彩色多普勒超声对子宫下段切口处早期胚胎着床的诊断价值

目的探讨子宫下段剖腹产切口处早期胚胎着床的灰阶超声及彩色多普勒超声的特征. 方法 28例子宫下段剖腹产切口处早期妊娠的患者均行超声检查,记录各病例的二维图像及收缩期峰值血流速度和血流阻力指数.结果子宫下段剖腹产切口处早期胚胎着床的二维图像具有特征性表现,部分病例彩色多普勒频谱表现为高速低阻特征.结论彩色多普勒超声是无创性诊断子宫下段切口处早期妊娠的可靠方法.     

Gray-scale and Doppler characteristics of fibrous cortical defects in a child

We report the case of a 9.5-year-old boy who underwent sonographic and radiographic examinations because of knee pain. Two fibrous cortical defects were discovered, in his right femur and left tibia; the femoral lesion was seen more easily on sonography than on radiography. On gray-scale sonography, the lesions were characterized as a scalloped indentation of the cortical surface containing hypoechoic soft tissue. On color Doppler sonography, discrete vessels were found at the periphery and within the substance of the lesions, and on spectral Doppler analysis, low-resistance arterial flow was detected in those vessels. Follow-up examinations performed 10 and 19 months after our initial examination showed signs that the lesions were healing. The diagnosis of fibrous cortical defect was suggested by the gray-scale and Doppler sonographic characteristics and confirmed on radiography. Although radiography is required to document these lesions if found incidentally on sonography, follow-up examinations using only sonography may be feasible.     

Granulomatous mastitis: gray-scale and color Doppler sonographic findings

PURPOSE: We examined the roles of gray-scale and color Doppler sonography in the diagnosis of granulomatous mastitis. METHODS: We retrospectively studied the clinical, mammographic, and sonographic findings in 10 women 24-57 years old (mean age, 35.9+/-13.9 years) who had a histopathologic diagnosis of granulomatous mastitis. All patients underwent gray-scale sonographic examination, and 8 patients were further examined with color Doppler imaging. Seven patients had previously undergone mammography. RESULTS: Mammographic findings were nonspecific in all 7 patients. Gray-scale sonographic findings were compatible with mastitis in 6 (60%) of 10 patients. Doppler examination showed increased arterial and venous vascularization within and around the lesion in 5 of 8 patients, but the spectral analysis findings were not specific for granulomatous mastitis. CONCLUSIONS: Neither mammography nor Doppler sonography plays a significant role in the differential diagnosis of granulomatous mastitis versus fibroadenoma or carcinoma. Gray-scale sonography shows findings specific for granulomatous mastitis in some cases, but all cases require histopathologic confirmation for final diagnosis.     

Color and power Doppler sonography of liver hemangiomas: a dream unfulfilled?

PURPOSE: The aim of this study was to determine whether color Doppler or power Doppler sonography can aid in the diagnosis of hepatic cavernous hemangiomas. METHODS: We imaged 25 hepatic cavernous hemangiomas in 17 patients with gray-scale, color Doppler, and power Doppler sonography. Five malignant lesions were also imaged in the same manner for reference. Hemangiomas had been previously diagnosed by biopsy in 8 patients (15 lesions) and by CT, MRI, and/or tagged red blood cell scanning in 9 patients (10 lesions). RESULTS: Of the 25 hemangiomas, color or power Doppler imaging showed no internal blood flow in 23. Of these 23 lesions, 11 showed a peripheral flow pattern believed to represent flow in displaced blood vessels. This pattern was better visualized with power Doppler imaging in 3 lesions and equally well visualized with color and power Doppler imaging in 8 lesions. Two hemangiomas that had unusual central fibrosis with large vessels in 1 patient showed diffusely increased blood flow on power Doppler study. All 5 malignant lesions showed flow in peripheral vessels, and 1 showed internal vascularity as well. CONCLUSIONS: Neither color nor power Doppler imaging improved the capability of sonography for making a specific diagnosis of benign hepatic cavernous hemangioma.     

Value of sonography in the assessment of space-occupying lesions of the anterior nasal fossa

PURPOSE: This study was conducted to define the gray-scale, color, and power Doppler sonographic appearances and spectral analysis patterns of anterior nasal masses. METHODS: Eight patients with anteriorly located nasal masses were referred to our hospital for CT of the paranasal sinuses. Subsequently, they were examined with a high-frequency linear-array ultrasound transducer. We performed gray-scale sonography and color and power Doppler imaging. RESULTS: Five masses were nasal hemangiomas. The three remaining masses were a submucosal glandular cyst, a nasolabial cyst, and tuberculum septi hypertrophy. Three of the hemangiomas were histopathologically confirmed. Sonography identified the anatomic origin of all 8 lesions. On color and power Doppler imaging, the 5 hemangiomas exhibited intense vascularity that decreased with compression. Spectral analysis demonstrated arterial and venous flow within the hemangiomas, with resistance indices of 0.60-0.66 and peak systolic velocities of 6.4-18.4 cm/second. The other 3 lesions were avascular or had vascularity only at the periphery. CONCLUSIONS: Anterior nasal fossa tumors can frequently be diagnosed by clinical examination, but specific sonographic and Doppler patterns can help to establish the anatomic origin, the local extension, and the correct diagnosis in indeterminate cases, obviating other diagnostic imaging or surgical procedures.     

Sonographic findings in glomus tympanicum tumor

A glomus tympanicum tumor that is associated with a visible retrotympanic mass is the most frequent cause of pulsatile tinnitus. The preoperative diagnostic approach to this lesion includes a meticulous physical examination as well as high-resolution CT, magnetic resonance angiography, and digital angiography, which can also be used for preoperative embolization. We report the use of color transcranial Doppler sonography in the evaluation of glomus tympanicum tumor in a 67-year-old woman with a 3-year history of left tinnitus. An otoscopic examination revealed a reddish pulsatile mass behind an intact tympanic membrane. No lesions were visualized on gray-scale sonography. Contrast-enhanced color transcranial Doppler sonography showed a vascular ovoid mass that measured 2 x 1 x 1 cm; spectral analysis of the lesion revealed arterial flow with a low resistance index. Color transcranial Doppler sonography helped define the dimensions and vascular characteristics of the lesion.     

Splenic artery aneurysm: value of color Doppler and the limitation of gray-scale ultrasonography

Background: To reevaluate the advantages and limitations of gray-scale and color Doppler sonography in the diagnosis of splenic artery (Sp-A) aneurysm. Methods: We reviewed the gray-scale and color Doppler sonograms of five cases with Sp-A aneurysm (four patients with portal hypertension and one patient without portal hypertension). Color Doppler sonography was performed in all five patients, and power Doppler sonography was performed in three. Results: Gray-scale sonography failed to detect the aneurysm in four of five cases because of a surrounding splenorenal (Sp-R) shunt in three patients and marked calcification of the aneurysmal wall in one patient. Pulsed Doppler sonography showed a slightly turbulent pulsatile flow along the aneurysmal wall, which immediately led to the diagnosis in four cases, including the three cases with Sp-R shunt. In one case, color Doppler sonography failed to detect the aneurysm because of a markedly calcified aneurysmal wall, although power Doppler sonography could visualize the aneurysm. Conclusions: Gray-scale sonography is not a useful diagnostic tool for Sp-A aneurysm. Clinicians should use color Doppler sonography in the evaluation of the splenic hilus in patients with Sp-R shunt to find a small Sp-A aneurysm. The addition of power Doppler sonography is helpful in visualizing calcified Sp-A aneurysms.     

Pancreatic arteriovenous malformation presenting as cysts: Doppler sonographic diagnosis

A 50-year-old man presented with multiple lesions resembling cysts throughout the pancreas on gray-scale sonography. Pulsatile blood flow detected within the lesions on color Doppler sonography led to the diagnosis of pancreatic arteriovenous malformation (PAVM). Most previously reported PAVMs have been described as having a poorly defined, reticular, or mosaic-like hypoechoic appearance on gray-scale sonography; the cystic appearance of the PAVM seen in our case is unusual.     

Torsion of the spermatic cord: sonographic diagnosis

This article describes the ultrasound guidelines for evaluating patients with spermatic cord torsion, including gray-scale, Doppler with spectral analysis, and color and power Doppler sonography. The sonographic and Doppler features of acute, subacute, and chronic torsion of the spermatic cord are demonstrated and discussed.     

Differential diagnosis of solid breast lesions: contribution of Doppler studies to mammography and gray scale imaging.

OBJECTIVE: To assess the role of Doppler sonography when used in conjunction with mammography and gray scale sonography in differentiating solid breast lesions and to find out whether lesion size is a limiting factor for Doppler evaluation. METHODS: One hundred twelve lesions (70 malignant and 42 benign) detected with mammography and sonography were prospectively examined with color, power, and pulsed Doppler sonography. Vascularity was analyzed morphologically (vessel location, form, and color tone) and semiquantitatively (by spectral indices) to determine the valuable diagnostic flow characteristics. The lesions were classified by 2 observers as benign or malignant on the basis of each diagnostic technique (namely, a combination of mammography and gray scale sonography, presence or absence of blood flow, morphologic flow analysis, and spectral flow analysis). The results were compared with the histologic diagnosis in 105 lesions and with the clinical and radiologic diagnosis after at least 2 years of follow-up in 7 lesions. RESULTS: The sensitivity and specificity of the mammography-gray scale sonography combination were 98.6% and 76.2%, respectively. Neither morphologic nor spectral Doppler analysis proved to be successful on its own, however, information obtained from investigated morphologic and spectral flow features increased the specificity of mammography and gray scale sonography for lesions 10 mm and smaller (from 88.9% to 100%) and those larger than 10 mm (from 70% to 96.6%). CONCLUSIONS: Our data show that Doppler sonography is a beneficial adjunct to mammography and gray scale sonography for solid breast lesions 10 mm and smaller and those larger than 10 mm.     

Differential diagnosis of hepatic cystic lesions with gray-scale and color Doppler sonography

PURPOSE: This study was conducted to evaluate the effectiveness of sonography, especially color Doppler sonography, in the differential diagnosis of cystic hepatic lesions. METHODS: Ninety-two pathologically or clinically proven hepatic cystic lesions (20 cystic malignancies, 24 abscesses, and 48 simple cysts) were evaluated with gray-scale and color Doppler sonography. The sonographic features were analyzed retrospectively. The percentage, sensitivity, specificity, and positive and negative predictive values of the sonographic features of each disease category were calculated. RESULTS: On gray-scale sonography, the simple cysts were easily distinguished from cystic malignancies and abscesses. While no significant differences were found between hepatic cystic malignancies and hepatic abscesses with respect to the number, shape, margin status, and presence of thick wall of the lesion, the presence of septation and mural nodules was significantly higher in the cystic malignancies than in abscesses. The sensitivity and specificity of color Doppler sonography in differentiating cystic malignancies from abscesses and simple cysts were 85% and 96%, respectively. CONCLUSIONS: Color Doppler sonography provides information about blood flow that supplements that gained on gray-scale sonography, and the presence of color signals in the solid portion of the cystic lesions carries a high diagnostic value in differentiating hepatic cystic malignancies from abscesses and simple cysts.     

Gonadal brucellar abscess: imaging and clinical findings in 3 cases and review of the literature

We report the cases of 3 patients with brucellar gonadal abscess who were examined with gray-scale and color Doppler sonography. In these 3 cases, sonography revealed a thick-walled avarian (n = 2) or testicular (n = 1) abscess. Duplex Doppler sonography indicated a low-resistance type of flow in all 3 patients. The diagnosis of brucellar gonadal abscess is difficult, because it may have a misleading tumor-like appearance. Awareness of the imaging findings of gonadal abscess in patients with brucellosis and correlation with the results of serologic testing can allow early diagnosis, especially in endemic areas.     

Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs

Scrotal ultrasonography (US) is usually the initial imaging modality for evaluating patients who present with acute pathologic conditions of the scrotum. Acute epididymitis, acute epididymo-orchitis, torsion of the spermatic cord (TSC), and other acute scrotal abnormalities may have similar findings at clinical examination. Pain and swelling make the clinical examination difficult, sometimes practically impossible, potentially resulting in management delays. The objective of this review is to summarize the main clinical signs of the TSC and to illustrate and briefly discuss the US features of this entity, including gray-scale imaging, color Doppler with spectral analysis, and power Doppler sonography. Although TSC can occur at any age, it is most common in adolescent boys. The intensity of the symptoms and the US findings vary with the duration of the torsion, number of twists in the spermatic cord (degree of rotation), and how tightly the vessels of the cord are compressed. An enlarged, more spherical, and diffusely hypoechogenic testis without detectable arterial and venous testicular flow at color and power Doppler US is considered diagnostic of acute testicular ischemia. The presence of a color or power Doppler signal in one part of the testis does not exclude TSC. Positive blood flow but significantly diminished, usually near or inside the mediastinum, may be found, mainly in the partial or incomplete TSC. Identification of a large echogenic extratesticular mass distal to the site of the torsion, frequently misinterpreted as a chronic epididymitis, can be the key to the diagnosis of TSC. When a small arterial sign is found a low amplitude waveform is present with an increased resistive index on the affected side due to a diminished, absent, or reversed diastolic flow. Gray-scale imaging, color Doppler, power Doppler and pulsed Doppler with spectral analysis are very effective to make or exclude the diagnosis of TSC.     

Vascular and nonvascular complications of renal transplants: sonographic evaluation and correlation with other imaging modalities, surgery, and pathology

Cadaveric or living donor renal transplantation is commonly performed in individuals with end-stage renal disease. In recent years, gray-scale sonography, coupled with color Doppler sonography (CDUS), power Doppler sonography (PDUS), or spectral Doppler sonography, has become the primary imaging modality for these patients. Postoperative serial sonography is performed to detect complications and aid in posttransplant management. In addition, sonography is used to guide percutaneous aspiration of fluid or biopsy to diagnose rejection or renal and perirenal masses.In this article we discuss the spectrum of sonographic findings, both vascular and nonvascular, of renal transplant complications, including but not limited to renal arterial and venous stenosis and thrombosis, peritransplant collections (lymphoceles, hematomas, urinomas, and seromas), posttransplant lymphoproliferative disorder, and postbiopsy complications (hematomas, pseudoaneurysms, and arteriovenous fistulas). We correlate sonographic findings with those from other imaging modalities (such as angiography, CT, and MRI) and findings at surgery and pathology when possible.     

Color doppler sonography avoids misinterpretation of the "parallel channel sign" in the sonographic diagnosis of cholestasis.

PURPOSE: The intrahepatic "parallel channel sign" on gray-scale sonograms is generally interpreted as representing dilated bile ducts, but it may also be caused by enlargement of intrahepatic arteries. This study was performed to evaluate the incidence of misinterpretation of the parallel channel sign without color Doppler sonography and the characteristics of patients in whom misinterpretation of the parallel channel sign is likely to occur. METHODS: A total of 1,100 patients were examined by sonography. All patients with a parallel channel sign on gray-scale sonograms underwent color Doppler sonography. In addition, laboratory values related to cholestasis were measured. RESULTS: The parallel channel sign was observed in 57 patients (5.2%). In 35 (61%) of these patients, color Doppler sonography revealed blood flow in both lumina, indicating that the parallel channel sign was not caused by enlarged bile ducts. Eighty-six percent of this group had nonbiliary liver disease; the enlarged hepatic artery branches were associated with liver cirrhosis in 63% of this group. Color Doppler sonography confirmed that the other 22 patients (39%) had an enlarged intrahepatic bile duct. CONCLUSIONS: Use of color Doppler sonography can help avoid misinterpretation of the parallel channel sign, especially in patients with nonbiliary liver disease.     

Color Doppler sonographic diagnosis of dissecting aneurysm of the superior mesenteric artery

We report a case of dissecting aneurysm of the superior mesenteric artery (SMA) diagnosed on gray-scale and color Doppler sonography and confirmed on angiography. Spontaneous dissection of the SMA is rare, and there are few reported cases of the color Doppler sonographic findings. Gray-scale sonography revealed an aneurysmal dilatation of the SMA 3-4 cm from the SMA's origin, with an echogenic linear membrane (an intimal flap) within the aneurysm. Color Doppler sonography showed color flow within the aneurysm and showed that the intimal flap separated the aneurysm into 2 lumina. Spectral analysis revealed anterograde flow in the anterior (ie, true) lumen and retrograde flow in the posterior (ie, false) lumen.     

Early ovarian cancer: 3-D power Doppler

Transvaginal sonography plays an important role in the assessment of the morphology of ovarian lesions. However, the accuracy of the technique is limited due to the significant number of false-positive results. Color Doppler imaging and pulsed Doppler spectral analysis enable evaluation of ovarian tumor blood flow, analysis of the distribution of blood vessels, and quantitative measurement of blood flow velocity waveforms. These parameters increase the sensitivity and specificity of ultrasound evaluation of ovarian tumors. Unfortunately, there is no consensus as to which Doppler parameters and cutoff values are the most predictive of malignancy. Three-dimensional (3-D) power Doppler ultrasound provides a new tool to evaluate features of tumor vascularity. Three-dimensional ultrasound and 3-D power Doppler imaging in patients with “positive” findings on standard ultrasound tests, which encompass annual gray-scale transvaginal sonography followed by transvaginal color Doppler ultrasound in selected cases, represent a novel approach for early and accurate detection of ovarian cancer through screening. Combined evaluations of morphology and neovascularity by 3-D power Doppler ultrasound may improve early detection of ovarian carcinoma. Contrast-enhanced 3-D power Doppler sonography facilitates visualization of adnexal tumor vessels, which may aid in differentiating benign from malignant adnexal lesions.     

Monitoring of fracture calluses with color Doppler sonography

PURPOSE: Fracture callus formation is closely associated with vascular invasion, and the use of color Doppler sonography has been suggested as a means to monitor, earlier than gray-scale sonography, the first stages of the healing process. We report the findings in a series of patients with tibial fractures in whom both gray-scale sonography and color Doppler imaging were employed to monitor new bone formation at the fracture site. METHODS: Twenty patients with tibial fractures treated with external fixator frames were examined sonographically about 10 days after surgery and then about every 25 days until radiographic demonstration of consolidation. RESULTS: Eighteen of 20 patients had a well-developed callus, while the remaining 2 patients showed delayed fracture healing. In patients with normal callus development, color Doppler imaging demonstrated the progressive formation of new vessels until about 100 days from the surgery; at subsequent examinations, flow signals decreased, and bone remodeling was confirmed by conventional radiography and gray-scale sonography. The resistance indices in these patients tended to decrease in the early weeks after surgery and then slightly increased. In contrast, lack of development of flow signals and persistence of high resistance indices were observed in the 2 patients with delayed fracture healing. CONCLUSIONS: Color Doppler sonography seems to have the capability to predict whether the development of fracture calluses will be normal or delayed.     

Power Doppler imaging and evaluation of the resistive index in focal nodular hyperplasia of the liver

Focal lesions of the liver represent a significant diagnostic problem for various imaging modalities. The aim of this study was to assess the value of power Doppler sonography versus conventional color Doppler imaging in the depiction of hypervascular focal nodular hyperplasia (FNH) of the liver and to investigate the resistive index (RI) in the lesions' feeding arteries. Eighteen histologically proved FNHs in 14 patients were evaluated by gray-scale ultrasound, conventional color Doppler, and power Doppler sonography. With conventional color Doppler, a feeding arterial vessel could be depicted in only 4/18 lesions and hypervascularization was detected in 6/18 lesions. Power Doppler was more sensitive in detecting feeding arteries (16/18) within hypervascular lesions (15/18). RI values in the feeding arteries (mean = 0.51) significantly differed from those in the main hepatic artery or its intraparenchymal branches (mean = 0.68) in the same patient. The mean RI-difference was 0.19, suggesting hemodynamically significant arteriovenous shunting. Power Doppler sonography significantly increases sensitivity in the diagnosis of focal nodular hyperplasia of the liver and reliably permits the distinction of these lesions from hepatocellular carcinomas. Received: 17 January 1996/Accepted after revision: 8 May 1996