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El-Aleem RA, Abd Allah AA, Shehata MR, Seifeldein GS, Hassanein SM. Diagnostic performance of spectral Doppler in acute appendicitis with an equivocal Alvarado score. Emerg Radiol 2024; 31:141-149. [PMID: 38265604 DOI: 10.1007/s10140-024-02205-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE This study aims to evaluate the added value of duplex Doppler examination to the routinely graded compression grayscale ultrasound (US) for patients with suspected acute appendicitis (AA) in correlation with surgical management outcomes. METHODS The study lasted from January 2020 to March 2021. Throughout that period, patients who had suspected appendicitis were included with a visible appendix in the grayscale US. These patients were categorized clinically based on Alvarado's score. They underwent graded compression grayscale US of the appendix and duplex Doppler study. Subsequently, they were assigned for non-contrast multislice computed tomography (MSCT) according to Alvarado's score and underwent either emergency appendicectomy or conservative clinical management afterward. A Student's t-test was used to determine if there were significant differences in the mean values between the groups. The diagnostic performance of spectral Doppler US for the diagnosis of AA was depicted. RESULTS Eighty-four patients with visualized color flow in the appendicular Doppler US were enrolled, with 60 (71.4%) having AA, and 24 (28.6%) not having appendicitis. Spectral Doppler criterion of PSV greater than 8.6 cm/s demonstrated a high sensitivity of 91.67% and specificity of 77.78% for patients with Alvarado score ranging from 4 to 7, and appendiceal MOD ranging from 6 to 8 mm, while a discriminatory criterion of RI greater than 0.51 had a high sensitivity of 100% and a relatively lower specificity of 66.67%. CONCLUSION The patients with AA have significantly higher point PSV and point RI values than those without AA and are especially useful in equivocal patients whose MODs and Alvarado scores are in the diagnostically equivocal ranges of 6-8 mm and 4-7, respectively, with the point PSV and RI demonstrating negative predictive value 87.5% and 100%.
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Affiliation(s)
- Reham Abd El-Aleem
- Department of Diagnostic Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdelrahman A Abd Allah
- Department of Diagnostic Radiology, Faculty of Medicine, New Valley University, Kharga, Egypt
| | | | - Gehan S Seifeldein
- Department of Diagnostic Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Sara M Hassanein
- Department of Diagnostic Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Hong SJ, Hong LW, He XQ, Zhong XH. Ultrasound blood flow characteristics changes in fetal umbilical artery thrombosis: A retrospective analysis. World J Clin Cases 2024; 12:240-248. [PMID: 38313644 PMCID: PMC10835684 DOI: 10.12998/wjcc.v12.i2.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Umbilical artery thrombosis (UAT) is extremely uncommon and leads to adverse perinatal outcomes. Hypercoagulation of blood in pregnant women is suspected to be an important risk for UAT. Ultrasound is an effective way to detect thrombosis. The mother can monitor her own fetal health using ultrasound, which enables her to take preventative action in case of emergency. AIM To investigate ultrasonic blood signal after UAT in the umbilical artery, and evaluate the relationship between hypercoagulability and UAT. METHODS We described a case of a newly formed UAT with markedly altered ultrasonic indices of umbilical artery blood flow, and retrospectively studied it with 18 UAT patients confirmed by histopathology from October 2019 and March 2023 in Xiamen Women and Children's Hospital. Patients' information was collected from medical archives, including maternal clinical data, neonatal outcomes, pathological findings and ultrasonic indices of umbilical artery blood flow, such as systolic-diastolic duration ratio (S/D), resistance index (RI), pulsatility index (PI) and peak systolic velocity (PSV). Ultrasound and coagulation indices were analyzed with matched samples t-test and Wilcoxon rank sum test using the statistical packages in R (version 4.2.1) including car (version 3.1-0) and stats (version 4.2.1), and visualized by ggplot2 package (version 3.3.6). RESULTS A patient with normal findings in second and third-trimester routine ultrasound scan developed UAT with severe changes in ultrasonic indices of umbilical artery blood flow (within 2.5th of reference ranges) in a short period of time. Statistical analysis of umbilical artery blood flow ultrasound indices for 19 patients with UAT showed that the decrease in S/D, RI, and PI and increase of PSV during the disease process was greater than that of non-UAT. All 18 patients delivered in our hospital showed characteristic manifestations of UAT on histological examination after delivery, most of which (16/18) showed umbilical cord abnormalities, with 15 umbilical cord torsion and 1 pseudoknot. Coagulation parameters were not significantly changed in UAT patients compared with normal pregnancy women. CONCLUSION Significant changes in ultrasound indicators after UAT were demonstrated. PSV can play important roles in the diagnosis of UAT. Hypercoagulability alone is not sufficient for the occurrence of UAT.
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Affiliation(s)
- Si-Jie Hong
- Department of Ultrasound, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Li-Wei Hong
- Ministry of Science and Education, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Xiao-Qin He
- Department of Ultrasound, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Xiao-Hong Zhong
- Department of Ultrasound, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China
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Han HJ, Kim JM. The Relationship between Transcranial Doppler Ultrasonography and Visual Field Test Results in Glaucoma and Glaucoma Suspect Patients. Korean J Ophthalmol 2023; 37:437-445. [PMID: 37899287 PMCID: PMC10721401 DOI: 10.3341/kjo.2023.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 10/31/2023] Open
Abstract
PURPOSE To evaluate the relationships between parameters of transcranial ultrasonography and results of visual field tests in patients with open angle glaucoma or suspected of having glaucoma. METHODS This retrospective study was based on data from medical records of patients who visited the Department of Ophthalmology in Kangbuk Samsung Hospital from January 1, 2016, to October 17, 2019, and underwent transcranial Doppler ultrasonography as part of a routine health examination. Ophthalmic data were visual acuity, intraocular pressure, optical coherence tomography, and Humphrey visual field test results. Retinal nerve fiber layer defect was confirmed by a glaucoma specialist. Patients' ophthalmic data, such as average ganglion cell layer thickness, visual field index, pattern standard deviation, and mean deviation, were divided into quartiles. Each ophthalmic artery parameter from transcranial Doppler ultrasonography was compared between quartiles. RESULTS A total of 162 patients were reviewed. There was no difference in Doppler ophthalmic artery (OA) parameters between patients with or without retinal nerve fiber layer defect. None of the quartile groups of average ganglion cell layer thickness showed significant difference in any OA parameters. Patients in the low-visual field index quartile showed significant low peak systolic velocities of OAs when adjusted for age, sex, and presence of diabetes mellitus or hypertension (p = 0.016). A higher pattern standard deviation showed lower peak systolic velocity (p = 0.046). There was no significant tendency between any other OA parameter and mean deviation value. CONCLUSIONS Our study suggests that hemodynamic parameters of ophthalmic arteries might be associated with visual field status of patients. Further large-population studies are needed in order to better understand the relationship between visual function and ocular blood flow.
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Affiliation(s)
- Hyo Ji Han
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sulzer TAL, Macedo TA, Strissel N, Hesley GK, Lekah A, Tallarita T, Dias-Neto M, Huang Y, Tenorio ER, Vacirca A, Mesnard T, Baghbani-Oskouei A, Savadi S, de Bruin JL, Verhagen HJM, Mendes B, Oderich GS. Changes in renal-mesenteric duplex ultrasound velocities after fenestrated and branched endovascular aortic aneurysm repair. J Vasc Surg 2023; 78:1162-1169.e2. [PMID: 37453587 DOI: 10.1016/j.jvs.2023.06.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Stenting of renal and mesenteric vessels may result in changes in velocity measurements due to arterial compliance, potentially giving rise to confusion about the presence of stenosis during follow-up. The aim of our study was to compare preoperative and postoperative changes in peak systolic velocity (PSV, cm/s) after placement of the celiac axis (CA), superior mesenteric artery (SMA) and renal artery (RAs) bridging stent grafts during fenestrated-branched endovascular aortic repair (FB-EVAR) for treatment of complex abdominal aortic aneurysms (AAA) and thoracoabdominal aortic aneurysms. METHODS Patients were enrolled in a prospective, nonrandomized single-center study to evaluate FB-EVAR for treatment of complex AAA and thoracoabdominal aortic aneurysms between 2013 and 2020. Duplex ultrasound examination of renal-mesenteric vessels were obtained prospectively preoperatively and at 6 to 8 weeks after the procedure. Duplex ultrasound examination was performed by a single vascular laboratory team using a predefined protocol including PSV measurements obtained with <60° angles. All renal-mesenteric vessels incorporated by bridging stent grafts using fenestrations or directional branches were analyzed. Target vessels with significant stenosis in the preoperative exam were excluded from the analysis. The end point was variations in PSV poststent placement at the origin, proximal, and mid segments of the target vessels for fenestrations and branches. RESULTS There were 419 patients (292 male; mean age, 74 ± 8 years) treated by FB-EVAR with 1411 renal-mesenteric targeted vessels, including 260 CAs, 409 SMAs, and 742 RAs. No significant variances in the mean PSVs of all segments of the CA, SMA, and RAs at 6 to 8 weeks after surgery were found as compared with the preoperative values (CA, 135 cm/s vs 141 cm/s [P = .06]; SMA, 128 cm/s vs 125 cm/s [P = .62]; RAs, 90 cm/s vs 83 cm/s [P = .65]). Compared with baseline preoperative values, the PSV of the targeted vessels showed no significant differences in the origin and proximal segment of all vessels. However, the PSV increased significantly in the mid segment of all target vessels after stent placement. CONCLUSIONS Stent placement in nonstenotic renal and mesenteric vessels during FB-EVAR is not associated with a significant increase in PSVs at the origin and proximal segments of the target vessels. Although there is a modest but significant increase in velocity measurements in the mid segment of the stented vessel, this difference is not clinically significant. Furthermore, PSVs in stented renal and mesenteric arteries were well below the threshold for significant stenosis in native vessels. These values provide a baseline or benchmark for expected PSVs after renal-mesenteric stenting during FB-EVAR.
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Affiliation(s)
- Titia A L Sulzer
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Thanila A Macedo
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
| | | | | | | | | | - Marina Dias-Neto
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Ying Huang
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Emanuel R Tenorio
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Andrea Vacirca
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Thomas Mesnard
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Aidin Baghbani-Oskouei
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Safa Savadi
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Jorg L de Bruin
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bernardo Mendes
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Gustavo S Oderich
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
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Kawabuchi K, Nakamura M. Changes in blood flow in the dorsal scapular artery and relationship to shoulder joint function in rotator cuff tears. JSES Int 2023; 7:2356-2360. [PMID: 37969537 PMCID: PMC10638572 DOI: 10.1016/j.jseint.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background One of the pain-related factors in rotator cuff tears (RCTs) is abnormal scapular motion, which is thought to be related to the levator scapulae muscle activation. Additionally, attention has recently focused on the peak systolic velocity (PSV) as one of the causes of pain, but blood flow outside of the vessels supplying the rotator cuff has not been clarified. This study aimed to determine the difference in PSV in the dorsal scapular artery (DSA), which is the vessel that supplies the levator scapulae muscles, and the association between PSV and pain and shoulder function in patients with RCTs between the tear and nontear sides. Methods This study included 31 patients with RCTs with tear and nontear sides. Magnetic resonance imaging and radiographic examinations included Cofield classification, Goutallier classification, thickening of the coracohumeral ligament, and measurement of the acromiohumeral interval. Clinical evaluation included an automatic range of motion (ROM) for flexion, abduction, and external rotation (ER), a visual analog scale, and the Shoulder36. PSV was evaluated using ultrasound pulsed Doppler mode to assess PSV of DSA. The PSV of DSA on the first rib was drawn in the medial aspect of the suprascapular angle in the long axis, and the maximum PSV waveform was measured three times. The average value was used for further analysis. Results The PSV in the DSA was significantly higher (P = .04, 95% confidence interval: 0.2-7.6) on the tear (22.6 ± 7.4 cm/s) than the nontear sides (18.9 ± 6.9 cm/s). In addition, a significant negative correlation (r = -0.46, P = .0087) was found between PSV in DSA and ER on the tear side. Conclusion This study revealed a significantly increased PSV in the DSA on the tear side in RCTs and negatively correlated with ER ROM. The results suggest that increased PSV in the DSA may contribute to ER ROM limitation in the glenohumeral joint.
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Affiliation(s)
- Keita Kawabuchi
- Rehabilitation Room, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Science, Nishi Kyushu University Ozaki, Kanzaki, Saga, Japan
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Zheng H, Zheng B, Yang S, Mou X, Zhang X, Huang H, Wu X. Effect of intravenous thrombolysis combined with endovascular treatment on vascular recanalization rate and peak systolic velocity in patients with acute cerebral infarction. Pak J Med Sci 2023; 39:1291-1295. [PMID: 37680818 PMCID: PMC10480741 DOI: 10.12669/pjms.39.5.7573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/19/2023] [Accepted: 06/22/2023] [Indexed: 09/09/2023] Open
Abstract
Objectives To investigate the efficacy of intravenous thrombolysis (IVT) combined with endovascular treatment (EVT) on vascular recanalization rate and peak systolic velocity (PSV) in patients with acute cerebral infarction (ACI). Methods A retrospective observational study was conducted from January 2019 to December 2021 in Chengdu First People's Hospital. The clinical data of 96 patients with ACI were reviewed and the patients were assigned to either the control group (IVT alone, n=54) or the observation group (IVT+EVT, n=42). The vascular recanalization rate, PSV, neurological function, modified Rankin Scale (mRS) score and major adverse cardiovascular events (MACE) were compared between groups. Results The vascular recanalization rate and PSV in the observation group were higher than the control group (P<0.05). The NIHSS scores of the observation group at 24 hour, one week and one month after treatment were significantly lower than those of the control group (P<0.05). The mRS scores of the observation group were significantly lower than the control group after treatment (P<0.05), while there was no difference in the incidence of MACE between groups (P>0.05). Conclusions IVT combined with EVT can improve the vascular recanalization rate and PSV in patients with ACI, which is worthy of promotion in clinical practice.
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Affiliation(s)
- Hui Zheng
- Hui Zheng, Department of Neurology, Chengdu First People’s Hospital, Chengdu 610000, Sichuan Province, P.R. China
| | - Bo Zheng
- Bo Zheng Department of Neurology, Yaan People’s Hospital, Yaan 625000, Sichuan Province, P.R. China
| | - Shu Yang
- Shu Yang Department of Neurology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu 610000, Sichuan Province, P.R. China
| | - Xin Mou
- Xin Mou, Department of Neurology, Chengdu First People’s Hospital, Chengdu 610000, Sichuan Province, P.R. China
| | - Xuan Zhang
- Xuan Zhang, Department of Neurology, Chengdu First People’s Hospital, Chengdu 610000, Sichuan Province, P.R. China
| | - Huiying Huang
- Huiying Huang Department of Neurology, People’s Hospital of Leshan, Leshan 614000, Sichuan Province, P.R. China
| | - Xiaoping Wu
- Xiaoping Wu, Department of Neurology, Chengdu First People’s Hospital, Chengdu 610000, Sichuan Province, P.R. China
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Rallis D, Kapetaniou K, Machas P, Balomenou F, Giapros V, Saliakellis E. A systematic review and meta-analysis of the role of Doppler ultrasonography of the superior mesenteric artery in detecting neonates at risk of necrotizing enterocolitis. Pediatr Radiol 2023; 53:1989-2003. [PMID: 37310444 PMCID: PMC10497699 DOI: 10.1007/s00247-023-05695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Abstract
The role of postnatal Doppler measurements of the superior mesenteric artery (SMA) in detecting neonates at risk of necrotizing enterocolitis (NEC) remains uncertain; therefore, we systematically reviewed and meta-analyzed the existing evidence regarding the usefulness of SMA Doppler measurements in detecting neonates at risk for NEC. We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and we included studies which reported the following Doppler ultrasonography indices: peak systolic velocity, end-diastolic velocity, time average mean velocity, differential velocity, pulsatility index (PI) and resistive index. Eight studies were eligible for inclusion in the meta-analysis. Evidence suggested that, during the first postnatal day, neonates who developed NEC had a significantly higher peak systolic velocity (mean difference of 2.65 cm/s (95% confidence interval [CI] 1.23, 4.06, overall effect Z=3.66, P<0.001)), higher PI (mean difference of 1.52 (95% CI 0.00, 3.04, Z=1.96, P=0.05)) and higher resistive index (mean difference of 1.09 (95% CI 0.59, 1.60, Z=4.24, P<0.001)), compared to neonates who did not develop NEC. However, our findings do not support a strong association between the Doppler ultrasound indices and development of NEC at the time of disease onset. This meta-analysis suggests that first postnatal day SMA Doppler parameters, namely peak systolic velocity, PI and resistive index, are higher in neonates who develop NEC. On the other hand, the aforementioned indices are of uncertain significance once the diagnosis of NEC has been established.
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Affiliation(s)
- Dimitrios Rallis
- Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Stavrou Niarchou Avenue, 45500, Ioannina, Greece.
| | | | - Pavlos Machas
- Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Stavrou Niarchou Avenue, 45500, Ioannina, Greece
| | - Foteini Balomenou
- Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Stavrou Niarchou Avenue, 45500, Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Stavrou Niarchou Avenue, 45500, Ioannina, Greece
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Kivrak MB, Turk S, Takci A, Bolukbas B, Agaoglu RT, Coskun A. Pulse wave Doppler ultrasound of umbilical cord in experimentally induced pregnancy toxemia in sheep. Res Vet Sci 2023; 160:18-25. [PMID: 37235922 DOI: 10.1016/j.rvsc.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
Contrary to its widespread use in human cases, the use of Doppler ultrasonography is only recently becoming prevalent in farm animals. This study aimed to determine the effects of maternal metabolic and clinical changes on fetal hemodynamics during pregnancy toxemia with the doppler examination of umbilical cord. In the study twenty ewes with a single healthy fetus were included in the study. At the end of the 120th day of pregnancy, 20 single-bearing pregnant ewes were randomly categorized into two groups. Ewes in the control group were fed to meet all nutritional requirements. On the other contrary, the experimental ewes were fed to meet equivalent to 50 % of the daily needs and then fasted for 96 h. Doppler ultrasonographic examinations of umbilical cord were performed once every two days and once a day during fasting. Beta hydroxybutyric acid (BHBA) concentration was measured by taking blood from sheep on examination days. Pulse systolic velocity (PSV), end diastolic velocity (EDV), PSV/EDV, pulsatility index (PI), resistance index (RI), and fetal heart rate (FHR) as well as BHBA values and how those parameters has changed over time (time by treatment effect) due to energy deprivation during pregnancy were evaluated using repeated measure analysis of variance. No clinical signs were observed in both toxemia and control groups during restricted feeding. BHBA concentration increased and there was a significant time, time by treatment and main effect of treatment effect between groups. No significant main effect of treatment and time by treatment interaction was observed in the changes of PI, RI, FHR, and systolic/diastolic velocity values over time in both groups. FHR was reduced over time, and there was a significant time effect in FHR in both groups. Although doppler indices didn't increase, both PSV and EDV values increased significantly in the pregnancy toxemia group compared with the controls (Time P = 0.03, time by treatment interaction P < 0.05) and the main effect of treatment P < 0.05). The marked increase in blood velocities (PSV and EDV) in the umbilical cord is probably due to the compensatory functioning for excessive energy deprivation of the fetus. Therefore, PSV and EDV might be a valuable indicator for evaluating the fetus's health status during the management of the PT.
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Affiliation(s)
- Mehmet Bugra Kivrak
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Sivas Cumhuriyet University, Sivas, Türkiye.
| | - Sefer Turk
- Department of Internal Medicine, Faculty of Veterinary Medicine, Sivas Cumhuriyet University, Sivas, Türkiye
| | - Abdurrahman Takci
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Sivas Cumhuriyet University, Sivas, Türkiye
| | - Bora Bolukbas
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun, Türkiye
| | - Recep Taha Agaoglu
- Perinatology Department, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
| | - Alparslan Coskun
- Department of Internal Medicine, Faculty of Veterinary Medicine, Sivas Cumhuriyet University, Sivas, Türkiye
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Rimmele DL, Borof K, Wenzel JP, Jensen M, Behrendt CA, Waldeyer C, Schnabel RB, Zeller T, Debus ES, Blankenberg S, Gerloff C, Thomalla G. Differential association of flow velocities in the carotid artery with plaques, intima media thickness and cardiac function. Atheroscler Plus 2021; 43:18-23. [PMID: 36644504 PMCID: PMC9833222 DOI: 10.1016/j.athplu.2021.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 01/18/2023]
Abstract
Background and aims We aimed to determine the association of carotid intima media thickness (CIMT), carotid plaques, and heart function with peak systolic velocity (PSV) of the common (CCA) and internal carotid artery (ICA) in a cross-sectional study. Methods In the population-based Hamburg-City-Health-Study participants between 45 and 74 years were recruited. Cardio-vascular risk factors were assessed by history, blood samples, and clinical examination. CIMT, plaques, and PSV were determined by carotid ultrasound. Serum N-terminal brain natriuretic peptide (NT-proBNP) was determined as a biomarker for cardiac dysfunction, and left ventricular ejection fraction (LVEF) was quantified by echocardiography. Participants with carotid stenosis were excluded. Data were analyzed by multivariate linear regression. Results We included 8567 participants, median age was 62 years, 51.8% were women. Median CIMT was 0.75 mm, NT-proBNP 80 pg/ml, LVEF 58.5%, and 30.4% had carotid plaques. For women PSV decreased in decades from 89 to 73 cm/s in CCAs and 78 to 66 cm/s in ICAs, and for men from 91 to 76 cm/s in CCAs and from 70 to 66 cm/s in ICAs. Corrected for age, sex, red blood cell count, and blood pressure, in CCAs lower PSV was associated with carotid plaques (p < 0.001; β = -0.03), lower CIMT (p = 0.005; β = 0.007), higher levels of log-transformed NT-proBNP (p < 0.001; β = -0.01), and lower LVEF (p < 0.001; β = 0.01). In ICAs, lower PSV was independently associated with lower CIMT (p < 0.001; β = 0.02) and lower EF (p = 0.001; β = 0.007). Conclusions Markers of cardiac dysfunction and plaques are associated with lower and CIMT with higher flow velocities in the carotid arteries. Clinical Trial Registration http://www.clinicaltrials.gov, NCT03934957.
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Affiliation(s)
- David Leander Rimmele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Corresponding author. Department of Neurology, University Medical Centre Hamburg-Eppendorf Martinistr. 52, D-20246, Hamburg, Germany.
| | - Katrin Borof
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Per Wenzel
- Department of Cardiology, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
| | - Märit Jensen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Christian-A. Behrendt
- Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
| | - Christoph Waldeyer
- Department of Cardiology, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
| | - Renate B. Schnabel
- Department of Cardiology, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Tanja Zeller
- Department of Cardiology, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Germany
| | - E. Sebastian Debus
- Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Osman AMA, Helmy AS, Mikhail S, AlAyat AA, Serour DK, Ibrahim MY. Early Effects of Laparoscopic Sleeve Gastrectomy and Laparoscopic One-Anastomosis Gastric Bypass on Portal Venous Flow: a Prospective Cohort Study. Obes Surg 2021; 31:2410-8. [PMID: 33660156 DOI: 10.1007/s11695-021-05267-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is an infrequent, yet potentially lethal, complication of bariatric surgery. The aim of this prospective, non-randomized, cohort study is to compare between laparoscopic sleeve gastrectomy (LSG) and laparoscopic one-anastomosis gastric bypass (LOAGB) in terms of their early postoperative effects on portal venous flow and patency. METHODS Forty-nine morbidly obese patients were allocated to one of 2 groups (A or B). Group A patients underwent LSG, whereas group B patients underwent LOAGB. Portal venous Doppler ultrasound scanning was performed preoperatively and 2 weeks postoperatively in all cases, in order to assess the portal venous flow (PVF) in terms of flow direction and peak systolic velocity (PSV); as well as to assess the portal venous patency and exclude PVT. The mean change in PSV (ΔPSV) and the mean percentage change in PSV (%ΔPSV) were determined in both groups. RESULTS In all cases (group A (n = 26); group B (n = 23)), the direction of PVF was "hepatopetal" both preoperatively and 2 weeks postoperatively. The mean ΔPSV and the mean %ΔPSV were higher in LSG patients "group A" (- 0.84 cm/s and 3.25% respectively) compared with LOAGB patients "group B"(- 0.06 cm/s and 0.27% respectively); P = 0.038 and 0.039 respectively. The mean change in PSV was in the negative direction in both groups, i.e., "deceleration." No cases of PVT were reported in the study. CONCLUSIONS Laparoscopic sleeve gastrectomy is associated with greater reduction in portal venous peak systolic flow velocity in the early postoperative period, compared with laparoscopic one-anastomosis gastric bypass.
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11
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Thakur M, Strug MR, De Paredes JG, Rambhatla A, Munoz MIC. Ultrasonographic technique to differentiate enhanced myometrial vascularity/arteriovenous malformation from retained products of conception. J Ultrasound 2021. [PMID: 33651329 DOI: 10.1007/s40477-021-00574-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/13/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To objective of this study is to discuss the ultrasonographic technique to diagnose uterine enhanced myometrial vascularity/arteriovenous malformation (EMV/AVM) and differentiate it from retained products of conception. The study also reviews the management and outcome of EMV/AVM. METHODS We present a series of three women who developed EMV after early pregnancy loss and a control case of incomplete abortion, where colour Doppler ultrasound was used to distinguish retained products of conception from features of EMV. Clinical status and imaging findings, including peak systolic velocity (PSV), were used for the initial risk stratification of the patients. All cases with EMV/AVM were managed expectantly with serial ultrasound imaging and trending human chorionic gonadotropin levels. The patient with retained products of conception was managed by hysteroscopy and curettage. RESULTS In all cases, presentation was suggestive of incomplete abortion with retained products of conception. However, colour Doppler ultrasound demonstrated hypoechoic areas within the endometrium extending into the myometrium with a high maximum PSV. In the control case, colour Doppler ultrasound noted a heterogeneous area in the left uterine cavity; however, vascular flow in this area was distinct from the endometrium, suggesting retained products of conception. All three women with EMV were managed expectantly with close monitoring and good outcomes. CONCLUSION In patients with early pregnancy loss and bleeding or persistently elevated human chorionic gonadotropin levels, clinical status and appropriate use of ultrasound imaging with colour Doppler, including PSV measurement, can assist in recognition of EMV/AVM. Expectant management with serial ultrasound evaluation is a safe treatment option for EMV/AVM with low PSV and can minimise complications such as need for blood transfusion, uterine artery embolization, and hysterectomy.
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12
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Bush N, Rana SS, Gupta P, Kang M, Gupta R, Suri V, Ramachandran R, Kumar S, Dhibar DP. Renal doppler changes in patients with acute pancreatitis: A prospective study. Pancreatology 2020; 20:1275-1280. [PMID: 32873484 DOI: 10.1016/j.pan.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/28/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Renal Doppler to assess renal resistive index (RRI) is an attractive option to prognosticate acute kidney injury (AKI) in acute pancreatitis (AP) as it is feasible within scope of point-of-care ultrasound. However, RRI has been infrequently evaluated in AP. OBJECTIVE Prospectively study diagnostic and prognostic performance of RRI in patients with AP. METHODOLOGY 75 patients with AP were prospectively enrolled and followed till recovery/death. All patients were subjected to renal Doppler and RRI was compared between patients with and without AKI. RESULTS Thirty six patients developed AKI and 39 patients did not develop AKI. AKI network stage 1, 2 and 3 AKI was seen in 7(19.4%), 12(33.3%) and 17 (47.2%) patients respectively. Prognostic scoring done at admission by SIRS, modified marshal score, and BISAP scores, as well as duration of hospitalization and mortality rates were significantly higher in patients with AKI. Mean peak systolic velocity and RRI at upper, middle and lower poles of bilateral kidneys were comparable between patients with and without AKI. The RRI was abnormal in 46 (66.6%) patients and it was <0.6 in 35/46 (76%) and >0.7 in 11/46 (24%) patients respectively. RRI <0.6 was observed in 16 (53.3%) and 19 (48.7%) patients with and without AKI respectively (p = 0.80). RRI >0.7 was observed in 4 (53.3%) and 7 (48.7%) patients with and without AKI respectively (p = 0.74). CONCLUSIONS AKI is associated with poor prognosis in AP. RRI on renal Doppler at admission seems to have poor diagnostic as well as prognostic performance for AKI in patients with AP.
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Affiliation(s)
- Nikhil Bush
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Pankaj Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Mandeep Kang
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Susheel Kumar
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Deba Prasad Dhibar
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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13
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Krishnamurthy MB, Pharande P, Whiteley G, Hodges RJ, Malhotra A. Postnatal middle cerebral artery Dopplers in growth-restricted neonates. Eur J Pediatr 2020; 179:571-577. [PMID: 31836914 DOI: 10.1007/s00431-019-03540-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/02/2019] [Accepted: 11/28/2019] [Indexed: 11/25/2022]
Abstract
This prospective observational study compared the middle cerebral artery (MCA) Doppler characteristics of FGR neonates (N = 20) with abnormal antenatal Dopplers, with those of appropriately grown (AGA) neonates (N = 20), in the immediate postnatal period. MCA peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistive index (RI) were measured on day 1 and day 3. MCA PSV and EDV values were not significantly different between FGR (mean (SD) gestation: 31.4 (3.1) weeks, weight 1205 (463) grams) and AGA (31.1 (3.0) weeks; 1668 (490) grams) groups, on day 1 and day 3. Both FGR (30.85 (10.02) vs. 42.12 (9.16) cm/s, p = 0.007) and AGA groups (31.77 (9.32) vs. 42.0 (8.98) cm/s, p = 0.001) showed a significant increase in MCA PSV, but only the FGR group showed significant increase in EDV values (7.01 (4.23) vs. 11.78 (4.98), p = 0.002) from day 1 to day 3. This was associated with significant differences in RI (0.72 (0.10) vs. 0.79 (0.07), p = 0.01) and PI (1.36 (0.47) vs. 1.73 (0.4), p = 0.01) values between FGR and AGA groups on day 3.Conclusion: Significant differences in MCA resistive and pulsatility indices were noted in the first few days of life of FGR neonates with abnormal antenatal Doppler as compared with AGA neonates. This may suggest a delayed transition or persistence of cerebral redistribution in FGR neonates.What is Known:• FGR infants have increased risk of neonatal morbidity and mortality, and long-term neuro-disabilities.• Antenatal Doppler Ultrasound is the most common modality used to assess fetal growth restriction.What is New:• Antenatally detected abnormal cerebral Dopplers may persist during the neonatal period in growth-restricted neonates.• Early cerebral Doppler values may be a useful marker to identify "at risk" growth-restricted neonates..
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Affiliation(s)
- Mohan B Krishnamurthy
- Monash Newborn, Monash Children's Hospital, 246, Clayton Road, Melbourne, VIC, 3168, Australia
| | - Pramod Pharande
- Monash Newborn, Monash Children's Hospital, 246, Clayton Road, Melbourne, VIC, 3168, Australia
| | - Gillian Whiteley
- Diagnostic Imaging, Monash Health, 246, Clayton Road, Melbourne, VIC, 3168, Australia
| | - Ryan J Hodges
- Department of Obstetrics and Gynaecology, Monash University, 246, Clayton Road, Melbourne, VIC, 3168, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, 246, Clayton Road, Melbourne, VIC, 3168, Australia.
- Department of Paediatrics, Monash University, 246, Clayton Road, Melbourne, VIC, 3168, Australia.
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14
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Radhakrishnan P, Venkataravanappa S, Acharya V, Sahana R, Shettikeri A. Prediction of Fetal Anemia in Subsequent Transfusions: Is There a Need to Change the Threshold of the Peak Systolic Velocity of the Middle Cerebral Artery? Fetal Diagn Ther 2020; 47:491-496. [PMID: 32045908 DOI: 10.1159/000505398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/11/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Peak systolic velocity (PSV) of the middle cerebral artery (MCA) shows 100% sensitivity for predicting fetal anemia before the first intrauterine transfusion (IUT). However, its ability to predict subsequent transfusions has remained mostly controversial. OBJECTIVES To assess if there is a need to change the threshold of MCA-PSV from 1.5 to 1.69 multiples of the median (MoM) to predict fetal anemia and the need for subsequent IUT. METHODS This is a retrospective audit, wherein case records of mothers who underwent IUT at the Bangalore Fetal Medicine Centre between April 2008 and May 2017 were reviewed; 86 cases were included, and the data were analyzed using MS Excel. The MCA-PSV and pretransfusion Hb were converted into MoM. 40 fetuses that had more than 1 IUT were included in the analysis. -Results: 31/40 fetuses that had >1 IUT had an MCA-PSV >1.5 MoM, of which 29 were anemic according to the post-IUT Hb MoM. 20/29 (69%) had an MCA-PSV >1.69, whereas 9/29 (31%) had an MCA-PSV between 1.5 and 1.69 MoM. Our study shows that changing the MCA-PSV threshold from 1.5 to 1.69 MoM will reduce the detection of fetal anemia and hence the need for repeat IUT by 31%. CONCLUSIONS Increasing the fetal MCA-PSV threshold from 1.5 to 1.69 will miss out one-third of the fetuses that will require a 2nd, 3rd, or 4th IUT. This is more relevant in geographical areas where the parents must travel long distances for IUTs, which are performed in tertiary fetal care centers.
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Affiliation(s)
| | | | - Veena Acharya
- Department of Fetal Medicine, Bangalore Fetal Medicine Centre, Bangalore, India
| | - Reeth Sahana
- Department of Fetal Medicine, Bangalore Fetal Medicine Centre, Bangalore, India
| | - Anitha Shettikeri
- Department of Fetal Medicine, Bangalore Fetal Medicine Centre, Bangalore, India
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15
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Iizuka K, Takekawa H, Iwasaki A, Igarashi H, Suzuki K, Kobayashi S, Tsukui D, Hirata K. Suitable methods of measuring acceleration time in the diagnosis of internal carotid artery stenosis. J Med Ultrason (2001) 2020; 47:327-333. [PMID: 31912319 PMCID: PMC7181545 DOI: 10.1007/s10396-019-01000-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/03/2019] [Indexed: 11/12/2022]
Abstract
Purpose To enhance the utility of acceleration time (AcT) in the diagnosis of internal carotid artery (ICA) stenosis, we assessed the value of AcT measurements with different waveform patterns. Methods Ninety-three patients with acute atherothrombotic cerebral infarction were enrolled, and they underwent both carotid ultrasonography and digital subtraction angiography (DSA). AcT was determined by a conventional procedure (using the first peak point or the bending point) and the peak systolic velocity (PSV) procedure. The AcT ratio was calculated as (AcT of ICA)/(AcT of the ipsilateral common carotid artery). We evaluated the correlation of stenosis rate as assessed by the North American Symptomatic Carotid Endarterectomy Trial method using DSA (DSA-NASCET) with the AcT of ICA (ICA-AcT), the AcT ratio measured by the conventional procedure (conventional AcT ratio), and the AcT ratio measured by the PSV procedure (PSV AcT ratio). The area under receiver operating characteristic curves (AUC) for DSA-NASCET was calculated based on the ICA-AcT and AcT ratio. Results Forty-five vessels had 50% or greater ICA stenosis. DSA-NASCET was positively correlated with the conventional AcT ratio (r = 0.723), conventional ICA-AcT (r = 0.638), and PSV AcT ratio (r = 0.245). The corresponding AUCs for ICA stenosis ≥ 50% were 0.971, 0.886, and 0.572, respectively. Conclusion We demonstrated the usefulness of the conventional procedure for diagnosing stenosis of ICA origin using AcT and showed that the AcT ratio was a more beneficial parameter than AcT.
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Affiliation(s)
- Kentaro Iizuka
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan.,Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Hidehiro Takekawa
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan. .,Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan. .,Center of Medical Ultrasonics, Dokkyo Medical University, Tochigi, Japan.
| | - Akio Iwasaki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan.,Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Haruki Igarashi
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan.,Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Saro Kobayashi
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Daisuke Tsukui
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
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16
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Schou KV, Ekelund CK, Jensen LN, Nørgaard LN, Søgaard K, Rode L, Tabor A, Sundberg K. Short-Term Flow Changes in Monochorionic Survivor Twins after Ultrasound-Guided Umbilical Cord Occlusion. Fetal Diagn Ther 2019; 47:45-53. [PMID: 31195393 DOI: 10.1159/000500021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/27/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine hemodynamic changes by Doppler ultrasound of the living fetus during 24 h after umbilical cord occlusion (UCO) in monochorionic diamniotic (MCDA) twin pregnancies. METHOD We conducted a prospective observational study on fetuses undergoing UCO from 2015 to 2017. Doppler parameters peak systolic velocity (PSV) and umbilical pulsatility index (PI) were obtained in the middle cerebral artery (MCA), umbilical artery (UA) and ductus venosus (DV) before and right after UCO, and at 1, 3, 6, 12, and 24 h after. We used multiple of the median (MoM) to adjust for gestational age. Spaghetti plots visualized flow changes over time. Mixed model adjusting for paired longitudinal data compared the values at different time points. RESULTS A total of 16 women were included. MCA-PSV dropped within the first hour after surgery from 0.91 to 0.82 MoM (p = 0.08). MCA-PI and UA-PI increased in the first hour from 0.75 to 0.91 MoM (p = 0.02) and 0.94 to 0.98 MoM (p = 0.22), respectively. The DV-PIV increased to 1.14 MoM 3 h after surgery (p = 0.07). The spaghetti plots illustrated the small changes within the first hours and showed a stabilization of flow measurements near initial values 24 h after UCO. CONCLUSION Within the first hours after UCO the circulation of the survivor twin undergoes small hemodynamic changes.
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Affiliation(s)
- Katrine Vasehus Schou
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark, .,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark,
| | - Charlotte Kvist Ekelund
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lisa Neerup Jensen
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lone Nikoline Nørgaard
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Søgaard
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Line Rode
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Gentofte, Denmark
| | - Ann Tabor
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karin Sundberg
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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17
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Terasawa Y, Sakai K, Komatsu T, Sakuta K, Omoto S, Mitsumura H, Iguchi Y. Microbleeds of Lacunar Infarction and Middle Cerebral Artery Flow Velocity of Branch Atheromatous Disease Are Essential Factors of Stroke Etiology. Eur Neurol 2019; 81:19-23. [PMID: 31013495 DOI: 10.1159/000494672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 10/16/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although subcortical infarction patients sometimes show larger infarction size than the definition of small vessel occlusion (SVO), there are no specific predictors of larger size. The aim of this study was to identify the factors, including magnetic resonance imaging (MRI) and ultrasonographic parameters, to predict larger subcortical infarction. METHODS Consecutive patients with acute supratentorial subcortical infarction were studied. Patients were classified into 2 groups (L: larger group, ≥15 mm and ≥3 slices; S: smaller group, SVO based on the TOAST classification). Clinical information, MRI findings including the presence of microbleeds, and ultrasonography findings were evaluated and compared between the 2 groups. RESULTS A total of 120 patients (81 male, mean 67 years old) were enrolled. The L group included 22 patients (18%), and the S group had 98 patients (82%). On neuroimaging, microbleeds were seen less frequently in the L group than in the S group (23 vs. 53%, p = 0.017), and peak systolic velocity (PSV) by transcranial color-coded sonography was faster in the L group than in the S group (121 ± 39.8 vs. 83.4 ± 25.4 cm/s, p = 0.002). On multivariate logistic regression analysis, no evidence of microbleeds (OR 4.4, 95% CI 1.41-13.68, p = 0.011) and PSV over 92 cm/s (OR 3.1, 95% CI 1.007-9.719, p = 0.049) were found to be independently associated with larger size. CONCLUSION Microbleeds is related to smaller size and middle cerebral artery PSV > 92 cm/s indicate larger size in supratentorial subcortical infarcts.
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Affiliation(s)
- Yuka Terasawa
- Department of Neurology, Jikei University School of Medicine, Tokyo, Japan,
| | - Kenichiro Sakai
- Department of Neurology, Jikei University School of Medicine, Tokyo, Japan
| | - Teppei Komatsu
- Department of Neurology, Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi Sakuta
- Department of Neurology, Jikei University School of Medicine, Tokyo, Japan
| | - Shusaku Omoto
- Department of Neurology, Jikei University School of Medicine, Tokyo, Japan
| | - Hidetaka Mitsumura
- Department of Neurology, Jikei University School of Medicine, Tokyo, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, Jikei University School of Medicine, Tokyo, Japan
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18
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Prodan N, Sonek J, Wagner P, Hoopmann M, Abele H, Hamprecht K, Kagan KO. Splenic artery blood flow as a potential marker for materno-fetal transmission of a primary CMV infection. Arch Gynecol Obstet 2019; 299:1289-94. [PMID: 30905001 DOI: 10.1007/s00404-019-05119-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine the blood flow in the splenic artery as marker for materno-fetal transmission at about 20 weeks following a maternal first-trimester primary CMV infection. METHODS This is a retrospective study at the prenatal medicine unit at University of Tuebingen, Germany. Women were included who underwent an amniocentesis to examine the fetal infection status following a maternal primary CMV infection in the first trimester. In all cases, amniocentesis was done at about 20 weeks and at least 6 weeks after the maternal infection. As part of the detailed ultrasound examination prior to each amniocentesis, we examined the peak systolic velocity flow (PSV) and the pulsatility index (PI) of the splenic artery. Measurements were transformed into MoMs according to the normal curves of Ebbing et al. RESULTS: 81 Women fulfilled the inclusion criteria. Maternal and gestational age was 31.9 years and 20.6 weeks' gestation. Maternal-fetal transmission occurred in 13 of the cases. In fetuses without and with a CMV infection, mean PI was 0.98 MoM and 0.89 (p = 0.081). Mean PSV was significantly higher in the group of infected fetuses than in those without (1.24 vs. 0.94 MoM, p = 0.026). CONCLUSION The PSV may be a marker for maternal-fetal CMV transmission following a first-trimester maternal infection.
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Jørgensen DS, Vejlstrup N, Rode L, Ekelund CK, Macgowan CK, Jensen LN, Nørgaard LN, Portnoy S, Seed M, Sundberg K, Søgaard K, Forman JL, Tabor A. Magnetic Resonance Imaging: A New Tool to Optimize the Prediction of Fetal Anemia? Fetal Diagn Ther 2019; 46:257-265. [PMID: 30731466 DOI: 10.1159/000494615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The false-positive rate in the prediction of fetal anemia is 10-15%. We investigated if a new, noninvasive MRI method used as a supplement to ultrasound could improve the prediction. METHODS Fetuses suspected of anemia and controls were scanned in a 1.5-tesla MRI scanner 1-4 times during pregnancy. Cases were scanned before and after intrauterine blood transfusion with a T1-mapping MRI sequence in a cross-section of the umbilical vein. RESULTS Inclusion of 8 cases and 11 controls resulted in 10 case scans (2 cases were included twice) and 33 control scans. In controls, the T1 relaxation time was 1,005-1,391 ms; in cases with severe anemia, 1,505-1,595 ms, moderate anemia 1,503-1,525 ms, and no/mild anemia 1,245-1,410 ms. After blood transfusions, values dropped to 1,123-1,288 ms. The mean value in moderate and severe anemic cases was 275 ms higher than in controls (95% CI 210-341 ms, p < 0.0001), and after blood transfusion it was comparable to controls (3 ms, 95% CI -62 to 68 ms, p = 0.934). A 1,450-ms cut-off would have identified all cases in need of blood transfusion with no false-positive cases. CONCLUSIONS Our findings indicate a potential for this new MRI method to improve the prediction of fetal anemia as a supplement to ultrasound.
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Affiliation(s)
- Ditte S Jørgensen
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark, .,Faculty of Medicine and Health Sciences, University of Copenhagen, Copenhagen, Denmark,
| | - Niels Vejlstrup
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Line Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Charlotte K Ekelund
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christopher K Macgowan
- Departments of Medical Biophysics and Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lisa N Jensen
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lone Nikoline Nørgaard
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sharon Portnoy
- Departments of Medical Biophysics and Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mike Seed
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Division of Paediatric Cardiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karin Sundberg
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Søgaard
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ann Tabor
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Medicine and Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Dantas AMA, Palmieri ABS, Vieira MR, Souza MLR, Silva JC. Doppler ultrasonographic assessment of fetal middle cerebral artery peak systolic velocity in gestational diabetes mellitus. Int J Gynaecol Obstet 2018; 144:174-179. [PMID: 30471100 DOI: 10.1002/ijgo.12723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/08/2018] [Accepted: 11/22/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare Doppler ultrasonographic measurements of the fetal middle cerebral artery peak systolic velocity (MCA PSV) among women with or without gestational diabetes mellitus (GDM). METHODS A cross-sectional study was conducted among pregnant women who presented for prenatal care at a single hospital in Brazil between September 11, 2015, and January 6, 2017. Patients were stratified into a group with GDM and a control group without GDM. One Doppler ultrasonographic assessment was performed per participant. This measurement was made after diagnosis but before the start of treatment among women in the GDM group. Fetal ultrasonographic and biometric variables assessed included MCA PSV, MCA pulsatility index, umbilical artery pulsatility index, the MCA-to-umbilical artery ratio, abdominal circumference, and weight. RESULTS The study included 238 women: 115 in the GDM group and 123 in the control group. The median MCA PSV was 1.02 in the GDM group and 1.08 in the control group (P=0.036). No statistically significant between-group differences were found for the other fetal ultrasonographic variables or for the fetal biometric variables assessed. None of the maternal or fetal parameters assessed displayed a linear correlation with MCA PSV. CONCLUSION Doppler ultrasonographic measurements of MCA PSV were lowered among the fetuses of women diagnosed with GDM.
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Affiliation(s)
- Andrea M A Dantas
- Department of Postgraduate Studies in Health and the Environment, University of the Region of Joinville, Joinville, Brazil
| | - Andrea B S Palmieri
- Department of Postgraduate Studies in Health and the Environment, University of the Region of Joinville, Joinville, Brazil
| | - Mariana R Vieira
- Department of Medicine, University of the Region of Joinville, Joinville, Brazil
| | - Matheus L R Souza
- Department of Medicine, University of the Region of Joinville, Joinville, Brazil
| | - Jean C Silva
- Department of Postgraduate Studies in Health and the Environment, University of the Region of Joinville, Joinville, Brazil.,Department of Medicine, University of the Region of Joinville, Joinville, Brazil.,High Risk Sector, Hospital Maternidade Darcy Vargas, Joinville, Brazil
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21
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Liu F, Ye L, Wei W, Yang G, Ye Y, Meng J, Din X, Zhao S. Influence of laser needle-knife on PI-3K, AKT and VEGF mRNA expression in cervical spondylotic arteriopathy model rabbits. Saudi J Biol Sci 2018; 26:589-594. [PMID: 30899176 PMCID: PMC6408704 DOI: 10.1016/j.sjbs.2018.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 12/01/2022] Open
Abstract
Objective To determine the effect of laser needle-knife on PI-3K, AKT and VEGF mRNA expression of vertebral arteries in a rabbit model of cervical spondylotic arteriopathy (CSA) and the mechanism of action involved. Methods Forty healthy general-grade rabbits were divided into a normal control group, model group, acupuncture group, and laser needle-knife group (n = 10 rabbits per group), and the CSA rabbit model was established in all but groups but the normal control group. CSA model rabbits in the acupuncture group were treated by acupuncture at the Fengchi (GB 20) and Cervical Jiaji (EX-B 2) points, whereas rabbits in the laser needle-knife group were treated with laser needle-knife targeting the Jiaji points near the C5 spinous process. Rabbits in the normal control and model groups were fixed using similar methods. Behavioral characteristics of all rabbits were evaluated before and after treatment. Peak systolic velocity (PSV) of the right carotid and vertebral arteries in each group were examined using beside B ultrasound, and PI-3K, AKT, VEGF mRNA expression in vertebral arteries were determined by real-time PCR. Results The behavioral signs of rabbits were improved after treatment in both the acupuncture and laser needle-knife groups. In comparison with control group, PSV of right carotid arteries in acupuncture group and laser needle-knife group were enhanced significantly (P < 0.05 and P < 0.01), PSV of right vertebral arteries in acupuncture group and laser needle-knife group were enhanced significantly too (P < 0.01 and P < 0.05). PI-3K mRNA expression in laser needle-knife and acupuncture group was significantly higher than that in control group (P < 0.01, P < 0.05). AKT mRNA expression in laser needle-knife and acupuncture group was significantly higher than that in control group (P < 0.01). VEGF mRNA expression in laser needle-knife and acupuncture group was significantly higher than that in control group too (P < 0.01, P < 0.05). No significant differences were found in PI-3K, AKT and VEGF mRNA expression levels among acupuncture and laser needle-knife groups (P > 0.05). Conclusion Laser needle-knife could effectively intervene the mRNA expression of PI-3K, AKT and VEGF, this may be one of the mechanisms of the effect of laser needle-knife in treating CSA in rabbits.
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Affiliation(s)
- Fang Liu
- Hangzhou Red Cross Hospital, Hangzhou 310003, China.,Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Lihong Ye
- Hangzhou Red Cross Hospital, Hangzhou 310003, China
| | - Wei Wei
- Hangzhou Red Cross Hospital, Hangzhou 310003, China
| | - Gaoyi Yang
- Hangzhou Red Cross Hospital, Hangzhou 310003, China
| | - Yang Ye
- Hangzhou Red Cross Hospital, Hangzhou 310003, China
| | - Jun Meng
- Hangzhou Red Cross Hospital, Hangzhou 310003, China
| | - Xueyan Din
- Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Songjia Zhao
- Zhejiang Chinese Medical University, Hangzhou 310053, China
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22
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Chen LD, Pan FS, Zhou LY, Liu YB, Lv JY, Xu M, Xie XY, Lu MD, Wang Z, Wang W. Value of flaccid penile ultrasound in screening for arteriogenic impotence: a preliminary prospective study. BMC Med Imaging 2018; 18:40. [PMID: 30400881 PMCID: PMC6219149 DOI: 10.1186/s12880-018-0284-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 10/24/2018] [Indexed: 01/18/2023] Open
Abstract
Background This prospective study is to evaluate the potential value of sonographic measurements in the flaccid penis for the screening of arteriogenic impotence. Methods A consecutive series of 260 Chinese males consulting for sexual dysfunction and 54 controls underwent sonographic examination. The sonographic parameters were correlated with the clinical gold standards, including the international index of erectile function (IIEF) and penile erectile hardness grading scale (EHGS). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUROC) of flaccid peak systolic velocity (PSV) in predicting patients with normal function were analyzed. Results The mean cavernous PSV of both sides in the patients with sexual dysfunction ranged from 7.76 to 11.12 cm/sec with a stepwise increase in IIEF and EHGS grading scale (P < .05). The cutoff value of flaccid PSV for the differential diagnosis of grade 4 of IIEF-5 or EHGS was 8.20–8.90 cm/sec, with an AUROC of 0.657–0.724, specificity of 82.96–86.84% and PPV of 95.20–96.60%, respectively. Conclusions This simple flaccid PSV measurement is a specific tool for screening arteriogenic impotence.
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Affiliation(s)
- Li-Da Chen
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Fu-Shun Pan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Lu-Yao Zhou
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Yu-Bo Liu
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jian-Yao Lv
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Ming Xu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China.,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhu Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China.
| | - Wei Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China.
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23
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Brandt AH, Hansen KL, Ewertsen C, Holbek S, Olesen JB, Moshavegh R, Thomsen C, Jensen JA, Nielsen MB. A Comparison Study of Vector Velocity, Spectral Doppler and Magnetic Resonance of Blood Flow in the Common Carotid Artery. Ultrasound Med Biol 2018; 44:1751-1761. [PMID: 29804906 DOI: 10.1016/j.ultrasmedbio.2018.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/26/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
Magnetic resonance phase contrast angiography (MRA) is the gold standard for blood flow evaluation. Spectral Doppler ultrasound (SDU) is the first clinical choice, although the method is angle dependent. Vector flow imaging (VFI) is an angle-independent ultrasound method. The aim of the study was to compare VFI- and SDU-estimated peak systolic velocities (PSV) of the common carotid artery (CCA) with PSV obtained by MRA. Furthermore, intra- and inter-observer agreement was determined. MRA estimates were significantly different from SDU estimates (left CCA: p < 0.001, right CCA: p < 0.001), but not from VFI estimates (left CCA: p = 0.28, right CCA: p = 0.18). VFI measured lower PSV in both CCAs compared with SDU (p < 0.001) with improved precision (VFI: left: 24%, right: 18%; SDU: left 38%, right: 23%). Intra- and inter-observer agreement was almost perfect for VFI and SDU (inter-observer correlation coefficient: VFI 0.88, SDU 0.91; intra-observer correlation coefficient: VFI 0.96, SDU 0.97). VFI is more accurate than SDU in evaluating PSV compared with MRA.
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Affiliation(s)
- Andreas Hjelm Brandt
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Caroline Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simon Holbek
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Jacob Bjerring Olesen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Ramin Moshavegh
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Carsten Thomsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Radiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
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Leotta DF, Zierler RE, Sansom K, Aliseda A, Anderson MD, Sheehan FH. Evaluation of Examiner Performance Using a Duplex Ultrasound Simulator. Flow Velocity Measurements in Dialysis Access Fistula Models. Ultrasound Med Biol 2018; 44:1712-1720. [PMID: 29793851 PMCID: PMC6026548 DOI: 10.1016/j.ultrasmedbio.2018.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/08/2018] [Accepted: 04/16/2018] [Indexed: 05/04/2023]
Abstract
We developed a duplex ultrasound simulator for training and assessment of scanning skills. We used the simulator to test examiner performance in the measurement of flow velocities in dialysis access fistulas. Test cases were created from 3-D ultrasound scans of two dialysis access fistulas by reconstructing 3-D blood vessel models and simulating blood flow velocity fields within the lumens. The simulator displays a 2-D B-mode or color Doppler image corresponding to transducer position on a mannequin; a spectral waveform is generated according to Doppler sample volume location and system settings. Examiner performance was assessed by comparing the measured peak systolic velocity (PSV) with the true PSV provided by the computational flow model. The PSV measured by four expert examiners deviated from the true value by 7.8 ± 6.1%. The results indicate the ability of the simulator to objectively assess an examiner's measurement accuracy in complex vascular targets.
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Affiliation(s)
- Daniel F Leotta
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA.
| | - R Eugene Zierler
- Department of Surgery, Division of Vascular Surgery, University of Washington, Seattle, Washington, USA
| | - Kurt Sansom
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Mark D Anderson
- Department of Medicine, Division of Cardiology, University of Washington, Seattle Washington, USA
| | - Florence H Sheehan
- Department of Medicine, Division of Cardiology, University of Washington, Seattle Washington, USA
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25
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Loehfelm TW, Tse JR, Jeffrey RB, Kamaya A. The utility of hepatic artery velocity in diagnosing patients with acute cholecystitis. Abdom Radiol (NY) 2018; 43:1159-67. [PMID: 28840272 DOI: 10.1007/s00261-017-1288-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To test the diagnostic performance of elevated peak systolic hepatic arterial velocity (HAv) in the diagnosis of acute cholecystitis. METHODS 229 patients with an ultrasound (US) performed for right upper quadrant (RUQ) pain were retrospectively reviewed. 35 had cholecystectomy within 10 days of ultrasound and were included as test subjects. 47 had normal US and serology and were included as controls. Each test patient US was reviewed for the presence of gallstones, gallbladder distention, sludge, echogenic pericholecystic fat, pericholecystic fluid, gallbladder wall thickening, gallbladder wall hyperemia, and reported sonographic Murphy sign. Demographic, clinical, and hepatic artery parameters at time of original imaging were recorded. Acute cholecystitis at pathology was the primary outcome variable. RESULTS 21 patients had acute cholecystitis and 14 had chronic cholecystitis by pathology. For patients who went to cholecystectomy, HAv ≥100 cm/s to diagnose acute cholecystitis was more accurate (69%) than the original radiology report (63%), the presence of gallstones (51%), and sonographic Murphy sign (50%). Statistically significant predictors of acute cholecystitis included HAv ≥100 cm/s (p = 0.008), older age (p = 0.012), and elevated WBC (p = 0.002), while gallstones (p = 0.077), hepatic artery resistive index (HARI) (p = 0.199), gallbladder distension (p = 0.252), sludge (p = 0.147), echogenic fat (p = 0.184), pericholecystic fluid (p = 0.357), wall thickening (p = 0.434), hyperemia (p = 0.999), and sonographic Murphy sign (p = 0.765) were not significantly correlated with acute cholecystitis compared to chronic cholecystitis. CONCLUSION HAv ≥100 cm/s is a useful objective parameter that may improve the performance of US in the diagnosis of acute cholecystitis.
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26
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Nishihira T, Takekawa H, Suzuki K, Suzuki A, Tsukahara Y, Iizuka K, Igarashi H, Iwasaki A, Okamura M, Hirata K. Usefulness of acceleration time ratio in diagnosis of internal carotid artery origin stenosis. J Med Ultrason (2001) 2018; 45:493-500. [PMID: 29388010 PMCID: PMC6028849 DOI: 10.1007/s10396-018-0863-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/26/2017] [Indexed: 11/25/2022]
Abstract
Purpose The acceleration time (AcT) ratio of the internal carotid artery (ICA) is increased in ICA stenosis. However, there are few reports that have directly compared the AcT ratio to digital subtraction angiography (DSA) findings. Methods We evaluated 177 vessels with DSA and carotid artery ultrasonography. The AcT ratio was calculated as AcT of the ICA (ICA–AcT)/AcT of the ipsilateral common carotid artery (CCA). We evaluated the correlation of DSA–NASCET stenosis with the origin of the ICA or the peak systolic velocity (ICApsv) in the stenotic region, ICApsv/peak systolic velocity of the CCA (CCApsv), ICA–AcT, and AcT ratio. Sensitivity and specificity for stenosis ≥ 70% were calculated based on the ICApsv, ICApsv/CCApsv, ICA–AcT, and AcT ratio. Results Using NASCET criteria, 34 vessels had 70% or greater stenosis. DSA–NASCET showed a significant positive correlation with ICApsv, ICApsv/CCApsv, ICA–AcT, and AcT ratio (p < 0.0001). When the cut-off value for ICApsv was set at 176 cm/s, ICApsv/CCApsv at 2.42, ICA–AcT at 0.095 s, and the AcT ratio at 1.35, the sensitivity was 97.1, 97.1, 82.4, and 97.1%, and the specificity was 94.4, 91.0, 83.2, and 83.2%, for DSA–NASCET ≥ 70%, respectively. Conclusion The AcT ratio is a beneficial parameter for evaluating ICA stenosis as well as ICApsv and ICApsv/CCApsv.
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Affiliation(s)
- Takahito Nishihira
- Stroke Division, Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Hidehiro Takekawa
- Stroke Division, Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
- Center of Medical Ultrasonics, Dokkyo Medical University, Tochigi, Japan.
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Ayano Suzuki
- Stroke Division, Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Yuka Tsukahara
- Stroke Division, Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Kentaro Iizuka
- Stroke Division, Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Haruki Igarashi
- Stroke Division, Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Akio Iwasaki
- Stroke Division, Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Madoka Okamura
- Stroke Division, Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
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Abstract
Context: Ultrasonography of thyroid gland is a frequently performed investigation. Many of the diffuse thyroid pathologies are associated with altered vascularity. In view of potential applications and scant available data, there is a need to find normal values of Doppler indices of superior thyroid artery (STA). Aims: To find the normal range of Doppler indices like mean peak systolic velocity (PSV), resistivity index (RI), and pulsatility index (PI) of STA in clinically euthyroid adult individuals. Settings and Design: Prospective cross-sectional observational study. Materials and Methods: A study was done in the Department of Radiodiagnosis of a tertiary care hospital, involving clinically euthyroid adult volunteers. Ultrasonography of the thyroid gland with Doppler of bilateral STAs was performed and mean values of PSV, RI, and PI were calculated. Results: A total of 208 subjects, with a mean age of 37.7 years, underwent Doppler evaluation of STA; 148 of them were women and 60 were men. The mean PSV obtained was 16.94 ± 5.3 cm/s. Mean PI and RI were 0.93 ± 0.31 and 0.5 ± 0.13, respectively. There was no significant difference in the values obtained among both the genders. Conclusion: Mean values of Doppler indices of STA in euthyroid individuals have been found in this study.
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Affiliation(s)
- Upendra Kumar Joish
- Department of Radiodiagnosis, JJM Medical College, Davangere, Karnataka, India
| | - Y Kavitha
- Department of ENT, JJM Medical College, Davangere, Karnataka, India
| | - R Harikiran Reddy
- Department of Radiodiagnosis, JJM Medical College, Davangere, Karnataka, India
| | - Anitha S Prabhu
- Department of Radiodiagnosis, JJM Medical College, Davangere, Karnataka, India
| | - M Chetan Kumar
- Department of Radiodiagnosis, JJM Medical College, Davangere, Karnataka, India
| | - M C Siddharth
- Department of Radiodiagnosis, JJM Medical College, Davangere, Karnataka, India
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Tat J, Psaromiligkos IN, Daskalopoulou SS. Carotid Atherosclerotic Plaque Alters the Direction of Longitudinal Motion in the Artery Wall. Ultrasound Med Biol 2016; 42:2114-2122. [PMID: 27260245 DOI: 10.1016/j.ultrasmedbio.2016.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 04/21/2016] [Accepted: 04/25/2016] [Indexed: 06/05/2023]
Abstract
Longitudinal motion of the artery, a cyclical, bidirectional movement of the wall in the long axis of the artery, has recently gained interest in the characterization of artery function. The aim of this study was to evaluate longitudinal motion in patients with internal carotid atherosclerotic plaques. Speckle tracking ultrasound was used to assess common carotid artery wall motion in 12 patients with carotid plaque causing either moderate (50%-79%) or severe (80%-99%) stenosis based on the North American Carotid Endarterectomy Trial, and 23 healthy participants. Although healthy individuals were found to have a retrograde wall motion pattern, a distinct anterograde pattern was noted with plaque presence. Importantly, patients with severe plaque stenosis had greater anterograde motion (0.53 ± 0.36 mm) than those with moderate stenosis (0.17 ± 0.15 mm) (p < 0.05), likely owing to high wall shear stresses associated with greater peak systolic velocities at the site of stenosis (severe: 342.0 ± 99.4 cm/s, moderate: 177.5 ± 31.2 cm/s, p < 0.01). There were no differences in peak systolic velocities at plaque-free segments between plaque groups (severe: 80.2 ± 24.8 cm/s, moderate: 92.7 ± 23.0 cm/s). Blood flow at stenotic areas better predicted motion than plaque-free segments. We conclude that the presence of carotid plaque can have significant influence on longitudinal motion, with significantly greater anterograde displacements with increased stenosis. Future studies are needed to further investigate carotid artery wall mechanics.
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Affiliation(s)
- Jimmy Tat
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ioannis N Psaromiligkos
- Department of Electrical and Computer Engineering, McGill University, Montreal, Quebec, Canada
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29
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Park MY, Jung SE, Choi JI, Byun JY. Optimization of beam-flow angles for Doppler ultrasound flow velocity measurements using slanted gel pads. Springerplus 2016; 5:328. [PMID: 27064372 PMCID: PMC4791444 DOI: 10.1186/s40064-016-1977-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/06/2016] [Indexed: 11/21/2022]
Abstract
The aim of this study was to assess whether slanted gel pads can be used to optimize beam-flow angles and flow velocity measurements for Doppler ultrasound. The right carotid artery of a single healthy female volunteer was measured alternatively five times without and with an 18° angled slanted gel pad between the ultrasound transducer and skin by 13 radiologists. Beam-flow angles and peak systolic flow velocities (PSV) were measured along with assessment of spectral broadening. Beam-flow angles (P = 0.001) and PSV (P = 0.001) measurements showed a significant decrease when using slanted gel pads. The mean (±SD) beam-flow angles without and with the use of slanted gel pads were 66.7 (±4.2) and 56.1 (±5.8) degrees, respectively. The mean (±SD) PSVs without and with the use of slanted gel pads were 92.0 (±17.4) and 76.9 (±10.9) cm/s, respectively. There was a noticeable decrease in spectral broadening when using slanted gel pads. There was a significant linear correlation between beam-flow angle and peak systolic velocity. Coefficients of variation for peak systolic velocity without and with the use of gel pads were 18.9 and 14.2 %, respectively. These results demonstrate that slanted gel pads decrease beam-flow angles and overestimation of Doppler flow velocity measurements while potentially increasing the reliability of measurements.
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Affiliation(s)
- Michael Yong Park
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-gu, Seoul, 06591 Korea
| | - Seung Eun Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-gu, Seoul, 06591 Korea
| | - Joon-Il Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-gu, Seoul, 06591 Korea
| | - Jae Young Byun
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-gu, Seoul, 06591 Korea
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Lamin E, Weiss DA, Darge K, Dekio F, Canning DA. Growing Renal Mass: Lessons Learned on the Road From an Atypical Presentation to Successful Therapy. Urol Case Rep 2016; 3:157-60. [PMID: 26793537 PMCID: PMC4672655 DOI: 10.1016/j.eucr.2015.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 05/27/2015] [Accepted: 06/02/2015] [Indexed: 11/28/2022] Open
Abstract
A 25 4/7 week boy was born with a prenatal diagnosis of polyhydramnios and enlarged left kidney. Over the next 2 months serial ultrasounds demonstrated abnormal growth of the kidney, with 28.9% split function. At gestational age 39 4/7, he underwent a left radical nephrectomy. Pathology revealed congenital mesoblastic nephroma with mixed classic and cellular features. This case was puzzling due to prenatally diagnosed renal enlargement in a premature infant and inconclusive post-natal ultrasonographic imaging. Although the patient had paraneoplastic signs of polyhydramnios and hypertension, the mass did not have a classic appearance of CMN; possibly due to severe prematurity.
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Affiliation(s)
- Eliza Lamin
- Division of Urology, University of Pennsylvania Health System, Philadelphia, USA
| | - Dana A Weiss
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, USA; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Kassa Darge
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Fumiko Dekio
- Department of Pathology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Douglas A Canning
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, USA
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Vadana BMK, Pasumarthy A, Penumalli N, Bellapa NC. Renal Venous Doppler Study in Obstructive Uropathy. J Clin Diagn Res 2015; 9:TC13-5. [PMID: 26675709 DOI: 10.7860/jcdr/2015/15546.6794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 09/08/2015] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Obstructive uropathy is very common cause of pain abdomen. Recognition of the cause of the pain and level of obstruction is the goal. Ultrasound is the primary modality used for detection and characterization of obstructive uropathy along with conventional radiographs. Obstructive uropathy in early stages can be difficult to diagnose using standard B-mode USG or arterial sensitive index. AIM The purpose of this study is to evaluate the diagnostic accuracy of renal venous doppler ultrasound in diagnosing acute obstructive uropathy either alone or in addition to arterial doppler study of inter lobar arteries. As there is limited literature available till date on Indian population regarding renal venous doppler in obstructive uropathy, this study can be useful. MATERIALS AND METHODS Fifty patients presenting with features suggestive of obstructive uropathy were studied and compared with non-obstructed kidney of the same patient. Fifty normal individuals were studied and taken as controls. RESULTS The mean venous impedance index on the obstructed side (0.26 ± 0.07) was less than the mean venous impedance index on the unobstructed side (0.41 ± 0.08) and was statistically highly significant. There was no statistically significant difference in mean arterial Resistivity Index (RI). CONCLUSION Thus renal venous doppler study is a reliable tool in diagnosing cases of acute obstructive uropathy. Though its use as single parameter to identify obstruction still needs further studies, it can be used in conjugation with b mode ultrasound and arterial Doppler to identify obstruction.
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Affiliation(s)
| | - Ashirwad Pasumarthy
- Resident, Department of Radiodiagnosis, Dr. PSIMS & RF , Chinoutpally, Andhra Pradesh, India
| | - Neelima Penumalli
- Consultant Radiologist, Department of Radiodiagnosis, Dr. PSIMS & RF , Chinoutpally, Andhra Pradesh, India
| | - Narayan Chander Bellapa
- Professor and Head of Department, Department of Radiodiagnosis, Dr. PSIMS & RF , Chinoutpally, Andhra Pradesh, India
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Naffaa LN, Tandon YK, Irani N. Transcranial Doppler screening in sickle cell disease: The implications of using peak systolic criteria. World J Radiol 2015; 7:52-56. [PMID: 25729487 PMCID: PMC4326734 DOI: 10.4329/wjr.v7.i2.52] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/25/2014] [Accepted: 01/20/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare time average maximum mean velocity (TAMV) and peak systolic velocity (PSV) criteria of Trans Cranial Doppler (TCD) in their ability to predict abnormalities on magnetic resonance imaging (MRI)/magnetic resonance angiogram (MRA) in patients with sickle cell disease.
METHODS: A retrospective evaluation was performed of the outcomes in all patients with a Transcranial Doppler examination at our institution since the implementation of the hospital picture archiving and communication system (PACS) system in January 2003 through December 2012. All ultrasound imaging exams were performed by the same technologist with a 3 MHz transducer. Inclusion criteria was based upon the Transcranial Doppler procedure code in our PACS which had an indication of sickle cell disease in the history. The patient’s age and gender along with the vessel with the highest time averaged mean velocity as well as the highest peak systolic velocity was recorded for analysis. A subset of the study cohort also had subsequent MR imaging and Angiograms performed within 6 mo of the TCD examination. MRI results were categorized as having a disease related abnormality (vessel narrowing, collateral formation/moya-moya, or abnormal fluid attenuation inversion recovery signal in parenchyma indicative of prior stroke) or normal. The MRI results formed the comparison standards for TCD exams in evaluating intracranial injury. Sensitivity and specificity for the two TCD criteria (TAMV and PSV) were calculated to determine which could be a better predictor for intracranial vasculopathy /clinically occult strokes.
RESULTS: The study cohort for our institution was 110 patients with a total of 291 TCD examinations. These patients had a mean age of 7.6 years with a range from 2-18 years of age. Sixty-two of the 110 patients (56%) had two or more TCD exams. Thirty-seven patients (34%) had at least one MRI following a TCD examination. Of the 291 TCD examinations, 46 (16%) were conditional or abnormal by TAMV criteria. One hundred and sixteen (40%) were conditional or abnormal by PSV criteria. All studies that were abnormal by TAMV were also abnormal by PSV criteria. Seventy of the 116 (60%) studies which were conditional or abnormal by peak systolic criteria would not have been identified by time averaged mean maximum velocity criteria. The most frequent location of highest velocity measurement was noted to be in the middle cerebral artery regardless of whether it was measured by PSV or TAMV. From the 37 patients having one or more MRIs, 43 MRI exams were performed within 6 mo of a TCD examination. Twenty two (51%) MRIs had a disease related abnormality reported. When evaluating conditional or abnormal exams by PSV criteria against follow-up MRI/MRA, the sensitivity was 73% [16/(16 + 6)] and specificity was 81% [17/(4 + 17)]. When evaluating conditional or abnormal exams by TAMV criteria by follow-up MRI/MRA as the gold standard, the sensitivity was 41% [9/(9 + 13)] and the specificity was 100% [21/(21 + 0)]. In using conditional or abnormal criteria from PSV and TAMV to predict abnormalities on follow-up MRI/MR Angiogram, PSV was more sensitive (73% vs 41%) while TAMV was more specific (100% vs 81%).
CONCLUSION: Based on the data obtained at our institution and using the assumption that the best screening test is the one with the highest sensitivity, the peak systolic velocity could be the measurement of choice for TCD screening.
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