Three‐Dimensional Vascular Indices Calculated Using Conventional Power Doppler and High‐Definition Flow Imaging

Objective. The purpose of this study was to determine whether there are differences in 3‐dimensional (3D) vascular indices when calculated using high‐definition flow imaging (HDF) and power Doppler imaging (PD). Methods. Twenty‐five consecutive asymptomatic premenopausal women (mean age, 31 years; range, 28–33 years) without a history of gynecologic disease who attended routine gynecologic checkups were included in the study. All women had regular menstrual cycles, and none had uterine or myometrial disease detected on basal transvaginal sonography. All women underwent 3D transvaginal sonography. In each patient, a first volume using conventional PD was obtained, immediately followed by a second volume using HDF. Volumes were stored and subsequently analyzed for calculating 3D vascular indices (vascularization index [VI], flow index [FI], and vascularization‐flow index [VFI]) from the endometrium. Results. The median VI, FI, and VFI were significantly higher when calculated using HDF compared with conventional PD (P < .05). Conclusions. Three‐dimensional vascular indices calculated using HDF are higher than those calculated using conventional PD.     

Three‐Dimensional Ultrasonographic Bladder Volume Measurement

Objective. The purpose of this study was to investigate the reliability of Virtual Organ Computer‐Aided Analysis (VOCAL; GE Healthcare, Kretztechnik, Zipf, Austria) using the 4 standard rotation steps to measure the bladder volume with 3‐dimensional (3D) ultrasonography. Methods. Using the 4 standard rotation steps of VOCAL, 2 independent observers made 3D volume measurement data sets from the urinary bladder (n = 180). Sets of 30, 20, 12, and 6 planes were obtained from the sequential rotations of 6°, 9°, 15°, and 30°, respectively. The internal contours of the bladders were determined manually. Reliability was evaluated with the intraclass correlation coefficient (ICC), and Bland‐Altman plots were generated to examine bias and agreement. One‐way analysis of variance was used to compare bladder volume measurements between the angles. P < .05 was considered statistically significant. Results. A high degree of reliability was observed between pairs of different rotation angles (ICC, 0.994–0.999). There was good agreement between all pairs of different rotation angles, with percentages of the mean difference ranging from ?0.9% to 1.8%. No significant difference was found for bladder volume measurements by the VOCAL technique with varying rotation steps. Intraobserver and interobserver reliabilities were high (ICC, 0.994–0.998). Conclusions. Urinary bladder volume measurement by the VOCAL technique using different rotation steps is highly reliable. A plane rotation of 30° produces the fastest result.     

Reproducibility of Placental Volume and Vasculature Indices Obtained by 3‐Dimensional Power Doppler Sonography

Objective. The purpose of this study was to evaluate the reproducibility of 3‐dimensional (3D) power Doppler assessment of placental volumes and vascularization before adopting these in routine evaluation of normal and complicated pregnancies. Methods. A prospective study was performed on 30 normal singleton pregnancies from 11 to 14 weeks. To evaluate placental vascularization, 3D power Doppler sonography was applied to obtain a placental volume, and the volume acquired was analyzed using virtual organ computer‐aided analysis. Two consecutive measurements were taken from each patient by two observers blinded to each other's and the individual's previous measurement. This yielded a total of 60 data set pairs. The placental volume, vascularization index, flow index, and vascularization‐flow index (VFI) were calculated. Normal distribution of the data was confirmed with the Kolmogorov‐Smirnov test. Intraobserver and interobserver correlations were evaluated. Bland‐Altman plots and statistics were used to compare the 95% limits of agreement between measurements. Results. All 3D power Doppler placental volumes and vascular indices showed intraobserver correlations of 0.80 or higher. Similar excellent interobserver correlations were seen for all indices with the exception of the VFI, which showed a lower but acceptable correlation. The Bland‐Altman analyses indicated good reproducibility of the evaluated placental indices. Conclusions. Our findings provide validation of the technique, showing good reproducibility of the 3D power Doppler parameters when applied to studies of the placental volume and vascular tree.     

Role of Spectral Doppler Sonography in the Evaluation of Partial Testicular Torsion

Objective. The purpose of this series was to evaluate the role of spectral Doppler and color flow Doppler sonography in the evaluation of partial testicular torsion. Methods. Eight cases of partial testicular torsion, diagnosed on the basis of abnormal spectral Doppler waveforms or abnormal color flow Doppler findings, were retrospectively pooled from 2 teaching hospitals. Results. The age group ranged from 4 to 85 years. Testicles with partial testicular torsion showed variable spectral Doppler patterns, including increased, similar, or decreased amplitude of the arterial waveform relative to the contralateral testicle. Two cases showed reversal of arterial diastolic flow, and 1 case showed diastolic flow variability within the same testicle. Decreased blood flow was observed on color flow Doppler sonography in 7 of the 8 patients. Conclusions. Variability of the Doppler waveform when compared with the contralateral testicle and reversal of diastolic blood flow are indirect clues that aid in the diagnosis of partial testicular torsion.     

Sonographic Appearance of Trigger Fingers

Objective. The purpose of this study was to describe the sonographic appearance of the first annular (A1) pulley–flexor tendon complex in patients with trigger fingers. Methods. Thirty‐three trigger fingers in 33 patients were examined with a 7‐ to 15‐MHz probe. A control group consisted of 20 patients without trigger fingers. The study included systematic measurement of the thickness of the A1 pulley and a power Doppler assessment of the pulleys, tendons, and tendon sheaths. Results. Thickening and hypoechogenicity of the A1 pulley were found in all patients with trigger fingers. Measurements of A1 pulley thickness were significantly different (P < .0001) between the groups without trigger fingers (mean, 0.5 mm; range, 0.4–0.6 mm) and with trigger fingers (mean, 1.8 mm; range, 1.1–2.9 mm). Hypervascularization of the A1 pulley on power Doppler imaging was found in 91% of the trigger fingers but was never found in the healthy control group. Flexor tendinosis was found in 48% of the trigger fingers; tenosynovitis was found in 55%; and both were found in 39%. In the control group, tenosynovitis and tendinosis were not found. Conclusions. Thickening and hyper‐vascularization of the A1 pulley are the hallmarks of trigger fingers on sonography. Other frequently observed features include distal flexor tendinosis and tenosynovitis.     

Accuracy of 3-dimensional color Doppler-derived flow volumes with increasing image depth.

OBJECTIVES: We and others have reported on the use of digital color Doppler sonography from real-time 3-dimensional (3D) echocardiography and its use in accurately calculating cardiac flow volumes, namely stroke volume (SV) and, hence, cardiac output. However, in some patients, image depth is higher than average, and this may affect the accuracy of volume calculation. We sought to investigate the impact of image depth and the accompanying change in signal strength, spatial resolution, and pulse repetition frequency on the accuracy of SV calculation from 3D color Doppler data in an in vitro model. METHODS: A tube model of the left ventricular outflow tract was constructed from plastic tubing and connected to a pulsatile pump. The volume flowing through the tube was imaged using a 3D echocardiography system. Stroke volumes from the pump were computed from the DICOM data using commercially available software and compared with a reference standard of timed volumes with the use of a graduated measuring cylinder over a range of depth settings and SVs. RESULTS: There was good correlation between the 3D-derived SVs and the reference cylinder measures over all depths from 4 to 16 cm at 1-cm increments with a tube diameter of 17 mm, a pump rate of 60 beats/min, and SVs ranging from 20 to 70 mL. The average r(2) value for the 13 different depths was 0.976. However, the accuracy of the 3D method of volume calculation appeared to fall at depths greater than 13 cm, especially at higher SVs. CONCLUSIONS: Stroke volume calculation from real-time 3D color Doppler data in this in vitro study shows that at depths greater than approximately 13 cm, accuracy decreases, especially at higher SVs. This may be due to decreased resolution and the reduced frame rate at these depths. At shallower depths, volume calculation form the 3D Doppler data appears very accurate.     

Three‐Dimensional Power Doppler Vascular Sonographic Sampling for Predicting Ovarian Cancer in Cystic‐Solid and Solid Vascularized Masses

Objective. The purpose of this study was to explore the role of 3‐dimensional (3D) power Doppler (PD) sonography to discriminate between benign and malignant cystic‐solid and solid vascularized adnexal masses and to define cutoff values for 3D PD indices to be used in a clinical setting. Methods. A total of 143 consecutive women (mean age, 50.4 years; range, 17–82 years) with diagnoses of cystic‐solid or solid vascularized adnexal masses on B‐mode and 2‐dimensional PD sonography were evaluated by 3D PD sonography before surgery. Three‐dimensional PD sonography was used to assess vascularization within papillary projections and solid areas with a virtual organ computer‐aided analysis program. Three‐dimensional PD vascular indices (vascularization index [VI], flow index [FI], and vascularization‐flow index [VFI]) were automatically calculated. A definitive histologic diagnosis was obtained in each case. Results. A total of 113 masses (74%) were malignant, and 39 (26%) were benign. Morphologic evaluation revealed 30 unilocular solid masses (19.7%), 43 multilocular solid masses (28.3%), and 79 mostly solid masses (52%). The mean VI (9.365% versus 3.3%; P < .001), FI (34.318 versus 28.794; P < .001), and VFI (3.233 versus 1.15; P < 0.01) were significantly higher in malignant tumors. No differences were found in the resistive index, pulsatility index, and peak systolic velocity. Receiver operating characteristic analysis revealed an area under the curve of 0.77 (95% confidence interval, 0.69–0.85), 0.71 (0.60–0.81), and 0.75 (0.66–0.83) for the VI, FI and VFI, respectively. For reducing the false‐positive rate by almost one‐third, sensitivity values for the VI (cutoff, 1.556%), FI (25.212), and VFI (0.323) were 92%, 95%, and 93%, respectively. Conclusions. Three‐dimensional PD vascular indices could be helpful for reducing the false‐positive rate in cystic‐solid and solid vascularized adnexal masses.     

Interhemispheric Comparisons of Cerebral Blood Flow Velocity Changes During Mental Tasks With Transcranial Doppler Sonography

Objective. The purpose of this study was to evaluate hemispheric asymmetry of cerebral blood flow changes during various mental tests by applying transcranial Doppler sonography (TCD) to simultaneously monitor bilateral cerebral blood flow velocity changes. Methods. Twenty‐one participants without cerebrovascular disease performed 3 left hemispheric tasks (reading, calculation, and color scaling) and 3 right hemispheric tasks (face recognition, space imagination, and line orientation). Results. Mean velocities of the rest and performing periods did not differ significantly between the left and right hemispheric tasks. Although greater acceleration of blood flow velocity was observed on the left than on the right in most of the 6 tasks except line orientation (mean left – right ratio difference [D_l–r] ranged from ?0.018 to 0.071), this difference was larger for left hemispheric tasks (mean D_l–r ranged from 0.050 to 0.071) than right hemispheric tasks (mean D_l–r ranged from ?0.018 to 0.034; P < .001). Further comparisons of each pair of (ie, left and right) hemispheric tasks revealed that the most suitable left and right hemispheric tasks to show hemispheric asymmetry were reading and line orientation, respectively (P < .001). Conclusions. Hemispheric asymmetry of cerebral blood flow changes during mental tests is demonstrable with TCD only when comparing the D_l–r in response to suitable paired left and right hemispheric tasks.     

Doppler Waveforms and Blood Flow Parameters of the Superior and Inferior Mesenteric Arteries in Patients Having Behçet Disease With and Without Gastrointestinal Symptoms

Objective . To evaluate hemodynamic changes in mesenteric arteries in patients with Behçet disease with and without gastrointestinal symptoms. Methods . Doppler sonography of mesenteric arteries was performed in 25 symptomatic and 15 asymptomatic patients having Behçet disease and in 25 healthy control subjects. The peak systolic, minimal, and mean velocities, resistive and pulsatility indexes, inner diameter, cross‐sectional area, and blood flow volume of mesenteric arteries were evaluated. The results were compared between patient groups and controls. Results . The mesenteric artery flow was significantly greater in patients in the symptomatic group than in those in the asymptomatic group or in controls. In the superior mesenteric artery, mean velocity and mean blood flow volume (0.35 ± 0.18 m/s and 711 ± 404 mL/min, respectively; P < .0001) in the symptomatic group were significantly higher than in the asymptomatic group (0.16 ± 0.07 m/s and 305 ± 168 mL/min, respectively) or in controls (0.15 ± 0.07 m/s and 290 ± 123 mL/min, respectively). The mean peak systolic velocity (1.23 ± 0.47 m/s; P < .005) in the symptomatic group was significantly higher than in controls (0.93 ± 0.23 m/s). In the inferior mesenteric artery, mean velocity and mean blood flow volume (0.25 ± 0.10 m/s and 139 ± 79 mL/min) in the symptomatic group were significantly higher than in the asymptomatic group (0.16 ± 0.07 m/s; P < .006; and 78 ± 26 mL/min; P < .007) or in controls (0.17 ± 0.07 m/s; P < .003; 83 ± 48 mL/min; P < .004). Conclusions . In this study, symptomatic patients with gastrointestinal Behçet disease were associated with a significant increase in mesenteric artery flow that could be evaluated easily on spectral patterns of arteries during Doppler sonography. The Doppler sonographic findings also revealed that intestinal involvement in patients with Behçet disease without gastrointestinal symptoms is not significantly different from that of healthy controls.     

Postabortion Doppler Evaluation of the Uterus

Objective. The aim of this study was to investigate the incidence and causes of uterine hypervascular lesions showing low‐impedance, high‐velocity flow on color Doppler sonography (CDS) after first‐trimester dilation and curettage (D&C). Methods. This was a prospective study of 65 consecutive women who underwent first‐trimester termination of pregnancy. Color Doppler sonography of the uterus was performed on days 3 and 10 after D&C. If the myometrial hypervascularity (MH) persisted on day 10, a second D&C was performed, and then the patients were followed with weekly Doppler examinations. Results. In 16 of 65 women (24.6%), MH was detected with CDS on day 3 after D&C. In 3 cases, MH resolved spontaneously by postabortion day 10. In the remaining 13 patients, the second D&C performed on day 10 revealed retained products of conception (RPOC) in 8 patients (61.5%), a hydatidiform mole in 2 (15.4%), endometritis in 1 (7.7%), and no abnormality in 2 (15.4%). Complete resolution of the MH occurred in all cases. The mean period to the resolution of MH after the second D&C ± SD was 16.54 ± 11.06 days (range, 7–48 days). Univariate analysis revealed that gestational age at D&C (P = .012) and a history of any uterine surgery (P = .044) were significantly associated with postabortion MH. On binary logistic regression analysis, gestational age at D&C was the only independent predictive factor for MH (P = .016; odds ratio, 1.47; 95% confidence interval, 1.08–2.02). Conclusions. The presence of hypervascular areas within the myometrium is a common finding in the postabortion period, and in most cases, the cause of this finding is RPOC.     

Doppler Sonographic Findings in an Experimental Rabbit Model of Necrotizing Enterocolitis

Objective. The purpose of this study was to examine the clinical applicability of Doppler sonography by evaluating Doppler sonographic findings in an experimental rabbit model of necrotizing enterocolitis (NEC). Methods. Necrotizing enterocolitis was experimentally induced using a combination of endotoxin, hypoxia, and cold stress in 23 rabbits. Doppler sonography was performed to obtain the Doppler spectrum of the superior mesenteric artery. From the flow profile, the peak systolic velocity (PSV) and resistive index (RI) were calculated at 5 time sessions: initial and 1 to 2, 3 to 4, 5 to 6, and 20 to 24 hours. Animals were divided into 2 groups based on pathologic NEC scores (NEC‐positive [NEC+] group versus NEC‐negative [NEC?] group). Differences between the groups with regard to RI and PSV values were evaluated for each time session. Results. Comparison of RI and PSV values between the NEC+ and NEC? groups revealed a significant increase in the PSV in the NEC+ group during the 1‐ to 2‐hour session (P = .0199). Comparison of RI and PSV differences revealed a significant increase in RI and PSV differences in the NEC+ group during the 1‐ to 2‐hour session (P = .0095 and .0013, respectively). In the other time sessions, there was no difference between the groups. Conclusions. The NEC+ group showed a significant increase in the PSV and RI during the 1‐ to 2‐hour period.     

Carotid Stenosis Assessed With a 4‐Dimensional Semiautomated Doppler System

Objective. The purpose of this study was to compare peak systolic velocities (PSVs) and the degree of stenosis obtained with a real‐time 3‐dimensional (ie, 4‐dimensional) Doppler ultrasound scanner (Encore PV; VueSonix Sensors Inc, Wayne, PA) to conventional Doppler ultrasound imaging of the carotid arteries (common [CCA], internal [ICA], and external [ECA]). A secondary goal was to assess Encore volume flow measurements. Methods. Seventy patients referred for clinical carotid ultrasound participated in this pilot study. Peak systolic velocities of the CCA, ECA, and ICA were obtained bilaterally. The degree of stenosis in the ICA was calculated based on the ICA PSV and ICA/CCA PSV ratio. The Encore detects all 3‐dimensional blood flow velocity vectors within 10‐s longitudinal volumes of the ICA, ECA, and CCA. On the Encore, a reader determined the centerline of the vessels. The PSV and volume flow were then automatically calculated. The flow measurement error was obtained by comparing the CCA flow to the ICA and ECA flow. Data were compared using linear regression, intraclass correlation coefficients (ICCs), and Bland‐Altman analysis. Results. Due to technical difficulties, only 59 patients (323 vessel segments) were available for analysis. There was good agreement between methods for assessing the degree of stenosis based on the ICA PSV (ICC = 0.83; P < .0001) and, to a lesser degree, on the ICA/CCA PSV ratio (ICC = 0.65; P < .0001). Peak systolic velocity measurements obtained with conventional ultrasound and the Encore correlated in all vessels (r ≥ 0.32; P < .002), and Bland‐Altman analysis showed reasonable variations. The Encore mean volume flow error ± SD was ?4.1% ± 66.4% and was not biased (P = .57). Conclusions. A new semiautomated 4‐dimensional Doppler device is comparable to conventional Doppler ultrasound for assessment of carotid stenosis.     

Three‐Dimensional Power Doppler Angiography of Cyclic Ovarian Blood Flow

Objective. The purpose of this study was to assess the vascular indices generated by 3‐dimensional (3D) power Doppler angiography by evaluating the cyclic changes in the vascularity of normal ovaries, including those that were ovulating, nonovulating, and hormonally suppressed. Methods. In this prospective longitudinal observational study, a cohort of premenopausal regularly menstruating women with no known ovarian disease underwent 3D power Doppler imaging every 2 to 3 days for the duration of 1 menstrual cycle. Four indices were generated: vascularization index (VI), flow index (FI), vascularization‐flow index (VFI), and mean grayness. Comparisons of vascularity were made between ovulating, nonovulating, and hormonally suppressed ovaries. Normal ranges were established and graphed longitudinally. Results. Eighteen participants (36 ovaries) ages 28 to 45 years underwent an average of 10 examinations, yielding 368 acquired ovarian volumes for analysis. Seven participants used hormonal contraception. The VI, FI, and VFI were closely correlated (Pearson product moment correlation coefficients, 0.52–0.95). The vascular indices of ovulating ovaries were significantly higher than those of nonovulating ovaries (VI, FI, and VFI, all P < .001), with the largest discrepancies during the luteal phase. Hormonally suppressed ovaries had significantly lower vascularity throughout the cycle (VI, P < .002; FI, P < .001; VFI, P < .007). The vascular indices of all groups appeared to drop during the late follicular period and then rise again. Conclusions. The VI would suffice as the principal vascular parameter for 3D power Doppler analysis. Preovulatory scans may be more useful for distinguishing pathologic vascularization. Hormonally suppressed ovaries have significantly lower vascularity throughout the cycle. Normal‐appearing ovaries with vascular indices above the normal ranges established by these data may warrant further investigation.     

Cerebral haemodynamics during the Mueller manoeuvre in humans

Voluntary negative intra‐thoracic pressure (Mueller manoeuvre) is known to reduce arterial blood pressure (ABP). To investigate changes in cerebral blood flow velocity (CBFV) during 15 s Mueller manoeuvres at –30 mmHg intra‐thoracic pressure, 27 young (aged 21–31 years, group A) and 11 older (52–64 years, group B) healthy adults were studied using transcranial Doppler and non‐invasive ABP measurement (Finapres). After closely following the initial ABP drop, CBFV showed an overshoot during temporary recovery of ABP. Then ABP and CBFV decreased significantly to below baseline. While ABP declined further until the end of the manoeuvre, CBFV increased in group A 4·7 s (2·4–8·5) (median and range) and in group B 5·7 s (4·1–7·2) after the onset of the CBFV decrease. Critical closing pressure (CCP), calculated for each cardiac cycle from the dynamic pressure–flow relationship (DPFR), indicated a reduction of intra‐cranial pressure during the first half of the strain. DPFR‐related estimation of cerebrovascular resistance provided a more physiological response than the conventional cerebrovascular resistance quotient ABP/CBFV, and decreased about 1·5 s before the observed CBFV increase. A modification of the previously described dynamic auto‐regulation index ROR correlated significantly with CO₂ reactivity values (r=0·61, P=0·001). In conclusion, changes in CBFV during Mueller manoeuvres are likely to reflect dynamic cerebral auto‐regulation and may provide an estimate of dynamic cerebral auto‐regulation capacity. In older adults, the maximal dynamic auto‐regulatory response seems to be unchanged, but the onset of reaction is slightly delayed.     

Intratumoral Blood Flow Analysis in Epithelioid Trophoblastic Tumors

Objective. The purpose of this series was to describe the transvaginal color pulsed Doppler sonographic features of epithelioid trophoblastic tumors (ETTs) and to evaluate whether there were specific sonographic criteria to accurately distinguish them from other lesions. Methods. Seven cases of ETTs treated in the Women's Hospital of Zhejiang University were retrospectively analyzed. Doppler indices, including the Pourcelot resistive index (RI), pulsatility index (PI), and peak systolic to diastolic velocity (S/D) ratio from blood flow signals within the tumors were calculated from each waveform sample by using the software of the ultrasound machines. Results. Patients with ETTs had heterogeneously echoic masses and highly abnormal flow patterns. The mean PI, RI, and S/D ratio for the patients were 0.57 (range, 0.22–1.09), 0.42 (range, 0.2–0.7), and 1.89 (range, 1.25–3.40), respectively. Conclusions. The clinical usefulness of intratumoral blood flow assessment in ETTs is yet to be established. However, the multiparameter sonographic approach can help in diagnosis of an ETT.     

Brain Blood Flow and Velocity

Objective. Because transcranial Doppler sonography (TCD) is unable to measure arterial diameter, it remains unproven whether the changes in cerebral blood velocity it measures are representative of changes in cerebral blood flow (CBF). Our study was designed to compare velocity changes with flow changes measured by two magnetic resonance imaging (MRI) techniques, perfusion MRI and arterial spin labeling (ASL), using flavanol‐rich cocoa to induce CBF changes in healthy volunteers. Methods. We enrolled 20 healthy volunteers aged 62 to 80 years (mean, 73 years). Each was studied at baseline and after drinking standardized servings of cocoa for 7 to 14 days. Results. Changes in middle cerebral artery (MCA) flow by TCD were significantly correlated with changes in perfusion assessed by gadolinium‐enhanced MRI (r = 0.63; P < .03). Measurements with ASL showed a stronger correlation with borderline significance. Conclusions. Changes in flow velocity in the MCA associated with drinking cocoa were highly correlated with changes in CBF measured by the two MRI techniques using the tracer gadolinium and ASL. These results validate Doppler measurements of CBF velocity as representative assessments of CBF.     

Influence of resting before sonographic examination on Doppler measurements of renal blood flow

Renal artery stenosis (RAS) is the most common cause of secondary hypertension, via increases in plasma renin–angiotensin–aldosterone levels. Renal artery stenosis is diagnosed from blood examinations such as renin activity and from imaging examinations such as sonography. Patients are required to lie on the bed for 30 min before and during phlebotomy, since plasma renin activity is easily altered by posture. However, no such pre‐examination rest is required for sonography. The present study therefore investigated the possible influence of resting before examination on Doppler parameters used for the diagnosis of RAS. Subjects comprised 55 healthy young adults (24 males, 31 females; mean age, 22 ± 1 years). Sonographic measurements were made shortly after subjects entered the examination room and again after 30 min of rest lying on a bed. Median peak systolic velocity in the renal artery was significantly decreased after rest (106 cm/s, interquartile range (IQR) 96–121 cm/s) compared with before rest (120 cm/s, IQR 107–135 cm/s; p < .001). Median acceleration time in the intra‐renal segmental artery was also significantly shorter after rest (49 ms, IQR 38–54 ms) compared to before rest (50 ms, IQR 38–59 ms; p = .039). The present results suggest that serious consideration should be given regarding whether pre‐examination resting is needed to accurately interpret Doppler measurements of renal blood flow when diagnosing RAS from sonography.     

Umbilical Cord Cysts

Objective. The purpose of this series was to determine whether the use of different 3‐dimensional (3D) sonographic modes allows better definition of umbilical cord cysts and pseudocysts in utero. Methods. Two cases of umbilical cord cysts and 1 of a pseudocyst were analyzed and compared with 2‐dimensional (2D), 3D, angiopower Doppler, tomographic ultrasound imaging (TUI), virtual organ computer‐aided analysis (VOCAL), and automatic volume calculation (AVC) sonographic modes. All cases were followed during pregnancy. A karyotype analysis was also obtained. Results. Three‐dimensional sonography, TUI, and VOCAL allowed clear visualization and evaluation of the sizes, locations, and numbers of umbilical cord cysts. A clear differentiation between a pseudocyst and the yolk sac was obtained with AVC and angiopower Doppler sonography. The 3D sonographic surface mode allowed better visualization of other accompanying fetal malformations. Conclusions. Three‐dimensional sonography allows for a more accurate diagnosis and provides a clearer visualization of malformations than 2D imaging. Cysts and pseudocysts can be defined much more accurately by using the different modes described here.     

Radiosensitivity of Rat Mammary Tumors Correlates With Early Vessel Changes Assessed by Power Doppler Sonography

Objective . To investigate the changes occurring in the vascularization of tumors during irradiation, we used a model of autochthonous mammary tumors in rats and assessed early vascular changes after irradiation by power Doppler sonography. Methods . Mammary tumors were induced in 24 female Sprague Dawley rats by a single subcutaneous injection of N‐nitroso N‐methyl urea. After tumor areas reached 1 cm², the animals received a single fraction of 18‐Gy radiation or intraperitoneal saline injection. Power Doppler sonographic quantification of detected vessels was performed 1 day before irradiation and 7 days after the use of a power Doppler index of 5 different tumor imaging planes. Final tumor shrinkage was compared with early changes in the power Doppler index. Not all tumors regressed in a similar fashion. Radiosensitive tumors were defined as tumors with a greater than 50% decrease in baseline area 28 days after irradiation, whereas radioresistant tumors were tumors with a less than 50% decrease in baseline area. Statistical analysis was performed by the Mann‐Whitney U test. Results . Tumor area changes were similar in radioresistant and radiosensitive tumors 7 days after irradiation (–41% and –35%, respectively; P > .05, not significant), whereas reduction in the power Doppler index was significantly greater in radiosensitive tumors (mean value, –63%) than in radioresistant tumors (mean value, –12%) (P = .001). Late tumor regrowth was correlated with day 7 power Doppler index changes (P = .009). A 40% reduction in the power Doppler index at day 7 distinguished 8 of 9 radiosensitive tumors and 8 of 9 radioresistant tumors (P = .003). Conclusions . This study suggests that early changes in tumor perfusion as assessed by power Doppler sonography after tumor irradiation may precede the long‐term tumor regression.