Doppler color flow analysis of the uterine arteries before and after intrauterine device insertion: a prospective study.

OBJECTIVE: An intrauterine device (IUD) is one of the most frequently used methods of birth control around the world. Although a relationship between its use and menstrual disorders has been well documented, only a few studies have tried to show whether there are any vascular modifications. The aim of our study was to evaluate the influence of an IUD on uterine artery blood flow using Doppler assessment. METHODS: A total of 100 patients selected for IUD use were prospectively evaluated with Doppler analysis before and 30 days after insertion. The resistive index (RI) and pulsatility index (PI) were used to evaluate uterine artery vascular resistance. Patients were allocated in 2 groups according to whether they were (group 2) or were not (group 1) lactating.RESULTS: The PI and RI of the patients in groups 1 and 2 before and after IUD insertion were not statistically significantly different (P = .298 and .23). When we compared uterine artery blood flow indices before and after IUD insertion for groups 1 and 2 separately, we observed in group 1 that the mean +/- SD PI values were 2.45 +/- 0.62 and 2.55 +/- 0.55 (P = .38) and the RI values were 0.87 +/- 0.08 and 0.87 +/- 0.06 (P = .88) before and after IUD insertion, respectively. In group 2, the PI values were 2.31 +/- 0.55 and 2.37 +/- 0.69 (P = .68) and the RI values were 0.85 +/- 0.07 and 0.86 +/- 0.07 (P = .44) before and after IUD insertion. Finally, we used the mean blood flow indices of the uterine arteries of all patients to compare the effect of IUD insertion. Results were also not statistically significant when we compared PI and RI before and after IUD insertion. CONCLUSIONS: The presence of an IUD does not interfere with the vascular resistance of the uterine arteries that can be shown by Doppler flow assessments 1 month after insertion.     

彩色多普勒超声评价子宫肌瘤高强度聚焦超声治疗前后卵巢动脉血流动力学改变

目的探讨彩色多普勒超声在观察高强度聚焦超声（HIFU）治疗子宫肌瘤前后卵巢血供变化中的价值。方法32例子宫肌瘤患者在HIFU治疗前后行卵巢动脉彩色多普勒超声检查,测定收缩期最大血流速度（Vmax）、舒张末期血流速度（Vmin）、阻力指数（RI）和搏动指数（PI）,比较HIFU治疗前后卵巢动脉血流动力学变化。32例患者中随机抽取20例于术前及术后复查时检测卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）和孕酮（P）。结果32例子宫肌瘤患者HIFU术前后卵巢动脉各血流动力学参数无明显变化,P〉0．05;20例患者HIFU治疗前后卵巢内分泌激素比较差异亦无统计学意义（P〉0．05）。结论HIFU治疗子宫肌瘤对卵巢动脉的血供及功能无明显影响。     

Uterine artery embolization as a treatment for symptomatic uterine fibroids: a review of literature and case report

PURPOSE: To provide a case presentation and review of the literature on uterine artery embolization (UAE) as a treatment alternative for symptomatic uterine fibroids and to guide the nurse practitioner (NP) in patient selection, education, and periprocedural management of patients undergoing this procedure. DATA SOURCES: Research articles, clinical articles, and case studies pertaining to UAE. CONCLUSIONS: UAE is a safe, well tolerated, and effective nonsurgical treatment option for symptomatic uterine fibroids. This uterus-sparing procedure has low complication rates with excellent clinical outcomes and high patient satisfaction rates. The majority of women who undergo UAE report marked reduction in the severity of fibroid specific symptoms and significant improvement in their quality of life. Uterine fibroids are common in women and often produce symptoms that have a negative impact on quality of life. IMPLICATIONS FOR PRACTICE: The NP is instrumental in identifying which patients may be appropriate candidates for UAE, educating them about the risks and benefits of the procedure, and managing these patients before and after the procedure.     

Three-dimensional color Doppler sonography before and after fibroid embolization.

Three-dimensional color Doppler sonography was performed within 1 hour, 1 day, 3 months, and 6 months of fibroid embolization in 20 patients who had a total of 31 fibroids greater than 2 cm in average dimension. The greatest decrease in vascularity occurred 1 day after the procedure, whereas the greatest volume change was found at the 3 month follow-up examination. In about one half of the patients scanned, depiction of fibroid vascularity by color Doppler sonography was found to improve the delineation of the size, location, and extent of myometrial involvement. Hypervascular fibroids (12 of 31) tended to decrease in size after treatment more than isovascular (10 of 31) or hypovascular ones (9 of 31). Additional investigations that are similar to this one will be needed to determine if three-dimensional color Doppler sonography can be used to predict those who will be responders, partial responders, or nonresponders to embolotherapy.     

A systematic review and meta-analysis of the safety and efficacy of uterine artery embolization vs. surgery for symptomatic uterine fibroids

Purpose: The aim of this study was to systematically review the safety and efficacy of uterine artery embolization (UAE) versus surgery for symptomatic uterine fibroids.Materials and Methods: An electronic search of the Cochrane Library, PubMed, Embase and Web of Science databases was conducted from their inception to May 2017 for randomized controlled trials (RCTs) that assessed UAE versus surgery for the treatment of symptomatic uterine fibroids. The references of the included studies were also retrieved. Two reviewers independently screened the studies based on the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality. The meta-analysis was conducted using RevMan 5.3 software.Results: A total of seven RCTs involving 859 patients were included. The results of the meta-analysis showed a shorter hospital stay and recovery time for UAE as compared to surgery. Surgery was not reported to be better for improving health-related quality of life in any of the included studies. There were no significant differences in patient satisfaction (1-2 and 5 years), and intra-procedural complications or major complications (1 year). However, the rates of minor complications (1 year) and further interventions (2 and 5 years) were significantly higher in patients who underwent UAE rather than surgery. The rates of pregnancy and live births were significantly lower among patients who underwent UAE than surgery.Conclusion: UAE is safe and effective, and has the advantages of shorter hospital stay and recovery time as compared to surgery. However, UAE has the risk of re-intervention, and lower pregnancy and live birth rates.     

Transperineal versus transvaginal color Doppler imaging of the uterine circulation

Transperineal sonography has been described as being useful in assessing patients in special clinical situations such as posterior placenta previa, preterm labor, stress incontinence, and vaginal atresia. We explored the feasibility of this approach in assessing the uterine circulation in 54 subjects, of whom 36 were postmenopausal. We found that visualization of the uterine artery by the transperineal approach was satisfactory in most patients. The uterine arterial Doppler indices obtained from this approach were compared with those obtained by the transvaginal route. Highly significant correlations were found (correlation coefficient r for pulsatility index = 0.74, p < 0.0001). No significant differences in results between the two approaches were detected using the Wilcoxon Matched-Pairs Signed-Rank test. We conclude that transperineal Doppler studies of the uterine circulation are possible and may be useful in certain patient groups. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25:293–299, 1997     

Fertility after uterine artery embolization: a review

Uterine artery embolization (UAE) research has largely been focused on women over 40 years, yet women of reproductive age undergo UAE without any increased morbidity. Some physicians refrain from recommending UAE to women in this age group because of some research findings showing a negative effect on fertility. This review presents a comprehensive discussion of the fertility potential of women undergoing UAE, in terms of pregnancy rates and complications as well as ovarian function and reserve. Findings indicate many benefits for women desiring fertility who undergo UAE over traditional myomectomy.     

Use of three‐dimensional power doppler sonography in the diagnosis of uterine arteriovenous malformation and follow‐up after uterine artery embolization: Case report and brief review of literature

Arteriovenous malformations (AVM) of the uterus can cause life‐threatening hemorrhage. Unexplained, heavy vaginal bleeding in a reproductive age woman should raise suspicion for an AVM. Here a 37‐year‐old woman had increasingly severe vaginal bleeding for 15 days. Serum β‐hCG was elevated. Two‐dimensional transvaginal ultrasound suggested retained products of conception. Before dilation and curettage (D&C), color Doppler and three‐dimensional (3D) power Doppler demonstrated findings indicative of uterine AVM. A bilateral uterine artery embolization was performed without complications. Three months after uterine artery embolization, 3D power Doppler ultrasonography found complete resolution of the AVM. This case illustrates the importance of assessing both gray‐scale and 3D power Doppler, and the ability of postprocedure Doppler to assess resolution. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:327–334, 2015     

Role of uterine artery Doppler flow in fibroid embolization.

OBJECTIVE: To determine whether Doppler flow measurements are useful in predicting variables associated with uterine fibroid embolization, including shrinkage of the uterus and myomas, adenomyosis, and uterine fibroid embolization failure. METHODS: A group of 227 patients with menorrhagia or postmenopausal bleeding secondary to uterine myomas were evaluated with uterine artery Doppler flow sonography before uterine fibroid embolization. Doppler flow measurements were repeated 6 months after uterine fibroid embolization for 188 of the patients. Data were analyzed for correlations between peak systolic velocity and uterine fibroid embolization patient data, including size and shrinkage of the uterus and myomas, embolization particle size, adenomyosis, and uterine fibroid embolization failure. RESULTS: Initial peak systolic velocity was positively correlated with the size and shrinkage of myomas and uterine volume. Peak systolic velocity was positively correlated with the size and load of embolization particles and was significantly lower (mean, 33.2 cm/s) in patients with adenomyosis than those without adenomyosis (mean, 39.3 cm/s). High peak systolic velocity (>64 cm/s) was a significant predictor of failure. Postembolization peak systolic velocity (mean, 21.85 cm/s) was significantly lower than preembolization peak systolic velocity (mean, 40.33 cm/s) and was not correlated with uterine fibroid embolization variables. CONCLUSIONS: Doppler flow measurements can aid in predicting adenomyosis and uterine fibroid embolization failure. Postembolization peak systolic velocity did not show value.     

Avoidable morbidity in a patient with pseudoaneurysm of the uterine artery after cesarean section

We report the case of a 25-year-old female who presented to the emergency department with vaginal bleeding after a cesarean section. A diagnosis of pseudoaneurysm of the uterine artery was established radiologically; however, failure to consider this potentially life-threatening complication of cesarean section resulted in unnecessary morbidity. Doppler sonography and CT have been shown to be excellent tools for accurate diagnosis of uterine artery pseudoaneurysms, and selective arterial embolization remains the intervention of choice.     

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.     

Persistent median artery in the carpal tunnel: color Doppler ultrasonographic findings.

OBJECTIVE: To describe the ultrasonographic and color Doppler ultrasonographic findings in 2 patients with carpal tunnel syndrome associated with a persistent median artery and to report the frequency of this anatomic variation in healthy volunteers. METHODS: Two patients with the clinical appearance of carpal tunnel syndrome and 100 wrists and distal forearms of 50 asymptomatic volunteers were examined with ultrasonography and color Doppler ultrasonography. The frequency and size of a persistent median artery and its relationship to median nerve anatomy in the carpal tunnel were evaluated. RESULTS: A large persistent median artery of 3 mm in diameter was found in the affected hands in both patients with carpal tunnel syndrome. Findings were confirmed at surgery. Among the asymptomatic volunteers, a persistent median artery could be found in 13 (26%, 10 [20%] unilateral and 3 [6%] bilateral), with a mean diameter of 1.1 mm (range, 0.5-1.7 mm). In 10 (63%) of 16 hands, the persistent median artery was associated with high division of the median nerve or a bifid nerve configuration in the carpal tunnel. CONCLUSIONS: A persistent median artery is a common condition in healthy individuals and in most cases is related to median nerve variations such as high division or a bifid nerve. Because a persistent median artery has a superficial course close to the transverse carpal ligament, preoperative diagnosis of this anatomic variation may be of clinical importance.     

Three-dimensional power Doppler imaging in depicting vascularity in hepatocellular carcinoma.

OBJECTIVE: To assess the ability of three-dimensional power Doppler imaging to depict vascularity in hepatocellular carcinoma. METHODS: Forty-three patients with hepatocellular carcinomas were subjected to two- and three-dimensional power Doppler imaging, and 14 of them also underwent angiography. The delineated amounts of intratumoral Doppler signals were compared between 2 methods of power Doppler imaging in 43 patients. In the 14 patients who also underwent angiography, the patterns of blood supply depicted by 2 methods of power Doppler imaging were compared with that depicted by angiography, and the intratumoral vascularity on three-dimensional projection images and angiograms was also quantitatively assessed by calculating the vascularity-area ratio with graphics software. RESULTS: In comparison with two-dimensional power Doppler imaging, three-dimensional power Doppler imaging was subjectively determined as showing more intratumoral Doppler signals in 32 (74.4%) of the 43 lesions. The accuracies in depicting vascular patterns were 64.3% (9 of 14) for three-dimensional projection images and 14.3% (2 of 14) for two-dimensional slices compared with the results of angiography. The vascularity-area ratios on three-dimensional power Doppler imaging projections and angiograms were 46.0% +/- 25.6% and 48.5% +/- 22.5% (mean +/- SD), respectively (P > .05). Three-dimensional projection images correlated significantly with angiograms in quantifying the vascularity (gamma = 0.87; P < .001). CONCLUSIONS: A three-dimensional power Doppler projection image gives a better overall picture of vascular distribution than a two-dimensional slice and correlates with angiography significantly for delineating vascularity in hepatocellular carcinoma.     

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

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

Value of Doppler sonography for predicting clinical outcome after renal artery revascularization in atherosclerotic renal artery stenosis.

OBJECTIVE: The purpose of this study was to prospectively evaluate the usefulness of Doppler sonography for predicting blood pressure and renal function improvement after percutaneous renal angioplasty in patients with unilateral atherosclerotic renal artery stenosis. METHODS: Thirty-six patients with successfully revascularized unilateral atherosclerotic renal artery stenosis were included. Patients were evaluated by Doppler sonography before treatment, with the resistive index (RI) and acceleration being measured in both kidneys. Blood pressure, number of antihypertensive drugs, and serum creatinine concentration were assessed before treatment and thereafter during a 23 +/- 15-month (mean +/- SD) period. RESULTS: In 20 of the 36 patients (55%), the RI was less than 0.80 before revascularization. After treatment, blood pressure improved in 17 (85%) of those 20 patients and improved in 8 (50%) of 16 patients with an RI of greater than 0.80 (P < .05). Twenty-five patients had renal insufficiency pretreatment, and 11 (44%) had a baseline RI of less than 0.80. Improvement in renal function after angioplasty was shown in 5 (45%) of these 11 patients and in 4 (28.5%) of 14 in the group with high RI (P > .05, not significant). On analysis of acceleration, blood pressure improved in 9 (69%) of 13 patients with acceleration of greater than 3 m/s(2) and in 16 (69.5%) of 23 with acceleration of less than 3 m/s(2) (P > .05). In patients with renal insufficiency, 5 (50%) of 10 cases with normal baseline acceleration and 4 (27%) of 15 with low acceleration showed improvement in renal function (P > .05). CONCLUSIONS: An elevated RI should not exclude patients from a revascularization procedure because, although renal RI does correlate with blood pressure response to revascularization, it is not a useful parameter in predicting renal function outcome. Acceleration has no prognostic value.     

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.     

Three-dimensional quantification of tumor vascularity as a tertiary test after B-mode and power Doppler evaluation for detection of ovarian cancer.

OBJECTIVE: The purpose of this study was to investigate the role of 3-dimensional (3D) quantification of tumor vascularity in the differential diagnosis of pelvic indeterminate masses with a solid appearance or unilocular or multilocular cysts with a solid component showing central vascularization on 2-dimensional power Doppler sonography. METHODS: One hundred fifty-seven consecutive pelvic masses in 153 patients were included in this study and underwent sonography before surgery. Masses that showed a typical benign pattern on B-mode sonography (n = 112) and indeterminate masses with peripheral or absent flow on power Doppler sonography (n = 10) were not evaluated by 3D sonography. Only masses with central vascularization were submitted to 3D power Doppler imaging (n = 35). The following 3D vascular parameters were calculated: relative color and flow measure (similar to the vascularization flow index obtained with other systems). RESULTS: With receiver operating characteristic curve analysis, the best cutoff values for relative color and flow measure were 4.4 and 2.7, respectively. Flow measure had sensitivity of 68% and specificity of 40% in the overall population submitted to 3D power Doppler sonography. Accuracy slightly increased when masses with small papillary projections (<10 mL) were excluded. In this group (n = 22), sensitivity was 83%, and specificity was 50%. CONCLUSIONS: In masses with central vascularization on 2-dimensional power Doppler sonography, the use of 3D quantification of tumor vascularity had low diagnostic accuracy in the detection of adnexal malignancies, although an increase in accuracy in masses with a solid portion of greater than 10 mL was reported.     

彩色多普勒超声在脑梗死患者颈动脉病变中的应用价值

目的:应用彩色多普勒超声检查初步探讨脑梗死与颈动脉粥样硬化病变的关系及特点。方法:对52例脑梗死患者和49例非脑梗死患者进行颈动脉彩色多普勒超声检查。结果:52例脑梗死患者有颈动脉粥样硬化斑块形成者35例,检出率67.3%。颈动脉粥样硬化斑块好发于颈动脉分叉处。软斑、溃疡斑是脑梗死患者的主要栓子来源。结论:颈动脉粥样硬化斑块与脑梗死有密切相关性。彩色多普勒超声检测脑梗死患者颈动脉粥样硬化斑块形成有重要临床价值。     

Evaluation of renal artery stenosis with velocity parameters of Doppler sonography.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of velocity parameters for the diagnosis of renal artery stenosis (RAS) with color Doppler sonography and to determine the optimal threshold values for these parameters. METHODS: The study group was composed of 187 renal arteries, which were examined by color Doppler sonography and angiography. Four Doppler parameters, including the peak systolic velocities (PSVs) in the renal and interlobar arteries, the renal-aortic ratio, and the renal-interlobar ratio (RIR), were measured. Receiver operating characteristic curve analysis was performed to determine the optimal parameter. The sensitivity, specificity, and negative and positive predictive values at various threshold values were calculated. RESULTS: Doppler sonographic examination was technically successful in 96% of renal arteries (180/187). The RIR was determined to be the best parameter. With threshold values of RIR greater than 5, PSV greater than 150 cm/s in the renal artery, renal-aortic ratio greater than 2, and PSV less than 25 cm/s in the interlobar artery, the sensitivity values were 88%, 81%, 70%, and 74%, respectively. An RIR greater than 5 and PSV less than 15 cm/s in the interlobar artery provided the optimal combination of parameters, with sensitivity and specificity of 91% and 87%, respectively. CONCLUSIONS: The RIR is the best velocity parameter in the detection of RAS (> or =50%), and its best cutoff is 5. Valuing influencing factors of PSV in the renal artery will help reduce misdiagnosis. The combination of RIR greater than 5 and PSV less than 15 cm/s in the interlobar artery provides the best diagnostic efficiency of RAS.