰富,与妇科原发肿瘤相比,复发灶血流阻力较高、速度较低,具有独特的声像图和血流动力学特征.TVS-CD将TVS与CDE和SD结合,可以检出较小的盆腔复发病灶,更准确地显示病灶内部结构和血流形态学、动力学表现,对妇科恶性肿瘤术后复发灶的早期发现和定性诊断具有重要价值,可作为临床随访观察的重要手段.     

Leydig cell tumors of the testis: gray scale and color Doppler sonographic appearance.

OBJECTIVE: To determine the gray scale and color Doppler sonographic features of Leydig cell tumors of the testis in a series of patients. METHODS: We retrospectively analyzed the sonographic appearance of 10 proven Leydig cell tumors in 9 patients aged 26 to 47 years. Sonographic features that were reviewed included the size and echogenicity of the tumors, presence of cystic areas or calcifications, and distribution pattern of detectable blood flow on color or power Doppler imaging. RESULTS: The tumors ranged from 0.4 to 3.0 cm in diameter, but most were less than 1.0 cm in diameter. In 1 testis, 2 discrete Leydig cell tumors were found. Nine (90%) of the 10 tumors were homogeneously hypoechoic. Only 1 tumor was isoechoic with the testis. None of the tumors contained calcifications. Of 8 tumors with color Doppler imaging, 7 (88%) showed a characteristic pattern of increased peripheral blood flow, which was either circumferential or punctate. Only 1 tumor was found with internal hypervascularity. CONCLUSIONS: Peripheral hypervascularity in a hypoechoic testicular tumor that has little or no internal color Doppler flow should suggest the possibility of a Leydig cell tumor, and consideration should be given to testicle-sparing surgery.     

B-flow sonographic evaluation of hemodialysis fistulas: a comparison with low- and high-pulse repetition frequency color and power Doppler sonography.

OBJECTIVE: The purpose of this study was to determine the effectiveness of B-flow sonography in the evaluation of hemodialysis fistulas and to compare this new technique with color and power Doppler sonography. METHODS: In this study, 32 randomly selected patients (mean age, 46 years; age range, 18-87 years) with normally functioning hemodialysis fistulas were evaluated with low- and high-pulse repetition frequency (PRF) color and power Doppler sonography (PRF values of 3 and 10 kHz) and B-flow sonography. All images were reviewed and graded independently by 2 observers for luminal filling with flow signals, visibility of the intimal layer, and overall image quality. The study was approved by the Institutional Review Board, and informed consent was obtained from all patients. RESULTS: Statistical analysis with Friedman and Wilcoxon signed rank tests revealed that B-flow sonography was superior to other techniques for luminal filling and visibility of the intimal layer (P = .000). For overall image quality, B-flow sonography was also the best method according to the Friedman test (P = .000). However, the Wilcoxon test showed no significant difference between B-flow and high-PRF (10-kHz) color and power Doppler sonography (P = .131). The kappa scores reflected moderate to good interobserver agreement (kappa = 0.285-0.784). CONCLUSIONS: B-flow sonography is a relatively new and superior imaging technique that provides direct visualization of the blood echoes and the morphologic characteristics of the surrounding vessel wall simultaneously. During the evaluation of hemodialysis shunts, the major advantage of this technique is its ability to avoid artifacts such as aliasing and overwriting.     

Accurate characterization of the main trunk of the anterior cerebral artery by means of intraoperative sononavigation with Doppler sonography: implications for brain tumor surgery.

OBJECTIVE: Doppler sonography can be used for real-time intraoperative localization of arteries within or near brain tumors but is less useful for distinguishing between arteries with similar diameters, such as the main trunk and branches of the anterior cerebral artery (ACA). By contrast, sononavigation provides real-time information in alignment with magnetic resonance imaging scans and may be of use in characterizing the identity of individual arteries on Doppler sonographic images. The goal of this study was to determine whether sononavigation can distinguish the main trunk of the ACA from the branches of the ACA on Doppler sonographic images. METHODS: Doppler sonography was used in 3 patients undergoing surgical resection of brain tumors involving the main trunk of the ACA. The location of the main trunk of the ACA was characterized by sononavigation. RESULTS: With these data, tumor resection was performed with preservation of the main trunk of the ACA. Gross total resection was achieved in 1 case. CONCLUSIONS: Intraoperative sononavigation with Doppler sonography accurately localized the main trunk of the ACA and enabled preservation of this structure during tumor resection. This method may be applicable to the characterization of other critical arteries and may allow tumor resection with decreased morbidity.     

Role of Spectral Doppler Sonography in the Evaluation of Partial Testicular Torsion

Objective. The purpose of this series was to evaluate the role of spectral Doppler and color flow Doppler sonography in the evaluation of partial testicular torsion. Methods. Eight cases of partial testicular torsion, diagnosed on the basis of abnormal spectral Doppler waveforms or abnormal color flow Doppler findings, were retrospectively pooled from 2 teaching hospitals. Results. The age group ranged from 4 to 85 years. Testicles with partial testicular torsion showed variable spectral Doppler patterns, including increased, similar, or decreased amplitude of the arterial waveform relative to the contralateral testicle. Two cases showed reversal of arterial diastolic flow, and 1 case showed diastolic flow variability within the same testicle. Decreased blood flow was observed on color flow Doppler sonography in 7 of the 8 patients. Conclusions. Variability of the Doppler waveform when compared with the contralateral testicle and reversal of diastolic blood flow are indirect clues that aid in the diagnosis of partial testicular torsion.     

Color Doppler sonography of bile duct tumor thrombi in hepatocellular carcinoma.

OBJECTIVE: To determine with the use of color Doppler sonography whether bile duct tumor thrombi had detectable vasculature in hepatocellular carcinoma. METHODS: Among 491 patients with tissue-proven hepatocellular carcinoma, 9 (1.8%) had bile duct tumor thrombi. All 9 patients had spectral Doppler sonography guided by color Doppler sonography (3.75-MHz convex probe). RESULTS: All 9 patients had dilated bile ducts with isoechoic thrombi. Eight patients had tumors infiltrating into and obstructing adjacent major bile ducts. The other patient had common hepatic duct tumor emboli that were not adjacent to primary tumors. Color signals were detectable within bile duct tumor thrombi in 7 patients. All of them had pulsatile waveforms on spectral analyses. CONCLUSIONS: Bile duct tumor thrombosis with obstructive jaundice was a rare complication of hepatocellular carcinoma. A detectable color signal with pulsatile waveforms was shown in most cases by color Doppler sonography with spectral analyses.     

Sonographic Appearance of Trigger Fingers

Objective. The purpose of this study was to describe the sonographic appearance of the first annular (A1) pulley–flexor tendon complex in patients with trigger fingers. Methods. Thirty‐three trigger fingers in 33 patients were examined with a 7‐ to 15‐MHz probe. A control group consisted of 20 patients without trigger fingers. The study included systematic measurement of the thickness of the A1 pulley and a power Doppler assessment of the pulleys, tendons, and tendon sheaths. Results. Thickening and hypoechogenicity of the A1 pulley were found in all patients with trigger fingers. Measurements of A1 pulley thickness were significantly different (P < .0001) between the groups without trigger fingers (mean, 0.5 mm; range, 0.4–0.6 mm) and with trigger fingers (mean, 1.8 mm; range, 1.1–2.9 mm). Hypervascularization of the A1 pulley on power Doppler imaging was found in 91% of the trigger fingers but was never found in the healthy control group. Flexor tendinosis was found in 48% of the trigger fingers; tenosynovitis was found in 55%; and both were found in 39%. In the control group, tenosynovitis and tendinosis were not found. Conclusions. Thickening and hyper‐vascularization of the A1 pulley are the hallmarks of trigger fingers on sonography. Other frequently observed features include distal flexor tendinosis and tenosynovitis.     

Sonographic depiction of intratumoral vascularity with 2- and 3-dimensional color Doppler techniques.

OBJECTIVE: The purpose of this study was to describe patterns seen on 2- and 3-dimensional color Doppler sonographic depiction of intratumoral vessels and to correlate these patterns to histopathologic findings in an attempt to assess their clinical importance. METHODS: We conducted a retrospective analysis of 26 patients with ovarian masses and intratumoral abnormalities in whom standard 2- and 3-dimensional color Doppler sonography was performed. RESULTS: Two- and 3-dimensional color Doppler sonography depicted several patterns of vascularity within ovarian masses. These included masses with vascularity confined to the wall or loculus and those with central versus peripheral vascularity. The presence of central intratumoral vascularity had a high positive predictive value (90%) for malignancy. Conversely, the absence of intratumoral vascularity had a high negative predictive value (96%). CONCLUSIONS: Three-dimensional color Doppler sonography is helpful in depicting overall vessel density and branching patterns within an intratumoral abnormality. This technique seems to be useful in distinguishing benign from malignant ovarian masses.     

Unusual motion detected on real‐time sonography inside a glomus tumor in the thigh

Glomus tumors are rare and many have been reported to have a hypervascular appearance on color or power Doppler sonography. We report a pathologically proven case of superficial glomus tumor within the thigh with no detectable color flow signals on color or power Doppler sonography. In addition, real‐time sonography showed spontaneous motions within the tumor, which were not synchronized with vascular or respiratory motions, and misled the presurgical diagnosis of a suspected parasite in a patient who had direct contact with multiple animal species. The etiology of this internal motion remains hypothetical but, if reconfirmed, this finding may be a useful adjunctive sign for the diagnosis of glomus tumors. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2013     

Doppler Sonographic Findings in an Experimental Rabbit Model of Necrotizing Enterocolitis

Objective. The purpose of this study was to examine the clinical applicability of Doppler sonography by evaluating Doppler sonographic findings in an experimental rabbit model of necrotizing enterocolitis (NEC). Methods. Necrotizing enterocolitis was experimentally induced using a combination of endotoxin, hypoxia, and cold stress in 23 rabbits. Doppler sonography was performed to obtain the Doppler spectrum of the superior mesenteric artery. From the flow profile, the peak systolic velocity (PSV) and resistive index (RI) were calculated at 5 time sessions: initial and 1 to 2, 3 to 4, 5 to 6, and 20 to 24 hours. Animals were divided into 2 groups based on pathologic NEC scores (NEC‐positive [NEC+] group versus NEC‐negative [NEC?] group). Differences between the groups with regard to RI and PSV values were evaluated for each time session. Results. Comparison of RI and PSV values between the NEC+ and NEC? groups revealed a significant increase in the PSV in the NEC+ group during the 1‐ to 2‐hour session (P = .0199). Comparison of RI and PSV differences revealed a significant increase in RI and PSV differences in the NEC+ group during the 1‐ to 2‐hour session (P = .0095 and .0013, respectively). In the other time sessions, there was no difference between the groups. Conclusions. The NEC+ group showed a significant increase in the PSV and RI during the 1‐ to 2‐hour period.     

彩色多普勒超声在阴囊急症中的应用

应用彩色多普勒超声（ＣＤＳ）评价３７例急性阴囊疼痛患者。采用直接探测法及低速血流设置。与健侧阴囊ＣＤＳ表现相比较，将患侧阴囊ＣＤＳ结果分为正常血流灌注、低血流灌注、无血流灌注和高血流灌注。结果显示：以睾丸内无血流灌注诊断睾丸扭转５例，敏感性和特异性均为１００％。以睾丸和附睾内高血流灌注诊断睾丸炎及附睾炎的敏感性为８３．３％，特异性为１００％，准确性为８９．２％。表明ＣＤＳ可准确地区分睾丸扭转和炎症，是一种评价急性阴囊肿瘤准确可靠及临床价值较高的方法     

Hepatocellular carcinoma: contrast enhancement with Levovist.

OBJECTIVE: To present the sonographic appearance of hepatocellular carcinoma imaged with the intravenous contrast agent Levovist. METHODS: We reviewed our experience using Levovist (Schering AG, Berlin, Germany) for the sonographic diagnosis of hepatocellular carcinoma. RESULTS: Contrast-enhanced sonography with Levovist facilitated detailed evaluation of tumor vascularity in hepatocellular carcinoma. CONCLUSIONS: Contrast-enhanced sonography with Levovist enhances the role of sonography in the diagnosis of hepatocellular carcinoma. It provides detailed information about tumor vascularity and the contrast enhancement pattern.     

Angiographic power 3-dimensional quantitative analysis in gynecologic solid tumors: feasibility and reproducibility.

OBJECTIVE: To determine the reproducibility of a simplified method of power Doppler 3-dimensional (3D) sonographic examination. METHODS: Twenty-nine patients with solid pelvic masses underwent transvaginal 3D power Doppler evaluation. The volume of interest was obtained by drawing the margins of the largest section of the mass in the 3 orthogonal planes. The 3D vascular parameters ("relative color," "average color," and "flow measure") obtained by our method were compared with those calculated by a manufacturer-suggested model based on several parallel section planes drawn on the longitudinal frames. The intraobserver variability was quantified on 5 different 3D images acquired by the same operator at 5-minute intervals for each patient. The intraobserver variability was also assayed in 10 patients at 24-hour intervals. Ten patients were scanned by a second sonographer for interobserver variability. RESULTS: There was high agreement between the 3D parameters obtained with the 2 methods. The 3D indices were similar in repeated observations at 5-minute intervals (median coefficients of variation for relative color, average color, and flow measure, 10.9, 4.5, and 13.0, respectively) and at 24-hour intervals (intraclass correlation coefficients for relative color, average color, and flow measure, 0.920, 0.978, and 0.978) and by the second sonographer (interclass correlation coefficients for relative color, average color, and flow measure, 0.978, 0.966, and 0.997). CONCLUSIONS: The acceptable rates of intraobserver and interobserver variability make this approach potentially suitable for research protocols.     

Application of power Doppler vocal fremitus sonography in breast lesions.

OBJECTIVE: The purpose of this study was to illustrate the method and use of power Doppler vocal fremitus (PDVF) sonography in the detection and diagnosis of breast lesions. METHODS: One case was evaluated by various sonographic parameters and equipment to determine how the VF images were affected. Cases illustrative of a broad range of breast conditions were also collected. Each image pair consisted of B-mode and VF images to maintain an identical projection and to illustrate the influence of PDVF sonography. RESULTS: With B-mode and PDVF sonography, we evaluated and compared various breast conditions, including normal anatomic structures and abnormal lesions. We found that PDVF sonography is useful for distinguishing abnormal masses from normal tissue, such as differentiating between isoechoic tumors and isoechoic glandular tissues, and discriminating entrapped fat lobules from isoechoic tumors. Furthermore, PDVF sonography was useful for determining whether intracystic echoes are attached to the cyst wall. CONCLUSIONS: Power Doppler VF imaging is a valuable adjunct tool to B-mode sonography in the evaluation of breast lesions.     

A sign of arteriogenic insufficiency on penile Doppler sonography: retrograde flow in penile cavernosal-spongiosal communications.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic usefulness of determining retrograde flow in the penile cavernosal-spongiosal communications (CSCs) with Doppler sonography. METHODS: Thirty-two consecutive men with erectile dysfunction (mean age, 40 years; range, 19-61 years) underwent penile color Doppler sonography. All patients were evaluated for flow direction in the CSCs. RESULTS: Eight of the 32 patients had normal Doppler sonographic findings; 8 had signs of veno-occlusive dysfunction; and 16 had arterial insufficiency. Doppler sonographic examinations of the patients with normal Doppler sonographic findings (100%) and veno-occlusive dysfunction (100%) showed a normal direction of flow in the CSCs. Thirteen of the 16 patients with arterial insufficiency had a normal direction of flow in the CSCs; however, reversal of the flow direction in the CSCs (from the urethral artery back to the cavernosal artery) was observed in the remaining 3 patients. CONCLUSIONS: Investigating the direction of flow in the cavernosal artery, CSCs, and urethral artery is not time-consuming and may help establish an accurate diagnosis of arteriogenic impotence, especially in patients with borderline peak systolic flow velocity values.     

Color Doppler sonography: Anatomic and physiologic assessment of the thyroid

The purpose of this study was to assess the potential application of color Doppler sonography in thyroid imaging. Thyroid nodules and other thyroid pathology detected by color Doppler ultrasound and nuclear scintigraphy were compared in 115 patients. The majority of “cold” nodules demonstrated a peripheral rim of color flow and no internal color flow with color Doppler sonography. A large number of “hot” nodules demonstrated internal color flow. Color Doppler sonography was helpful in delineating nodules in otherwise inhomogeneous glands. We determined that color Doppler cannot reliably distinguish benign from malignant thyroid nodules; fine-needle aspiration biopsy remains the most accurate method in differentiating benign and malignant lesions. We suggest that color Doppler sonography plays only a limited role in the evaluation of nodular thyroid disease at this time. The color Doppler appearance of other thyroid disorders (including toxic multinodular goiter, Graves' disease, and thyroiditis) is discussed. © 1995 John Wiley & Sons, Inc.