经阴道彩色多普勒超声在子宫内膜癌诊断中的应用

目的：探讨经阴道彩色多普勒超声对子宫内膜癌的诊断价值。方法：采用TVCDS检查子宫内膜癌15例，观察内膜血流情况及用PD(频谱多普勒)检测病变区血流速度，测得RI值。结果：子宫内膜内彩色血流信号异常丰富，呈现低阻力血流，RI=0．35 0．05。结论：经阴道彩色多普勒超声具有高分辨特征，并能提供高敏感性的血流信息，对子宫内膜癌诊断有重要价值。     

彩超对肺实性占位性病变的应用价值

目的:通过对肺周及肺内实性病灶的彩色信号和多普勒频谱分析,比较良恶性病变的不同表现,探讨彩超在鉴别肺实性病变良恶性方面的价值和方法。资料和方法:1997年3月～2000年12月,经X线或CT定位,B超及彩超共观察肺实性病变107例,其中彩超观察满意的101例为本文研究对象,包括良性38例,恶性63例。有95例经病理证实,包括手术病理17例,穿刺病理68例,支气管镜检8例,痰检2例;另6例炎性病变抗炎治疗后CT证实病灶消失。结果:良性和恶性病变的血流检出率分别为82%和59%,有显著性差异。良性病变动脉峰值流速39.4±28.0cm?s,阻力指数0.71±0.32;恶性病变分别为20.5±20.0cm?s,0.36±0.31。结论:彩超能很好显示肺实性病变内血流状况,对鉴别良恶性病变有重要的参考价值。     

甲状旁腺良恶性肿瘤的彩超诊断价值

目的：探讨彩色多普勒超声高频探头对甲状旁腺良恶性肿瘤的诊断价值。方法：用ATLHDI3000彩超仪探头频率5－10MHz,对15例甲状旁腺良恶性肿瘤进行了分析和研究,全部经手术病理证实。结果：良恶性甲腺旁肿瘤彩色超声声像图改变具有不同的特点,为其鉴别诊断提供了可靠依据。结论：彩超为良恶性甲状旁腺肿瘤的鉴别诊断及术前定位提供了可靠的检查方法。     

Groin hernias in adults: value of color Doppler sonography in their classification.

PURPOSE: We assessed the abilities of color Doppler and power Doppler sonography to distinguish among types of groin hernias by demonstrating the inferior epigastric artery (IEA) and its relationship with the hernia sac. METHODS: Nineteen consecutive patients (14 men and 5 women), clinically diagnosed as having groin hernias and scheduled to undergo herniorrhaphy, were prospectively enrolled in this study. Ultrasound examinations were performed preoperatively with a 6-12-MHz linear-array transducer. The IEA was identified, if possible, and its relationship to the hernia sac assessed. The sonographic diagnoses were compared with the operative findings. RESULTS: There were 15 indirect inguinal hernias, 4 direct inguinal hernias, and 1 femoral hernia; 1 patient had bilateral inguinal hernias (indirect and direct). In 18 (90%) of 20 hernia cases, the trunk segment of the IEA could be visualized. In 11 (55%) of 20 hernia cases, the origin segment of the IEA could be visualized and its relationship with the hernia sac assessed. In 9 (82%) of the 11 hernia cases, hernia types were correctly diagnosed by sonography. The overall accuracy of sonography for diagnosing the type of hernia was 45% (9 of 20 hernias). CONCLUSIONS: Color Doppler sonography can accurately differentiate types of groin hernias if the origin segment of the IEA and the hernia sac can be visualized simultaneously. However, color Doppler sonography sometimes failed to visualize this segment.     

Diagnostic criteria for locating acquired arteriovenous fistulas with color Doppler sonography

PURPOSE: The purpose of this prospective study was to evaluate and determine criteria for locating acquired arteriovenous fistulas using color Doppler sonography. METHODS: We performed color Doppler sonography on 12 consecutive patients with acquired arteriovenous fistulas. We evaluated the morphologic and hemodynamic changes in the involved vessels to help locate the fistulas (10 in the extremities, 1 in the neck, and 1 in the abdomen). RESULTS: In all cases, turbulent high-velocity flow spectrum and flow signals were present at the fistula sites, and arterialized waveforms from the draining veins were detected. In the 10 cases of acquired arteriovenous fistulas in the extremities, the resistance indices in the arteries proximal to the fistulas were all less than 1.00 (mean, 0.65), whereas the resistance indices in the arteries distal to the fistulas were all 1.00 or greater (mean, 1.17). In 70% of the cases, the diameter of the artery proximal to the fistula was at least 1.2 mm larger than that distal to the fistula. The fistula site was inferred by the point of maximal venous dilatation in 70% of the cases and by the focal perivascular color artifact in 82% of the cases. The fistula site was identified on gray-scale sonography and color flow imaging in 33% and 75% of the cases, respectively. CONCLUSIONS: Fistula sites can be located effectively and quickly by a combination of major and minor diagnostic criteria. The major diagnostic criteria are (1) junction of low- and high-resistance flow in the supplying artery, (2) a high-velocity arterialized waveform in the draining vein, and (3) a turbulent, high-velocity flow spectrum at the junction of the artery and the vein. The minor diagnostic criteria are (1) direct communication between the involved artery and vein, (2) significant change in the diameter of the supplying artery, (3) a focal point of venous dilatation, and (4) a focal perivascular color artifact.     

正常中晚期妊娠输尿管射尿的彩色多普勒检查

目的：了解正常中晚期妊娠输尿管的尿动力学改变是否影响输尿管射尿,方法：彩色多普勒超声观察32例中晚期妊娠妇女和11例非妊娠对照者膀胱射尿情况,观察时间5分钟。结果：妊娠受试者平均射尿5．9次／分,左,右侧射尿频率平均差异百分比为49％,对照组平均射尿7．3次／分,左,右射尿频率差异百分比为13％, 试组与对照组之间射尿对称性方面具有显著性差异（P＜0．05）,32例妊娠受试者中有7例有单侧射尿缺乏,而对照者中无1例单侧射尿缺乏,结论：在妊娠中晚期,由于两侧输尿管射尿的不对称性,用彩色多普勒超声检测输尿管射尿诊断中晚期妊娠合并输尿管结石应慎应用 。     

彩色多普勒超声造影在血管疾病中的应用

近年来经周围静脉注射的超声造影剂的出现使超声造影技术得以在临床上广泛应用。本文介绍了经周围静脉彩色多普勒超声造影的原理及其在周围血管疾病诊断中的应用。     

Observer experience improves reproducibility of color Doppler sonography of orbital blood vessels

PURPOSE: The study investigated the reproducibility of orbital blood flow measurements with color Doppler imaging (CDI) at different stages of observer experience. METHODS: The subjects were 31 healthy volunteers and 2 sequential groups of 25 glaucoma patients each. Repeated blood flow measurements (usually 3 sets) in orbital vessels (ophthalmic artery, short posterior ciliary arteries, central retinal artery, and central retinal vein) were performed by the same observer in a single session in each subject. RESULTS: The parameters with the best reproducibility were the resistance index (mean coefficient of variation [COV], 3.3-8.8%), the peak systolic velocity (mean COV, 6.9-13.7%), the time-averaged velocity (mean COV, 7.2-16.0%), and the systolic acceleration time (mean COV, 8.8-12.3%). The mean COV was greater (9.9-20.3%) for the other arterial flow parameters (end-diastolic velocity and systolic acceleration) and for the venous flow velocities (maximum and minimum). The COVs of the parameters were improved by 20-40% as the observer became more experienced in ophthalmic CDI. CONCLUSIONS: We confirm the general reliability of CDI measurements in orbital vessels and show that observer experience improves reproducibility. It appears, however, that observer performance in these measurements is vessel specific.     

Improved investigation of portal-hepatic veins by echo-enhanced Doppler sonography

Microbubbles of air released from a galactose vehicle (Levovist^®) amplify the intensity of Doppler signals. They survive both pulmonary and systemic capillary passage, leading to echo enhancement in the entire vascular system. The aim of this study was to investigate this agent in patients with liver disease and insufficient Doppler signals. A total of 275 Doppler examinations were performed in 176 patients; 20 of these patients could not be studied conventionally due to bowel gas, obesity or noncompliance. They received Levovist^® to examine portal or hepatic veins or TIPS patency. Angiography, computed tomography (CT) scan or magnetic resonance tomographic angiography (MRTA) was performed subsequently as a control. After administration of Levovist^®, portal or hepatic veins and TIPS patency could be unequivocally assessed in 18 of the 20 patients. In two patients, suspected occlusion of the portal vein was disproved because the diagnosis was not confirmed later. Only minor adverse effects were encountered. Echo-enhanced Doppler sonography with Levovist^® is well tolerated. Further study of the value of Levovist^® for the assessment of portal-hepatic vessels not amenable to conventional Doppler sonography is justified.     

Transvaginal color Doppler sonography for predicting response to concurrent chemoradiotherapy for locally advanced cervical carcinoma

PURPOSE: This study was conducted to evaluate the potential role of transvaginal color Doppler sonography (TVCD) in predicting response to concurrent chemoradiotherapy for locally advanced cervical cancer. METHODS AND MATERIALS: Tumor vascularity was assessed using TVCD before the start of concurrent chemoradiotherapy in 21 patients (median age, 47 years; range, 31-75 years) with histologically proven locally advanced cervical cancer. The lowest resistance index (RI), lowest pulsatility index (PI), and highest peak systolic velocity (PSV) from central vessels within the tumor were recorded and used for analysis. All patients were clinically evaluated by physical examination and CT scanning after completing the chemoradiotherapy protocol. Complete clinical response (CR) was determined when no residual tumor was found. Partial clinical response (PR) was determined when the tumor volume had decreased more than 50%. RESULTS: CR was achieved in 11 patients (52%), whereas 10 (48%) had PR. The initial median tumor volume was not statistically different between those with CR (26 cm3) and those with PR (28 cm3) (p = 0.71). RI was higher in those tumors with CR (median, 0.47) than in those with PR (median, 0.29) (p < 0.01). Likewise, PI was higher in tumors with CR (median, 0.81) than in those with PR (median, 0.41) (p < 0.01). No differences were found in PSV. The likelihood ratio for CR for tumors with a lowest RI of 0.35 or more was 2.7 (95% confidence interval, 1.8-3.6) and the likelihood ratio for CR for tumors with a lowest PI of 0.45 or more was 3.3 (95% confidence interval, 2.1-4.5). CONCLUSIONS: The results suggest that TVCD may be useful in predicting clinical response to concurrent chemoradiation in patients with locally advanced cervical cancer.     

Differential diagnosis of hepatic cystic lesions with gray-scale and color Doppler sonography

PURPOSE: This study was conducted to evaluate the effectiveness of sonography, especially color Doppler sonography, in the differential diagnosis of cystic hepatic lesions. METHODS: Ninety-two pathologically or clinically proven hepatic cystic lesions (20 cystic malignancies, 24 abscesses, and 48 simple cysts) were evaluated with gray-scale and color Doppler sonography. The sonographic features were analyzed retrospectively. The percentage, sensitivity, specificity, and positive and negative predictive values of the sonographic features of each disease category were calculated. RESULTS: On gray-scale sonography, the simple cysts were easily distinguished from cystic malignancies and abscesses. While no significant differences were found between hepatic cystic malignancies and hepatic abscesses with respect to the number, shape, margin status, and presence of thick wall of the lesion, the presence of septation and mural nodules was significantly higher in the cystic malignancies than in abscesses. The sensitivity and specificity of color Doppler sonography in differentiating cystic malignancies from abscesses and simple cysts were 85% and 96%, respectively. CONCLUSIONS: Color Doppler sonography provides information about blood flow that supplements that gained on gray-scale sonography, and the presence of color signals in the solid portion of the cystic lesions carries a high diagnostic value in differentiating hepatic cystic malignancies from abscesses and simple cysts.     

Application of color Doppler ultrasonography to ulcerative colitis

We used color Doppler ultrasonography (US) to evaluate bowel wall thickening in ulcerative colitis and to determine the value of this modality in this application. Twelve patients (6 men and 6 women) with ulcerative colitis underwent both gray-scale and color Doppler US. Bowel wall thickness and wall echotexture were recorded by gray-scale US, and the presence of intramural color Doppler flow and arterial signal were evaluated by color Doppler US. Color Doppler flow was graded as ‘weak’ or ‘abundant’, and resistive index was calculated; clinical severity of disease activity was also graded, and serum CRP level was measured. Variation in serum CRP levels and intramural color Doppler flow according to clinical severity, and the correlations between serum CRP levels and the number of blood flow signals were statistically significant. In 10 of the 12 patients, analysis of the Doppler waveform showed an arterial blood flow signal, and mean resistive index value was determined to be 0.550. We thus conclude that information provided by gray-scale and color Doppler US is useful in evaluating bowel wall thickening in ulcerative colitis.     

Hepatocellular carcinoma: therapeutic experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with the contrast agent Levovist.

OBJECTIVE: To describe our experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with Levovist (SH U 508A; Nihon Schering, Osaka, Japan) for hepatocellular carcinoma after transcatheter arterial infusion. METHODS: Twenty patients (17 men and 3 women; mean age, 58.4 years) with 23 hepatocellular carcinoma nodules (mean +/- SD, 2.7 +/- 1.5 cm) underwent percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography 1 week after transcatheter arterial infusion. Therapeutic effects were assessed by contrast-enhanced computed tomography and posttreatment fine-needle biopsy. This study was performed on a prospective basis. RESULTS: After the transcatheter arterial infusion, contrast-enhanced color Doppler sonography showed intense intratumoral color signals in all 23 hepatocellular carcinomas. After the percutaneous ethanol injection, contrast-enhanced color Doppler sonography, fine-needle biopsy, and contrast-enhanced computed tomography showed no color signals, no viable tumor tissues, and no enhancement in any of the 23 hepatocellular carcinomas. Three to 5 (mean, 3.3) percutaneous ethanol injection sessions with a 5.2- to 15.6-mL (mean, 12.8-mL) total volume of ethanol per tumor were required for complete disappearance of color signals on contrast-enhanced color Doppler sonography. CONCLUSIONS: Percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography has considerable efficacy in treating hepatocellular carcinoma.     

Posterior mediastinal arteriovenous malformation with atypical color Doppler sonographic findings

An arteriovenous malformation (AVM) is an anomaly of capillary development that results in a direct connection between branches of an artery and veins, with no intervening capillary network. A definite diagnosis of AVM is usually made with angiography. We report the case of a posterior mediastinal AVM found on routine sonography in a 64-year-old woman with neglected hypertension and severe back pain. Color Doppler imaging showed 2 adjoined vascular structures without a typical mosaic-like flow pattern, and spectral Doppler analysis showed low-resistance flow and arteriovenous shunting in 2 adjoined vascular structures. The diagnosis was subsequently confirmed by angiography. Because disastrous bleeding could result if needle biopsy were performed inadvertently in the case of a suspected mediastinal AVM, we suggest that color Doppler sonography be attempted if there is an adequate acoustic window.