Contribution of power Doppler and gray-scale ultrasound of the median nerve in evaluation of carpal tunnel syndrome

Aim of the work

To assess the role of gray-scale and power Doppler ultrasound (US) of the median nerve at the wrist in evaluating carpal tunnel syndrome (CTS).

Materials and methods

Seventy-one wrists in 51 patients with CTS in addition to 50 healthy volunteers that served as the control group were enrolled in this study. The following sonographic parameters were evaluated in both patients and controls: cross sectional area of the median nerve just proximal to the tunnel inlet (CSA1), at the pisiform bone level (CSA2), the CSA difference (ΔCSA), flattening ratio of the median nerve and bowing of the flexor retinaculum. The power Doppler US was used to assess the number of nerve vessels with estimation of the vascularity score.

Results

The ΔCSA revealed an excellent discriminative ability (AUC = 0.988) in differentiating patients with CTS at an optimal cut-off value of 3.9 mm². Intraneural hypervascularization was significantly correlated with the ΔCSA of the median nerve (P < 0.001), while not significantly correlated with the age of patients, median nerve flattening ratio and bowing of flexor retinaculum.

Conclusion

The ΔCSA and vascularity score of the median nerve are important and useful sonographic parameters in evaluation of CTS.     

Follow-up study of renal transplants by duplex Doppler and gray-scale ultrasound.

In the early postoperative period after renal transplantation 388 follow-up ultrasound examinations were performed in 77 patients. Over a period of 18 months standardized duplex indices (resistive index, pulsatility index) and gray-scale parameters (parenchyma/sinus index; medulla/cortex index) were sampled. These data were correlated retrospectively with clinical and pathological diagnoses. To delineate the individual course of duplex and gray-scale indices during different transplant diseases we created a new parameter: the MID (maximal index difference) which is a result of the difference between the highest index during the phase of renal dysfunction and the lowest index during the phase of normal renal function. This MID, calculated for duplex indices and for the parenchyma/sinus index, indicated significant differences in the behavior of renal transplants during the four main diseases: interstitial rejection, vascular rejection, acute tubular necrosis and Cyclosporine A nephrotoxicity. Using the MIDs, a table of cut-off values was established, which enables to differentiate retrospectively these four transplant complications with a sensitivity of 84% and specificity of 81%. In our opinion consequent follow-up examinations with duplex and gray-scale sonography should be performed, enabling sonography to become a helpful diagnostic instrument in the monitoring of renal transplants.     

Arthrosonography: gray-scale ultrasound evaluation of the shoulder.

Gray-scale ultrasound images of the shoulders of 6 rhesus monkeys were obtained before and after fluid instillation to assess the ability of ultrasound to diagnose joint disorders. The normal bony landmarks and muscular structures were shown. After the fluid was introduced, fluid collections were identified in the axillary pouch and subscapular bursa. Ultrasound is a promising new method of detecting intra-articular effusions of the shoulder.     

经阴道彩超检测宫颈癌血流动力学改变的临床价值

目的探讨经阴道彩色多普勒超声（TV-CDS）检测宫颈癌的血流动力学改变的临床价值。方法对42例经病理确诊为宫颈癌的患者和46例正常健康妇女行TV-CDS检查,回顾性分析宫颈癌的超声血流动力学改变情况及血流动力学指标与肿瘤的组织学分类、临床分期之间的关系。结果与对照组比较,宫颈癌组肿瘤内血流信号明显增多,PSV明显增高,RI明显降低（P〈0．01）;不同组织学类型的宫颈癌组织内,PSV、RI之间差异无统计学意义（P〉0．05）;临床分期不同,宫颈癌组织内PSV、RI之间差异有统计学意义（P〈0．01）。结论TV-CDS能客观评价宫颈癌的血流信号及血流动力学指标变化,且癌组织内超声血流动力学指标与肿瘤临床分期存在相关性。     

肝移植术前术后彩超监测的应用价值

 目的 探讨彩色多普勒超声(CDFI)对肝移植术前术后的应用价值.方法 对39例肝移植患者分别于术前术后多次进行彩色多普勒超声检查,并检查21例健康人肝的血流动力学改变.结果 术前彩色多普勒超声筛选适合手术患者36例,其中肝癌21例,肝硬化失代偿11例,肝硬化并肝癌4例.术后早期出现肝脏轻度增大,不同程度的胸腔积液、腹腔积液及胆囊窝积液.10例出现排斥反应,1例出现肝动脉并发症.结论 彩色多普勒超声对肝移植术前、术后的检查具有重要的临床意义,术前可选择适合手术的患者,术后可有效地观察移植肝形态学变化及血流动力学的变化,对提高肝移植手术的成功率有重要的应用价值.     

Contrast-enhanced ultrasound after devascularisation of neuroendocrine liver metastases: functional and morphological evaluation

Objective

To evaluate morphological and perfusion changes in liver metastases of neuroendocrine tumours by contrast-enhanced ultrasound (CEUS) after transarterial embolisation with bead block (TAE) or trans-arterial chemoembolisation with doxorubicin-eluting beads (DEB-TACE).

Methods

In this retrospective study, seven patients underwent TAE, and ten underwent DEB-TACE using beads of the same size. At 1 day before embolisation, 2 days, 1 month and 3 months after the procedure, a destruction-replenishment study using CEUS was performed with a microbubble-enhancing contrast material on a reference tumour. Relative blood flow (rBF) and relative blood volume (rBV) were obtained from the ratio of values obtained in the tumour and in adjacent liver parenchyma. Morphological parameters such as the tumour’s major diameter and the viable tumour’s major diameter were also measured. A parameter combining functional and morphological data, the tumour vitality index (TVI), was studied. The Wilcoxon rank-sum test and Fisher’s test were used to compare treatment groups.

Results

At 3 months rBF, rBV and TVI were significantly lower (P?=?0.005, P?=?0.04 and P?=?0.03) for the group with doxorubicin. No difference in morphological parameters was found throughout the follow-up.

Conclusions

One parameter, TVI, could evaluate the morphological and functional response to treatments.

Key Points

? Contrast-enhanced ultrasound provides morphological and functional information about neuroendocrine hepatic metastases ? CEUS can evaluate changes after transarterial chemoembolisation, transarterial-embolisation and transarterial radioembolisation ? Functional (but not morphological) imaging reveals differences between TAE and DEB-TACE therapy ? To combine morphological and functional parameters, a tumour vitality index is proposed ? TVI can be used to monitor treatments acting on tumour vascularisation     

彩超对乳腺癌术后腋窝血管血流动力学改变的临床观察

目的：探讨乳腺癌术后患者腋窝血管的血流动力学状态是否存在改变及应用彩色多普勒超声检查的可行性。方法：搜集我院69例右乳腺癌改良根治术后复查患者,用彩色多普勒超声观察其腋动脉、静脉的内径（internal diameter,ID）、收缩期最大流速（peak systolic velocity,PSV）、舒张末期流速（end diastolic velocity,EDV）、平均流速（time averge velocity,TAV）、搏动指数（pulsatility index,PI）及阻力指数（resistivity index,Ⅲ）,与正常组作对照,进行统计学处理。结果：术后患肢腋静脉的PSV、EDV、TAV值较正常对照组减慢约24．0％,36．7％,34．9％;患肢腋动脉收缩期、舒张期、平均流速分别降低23．7％,47．9％,28．3％,差异均有统计学意义（P〈0．05）。术后血管工ID、PI、RI未见明显改变。术后有上肢水肿者较无症状者腋静脉PSV、EDV、TAMAX值明显下降（P〈0．05）,而腋动脉各参数无明显改变（P〉0．05）。结论：乳腺癌改良根治术对腋窝血管的处理一定程度影响患侧上肢的血供。彩色多普勒超声检查腋窝血管血流动力学是一种可靠的方法。     

超声诊断酒精性肝病的临床分析

我国酒精性肝病（ALD）的发病率逐年上升,已成为仅次于病毒性肝炎的第二大肝病,传统上酒精性肝病分为三类,即酒精性脂肪肝（AFL）、酒精性肝炎（AH）、酒精性肝硬化（AC）,三者可单独出现,也可同时并存或先后出现。本研究就我院近年来收治的120例ALD患者的临床资料进行回顾性分析,现报道如下。     

Focal liver lesions: Doppler ultrasound

Echo patterns of focal liver lesions as well as other morphological criteria do not suffice for differential diagnosis. In an attempt to increase the specificity of ultrasound of focal liver lesions, several years of Doppler-flow information was evaluated. Recent advances in ultrasound technology (power Doppler imaging, second harmonic imaging) as well as commercial availability of an intravenous signal enhancer (contrast agent) have additionally improved results of this technique. Received: 9 January 1998; Revision received: 18 May 1998; Accepted: 14 July 1998     

Doppler ultrasound evaluation of extracranial cerebrovascular disease

Summary Carotid Doppler examination was compared with arteriographic findings in 125 patients. The results demonstrated exact correlation in 87% of vessels studied. Clinically significant errors occurred at a rate of 4.5%. Clinically insignificant errors (8.5%) were usually the result of wall disease being mistaken for nonhemodynamically significant stenosis.     

Color Doppler ultrasound for evaluation of vasomotor activity in patients with carpal tunnel syndrome

Background  

Patients with carpal tunnel syndrome (CTS) have a variety of vasomotor symptoms. Here, we aimed to study the vasomotor activity of the radialis indicis (RI) artery (median nerve territory) and the radial palmar digital (RPD) artery of the little finger (ulnar nerve territory) before and after sympathetic stimulation in CTS patients using color Doppler ultrasound.     

The role of hepatic arterial Doppler ultrasound after liver transplantation: an 'audit cycle' evaluation

AIMS: To compare the diagnostic performance of hepatic arterial (HA) Doppler ultrasound post-liver transplantation for hepatic artery thrombosis and stenosis in our unit with the literature. To evaluate the role of the technique in clinical practice. MATERIALS AND METHODS: In a two-phase 'audit cycle' study, adult OLT patients had Doppler studies comprising detection of HA flow and measurements of peak systolic velocity, resistive index and systolic acceleration time. In phase I, patients had Doppler examinations 'routinely' and for any hepatic biochemical abnormality. In phase II, Doppler ultrasound was performed early post-OLT and later only if a senior transplant clinician suspected graft ischaemia. In addition to HA measurements the waveform was visually assessed. Clinical outcome was the 'gold standard'. RESULTS: Phase 1: 38 patients, 40 OLT operations, 125 Doppler studies; 14 arteriograms. Phase 2: 35 patients, 42 OLT operations, two HA angioplasties, one HA revision, one non-occlusive thrombus, 140 studies; 17 arteriograms. Results; Phase 1 [Phase 2]: sensitivity 80% [100%]; specificity 71% [81%]; PPV 28% [56%]; NPV 96% [100%]; incidence of HA abnormality 12.5% [19. 5%]; likelihood ratio of negative result 0.28 [0]; of positive result 2.8 [5.3]. CONCLUSION: Previously reported results are reproducible. Normal HA waveform should also be a criterion of normality. The technique is very sensitive but relatively non-specific. Predictive values improve with discriminate use. MacEneaney, P. M. (2000). Clinical Radiology55, 517-524.     

彩超在原位肝移植术后监测中的应用价值

随着器官移植技术日趋成熟和完善,原位肝移植得到迅速发展,目前已成为临床治疗终末期肝病的有效方法。彩色多普勒超声作为一种无创的诊断技术,是肝移植术后监测的首选影像检查方法。现对本院2002年~2005年的24例肝移患者术后超声鉴别监测结果报道如下。1材料与方法本组24例,男性23例,女性1例,年龄32~56岁,平均40岁。其中8例原发性肝癌,肿块大小3~8cm。数目2~6个,12例肝硬化,1例为急性重症肝炎,3例为亚急性重症肝炎,均采用背驮式肝移植术。采用Acuson 128xp 10彩色多普勒超声诊断仪,探头频率2·5~3·5MHz。检查时间:术后12h查1次,以后每天1…     

Emergency Doppler evaluation of the liver and kidneys

Doppler ultrasound is useful in the emergent evaluation of the liver and kidney transplant patient. Arterial stenosis, pseudoaneurysm, and venous thrombosis are treatable causes of allograft failure that can be detected easily with color and spectral Doppler. Doppler has a limited but important role in the emergent evaluation of the native liver and kidneys, usually involving prior biopsy or instrumentation.