Torsed appendix testis: gray scale and color Doppler sonographic findings compared with normal appendix testis.

OBJECTIVE: The purpose of this study was to compare the size, shape, echogenicity, and blood flow of the appendix testis on sonography in control subjects and in patients with a torsed appendix testis and to evaluate the usefulness as well as the limitations of these criteria. METHODS: This was a retrospective analysis of 11 lesions with torsed appendix testes and 15 normal appendix testes in 12 children. The following gray scale and color Doppler sonographic features were analyzed: size, shape, echogenicity, and blood flow of the appendix testis. RESULTS: The size of the appendix testis was larger in patients with a torsed appendix testis than in the control subjects (P < .05). A spherical shape of the appendix testis was more common in patients with a torsed appendix testis (P < .05). There was no blood flow within both the torsed and normal appendix testes. However, the frequency of increased periappendiceal blood flow was higher in patients with a torsed appendix testis (P < .05). There was no significant difference in the echogenicity between the torsed and normal appendix testes. CONCLUSIONS: Gray scale and color Doppler sonography may be helpful in the diagnosis of torsion of the appendix testis. A size of 5 mm or larger, spherical shape, and increased periappendiceal blood flow are indicative of a torsed appendix testis.     

Intratesticular varicocele: gray scale and color Doppler sonographic appearance.

OBJECTIVE: The purpose of this study was to evaluate the gray scale and color Doppler appearances of intratesticular varicocele (ITV) in a relatively large series of men and to compare the findings with those previously reported. METHODS: Fifteen ITVs found in 12 men referred for sonographic examination of a variety of scrotal conditions were retrospectively evaluated. Review of the side, location, shape, and diameter of the dilated veins, the presence of an extratesticular varicocele (ETV), and the color Doppler appearance of the ITV before and during the Valsalva maneuver was performed. RESULTS: Seven (47%) of 15 ITVs were located in the left testis, 2 (13%) in the right, and 3 (20%) bilateral. Eighty-six percent of the ITVs were associated with an ipsilateral ETV. The locations of the ITVs were subcapsular in 60% of the cases and within or near the mediastinum of the testis in 40%. The shapes of the ITVs were tubular in 46%, oval in 27%, and both tubular and oval in the remaining 27%. Color Doppler imaging showed spontaneous flow in 60% of cases, whereas in the remaining 40%, the blood flow could be seen only after the Valsalva maneuver. CONCLUSIONS: Intratesticular varicocele is a rare condition with a variable clinical and sonographic appearance. It is usually associated with ETV. It occurs in the left, right, or both testes and may be subcapsular or mediastinal in location. The prevalence of a subcapsular location of ITVs in this series was by far higher than previously mentioned in the literature. The Valsalva maneuver plays a very important role in the diagnosis of ITV because in almost half of cases, the flow will not show up spontaneously.     

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

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

The sonographic and color Doppler features of retained products of conception.

OBJECTIVE: The purpose of this study was to identify the sonographic features of retained products of conception (RPOCs). METHODS: Cases of clinically suspected RPOCs referred for pelvic sonography between September 1994 and July 2001 were identified. Patient age, indication, gestational age at delivery, and days postpartum were recorded and sonographic findings were reviewed. Outcomes were determined from medical records and pathology reports. RESULTS: One hundred sixty-three cases were identified. Indications for pelvic sonography included vaginal bleeding in 82 (50%), pelvic pain in 77 (47%), and fever in 55 (34%). Gestational age at delivery ranged from 14 to 43 weeks (mean, 37 weeks), and the sonographic examination was performed from 0 to 95 days postpartum (mean, 21 days). Thirty-six patients underwent surgical intervention, and 28 of these had RPOCs. The remaining 127 patients were followed clinically. An endometrial mass was the most sensitive (79%) and specific (89%) sonographic feature for RPOCs. The isolated finding of either complex fluid in the endometrial canal or a thick endometrium measuring greater than 10 mm had low sensitivity, specificity, and negative and positive predictive values. None of the patients with RPOCs had normal sonographic findings. The absence of an endometrial mass or complex fluid and an endometrial thickness of less than 10 mm were considered normal findings. Color Doppler flow was detected in the endometrium somewhat more often when RPOCs were present than in the absence of RPOCs (75% versus 40%). CONCLUSIONS: An endometrial mass is the most sensitive finding for RPOCs. If no mass or endometrial fluid is seen and the endometrial thickness is less than 10 mm, RPOCs are extremely unlikely. The absence of blood flow does not exclude the diagnosis of RPOCs.     

新型超声造影技术的彩超造影与实时灰阶造影对肝占位病变的应用

目的:应用新型超声造影剂及超声匹配成像新技术,比较彩超及实时灰阶超声造影两种方法对肝占位性病变的应用价值。方法:对35例肝占位性病变总计77个病灶中的42个重点进行造影观察。结果:彩超造影前后血流增强程度评价差异显著(P<0.001);实时灰阶造影结果显示可明显提高肿瘤的定性诊断率(P<0.001)。本组35例造影前为77个病灶,彩超造影后为77个病灶;而实时灰阶造影后共计发现101个病灶,增加24个(23.8%)。结论:彩超造影可以提高肝占位性病变的血流检出率,有助于诊断;实时灰阶造影不仅可对肝占位性病变作出定性诊断,还能提高病灶的检出率。故灰阶超声造影较彩超造影更为重要。     

Contrast-enhanced power Doppler sonography in breast lesions: effect on differential diagnosis after mammography and gray scale sonography.

OBJECTIVE: To evaluate the efficacy of contrast-enhanced power Doppler sonography in the differential diagnosis of breast lesions after a mammography-gray scale sonography combination. METHODS: Sixty-eight patients with 69 breast masses underwent power Doppler sonography before and after intravenous injection of a contrast agent. The lesions were diagnosed as "highly suggestive of malignancy" (category 5; n = 32), "suspicious" (category 4; n = 21), and "probably benign" (category 3; n = 16) by mammography and gray scale sonography, modeled on the American College of Radiology Breast Imaging Reporting and Data System classification. Power Doppler findings did not affect patient treatment. The authors subjectively evaluated the estimated area of vascularity, degree of enhancement following contrast agent administration, morphologic features, and distribution of vessels within the lesions. RESULTS: The final diagnoses were malignant in 28 lesions and benign in 41. Significant enhancement after contrast agent injection was detected in both the malignant and benign groups. Only 2 criteria, estimated area of vascularity and degree of enhancement following contrast agent administration, proved to be significant diagnostic determinants for contrast-enhanced power Doppler sonography (P < .001; interobserver agreements, 74.4 and 77.8, respectively). Contrast-enhanced power Doppler sonography provided a higher specificity, positive predictive value, and negative predictive value than power Doppler sonography but a lower sensitivity and negative predictive value than mammography-gray scale sonography. Only in the category 4 lesions could the combination of mammography-gray scale sonography and contrast-enhanced power Doppler sonography accomplish a higher specificity (71%) and positive predictive value (70%) than mammography-gray scale sonography (39% and 53%, respectively). CONCLUSIONS: Power Doppler and contrast-enhanced power Doppler sonography cannot be recommended as confirmatory tests in Breast Imaging Reporting and Data System category 3 and category 5 lesions. Although contrast-enhanced power Doppler sonography may help reduce unnecessary biopsies in Breast Imaging Reporting and Data System category 4 lesions, recommendation of its use has many drawbacks, such as imperfectly established criteria, lack of absolute certainty, and high cost.     

Transvaginal gray scale and color Doppler sonography in primary ovarian cancer and metastatic tumors to the ovary.

OBJECTIVE: To compare gray scale and color Doppler features of primary and metastatic ovarian carcinomas. METHODS: Clinical, sonographic (gray scale and color Doppler), and histopathologic data of 143 patients with primary (n = 127 adnexal masses) and metastatic (n = 34 adnexal masses) ovarian cancer were reviewed. Morphologic gray scale parameters assessed were bilaterality, tumor volume, echogenicity, and presence of septa, papillary projections, or solid areas. Color Doppler parameters were presence of blood flow, tumor blood flow location (central versus peripheral), subjective impression of blood flow amount (scanty, moderate, or abundant), lowest resistive index, lowest pulsatility index, and maximal peak systolic velocity (centimeters per second). RESULTS: No statistical differences were found in bilaterality, tumor volume, presence of septa, papillary projections or solid areas, presence of blood flow, tumor blood flow location, subjective impression of blood flow amount, lowest resistive index, lowest pulsatility index, and maximal peak systolic velocity. Metastatic carcinomas were more frequently purely solid tumors (47% versus 26%; P = .001; likelihood ratio, 2.4; 95% confidence interval, 1.2-4.7). CONCLUSIONS: The presence of a purely solid tumor indicates a higher probability of metastatic carcinoma than primary ovarian cancer. However, with the use of gray scale and color Doppler sonography, it is difficult to differentiate primary ovarian carcinomas from metastatic tumors to the ovary.     

Subcutaneous angioleiomyomas: gray-scale and color Doppler sonographic appearances

PURPOSE: To describe the gray-scale Doppler and sonographic features of a series of subcutaneous angioleiomyomas. METHODS: The sonographic appearances of 10 pathologically proven angioleiomyomas were retrospectively reviewed; 4 in women and 6 in men, with an age range from 33 to 77 years. We evaluated size, shape, echo pattern, margins, location, relationships with adjacent structures, and vascularity. Examinations were performed using a multifrequency linear array transducer (9-11 MHz) connected to a Logiq 500 scanner (GE, Milwaukee, Wl). RESULTS: All tumors were subcutaneous and located in the extremities (7 in the lower extremities, 3 in the upper extremities). The sizes ranged from 0.6 to 6.4 cm, with an average size of 2 cm. All of the lesions were hypoechoic with well-defined margins, and 9 were oval. Intratumoral calcifications were observed in two patients. Vascularity was easily detected in all of them, and 4 tumors had a clear vascular pedicle. The spectral Doppler analysis performed in 5 cases, revealing a low-resistance arterial waveform in 4 patients. CONCLUSIONS: Although angioleiomyomas are uncommon soft tissue tumors, the presence of a well-defined, hypoechoic, vascular subcutaneous tumor in the extremities should raise the possibility of such a diagnosis.     

彩色多普勒超声在胃肠间质瘤诊断中的应用价值

目的探讨彩色多普勒超声在胃肠间质瘤诊断中的价值。方法对2001年1月至2005年2月在我院经手术及病理证实的13例胃肠间质瘤的临床及超声诊断资料加以回顾性分析。结果本组病例彩色多普勒超声均表现为有包膜,边界清晰,内部回声均质或不均质的实质性肿块,血供丰富。结论彩色多普勒超声对胃肠间质瘤,尤其对小肠和结肠间质瘤的诊断是经济、有效而无痛苦的诊断手段。     

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.     

Detection and characterization of perianal inflammatory disease: accuracy of transperineal combined gray scale and color Doppler sonography.

OBJECTIVE: To evaluate the accuracy of transperineal gray scale and color Doppler sonography for the detection and characterization of perianal inflammatory disease with surgical correlation. METHODS: Eighty-seven patients with suspected perianal inflammatory disorders underwent transperineal gray scale and color Doppler sonography with a linear 4- to 7-MHz transducer that was used to scan the entire perianal region for the detection of suspected inflammatory disorders. Each detected inflammatory disorder was evaluated to determine its morphologic characteristics and extent. Color Doppler sonography was applied to assess the presence of increased vascularity in the perianal region. In comparison with surgical findings, the diagnostic performance of transperineal sonography was assessed by means of receiver operating characteristic analysis for lesion detection and the Spearman rho test for lesion characterization. Logistic regression analysis was used to assess whether increased perineal vascularity was a predictive factor of perianal inflammatory disease. RESULTS: Seventy-seven perianal inflammatory disorders were confirmed in 62 patients. Gray scale sonography achieved a significantly good performance in the detection (area under the curve = 0.86; P < .001) and characterization (r = 0.65; P < .001) of perianal inflammatory disease. For the detection of perianal fistulas and abscesses, sensitivity was 100% for both, and specificity was 100% and 94%, respectively. With the use of color Doppler sonography, the diagnostic confidence increased slightly (area under the curve = 0.89) but significantly (P = .002). Logistic regression analysis identified hypervascularity at the periphery of a perianal lesion as a significant independent predictor of an inflammatory disease. CONCLUSIONS: Combined gray scale and color Doppler sonography enables a high detectability rate and comprehensive characterization of perianal abscesses and fistulas.     

高频彩色多普勒超声在睾丸附睾急症诊断中的应用

目的探讨高频彩色多普勒技术诊断睾丸附睾急症的价值。方法回顾分析111例睾丸附睾急症患者的声像图资料。结果 111例中,急性附睾炎68例,急性睾丸附睾炎8例,睾丸扭转16例,睾丸附件扭转3例,睾丸血肿10例,睾丸破裂6例。结论高频彩色多普勒超声在诊断睾丸附睾急症方面有很高的临床价值。     

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.     

彩色多普勒血流显像在睾丸炎及附睾炎诊断中的应用

目的探讨彩色多普勒血流显像（cDFI）对睾丸炎及附睾炎的诊断价值。方法应用CDFI对75例睾丸炎及附睾炎进行检查。结果75例患者中睾丸炎25例，附睾炎35例，睾丸附睾炎15例。结论CDFI对睾丸炎与附睾炎疾病的诊断具有较高的应用价值。     

附睾炎及精索炎的彩色多普勒诊断价值

目的 探讨彩色多普勒超声在急、慢性附睾炎及精索炎诊断中的临床价值。方法 采用ATL超9、Sequoia 512、Aloka SSD-3500彩色超声诊断仪，探头频率5～10MHz，对病患部位进行观察。结果 附睾炎及精索炎急性期在二维图像上表现为不同程度的低回声水肿、体积增大，彩色多普勒显示血供丰富等血流动力学改变，治疗后血流明显减少。慢性期二维图像表现为病患部位回声增粗、不均匀，周边毛糙、不平，彩色多普勒显示血供减少，血流速度低于正常。结论 由于超声图像直观，解剖特征强，方便易行，应用于附睾及精索检查时，根据组织形态及血流信号的改变，可作为诊断与疗效评定的重要指标。     

Doppler sonographic assessment of posttraumatic reflex sympathetic dystrophy.

OBJECTIVE: To reveal the arterial Doppler sonographic findings in cases of posttraumatic reflex sympathetic dystrophy METHODS: Eleven patients had hand reflex sympathetic dystrophy, and 9 had foot reflex sympathetic dystrophy. The duration of symptoms ranged from 1 to 28 weeks, and the history of fracture ranged from 6 to 48 weeks. Bilateral brachial or popliteal arteries proximal to injuries were evaluated by Doppler sonography with a 7.5-MHz linear transducer. All patients also had triphasic bone scintigraphy and extremity thermography RESULTS: Two patients had monophasic waveforms and 4 had low-pulsatility triphasic waveforms on the affected limbs when compared with the asymptomatic limbs. All opposite asymptomatic limbs had normal triphasic waveforms in these 6 cases. Spectral analysis revealed a loss or decrease of a normal reversed flow component with a reduced pulsatility index on the affected limb. Fourteen other patients had symmetric triphasic waveforms. We observed that the patients who had stage 1 reflex sympathetic dystrophy and warm limbs with durations of symptoms of more than 2 weeks had positive Doppler sonographic findings, whereas all patients with stage 2 reflex sympathetic dystrophy and all with normal skin temperature, regardless of stage, had normal waveforms. CONCLUSIONS: Doppler sonography revealed loss of normal triphasic arterial waveforms in some of the cases of stage 1 disease, whereas many cases of stage 1 disease and all cases of stage 2 disease had normal findings. Therefore, we think that Doppler sonography cannot be used for the diagnosis of reflex sympathetic dystrophy but may help in assessing hemodynamic stages of the disease.     

Ovarian sclerosing stromal tumors: gray scale and color Doppler sonographic findings.

Sclerosing stromal tumors are rare benign ovarian stromal tumors, which have distinctive clinical and pathologic features. The tumors occur predominantly in the second and third decades and are histologically characterized by the pseudolobular pattern of the cellular and hypocellular areas, marked vascularity, and heterogeneity of the cellular area. We analyzed 7 cases of sclerosing stromal tumors, which showed a typical sonographic appearance. On sonograms, sclerosing stromal tumors were solid and cystic and contained multiple round or cleftlike cysts. Ascites was rare. On transvaginal color Doppler sonograms, sclerosing stromal tumors were very hypervascular in the peripheral solid area and internal intercystic space and showed low-impedance flow. We conclude that sclerosing stromal tumors should be considered in young women with menstrual irregularity who have hypervascular solid and cystic adnexal masses.     

彩色多普勒超声造影在诊断肝肿瘤中的应用

目的 探讨超声造影剂Sono Vue在彩色多普勒超声造影诊断肝肿瘤中的应用。方法 对32例肝占位性病变(直径11～112mm，平均43mm；其中良性13例，恶性19例)进行彩色多普勒超声造影，造影剂采用Sono Vue，浓度5mg／ml，观察造影后肝肿瘤内血流增强情况。结果 良性病变血流显示率由造影前的53．8％提高到造影后的76．9％，恶性病变血流显示率则由78．9％提高到100％。肝肿瘤诊断符合率造影前为75．0％(24／32)，造影后为90．6％(29／32)。结论 Sono Vue彩色多普勒超声造影反映肝肿瘤内的血供情况有较高的敏感性和特异性，对肝肿瘤的鉴别诊断及提高诊断准确性有较大帮助。     

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.