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.     

乳腺肿块的能量多普勒血流定量与病理微血管定量相关性研究

目的　研究超声造影及能量多普勒技术测定乳腺肿瘤的彩色象素密度与病理微血管密度的相关性。方法　应用超声造影和能量多普勒技术观察 5 1例乳腺肿块血流信号 (2 8例良性 ,2 3例恶性 ) ,计算机辅助测量肿瘤血流的彩色象素密度 ,对手术标本进行抗CD3 4因子免疫组化染色测量肿瘤微血管密度。结果　彩色象素密度及微血管密度值均表现为同样梯度 ,即恶性组 >良性组 >对照组 (10例远离肿块的周围乳腺组织 )。恶性组中腋下淋巴结转移组的彩色象素密度及微血管面密度均高于无腋下淋巴结转移组 (P <0 .0 5 )。能量多普勒测定的彩色象素密度与病理微血管面密度有较好的相关性 (r =0 .84,P<0 .0 0 1)。结论　能量多普勒血流定量测值与肿瘤微血管密度测值相关性较好 ,能量多普勒超声造影对乳腺肿瘤的鉴别诊断及乳癌预后的评估有帮助     

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.     

Color Doppler sonography of endometrial masses.

OBJECTIVE: To correlate the color Doppler sonographic features of endometrial masses with histologic characteristics and microvessel density. METHODS: We performed a retrospective analysis of 10 postmenopausal and 5 premenopausal women with abnormal bleeding who had color Doppler sonography and histologic studies of endometrial masses. RESULTS: Endometrial masses that contained multiple branches on color Doppler sonography were more likely carcinomas, even though both polyps and carcinomas were vascular on color Doppler sonography and their microvessel densities were similar. On color Doppler sonography, polyps averaged 1.2 detectable vessels versus 3.4 for carcinomas. CONCLUSIONS: Color Doppler sonography may be useful in distinguishing carcinomas from polyps in women with thickened endometria.     

Tumor vascularization in experimental melanomas: correlation between unenhanced and contrast enhanced power Doppler imaging and histological grading

The purpose of this study was to evaluate the reliability of unenhanced and enhanced power Doppler sonography in visualization of intratumoral angioneogenesis. Thirty-seven malignant melanomas, which had been implanted intra- or subcutaneously in 22 mice, were examined. Various B-mode criteria, power Doppler criteria and spectral Doppler parameters were evaluated before and after IV-application of the d-galactose-based contrast agent Levovist. After sonographic examination, all tumors were analyzed histologically with semiquantitative grading of tumoral vascularization. Unenhanced, in 70% of the tumors, no intratumoral vessels were visible using power Doppler, but only in 11% of the intracutaneous and in 0% of the subcutaneous after injection of the contrast agent. The enhanced mode was definitely superior to unenhanced Doppler in showing the intratumoral vascularity. The intratumoral vascular structure could be sufficiently analyzed in 30% of all tumors by unenhanced Doppler, but in 92% enhanced. The mean percentage vessel area increased about 433% after application of Levovist (intracutaneous: 485%, subcutaneous: 280%). Despite the missing direct correlation between the sonographically and histologically determined grade of tumor vascularization (Pearson's correlation unenhanced 0,356, p <.05/enhanced 0.395, p <.05), the correlation between the percentage vessel area and the histologic grade of vascularization was improved after application of the contrast agent (Pearson's correlation unenhanced 0.347, p <.05/enhanced 0.686, p <.01). We did not find a significant direct correlation between histologically and sonographically determined degree of vascularization. However, the correlation was improved using a d-galactose-based signal-enhancing agent in power Doppler sonography.     

Color Doppler sonohysterography of endometrial polyps and submucosal fibroids.

OBJECTIVE: To describe the typical sonographic findings and clinical applications of color Doppler sono-hysterography and to correlate the vascularity of lesions seen on color Doppler sonohysterography to microvessel density and the presence of vessels greater than 0.5 mm. METHODS: Color Doppler sonohysterography was performed on 25 women with abnormal uterine bleeding. The vascularity (number of vessels > 0.5 mm) and their configuration seen on color Doppler sonohysterography were compared with those obtained on the excised specimen. Microvessel density and histologic features were correlated to the visualization of vessels greater than 0.5 mm and their arrangement on color Doppler sonography. RESULTS: The color Doppler sonographic findings in 18 polyps, 3 submucosal fibroids, and 1 clot showed distinct vascularity patterns. Polyps typically contained a single feeding vessel, whereas fibroids had several vessels, which arose from the inner myometrium. Lesions with higher microvessel density tended to have more vessels greater than 0.5 mm as depicted on color Doppler sonography. CONCLUSIONS: Color Doppler sonohysterography may be useful in distinguishing polyps from submucosal fibroids based on the vascularity of the lesions. The number of vessels seen on color Doppler sonography approximates microvessel density within the lesions.     

Correlation Between 2‐ and 3‐Dimensional Assessment of Tumor Volume and Vascular Density by Ultrasonography in a Transgenic Mouse Model of Mammary Carcinoma

Objective . Visualization and quantification of angiogenesis are instrumental in development of antiangiogenic therapy. Although both 2‐dimensional (2D) and 3‐dimensional (3D) ultrasonography have been used to monitor tumor growth and vasculature development, the correlation between them has not been sufficiently investigated. We hereby investigated the 2D and 3D sonographic correlation for tumor volume and vascular density confirmed by histologic assessment in the polyoma virus middle T antigen (PyMT) mouse model of mammary carcinoma. Methods . Female PyMT mouse tumors were evaluated by ultrasonography in the 2D region of interest (ROI), 3D tumor volume, and 2D and 3D microvascular density after a bolus infusion of a nontargeted contrast‐enhanced microbubble agent. Texas Red‐dextran was used for quantitative histologic assessment of the tumor microvascular density. Results . The individual 2D tumor ROI area correlated with the 3D tumor volume throughout the 2‐week period. However, the extent of the increase in the 3D volume (380%; P < .01; n = 10) was higher than that of the 2D ROI area (72%; P < .01; n = 8–11). A significant and comparable increase in vascular density accessed by both 2D (87%; P < .05; n = 8) and 3D (64%; P < .05; n = 8) imaging was documented. Vascular density obtained through 3D imaging correlated significantly with 2D measurement. These data were confirmed by Texas Red‐dextran quantification of vascular density. Conclusion . This study showed a valid application of sonographically based imaging technology in tumor volume and vascular density assessment as well as their 2D and 3D correlation, of which tumor vascular density measured by 2D ultrasonography appeared to be better correlated with the 3D data. Our data indicate that ultrasonography can be applied for real‐time, accurate, noninvasive imaging of the tumor volume and vascular density in preclinical models.     

Fibroadenomas: computer-assisted quantitative evaluation of contrast-enhanced power Doppler features and correlation with histopathology

We aimed to evaluate whether the histopathologic variability of fibroadenomas accounts for their varied appearance in contrast enhanced power Doppler (PD). Forty patients with fibroadenomas (aged 19 to 61 years) underwent power Doppler ultrasound (US) prior to and following IV bolus injection of a microbubble contrast agent. A 3-min computer-assisted assessment of the color pixel density (CPD) was used for objective evaluation of the increase in color Doppler signals. Enhancement characteristics were correlated to histopathologic features of microvessel density and epithelial hyperplasia, patient's age, tumor size, use of exogenous hormones and menopausal status. Epithelial hyperplasia was diagnosed in 19 patients. Compared to baseline values, patients with epithelial hyperplasia showed a significant increase in mean CPD following contrast media administration (p < 0.01). There was a significant correlation to patient's age (p < 0.0001) and tumor size (p < 0.0001), but not to the use of exogenous hormones and menopausal status. Microvessel counts did not show a significant correlation to CPD at baseline (p = 0.07) or with CPD on contrast enhanced PD (p = 0.13), or with patient age (p = 0.43) or tumor size (p = 0.34). Intratumoral epithelial hyperplasia, primarily occurring in young patients, may contribute to the differential diagnostic overlap in some fibroadenomas and thus limit the ability of PD to distinguish between benign and malignant masses on the basis of enhancement characteristics.     

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.     

Straight Vessel Pattern and Rapid Filling Time

Six patients with 7 lesions that were histologically confirmed as primary testicular lymphoma were preoperatively investigated with a standardized sonographic protocol including contrast‐enhanced sonography. Duplex and contrast‐enhanced sonography showed marked hypervascularization in all 7 lesions. On contrast‐enhanced sonography, the filling time of lymphomatous lesions was significantly shorter than the filling time of a size‐matched sample of 10 patients with seminomas (P < .0001). The sonographic hallmarks of testicular lymphoma in our case series were as follows: (1) sharply demarcated homogeneous hypoechoic testicular lesions with marked hypervascularization; (2) a rapid (<7 seconds) filling time of contrast bubbles; and (3) a straight and parallel course of intralesional vessels on contrast‐enhanced sonography.     

Fine‐tuning the Diagnosis of Fetal Scalp Cysts

Objective. The purpose of this series is to emphasize the importance of an exhaustive and appropriately conducted sonographic examination in the correct diagnosis of fetal cystic scalp lesions and the place of magnetic resonance imaging (MRI) in the diagnostic sequence. Methods. Transabdominal and transvaginal 2‐ and 3‐dimensional sonography with color and power Doppler imaging as well as 3‐dimensional rendering techniques such as inversion and Doppler angiography were used. In 1 case, an MRI study was performed. Results. In 1 case, the MRI missed and the different sonographic techniques correctly made the diagnosis of a meningocele. In the second case, sonography was sufficient to establish the diagnosis of an epidermal cyst. Conclusions. These 2 cases show the value of going the distance with the newly available high‐frequency sonography. Ultimately, the correct diagnoses were made with the tools offered by sonography without the need for any other imaging modality.     

Power Doppler sonography of breast masses: correlation of Doppler spectral parameters with tumor angiogenesis and histologic growth pattern.

The purpose of this study was to examine the relationship between spectral analysis on power Doppler sonography and microvessel density. Power Doppler sonography was performed in 71 patients with breast masses (36 invasive carcinomas and 35 benign lesions). Microvessel density was measured in surgical specimens from all breast carcinomas using anti-factor VIII-related antibody. Invasive carcinomas were divided into two groups according to their growth pattern (solid type, scirrhous type). The pulsatility index and resistive index were high in malignant tumors compared with those in benign lesions (P < 0.001). The maximum velocity had weak statistical significance (P < 0.05). Although the correlation of maximum velocity with microvessel density was strong in solid tumors (P < 0.001), the maximum intensity in scirrhous tumors had no correlation with microvessel density. In conclusion, solid tumors showed a tendency toward correlation of maximum velocity with microvessel density. High maximum velocity with high microvessel density suggests breast carcinoma and could be predictive of a poor prognosis in invasive breast carcinoma.     

增强超声诊断小乳腺癌及评价血管生成活性的价值

目的研究声诺维(SonoVue)造影增强能量多普勒对小乳腺癌鉴别诊断的意义及评价小乳腺癌血管生成活性的价值.方法增强能量多普勒研究39例乳腺小病灶(恶性21例,良性18例),图像定量计算病灶内彩色像素密度.与术后免疫组化所测微血管密度(MVD)对照,分析两者的相关性.结果增强前彩色像素密度恶性组与良性组间无显著性差异,且彩色像素密度与MVD无相关性.增强后能量多普勒恶性组彩色像素密度高于良性组,与MVD呈正相关(r=0.67,P＜0.05).结论声诺维有助于小乳腺癌的鉴别诊断,增强能量多普勒可有效评价小乳腺癌血管生成活性.     

Sonographic evaluation of early-stage breast cancers that undergo neoadjuvant chemotherapy.

OBJECTIVE: We prospectively evaluated low-stage breast cancers treated with neoadjuvant chemotherapy using whole-volume sonography and color Doppler imaging. METHODS: Thirty-four women with breast cancer (mean maximum size, 2.4 cm) received neoadjuvant chemotherapy with doxorubicin and docetaxel. Targeted whole-volume sonography of tumor sites was performed before and after chemotherapy to assess mass size, color pixel speed-weighted density, and American College of Radiology Breast Imaging Reporting and Data System sonographic characteristics. After chemotherapy, tumor sites were excised by lumpectomy or mastectomy. RESULTS: Three (11.3%) of 34 patients had a complete histologic response. After chemotherapy, correlation was r = 0.716 between final histologic and sonographic sizes. Compared with histologic residual tumors, sonography had 4 false-negative results, 3 false-positive results, and 27 true-positive results (sensitivity, 87%), with no false-negative results among a subgroup of tumors of 7 mm and larger (sensitivity, 100%). The 3 cases with false-positive results were histologic fibrosis or biopsy changes. Mean speed-weighted density was 0.015 before and 0.0082 after chemotherapy (P = .03). After chemotherapy, vascularity was less common within (P = .06) or adjacent to (P = .009) masses or in tumor sites (P = .05). Prechemotherapy variables of gray scale characteristics and vascularity were compared with final histologic size, and all had P > .20. CONCLUSIONS: Postchemotherapy sensitivity of sonography was high for residual tumors of 7 mm or larger. Correlation was moderate between histologic and sonographic final tumor sizes. False-positive results were caused by fibrosis or biopsy-related changes. False-negative results occurred with residual tumor size of 6 mm or smaller. After chemotherapy, vascularity usually decreased, and this was not specific for complete response. Before chemotherapy, no vascular or gray scale feature at initial imaging predicted complete responders.     

Sonographic depiction of changes of tumor vascularity in response to various therapies

PURPOSE: To evaluate the diagnostic accuracy of power Doppler sonography for the depiction of changes in tumor vascularity with various therapeutic regimens. MATERIALS AND METHODS: Tumor cells were implanted subcutaneously in thirty-two mice and assigned to four treatment groups: control, radiation therapy, antiangiogenesis therapy (VEGF [vascular endothelial growth factor] receptor antagonist, SU11248), or combined antiangiogenesis and radiation therapy. Twenty of these mice were scanned with power Doppler sonography at two time points over the course of treatment, and power-weighted pixel densities were assessed. The other twelve mice each underwent subcutaneous placement of a dorsal skin-fold window over the tumor site, allowing for daily angiogenesis assessment of vascular length density. All tumor specimens had correlative histologic analyses performed, including immunohistochemical stains for microvasculature. RESULTS: Sonographic measurements revealed significant longitudinal differences in tumor vascularity among the four treatment groups: control mice receiving no treatment demonstrated a doubling in intra-tumor color pixel density (P < 0.02); those receiving radiation alone increased by 68% (P < 0.04); those receiving oral therapy alone increased by 44% (P = 0.016); and those receiving combination therapy decreased by 38% (P < 0.02). Tumor vascularity independently measured in the twelve mice with the skin-fold windows revealed a similar response to each type of treatment. Post-mortem tumor histology was consistent with both sonographic and skin-fold window measurements. CONCLUSION: Power Doppler sonography was accurate and reliable in measuring tumor vascularity changes in this model. These results were independently confirmed by a quantitative method relying on direct visualization of the microvasculature. Because it is rapid and non-invasive, sonographic quantification is beneficial in assessing the anti-angiogenic effects of various treatment strategies for cancer.     

Ultrasound assessment of angiogenesis in a matrigel model in rats

Matrigel, a basement membrane extract, has been extensively used in in vivo angiogenesis. Contrast ultrasound imaging (CUI) of implanted Matrigel plugs with (+bFGF) and without basic fibroblast growth factor (-bFGF) was performed 7 and 14 d after implantation, followed by histologic analysis. Statistically significant differences between +bFGF and -bFGF plugs were apparent at d 7 in both plug size and contrast enhancement (both p < 0.05). Histopathology revealed differences in microvessel density (MVD) between +bFGF and -bFGF at d 7 and d 14. A significant correlation between MVD and both power Doppler contrast-enhanced area (r = 0.65, p < 0.05) and fraction of plug enhanced (r = 0.59, p < 0.05) was present. CUI of Matrigel plugs was shown to be a robust method for distinguishing between two different angiogenic states. Ultrasound measurements of blood flow in the plugs correlated with MVD, a histologic technique used to quantify tumor angiogenesis.     

Correlation between estimates of tumor perfusion from microbubble contrast-enhanced sonography and dynamic contrast-enhanced magnetic resonance imaging.

OBJECTIVE: We compared measurements of tumor perfusion from microbubble contrast-enhanced sonography (MCES) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in an animal tumor model. METHODS: Seven mice were implanted with Lewis lung carcinoma cells on their hind limbs and imaged 14 days later with a Philips 5- to 7-MHz sonography system (Philips Medical Systems, Andover, MA) and a Varian 7.0-T MRI system (Varian, Inc, Palo Alto, CA). For sonographic imaging 100 microL of a perfluoropropane microbubble contrast agent (Definity; Bristol-Myers Squibb Medical Imaging, Billerica, MA) was injected and allowed to reach a pseudo steady state, after which a high-mechanical index pulse was delivered to destroy the microbubbles within the field of view, and the replenishment of the microbubbles was imaged for 30 to 60 seconds. The MRI included acquisition of a T(10) map and 35 serial T(1)-weighted images (repetition time, 100 milliseconds; echo time, 3.1 milliseconds; alpha, 30 degrees ) after the injection of 100 microL of 0.2-mmol/kg gadopentetate dimeglumine (Magnevist; Berlex, Wayne, NJ). Region-of-interest and voxel-by-voxel analyses of both data sets were performed; microbubble contrast-enhanced sonography returned estimates of microvessel cross-sectional area, microbubble velocity, and mean blood flow, whereas DCE-MRI returned estimates of a perfusion-permeability index and the extravascular extracellular volume fraction. RESULTS: Comparing similar regions of tumor tissue seen on sonography and MRI, region-of-interest analyses revealed a strong (r(2) = 0.57) and significant relationship (P < .002) between the estimates of perfusion obtained by the two modalities. CONCLUSIONS: Microbubble contrast-enhanced sonography can effectively depict intratumoral heterogeneity in preclinical xenograft models when voxel-by-voxel analysis is performed, and this analysis correlates with similar DCE-MRI measurements.     

In Situ Kidney Insonation With Microbubble Contrast Agents Does Not Cause Renal Tissue Damage in a Porcine Model

Objective. Knowledge and quantification of the microcirculation are very important for estimating the status of an organ. Real‐time contrast‐enhanced sonography assesses microvascular tissue perfusion. This technique has been proposed as innocuous; however, data from experimental animals (rats) have shown renal interstitial microhemorrhage after the procedure. Therefore, we developed a porcine model to explore potential renal damage that in situ exposure might cause. Methods. Kidneys from 8 anesthetized pigs were surgically exposed. An ultrasound contrast agent (sulfur hexafluoride) was infused through the femoral vein in a continuous perfusion. Destructive ultrasonic flashes were applied with a high mechanical index over only 1 kidney (the contralateral kidney was used as a control). Blinded histologic and laboratory analyses were performed to reveal any lesions. Results. Histologic analysis of the kidney samples showed no evidence of renal damage. Biochemical parameters that could represent renal tissue damage and hemoglobin levels did not change after the microbubble‐ultrasound interaction. Conclusions. The ultrasound contrast agent‐ultrasound interaction in anesthetized pig kidneys under the output level for the imaging visualization and microbubble destruction used did not cause tissue damage. Our results suggest that this procedure could be used in humans for regular analysis of the kidney microcirculation with minimal risk of tissue damage.     

Novel Use of Contrast‐Enhanced Sonography in the Diagnosis of Central Uterine Necrosis Following Embolization for Postpartum Hemorrhage

Since 2007, we have identified 2 cases of central uterine necrosis after uterine arterial embolization for postpartum hemorrhage. Contrast‐enhanced sonography showed an absence of enhancement of the internal myometrium. Magnetic resonance imaging with gadolinium confirmed the diagnosis. The images obtained for the first case were corroborated by histologic analysis from a hysterectomy done for sepsis. For the second case, contrast‐enhanced sonography performed during a follow‐up period of conservative treatment revealed a reduction of necrosis. Our study shows that contrast‐enhanced sonography seems to be a useful examination as an adjunct to grayscale and power Doppler imaging in the diagnosis and follow‐up of uterine necrosis.     

High‐Frequency Sonography in the Evaluation of Psoriasis

Objective. The purpose of this study was to show the potential of the latest sonographic equipment using high‐frequency probes and a very sensitive power Doppler (PD) technique in depicting both skin and nail changes in patients affected by psoriasis. Methods. The study was conducted in 30 patients with a diagnosis of psoriasis clinically performed by an experienced dermatologist and 15 healthy participants, using a currently available sonography system equipped with a variable‐frequency transducer ranging from 6 to 18 MHz and a Doppler frequency ranging from 7 to 14 MHz. Results. The images illustrated in this presentation are representative examples of the ability of sonography to show and characterize even minimal morphostructural and blood flow changes in patients with both psoriatic plaques and onychopathy. Conclusions. This report provides pictorial evidence that high‐resolution gray scale sonography with a PD technique is a real‐time and noninvasive imaging technique that can be used as an adjunct to the clinical evaluation in assessing psoriatic disease.