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.     

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.     

A sign of arteriogenic insufficiency on penile Doppler sonography: retrograde flow in penile cavernosal-spongiosal communications.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic usefulness of determining retrograde flow in the penile cavernosal-spongiosal communications (CSCs) with Doppler sonography. METHODS: Thirty-two consecutive men with erectile dysfunction (mean age, 40 years; range, 19-61 years) underwent penile color Doppler sonography. All patients were evaluated for flow direction in the CSCs. RESULTS: Eight of the 32 patients had normal Doppler sonographic findings; 8 had signs of veno-occlusive dysfunction; and 16 had arterial insufficiency. Doppler sonographic examinations of the patients with normal Doppler sonographic findings (100%) and veno-occlusive dysfunction (100%) showed a normal direction of flow in the CSCs. Thirteen of the 16 patients with arterial insufficiency had a normal direction of flow in the CSCs; however, reversal of the flow direction in the CSCs (from the urethral artery back to the cavernosal artery) was observed in the remaining 3 patients. CONCLUSIONS: Investigating the direction of flow in the cavernosal artery, CSCs, and urethral artery is not time-consuming and may help establish an accurate diagnosis of arteriogenic impotence, especially in patients with borderline peak systolic flow velocity values.     

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.     

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.     

Erectile dysfunction: the role of penile Doppler ultrasound in diagnosis

Erectile dysfunction (ED) is a common and debilitating condition with physical, psychological, and pharmacological aetiologies. The physical causes can be divided into problems with arterial inflow, structural penile abnormalities, or problems with the venous occlusion mechanism. Penile Doppler sonography is a specialized technique requiring a thorough knowledge of the topic in order to aid diagnosis and direct subsequent treatment. This technique is indicated in those patients with erectile dysfunction who do not respond to oral pharmacological agents (e.g., PDE-5 inhibitors). This pictorial essay will visit the anatomy and physiology of penile erection, the technique for performing the procedure, and review the imaging features for specific causes of ED.     

冠脉血流显像和冠脉解剖的对照研究

本文应用彩色多普勒冠状动脉血流显像新技术检查了３７例健康成人和冠状动脉解剖进行对照研究。依据心脏解剖研究探讨了冠状动脉血流显像时常用切面及探查手法，并提供了生理状态冠状动脉血流的显像特点和多普勒测值。本文详细讨论了冠脉解剖、冠状动脉血流显像新技术的优越性及其临床应用的潜力。同时，对此项技术的局限性提出了自己的见解。     

Current applications of duplex and color Doppler ultrasound imaging: abdomen

Duplex ultrasound studies and color Doppler imaging have substantially enhanced the diagnostic capabilities of abdominal ultrasonography. The status of the flow in the major abdominal vessels is routinely obtainable along with anatomic information about the organs that they supply. The current applications of duplex and color Doppler imaging in evaluating the hepatic vascular system, hepatic transplants, aorta, splanchnic arterial system, renal artery and vein, renal transplants, and penile arterial system are reviewed. The indications for and limitations of these examinations, as well as the potential future uses, are discussed.     

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.     

Role of Spectral Doppler Sonography in the Evaluation of Partial Testicular Torsion

Objective. The purpose of this series was to evaluate the role of spectral Doppler and color flow Doppler sonography in the evaluation of partial testicular torsion. Methods. Eight cases of partial testicular torsion, diagnosed on the basis of abnormal spectral Doppler waveforms or abnormal color flow Doppler findings, were retrospectively pooled from 2 teaching hospitals. Results. The age group ranged from 4 to 85 years. Testicles with partial testicular torsion showed variable spectral Doppler patterns, including increased, similar, or decreased amplitude of the arterial waveform relative to the contralateral testicle. Two cases showed reversal of arterial diastolic flow, and 1 case showed diastolic flow variability within the same testicle. Decreased blood flow was observed on color flow Doppler sonography in 7 of the 8 patients. Conclusions. Variability of the Doppler waveform when compared with the contralateral testicle and reversal of diastolic blood flow are indirect clues that aid in the diagnosis of partial testicular torsion.     

Prenatal diagnosis of ventriculocoronary arterial communication in fetuses with hypoplastic left heart syndrome.

OBJECTIVE: The purpose of this series was to describe the fetal echocardiographic findings in hypoplastic left heart syndrome with aortic atresia and ventriculocoronary arterial communication and implications of these findings. METHODS: We describe 2 fetuses with hypoplastic left heart syndrome with ventriculocoronary arterial communication diagnosed at 29 and 20 weeks' gestation, respectively. The underlying cardiac anatomy consisted of a hypoplastic left heart and mitral stenosis with aortic atresia. We used color Doppler and pulsed Doppler sonography on the surface of the myocardium to specifically look for coronary arterial flow. RESULTS: By color Doppler sonography, ventriculocoronary arterial communication was shown between the left ventricular cavity and the left coronary artery with characteristic bidirectional flow on pulsed Doppler examination. There was no mitral regurgitation. The left ventricular myocardium was substantially hypertrophied. The first patient underwent surgical Norwood palliation and died after a prolonged postoperative course. The second patient underwent stenting of the arterial duct and bilateral pulmonary artery banding in the catheterization laboratory but died after a few weeks. Implications of ventriculocoronary arterial communication in association with hypoplastic left heart syndrome are discussed. CONCLUSIONS: It is possible to accurately diagnose ventriculocoronary arterial communication on fetal echocardiography. The presence of ventriculocoronary arterial communication is seen exclusively in a subgroup of patients with an aortic atresia and mitral stenosis variant of hypoplastic left heart syndrome. The prognosis is poor in this subgroup of patients.     

Comparison of forearm plethysmography methods with brachial artery pulsed Doppler flowmetry in man

Summary. Blood flow in the forearm was evaluated using simultaneous measurements of pulsed Doppler flowmetry and strain-gauge plethysmography in 32 normal subjects and 91 patients with sustained essential hypertension. The two determinations of blood flow were strongly correlated (r = 0·58). Measurements with strain-gauge plethysmography reflected changes in blood flow velocity but were poorly correlated with changes in arterial diameter as measured by pulsed Doppler flowmetry. The latter method permits evaluation of instantaneous variations in blood flow velocity and detection of active modifications of arterial diameter.     

Color flow Doppler ultrasonography: comparison with peripheral arteriography for the investigation of peripheral vascular disease.

Using arteriography as the gold standard, Color flow Doppler ultrasonography was evaluated with regard to its ability to detect peripheral vascular occlusive disease and hemodynamically significant stenosis in patients having peripheral arteriography. One hundred legs in 51 patients were compared at seven arterial segments for disease. Color flow Doppler ultrasonography correctly detected 84 occluded segments, and demonstrated a sensitivity and specificity for patency vs occlusive disease of 95% and 99%, respectively. One hundred and thirty hemodynamically significant lesions (occlusions plus significant stenosis) were correctly identified with color flow Doppler ultrasonography, with a sensitivity and specificity of 92% and 97%, respectively. Color flow Doppler ultrasonography is a safe, inexpensive, and noninvasive method of accurately documenting significant peripheral arterial disease and offers a new first-line investigation for patients presenting with symptoms of peripheral arterial insufficiency.     

Basics of abdominal and pelvic duplex: instrumentation, anatomy, and vascular Doppler signatures.

The capabilities and limitations of color duplex sonography are briefly discussed in this article. Following this, basic Doppler and hemodynamic principles are reviewed, with emphasis on the concept of arterial pulsatility, as reflected in Doppler velocity waveforms. The bulk of the article is devoted to abdominal vascular anatomy and a review of the Doppler signatures that facilitate identification to abdominal vessels. This subject is complex, and an intimate command of abdominal vascular anatomy can only be achieved when detailed study is coupled with sonographic experience. It is hoped that the anatomic drawings and sonographic illustrations included in this work will assist the neophyte sonographer with the difficult task of mastering the anatomy and normal Doppler characteristics of abdominal vessels.     

Doppler ultrasonographic findings on hepatic arterial vasospasm early after liver transplantation.

OBJECTIVE: Hepatic arterial vasospasm has not been well recognized clinically as a post-liver transplant vascular complication because of the lack of sufficient data and diagnostic standards. The goal of this study was to provide new evidence and a diagnostic model for the clinical appreciation of hepatic arterial vasospasm and evaluate the role of ultrasonography in the diagnostic process. METHODS: Nine post-orthotopic liver transplant cases were retrospectively reviewed. Multiple clinical measurements were analyzed. Routine Doppler ultrasonography was performed within 24 hours, and additional ultrasonographic examinations were conducted as indicated. Each of the 9 patients was given a single 10 mg dose of nifedipine sublingually and monitored by ultrasonography when vasospasm was suspected on the basis of the Doppler ultrasonographic results. RESULTS: Doppler ultrasonography showed high-resistance hepatic arterial flow with absence of antegrade flow and even reversal of flow during diastole both extrahepatically and intrahepatically in all cases. Ten to 45 minutes after administration of the vasodilator, antegrade diastolic flow was observed along the course of the main hepatic artery and its intrahepatic branches with the resistive indices decreasing on average from 1.0 to 0.76. In addition, the peak systolic velocities increased from 57 cm/s before nifedipine administration to 77 cm/s after administration. CONCLUSIONS: High-resistance hepatic arterial flow (resistive index = 1) early after liver transplantation is indicative of hepatic arterial vasospasm if it responds to vasodilators. Doppler ultrasonography is a useful tool for the diagnosis of this vascular complication.     

彩超及频谱Doppler超声在乳腺肿块鉴别诊断中的应用

本文对６１例６８个乳腺肿块进行了彩色Ｄｏｐｐｌｅｒ血流显像（ＣＤＦＩ）及脉冲Ｄｏｐｐｌｅｒ（ＰＤ）的检测，其中乳癌２２例，良性肿块３９例，均经手术和病理证实。结果表明：ＣＤＦＩ能迅速显示乳腺肿块的血流形态和分布，ＰＤ可区分动、静脉血流，在ＣＤＦＩ引导下进行检测可避免单纯ＰＤ检测的盲目性。动脉血流在２１例乳癌和６例乳腺良性肿块中获得，而乳癌的血流阻力指数（ＲＩ）均大于０．５５．彩超及频谱（双功彩色）Ｄｏｐｐｌｅｒ超声诊断乳腺肿块的总符合率可达９７．１％，高于灰阶超声诊断。因此，Ｄｏｐｐｌｅｒ超声对乳腺肿块性质的判断是有价值的。     

彩色多普勒超声对腮腺肿块的血液动力学研究

本文对41例腮腺肿块进行了彩色多普勒血流显像（CDFI）及脉冲多普勒（PD）的检测，其中腮腺癌11例，良性肿块3O例，均经手术和病理证实。结果表明：CDFI能迅速显示腮腺肿块的血流形态和分布。PD可区分动、静脉血流，在CDFI引导下进行检测可避免单纯PD检测的盲目性。动脉血流在10例腮腺癌和4例良性肿块中获得，而腮腺癌的血流阻力指数（RI）均大于0．55。彩色多普勒诊断腮腺肿块的总符合率可达975％（39／40），明显高于灰阶超声诊断。     

Doppler methods for quantitative measurement and localization of peripheral arterial occlusive disease by analysis of the blood flow velocity waveform

Errors concerned with the use of continuous wave Doppler ultrasound for the quantitative assessment of peripheral arterial occlusive disease by analysis of the blood flow velocity waveform are briefly examined. It is shown that, while some of the simpler signal processing techniques are inadequate, techniques such as real-time frequency analysis of the Doppler signal can yield information of quantitative value. A new multifilter system is described that yields the instantaneous maximum velocity waveform. From the results of preliminary patient studies using this system, it is concluded that clinically significant peripheral arterial disease can be quantified and regionally localized.     

正常阴囊的彩色多普勒超声检测

作者用彩色多普勒超声对72例正常人阴囊内各血管的解剖及血流动力学进行研究。检测了各动脉血流收缩期最大流速、舒张末期流速，每搏平均流速及搏动指数、阻力指数。拟出各参数的正常值范围，分析各参数变化的特征，并探讨其临床意义。作者认为，彩色多普勒能够识别正常阴囊内血管的解剖及其血流变化，有助于阴囊内急症的鉴别诊断。文中对检测方法也进行了探讨。     

彩色多普勒在子宫肌瘤介入治疗前后的应用价值

目的 探讨彩色多普勒评价子宫动脉栓塞术治疗子宫肌瘤疗效的价值。方法 应用彩色多普勒血流图(CDFI)观察18例子宫肌瘤患者，其中行子宫双侧动脉栓塞术10例，左侧7例，右侧1例，术后1—3个月复查。结果 ①术后肌瘤回声明显改变，瘤体内无血流或减少；②术后子宫体积、肌瘤体积逐渐缩小，3个月时分别较术前缩小75．68％(P＜0．01)、76．87％(P＜0．01)；③临床症状明显减轻或消失。结论 CDFI是无创观察栓塞术前后子宫肌瘤变化的有效手段，对术前诊断、术后疗效观察以及临床选择治疗方法等具有重要价值。