Identification of feeding arteries to establish the intra- or extraparotid location of jugulodigastric nodules: value of color Doppler sonography

OBJECTIVE: The objective of our study was to determine the value of color Doppler imaging as an adjunct to gray-scale sonography to reveal the intra- or extraparotid origin of jugulodigastric nodules of uncertain location. SUBJECTS AND METHODS: Forty nodules in the jugulodigastric area from 38 patients were imaged with gray-scale, color, and power Doppler sonography. Nodules receiving vessels from salivary glands were assumed to be intraglandular; those accepting vessels from paraparotid spaces were considered to arise from outside the gland. Imaging results were correlated with biopsy and surgical findings. RESULTS: In 38 of 40 cases, color and power Doppler sonography displayed discrete feeding arteries leading to the nodules: 25 nodules had one supplying artery, nine received two arteries, and four had three or more arteries. Intraparotid nodules received vessels from the gland in 20 cases. In two cases, the source of vessels was indeterminate. In two malignant tumors, multiple arteries derived from both the parotid and the neck spaces. All 14 extraparotid nodules received the arterial supply from paraparotid spaces. Color Doppler sonography enabled prediction of the intraglandular location of the nodules in 91% of cases and the extraglandular location in 87.5% of cases. The correct diagnosis was achieved in 34 of 40 nodules, with a global accuracy of 85%. CONCLUSION: Color Doppler sonography can help to assess the intra- or extraparotid location of jugulodigastric nodules. In practice, this technique can support the diagnosis when gray-scale sonography raises doubts about the origin of a jugulodigastric nodule.     

Blood flow in healthy gallbladder walls on color and power Doppler sonography: effect of wall thickness and gallbladder volume.

OBJECTIVE: The purpose of this study was to determine the effect of gallbladder contraction on the conspicuity of flow in the normal gallbladder wall. SUBJECTS AND METHODS: Ten healthy adult volunteers without clinical evidence of gallbladder disease participated in the study. After patients fasted overnight, the gallbladder was scanned using gray-scale, color Doppler, and power Doppler sonography. The subjects were then given a standard meal consisting of 478 ml of a carbohydrate-rich dietary supplement, and the imaging sequence was repeated 20 and 45 min thereafter. Mural flow was graded using a four-step grading scheme. Gallbladder volume, wall thickness, and visibility of mural flow at all three time points were statistically compared. RESULTS: Enhanced mural flow was seen after meal consumption in all but one volunteer. Overall, mural flow was significantly greater 45 min after eating than at baseline or 20 min on color Doppler sonography (p = .004) and power Doppler sonography (p = .008). CONCLUSION: Flow in the gallbladder wall is a normal finding that is seen more easily when the gallbladder is contracted. This fact must be kept in mind when sonography is used with patients in whom acute cholecystitis is suspected, particularly if they do not fast before sonography.     

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.     

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.     

Using gray-scale and color and power Doppler sonography to detect prostatic cancer

OBJECTIVE: We performed a prospective study to assess gray-scale and color and power Doppler sonography for the detection of prostatic cancer and to determine the impact of operator experience. SUBJECTS AND METHODS: Four radiologists with prior experience using gray-scale and Doppler imaging and four urologists with prior experience limited to gray-scale imaging performed sextant biopsies on 251 patients. Each biopsy site was prospectively scored for gray-scale and Doppler abnormality. RESULTS: Cancer was detected in 211 biopsy sites from 85 patients. Overall agreement between sonographic findings and biopsy results as measured with the kappa statistic was minimally superior to chance (kappa = 0.12 for gray-scale, kappa = 0.11 for color Doppler, kappa < or =0.09 for power Doppler). With respect to gray-scale diagnosis of cancer, the performance of radiologists (kappa = 0.12) and urologists (kappa = 0.13) was similar. With respect to power Doppler, the performance of radiologists (kappa = 0.09) was superior to that of urologists (kappa = -0.03, p<0.002). Among patients with at least one positive biopsy for cancer, foci of increased power Doppler flow detected by a radiologist were 4.7 times more likely to contain cancer than adjacent tissues without flow. CONCLUSION: Gray-scale and Doppler imaging did not reveal prostatic cancer with sufficient accuracy to avoid sextant biopsy. Power Doppler may be useful for targeted biopsies when the number of biopsy passes must be limited. There is benefit from increased operator experience with Doppler imaging, but there is no demonstrable benefit of power Doppler over conventional color Doppler sonography.     

Power Doppler sonography: evaluation of hepatocellular carcinoma after treatment with transarterial embolization or percutaneous ethanol injection therapy

OBJECTIVE: The aim of this study was to compare tumor detectability by assessing the vascularity on power and color Doppler sonography and CT after transarterial embolization or percutaneous ethanol injection therapy or both in hepatocellular carcinoma. SUBJECTS AND METHODS: Forty-seven nodules of hepatocellular carcinoma (size, 28 +/- 7 mm [mean +/- standard deviation]; range, 20-40 mm) in 38 patients were treated with transarterial embolization (n = 6), percutaneous ethanol injection therapy (n = 23), and transarterial embolization plus percutaneous ethanol injection therapy (n = 9). Power Doppler sonography, color Doppler sonography, and CT were performed before and 2 weeks, 3 months, and 6 months after the treatments. The existence of hepatocellular carcinoma was confirmed by positive findings for color signals on both Doppler sonography techniques and for tumor stains on CT. All the tumors were determined to be malignant by microscopic examination of biopsy specimens. RESULTS: Before the treatments, power Doppler sonography (100%) and CT (100%) were significantly more effective than color Doppler sonography (61.7%) (p < 0.001, for both). Six months after the treatments, the sensitivity of power Doppler sonography (87.5%) was significantly better than that of color Doppler sonography (12.5%) but was not significant in comparison with CT (66.6%). However, power Doppler sonography detected color signals in two of three tumors in which iodized oil was accumulated and no tumor stain appeared on CT, and the two lesions detected with power Doppler sonography were carcinomas. CONCLUSION: Power Doppler sonography can be considered the most sensitive technique in assessing the viability of hepatocellular carcinoma treated with transarterial embolization or percutaneous ethanol injection therapy or both.     

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.     

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     

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     

Ultrasound detection of colonic polyps: perspective

Colorectal cancer is often preventable if the precursor adenoma is detected and removed. Although ultrasound is clearly not one of the widely accepted screening techniques, this non-invasive and radiation-free modality is also capable of detecting colonic polyps, both benign and malignant. Such colon lesions may be encountered when not expected, usually during general abdominal sonography. The discovery of large colonic polyps is important and can potentially help reduce the incidence of a common cancer, whereas detection of a malignant polyp at an early stage may result in a curative intervention. This pictorial review highlights our experience of sonographic detection of colonic polyps in 43 adult patients encountered at our institutions over a 2-year period. 4 out of 50 discovered polyps were found to be malignant lesions, 3 polyps were hyperplastic, 1 polyp was a hamartomatous polyp and the rest were benign adenomas. The smallest of the detected polyps was 1.3 cm in diameter, the largest one was 4.0 cm (mean 1.7 cm; median 1.6 cm). In each case, polyps were discovered during a routine abdominal or pelvic examination, particularly when scanning was supplemented by a brief focused sonographic inspection of the colon with a 6–10 MHz linear transducer. In this paper, we illustrate the key sonographic features of different types of commonly encountered colonic polyps in the hope of encouraging more observers to detect these lesions, which may be subtle.Colorectal cancer is the second most frequent cause of cancer-related death in North America and western Europe [1]. Each of us is thought to have a 6% chance of developing colorectal carcinoma—yet it is preventable in the majority of individuals if the precursor adenoma is detected and removed [2-5]. Although several screening techniques already exist with varying capability and invasiveness, a large percentage of the population remains unscreened, largely due to poor patient acceptance of routine colorectal screening [6].Ultrasound is not one of the widely accepted screening techniques for detecting colonic polyps. However, transabdominal ultrasound has been shown to demonstrate benign colonic polyps of significant size in both children and adults, with a reported sensitivity of 28.6% and specificity of 99.4% for detection of polyps greater than 10 mm diameter in the adult population [7,8]. With the use of hydrocolonic sonography, as described by Limberg, an accuracy of 91% for detection of colonic polyps greater than 7 mm diameter may be achieved [9]. As a screening tool, however, neither conventional nor hydrocolonic ultrasound has gained wide clinical acceptance.This pictorial review highlights our experience of sonographic detection of 50 colonic polyps in 43 adult patients encountered at our institutions over a 2-year period (June 2009–June 2011). All polyps were subsequently confirmed by endoscopic removal and histological examination. Four out of fifty discovered polyps were found to be malignant lesions, three polyps were hyperplastic, one polyp was a hamartomatous polyp and the rest were benign adenomas. The smallest of the detected polyps was 1.3 cm in diameter and the largest was 4.0 cm (mean 1.7 cm; median 1.6 cm). In each case, polyps were discovered during a routine abdominal or pelvic examination when scanning was supplemented by a 2–3 min focused sonographic inspection of the colon with a 6–10 MHz linear transducer, as described below. All polyps were an incidental finding identified when the colon was accessible to ultrasound evaluation. This was not a purposeful study to evaluate performance of routine ultrasound in colonic polyp detection and thus endoscopy was not performed to confirm normality. Our intention, with hindsight, was to try and maximise the usefulness of conventional sonography.Similar to other observers, we found that colonic polyps greater than 1.0 cm diameter can be discovered on conventional ultrasound. We did not use hydrosonography or any special preparation prior to ultrasound. In our experience, the proximal sigmoid and distal descending colon were a frequent site of sonographically detectable polyps because these colon segments were often accessible to ultrasound without any special preparation. However, we also noted that the full length of the colon was not confidently visualised in at least half of our patients, which underlines the inherent limitations of conventional ultrasound. The most frequent blind areas of the colon to ultrasound were rectosigmoid, splenic and hepatic flexures, largely because these areas were faecally filled while not amenable to transducer compression owing to their anatomical position.Nevertheless, detection of a large colonic polyp is clearly important—once a polypoid lesion is discovered, the approach is obvious: endoscopic localisation and removal of the lesion with subsequent histological assessment. Uncovering a polypoid lesion with apparent malignant features will also expeditiously warrant a staging evaluation by CT.This article aims to illustrate the typical sonographic features of different types of commonly encountered polyps and to emphasise the potential role of conventional ultrasound in colonic polyp detection.     

CT colonography: value of scanning in both the supine and prone positions

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of CT colonography when patients were imaged in both the supine and prone positions. We evaluated whether imaging in two positions decreased the number of collapsed colonic segments and increased sensitivity for polyp detection. MATERIALS AND METHODS: Twenty-three patients underwent CT colonography in both the supine and prone positions. Colonic distention for each of the 46 scans was graded. Adequacy of distention for either position alone was compared with that of the combination of the two positions. Polyp data revealed by colonoscopy were reviewed, and the CT data were then retrospectively reviewed for polyp detection. RESULTS: When each scan was considered alone without benefit of the scan obtained in the opposite position, 27 (58.7%) of 46 scans showed inadequate distention. When scans obtained in both positions were considered together, 20 (87.0%) of 23 patients had adequate distention with the grading system used. However, this value increased to 23 (100%) of 23 patients when the reasons for inadequate distention in the three patients were considered. Of the 27 polyps detected with colonoscopy, 21 (77.8%) were also detected retrospectively with CT colonography. Colonoscopy showed 20 polyps that were 5 mm or larger; nineteen (95.0%) of these 20 polyps were also detected retrospectively with CT colonography, nine (47.4%) of which were seen in only one position. CONCLUSION: Use of both the supine and prone positions for patients undergoing CT colonography improves evaluation of the colon and increases sensitivity for polyp detection.     

Computerized detection of colonic polyps at CT colonography on the basis of volumetric features: pilot study

PURPOSE: To develop a computer-aided diagnosis (CAD) scheme for automated detection of colonic polyps on the basis of volumetric features and to assess its accuracy on the basis of colonoscopy, the standard. MATERIALS AND METHODS: Computed tomographic (CT) colonography was performed in patients with use of standard bowel cleansing, air insufflation, and helical scanning in supine and prone positions. The colon was extracted from volumetric data sets generated from transverse CT sections. Volumetric features characterizing polyps were computed at each point in the extracted colon. Polyps were detected by means of hysteresis thresholding and fuzzy clustering followed by a rule-based test on the basis of feature values. Locations of the detected polyps were compared with those detected at conventional colonoscopy. RESULTS: Forty-one cases were analyzed: nine cases with polyps and 32 without polyps. Each case with polyps had one polyp of clinically important size (six were 5-9 mm; three, 10 mm). Thus, there were 82 volumetric data sets, 18 included polyps. Eighty-nine percent (16 of 18) of the polyps were detected. Each of the two false-negative findings was detected in the other position; thus, 100% of polyp cases were detected, with 2.5 false-positive findings per patient. The false-positive findings were similar to those due to common perceptual errors. Most of the false-positive findings were easily distinguishable from true polyps by experienced radiologists. CONCLUSION: The CAD scheme has the potential to depict polyps with high sensitivity and an acceptable false-positive rate.     

Assessment of fetal swallowing with gray-scale and color Doppler sonography

OBJECTIVE: Our study was focused on the evaluation of fluid dynamics to assess the value of gray-scale and color Doppler sonography for evaluating the development of fetal swallow-related movements from early gestation until birth. MATERIALS AND METHODS: We examined 56 fetuses from weeks 15-39 of gestation. Each fetus was examined throughout four distinct periods of gestation: weeks 15-18, 22-25, 30-34, and 37-39. During the examination, seven gray-scale sonography or color Doppler sonography patterns and their prevalence were considered. RESULTS: Mandibular and/or labial movements (chi2 = 56.4, p < 0.0001) and their rhythmic activity (chi2 = 41.4, p < 0.0001) were seen on gray-scale sonography in an increasing percentage of fetuses as gestational age increased. Doppler findings showed an increase for nose-mouth flow signals (chi2 = 57.6, p < 0.0001), larynx-esophagus flow signals (chi2 = 13.2, p = 0.0003), and effective swallowing (chi2 = 36.0, p < 0.0001) as gestational age increased. CONCLUSION: There is a trend in the fetus toward development of increased coordinated movement and more functional nose-mouth flow with increasing gestational age: 32.1% of the 56 fetuses in our series achieved effective swallowing at 37-39 weeks, on the basis of gray-scale and Doppler evaluations. Knowledge of the physiologic mechanism involving swallowing development may allow identification of altered swallow-related movements in fetuses with malformations of the digestive tract or with neurologic disorders.     

Differentiation of benign and malignant tumors of the parotid gland: value of pulsed Doppler and color Doppler sonography

To establish criteria for the differentiation of benign and malignant tumors of the parotid gland using color Doppler sonography (CDS) and pulsed Doppler sonography (PDS) we examined 37 patients with parotid tumors by gray-scale ultrasound, CDS, and PDS. Tumor vascularization displayed by CDS was graded subjectively on a 4-point scale (0 = no vascularization, 3 = high vascularization). From the Doppler spectrum, the highest systolic peak flow velocity, the resistive index (RI), and the pulsatility index (PI) were calculated. There were 11 malignant and 26 benign tumors. Tumor vascularization by CDS was grade 0 or 1 in 88.5 % of benign lesions, whereas it was grade 2 or 3 in 82 % of malignant lesions (P < 0.0001). The highest systolic peak flow velocity was statistically significantly higher in malignant lesions than in benign lesions. Using a threshold systolic peak flow velocity of 25 cm/s, sensitivity was 72 % and specificity was 88 % for the detection of a malignant tumor. Evaluation of tumor vascularization by CDS and PDS cannot differentiate between benign and malignant parotid tumors with certainty. However, high vascularization and high systolic peak flow velocity in tumor vessels should raise the suspicion of malignancy, even if tumor morphology on gray-scale sonography indicates a benign lesion. Received 5 February 1998; Accepted 5 March 1998     

Ultrasound in Crohn's disease of the small bowel

OBJECTIVE: The purpose of this work is to prospectively evaluate high resolution ultrasonography with graded compression in the ability to detect Crohn's disease of the small bowel (CDSB) together with its complications and activity signs, compared with enteroclysis, CT and immunoscintigraphy in the mirror of the final diagnosis. METHODS AND MATERIAL: In a series of 73 consecutive patients, who were referred for enteroclysis with suspected Crohn's disease of the small bowel computed tomography (CT), ultrasound (US), immunoscintigraphy with 99mTc labeled monoclonal antigranulocyte antibody (AGAb) examinations were performed within 10 days from each other. For the final evaluation the diagnosis of CDSB was based on combination of clinical and enteroclysis findings (73 cases) and in 17 cases additional surgical and pathological data were available. The results of other modalities were blinded to the radiologists performing and reading out the exams. The diagnostic values of each modality was assessed also in those 18 patients, who had early Crohn's disease. In the group of 43 patients with proven CDSB who had all the four imaging modalities, the modalities were compared in their ability to demonstrate various pathological conditions related to CD. Increased (>500 ml/min) flow measured by Doppler US in the superior mesenteric artery and increased color signs in the gut wall seen by power Doppler sonography were compared to CDAI. RESULTS: Of the 73 patients the combination of enteroclysis and clinical tests demonstrated CDSB in 47. The sensitivity, specificity and accuracy of ultrasound were 88.4, 93.3 and 90.4%, respectively. Enteroclysis was the most accurate method. CT was more sensitive than US, but less specific. The accuracy of US, CT and scintigraphy were similar. In the group of 18 patients, who had early CDSB, the sensitivity of US decreased to only 67%, CT and scintigraphy had higher values. Intra- and perimural abscesses, and sinus tracts were also more frequently visualized by US, especially if they were small. US was superior than CT in detecting stenoses and skip lesions, but inferior to enteroclysis. US and CT detected more fistulas, than enteroclysis. Compared to CT, US detected more cases with mesenteric lymphadenopathy, equal cases with abscesses and free peritoneal fluids. In detecting mesenteric inflammatory proliferation CT, and in detecting colonic involvement CT and immunoscintigraphy were slightly superior than graded compression US. Patterns of mural stratification detected by ultrasound correlated well with the enteroclysis severity stages. There was only 59% agreement between increased superior mesenteric artery flow detected by Doppler sonography and CDAI, and 60.5% agreement between increased number of Color pixels in the gut wall measured by power Doppler and increased CDAI. CONCLUSION: High resolution graded compression sonography is a valuable tool for detecting small intestinal Crohn's disease. It has similar diagnostic values as CT. However in early disease the sensitivity substantially decreases. In known Crohn's disease for following disease course, evaluating relapses and extramural manifestations US is an excellent tool. Doppler and Power Doppler activity measurements do not correlate well with the more widespread clinical activity index.     

Initial experience with contrast-enhanced sonography of the prostate

OBJECTIVE: We investigated the usefulness of contrast-enhanced sonography to depict vascularity in the prostate and improve the detection of prostatic cancer. SUBJECTS AND METHODS: Twenty-six patients with an elevated prostate-specific antigen level (> or = 4 ng/ml) or an abnormal digital rectal examination were enrolled in a phase II study of an i.v. injected sonographic contrast agent. Continuous gray-scale, intermittent gray-scale, phase inversion gray-scale, and power Doppler sonography of the prostate were performed. Sonographic findings were correlated with sextant biopsy results. RESULTS: After the administration of contrast material, gray-scale and Doppler images revealed visible enhancement (p < 0.05). Using intermittent imaging, we found focal enhancement in two isoechoic tumors that were not visible on baseline images. No definite focal area of enhancement was identified in any patient without cancer. Contrast-enhanced images revealed transient hemorrhage in the biopsy tracts of three patients. CONCLUSION: Enhancement of the prostate can be seen on gray-scale and Doppler sonographic images after the administration of an i.v. contrast agent. Contrast-enhanced intermittent sonography of the prostate may be useful for the selective enhancement of malignant prostatic tissue.     

Contrast-enhanced versus conventional and color Doppler sonography for the detection of thrombosis of the portal and hepatic venous systems

OBJECTIVE: We conducted a prospective study to compare sonography, color Doppler sonography, and contrast-enhanced sonography for the detection and characterization of portal and hepatic vein thrombosis complicating hepatic malignancies. SUBJECTS AND METHODS: Three hundred sixteen patients with biopsy-proved hepatic tumors were studied at baseline and 3 months later with sonography, color Doppler sonography, and contrast-enhanced sonography. Thrombosis was defined as the presence of intraluminal echogenic material at sonography, absence of intraluminal color signals at color Doppler sonography, and presence of nonenhancing intraluminal area at contrast-enhanced sonography. Thrombi were considered malignant if they displayed continuity with tumor tissue at sonography, intrathrombus color signals at color Doppler sonography, and enhancing signals at contrast-enhanced sonography, both having arterial waveforms at Doppler spectral examination. Definitive diagnoses were obtained by sonographically guided biopsy except for thrombi displaying at conventional sonography unequivocal continuity with tumor tissue. RESULTS: Thrombosis was detected in 79 (25.0%) of 316 patients at baseline and in 83 (26.3%) of 316 patients after 3 months. Eighty-one (97.6%) of the 83 thrombi were malignant. Definitive diagnosis was performed by imaging in 60 (72.3%) of the 83 cases and by biopsy in 23 cases (27.7%). For thrombus detection, contrast-enhanced sonography displayed significantly higher sensitivity than color Doppler sonography (p = 0.004) and borderline superiority over sonography (p = 0.058). For thrombus characterization, contrast-enhanced sonography was significantly more sensitive than color Doppler sonography (p < 0.0005) and conventional sonography (p = 0.02). CONCLUSION: Contrast-enhanced sonography is superior to sonography and color Doppler sonography for the detection and characterization of portal and hepatic vein thrombosis complicating hepatic malignancies.     

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     

Color and spectral Doppler mirror-image artifact of the subclavian artery

The mirror-image artifact, which has been previously described in gray-scale sonographic imaging, is also readily visualized with both spectral and color Doppler flow imaging. In 10 consecutive healthy subjects, a mirror image of the subclavian artery was readily apparent at gray-scale, spectral Doppler, and color Doppler sonography. An experimental in vitro model was constructed to demonstrate that the lung apex, which is located immediately posterior to the subclavian artery, acts as the highly reflective acoustic interface to form this artifact. Knowledge of the presence of the mirror-image artifact should be helpful to the radiologist and sonographer in avoiding misinterpretation of this important pitfall in both spectral and color Doppler flow imaging of the subclavian region, where there is a plethora of branching vessels.     

Sonography with color and pulsed Doppler in fetal pulmonary malformations

OBJECTIVE: Evaluate the advantages of color Doppler and pulsed Doppler in the diagnosis and prognosis of fetal pulmonary malformations. MATERIALS AND METHOD: This retrospective study of 24 fetuses explored pulmonary malformations using sonography. A classification into four groups was made based on the presence of cysts and the echogenicity of the lesion, then analysis of video recordings including Doppler with an interpretation chart: afferent vessel, color chart, spectrum shape (afferent vessel and within the malformation) to determine the contribution of Doppler within each group. RESULTS: Four lesions were avascular: bronchogenic cysts (three cases), subphrenic sequestration (one case). The other lesions were vascularized and color Doppler determined the source of vascularization feeding the malformation: branches of the pulmonary artery in 13 cases (eight cases of cystic adenomatoid disease, two cases of atresia, and three airway obstacles) or the aorta in seven cases (pulmonary sequestrations) with pulmonary venous return, six cases (intralobular sequestrations), or systemic venous return, one case (extralobular sequestration). The pulsed Doppler recording in the malformation (six cases) completed the color Doppler examination by showing the different spectrum shapes according to the aortic or pulmonary source of flow. The color chart matched in three cases (normal pulmonary segmentation) and was heterogeneous in eight cases (parenchymatous dysplasia). Furthermore, perfusion intensity was correlated with lesion progression. CONCLUSION: Color Doppler and pulsed Doppler provided a more precise diagnosis of these malformations and seems to contribute prognostic information.