Common hepatic artery aneurysm: diagnosis with duplex sonography and color Doppler.

Hepatic artery aneurysms are uncommon lesions, often with a nonspecific clinical presentation and difficult to diagnose before rupture. The authors report a case which was correctly diagnosed with non-invasive procedures (duplex sonography and color Doppler).     

Venous diagnosis using duplex sonography

Duplex sonography is an excellent alternative in sonographically accessible regions of the venous system if i.v. administration of contrast media for opacification is not possible for technical reasons or because of medical contraindications.     

下肢深静脉血栓的彩色多普勒超声诊断

目的：探讨彩色多普勒超声(CDFI)对下肢深静脉血栓(DVT)的诊断要点和临床价值。方法：对30例共34条患肢进行彩超检查，分析其类型、声像图特征，并与X线血管造影进行对照。结果：30例患者中左侧血栓22例(73．0％)，右侧4例(13．3％)，左右侧同时发病4例(13．3％)。34条患肢中中心性血栓18条(53．0％)，外周性8条(23．5％)，广泛性8条(23．5％)。34条受累静脉均有不同程度的扩张且探头加压无管腔压瘪(100％)。急性血栓为均匀低回声，不均匀偏高回声多提示为慢性血栓。CDFI显示受累静脉内血流信号消失或仅有少量溪流。结论：CDF1可为下肢DVT的检出、分类等提供可靠的诊断依据。     

Budd-Chiari syndrome: value of duplex sonography and colour Doppler imaging for diagnosis and follow-up

This retrospective study was designed to evaluate duplex sonography in the diagnosis and follow-up of patients with Budd-Chiari syndrome. Thirteen patients with clotting disease and histologically proven Budd-Chiari syndrome (3 acute and 10 chronic cases) were examined, using conventional duplex sonography (n=5) or colour-coded duplex sonography (n=8). Results were compared with CT in 6 cases, MRI in 11, coeliac and mesentric angiography in 5, and hepatic wedge venography and cavography in 6. Of 39 hepatic veins examined, 33 had an abnormal appearance on ultrasound studies: endoluminal thrombus, stenosis, dilatation, thick wall echoes. Doppler findings included total obstruction of 8 hepatic veins, reversed flow in 22 hepatic veins and intrahepatic collaterals with continous non-phasic flow in all cases. Duplex sonography showed portal thrombosis (n=1), evidence of portal hypertension (n=8) and inferior vena cava thrombosis (n=2). Nine patients were treated surgically. Patency of portocaval shunts was correctly assessed with colour coded duplex sonography in 8 of 9 patients. We believe that colour Doppler imaging is the procedure of choice for initial diagnosis of Budd-Chiari syndrome. Correspondence to: M. F. Bellin     

Distinction between obstructive and nonobstructive pyelocaliectasis with duplex Doppler sonography

Because animal studies have shown that renal obstruction increases renal vascular resistance, we theorized that obstruction would change the Doppler waveform. We studied the value of the resistive index (RI) calculated from the duplex Doppler waveform to distinguish between obstructive and nonobstructive pyelocaliectasis in 229 kidneys in 133 patients. The RI is the peak systolic frequency shift minus the minimum diastolic frequency shift, then divided by the peak systolic frequency shift. Duplex Doppler sonography was performed prospectively in 70 kidneys with pyelocaliectasis before the presence or absence of obstruction was established. In 54 of 70 kidneys, the presence or absence of obstruction was proved by interventional methods (percutaneous nephrostomy, antegrade or retrograde pyelography, loopography), and in the rest it was proved by body CT, excretory urography, or surgery. Thirty-eight kidneys were found to be obstructed, and 32 had nonobstructive dilatation. In addition, 159 kidneys without pyelocaliectasis were studied to identify possible limitations of Doppler sonography in the diagnosis of obstruction. Clinical history and laboratory data were used to determine that 109 of these kidneys were in normal subjects and 50 were in patients with nondilated renal disease. There was a significant difference between the mean RI of the obstructed (0.77 +/- 0.05) and the nonobstructed dilated (0.63 +/- 0.06) kidneys (p less than .01). Analysis of the receiver-operating-characteristic curve showed an RI of 0.70 to be a good discriminatory level for obstruction, resulting in a sensitivity of 92%, a specificity of 88%, and an accuracy of 90%. All 109 normal kidneys had an RI less than 0.70. Over half (27/50) of the kidneys in patients with nondilated renal disease had an elevated RI (greater than or equal to 0.70). Ninety-six patients had Doppler examinations on both kidneys, and in only six patients did the RI values of each kidney differ by more than 0.10; all six were proved to have unilateral obstruction. Use of duplex Doppler sonography should improve the specificity, and thus the accuracy, of sonography in the noninvasive diagnosis of obstruction and should be used when a dilated collecting system is identified.     

Renal diuretic duplex Doppler sonography in childhood hydronephrosis

OBJECTIVE: The purpose of this study was to determine the diagnostic value of diuretic duplex Doppler sonography in distinguishing between obstructive and nonobstructive hydronephrosis in children by calculating the resistive indices (RI) before and after administration of furosemide. MATERIAL AND METHODS: We prospectively evaluated 28 kidneys (2 solitary) in 15 patients with unilateral or bilateral neonatal hydronephrosis. All patients underwent diuretic renography and duplex Doppler sonography before and after administration of furosemide. RESULTS: According to the half-time drainage patterns at diuretic renography, 13 kidneys were classified as nonobstructed and 15 as obstructed. At baseline, the mean RI values of nonobstructed and obstructed kidneys were not significantly different (0.66 and 0.64, respectively). Ten minutes after the injection of furosemide, the mean RI values of the nonobstructed and obstructed kidneys were 0.68 and 0.70, respectively. The increase in RI over the baseline 10 min after the diuretic injection was statistically significant (p<0.00001) in the obstructed kidneys. CONCLUSION: The baseline RI value of 0.70 is not a definite value for distinguishing obstructed from nonobstructed systems. An increase in RI of at least 10% over the baseline seems to be a more reliable criterion, especially when it is used in conjunction with diuretic renography.     

Diagnosis of neonatal hemochromatosis with MR imaging and duplex Doppler sonography

Neonatal hemochromatosis is a rare congenital disorder which affects both fetuses and newborns. It is characterized by hepatocellular failure, often appearing on the first day of life in the form of coagulopathy, hypoalbuminemia, hypoglycemia, and jaundice. Most of the affected infants die early in life, and definitive diagnosis has often been made only by post-mortem evaluation. With the help of MRI, plus increasing awareness of the disorder, diagnosis is now often made early, even in utero. Duplex Doppler sonography does not provide information on siderosis but shows abnormalities in the liver or blood-flow patterns associated with liver disease. Received: 24 September 1998; Revised: 23 November 1998; Accepted: 27 January 1999     

Sexual impotence caused by vascular disease: diagnosis with duplex sonography

We used duplex Doppler sonography to assess the hemodynamic function of the penis in patients with impotence to determine if there is arterial disease or if the veins are incompetent. The penis was scanned in the flaccid state, then again after erection was induced by intracorporal injection of papaverine. The diameter of each cavernosal artery was measured before and after injection and, by using Doppler sonography, the maximal systolic velocity in each cavernosal artery was measured. The Doppler gate was placed over the dorsal vein to detect any flow in that vein signifying venous leakage. The Doppler gate then was placed over the cavernosal veins in an attempt to detect cavernosal venous incompetence. Forty-five men with impotence were included in the study. In 39 patients, the cause of impotence was confirmed by other studies. The diameter of the cavernosal arteries and the increase in diameter of these arteries after induction of an erection were similar in all diagnostic groups. The peak systolic velocity, however, was decreased in patients with arterial insufficiency as compared with the velocity in normal subjects. In normal subjects, the mean peak velocity was 47 +/- 9 cm/sec; in patients with mild to moderate arterial insufficiency it was 35 +/- 16 cm/sec; in patients with severe arterial insufficiency it was 7 +/- 8 cm/sec. The difference in peak velocities between the right and left cavernosal arteries after papaverine injection (asymmetric arterial response) was significantly larger in patients with mild to moderate arterial insufficiency than in other diagnostic groups. Four patients with venous incompetence had detectable flow in the dorsal vein, but no flow could be detected with Doppler sonography in the cavernosal veins in any patients, including those who were proved to have significant cavernosal venous leaks. Our findings suggest that Doppler measurement of maximal systolic velocity in the cavernosal arteries after papaverine injection is an accurate indicator of arterial function. Asymmetric flow in the cavernosal arteries also suggests some degree of arterial insufficiency. Diameters of the cavernosal arteries and their increase after injection are not predictive of arterial patency. Doppler sonography cannot show cavernosal venous leakage, but in some cases it can show dorsal venous incompetence.     

Evaluation of lower extremity bypass grafts with use of color duplex sonography.

This article reviews the wide variety of graft procedures currently used to bypass lower extremity atherosclerotic disease and the means used to evaluate the grafts, which can be biologic, synthetic, or a combination of both. Graft failure rate can be as high as 10% within the first 10-14 days after placement, leveling off to approximately 2%-4% per year thereafter. Many of the early complications associated with graft placement can be attributed to technical errors in bypass construction. Although angiography remains the standard of reference for the evaluation of these grafts, duplex ultrasound is increasingly being utilized to document patency and detect suspected complications such as intimal flap, perigraft collection, arteriovenous fistula, pseudoaneurysm, and stenosis or occlusion. Sonography is able to clearly depict the echogenic walls of synthetic grafts and demonstrate whether blood flow wave-forms and blood flow velocity in both synthetic and biologic grafts are normal, thus enabling a more accurate diagnosis of suspected complications to be made. Familiarity with the normal sonographic appearance of these grafts, their anastomoses, potential complications, and the pitfalls in making a diagnosis is essential if an accurate diagnosis is to be made.     

MRI and color-coded duplex sonography: diagnosis of partial priapism

A case of partial priapism is reported diagnosed by contrast-enhanced MR imaging and color-coded duplex sonography. Follow-up examinations after 4 weeks and 3 months were performed. According to the results of color-coded duplex sonography and MRI, a partial priapism with development from the subacute stage to a fibrous residuum after spontaneous lysis was diagnosed. There are only very few cases of partial priapism reported in the literature and this is the first case report that demonstrates diagnosis and follow-up both by color-coded duplex sonography and contrast-enhanced MR imaging.     

Renal transplant rejection. Limited value of duplex Doppler sonography

Over a two-year period, 275 duplex Doppler ultrasound (US) examinations were performed on 75 renal allograft recipients. Retrospective visual analysis of the Doppler tracings was compared to concurrent clinical findings and to biopsy results. One hundred eight of the 176 Doppler examinations (61%) that showed acute rejection clinically or histologically were interpreted as rejection, while 80 of 99 examinations (81%) in clinically normal patients were interpreted as normal. Two hundred thirty-four examinations had resistive index (RI) calculations. Seventy-two of 141 examinations (51%) with RI less than 0.70 had clinical or biopsy evidence of rejection. Studies compared with only concurrent biopsies revealed that 35 of 39 US examinations interpreted as rejection were confirmed histologically, but only one of 32 examinations that appeared normal sonographically was histologically normal. The low sensitivity of Doppler US, whether by waveform analysis or RI calculation, makes it a poor screening test for acute rejection. The findings support the conclusion that Doppler sonography cannot replace biopsy in the evaluation of renal transplant dysfunction, particularly when the waveform analysis is normal and the RI less than 0.70.     

Pulsed Doppler duplex sonography and CT of portal vein thrombosis

Five patients with partial or complete portal vein thrombosis were examined by both computed tomography (CT) and pulsed Doppler duplex scanning. Duplex scanning correctly identified portal vein thrombosis in all five. Duplex sonography may be the preferred technique to detect and follow portal vein thrombosis because of lower cost, lack of need for intravenous contrast material, and easier availability for multiple follow-up examinations.     

Differential diagnosis of lymphadenopathy: power Doppler vs color Doppler sonography

Our objective was to compare color and power Doppler sonography of superficial lymph nodes. One hundred ninety-three lymph nodes in 161 patients were assessed by color and power Doppler sonography using standardized settings. We tested which modality displayed more intranodal vessels and checked if these differences would have altered the diagnosis. Additional vessels were seen by color Doppler sonography in 18 nodes and by power Doppler sonography in 58 nodes. Amongst those nodes were 15 nodes which showed no vascularization in color Doppler sonography and 23 nodes with only few intranodal flow signals; however, the better sensitivity of power Doppler sonography had no impact on the diagnosis in 42 of 58 nodes. Diagnostic confidence was increased in 7 nodes which showed normal vessels only in power Doppler sonography, although missing flow signals were defined as a benign finding. Pathological vessels were displayed only by power Doppler sonography in 9 nodes, but 6 of these 9 results proved to be false positive. Power Doppler sonography displays more intranodal flow signals than color Doppler sonography, but the diagnostic impact is low because of an increased risk of false-positive results.     

Congenital anomalies and anatomical variants of the inferior vena cava and left renal vein: noninvasive diagnosis with duplex Doppler sonography

The sonographic findings in five patients with congenital anomalies of the interior vena cava and left renal vein are presented. We encountered two patients with duplication and two with transposition of the inferior vena cava, and one with a retroaortic left renal vein, In four cases the findings were confirmed by demonstrating venous flow within the anomalous vascular structures using duplex Doppler equipment. The diagnostic capabilities of sonographic imaging and Doppler analysis of blood flow allow noninvasive recognition of these vascular anomalies. In our opinion, invasive studies are needed only when retroperitoneal structures are difficult to assess by ultrasound because of obesity and/or abundant overlying intestinal gas.