Hemangioma of the ovary. A case report

BACKGROUND: Ovarian hemangioma is extremely rare. CASE: We report a case of a 32-year-old woman who complained of pelvic pain due to a large right adnexal mass. On color Doppler sonography the mass showed very rich and complex vascularity, with prominent blood flow. A 10 x 8-cm hemangioma of the right ovary was resected. CONCLUSION: Hemangiomas should be considered when a richly vascularized tumor with prominent blood flow is detected on color Doppler sonography or magnetic resonance imaging.     

Use of power Doppler in pediatric neurosonography: a pictorial essay

In pediatric neurosonography, conventional color Doppler imaging has been the primary adjunct to routine gray-scale imaging. Power Doppler sonography is a relatively recent development that does not have the limitations of conventional color Doppler ultrasound. The power Doppler technique measures the energy of moving red blood cells instead of the velocity and direction of flow. Advantages of this technique include increased sensitivity for identifying flow in slow-flow states, more complete evaluation of a vessel, and more accurate evaluation of the course of the vessel. Power Doppler sonography is helpful in evaluation of the neonatal brain in a variety of clinical situations: identifying the exact locations of extraaxial fluid collections, differentiating intraventricular clot from normal choroid plexus, detecting intraventricular hemorrhage, and demonstrating asymmetries in cerebral perfusion. However, in certain difficult cases, use of both conventional color Doppler sonography and power Doppler sonography produces increased diagnostic accuracy because these techniques furnish complementary information.     

Effect of opioid blockade on insulin and growth hormone (GH) secretion in patients with polycystic ovary syndrome: the heterogeneity of impaired GH secretion is related to both obesity and hyperinsulinism

Amplitude-coded color Doppler sonography (ACD) has become an useful adjunct to gray-scale US and conventional color Doppler sonography (CD) for the assessment of vascular diseases and pathologic conditions that might affect or alter tissue vascularization or perfusion. Basically, all US units that generate conventional color Doppler information through autocorrelation technique are capable of displaying ACD. This technique is also referred to as power Doppler, amplitude-mode color Doppler US, color Doppler energy (CDE), or US angiography. Amplitude-coded color Doppler sonography has already emerged as a valuable adjunct to conventional CD, particularly for evaluating flow in parts of the body where CD signal is weak because of slow flow, small blood vessels, or both.     

Scrotal imaging

Scrotal ultrasonography has many indications. Evaluation of testis masses, hydroceles, and extratesticular structures are the most common indications. Color Doppler ultrasound has made assessment of scrotal blood flow possible. This enables the sonographer to make specific diagnoses in cases of acute scrotal pain. Other indications include evaluating infertile men, searching for an undescended testis, and evaluating the traumatized scrotum.     

Value of echo-enhanced Doppler sonography in evaluation of transjugular intrahepatic portosystemic shunts

OBJECTIVE: The value of echo-enhanced color and power Doppler sonography in the evaluation of transjugular intrahepatic portosystemic shunts (TIPS) was assessed and compared with that of unenhanced Doppler sonography and portal angiography. SUBJECTS AND METHODS: In a prospective randomized trial, 31 shunts in 30 patients underwent unenhanced conventional color and power Doppler sonography and portal venography including pressure measurements. The patients were allocated to either echo-enhanced conventional color Doppler sonography or echo-enhanced power Doppler sonography. For echo enhancement, a galactose-based suspension was administered IV. Shunt stenoses, if present, were quantified by percentage of stenosis and correlated with angiography, which was the gold standard. The diagnostic confidence of unenhanced and echo-enhanced Doppler sonography was assessed using a visual analog scale. RESULTS: In the diagnosis of shunt occlusion, echo-enhanced Doppler sonography yielded a sensitivity and a specificity of 100% and 100%, respectively, compared with 100% and 89%, respectively, for unenhanced Doppler sonography. Our evaluation of hemodynamically significant stenoses (portosystemic gradient > or = 15 mm Hg) found echo-enhanced Doppler sonography to be superior to unenhanced Doppler sonography (sensitivity and specificity of 82% and 83%, respectively, compared with 64% and 80%, respectively). In the detection of a shunt stenosis based on morphologic criteria only, echo-enhanced Doppler sonography yielded a sensitivity and a specificity of 78% and 100%, respectively, compared with 47% and 50%, respectively, for unenhanced Doppler sonography. Power Doppler imaging did not improve diagnostic accuracy but did increase diagnostic confidence for unenhanced Doppler sonography compared with conventional color Doppler sonography. The diagnostic confidence for sonographic evaluation of TIPS was significantly (p < .001) increased and the variability of hemodynamic measurements was markedly decreased with echo-enhanced sonography. CONCLUSION: Echo-enhanced Doppler sonography provides images of TIPS like those of angiography and allows morphologic assessment of the shunts, complementary to the essential pulsed Doppler waveform analysis that would be performed in a more guided manner. Also, echo-enhanced Doppler sonography significantly increases the sensitivity and specificity in the diagnosis of shunt dysfunction. The high diagnostic confidence and the diminished variability of spectral Doppler measurements may improve acceptance of sonographic evaluation of TIPS. Echo-enhanced Doppler sonography is safe and effective and may reduce the instances in which TIPS sonographic surveillance is nondiagnostic, in which case angiographic assessment is required.     

Diagnostic imaging for pediatric scrotal disorders

Classification of pediatric scrotal disorders into three typical clinical manifestations--acute scrotal disorders, scrotal masses, and cryptorchidism--provides a practical basis for evaluation with the most commonly used modalities--sonography, scintigraphy, and magnetic resonance (MR) imaging. Acute scrotal disorders of children include acute epididymitis, torsion of an appendix testis or appendix epididymis, and torsion of the spermatic cord. Either scintigraphy or sonography may be used as the first imaging study, and both can aid in distinguishing among the disorders to different degrees. However, sonography is becoming the preferred modality, primarily because of the superior anatomic detail provided. Scrotal masses are also best depicted with sonography, although MR imaging can occasionally be a useful adjunctive modality. In cases of suspected cryptorchidism with equivocal clinical findings, both sonography and MR imaging may be useful, although sonography is usually the initial study. Knowledge of characteristic imaging appearances, as well as benefits and limitations of the available modalities, enables appropriate, expeditious radiologic evaluation of pediatric scrotal disorders.     

Standard versus individually planned irradiation field in radiotherapy of infradiaphragmatic lymph node sites]

PURPOSE: The aim of this study was to determine the utility of scrotal sonography in the evaluation of patients with scrotal pain or swelling following inguinal hernia repair. METHODS: From our database, we identified patients who were referred for sonographic evaluation because of persistent scrotal pain or swelling after inguinal hernia repair between July 1994 and February 1996. Sonograms and medical charts were reviewed retrospectively. RESULTS: Eight patients were included in this study. Doppler sonography demonstrated evidence of testicular infarction in 2 patients and absence of intratesticular diastolic flow in 1 patient. Five patients had postoperative fluid collections with sonographically normal testes. CONCLUSIONS: Scrotal sonography can diagnose testicular infarction following hernia repair and distinguish postoperative fluid collections from recurrent hernias.     

Evaluation of acute scrotum in the emergency department

A 2-year retrospective review of 238 cases of acute scrotal pain encountered in a children's hospital emergency department is presented. The incidences of testicular torsion, torsion of a testicular appendage, and epididymitis were 16%, 46%, and 35%, respectively. Testicular salvage was critically dependent on the interval between onset of pain and surgical intervention. No testis likely to have been viable at the time of presentation was "lost." The diagnostic error rate on first encounter was 7%, resulting in 10 negative scrotal explorations. With the exception of cases of far-advanced necrotic testes, both color Doppler ultrasound and radioisotope imaging were highly specific diagnostic modalities. Thirty-nine percent of the children with epididymitis who underwent investigation were found to have either structural or functional urinary tract abnormalities. Noninvasive urodynamic studies appear to be useful screening modalities in older children with epididymitis.     

Conventional color Doppler velocity sonography versus color Doppler energy sonography for the diagnosis of acute experimental torsion of the spermatic cord

OBJECTIVE: We compared color Doppler velocity sonography and color Doppler energy sonography for the diagnosis of spermatic cord torsion in a canine model and determined the degree of torsion necessary to acutely halt testicular blood flow. MATERIALS AND METHODS: Spermatic cord torsion was created in five dogs by exposing and rotating the ipsilateral testis 0 degree, 180 degrees, 270 degrees, 360 degrees, 450 degrees, and 540 degrees. Detorsion followed. The testicles were scanned at each torsion stop using both color Doppler velocity sonography and color Doppler energy sonography. Doppler parameters were optimized (by phantom and test scans) and maintained at a tolerable noise level throughout the experiment. Readers who were unaware of the degree of torsion compared flow in the rotated and contralateral control testes. RESULTS: Flow became undetectable by color Doppler velocity sonography and color Doppler energy sonography at 450 degrees in four of five cases and at 540 degrees in one of five cases. We found no significant difference between the velocity and the energy techniques for detecting this absence of flow (p > .05, Wilcoxon test). We found a significant difference in degree of flow for both techniques when comparing controls and all degrees of torsion combined (p < .006, Mann-Whitney test), but significance was achieved at lesser degrees of torsion with the velocity technique than with the energy technique (180 degrees and 360 degrees, respectively, Wilcoxon test). CONCLUSION: Color Doppler energy sonography was not significantly more sensitive than color Doppler velocity sonography for the diagnosis of spermatic cord torsion in this model. Complete occlusion of arterial inflow occurred at 450-540 degrees of torsion.     

A case of Caroli's disease: usefulness of color Doppler sonography for evaluating the malformation of the intrahepatic bile ducts

Caroli's disease is a rare congenital disorder with multiple cystic dilatations of the intrahepatic bile ducts. In addition to the nonobstructive localized dilatation of the bile ducts, intraluminar bulbar protrusions of the wall and bridge formation across dilated lumina have been demonstrated on sonography and computed tomography. We present a case in which color Doppler sonography clearly showed a blood flow signal toward the periphery of the liver in the protrusion of the dilated intrahepatic bile ducts. Color Doppler sonography is a useful noninvasive method for evaluating the malformation of Caroli's disease.     

Clinical usefulness of transrectal sonography and transperineal color Doppler flow imaging in the diagnosis of intrapelvic venous congestion syndrome

BACKGROUND: The present study was designed to reveal the possible use of transrectal sonography (TRS) and transperineal color Doppler flow imaging in predicting intrapelvic venous congestion syndrome (IVCS), as evaluated by three dimensional magnetic resonance venography (3D-MRV). METHODS: Thirty-one patients with prostatodynia and eleven control men were enrolled in this study. The diagnosis of IVCS was made based on the findings by 3D-MRV, such as the dilation of the prostatic capsular vein, the dilation of the pudendal plexus, the interruption of the internal pudendal vein and the dilation of the plexus behind the bladder. The prostatic capsular vein was observed ultrasonically as "sonolucent zone (SZ)", and the maximum width of SZ was measured on sonograms. Transperineal color Doppler flow imaging was used to detect blood flow images of the prostatic capsular vein. The maximum velocity of it was also measured on sound spectrogram. RESULTS: IVCS was confirmed in 29 cases (IVCS group) and the other 13 cases were regarded as non-IVCS group. IVCS was recognized much more frequently in patients with prostatodynia than in controls (87% vs 18%, p < 0.0001). The maximum width of SZ was 2.4 mm (mean) in non-IVCS group, compared to 4.4 mm in IVCS group (p < 0.0001). The cutoff value of 3.0 mm for the maximum width of SZ showed as high as 86% of sensitivity for the detection of IVCS. The maximum velocity of retrograde venous flow during Valsalva's maneuver in IVCS group (mean 14.4 cm/s) was faster than non-IVCS group (mean 7.1 cm/s, p < 0.05). The cutoff value of 10 cm/s for the maximum retrograde venous flow velocity showed as high as 69% of sensitivity for the detection of IVCS. CONCLUSIONS: Both TRS and transperineal color Doppler flow imaging were usefull as a predictor for IVCS.     

Renal vascular Doppler imaging: clinical benefits of power mode

Power Doppler ultrasound (US) is a new technology that is superior to conventional color Doppler imaging in the detection of blood flow. Because of its greater sensitivity to flow and reduced angle dependence, power Doppler US demonstrates optimal color filling of renal pedicular vessels and allows improved evaluation of the renal parenchymal microvasculature. Power Doppler US was used as an adjunct to conventional color Doppler imaging in technically challenging cases and to improve evaluation of renal vascular disorders in a series of 916 patients. The primary clinical advantages of using power Doppler US compared with conventional color Doppler imaging include better morphologic appreciation of atherosclerotic changes in the renal artery wall, allowing improved diagnostic performance especially in hemodynamically nonsignificant plaques; ability to differentiate between subocclusive renal artery stenosis and occlusion; increased confidence in the diagnosis of renal vein thrombosis and in the assessment of caval tumor thrombus; and better appreciation of renal cortical perfusion defects. In addition, because of its greater sensitivity to perivascular artifact, power Doppler US has the potential to increase the detection rate for intrarenal arteriovenous fistulas.     

A case of large neonatal arteriovenous malformation with heart failure. Color Doppler sonography, MRI and MR angiography as early non-invasive diagnostic procedures

We report a case of a large arteriovenous malformation (AVM) of neonatal onset with heart failure. Transfontanel color Doppler sonography revealed abnormal vessels in the early stage of the investigation. Magnetic resonance imaging (MRI) revealed numerous flow voids suggesting abnormal vessels, and magnetic resonance angiography (MRA) disclosed numerous bizarre abnormal vessels. Color Doppler sonography is a convenient and appropriate procedure for the early bedside diagnosis of neonatal AVMs. MRI and MRA can replace cerebral angiography for the diagnosis of neonatal AVMs.     

The effect of inorganic pyrophosphate on the transport of oleanolic acid monoglycosides into vacuoles isolated from Calendula officinalis leaves

OBJECTIVE: The objective of our study was to determine the value of using color and power Doppler sonography to reveal extrathyroidal feeding arteries in the detection of abnormal parathyroid glands. SUBJECTS AND METHODS: Forty-four patients with primary hyperparathyroidism were imaged prospectively with high-resolution gray-scale, color flow, and power Doppler sonography. The presence of extrathyroidal arteries supplying the adenomas was noted. All patients underwent subsequent neck exploration. The locations of the abnormal glands were recorded. RESULTS: At surgery, 51 abnormal parathyroid glands were removed in the 44 patients. Sonography correctly revealed an adenoma in 40 of the 44 patients. Likewise, sonography revealed 42 of the 51 adenomas. Nine false-negative and two false-positive interpretations of the sonograms were made. Thus, overall sensitivity was 83%, specificity was 98%, and accuracy was 94%. Three of the false-negative interpretations were ectopic glands within the superior mediastinum. Excluding these three glands from analysis, the sensitivity for detection of adenomas within the neck was 88%, specificity was 98%, and accuracy was 95%. An extrathyroidal artery leading to a parathyroid adenoma was seen in 35 of the 42 adenomas revealed by sonography. The presence of an extrathyroidal artery leading to an adenoma was found to aid in the detection of an otherwise inconspicuous parathyroid gland in five patients, which improved sensitivity from 73% to 83%. CONCLUSION: Prominent vessels supplying parathyroid adenomas are frequently revealed by color flow and power Doppler sonography. These vessels can serve as "road maps" to abnormal parathyroid glands.     

Endothelial dysfunction occurs in children with two genetic hyperlipidemias: improvement with antioxidant vitamin therapy

The development of color-flow imaging has made ultrasound the primary imaging modality for the evaluation of testicular pathology. The ability to distinguish between epididymo-orchitis and torsion is of great clinical significance in those patients with acute onset of pain. Not only does the appropriate treatment depend on the correct diagnosis, but the outcome following that treatment is also dependent on establishment of the diagnosis. Although it is of less importance in the evaluation of testicular neoplasms, color-flow imaging does provide adjunctive information that can aid in establishment of the proper diagnosis in confusing clinical situations. The diagnosis of varicocele depends on color-flow imaging, and the prediction of testicular viability following trauma is essential for proper treatment. More studies concerning the use of power Doppler for imaging of scrotal disorders are necessary to determine what its role will be.     

Color Doppler imaging assessment of blood flow in vascularized pedicle grafts for avascular necrosis of the femoral head: angiographic correlation

The aim of this study was to examine whether color Doppler imaging can be used to assess vascular patency after use of pedicle pelvic bone grafts in the operative treatment of avascular necrosis of the femoral head. We performed color Doppler imaging and selective angiography in 10 consecutive patients (12 hip joints) treated for avascular necrosis of the femoral head. In comparison to angiographic results, nine patent and two occluded grafts were demonstrated correctly by color Doppler imaging. In one case, a graft confirmed as patent by angiography was not demonstrable by color Doppler imaging. Accuracy, sensitivity, and specificity of color Doppler imaging were high when compared to angiography as a standard. Color Doppler imaging is suited to evaluate vascular patency after use of vascularized pedicle bone grafts in the treatment of avascular necrosis of the femoral head.     

Visualization of tumor vessels in hepatocellular carcinoma. Power Doppler compared with color Doppler and angiography

PURPOSE: To assess the visualization of tumor vessels in hepatocellular carcinoma (HCC) by power Doppler sonography. MATERIAL AND METHODS: We examined 40 patients with 47 HCC lesions by means of power Doppler sonography and compared its visualization of tumor vessels with those of color Doppler and angiography. RESULTS: In 38 (81%) of the 47 lesions, power Doppler sonography improved the visualization of tumor vessels compared with color Doppler sonography; in the remaining lesions no significant difference was noted. In lesions located within 7 cm in depth, there was no significant difference between power Doppler sonography and angiography. In 10 (83%) out of 12 small (< or = 2 cm in diameter) lesions and in 11 (85%) out of 13 hypovascular lesions, power Doppler sonography performed considerably better than angiography. In deeper-seated lesions, however, angiography was significantly superior to power Doppler sonography. CONCLUSION: Power Doppler sonography is more sensitive in detecting the fine tumor vessels in most HCCs than color Doppler sonography. In addition, power Doppler sonography can replace angiography in evaluating tumor vascularity in HCCs except in lesions that are deep-seated or located near the heart. In these lesions, angiography can complement power Doppler sonography in demonstrating tumor vessels.     

Solitary hepatic lesions with a hypoechoic rim: value of color Doppler sonography

OBJECTIVE: A hypoechoic rim around a focal liver lesion as revealed by conventional sonography may be present in malignant liver lesions as well as in benign liver lesions. This study evaluated the potential of color Doppler sonography in differentiating various focal liver lesions with a hypoechoic rim. CONCLUSION: Color Doppler sonography may be helpful in distinguishing focal nodular hyperplasia (FNH) from other focal liver lesions. The characteristic finding of blood flow within the hypoechoic rim of FNH is most likely caused by small vessel abnormalities that have previously been described for FNH.     

Disruption of p53 function in immortalized human cells does not affect survival or apoptosis after taxol or vincristine treatment

OBJECTIVE: We assessed the feasibility of contrast-enhanced color Doppler, power Doppler, and spectral duplex sonography for visualization and quantification of flow through transjugular intrahepatic portosystemic shunts (TIPS) in patients in whom the baseline sonographic evaluation was unsatisfactory. SUBJECTS AND METHODS: Thirty-three patients underwent color Doppler, power Doppler, and spectral duplex sonography after TIPS insertion or before TIPS revision (mean time interval +/- SD, 1 +/- 1 day). All sonograms were obtained before and after patients received echo-enhancing contrast material. Sonography was evaluated with regard to presence or absence of flow in the mid portion, portal segment, and hepatic segment of the shunt. The maximal peak velocity was measured in the mid portion of the shunt. For identifying and quantifying stenoses, the percentage of luminal diameter reduction was calculated at the tightest part of the shunt. Shunt angiography and measurements of portosystemic pressure gradients were independently evaluated and compared with the sonographic findings. RESULTS: Flow visualization on unenhanced color Doppler sonography was significantly improved through the use of power Doppler sonography and contrast-enhanced color Doppler and power Doppler sonography (p < .01). Between contrast-enhanced power Doppler and contrast-enhanced color Doppler sonography, a significant difference was found in the portal and hepatic segments (p < .05). All shunt stenoses (n = 8) and occlusions (n = 3) were revealed by power Doppler sonography, whereas color Doppler sonography failed to reveal six of eight stenoses. Compared with unenhanced sonography, the quality of spectral duplex sonography was improved in eight patients after contrast enhancement (p < .05). Maximal peak velocity ranged from 54 to 252 cm/sec (mean +/- SD, 132.7 +/- 52.1 cm/sec) in normal shunts and from 24.5 to 70.0 cm/sec (mean +/- SD, 45.0 +/- 18.9 cm/sec) in stenosed shunts. No correlation was found between maximal peak velocity and portosystemic pressure gradients (r = .28). CONCLUSION: Unenhanced power Doppler and contrast-enhanced color and power Doppler sonography can be helpful in the assessment of TIPS status in patients who previously underwent unsatisfactory sonography. These techniques may allow anatomic evaluation and quantification of shunt stenosis in most patients. Contrast enhancement may also considerably improve the quality of spectral duplex sonography.     

Sonographic detection of tumor blood flow using a new contrast agent in woodchuck hepatomas

The aim of this study was to assess the ability of perfluoropropane-filled albumin microspheres to visualize tumor blood flow in woodchuck hepatomas. Ten tumors in five woodchucks with hepatomas were imaged before and after intravenous injection (dosages of 0.01 ml/kg to 2.0 ml/kg) of an agent using color Doppler sonography and gray scale ultrasonography. Both enhanced imaging modalities demonstrated blood flow around and within all tumors. Enhanced gray scale ultrasonography demonstrated sonographic "tumor blush" in seven tumors (70%). In conclusion, tumor blood flow in woodchucks was visualized more clearly using the agent on both color Doppler and gray scale ultrasonography.