Usefulness of echo-color Doppler in differentiating parathyroid lesions from other cervical masses

. The aim of our study was to clarify possible differential color Doppler US features between parathyroid lesions and other cervical masses. A total of 56 parathyroid lesions in 54 patients with primary hyperparathyroidism were preoperatively examined with color Doppler sonography. Color Doppler flow patterns were compared with those of 72 thyroid nodules and 20 cervical lymph nodes. In 38 parathyroid lesions a correlation between color Doppler patterns and size, location, and pathological findings was performed. Color Doppler sonography showed five vascular distribution patterns: pattern I, absence of flow; pattern II, focal peripheral flow (“vascular pole”) with arterial Doppler spectrum; pattern III, peripheral flow; pattern IV, internal flow (“parenchymal pattern”); pattern V, peripheral and intranodular flow. Pattern I was not specific for any cervical lesion considered. Conversely, pattern IV was observed solely in parathyroid lesions, and pattern II was observed in only one nonparathyroid lesion (thyroid nodule). Mixed pattern (pattern V) was observed solely in thyroid nodules. In addition, pattern III was a characteristic finding of thyroid nodules and was observed in only one parathyroid lesion. Color Doppler patterns of the parathyroid masses did not correlate with the size of the lesion or pathological findings, but only with the location of the gland. Our study showed that color Doppler assessment of parathyroid lesions is a useful integration of gray-scale US and may be helpful in distinguishing parathyroid lesions from other cervical masses. Received 6 November 1995; Revision received 9 January 1996; Accepted 19 February 1996     

Graded compression sonography of the colon in the diagnosis of polyps in pediatric patients

OBJECTIVE: We report seven cases of juvenile polyps detected by graded compression gray-scale and color Doppler sonography in five children with nonspecific symptoms. CONCLUSION: Intestinal polyps can be detected by graded compression gray-scale and color Doppler sonography without colonic preparation. On gray-scale sonography, polyps appeared as spherical or ovoid hypoechoic nodules in the colon lumen. Small cysts were identified inside the nodules. Four polyps had fewer and smaller cysts, whereas three others contained many cysts. A hyperechoic layer surrounding the polyp corresponded to the submucosa. In two patients, the polyp was visualized in the transverse colon and caused a colocolic intussusception, which reduced spontaneously during sonography. Color Doppler sonography showed four hypovascularized and three hypervascularized polyps.     

Omental infarction in children: color Doppler sonography correlated with surgery and pathology findings

OBJECTIVE: The objective of our report is to describe color Doppler sonography findings of omental infarction and correlate them with surgical and pathology findings. Ten children underwent preoperative gray-scale and color Doppler sonographic examinations; omental infarction was confirmed at surgery. CONCLUSION: Color Doppler sonography findings were reviewed and correlated with surgical and pathology findings. Color Doppler sonography features of idiopathic omental infarction differ from those of infarction secondary to omental torsion.     

Color Doppler sonography in the evaluation of erectile dysfunction.

Color Doppler sonography can be useful in the evaluation of erectile dysfunction, which can result from psychogenic, endocrinologic, neurogenic, pharmacologic, and vasogenic causes. It is used to determine the integrity of the vascular mechanism. After an intracavernosal injection of a vasodilatory agent, color Doppler sonography is performed to evaluate cavernosal arteries and dorsal vessels. Color flow imaging allows direct visualization of intrapenile anatomy, vascular variants, and disease. It is also helpful in demonstrating transitions in cavernosal and dorsal blood flow. Color Doppler sonography is combined with spectral interrogation of the cavernosal arteries and dorsal veins to help determine peak systolic and end-diastolic velocities. Cavernosal artery size and systolic velocities help diagnose arterial insufficiency. Recent work on cavernosal artery diastolic flow and dorsal vein flow has indicated that color Doppler sonography, when correlated with cavernosographic findings, may be helpful in diagnosing venous incompetence. Temporal variations in transitions in cavernosal artery and dorsal vein flow during various stages of erection are important in the accurate diagnosis of vasogenic impotence.     

Amplitude-coded color Doppler: clinical applications

Amplitude-coded color Doppler sonography (ACD) has become an useful adjunct to gray-scale US and conventional color Doppler sonography (CD) for the assessment of vascular diseases and pathologic conditions that might affect or alter tissue vascularization or perfusion. Basically, all US units that generate conventional color Doppler information through autocorrelation technique are capable of displaying ACD. This technique is also referred to as power Doppler, amplitude-mode color Doppler US, color Doppler energy (CDE), or US angiography. Amplitude-coded color Doppler sonography has already emerged as a valuable adjunct to conventional CD, particularly for evaluating flow in parts of the body where CD signal is weak because of slow flow, small blood vessels, or both. Received: 1 December 1997; Revision received: 26 March 1998; Accepted: 2 June 1998     

经直肠彩色多普勒超声对前列腺癌的诊断价值

目的　探讨经直肠彩色多普勒超声检查法对前列腺癌的诊断价值。方法　对 13 5例临床疑有前列腺癌的病人行经直肠灰阶超声及彩色多普勒超声检查 ,利用彩色直方图计算软件测得前列腺内异常血流增多区域的彩色血流面积占所选区域面积的百分比(theblackandwhitecolorratio ,BCR) ,并与其整个前列腺内血流BCR比较。每例患者均行经直肠超声引导下前列腺穿刺活检。结果　13 5例病人经前列腺穿刺病理证实前列腺癌 73例 ,前列腺增生症 5 0例 ,前列腺炎 12例。经直肠灰阶超声检查发现异常回声 84例 ,前列腺癌 5 1例 ,前列腺增生症 2 6例 ,前列腺炎 7例。经直肠彩色多普勒超声检查发现异常血流增多的 73例 ,前列腺癌 5 6例 ,其中 12例为灰阶超声无异常发现的位于内腺的前列腺癌。前列腺增生症 11例 ,前列腺炎 6例。经直肠灰阶超声及彩色多普勒超声检查对诊断前列腺癌的敏感性、特异性、阳性预测值分别为 70 .0 % ,46.8% ,60 .7%和 76.7% ,72 .6% ,76.7%。结论　经直肠彩色多普勒超声检查应列为前列腺癌的常规检查 ,这对提高前列腺癌的检出率 ,特别对位于内腺的前列腺癌有重要意义     

彩色多普勒超声诊断肢体血管疾病

目的：提高彩色多普勒超声在肢体血管性疾病的诊断率。材料和方法：利用彩色多普勒超声和双工多普勒超声技术对３２例血管疾病进行了检查，其中肢体动脉性疾病８例，肢体静脉性疾病２４例。结果：各种肢体血管性疾病在血流方向、速度、血流性质以及频谱形态等方面有其各自相对特异的超声表现。结论：彩色多普勒超声对肢体动静脉疾病既有安全、无创、双侧对比容易的优点，又可直接确定受累动静脉的损害部位，有助于早期诊断，治疗和预防。     

Therapeutic ligature of hypogastric arteries: color Doppler follow-up

PURPOSE: To evaluate the interest of color Doppler sonography in the watching of therapeutic ligature of hypogastric arteries. PATIENTS AND METHODS: Thirteen female patients presenting a serious haemorrhage in the post-partum and be in managed by bilateral hypogastric ligature, have undergone a systematic protocol of investigation involving a Doppler sonography in the fourth day after intervention and then monthly until repermeabilization of the internal iliac arteries. RESULTS: In all cases, the first exam showed down-side the ligature, a flow inversion with an important pelvic collateral circulation. The next Doppler exams showed repermeabilization of the hypogastric arteries after an average interval of 5 months (extremes: 1 to 6 months). CONCLUSION: Color Doppler showed the resolvent character of therapeutic ligature of the hypogastric arteries and may estimate with sufficient accuracy the interval of repermeabilization.     

鼻咽癌肝转移超声诊断的价值

目的探讨二维及彩色多普勒超声诊断鼻咽癌肝转移的价值.材料与方法回顾性分析6例19个鼻咽癌肝转移病灶的二维及彩色多普勒声像图特征.结果鼻咽癌肝转移二维超声表现为以囊性为主的囊实混合性回声或囊肿样回声.囊壁多不规则增厚、囊内有分隔或囊壁上有乳头样结节样实性突起.5例为多发病灶.6例彩色多普勒均于瘤内或壁上引出动脉血流信号,其中5例为高速动脉血流(流速＞40cm/s)结论鼻咽癌肝转移表现以囊性为主的囊实混合性肿块或囊肿样回声,彩色多普勒在病灶内引出高速动脉血流信号为鼻咽癌肝转移与肝脏良性囊性病变的鉴别诊断提供了重要依据.     

Comparison of tuberculous and pyogenic epididymal abscesses: clinical, gray-scale sonographic, and color Doppler sonographic features

OBJECTIVE: The purpose of this study was to evaluate the capability of clinical, gray-scale sonographic, and color Doppler sonographic features for differentiating tuberculous and pyogenic epididymal abscesses. MATERIALS AND METHODS: Retrospective analysis was performed in 10 cases of tuberculous epididymal abscess and in 13 cases of pyogenic epididymal abscess. The following clinical, gray-scale sonographic, and color Doppler sonographic features were analyzed: patient's age; duration of symptoms; scrotal tenderness; presence of sinus tract; concurrent tuberculosis in other organs; location, size, and echogenicity of the abscess; hyperechoic rim; testicular involvement; hydrocele; and blood flow in the epididymal lesion. RESULTS: Tuberculous epididymal abscess had a longer duration of symptoms (p = 0.0001) and a lower frequency of scrotal tenderness (p = 0.0048) than pyogenic epididymal abscess. The size of the abscess was larger in tuberculous epididymal abscess than in pyogenic epididymal abscess (p = 0.0002). The degree of blood flow in the peripheral portion of the abscess was lower in tuberculous epididymal abscess (p = 0.001). The patient's age, location and echogeninicity of the abscess, presence of sinus tract, hyperechoic rim, testicular involvement, and hydrocele did not differ between the tuberculous and pyogenic epididymal abscesses. CONCLUSION: Some clinical findings, gray-scale sonography, and color Doppler sonography were useful in differentiating tuberculous epididymal abscess from pyogenic epididymal abscess. The presence of long-term scrotal swelling without tenderness and a lower degree of blood flow in the peripheral portion of a large abscess are suggestive of tuberculous epididymal abscess.     

MR angiography versus color Doppler sonography in the evaluation of renal vessels and the inferior vena cava in abdominal masses of pediatric patients.

OBJECTIVE: Involvement of renal vessels and the inferior vena cava (IVC) plays a decisive role during operative planning for removal of abdominal masses in pediatric patients. Advantages and limitations of MR angiography and color Doppler sonography for determining these factors were evaluated. MATERIALS AND METHODS: MR angiography and color Doppler sonography were performed preoperatively in 42 neonates, infants, and children with abdominal masses and were compared with spin-echo MR imaging and with surgical findings. Variables evaluated were anatomic variants, vessel displacement, patency of vessels, collateral circulation, and intravascular tumor extension. Quality of vessel visualization was assessed in vessels not affected by tumor. RESULTS: In 88% of unaffected renal vessels, the entire vessel course could be visualized on MR angiography compared with 58% on color Doppler sonography and 43% on spin-echo MR imaging. In four of nine cases, color Doppler sonography revealed an accessory renal artery, whereas MR angiography revealed these variants in seven of nine cases. MR angiography showed 79% and color Doppler sonography 66% of displaced vessels. Unlike MR angiography, color Doppler sonography did not reveal five stenotic renal veins because they could not be completely imaged. In two cases, however, MR angiography falsely indicated an occlusion of the IVC, whereas color Doppler sonography showed residual flow. CONCLUSION: Anatomic variants, vessel displacement, collateral circulation, and neoplastic vessel infiltration were revealed more accurately by MR angiography than by color Doppler sonography. In cases in which patency of the IVC is unclear on MR angiography, color Doppler sonography should also be performed.     

Budd-Chiari syndrome: detection with color Doppler sonography.

The value of color Doppler sonography in evaluating newly diagnosed Budd-Chiari syndrome in five patients was studied. Hepatic venous findings included absence of vessels (one patient), flow reversal (two patients), narrowing (four patients), and tortuosity (three patients). Detected collaterals included hepatic venous to hepatic venous (four patients), hepatic venous to subcapsular systemic venous (two patients), and portosystemic (three patients). Hepatic venous spectral Doppler waveforms were flat and essentially aphasic in four patients, indicative of distal hepatic venous compression. The inferior vena cava was markedly compressed in two patients and slightly compressed in one. Color Doppler sonography allowed more reliable and confident identification of irregular, compressed, or otherwise abnormal hepatic veins than did conventional sonography. Color Doppler sonography also showed collateral vessels that were undetected with conventional sonography or other imaging techniques. Our results suggest that color Doppler sonography may be a valuable tool in the initial diagnosis and evaluation of suspected Budd-Chiari syndrome.     

Color Doppler sonography of benign and malignant ovarian masses.

The use of transvaginal and transabdominal color Doppler sonography for the assessment of ovarian tumor vascularity was investigated in 62 cases of surgically excised and histologically examined ovarian masses. The modality was used to differentiate tumor neovascularity from normal arterioles (which contain smooth muscle in their media) on the basis of differences in the pulsatility observed in Doppler waveforms. Of the 25 malignant tumors in the series, 20 had low-impedance flow (pulsatility index of less than 1.0), and none had the diastolic notch seen in vessels in normal tissue. Three benign lesions, including two dermoid cysts and one tubo-ovarian abscess, also had low-impedance flow. The negative predictive value of color Doppler sonography was 98%, whereas the positive predictive value was 83%. Color Doppler sonography seems to be accurate for excluding malignancy, but some misdiagnosis may occur in cases of inflammatory and metabolically active benign masses.     

B-flow imaging of the hepatic vasculature: correlation with color Doppler sonography

OBJECTIVE: B-flow imaging is a non-Doppler technology that provides real-time imaging of blood flow during gray-scale sonography. The utility of B-flow imaging is reflected in numerous publications that describe normal and pathologic findings in the carotid arteries and hemodialysis fistulas. However, there is a paucity of articles describing B-flow imaging of the abdominopelvic viscera. The purpose of this article is to illustrate a spectrum of findings encountered during noninvasive flow evaluation of the hepatic vasculature, correlating the Doppler sonography and B-flow imaging findings. CONCLUSION: Color and spectral Doppler sonography are invaluable for noninvasive evaluation of the hepatic vasculature. However, a number of pitfalls and artifacts have been described that can cause important pathologic findings to be overlooked or can suggest incorrect diagnoses. In our experience, B-flow imaging often correctly displays normal and pathological vascular structures for which Doppler sonographic findings have been misleading or erroneous.     

Color Doppler sonography of hemodialysis vascular access: comparison with angiography

This study was performed to define the color Doppler sonographic appearance of normal and abnormal hemodialysis vascular access and to compare color Doppler sonography with angiography. Twenty-eight patients (nine with Brescia-Cimino fistulas and 19 with synthetic grafts) were imaged with digital subtraction angiography and color Doppler sonography. The examinations were interpreted independently and then interpreted together to determine the accuracy of the two methods. With angiography as the gold standard, color Doppler sonography correctly identified 20 of 23 stenosed vessels, three of four occluded vessels, four of four thrombosed vessels, and 18 of 19 pseudoaneurysms. Overall, color Doppler sonography correctly identified all lesions that were seen angiographically in 16 of 19 patients with synthetic grafts and in four of nine patients with Brescia-Cimino fistulas. Five asymptomatic arterial steals were detected sonographically. One of these was identified with angiography. Color Doppler sonography is an adequate means of imaging suspected complications of hemodialysis vascular access, and it should be used in selected patients. However, digital subtraction angiography is more sensitive and should be the initial imaging technique for most of these patients.     

Color Doppler sonography in penetrating injuries of the neck.

PURPOSETo determine whether color Doppler sonography can be a sensitive alternative to screening arteriography for identifying arterial injury in patients with penetrating traumatic neck injuries.METHODSFifty-two patients admitted to our trauma center with penetrating neck injuries (gunshot wounds and lacerations) were examined prospectively with color Doppler sonography, and findings were compared with the results of angiography (n = 44), with findings at surgery (n = 4), and with clinical status (n = 4).RESULTSColor Doppler sonography correctly detected all serious injuries of the carotid arteries (n = 6; 5 diagnosed at angiography and 1 at surgery) and all injuries of the vertebral arteries (n = 4; all diagnosed at angiography). Sonography missed 1 instance of reversible narrowing of the internal and external carotid arteries and did not show 2 normal vertebral arteries.CONCLUSIONColor Doppler sonography was as accurate as angiography in screening clinically stable patients with zone II or III injuries and no signs of active bleeding. Our initial results suggest that in the future, sonography may be used as a screening examination for arterial lesions in patients with penetrating neck injuries.     

Impact of sonography in gouty arthritis: comparison with conventional radiography, clinical examination, and laboratory findings

OBJECTIVE: To explore the typical sonographic features of gray-scale and Power Doppler of acute and chronic gouty arthritis in conjunction with radiographic, clinical, and laboratory findings. MATERIALS AND METHODS: All hand, finger, and toe joints of 19 patients with acute and chronic gout were examined with gray-scale and Power Doppler sonography. The number and size of bone changes detected with sonography was compared to radiographic findings. Vascularization of the synovial tissue was scored on Power Doppler (grades 0-3), and was compared with clinical appearance, including swelling, tenderness, and redness (grades 0-3). RESULTS: In acute gout, mild to moderate echogenic periarticular nodules with sonotransmission and hypervascularization of the edematous surrounding soft tissue were found. In chronic gout, tophaceous nodules completely blocked transmission of US wave, leading to strong reflexion and dorsal shadowing in a minority of cases. No significant difference in the detection of large bone changes (>2mm) was found between sonography and radiography. However, gray-scale sonography was significantly more sensitive in the detection of small bone changes (p<0.001). Power Doppler scores were statistically significantly higher than clinical examination scores (p<0.001). DISCUSSION: Sonography is superior to radiographs in evaluating small bone changes. The inflammatory process in joints can be better detected with Power Doppler sonography than with clinical examination. Typical sonographic appearance of acute and in particular of chronic gout might provide clues on gouty arthritis that adds to the information available from conventional radiography, clinical, and laboratory findings.     

Color Doppler imaging of portosystemic shunts

This study was designed to investigate the utility of color Doppler sonography in the evaluation of portosystemic shunts. Thirty-one patients with a total of 32 shunts were imaged. The types of shunts examined included portacaval, five; mesocaval, eight; distal splenorenal (Warren), 14; and mesoatrial, five. Sonography was performed without knowledge of the status of the shunt, although the type of shunt was known before beginning the study. The sonographic studies were evaluated to determine their sensitivity and specificity on the basis of a prospective comparison with angiography or MR imaging (22 cases). The possible advantages of color Doppler over duplex Doppler sonography in evaluating portosystemic shunts were also investigated, as was the ability of color Doppler sonography to image specifically the shunt anastomoses. Color Doppler sonography successfully inferred shunt patency (17 cases) or thrombosis (five cases) in all 22 shunts for which correlative imaging was available (sensitivity = 100%, specificity = 100%). In comparing duplex with color Doppler sonography in all 32 shunts, the two techniques were almost equally effective in establishing patency in portacaval, mesocaval, and mesoatrial shunts. Duplex Doppler sonography, however, provided useful diagnostic information in only four of 14 splenorenal shunts. Color Doppler correctly inferred patency or thrombosis in all 14. Among all 32 shunts, the anastomosis was shown clearly by color Doppler in 23, probably in four, and not all in five. Our results suggest that color Doppler sonography is an excellent method for the evaluation of all varieties of surgically created portosystemic shunts. In particular, color Doppler sonography appears to be superior to duplex Doppler sonography in imaging splenorenal communications.     

彩色多普勒超声监测Graves病甲状腺动脉栓塞后血流变化的临床研究

目的 研究彩色多普勒超声在监测甲状腺动脉栓塞治疗Grayes病后甲状腺血流变化，以及对临床疗效的评估作用。方法 31例确诊Graves病的患者行甲状腺动脉栓塞治疗，其中11例用彩色多普勒超声监测治疗前后甲状腺的血流变化，观察指标有甲状腺内部血流信号、甲状腺上动脉舒张期内径、收缩期最大血流速度(Vmax)、舒张期最小血流速度(Vmin)、阻力指数(RI)和甲状腺大小。同时观察临床症状和相关的实验室检查指标的变化情况。结果 Graves病甲状腺动脉栓塞治疗后，甲状腺上动脉舒张期内径、Vmax和Vmin明显降低，甲状腺内部血流明显减少，甲状腺体积缩小。临床症状好转或消失，相关的实验室检查指标恢复正常。结论 彩色多普勒超声可用于评估甲状腺动脉栓塞治疗Grayes病的疗效，是一种较好的无创性动态监测方法。     

Color Doppler sonography of the hepatic artery and portal venous system

Color Doppler sonography is an important noninvasive diagnostic tool for detecting abnormalities of the hepatic vasculature in patients with diffuse liver disease. To study its usefulness in these cases, we retrospectively reviewed the findings in 147 patients with abnormal portal venous color Doppler sonograms. This group comprised all patients with abnormal portal venous color Doppler sonograms studied from February 1987 to July 1989. Correlative imaging was not available in all cases. The sonographic diagnoses included (1) portal venous thrombosis (50 patients, 93 vessels); (2) portal-systemic or portal-portal collaterals (80 patients, 95 collaterals); (3) reversed, bidirectional, or other abnormal portal venous flow patterns (36 patients); and (4) abnormal hepatic arterial flow (20 patients). Since the results reported derive from a retrospective review without consistent correlation with other imaging studies, no appraisal of the sensitivity or accuracy of portal color Doppler sonography could be made from our data. The ability of color Doppler sonography to visualize flow without altering hemodynamics has led to several novel observations in these patients. These include increased arterial flow in states of low portal blood flow, reversal of portal flow direction postprandially, coincident reversed and hepatopetal flow in different branches of a single portal vein, and normal helical portal venous flow. These and other findings show that color Doppler sonography has enhanced our ability to detect abnormalities of the hepatic and portal venous system.