The distribution of microvascular response in Achilles tendonopathy assessed by colour and power Doppler

Objectives To assess the distribution of microvascular response on colour Doppler (CD) and power Doppler (PD) ultrasound (US) of the tendo Achilles (TA) in tendonopathy, and to look for any relationship between tendon morphology and symptoms.Design and patients A retrospective, observational study was carried out on consecutive ambulant US patients with suspected tendonopathy, presenting with pain or an Achilles mass. Exclusion criteria were: use of steroids, and previous or possible rupture or surgery in either tendon or arthropathy. Using a 5–12 MHz linear array probe (ATL HDI 3000) both TAs were scanned. Tendonopathy was defined as tendon swelling and/or hypoechogenicity of the TA. The site, number and distribution of microvascularity, on CD and PD, and the anteroposterior size were recorded, with the analysis masked.Results Fifty-two patients presented with TA pain and six also with swelling. There were 34 males and 18 females, aged from 11 to 78 years (mean 45 years). Fifty-five TAs that showed tendonopathy with hypoechogenic areas were all observed to be over 5.9 mm (mean 11.1 mm, range 5.9–20 mm), of which 45 were symptomatic with abnormal PD and 24 with abnormal CD flow. It was observed that the extent and completeness of vessel branching was more extensive on PD than CD. All TAs demonstrating tendonopathy were over 5.9 mm in adults and all TAs that showed PD flow were over 6.5 mm. All microvessels originated towards the TA from the ventral surface usually into tendonopathy, and were 16-fold more frequent around the margins. There were 49 TAs with normal spectral US, and with no PD flow, with a mean size of 4.5 mm (range 3.0–7.4 mm). For the right and left TAs independently analysed and taking the 40 patients with a paired asymptomatic and symptomatic tendon: (1) There was a highly significant difference in size (P<0.00001) using the paired t-test (parametric) between the asymptomatic tendon (mean 5.2±1.4 mm (1 SD)), and the contralateral morphologically abnormal and symptomatic side (mean 9.7±1.4 mm). (2) There was no linear Pearson correlation (0.25) between TA size and duration of symptoms (P=0.11) for symptomatic tendons. (3) There was a positive Spearman correlation (0.84) between the number of vessels and TA size (P<0.00001). (4) There was a significant difference in the number of PD vessels using the non-parametric Wilcoxon signed test (P<0.00001) between the symptomatic and asymptomatic groups.Conclusions (1) PD shows more tendon microvascularity than CD in TA tendonopathy. (2) All microvessels arise on the ventral side of the TA. (3) There is a non-linear relationship between tendonopathy, TA size and the amount of microvascularity, but not between PD and duration of symptoms. (4) Morphologically abnormal adult TAs were larger than 5.9 mm, and PD flow was only seen in TAs above 6.5 mm.     

The update of ultrasound techniques in diagnosis of inflammatory bowel disease

Objective

To evaluate the value of conventional abdominal ultrasound and color Doppler in the diagnosis of inflammatory bowel disease (IBD) and its complications.

Materials and methods

40 patients suffering from colonic symptoms were evaluated by high resolution ultrasonography and color Doppler scanning.

Results

The accuracy of conventional abdominal ultrasound in detecting inflammatory bowel cases was 80% and the accuracy of color Doppler in detecting the hypervascularity was 75%.

Conclusion

Conventional ultrasound is a widely available non-invasive method for imaging the alimentary gastrointestinal tract. This can provide an important contribution for diagnosis and monitoring of disease activity. Color Doppler sonography has proved to be a valuable method for the assessment of disease activity in inflammatory bowel disease.     

彩色多普勒超声对小儿克罗恩病活动性评估的预测价值

目的 探讨彩色多普勒超声评价儿童克罗恩病（Crohn’s Disease, CD）的活动性,并与儿童克罗恩活动指数（Pediatric Crohn’s Disease Activity Index, PCDAI）进行相关性比较。方法 选取2015年1月～2020年12月在广州市妇女儿童医疗中心确诊为克罗恩病患儿68例,其中PCDAI评分<15分（非活动期）14例,15～45分（活动期）54例,分别对增厚肠壁根据能量多普勒超声表现进行Limberg分型,应用频谱多普勒超声测量肠壁动脉峰值收缩期速度（PSV）、舒张末期速度（EDV）、阻力指数（RI）,并对比各组之间的差异,同时将对RI及PCDAI进行相关性分析。结果 非活动期患儿受累肠壁血流以Limberg Ⅰ、Ⅱ型为主,活动期以Ⅲ、Ⅳ型为主,差异有统计学意义（u=4.51,P<0.01）。非活动期受累肠壁动脉平均RI显著高于活动期,有显著差异性（t=3.39,P<0.01）,PSV值非活动期与重度活动期组存在轻微的差异有统计学意义（t=2.13,0.01 相似文献   

Assessment of dynamic contrast enhancement of the small bowel in active Crohn's disease using 3D MR enterography

Purpose

To retrospectively compare the dynamic contrast enhancement of the small bowel segments with and without active Crohn's disease at 3D MR enterography (MRE).

Materials and methods

Thirteen patients (five men, eight women; mean age 41.2 years; range 29-56) were imaged on a 1.5-T MR scanner (Sonata, Siemens Medical) with standard MR sequences after having ingested 1000 ml of a 3% mannitol solution. Subsequently, high resolution 3D gradient-echo (volumetric interpolated breath-hold examination = VIBE) data sets were obtained pre-contrast and 20-40 s, 60-80 s, and 120-140 s after i.v. Gd-DOTA administration (0.2 mmol/kg). Signal enhancement was measured on single slices both in normal and histologically confirmed (12/13) inflamed small bowel wall segments as well as in the aorta, the psoas muscle, and the background to calculate signal-to-noise (SNR) and contrast-to-noise ratios (CNR).

Results

Small bowel wall enhancement was significantly higher (p < 0.05) in inflamed compared to normal segments at 20-40 s (SNR inflamed: 58.7 ± 33.8 vs normal: 36.0 ± 19.8; p = 0.048; CNR inflamed: 34.8 ± 23.4 vs normal: 16.3 ± 11.2; p = 0.017) and at 60-80 s (SNR: 60.3 ± 25.1 vs 41.9 ± 20.0; p = 0.049; CNR: 34.9 ± 15.1 vs 19.3 ± 13.2; p = 0.01) after i.v. contrast administration, respectively. Even at 120-140 s CNR was still increased in inflamed segments (33.7 ± 16.0 vs 18.1 ± 13.2; p = 0.04), while differences in SNR did not attain statistical significance (63.0 ± 26.2 vs 45.3 ± 23.3; p = 0.15).

Conclusion

In active Crohn's disease, histologically confirmed inflamed small bowel wall segments demonstrate a significantly increased early uptake of gadolinium on 3D VIBE sequences compared to normal small bowel segments.     

Breast cancer: assessment of vascularity by colour Doppler

We examined 37 patients with proven breast cancer using colour-coded Doppler sonography. Feeding vessels as well as vascular structures in the centre and the periphery of the tumour could be detected in the majority of cases. In a minority, however, no or only a few vessels with very slow flow velocities could be demonstrated. These widely varying results correspond well to histological findings reported in the literature. Comparisons of different examinations suffer from the lack of sufficient standardisation and validation. We conclude that despite the detectability of tumour vessels in breast tumours the role of the method in the differentiation of benign and malignant lesions remains in doubt. Correspondence to: S. Delorme     

Crohn's disease: current imaging approach

Purpose: This paper discusses the role of different imaging modalities in the diagnostic work-up of Crohn's disease (CD). Methods: We present a concept, which emphasizes different diagnostic aspects with regard to primary diagnosis, follow-up and assessment of complications of CD. The most effective imaging approach to various diagnostic problems of CD is discussed in detail. Discussion: With regard to the primary diagnosis barium studies should contribute to differentiate between CD and ulcerative colitis. Beyond that, these studies should evaluate location and extent of disease. During the follow-up bowel sonography provides staging of disease and enables the detection of complications at an early stage. CT is a valuable tool in the preoperative assessment of complications, such as fistulae and abscesses.      

MR肠管成像指标评估小肠克罗恩病活动性的价值

目的 探讨磁共振肠管成像(MRE)评估小肠克罗恩病(CD)活动性的价值.方法 对肠镜确诊的29例CD患者进行MRE检查.计算自旋回波螺旋桨技术脂肪抑制T2WI序列末端回肠炎症肠壁和邻近正常小肠肠壁、竖直肌的T2信号强度的比值.将动脉期3D肝脏快速容积成像序列末端回肠炎症肠壁和相同部位的平扫T1信号强度做对比,分别对T1和T2比值评分(0～3分).评估末端回肠炎症肠壁的厚度、淋巴结、肠管周围T2信号、齿梳征、肠管变形和溃疡、息肉的分值(0～3分).运用简化版CD肠镜评分方法(0～12分)对CD末端回肠急性活动性炎症进行评分.分析MRE活动性指标和肠镜急性炎症评分相关性.导出MRE回归方程并计算MRE模型预测急性炎症的受试者工作特征曲线.结果 管壁厚度,炎症肠壁T2/邻近正常肠壁T2(T2 ratio),动脉期炎症肠壁T1/平扫炎症肠壁T1(T1 ratio),肠管周围T2信号,管壁溃疡和息肉,齿梳征与肠镜急性炎症活动性评分具有一定的相关性.导出回归方程:SES-CD(the simple endoscopic score for crohng disease)=-0.268 +0.793×T1 ratio+1.977×肠管周围T2信号+0.643×肠壁厚度(R squared=0.662).MRE模型检测急性炎症的能力,敏感性82.4％,特异性83％,曲线下面积0.919(95％ CI 0.84,0.998).结论 T1ratio、管壁厚度、齿梳征、肠管周围T2信号能够较好地预测肠壁炎症活动性;导出的MRE模型能够准确的预测CD急性炎症(AUC ＞0.9).     

哺乳期和哺乳期后女性乳腺疾病的超声诊断

目的探讨哺乳期和哺乳期后女性乳腺疾病的声像图特征及临床价值。方法应用高频超声探测哺乳期和哺乳期后女性患者的乳腺病变,对不同类型的声像图进行回顾性总结和分析,重点研究积乳囊肿的声像图特征。结果本组97例,其中乳汁淤积伴感染(乳腺炎)30例,乳腺脓肿25例,积乳囊肿30例,积乳囊肿实变7例,积乳囊肿钙化5例。结论结合病史、临床表现及彩色多普勒超声有助于乳腺疾病的诊断及鉴别诊断,超声检查是一种操作简便、实用而有效的影像学诊断方法。     

Multiplanar spiral CT enterography in patients with Crohn's disease using a negative oral contrast material: initial results of a noninvasive imaging approach

The aim of this study was to prospectively define the role of multiplanar spiral CT enterography with a new negative oral contrast material for noninvasive assessment of the small bowel in patients with Crohn's disease. Thirty patients with established Crohn's disease prospectively underwent spiral CT enterography at 45-60 min after distension of the small bowel with 1400 ml of a negative oral contrast material (Mucofalk water enema). Spiral CT scans were obtained 50 s after administration of intravenous contrast material with the following parameters: 5-mm collimation; 7.5-mm/s table feed; and 3-mm reconstruction interval. The adequacy of bowel opacification, luminal distension, and the contribution of two-dimensional multiplanar reformatted imaging were assessed by two observers. Spiral CT imaging findings were compared with results of enteroclysis as well as endoscopic and histological findings in all patients. Spiral CT enterography with Mucofalk water enema was well tolerated in 29 of 30 patients. Findings on spiral CT enterography were comparable with those of barium studies in 25 of 30 patients, superior to those on barium studies in 4 patients, and inferior in 1 patient ( p<0.05). The addition of multiplanar reformatted images to axial spiral CT scans significantly improved observers' confidence in image interpretation ( p<0.05) but did not reveal additional abnormalities. Multiplanar spiral CT enterography with Mucofalk excellently provides information in patients with Crohn's disease. This technique accurately depicts the level of small bowel obstruction and the extent of inflammatory small bowel disease and its extraluminal complications.     

Vascularization of malignant and benign skin tumours measured by D-galactose-based signal-enhanced colour Doppler sonography

Purpose: Evaluation of colour Doppler criteria to differentiate between malignant and benign skin tumours on the basis of the degree of vascularization.Material and Methods: The B-mode sonomorphology and the degree of vascularization in colour Doppler of 81 clinically potentially malignant tumours of cutaneous and subcutaneous structures were analyzed and quantified by number of intratumoral vessels per sonographic slice and percentage vessel area.Results: Of all criteria employed, counting the intratumoral vessels visible on one ultrasound slice after application of a signal-enhancing agent led to highest sensitivity (94%) of all used criteria but the specificity was poor (64%). The highest specificity (88%) and greatest diagnostic accuracy (86%) discriminating benign and malignant lesions were found using the criterion "percentage vessel area >5.0%" after all inflamed lesions had been excluded on the basis of clinical criteria. Plain colour Doppler increased the specificity up to 97%, although the sensitivity decreased simultaneously to max. 75%. Analysis of the B-mode morphology and spectral Doppler parameter of intratumoral vessels did not contribute to the differential diagnosis.Conclusion: Signal-enhanced colour Doppler sonography is a valuable tool in the pretherapeutic assessment of cutaneous lesions. This method may be relevant for therapy and prognosis.     

高频彩色多普勒超声诊断精索静脉曲张临床分析

目的:探讨高频彩色多普勒超声在精索静脉曲张(Vc)中的诊断价值。方法:采用高频彩色多普勒超声检测749例Vc患者并对其进行统计分析。结果:亚临床型与临床型Vc发病年龄有极显著差异;临床分型相同时,曲张的精索静脉内径与同侧睾丸最大截面积无相关性;左右侧精索静脉内径、睾丸最大截面积均高度相关。结论:曲张的精索静脉内径大小对同侧睾丸最大截面积无影响;双侧精索静脉曲张患者左右两侧病变关系密切。     

乳腺叶状囊肉瘤临床钼钯X线与彩超征象分析

目的：结合文献资料分析总结乳腺叶状囊肉瘤的临床特点、钼钯X线与彩色多谱勒超声影像征象。方法：随机搜集临床资料完整的乳腺叶状囊肉瘤7例，每例患者均接受钼钯X线与彩色多谱勒超声检查，所有病例均经手术病理证实。结果：叶状囊肉瘤患者病史多较长，病灶体积一般较大，或在短时期内增长迅速。钼钯X线片上病灶多表现为密度均匀、边缘光滑的分叶状肿块。彩色多谱勒超声检查，病灶以不均匀中低回声为主。结论：叶状囊肉瘤多发于40—50岁，患者有较为独特的临床特点，结合钼钯X线与B型超声征象可以作出诊断。     

The contribution of colour Doppler flow imaging to the study of cerebral haemodynamics in the neonate

We investigated the contribution of colour Doppler flow imaging (CDFI) to duplex-ultrasonography of the neonatal brain. In pre- and full-term infants, CDFI facilitated spectral analysis of blood flow velocity wave forms in most major intracranial arteries, enabling blood flow velocity measurements. Moreover CDFI depicted major deep and superficial veins, enabling venous blood flow velocity measurements. Smaller arteries could also be imaged in a substantial number of infants in regions with haemorrhagic or ischaemic lesions. The method may also offer the opportunity to assess regional cerebral blood flow in the neonatal brain, although further study is necessary to determine whether accurate, reproducible flow velocity measurements are possible in these vessels.     

Color Doppler appearance of penile cavernosal-spongiosal communications in patients with severe Peyronie's disease

Our objective was to investigate the prevalence and Doppler characteristics of penile cavernosal-spongiosal communications (CSC) in patients with severe Peyronie's disease. These vessels are either anastomoses connecting the cavernosal arteries with the urethral arterial network or afferent vessels to the corpus spongiosum. Twenty patients with severe Peyronie's disease underwent penile color Doppler US after intracavernous injection of prostaglandin E(1). Study inclusion criteria were penile curvature or shortening which made intercourse difficult or impossible. The quality of erectile response was subjectively scored. The spectral characteristics of CSC were evaluated in comparison with waveform changes in cavernosal artery. There were 4 patients with normal erectile response, 10 with discrepancy in rigidity of the penile base and tip, 4 with veno-occlusive dysfunction and 2 with arteriogenic dysfunction. The CSC just proximal to the plaques had peak systolic velocity (PSV) significantly higher and resistance index (RI) significantly lower than the other CSC. The PSV in CSC near the plaques of patients with base-tip discrepancy and with veno-occlusive dysfunction were significantly higher than in the other patients. In patients with severe Peyronie's disease CSC near the plaques remain patent with low-resistance flow supporting the hypothesis that blood leakage can occur through these vessels.     

彩色多普勒超声在川崎病早期诊断及治疗监测中的价值

目的:探讨超声心动图在川崎病早期诊断及治疗监测中的价值。方法:对2003年6月-2006年6月临床诊断为川崎病的391例患儿超声心动图表现及临床实验室资料(如血小板,血沉、CRP)进行回顾性分析,并将其实验室资料分冠状动脉扩张和非冠状动脉扩张两组进行统计学分析。结果:391例患者中冠状动脉病变160例,其中LCA扩张68例,RCA47例,LCA、RCA同时扩张40例,冠状动脉瘤10例,并发心包积液5例,左心室增大8例,两组实验室资料有显著差异。结论:川崎病行超声心动图检查不仅为川崎病早期诊断提供依据,而且对指导其治疗和估计预后也有重要的价值。     

Assessment of Crohn''s Disease Activity by Doppler Sonography of the Superior Mesenteric Artery, Clinical Evaluation and the Crohn''s Disease Activity Index: A Prospective Study

AIM: Recent data have shown that superior mesenteric artery (SMA) flow rates are significantly increased in active Crohn's disease, suggesting that SMA flow may be a useful, non-invasive index of disease activity. The aim of this prospective study was to evaluate the use of SMA Doppler sonography as an indicator of Crohn's disease activity and to compare with clinical evaluation and the Crohn's disease activity index (CDAI). MATERIALS AND METHODS: Patients with active Crohn's (n = 19), inactive Crohn's (n = 17) and control subjects (n = 17) were evaluated. Categorization of disease activity was based on a reference standard. CDAI scores were also calculated independently. The SMA flow parameters evaluated were resistive index, pulsatility index, end diastolic velocity, peak systolic velocity, time averaged maximum velocity, cross-sectional area and maximum flow volume. RESULTS: Using a three-group ANOVA for each of peak systolic velocity (PSV) (P = 0.01), end-diastolic velocity (EDV) (P = 0.04), pulsatility index (PI) (P = 0.003), time-averaged maximum velocity (TAMV) (P = 0.05), and maximum flow volume (TAMV.CSA) (P = 0.01), there was a significant effect of group. Using post-hoc tests, only EDV (P = 0.01), TAMV (P = 0.02) and TAMV.CSA (P = 0.003) were significantly different between active and inactive Crohn's disease, though with considerable overlap of values for EDV and TAMV. The mean CDAI scores were significantly different between patients with active Crohn's (287) and inactive Crohn's (71) (P = 0.0001) and correlated well with the reference standard. CONCLUSION: Only three of several parameters previously described as allowing Crohn's disease activity assessment actually did so in our study. However, for two of these parameters (EDV, TAMV), there was overlap between the measurements in the active and inactive groups, thus limiting the ability to discriminate disease activity in practice. The degree of overlap for maximum flow volume (TAMV.CSA) between active and inactive disease was considerably less and this parameter may be more discriminatory of disease activity. On the other hand, we found CDAI scores to be accurate in disease categorization. We agree that there appear to be hyperdynamic changes in active Crohn's disease but suggest that Doppler ultrasound assessment does not reliably assess disease activity in routine clinical practice.     

克隆病X线征象与病理对照分析（附26例分析）

目的：总结26例克隆病X线表现,提高对本病的认识和诊断水平。方法：回顾性分析20年间26例经手术病理证实的克隆病,并结合大体病理标本和X线征象进行对照分析。结果：克隆病发病部位回肠最多,其次是空肠和结肠。病理标本与X线胃肠钡餐造影显示节段性局限性环形狭窄占77%,狭窄肠腔多在1cm之内;小肠扩张肠段形成“假结肠征”占61%,扩张肠管横径在5-13cm;病变区裂隙状、尖刺状溃疡均可见,粘膜皱襞变平或消失占54%;本组4例继发肠套迭。结论：克隆病病理改变与X线钡餐造影征象相对应,根据其胃肠钡餐造影、钡剂灌肠造影检查的特征性改变完全可以诊断本病。     

TCD对糖尿病合并高血压脑血管病变的研究

目的：应用经颅多普勒超声（TCD）探讨糖尿病合并高血压患者的脑血管功能状态及血流动力学变化。方法：应用TCD检测糖尿病合并高血压患者颅内动脉，并与糖尿病组、对照组就脑动脉平均血流速度、动脉血流速度异常分布状况、血流频谱形态、搏动指数参数的结果进行统计学分析。结果：糖尿病合并高血压组颅内动脉血流速度、血流频谱形态、搏动指数异常检出率明显高于糖尿病组及对照组（P〈0.05；P〈0．001）；血流速度增快以MCA多见，血流速度减慢以椎-基底动脉为主。结论：TCD可对糖尿病合并高血压患者脑血管状态提供客观的信息，在临床诊断、治疗、预防评估中起到重要作用。     

Color Doppler US findings in the diagnosis of arterial occlusive disease of the lower limb

Peripheral arterial occlusive disease (PAOD) of the lower limb is a widely spread disease at the present time. After clinical examination, which includes a comprehensive history of the patient, different imaging modalities are competitive in the exact assessment of PAOD. Besides digital subtraction angiography and MR -angiography, color Doppler US is an established imaging modality in the diagnosis of PAOD.
This article illustrates the typical color Doppler US findings in PAOD of the lower limb. Duplex images of normal and pathological findings are presented, and the limitations of the method are pointed out. Color Doppler US examination strategies in patients suffering of PAOD are outlined.