Investigation of lacrimal sac space-occupying lesions using color doppler ultrasound, computed tomography, and computed tomography dacryocystography

AIM:To observe the imaging features of color Doppler ultrasound(CDU)and computed tomography(CT)or computed tomography dacryocystography(CT-DCG)in different types of lacrimal sac space-occupying lesions(SOLs).METHODS:This retrospective case series study included 21 patients with lacrimal sac SOLs who underwent lacrimal sac surgery between January 2018 and March 2022.The imaging features of CDU and CT or CT-DCG in these patients were extracted from the examination cloud system.The images were observed and analyzed.RESULTS:The detection rate of lacrimal SOLs between CDU(21/21,100%)and CT or CT-DCG(20/21,95.2%)had no statistically significant difference(P=1.0).CDU could detect the blood flow signals in all SOLs except mucocele and mucopeptide concretion.Among them,polyps had characteristic imaging changes on CDU and CT-DCG.The mucoceles and mucopeptide concretions had characteristic imaging changes on CDU,which could provide more information for differential diagnosis.CONCLUSION:The morphology and internal blood flow signals of lacrimal sac SOLs can be observed using CDU.CT or CT-DCG has advantages in observing structural damage around the lacrimal sac mass.Therefore,CDU may be used as a routine examination to exclude lacrimal sac SOLs before dacryocystorhinostomy in the absence of preoperative CT or CT-DCG.

Hemodynamic analysis of esophageal varices in patients with liver cirrhosis using color Doppler ultrasound

AIM： To study the portal hemodynamics and their relationship with the size of esophageal varices seen at endoscopy and to evaluate whether these Doppler ultrasound parameters might predict variceal bleeding in patients with liver cirrhosis and portal hypertension. METHODS： One hundred and twenty cirrhotic patients with esophageal varices but without any previous bleeding were enrolled in the prospective study. During a 2-year observation period, 52 patients who had at least one episode of acute esophageal variceal hemorrhage constituted the bleeding group, and the remaining 68 patients without any previous hemorrhage constituted the non-bleeding group. All patients underwent endoscopy before or after color Doppler-ultrasonic examination, and images were interpreted independently by two endoscopists. The control group consisted of 30 healthy subjects, matched to the patient group in age and gender. Measurements of diameter, flow direction and flow velocity in the left gastric vein （LGV） and the portal vein （PV） were done in all patients and controls using color Doppler unit. After baseline measurements, 30 min after oral administration of 75 g glucose in 225 mL, changes of the diameter, flow velocity and direction in the PV and LGV were examined in 60 patients with esophageal varices and 15 healthy controls. RESULTS： The PV and LGV were detected successfully in 115 （96%） and 105 （88%） of 120 cirrhotic patients, respectively, and in 27 （90%） and 21 （70%） of 30 healthy controls, respectively. Among the 120 cirrhotic patients, 37 had F1, 59 had F2, and 24 had F3 grade varices. Compared with the healthy controls, cirrhotic group had a significantly lower velocity in the PV, a significantly greater diameter of the PV and LGV, and a higher velocity in the LGV. In the cirrhotic group, no difference in portal flow velocity and diameter were observed between patients with or without esophageal variceal bleeding （EVB）. However, the diameter and blood flow velocity of the LGV were significantly higher for EVB （＋） group compared with EVB （-） group （P〈0.01）. Diameter of the LGV increased with enlarged size of varices. There were differences between F1 and F2, F1 and F3 varices, but no differences between F2 and F3 varices （P = 0.125）. However, variceal bleeding was more frequent in patients with a diameter of LGV 〉6 mm. The flow velocity in the LGV of healthy controls was 8.70＋1.91 cm/s （n = 21）. In patients with liver cirrhosis, it was 10.3＋2.1 cm/s （n = 12） when the flow was hepatopetal and 13.5＋2.3 cm/s （n = 87） when it was hepatofugal. As the size of varices enlarged, hepatofugal flow velocity increased （P〈0.01） and was significantly different between patients with F1 and F2 varices and between patients with F2 and F3 varices. Variceal bleeding was more frequent in patients with a hepatofugal flow velocity 〉15 cm/s （32 of 52 patients, 61.5%）. Within the bleeding group, the mean LGV blood flow velocity was 16.6＋2.62 cm/s. No correlation was observed between the portal blood flow velocity and EVB. In all healthy controls, the flow direction in the LGV was hepatopetal, toward the PV. In patients with F1 varices, flow direction was hepatopetal in 10 patients, to-and-fro state in 3 patients, and hepatofugal in the remaining 18. The flow was hepatofugal in 91% patients with F2 and all F3 varices. Changes in diameter of the PV and LGV were not significant before and after ingestion of glucose （PV： 1.41＋1.5 cm before and 1.46＋1.6 cm after; LGV： 0.57＋1.7 cm before and 0.60＋1.5 cm after）. Flow direction in the LGV was hepatopetal and to-and-fro in 16 patients and hepatofugal in 44 patients before ingestion of glucose. Flow direction changed to hepatofugal in 9 of 16 patients with hepatopetal and to-and-fro blood flow after ingestion of glucose. In 44 patients with hepatofugal blood flow in the LGV, a significant increase in hepatofugal flow velocity was observed in 38 of 44 patients （86%） with esophageal varices. There was a relationship between the percentage changes in flow velocity and the size of varices. Patients who responded excessively to food ingestion might have a high risk for bleeding. The changes of blood flow velocity in the LGV were greater than those in the PV （LGV： 28.3＋26.1%, PV： 7.2＋13.2%, P〈0.01）, whereas no significant changes in the LGV occurred before and after ingestion of glucose in the control subjects. CONCLUSION： Hemodynamics of the PV is unrelated to the degree of endoscopic abnormalities in patients with liver cirrhosis. The most important combinations are endoscopic findings followed by the LGV hemodynamics. Duplex-Doppler ultrasonography has no value in the identification of patients with cirrhosis at risk of variceal bleeding. Hemodynamics of the LGV appears to be superior to those of the PV in predicting bleeding.

Clinical Evaluation of Color Doppler Ultrasound in Selecting the Optimal Treatment Modality for Infantile Hemangioma

Objective We investigated the efficacy and safety of 1064 nm Nd： YAG laser, intense pulsed light （IPL）, and lauromacrogol injection in the treatment of hemangioma, in order to evaluate the value of color Doppler ultrasound guidance in choosing the optimal treatment modality. Methods Infantile patients who were clinical diagnosed as hemangiomas were randomly divided into group A, who had color Doppler ultrasound examinations before the treatment, and group B who had the treatment without ultrasound evaluation. Patients in the group A were assigned into subgroups according to the depth of lesion by sonography： group A-1 for those who had a lesion depth 〈1.2 mm, and took intense pulsed light therapy; group A-2 for those who had a lesion depth ≥1.2mm and 〈 3 mm, and took long pulse 1064 nm Nd：YAG laser therapy; group A-3 for those who had a lesion depth ≥3mm and 〈5 mm, and were treated by IPL combined with long pulse 1064 nm Nd：YAG laser treatment; Group A-4 for those who had a lesion depth ≥5 mm, and took lauromacrogol injection therapy. Patients in the group B took long pulse 1064 nm Nd：YAG laser treatment without preoperative ultrasound evaluation. The efficacy and adverse reactions of the treatments between the groups were evaluated and compared statistically. Results Totally 113 patients with 128 skin lesions were enrolled in this study, 85 in the group A （mean age 6.8±7.9 months） and 28 in the group B （mean age 6.9±9.9 months）. The mean depth of hemangioma was 3.3±1.1 mm in the group A, ranging from 0.5-7.8 mm, with 0.8±0.4 mm, 2.2±0.4 mm, 4.2±0.6 mm and 6.2±0.7 mm in group A1, A2, A3 and A4, respectively. The cure rates and effective rates in the group A were significantly higher than those in the group B （cure rates： 64.5% vs 56.3%, U=3.378, P=0.045; effective rates： 89.5% vs 78.1%, U=4.163, P=0.041）. The adverse effect rates of the group A （vesicle 20.0%, pigmentation 46.9%, scarring 17.7%） were lower than those of the group B （vesicle 21.9%, pigmentation 60.4%, scarring 25.0%）. Incidences of pigmentation and scarring were statistically significantly different （U=3.884, P=0.034, and U=4.016, P=0.032 respectively） between the two groups. Conclusion With the guidance of color Doppler ultrasound, the efficacy and safety of long pulse 1064 nmNd：YAG laser, intense pulsed light, and lauromacrogol injection in the treatment of infantile hemangioma have better outcomes compared to laser treatment alone without preoperative ultrasound examination.

Assessment of Uterine Receptivity by Endometrial and Subendometrial Blood Flows Measured by Vaginal Color Doppler Ultrasound in Women Undergoing IVF Treatment

Objective To evaluate endometrial and subendometrial blood flows measured by vaginal color Doppler ultrasound as a predicator of endometrial receptivity in women undergoing IVF treatment. Methods A total of 119 infertile patients undergoing the first IVF/ICSI-ET cycle were recruited. Three groups were divided according to a color Doppler ultrasound examination performed on the day of hCG injection. Group A, endometrial and subendometrial blood flows were 2 branches and below; group B, endometrial and subendometrial blood flows were between 3 and 4 branches; group C, endometrial and subendometrial blood flows were 5 branches and above. Patients were transferred 1-3 embryos each. Demographic data, ovarian responses, endometrial thickness, PI, RI, development of embryo and IVF result among groups were compared. Results Demographic data, ovarian responses, endometrial thickness, PI, RI and development of embryo among groups have no significant difference. The pregnancy rate of group A was significantly lower than that of group B （P〈0.05） and group C （P〈0.01）. The implantation rate of group A was significantly lower than than of group C （P〈0.01）. There was no significant difference of the rate of pregnancy and implantation between group B and group C （P〉0.05）. Conclusion Endometrial and subendometrial blood flows measured by vaginal color Doppler ultrasound is a good predicator of pregnancy during IVF treatment. A good endometrial and subendometrial blood flows is benefit for the result of IVF.

Pulsed Umbilical Artery Doppler Ultrasound Findings in Management of High-Risk Term Pregnant Women during Labour

Purpose: Intrapartum Doppler velocimetry is a non-invasive investigation method. This method is useful for evaluating the pathophysiological mechanisms underlying changes in fetal heart rate. This study aimed to determine the usefulness of Doppler ultrasound findings during labor in high-risk women on determining the mode of delivery and outcome of the newborn. Methods: A cross-sectional study was conducted from January 1, 2015 to December 31, 2015 on 100 high-risk pregnant women during labor. The study was performed in the Maternity Teaching Hospital in Erbil City, Kurdistan Region, Iraq. Results: The majority of women (77%) had a normal end-diastolic blood flow pattern through the umbilical artery. A total of 76.9% of those with abnormal Doppler results had a Cesarean delivery compared with only 9.5% of those with normal Doppler results (p p p = 0.07) and fifth minutes (p = 0.01). Conclusions: Abnormal umbilical artery Doppler ultrasound findings in high-risk pregnancies for women in labor are associated with increased rates of emergency cesarean sections and a poor outcome of the newborn.

Use of doppler ultrasound to predict need for transjugular intrahepatic portosystemic shunt revision

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is used to treat complications of portal hypertension,such as ascites and variceal bleeding(VB).While liver doppler ultrasound(DUS)is used to assess TIPS patency,trans-shunt venography(TSV)is the gold standard.AIM To determine the accuracy of DUS to assess TIPS dysfunction and for need for revision.METHODS Retrospective review of patients referred for TIPS revision from 2008-2021.Demographics,DUS parameters at baseline and at the DUS preceding TIPS revision,TSV data were collected.Receiver operating characteristics curves,sensitivity,specificity,performance for doppler to predict need for revision were performed.Univariate and multivariate analyses were used to predict clinical factors associated with need for TIPS revision.RESULTS The cohort consisted of 89 patients with cirrhosis(64%men,76%white,31%alcohol as etiology);median age 59 years.Indication for initial TIPS were VB(41%),refractory ascites(51%),and other(8%).TIPS was revised in 44%.On univariate analysis,factors associated with need for TIPS revision were male(P=0.03),initial indication for TIPS(P=0.05)and indication for revision(P=0.01).Revision of TIPS was associated with lower mortality(26%vs 46%)and significantly lower rates of transplant(13%vs 24%;P=0.1).In predicting need for TIPS revision,DUS has a 40%sensitivity,45%specificity,PPV 78%,and NPV 14%.The most accurate location for shunt velocity measure was distal velocity(Area under the curve:0.79;P=0.0007).CONCLUSION DUS has poor overall sensitivity and specificity in predicting need for TIPS revision.Non-invasive methods of predicting TIPS dysfunction are needed since those needing TIPS revision had better survival.

Doppler Ultrasound Abnormalities of the Lower Limbs in Patients with Diabetic Foot at the Yopougon University Hospital in Ivory Coast

Background: Diabetic foot is a frequent complication of diabetes, of multifactorial origin, associating nervous and/or circulatory disorders to which infection is often added. Its care is multidisciplinary and requires coordination between different actors. In this context, arterial doppler ultrasound is essential in the diagnosis of diabetic arteriopathy and participates in therapeutic decision-making. The aim of this study was to describe the abnormalities found on Doppler ultrasonography of patients hospitalized for the diabetic foot in the Ivory Coast. Methods: We conducted a retrospective descriptive study including 235 patients hospitalized for the diabetic foot in the Endocrinology department of the Yopougon University Hospital from February 2002 to December 2015. All records of patients who performed arterial Doppler ultrasound of the lower limbs were selected and the various abnormalities were described. Results: The sex ratio (M/F) was 1.1 (124 men to 111 women). The predominant age group was 61.2 years. Type 2 diabetes was found in 97.4% of cases. The average evolution of diabetes was 8.9 years with extremes of 1 and 32 years. Wet gangrene was the most common type of lesion found in 75.8% of cases. On ultrasonography, 98.7% of the patients had an arterial abnormality of the lower limbs. It was bilateral in 62.2% of cases, dominated by atheromatous overloads and mediacalcosis in 46.4% and 43.8% of cases, respectively. Arterial stenosis was lesions hemodynamically found in 76.3% of cases and arterial occlusions in 32.7% of cases. The amputation rate was 72.7%. Conclusion: This study shows the high frequency of arterial abnormalities in patients with the diabetic foot with a predominantly distal involvement. Arterial Doppler ultrasound of the lower limbs remains an essential tool in the care of diabetic foot. This easily accessible, non-invasive examination has a key role in therapeutic decision-making.

Pulse wave Doppler ultrasound of testicular arteries and their relationship with semen characteristics in healthy bulls

Background: Semen evaluation is used to estimate the testicular function. In bulls, the spermatozoa present in the ejaculate are the result of a process that begun more than 2 mo earlier, bequeathing a delayed depiction of the actual function of the testis. Since testis vascularization might be critical for the gonad function, selected pulse wave Doppler ultrasound parameters were assessed in this study, for instance the peak systolic velocity, the end diastolic velocity and the resistive index of the testicular artery along the spermatic cord, the marginal portion of the testicular artery and the intratesticular branches of the testicular artery both in healthy adult and young bulls.Correlations between these parameters and characteristics of semen that was collected numerous times, before and after the Doppler ultrasound examination.Results: The peak systolic velocity and the end diastolic velocity measured in the testicular artery along the spermatic cord(supratesticular artery – SA) were variable among the bulls and within individual bulls, likely due to the convoluted course of the vessel. The resistive index was found highly repeatable in the same bull. A reduction in the resistive index was found between the supratesticular artery and the marginal portion of the testicular artery(P < 0.01), and between the marginal portion of the testicular artery and the intratesticular branches of the testicular artery(P < 0.05). No differences were recorded for the pulse wave Doppler ultrasound parameters in young bulls compared with adults. A significant correlation was found between the resistive index of the marginal portion of the testicular artery and total sperm in the ejaculate(r = 0.516, P < 0.05), the immature sperm(r = 0.462, P < 0.05), the teratoid sperm(r = 0.375, P < 0.05), and the "Dag defect" sperm(r = 0.389, P < 0.05). Similarly, the resistive index of the intratesticular branches of the testicular artery were found correlated with the total sperm number in the ejaculate(r = 0.568, P < 0.05), the immature sperm(r = 0.523, P < 0.05), the teratoid sperm(r = 0.418, P < 0.05), and the "Dag defect" sperm(r = 0.341, P < 0.05).Conclusions: The data presented in this study suggest that the resistive index, measured at the marginal portion of the testicular artery, could be an easy-to-perform parameter to evaluate the spermatogenesis quality in young bulls and normal adults.

Assessment of voluntary rhythmic muscle contraction-induced exercising blood flow variability measured by Doppler ultrasound

Given recent technological developments, ultrasound Doppler can provide valuable measurements of blood velocity/flow in the conduit artery with high temporal resolution. In human-applied science such as exercise physiology, hemodynamic measurements in the conduit artery is commonly performed by blood flow feeding the exercising muscle, as the increase in oxygen uptake (calculated as a product of arterial blood flow to the exercising limb and the arterio-venous oxygen difference) is directly proportional to the work performed. The increased oxygen demand with physical activity is met through a central mechanism, an increase in cardiac output and blood pressure, as well as a peripheral mechanism, an increase in vascular conductance and oxygen extraction (a major part of the whole exercising muscles) from the blood. The increase in exercising muscle blood flow in relation to the target workload (quantitative response) may be one indicator in circulatory adjustment for the ac- tivity of muscle metabolism. Therefore, the determination of local blood flow dynamics (potential oxygen supply) feeding repeated (rhythmic) muscle contractions can contribute to the understanding of the factors limiting work capacity including, for instance, muscle metabolism, substance utilization and magnitude of vasodilatation in the exercising muscle. Using non-invasive measures of pulsed Doppler ultrasound, the validity of blood velocity/flow in the forearm or lower limb conduit artery feeding to the muscle has been previously demonstrated during rhythmic muscle exercise. For the evaluation of exercising blood flow, not only muscle contraction induced internal physiological variability, or fluctuations in the magnitude of blood velocity due to spontaneous muscle contraction and relaxation induced changes in force curve intensity, superimposed in cardiac beat-by-beat, but also the alterations in the blood velocity (external variability) due to a temporary sudden change in the achieved workload, compared to the target workload, should be considered. Furthermore, a small amount of inconsistency in the voluntary muscle contraction force at each kick seems to be unavoidable, and may influence exercising muscle blood flow, although subjects attempt to perform precisely similar repeated voluntary muscle contractions at target workload (muscle contraction force). This review presents the methodological considerations for the variability of exercising blood velocity/flow in the limb conduit artery during dynamic leg exercise assessed by pulsed Doppler ultrasound in relation to data previously reported in original research.

A Fertility Assessment of Infertile Men with Varicocele by Means of Doppler Ultrasound

The diameters of spermatic veins and blood reflux in sixty-two male patients with infertility caused by varicocele were assessed with Doppler ultrasound in this study. Scrotal thermograph, testes volume and semen analysis were also applied to analysis of these patients. Among sixty-two patients, thirty-one received high ligation of internal spermatic vein. The results showed: 1. The diameter of spermatic veins was negatively correlated with fertility index and positively correlated with Doppler grading of blood reflux. 2. In operative patients, the effect of surgery was better in patients with blood reflux than in those without blood reflux. It was suggested the diameter of spermatic veins probably reflects the duration and serious degree of blood reflux in spermatic vein, and may be used for assessment of severity of male infertility in combination with semen analysis.

Transcending boundaries:Unleashing the potential of multi-organ point-of-care ultrasound in acute kidney injury

Acute kidney injury(AKI)is a clinical syndrome characterized by a rapid increase in serum creatinine levels or a decrease in urine output or both.In spite of thorough history-taking,physical examination,and laboratory analysis,there are limitations in the diagnostic process and clinical monitoring of AKI.Point-of-care ultrasonography(POCUS),a limited ultrasound study performed by clinicians at the bedside,has emerged as a valuable tool in different clinical settings.In this discussion,we explore the potential of POCUS performed by nephrologists to address specific questions encountered in the diagnosis and management of AKI patients.POCUS not only aids in excluding hydronephrosis but also provides real-time insights into hemodynamics,enabling formulation of individualized treatment plans.Further studies are required to assess the impact of multi-organ POCUS on pragmatic patient outcomes related to AKI,as well as its potential in risk stratification and identification of different levels of AKI severity and pathophysiological signatures.

Emboli detection using the Doppler ultrasound technique

Embolic detection is very important to the early diagnosis of vessel disease. The Doppler ultrasound technique is one of the common methods to detect the emboli non-invasively. When the emboli pass through the sample volume of the Doppler ultrasound instrument, there exist high intensity transient Doppler signals. Thus the emboli can be detected directly from the variation of Doppler signal amplitude. Since there may be some disturbance in the system, this general detection method has great limitation. To improve the accuracy of emboli auto-detection, several novel methods are studied to obtain the sensitive characteristic of the emboli signals using the new signal processing theories.

Measurement of Liver Size and Intrahepatic Blood Flow of Red-eared Turtles by Color Doppler Ultrasound

In the study, a total of 20 red-eared turtles （ half male and half female） were selected to conduct the measurement of liver size and intrahepatic blood flow of red-eared turtles by color Doppler ultrasound. The results showed that the fight hepatic lobe could be scanned through the right carotid anterior acoustic win- dow, and the left hepatic lobe could be scanned through the left carotid anterior acoustic window, but the vision would be obstructed by the air in trachea. The liver could also be scanned through the left femoral anterior acoustic window and the fight femoral anterior acoustic window when filling of bladder was good. The correla- tion regression analysis suggested that estimated values of liver showed no linear relationship with weight, the longest back curve and the widest back curve. Through the study, the normal indicators for ultrasound examination of red-eared turtle liver were established, in order to provide a reference for examination of turtle liver.

Correlation between Perifollicular Vascularity and Outcome in Stimulated Intrauterine Insemination Treatment Cycles: A Study Using Two-Dimensional Transvaginal Power Doppler Ultrasound

Objective:?The aim of this study is to assess any potential relationship between perifollicular vascularity and occurrence of pregnancy in cases of stimulated IUI cycles using the subjective grading system by 2D transvaginal power Doppler ultrasonography.?Design: A prospective cross sectional cohort study. Method: This is a prospective cross-sectional cohort study of 90 stimulated IUI treatment cycles. Selected women were prescribed clomiphene citrate combined with highly purified urinary follicle stimulating hormone. All patients underwent serial transvaginal ultrasound scans starting from day 6 to 7 of the cycle. Perifollicular Doppler blood flows were assessed in dominant follicles ≥18 mm. The patients then were categorized into 3 groups (high vascularity group {G3 & G4}, low vascularity group {G1 & G2} and mixed grades group). Other parameters measured included number of follicles ≥ 18 mm in both ovaries, endometrial thickness and estradiol (E2) level . Human chorionic gonadotropin (hCG) injection 10,000 IU IM was given to the patient when the dominant follicle reached 18 mm in diameter. At that time, the endometrium was evaluated as regards endometrial thickness. IUI was carried out using prepared/“washed” semen (husband). All patients received luteal support in the form of progesterone from day of IUI for 14 days. Serum Β-hCG was estimated 2 weeks after insemination. Results: In this study, from all 90 cases only 8 cases got pregnant with pregnancy rate of 8.88% (6 cases got pregnant in high grade vascularity group;2 cases in mixed grades group and no cases got pregnant?in low grade group). There was statistically significant difference among the 3 groups as regarding?the pregnancy rate (P value = 0.02). There is statistically significant difference in perifollicular resistance index (RI) and pulsatility index (PI) between pregnant and non pregnant cases (P value = 0.016 and 0.047 respectively). In this study, there is no statistically significant difference between pregnant and non pregnant cases as regarding endometrial thickness and E2 level at the day of hCG administration (P value = 0.39 and 0.76 respectively). Conclusion: Perifollicular blood-flow assessment by 2D transvaginal power Doppler is a good predictive for the outcome of stimulated IUI cycles.

Doppler Ultrasound in Post-Molar Gestational Trophoblastic Neoplasia

Objectives: To evaluate the role of Doppler ultrasound in prediction and follow up during management of gestational trophoblastic neoplasia (GTN). Methods: The study was performed at Oncology Unit, Maternity Hospital, Ain Shams University in the period from November 2015 to December 2018. Forty cases of complete mole, after evacuation and follow up of serum human chorionic gonodotrophin (β-hCG) titre until it reached zero level (group I) and forty post molar GTN cases (group II) were included in the study. Doppler ultrasound of the subendometrial and intramural blood flow was done for all cases of group I and II. Doppler included two dimensional and three dimensional power Doppler indices. Group II received Methotrexate (MTX) and folinic acid in a dose of 8-day MTX-FA regimen. Doppler follow up for six months of group II concurrently with the chemotherapy regimen was done. Results: A statistically significant difference was found between group I and II regarding initial readings of all Doppler parameters. Follow up for 6 months of GTN cases revealed progressive statistically significant decrease of intramural and subendometrial three dimensional power Doppler (3DPD) indices, while there was a significant increase in two dimensional (2D) Doppler parameters. Four cases were resistant to Methotrexate chemotherapy. Cut off values were determined for prediction of GTN. Multivariate analysis revealed that the most predictive parameter was the subendometrial pulsatility index (PI), odds ratio = 10.63 (95% CI: 1.30 - 86.89). The cut-off point for sub-endometrial PI was: 2.05 (AUC, 90%;sensitivity, 88%;specificity, 76%, PPV 78%, and NPV 86%) with a diagnostic accuracy of 87%. To and Fro sign may be considered a pathognomonic intramural ultrasound sign for prediction of GTN chemo-resistance or choriocarcinoma. Conclusion: Cut off values for Doppler parameters can be used for early predication of GTN. Doppler ultrasound indices can be used during follow up of GTN cases concurrently with serum β-hCG to monitor the response to treatment.

Adverse Short-Term Outcomes of Preterm Infants Born to Mothers with Preeclampsia by Doppler Cranial Ultrasound Investigation

Objective: In preeclampsia, abnormal fetal hemodynamics changes can be detected by Doppler ultrasound and predicted the perinatal outcome. But seldom studies focus on these preterm neonate’s hemodynamics changes during 72 hours after birth and the adverse short-term outcomes. The present study is planned to assess the parameters of middle cerebral arteries and associate the short-term outcome at 37 weeks early term age in pregnancies complicated by preeclampsia. Methods: A total of 114 preterm neonates were included. The Doppler cranial ultrasound was performed to bilateral middle cerebral arteries within 12 - 24 hours, 36 - 48 hours, 60 - 72 hours after birth for all the eligible study neonates. The parameters of resistive index (RI), resistive index (PI) and middle cerebral velocity (MBFV) were recorded by Doppler cranial ultrasound and 106 infants survived assessed by the Neonatal Behavioral Neurological Assessment (NBNA) at 37 weeks early term-equivalent age. Results: There were a total of 106 subjects that finally completed the NBNA examination at 37 weeks of early term-equivalent age. In the surviving infants, there were a total of 26 infants with abnormal NBNA scores, among them, 12 infants’ mothers were diagnosed with preeclampsia, accounting for up to 46.1%. In these preterm neonates, the lower velocity of bilateral middle cerebral arteries was observed in abnormal infants (p Conclusion: Velocity of middle cerebral artery is significantly abnormal in preeclampsia. The slower velocity in the 72 hours after birth, the higher associated with adverse perinatal short-term outcome.

Diagnosis of parathyroid tumor using Color Doppler ultrasound

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The Diagnostic Value of Color Doppler Ultrasound and Grey Scale Sonography in Predicting the Malignancy of Thyroid Nodules

Retrospective study was done at KAUH to determine the sonographic characteristics in predicting the malignancy of thyroid nodules. The sample was 120 patients consisting of 70 benign nodules and 50 malignant nodules. Out of 120 patients, 106 (88.3%) female and 14 (11.7%) male patients. Out of 106 female patients, 64 (91.45) had benign and 42 had malignant thyroid nodules. Out of 14 (11.7) male patients, 6 had benign and 8 had malignant thyroid nodules. The youngest patient in our study was 31 years and the oldest patient was 76 years. The common range of patients age was ≥ 60 years and consisting of twenty (28.6%) benign thyroid nodules and fourteen (28%) malignant thyroid nodules. The majority of patients’ age group with malignant thyroid nodules were between 50 - 60 years and consisting of twenty (40%) malignant nodules. In our study, according to the result of gray scale and color Doppler ultrasonography, hypo-echogenicity, solid echo structure, micro-calcification and intra-nodular vascularity were the significant characteristics of malignancy in nodules with sensitivity (72%, 74%, 48% and 88% respectively), specificity (66%, 63%, 94% and 69% respectively), PPV (60%, 59%, 86% and 67% respectively) and NPV (77%, 77%, 72% and 89% respectively).

Place of Doppler Ultrasound in the Characterization of Ovarian Cysts: About 35 Cases

Pelvic ultrasound is the first-line examination for the diagnosis of ovarian cysts. When coupled with Doppler, it allows the diagnosis to be directed towards the benign or malignant nature of the cyst. These benign tumors are frequent in pubertal period. We report a descriptive study in 35 patients aged between 18 and 32 years of age who received a pelvic inflammatory etiology assessment. The purpose of this study was to show the place of pelvic ultrasound in the diagnosis of ovarian cysts.

Comparative Study of Radiological Changes in Hands and Feet in Patients Suffering from Early Rheumatoid Arthritis by Power Doppler Ultrasound and Direct Digital Radiography

Rheumatoid arthritis is a chronic multisystem disease of unknown cause. The characteristic feature of RA is persistent inflammatory synovitis. The natural history of disease is such that the early months of the disease are critical period during which reversible joint damage occurs. So early diagnosis of RA and appropriate drug application is the only way to save a patient from this crippling disease. In India, the cost of investigations is a significant factor for most of the patients. Ultrasonography or Power Doppler Ultra Sound (PDUS) has the advantage of being economic in spite of its sensitivity in assessing both inflammatory and destructive changes. The aim of the present study was to evaluate the diagnostic efficiency of PDUS in early rheumatoid arthritis. The study was performed with the patients attending Rheumatology Clinic. A total number of 106 patients of clinically suspected rheumatoid arthritis were studied as per selection criteria. Radiological examinations of hands were done by digital radiography and PDUS in a group of 53 patients, assessment of foot changes by PDUS and Digital Radiography were done in another similar group of 53 patients. Final diagnosis by ACR EULAR-2010 criteria is done for all the patients. The comparative study reveals that synovial vascularity as demonstrated by PDUS is much more effective in diagnosing early rheumatoid arthritis, both in hand and in feet than digital radiograph. PDUS of feet may yield earlier and better findings than hands, which is conventionally used in patients suffering from early rheumatoid arthritis.