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.     

二维及彩色多普勒超声在指导异位妊娠治疗中的价值

目的 评坐二维及彩色多普勒声像图在指导异位妊娠治疗中的价值。方法 对临床怀疑宫外孕及急诊腹痛待查的113例患的二维及彩色多普勒声像图进行回顾性分析。结果 对27例典型胎囊型异位妊娠二维即可迅速作出诊断，对74例非典型包块型可通过彩色多普勒进一步明确诊断。结论 二维及彩色多普勒对异位妊娠尤其是非典型异位妊娠在选择保守与手术治疗方面可为临床提供有力依据。     

Sonographic diagnosis of a giant aneurysm of the common hepatic artery

Hepatic artery aneurysms are rare vascular lesions sometimes found incidentally during abdominal imaging. We present the case of a 61-year-old man whose initial symptoms were tenderness in the right upper quadrant of the abdomen and epigastric pain. Gray-scale sonography revealed ascites and an 8.1-cm mass in the region of the porta hepatis; color Doppler sonography revealed a turbulent arterial waveform with high peak systolic velocity. We diagnosed a giant aneurysm of the common hepatic artery. Three-dimensional CT angiography confirmed this diagnosis and also revealed hemoperitoneum. The patient underwent aneurysmectomy and recovered well. This case shows that the use of both sonography and CT angiography offers a promising alternative to conventional angiography for the diagnosis of and treatment planning for hepatic artery aneurysms.     

Assessment of resectability of pancreatic carcinoma by color Doppler sonography

This study was undertaken to evaluate the role of color Doppler sonography in the preoperative assessment of vascular involvement in patients with pancreatic carcinoma. Twenty-six pancreatic carcinomas were investigated with color Doppler sonography and angiography, and the results of these examinations were compared with those of surgical findings. Color Doppler sonography was more sensitive than angiography in depicting vascular involvement of carcinoma. Thus, it seems rational to perform a preoperative assessment in suspected pancreatic carcinoma patients initially with color Doppler sonography to improve patient management.     

Echo-enhanced color Doppler sonography in children and adolescents.

Fifty-one patients, with a range of underlying pathologic conditions, were studied prospectively to assess the diagnostic value of echo-enhanced color Doppler sonography in the pediatric and adolescent population Their diagnoses included various tumors, vascular disorders, cerebral bleeding, pathologic conditions of small parts, and focal lesions of parenchymal organs. All patients underwent color Doppler sonography before proceeding to echo-enhanced color Doppler sonography. Diagnoses were confirmed by additional imaging (computed tomography, magnetic resonance imaging, angiography, and scintigraphy) performed as appropriate, with or without histologic study. An additional 20 children did not proceed to echoenhanced color Doppler sonography as color Doppler sonography alone was found to be sufficiently diagnostic. Levovist (SHU 508A), a contrast agent based on galactose-encapsulated air microbubbles, is approved for pediatric applications in Austria and was used as the echo-enhancing agent. Echo-enhanced color Doppler sonography was performed a total of 63 times in 51 patients (mean age, 9.8 years). Compared to color Doppler sonography, echo-enhanced color Doppler sonography either detected or enhanced visualization of pathologic conditions in 55 investigations (87.3%), yielding an overall accuracy of 95.2% (sensitivity, 95%), versus 65.7% with color Doppler sonography. One spinal arteriovenous malformation, one cerebral cavernoma, and one liver lesion were missed. The contrast material was easy to administer; no adverse reactions were observed. We conclude that echoenhanced color Doppler sonography is beneficial in pediatric sonography. It enhances visualization of vessels and perfusion, thus offering a nonionizing imaging tool for detection and follow-up evaluation of pathologic conditions with disturbed vasculature in specific cases. In infants and in persons with superficial lesions it did not offer significant advantages over color Doppler sonography.     

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.     

Celiac artery aneurysm: Diagnosis by color Doppler sonography and three‐dimensional CT angiography

Celiac artery aneurysms are rare vascular lesions that are sometimes found incidentally during abdominal imaging. Their significance is in their potential to rupture, which can lead to death. We present the case of a celiac artery aneurysm diagnosed by color Doppler sonography and 3‐dimensional CT angiography. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 27:49–51, 1999.     

Lumen reduction measurements of the internal carotid artery before and after Levovist enhancement: reproducibility and agreement with angiography.

Our aim was to assess reproducibility of three different lumen reduction measuring methods--North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and common carotid--using power Doppler and color Doppler sonography before and after Levovist enhancement. We included 20 symptomatic patients with mild or severe carotid disease. North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and common carotid measurements on longitudinal views and European Carotid Surgery Trial measurements on transverse views were performed. Examinations were repeated and the results compared to assess reproducibility of measurements. Correlation with angiography was obtained by calculating Pearson correlation coefficients. Reproducibility was significantly better (P < 0.05) for European Carotid Surgery Trial and common carotid measurements (95% limits of agreement between -10% to 10% and -19% to 17%) as compared to North American Symptomatic Carotid Endarterectomy Trial measurements (95% limits of agreement between -11% to 21% and -21% to 23%). Variability of measurements after enhancement increased slightly (not significant) for both power and color Doppler sonography. Additionally, European Carotid Surgery Trial measurements, using nonenhanced power Doppler or color Doppler sonography, did not correlate significantly with angiography, whereas North American Symptomatic Carotid Endarterectomy Trial and common carotid measurements correlated well with angiography, particularly in power Doppler mode after enhancement (r = 0.88 and r = 0.82, respectively). We conclude that for lumen reduction measurements of the internal carotid artery with power and color Doppler sonography, the common carotid method is the only method that is reproducible and has good correlation with angiography, which slightly improves after Levovist enhancement.     

Vasculature in hepatocellular carcinoma after transcatheter arterial chemoembolization: comparison of power and color Doppler sonography.

The purpose of this study was to compare power Doppler sonography with conventional color Doppler sonography for the detection of the vascularity of hepatocellular carcinomas after transcatheter arterial chemoembolization. Of the 93 embolized hepatocellular carcinomas, hypervascularity was demonstrated in 36 on angiography; power Doppler sonography correctly identified pulsatile flow signals in 33 (92%) of these 36, whereas color Doppler sonography identified flow signals in 24 (67%). A statistically significant difference was noted when the sizes of the nodules were 30 mm or less. Despite technical difficulties, such as flash artifact, power Doppler sonography is superior to color Doppler sonography for detection of hypervascularity, especially in small embolized nodules of hepatocellular carcinoma (30 mm or less in diameter).     

Contrast‐Enhanced Sonographic Follow‐up After Stenting of Visceral Artery Aneurysms

We report 2 cases of exclusion of visceral artery aneurysms. The first was a common hepatic artery aneurysm treated with a multilayer stent; the second was a celiac trunk aneurysm excluded by a covered stent. Computed tomographic angiography was performed at regular intervals after each procedure, together with echo color Doppler imaging and contrast‐enhanced sonography. Computed tomographic angiography and contrast‐enhanced sonography were able to detect endoleaks in both patients and the related inflow vessel; moreover, diameter measurements of the sacs were identical. In our preliminary experience, contrast‐enhanced sonography appeared to be as accurate as computed tomographic angiography after endovascular visceral artery aneurysm exclusion.     

Color Doppler sonographic findings in renal vascular lesions

Three patients with renal vascular lesions, one congenital arteriovenous (AV) fistula and two renal pseudoaneurysms, were assessed with color Doppler sonography. The AV fistula was detected initially by color Doppler after having been missed by both real-time sonography and computed tomography. High frequency shift blood flow within a hypoechoic lesion noted by color Doppler characterized the AV communication. Both renal pseudoaneurysms had detectable bidirectional swirling blood flow within an anechoic portion of a complex mass. Findings in all three cases were confirmed by angiography or pathology. Color Doppler sonography seems potentially useful in the evaluation of renal vascular pathology.     

Intraabdominal extrapulmonary sequestration diagnosed by color doppler ultrasound at 22 weeks' gestation

Intraabdominal extrapulmonary sequestration is seen very rarely. When a left suprarenal mass is detected in prenatal sonography, vascularization of the lesion should be evaluated with color Doppler sonography. We present a case of intraabdominal extrapulmonary sequestration that was diagnosed by color Doppler ultrasound at 22 weeks' gestation. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2013     

Peripheral ischemic occlusive arterial disease: comparison of color Doppler sonography and angiography.

We examined 334 legs in 167 consecutive patients with advanced peripheral ischemic disease using color Doppler sonography and angiography. Angiography revealed 714 lesions (369 nonsignificant stenoses, 297 significant stenoses, and 48 occlusions) in the 334 legs examined. Overall, color Doppler sonography revealed diagnostic agreement with angiography in 668 of 714 lesions (93.5%), including 343 of 369 (92.9%) nonsignificant stenoses, 279 of 297 (93.9%) significant stenoses, and 46 of 48 (95.8%) occlusions. Overestimation occurred in 26 of 369 (7%) nonsignificant stenoses and 3 of 297 (1%) significant stenoses. Underestimation was observed in 15 of 297 (5%) significant stenoses and in 2 of 48 (4.2%) occlusions. Peak systolic velocity ratio correlated better (P < 0.01) than peak systolic velocity with diameter reduction percentage as assessed at angiography. Color Doppler sonography is an accurate noninvasive method for evaluating patients with peripheral ischemic disease.     

鳃裂囊肿和瘘管彩色多普勒超声检查误诊原因探讨

目的总结鳃裂囊肿和瘘管的彩色多普勒超声声像图特征,以减少误诊。方法回顾性分析我院经手术病理检查证实为鳃裂囊肿和瘘管17例的彩色多普勒超声声像图表现,并与手术病理检查结果进行对比分析。结果本组17例,12例以外耳道下方或颈侧肿块就诊,5例体检发现腮腺和甲状腺内结节就诊。我院和外院术前彩色多普勒超声检查,7例确诊鳃裂囊肿或瘘管,10例误诊,误诊率58.8%,误诊为腮腺实性肿物及颈部淋巴结炎伴液化各3例,甲状腺结节2例,腮腺囊肿及甲状舌管囊肿各1例。17例均行手术治疗,术后病理检查证实为鳃裂囊肿11例,鳃裂瘘管6例。术前彩色多普勒超声检查结果与术后病理诊断结果符合率41.2%(7/17)。结论临床虽然可根据彩色多普勒超声声像图特点及临床表现对鳃裂囊肿和瘘管做出诊断,但由于受各种因素影响易误诊,应注意与其他颈部囊性占位性病变相鉴别。     

Evaluation of the intratumoral vasculature of hepatocellular carcinoma by power Doppler sonography: advantages and disadvantages versus conventional color Doppler sonography

Background: To determine whether a difference exists in the relative ability of power Doppler sonography and conventional color Doppler sonography to detect the intratumoral vasculature of hepatocellular carcinoma based on lesion size and location. Methods: Sixty patients with 88 hepatocellular carcinoma lesions that showed tumor staining on angiography and were enhanced on dynamic computed tomography were evaluated. Power Doppler sonography and color Doppler sonography were used to detect the intratumoral vasculature, and their sensitivity to blood flow was evaluated. Results: Power Doppler sonography showed a superior detection rate for lesions smaller than 2 cm and located 4–8 cm from the abdominal surface in the right hepatic lobe as compared with color Doppler sonography (p < 0.01). Neither power Doppler sonography nor color Doppler sonography depicted the intratumoral vasculature of lesions located more than 8 cm from the abdominal surface (n = 14). Both color Doppler imagings exhibited a low detection rate for lesions in the left hepatic lobe (n = 31, p < 0.01). Conclusions: Power Doppler sonography should be applied in the evaluation of small or intermediate depth lesions because it is more sensitive to these lesions than color Doppler sonography, but it is not useful for left lobe and deep lesions. Received: 31 March 1999/Accepted: 14 July 1999     

彩超对医源性股动脉假性动脉瘤及动静脉瘘的诊断

目的探讨彩超对医源性股动脉的假性动脉瘤及动静脉瘘的诊断价值。方法心导管术后出现右腹股沟搏动性包块或异常血管杂音的12例患者行彩超检查。结果12例患者中，8例诊断为假性动脉瘤，4例诊断为动静脉瘘。结论彩超能明确诊断心导管术后发生的假性动脉瘤及动静脉瘘，可作为首选的检查方法。     

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.     

Sonographic appearance of congenital arteriovenous fistula of the hand

Congenital arteriovenous fistula of the hand is uncommon. We report a case of unusual congenital arteriovenous fistula forming multiple fistulous communications between the arteries and veins in the right hand. Clinical findings were confirmed by color Doppler sonography and digital subtraction angiography.     

Doppler sonographic indices in diagnosing the nutcracker phenomenon in a hematuric adolescent

Compression of the left renal vein between the aorta and the superior mesenteric artery, known as the nutcracker phenomenon, may cause gross or microscopic hematuria, pain in the flank, proteinuria, or a combination of these symptoms. We report the case of a hematuric adolescent diagnosed with a high index of suspicion by noninvasive Doppler sonography using the diagnostic indices of Doppler sonography established for adults with hematuria. Compression of the patient's left renal vein at the aortomesenteric portion and dilatation at the hilar portion were visualized by magnetic resonance angiography, which verified the diagnosis.     

彩色多普勒超声诊断肾盂癌

目的　分析肾盂癌的超声诊断特点以提高其诊断准确率。方法　应用彩色多普勒超声诊断肾盂癌患者 2 2例 ,分析其声像图特征。结果　大部分肾盂癌患者有肾脏肿大 ,肾盂积水 ,肾盂包块典型声像图表现。结论　在肾盂积水条件下 ,超声诊断小肾盂肿瘤 (d <2cm)更准确。