Power Doppler sonographic diagnosis of torsion in a wandering spleen

A wandering spleen is a rare clinical entity resulting from congenital maldevelopment or acquired laxity of the spleen's suspensory ligaments; it may result in torsion of the spleen. We report the gray-scale sonographic, power Doppler sonographic, and CT findings in a case of wandering spleen torsion. The gray-scale sonograms showed a displaced spleen that appeared as a homogeneous, hypoechoic mass suggestive of an enlarged, ectopic spleen in the central abdomen. Power Doppler sonograms showed no blood flow in the parenchyma or hilum of the spleen and were consistent with torsion and infarction in the spleen. Contrast-enhanced CT scans showed a homogeneous, unenhanced mass that was diagnosed as a torsioned wandering spleen. The hilar vessels of the spleen were also unenhanced.     

Splenic vascular malformations and portal hypertension in hereditary hemorrhagic telangiectasia: sonographic findings

Hereditary hemorrhagic telangiectasia, or Osler-Rendu-Weber disease, is an autosomal dominant disorder in which a variety of vascular dysplasias occur throughout the organ systems. We report the gray-scale and color Doppler sonographic findings in a case of hereditary hemorrhagic telangiectasia. Gray-scale sonographic examination revealed massive splenomegaly, multiple dilated intrasplenic vascular structures (some with adjacent punctate calcifications), an aneurysmal dilatation of the splenic vein, dilated intrahepatic portal branches, and marked atrophy of the right hepatic lobe. Color Doppler sonography showed dilatation of the truncus coeliacus and high-velocity flow in the splenic artery. There were significant aliasing in the splenic hilum and an abnormal, arterialized flow in intrasplenic branches of the splenic vein. The splenic vein was massively enlarged with increased flow velocity and contained an isolated aneurysmal dilatation in the hilum. There were multiple serpiginous retroperitoneal collateral vessels, and the left gastric vein was dilated with hepatofugal flow. The patient had portal hypertension that developed secondary to the increased portal flow.     

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.     

Relationship between sonographic and pathologic findings in epidermal inclusion cysts

PURPOSE: We evaluated the sonographic findings in epidermal inclusion cysts and related them to the pathologic findings. METHODS: We retrospectively reviewed the sonograms and pathology specimens of 24 patients with pathologically proven epidermal inclusion cysts. We evaluated the lesions for shape, size, internal echogenicity, posterior sound enhancement, and presence of color Doppler signals. We classified the masses into 5 sonographic types according to their internal echogenicity. The relationship between the sonographic types and the pathologic findings was examined. RESULTS: The masses were ovoid or spherical in 17 cases (71%), lobulated in 5 (21%), and tubular in 2 (8%). The longest diameter ranged from 1 to 6 cm (mean, 3.1 cm). Twenty-three cases (96%) were associated with posterior sound enhancement. Color Doppler signals were absent in 20 cases, but some vascularity was noted in 4 ruptured epidermal cysts, in areas of granulation tissue. The most common sonographic type was a hypoechoic lesion with scattered echogenic reflectors (10 cases). Sonographic findings were related to the lamellation of keratin debris and the granulation tissue secondary to rupture. Most cases with a lobulated configuration (4 of 5) or color Doppler signals (4 of 4) were ruptured cysts. CONCLUSIONS: Epidermal inclusion cysts most often appeared sonographically as a hypoechoic mass containing variable echogenic foci without color Doppler signals. Ruptured epidermal cysts, however, may have lobulated contours and show color Doppler signals, mimicking a solid mass.     

Splenic lymphangioma: US and CT diagnosis and clinical manifestations

BACKGROUND AND METHODS: We tried to determine the role and problems of gray-scale sonography (US), computed tomography (CT), and color Doppler sonography in the diagnosis of splenic lymphangioma on the basis of our experience with seven adult cases with this relatively rare tumor. RESULTS: (1) The whole spleen was replaced by a collection of cysts of different sizes with or without calcifications in six patients. In these patients, color Doppler sonography showed the intrasplenic arteries and veins running along the cyst walls. (2) The enlarged spleen occupied the whole upper abdomen and contained numerous small cysts in one patient. The patient was initially diagnosed as having a pancreatic tumor because of the location, but color Doppler sonography clearly demonstrated two vessels (artery and vein) running parallel from the center of the mass. This characteristic vascular structure led to the determination that the mass was the markedly enlarged spleen. (3) The splenic lesion was isolated in six patients but was associated with mesenteric and pleural lymphangioma in one symptomatic patient. CONCLUSIONS: (1) When US shows multiple cysts of different sizes in the spleen, the diagnosis of splenic lymphangioma is not difficult to make with US and CT alone. (2) Color Doppler sonography is a very useful tool to increase diagnostic confidence because it demonstrates the vasculature of the mass. (3) When examining patients with splenic lymphangioma, one should consider the possibility of multiorgan involvement.     

Hepatic hemangioma with arterioportal shunts

. Color Doppler sonograms and angiographic findings in 23 hepatic hemangioma patients were compared to clarify how arterioportal shunts influence color Doppler findings of hepatic hemangiomas. The results of our study showed that the presence of arterioportal shunts (six cases) gave rise to large feeding arteries (five cases), multiple intratumoral flows (six cases), and reversal of portal flow within (five cases) or around (four cases) the tumor. These color Doppler findings mimicked hypervascular malignant tumors. Knowledge of such unusual color Doppler findings in hepatic hemangiomas may help in avoiding misinterpretations of color Doppler sonograms.      

彩色多普勒超声对腹股沟区包块的诊断价值

目的探讨彩色多普勒超声对腹股沟区包块的诊断价值。方法回顾性分析经手术和病理证实或随访的53例腹股沟区包块的声像图资料,通过观察其二维声像图及彩色多普勒血流成像,分析包块的声像图特点及鉴别要点。结果 53例患者中腹股沟疝18例,声像图表现为与腹腔相通的无～强回声;鞘膜积液14例,声像图表现为无回声;肿大的淋巴结6例,声像图表现为椭圆形或圆形低回声;隐睾4例,声像图表现为椭圆形低回声,患者同侧阴囊内睾丸缺如;实性肿瘤3例,声像图表现为扁圆形低或等回声;血肿2例,声像图表现为不均匀低回声;精索炎2例,声像图表现为较健侧精索明显增粗且血流丰富;精索静脉曲张2例,声像图表现为网状无回声;子宫圆韧带囊肿1例,声像图表现为椭圆形无回声;蔓状血管瘤1例,声像图表现为不规则无回声,探头适当加压内见丰富血流。结论彩色多普勒超声对腹股沟区包块具有较高的诊断价值,可为临床诊疗提供可靠依据,应作为临床首选的检查方法。     

腱鞘巨细胞瘤的高频彩色多普勒超声表现特征

目的总结腱鞘巨细胞瘤的声像图特征，探讨高频彩以多普勒超声对腱鞘巨胞瘤的诊断价值。方法总结分析了37例经手术病理证实的腱鞘巨细胞瘤的二维和彩色多普勒超声特征。结果腱鞘巨细胞瘤声像图及血流图特征：1、指、趾等关节或肌腱旁实性低回声肿块，大部分回声均匀，少部分可见钙化及液化，巨方回声增强：2、肿瘤无包膜回声，与周围组织分界清晰；可压迫骨质和健及关切囊；3、多数瘤体内可探及丰富血流信号。结论 高频彩色普勒超声可作为腱鞘巨细胞瘤的首选检查手段之一。     

Sonographic appearance of a testicular yolk sac tumor in a 2-year-old boy

Yolk sac tumor (YST) of testis is the most common of all childhood testicular malignancies. We report a case of testicular YST in a 2-year-old boy. The tumor appeared sonographically as an ovoid, homogeneous, well-circumscribed, isoechoic, solid testicular mass with good sound-through transmission and increased internal vascularity on color Doppler imaging. The serum alpha-fetoprotein level was 4,396 ng/ml. Pathological examination confirmed YST at at stage I. Although the sonographic appearance of YST of the testis is nonspecific, the diagnosis is achievable in clinical practice on the combination of elevated serum alpha-fetoprotein level and sonograms depicting a solid testicular hypervascular mass.     

Mirror-image artifact mimicking epidural hematoma: usefulness of power Doppler sonography

During sonographic examination, a mirror-like interface can scatter the ultrasound beam, producing mirror-image artifacts. We describe a case of bilateral parietal cephalhematoma in the parietal region of a 2-day-old neonate that mimicked bilateral epidural hematoma on routine sonographic examination. Forceps had been used during delivery, and the neonate had been experiencing episodes of apnea since birth. Gray-scale coronal sonograms showed anechoic structures resembling epidural hematomas in the left and right parietal regions. However, color and power Doppler sonography showed normal vascular findings, thus permitting identification of the mirror-image artifact.     

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.     

Bronchioloalveolar carcinoma: sonographic pattern of 'pneumonia'.

BACKGROUND: the sonographic pattern of bacterial pneumonia is predominantly well known and characterized by an air bronchogram, a marked vascularity on color Doppler sonography, and a high-impedance arterial flow pattern on Doppler spectral analysis. METHODS: in a retrospective study the sonographic findings in seven patients with peripheral BAC on X-ray examination were evaluated in relation to number, size, margins, echomorphology and sonographic arterial flow patterns of the lesions. RESULTS: the following sonomorphologic characteristics were found: multiple foci (n=4), single foci (n=3), smooth margins (n=5), irregular margins (n=2) and maximal diameter of size (range 5-15 cm). The echomorphology of the lesions was homogenously hypoechoic (n=1) or showed airbronchograms (n=6). Color Doppler sonography revealed a vascular tree pattern (n=5) or a marked presence of blood vessels (n=2). Doppler flow spectral analysis of arteries in investigated patients (n=5) demonstrates a high impedance (triphasic) flow pattern in four patients and a low impedance (monophasic) flow pattern in one patient. CONCLUSIONS: these findings indicate that BAC frequently shows a sonographic pattern of 'pneumonia'.     

Correlation between microbubble contrast-enhanced color doppler sonography and immunostaining for Kupffer cells in assessing the histopathologic grade of hepatocellular carcinoma: preliminary results

PURPOSE: The aim of this study was to determine the histopathologic grades of hepatocellular carcinomas (HCCs) on the basis of the presence of Kupffer cells, using color Doppler sonography with the liver-specific microbubble contrast agent Levovist. METHODS: Color Doppler sonograms generated by stimulated acoustic emission were obtained 7 minutes after intravenous injection of 5 ml of Levovist (300 mg/dl) in patients with histopathologically confirmed HCCs. CT scans were also obtained and evaluated, and hematoxylin and eosin staining for morphologic examination and immunostaining (anti-CD68) for detecting Kupffer cells were performed for confirmation of the sonographic findings. RESULTS: Eighteen tumors had a defect in the color Doppler signal (color void) that corresponded with the baseline gray-scale image of the tumor. On histopathologic examination, these 18 tumors were all found to be either poorly or moderately differentiated HCCs with either a marked reduction in the number of or the absence of Kupffer cells. The remaining 2 tumors showed color signals. Histopathologic examination of these 2 tumors disclosed well-differentiated components within the tumors, with Kupffer cells in the tumor tissue. CONCLUSIONS: Color Doppler sonography using a liver-specific microbubble ultrasound contrast agent appears to reflect the histopathologic features of HCCs and may thus be useful for differentiating liver tumors and determining a treatment strategy.     

Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation.

OBJECTIVE: To determine the spectrum of sonographic findings on gray scale and color Doppler sonography in a series of pathologically proven cases of ovarian and adnexal torsion. METHODS: The study population included 15 patients with surgical confirmation of ovarian or adnexal torsion, or both, who underwent sonographic examination before surgery. All sonograms were reviewed retrospectively. RESULTS: Gray scale abnormalities included the following: complex masses in 11 (73%) of 15 patients, cystic masses in 3 (20%), and a solid mass in 1 (7%). Cul-de-sac fluid was present in 13 (87%) of 15 patients. Adnexal neoplasms were present in 4 (27%) of 15 (1 granulosa cell tumor and 3 dermoid cysts) on pathologic examination. Doppler findings were abnormal in 14 (93%) of 15 patients and normal in 1 (7%). Abnormal Doppler findings included no arterial and no venous flow in 6 (40%) of 15, decreased venous flow with no arterial flow in 5 (33%), decreased venous flow and decreased arterial flow in 2 (13%), and decreased arterial flow with no venous flow in 1 (7%). Small amounts of cul-de-sac fluid were present in 13 (87%) of 15 patients. CONCLUSIONS: The diagnosis of ovarian and adnexal torsion remains challenging. It cannot be based solely on the absence or presence of flow on color Doppler sonography, because the presence of arterial or venous flow does not exclude the diagnosis of adnexal torsion. Comparison with the morphologic appearance and flow patterns of the contralateral ovary will aid in diagnosis.     

Role of color Doppler imaging in diagnosing and managing pregnancies complicated by placental chorioangioma

PURPOSE: The purpose of this study was to evaluate the role of color Doppler imaging in the diagnosis and management of placental chorioangioma. METHODS: The medical records, sonographic reports, and sonograms of all pregnant women who had placental masses diagnosed in our sonography unit during the years 1992 through 2000 and had been evaluated using both gray-scale and color Doppler sonography were included in this study. Subjective evaluation of the amount and distribution of intralesional vascularity by color Doppler imaging was made in all cases. Cases of chorioangioma of the placenta were compared with cases of placental hemorrhage or subchorionic hematoma. The outcomes of the pregnancies were also recorded. RESULTS: Fifteen cases of placental masses were evaluated; 8 of them were identified as placental hemorrhage or subchorionic hematoma on the basis of the sonographic findings. The other 7 cases were identified prenatally as placental chorioangioma, at a mean menstrual age of 23 weeks and a mean maternal age of 29 years. The mean size of the tumor was 6.5 cm (range, 4-13 cm). All cases of chorioangioma showed either substantial internal vascularity or a large feeding vessel within the tumor. Three infants were delivered at term with favorable outcome; 2 of them demonstrated reduction of the intratumoral blood flow during follow-up. The other 4 cases were delivered at or before 32 weeks' menstrual age (1 intrauterine fetal death, 2 terminated pregnancies, and 1 normal infant). No case of placental hematoma demonstrated blood flow within the lesion or was associated with complications of the pregnancy. CONCLUSIONS: Color Doppler imaging helps differentiate placental chorioangioma from other placental lesions and may be useful in the prenatal follow-up of chorioangioma.     

Color and duplex Doppler sonography of hemangiopericytoma

We report the color Doppler sonographic features in a case of hemangiopericytoma of the thigh in a 52-year-old woman. Color Doppler sonography demonstrated the vascularity of the tumor, and spectral analysis showed waveform changes that suggested the presence of intratumoral arteriovenous shunting. The color Doppler findings correlated well with angiographic findings. Color Doppler sonography can demonstrate intratumoral arteriovenous shunting in hemangiopericytoma and may be used to help avoid profuse bleeding when performing a preoperative biopsy.     

肝硬化门静脉高压时脾、胃-肾静脉分流的超声诊断

目的探讨肝硬化门静脉高压时自发性脾、胃-肾静脉分流的彩色多普勒超声（CDFI）表现及其在诊断中的应用价值。方法回顾性分析门静脉高压时自发性脾、胃-肾静脉分流的21例CDFI图像特征。结果（1）自发性脾、胃-肾静脉分流声像图特点是脾、胃区与左肾之间异常走行的迂曲管道,频谱多普勒示其内血流为类似门静脉样频谱,动态观察可见其与左肾静脉相通;（2）在分流支较为粗大时可有间接的声像图表现：肝侧脾静脉内为离肝血流信号;左肾静脉内径增宽、血流速度增快及频谱形态改变。结论门静脉高压时自发性脾、胃-肾静脉分流具有典型的CDFI图像,可作为超声诊断的重要依据。     

Sonographic findings of mesenteric panniculitis: correlation with CT and literature review

PURPOSE: To evaluate the sonographic findings of mesenteric panniculitis (MP) and correlate them with CT findings. METHODS: We retrospectively evaluated the clinical, CT, and sonographic findings in 26 cases of MP in our hospital between January 1997 and July 2003. We also reviewed the sonographic features of MP previously described in the literature. RESULTS: The sonographic findings were well correlated to CT in 24 of 26 patients (92%). In these 24 cases, abdominal sonographic examination revealed a hyperechogenic, well-defined fatty mass (corresponding to the pseudocapsule CT sign) in the root of the mesentery, displacing the bowel loops. We found a clear interface between MP and normal intra abdominal fat. Examination with color Doppler sonography revealed the nondeviated mesenteric vessels within the mass. The persence of MP improved sonographic transmission in 9 obese patients and enabled the retroperitoneal vessels to be clearly visualized. Sonography was unable to demonstrate the preservation of the fat nearest the mesenteric vessels corresponding to the "fatty halo" sign on CT. CONCLUSIONS: Sonography is useful in the diagnostic workup for MP. The characteristic sonographic features of MP (well-defined mass, homogeneous hyperechogenicity of the mass, nondeviated vessels within the mass, and displaced bowel loops) correlate well with CT findings.     

高频彩色多普勒超声对睾丸精原细胞瘤的诊断价值

目的 :总结睾丸精原细胞瘤的声像图特征 ,探讨超声在此类疾病中的诊断价值。方法 :分析总结了 3 9例经术后病理证实的睾丸精原细胞瘤的二维及彩色多普勒超声特征。结果 :睾丸精原细胞瘤声像图表现为 :外生肿块型 9例、内生肿块型 2 6例、弥漫浸润型 4例。 3 9例睾丸精原细胞瘤 ,伴腹股沟及腹膜后淋巴结转移 14例。结论 :高频超声对睾丸精原细胞瘤的诊断及鉴别诊断有很大价值 ,可为临床诊断及治疗提供可靠的信息     

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.