Sonographic evaluation of penile trauma.

OBJECTIVE: The purpose of this presentation is to illustrate the normal sonographic anatomy of the penis and various imaging manifestations of penile trauma. METHODS: Penile trauma cases were collected and reviewed retrospectively from our archive. RESULTS: The normal sonographic anatomy of the penis and various pathologic conditions of patients with penile trauma are discussed. CONCLUSIONS: Sonography (especially with color Doppler sonography) is a useful imaging method for evaluating penile anatomy and various pathologic features in patients with penile trauma.     

Penile compartment syndrome: a possible explanation for penile pain in peyronie disease shown by penile sonography.

OBJECTIVE: Our purpose was to describe sonographic findings in patients with Peyronie disease that may explain persistent penile pain in these patients. We propose the term penile compartment syndrome for use in radiology and urology practice to describe this condition. METHODS: Thirty-five consecutive patients were examined. All these patients had clinically "mature" plaques with Peyronie disease. Penile duplex sonography was performed as part of the patient evaluation before possible corrective surgery. RESULTS: All patients had the classic sonographic finding of plaques in the tunica albuginea. Persistent venous insufficiency was noted in 3 patients (8.6%); we observed arterial insufficiency during dynamic evaluation of blood flow in 2 (5.8%); and in 2 cases, a low peak systolic velocity was accompanied by an abnormal cavernous artery structure. Four patients (11.4%) had extensive circular plaques in the tunica albuginea, limiting expansion of the cavernous body during erection, as shown by a constant cavernous body diameter of the affected side compared with an increasing diameter of the unaffected side during the progressive phases of erection. Patients with a constricting ring of plaques had persistent penile pain during erection as well as after injection during penile duplex sonography. CONCLUSIONS: Peyronie disease is caused by replacement of penile tunica albuginea tissue with inelastic scarring. One manifestation of Peyronie disease is painful erection. In patients with persistent erectile pain, we found circumferential inelastic scarring of the tunica albuginea. The findings of penile compartment syndrome on penile sonography may influence the urologist's choice of surgical technique for treating Peyronie disease.     

Cavernosal arterial anatomic variations and its effect on penile hemodynamic status.

OBJECTIVE: With continuous improvements in ultrasound technology, small vessels with remarkably slow blood flow that may not be assessed by color Doppler ultrasonography, can be evaluated using power Doppler ultrasonography. In the present study, penile arterial anatomic variations were determined with power Doppler ultrasonography and its impact on penile hemodynamic status. METHODS: A total of 54 patients with erectile dysfunction were evaluated with power Doppler ultrasonography. The effects of vascular anatomic variations and the structure of the corpora cavernosa and tunica albuginea on vascular status were assessed on both sides. RESULTS: A normal penile vascular system was observed in 35.2% and 25% of 54 patients (mean age: 46.6+/-11.5 years) at the radix and mid-shaft of the penis, respectively. Pure arterial component was observed in 40.7% (22/54) and 47.2% (17/36) of the patients at the base and mid-shaft of the penis, respectively. Penile arterial insufficiency was severe in 9.2 and 5.5% of the patients at the base and mid-shaft of the penis, respectively, whereas intrapenile truncus was found in six patients (5.5%), the ratio of single cavernosal artery, intrapenile and extrapenile bifurcations were 69.4, 7.4 and 12.0%, respectively. Twenty (18.5%) dorso-cavernosal perforators, 15 (13.9%) cavernoso-dorsal and 30 (27.8%) intercavernosal branches were found. Peak systolic blood flow velocity values were decreased in 12 of 36 patients (33.3%) distally, while increased blood flow was observed in 11 (30.5%). CONCLUSIONS: Hemodynamic parameters might be variable at either side of the penis and depend on intrapenile arterial anatomic variations. Parameters determined using power Doppler ultrasonography should be evaluated from the proximal to distal side of the penis to obtain reliable and standard results. However, variations of penile arterial anatomy and its effect on penile hemodynamic changes should not be overlooked especially in the patients who are candidates for penile reconstructive or vascular surgery.     

非血管性勃起功能障碍患者阴茎-尿道海绵体血管连接的彩色多普勒研究

目的 探讨非血管性勃起功能障碍(ED)患者阴茎-尿道海绵体血管连接(CSS)的形态及血流动力学特征.方法 应用彩色多普勒超声(CDUS)检测22例非血管性ED患者阴茎CSS形态和血流动力学状况.结果 勃起前所有病例阴茎均可观察到1～3支CSS,且都为朝向尿道海绵体的低速动脉频谱;勃起后阴茎可观察到CSS达4～8支,亦均为朝向尿道海绵体的动脉频谱,但其收缩期峰值速度(PSV)高于勃起前(P<0.001),RI则低于勃起前(P<0.05).阴茎勃起时CSS的PSV及RI均低于CA(P<0.001),但其PSV明显高于尿道海绵体动脉(UA)(P<0.001),而RI低于后者(P<0.001).结论 非血管性ED患者阴茎CSS为血流方向朝向尿道海绵体的动脉连接.     

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.     

Doppler sonography of the penile cavernosal artery: comparison of intraurethral instillation and intracorporeal injection of prostaglandin E1

PURPOSE: We compared the Doppler sonographic findings in the penile cavernosal artery (arteria profunda penis) after intraurethral instillation and intracorporeal injection of prostaglandin E1 (PGE1) to evaluate the hemodynamic changes during drug-induced erection. METHODS: Twenty healthy male volunteers were enrolled in the study. Ten subjects (intraurethral group) were examined with Doppler sonography of the penile cavernosal artery after intraurethral administration of 1 mg of PGE1. The remaining 10 subjects (intracorporeal group) underwent Doppler sonography of the cavernosal artery after intracorporeal injection of 5 microg of PGE1. The peak systolic velocity, minimal diastolic velocity, and resistance index were determined at 5-minute intervals for 30 minutes following administration of PGE1 in both groups. The results were compared between the 2 groups. RESULTS: The peak systolic velocity in the intraurethral group increased progressively from a mean of 31.1 cm/second at 5 minutes to 65.6 cm/second at 30 minutes after intraurethral administration of PGE1. In the intracorporeal group, the mean peak systolic velocity ranged from 44.1 to 83.2 cm/second, reached a maximum at 10 minutes, and then decreased continuously through 30 minutes after intracorporeal injection of PGE1. The mean peak systolic velocities were significantly higher in the intracorporeal group at 10 and 15 minutes (p < or = 0.05); the mean minimal diastolic velocities were significantly lower in the intracorporeal group at 15, 20, and 25 minutes (p < or = 0.05); and the mean resistance indices were significantly higher in the intracorporeal group at all time points except 5 minutes (p < or = 0.05). CONCLUSIONS: The intracorporeal injection of PGE1 produced a greater vasoactive response in the cavernosal artery than did intraurethral instillation.     

Color Doppler sonographic mapping of pulmonary lesions: evidence of dual arterial supply by spectral analysis.

OBJECTIVE: Within pulmonary lesions, flow signals of pulmonary arteries can be discriminated from flow signals of central bronchial and peripheral bronchial arteries on color Doppler sonography. Our aim was to evaluate the evidence and frequency of different arterial supplies of pleural-based pulmonary lesions using qualitative and quantitative color Doppler sonography. METHODS: Forty-one patients with roentgenologically confirmed pleural-based pulmonary lesions were investigated by color Doppler sonography. The following parameters were investigated: (1) qualitative color Doppler sonographic evidence of vascularization, (2) quantitative color Doppler sonographic evidence of arterial flow signals (resistive index and pulsatility index), and (3) number of different arterial flow signals in 1 lesion by color Doppler sonographic mapping. RESULTS: We found no vascularization in 5 patients, sparse vascularization in 21, and pronounced vascularization in 15. Quantitative color Doppler sonographic parameters were as follows: mean pulmonary artery resistive index, 1.2; mean central bronchial artery resistive index, 0.5; mean peripheral bronchial artery resistive index, 0.7; mean pulmonary artery pulsatility index, 7.8; mean central bronchial artery pulsatility index, 0.7; and mean peripheral bronchial artery pulsatility index, 1.6. There was a significant difference between all types of flow signals for resistive and pulsatility index values but not between pulmonary and peripheral bronchial arteries (P = .068). In 41 patients, 57 different arterial flow signals were determined; 19 (46%) of these patients had 2 or more different arterial flow signals in a lesion. There was no significant difference between benign and malignant lesions regarding the number of flow signals. CONCLUSIONS: Evidence of at least a dual arterial supply can be found on quantitative color Doppler sonography in almost 50% of pulmonary lesions. A single spectral analysis is not suitable for characterization of the arterial supply of pulmonary lesions.     

Post-traumatic erectile dysfunction: Doppler US findings

Erectile dysfunction can happen after trauma, particularly with vertebral, pelvic, or perineal injuries. Penile Doppler ultrasonographic (US) findings in these patients are various, from normal to serious arterial impairment, according to the severity and type of injury. With neurogenic causes, Doppler US findings are usually normal, but decreased flow in cavernosal arteries may also be encountered due to combined vascular injury. With arteriogenic causes, relatively or absolutely decreased peak velocity in cavernosal arteries can be encountered. Alterations of penile arterial anatomy are frequently found in these patients and can be secondary changes due to proximal arterial insufficiency. After trauma in the penis or perineum, distortion or reconstruction of vascular anatomy in addition to traumatic sequelae in the erectile tissue can be directly visualized on Doppler US. Venogenic impotence can also be a result of trauma, and Doppler US findings are the same as nontraumatic venous leak. High-flow priapism is another category of post-traumatic erectile dysfunction, which can be diagnosed conclusively by Doppler US. It can be managed by angiographic embolization, and Doppler US is useful in evaluating recurrence and erectile dysfunction after embolization.     

Doppler sonographic findings in children with idiopathic portal vein cavernous deformity and variceal hemorrhage.

OBJECTIVE: To describe the flow patterns in the portal vascular territory in children with portal vein cavernous deformity. METHODS: The study included 12 children (age 4-10 years) with hematemesis, melena, or both in whom B-mode gray scale sonography revealed small anechoic spaces replacing the site of the portal vein. The portal vein cavernous deformity was present either alone (in 8 patients) or with congenital hepatic fibrosis (in 4). Doppler sonography (color and spectral) was performed to assess the flow in the portal vascular territory, splenic vein, intrasplenic veins, and abdominal collaterals. RESULTS: Doppler sonography confirmed the venous flow waveform in the cavernous portal vein in all children with normal flow direction in the few intrahepatic portal vein branches and also in the intrahepatic veins. Splenomegaly was present in all. The intrasplenic veins were dilated in all but had normal flow direction except in 2 with spontaneous trans-splenic shunts. Gallbladder varices were shown in 4 patients, and perisplenic collaterals were shown in 3. CONCLUSIONS: Doppler sonography is a valuable noninvasive imaging technique for assessment of the portal hemodynamic profile in patients with portal vein cavernous deformity, which can affect subsequent treatment decision making. Trans-splenic shunts are uncommon, but this Doppler sonographic report documents such shunts in children with portal hypertension.     

Duplex Doppler sonography of the flaccid penis: potential role in the evaluation of impotence

PURPOSE: Duplex Doppler sonography of the cavernosal arteries of the penis with intracavernous injection (ICI) of vasoactive agents has been widely used to evaluate arterial insufficiency in impotence. Our goal was to assess the potential value of peak systolic velocity (PSV) measurements on the flaccid penis in the diagnosis of arteriogenic impotence. METHODS: Forty-four men underwent duplex Doppler sonography with PSV measurements before and after ICI of prostaglandin E(1). Three different cutoff values for lowest normal PSV before injection-5 cm/second, 10 cm/second, and 15 cm/second-were tested. RESULTS: Thirteen patients had arteriogenic insufficiency based on post-ICI duplex sonography and clinical response. Results for our different cutoff PSV values of 5 cm/second, 10 cm/second, and 15 cm/second in diagnosing arteriogenic impotence were, respectively: sensitivity 29%, 96%, and 100%; specificity 100%, 92%, and 23%; negative predictive value 80%, 92%, and 100%; positive predictive value 100%, 81%, and 41%; and overall accuracy 79%, 93%, and 44%. In the flaccid state, there was a significant difference in mean PSV between the "normal" group (12.6 +/- 0.9 cm/second) and the arteriogenic impotence group (7.7 +/- 1.1 cm/second). Twenty-nine patients with a bilateral PSV of 10 cm/second or less before ICI had a normal clinical response. CONCLUSIONS: A cutoff PSV value of 10 cm/second in the flaccid state had the best accuracy in predicting arterial insufficiency. Duplex Doppler sonography is proposed as the initial test to evaluate the penile arterial supply and to determine whether patients are good candidates for therapy with ICI.     

Uterine arteriovenous malformations: from diagnosis to treatment.

OBJECTIVE: The purpose of this study was to describe the sonographic features of uterine arteriovenous malformations (AVMs) and to describe the role and clinical outcome after transcatheter arterial embolization of symptomatic uterine AVMs. METHODS: In our institution, over a 4-year period, symptomatic uterine AVMs were diagnosed in 21 women. Endovaginal sonography with gray scale, color, and spectral Doppler imaging was performed on all patients. Fourteen patients required therapeutic angiography/embolization to control bleeding. These 14 patients had follow-up endovaginal sonography 24 hours after the procedure. RESULTS: The sonographic gray scale findings of uterine AVMs were nonspecific. The most common finding was subtle myometrial heterogeneity (n = 14), whereas other patients had small anechoic spaces in the myometrium (n = 7). Color Doppler sonography showed a tangle of vessels with multidirectional high-velocity flow that produced a "color mosaic" pattern. Spectral Doppler analysis showed arteriovenous shunting with high-velocity, low-resistance flow. Fourteen patients required transcatheter arterial embolization to control bleeding. Thirteen of 14 patients had no sonographic evidence of a residual AVM 24 hours after the procedure. One of 14 patients had a residual AVM requiring additional embolization. One patient had recurrent bleeding at 4 months and required further embolization. The remaining 7 patients were treated conservatively. CONCLUSIONS: Endovaginal sonography is the imaging modality of choice in patients with abnormal uterine bleeding. Routine use of color and spectral Doppler sonography allows one to confidently make the correct diagnosis. Transcatheter arterial embolization is an excellent treatment option. Endovaginal sonography should be used to monitor postembolization outcomes.     

Color Doppler sonographic findings in penile fracture

We performed color Doppler sonographic examination on 4 patients, 3 of whom had preliminary diagnoses of penile fracture and 1 of whom had undergone an operation due to penile fracture a year previously. Color Doppler sonography helped evaluate the relationships between the hematoma and the vascular structures and aided in differential diagnosis of the vascular injuries that may accompany tunical rupture (or have similar clinical presentations) and Mondor's disease; thus, this method has a crucial role in choosing the treatment approach. Color Doppler sonography may also assist in the follow-up of patients after surgical or conservative treatment.     

Sonographic diagnosis of urethral anomalies in infants: value of perineal sonography.

OBJECTIVE: To assess the value of urethral sonography including a perineal approach in evaluating urethral anomalies in infants. METHODS: A radiology database review identified 88 patients (mean age +/- SD, 64 +/- 84 days) who underwent voiding cystourethrography (VCUG) and urethral sonography as part of extended sonography of the urinary tract. Sonographic and VCUG images and reports were reviewed to assess agreement between both modalities for detection of urethral anomalies. RESULTS: Sonography facilitated the correct diagnosis of all 3 posterior urethral valves. The only urethral diverticulum, the only ectopic ureteric insertion into the urethra, the only urogenital sinus, and the only urethrovaginal fistula were also shown on sonography. In 73 (94%) of 78 cases, sonography correctly showed the absence of anomalies. In 5 infants, sonography could not reliably assess the urethra and showed indirect signs of urethral anomalies; however, these patients had normal urethras on VCUG. CONCLUSIONS: Our data show that sonography of the urethra is a valuable tool for diagnosis of urethral anomalies. Especially, negative findings on sonography are highly suggestive of the absence of urethral anomalies. Positive or equivocal sonographic findings should indicate VCUG.     

Median arcuate ligament syndrome.

OBJECTIVE: To describe the importance of obtaining erect views when evaluating the celiac artery with sonography. METHODS: Two patients had duplex and color flow Doppler sonographic evaluations of the celiac artery, including inspiration, expiration, and erect views. RESULTS: Both patients had elevated celiac artery velocities with inspiration and expiration. These results alone would suggest celiac artery stenosis. With erect views, the celiac artery velocities returned to normal. The addition of erect views allowed the correct diagnosis of median arcuate ligament syndrome to be made. CONCLUSIONS: When evaluating the celiac artery, it is important to include erect views to prevent misdiagnosis of celiac artery stenosis.     

彩色多普勒超声对糖尿病患者颈动脉粥样硬化斑块的诊断价值

目的 评价彩色多普勒超声对糖尿病患颈动脉粥样硬化斑块的诊断价值。方法 对72例糖尿病患及30例正常人做双侧颈动脉超声检查,测量颈动脉IMT值和血流频谱测值。结果 72例糖尿病患颈动脉IMT值明显增加,颈动脉粥样硬化斑块形成42例,发生率为58．3％,与正常组对比,有明显差异（P＜0．05）。结论 颈动脉硬化斑块与糖尿病有密切相关性。彩色多普勒检测糖尿病患颈动脉粥样硬化斑块形成有重要临床价值,对糖尿病患脑梗塞的预防有积极意义。     

Doppler sonography of deep cavernosal artery of the penis: variation of peak systolic velocity according to sampling location.

To determine if there are significant variations in the peak systolic velocity of cavernosal arteries according to the Doppler sampling location, Doppler sonography was performed in 32 patients with erectile dysfunction and 15 control patients. Doppler spectral waveforms were obtained at proximal and distal locations in cavernosal artery. The peak systolic velocity of the cavernosal artery was 39.0 +/- 11.2 cm/sec in proximal portion and 20.0 +/- 5.6 cm/sec in distal portion in patients with erectile dysfunction. In control patients, the peak systolic velocity was 39.8 +/- 8.0 cm/sec in proximal portion and 21.3 +/- 5.5 cm/sec in distal portion. The peak systolic velocity of the cavernosal artery varies significantly according to the sampling location in patients with erectile dysfunction as well as in control patients. Our study demonstrated that the sampling location needs to be standardized in performing Doppler sonography of the cavernosal arteries, and we propose the proximal cavernosal artery where it angles posteriorly as the standardized sampling location.     

Diagnosing carotid stenosis by Doppler sonography: state of the art.

OBJECTIVE: The goal of this review article is to present the state of the art in the clinical applications and technical performance and interpretation of carotid sonographic examinations. METHODS: Relevant publications regarding color and duplex Doppler sonography (CDDS) of the carotid arteries extracted from a computerized database (MEDLINE) and from references cited in these articles not appearing on the Internet were reviewed. RESULTS: The ability to quickly and efficiently identify stenosis in the carotid artery is an important goal for clinicians and vascular surgeons. Identification of potentially treatable carotid stenosis enables selection of appropriate candidates for endarterectomy or stent implantation. Advances in performance and interpretation of carotid sonographic studies over the last 20 years have been driven by technological improvements in gray scale and CDDS examinations and have made carotid sonography an important means to reach this goal. On the basis of CDDS, intima-media thickness measurements and plaque location and characterization on gray scale imaging, flow disturbance and areas of stenosis on color Doppler sonography, and flow velocities on spectral Doppler sonography are obtained. The degree of the diameter of a stenosis of the internal carotid artery is the main parameter used for therapeutic approaches. Advantages and limitations of the method are included. CONCLUSIONS: Carotid sonography is a unique imaging method for the investigation of carotid abnormalities. Noninvasive, accurate, and cost-effective, it provides morphologic and functional information. It is increasingly becoming the first and often the sole imaging study before endarterectomy, whereas costly and invasive procedures are reserved for special cases.     

Feasibility of dynamic 3-D color Doppler ultrasound for imaging penile vascular change in renal transplant patients with erectile dysfunction responding to sildenafil

Renal transplant recipients (RTRs) have a high incidence of erectile dysfunction (ED). Differentiation of penile vasculogenic impotence from other causes is important for treatment. Conventional 2-D color Doppler assessment after intracavernosal stimulant injection often fails to produce reliable results because of limited views by the cross-sectional imaging and the painful procedure. In comparison to the findings in three healthy volunteers, we determined cavernosal vascular hemodynamics in eight RTRs with ED before and after oral sildenafil by using live 3-D ultrasound and dynamic 3-D color Doppler. Results showed that, before sildenafil, penile arterial flow signals could only be reliably detected in one patient. After sildenafil, all had reliably detectable flow with grades II to III erection. Our data suggest that 3-D volumetric changes of the penis and its vasculature during erection can be studied by this technique and that this method could be useful for the evaluation of new drugs and therapeutic biofeedback.     

三维能量多普勒超声与血管造影对比观察肿瘤血管

目的：与血管造影对比。评价三维能量多普勒超声在观察肿瘤血上的可靠性和对肿瘤定性诊断的准确性。方法：58例经病理证实的腹部肿瘤患者接受三维能量多普勒超声检查,其中肝细胞性肝癌25例。肾癌5例。肝转移癌16例,肝血管瘤8例,肾血管瘤4例。58例中28例在一周内进行血管造影。结果：三维多普勒超声显示出肿瘤周连粗大、弯曲的供血动脉向肿瘤内部延伸,在肝转移瘤病例,可见肿瘤周边正常粗细的敌国管受压变形、移位并环绕肿瘤,在肝血管瘤,表现为肿瘤内部无明显血管,肿瘤周围可见部分血管环绕。结论：肿瘤三维能量多普勒超声图像与篾这造影动脉期图像非常相似,能准确显示肿瘤内部及周连的血流情况。三维能量多普勒超声显示肿瘤积压流的明显差异有助于鉴别肿瘤的性质。     

Cavernous transformation of the portal vein (CTPV): role of color Doppler sonography in the diagnosis

Objective: The aim of this study was to investigate the hemodynamics of cavernous transformation of the portal vein (CTPV) using color Doppler sonography and to correlate it with sonographic findings and clinical manifestations. Methods: Using color Doppler sonography, we studied 25 patients who satisfied the sonographic diagnostic triad of CTPV and compared clinical, sonographic, and color Doppler findings. We also compared the hemodynamics of the liver vasculature in a group of CTPV patients with that in a group of normal subjects. Results: We could differentiate five cases of dilated hepatic artery without formation of CTPV from 20 cases of CTPV. In 13 cases of CTPV, the cause of the portal vein thrombosis prior to CTPV could be determined. Two types of CTPV were distinguished: linear type (small diameter without tortuosity) and tortuous type (large diameter with tortuosity). There were no particular tendencies in the cause or distribution between the two groups, but the flow velocity was significantly higher in the tortuous type than in the linear type. Slow continuous flow with little or no respiratory variations was observed in CTPV by color Doppler sonography in agreement with previous reports, and the velocity of CTPV was slower than that of the portal flow in normal subjects. The flow velocity was not related to the cause or the presence of developed collaterals, and the flow direction was always hepatopetal. Conclusion: Color Doppler sonography was considered to be the most useful modality for the diagnosis and comprehension of the hemodynamics of CTPV.