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Background The authors presented their strategy to harvest extended thoracodorsal artery perforator flaps for resurfacing the large soft-tissue defects of extremities. Materials and Methods Thirty-three free extended thoracodorsal artery perforator flaps were harvested in thirty-three patients. The mean flap size was 145.2 cm2. The maximal flap length and width were 30 cm and 10 cm. The color Doppler sonography was used for preoperative assessment of perforators. Indocyanine green angiography was used for intraoperative assessment of flap viability in three patients. Results The vascular thrombosis, donor-site scar widening, delayed recipient-site wound healing were not significantly related to the patient and flap characteristics. Flap tip or partial necrosis was significantly related to age and peripheral vascular disease. True positive rate, false negative rate, and positive predictive value of color Doppler sonography for perforator identification were not different significantly between attending surgeon and residents. In the distance discrepancy of color Doppler sonography, significant difference was found based on the classifications of perforator size, perforator type, and sonographic operator. The indocyanine green angiography identified a hypoperfused distal area in a 30 cm long flap. Conclusion The color Doppler sonography locates the thoracodorsal artery perforators more precisely when scanned by experienced hands, in larger size or septocutaneous perforators. Using reliable and more perforators, applying muscle-sparing technique, considering suprafascial course of perforator and proper flap orientation are helpful in harvesting extended thoracodorsal artery perforator flaps. Indocyanine green angiography is an option for assessing flap viability, especially in elders and patients with peripheral vascular diseases.

The diagnostic significance of the color Doppler study of testicular blood flow in testicular torsion has been studied for about 40 years, however, the prognostic value of the results obtained is ambiguous, as are the actual imaging capabilities of the technique. Our own experience of 110 observations of testicular torsion in children older than the neonatal period allows us to draw statistically reliable conclusions. Made on equipment premium-class research made it possible to evaluate how visualization intratesticular vascular pattern, and whirpool-sign and submit the primitive model of the actual inversion, explaining the impossibility of rendering whirpool-sign with the greatest tight inversion. The dynamics of testicular blood flow was studied immediately after successful and unsuccessful manual detorsion and in the long term after operative detorsion and orchopexy. The publication contains a brief analysis of the literature and is extensively illustrated.

Inadequate luteolysis in fertility programs is a problem for lactating dairy cows treated with a single dose of PGF2α. The proportion of cows with complete luteolysis can be increased by administering 2 doses of PGF2α 24 h apart. This study hypothesized that a double dose of cloprostenol sodium (1.0 mg) could take the place of 2 doses 24 h apart due to its enhanced half-life. Cows were allocated to receive 1 of 3 treatments: negative controls: 0.5 mg of cloprostenol sodium (single; n = 337); positive controls: two 0.5-mg doses of cloprostenol sodium 24 h apart (two/24; n = 313); and treated: 1.0 mg of cloprostenol sodium (double; n = 298) at the final PGF2α of Double-Ovsynch. Cows received artificial insemination (AI) 16 h after final GnRH of Double-Ovsynch. Pregnancy diagnosis was determined at 24, 34, 62, and 184 d post-AI. Pregnancy loss was categorized in the following periods: between 24 to 34, 34 to 62, and 62 to 184 d post-AI. Ultrasonography (B-mode and color Doppler) was used to assess luteal function pre- and posttreatment with various doses of cloprostenol sodium. Luteal volume and luteal blood flow (LBF) from d 7 and 14 corpora lutea were determined before treatment (d -1), and 2 and 4 d after treatment. No evidence was observed of an effect of treatment on pregnancy rates per AI at 24, 34, or 62 d post-AI. No effect was observed of treatment on pregnancy losses occurring between d 24 and 34, 34, and 62, and between 62 and 184 d post-AI. However, third-plus parity cows treated with the single treatment had greater pregnancy loss compared with two/24 and double between d 24 and 34 post-AI. Third-plus parity cows that received the double treatment had lower LBF 2 and 4 d after treatment compared with cows treated with single. Amount of LBF present 4 d after treatment was not a predictor of pregnancy or pregnancy loss. A double dose (1.0 mg) of cloprostenol sodium may be a feasible alternative for fertility programs based on nondifferent outcomes to the two/24 treatment, lower pregnancy losses, and reduced LBF disappearance following treatment in third-plus parity cows in comparison with the single treatment.

Background Emergency appendectomy is often performed for de Garengeot hernia. However, in some cases, there may be a chance to perform an appendix-preserving elective surgery. Case description A 76-year-old woman presented to our hospital with complaints of a right inguinal swelling, which we diagnosed as a de Garengeot hernia using computed tomography (CT). B-mode ultrasonography (US) of the mass showed an appendix 4–6 mm in diameter with a clear wall structure; color Doppler US showed pulsatile blood flow signal in the appendiceal wall. Twenty-eight days later, herniorrhaphy with transabdominal preperitoneal repair (TAPP) was performed without appendectomy. Another 70-year-old woman presented to our hospital with complaints of a painful bulge in the right inguinal region. The diagnosis of de Garengeot hernia was made using CT. B-mode US showed an appendix 5 mm in diameter with a clear wall structure. Color Doppler US showed a pulsatile blood signal in the appendiceal wall. Seven days later, herniorrhaphy with TAPP was performed without appendectomy. Conclusion De Garengeot hernia is often associated with appendicitis; however, an appendix-preserving elective herniorrhaphy can be performed if US and intraoperative findings do not suggest appendicitis or circulatory compromise in the appendix.

In breast radiology, ultrasound detection of biopsy markers or clips for localization purposes is often challenging, especially in the axilla. The purpose of this research was to test the hypothesis that the surface roughness of biopsy clips would elicit a twinkling signature on color Doppler, making them more readily identifiable by ultrasound. Ultrasound color Doppler imaging of 12 biopsy markers was performed and consensus scoring of the degree of twinkling (0 [no twinkling] to 4 [exuberant twinkling]) was obtained for each of the markers. The surface roughness characteristics of the markers were measured using 3-D coherence scanning interferometry. The 3 markers scoring at least 3 for twinkling in vitro were cork, Q and Vision. Of these 3 markers, only the cork marker scored a 4 ex vivo and in cadaveric tissue. Surface roughness metrics demonstrated a positive estimated correlation with the twinkling scores (rho = 0.33, 95% CI = [–0.48 to 0.84]). Of the 12 markers tested, the markers that twinkled corresponded to surface roughness measured with non-contact 3-D optical imaging. Qualitatively, lower color scales and color frequencies optimized twinkling, but the most specific qualitative predictor of confidence in twinkling was insensitivity to changes in color scale and color frequency values.

Objective: To determine correlation between serum levels of Follicle Stimulating Hormone and Graafian Follicle vascularity on Doppler ultrasound in infertile females of Lahore, Pakistan. Study Design: Cross sectional study. Place and Duration of Study: Prime Ultrasound center, 2-Shalamrar Link Road, Mughalpura, Lahore, Pakistan From Mar 2018 to Sep 2019. Methodology: A total of 100 infertile females using simple random sampling were taken. All the married women of reproductive age and married for >12 months who have not conceived despite regular unprotected intercourse, having no other uterine and endometrial or ovarian pathology were taken. The patients who fail to provide serum hormone laboratory reports were excluded. Transvaginal ultrasonography was done for all females and graafian follicle vascularity on Doppler was measured on day 12 of the cycle. Results: The Median age of females was 28 (30-25) years range from 19 and 46 years. The median Follicle Stimulating Hormone levels at day 12 was 6 (8.25-5.22) mlU/ml with minimum and maximum FSH values as 3.20 and 40 mlU/ml. The median follicle size was 13.65 (16.04-10.84) (mm) with minimum and maximum size as 10 mm and 26 mm. There were 61% females who had Grade–1 perifollicular vascularity, 24% females had grade-2 and 15% females had grade-3 of perifollicular vascularity. There was significant positive correlation between perifollicular vascularity grades and Follicle-stimulating hormone levels day 12 (mm) i.e., r=0.309, p-value

Background: Threatened miscarriage is a common complication in the first trimester of pregnancy and is often associated with anxiety regarding pregnancy outcome. Approximately, 20% of pregnant women have symptoms of threatened abortion in the first trimester of pregnancy. A single serum cancer antigen 125 (CA-125) level determination is valuable in women with imminent abortion presenting with abdominal pain, vaginal bleeding or both rather than serial measurements. Objective: To evaluate the prognostic value of correlating the corpus luteum volume measured by two-dimensional ultrasound, and color doppler blood flow changes in the corpus luteum together with the results of serum CA-125 at the time of initial presentation with pregnancy outcome in patients with first trimesteric threatened abortion. Patients and methods: This prospective controlled study was held during the period from May 2015 to May 2018 on 100 women on their first trimester of pregnancy, 50 women having normal uncomplicated pregnancy and 50 women with clinical diagnosis of threatened abortion. The latter group was further subdivided into: group of patients who aborted (14 patients), and another group who continued their pregnancy and proceeded into the second trimester (36 patients). Results: It was found that the mean corpus luteum peak systolic velocity (CL PSV) for the threatened abortion (aborted) group was 30.68 ± 18.9 cm/sec, while for the threatened abortion (continued) group was 22.03 ± 12.9 cm/sec, and for the control group was 21.58 ± 13.77 cm/sec. The difference was statistically significant between threatened abortion (aborted) group and each of the threatened abortion (continued) group and the control group. The difference was statistically non-significant between the threatened abortion (continued) group, and the control group. The cut-off value of CL PSV at which there was a high probability of termination of pregnancy in threatened abortion cases, reached 17.785 cm/sec with a sensitivity of 63.6% and specificity of 54.4%. Conclusion: Serum CA-125 level determination was valuable in the women with symptoms of threatened abortion with a cut-off limit of 31.85 IU/ml of CA-125 level which carried a sensitivity of 86.4% and specificity of 80.7%. The study suggested that CA- 125 may be a cheap, sensitive and specific method in prediction of the cases of threatened abortion.

Purpose: To compare the capabilities and evaluate the effectiveness of gray-scale B-mode, Doppler mapping and contrast enhanced in the assessment of cystic renal lesions.Material and methods: Ultrasound examination (US) was performed in 61 patients with cystic kidney formations (category Bosniak ≥ II). Cysts of categories Bosniak ≥ III were histologically verified, rest (categories II–IIF) were under follow up. All patients underwent gray-scale ultrasound, color Doppler imaging and contrast enhanced (CEUS).Results: The efficiency of the B mode was: sensitivity 55.6 %; specificity 72.1 %; accuracy 62.3 %, in the CDI mode these indicators were 52.8; 80.1; 63.9 %, respectively. Contrast ultrasound significantly increased the capabilities of the method, and also made it possible to evaluate cystic formations according to the Bosniak criteria with indicators of the effectiveness of the method up to 100.0; 92.0; 96.7 %, respectively.Conclusions: CEUS demonstrated high informative value in the assessment of renal cystic formations in comparison with native ultrasound and Doppler modes, and therefore the technique should be considered as promising for inclusion in the algorithm of examination of complex renal cysts.

Graphical abstract, Highlights • SVG aneurysm may be diagnosed using TEE, color Doppler, and UEA. • An extracardiac mass after CABG raises suspicion of an SVG aneurysm. • Demonstration of flow by color Doppler or UEA aids in diagnosing SVG aneurysm. • SVG aneurysms are usually diagnosed ≥10 years after CABG (68%). • SVG aneurysms may cause extrinsic compression of adjacent structures (35%).

Contrast-enhanced ultrasonography (CEUS) is considered a promising technique for differentiation of benign and malignant tumors in humans. However, few studies have assessed superficial neoplasms in dogs by means of CEUS. The aim of this study was to identify ultrasonographic criteria evaluated by B-mode ultrasound (US) and CEUS that may be used to distinguish benign and malignant superficial neoplasms in dogs. A total of 63 superficial neoplasms from 59 dogs were evaluated using B-mode US and CEUS prior to histopathologic examination. Qualitative and quantitative parameters were compared between benign and malignant neoplasms by Fischer’s exact test or fixed effects model. With B-mode US, a significant difference was found for border definition, echogenicity and echotexture. With CEUS, a significant difference was found for the enhancement pattern at wash-in and the wash-out area under the curve at the center of the neoplasm. Malignant neoplasms had on average a lower regional blood volume during the wash-out phase compared to benign neoplasms. Despite these significant differences, there was a considerable overlap in B-mode and CEUS parameters between benign and malignant neoplasms. In conclusion, B-mode US and CEUS might contribute to malignancy prediction; however, based on individual ultrasonographic parameters, they seem unable to replace cytology or histopathology.

Background: Enlarged cervical nodes are very common presentation in radiology department. The accurate diagnosis of the cervical lymphadenopathy is very crucial for further management. The aim of this study was to evaluate the cervical lymphadenopathy by sonography and see the effec­tiveness of B mode ultrasound and color Doppler ultrasound in differentiation between the benign and malignant lymph nodes. Methods: A retrospective study was conducted in the Department of Radiology, College of Medical sci­ences, Bharatpur from 2019 to 2021 among 40 patients with clinically palpable cervical nodes. The so­nographic findings and FNAC/biopsy correlation were done with calculation of the p value, sensitivity, specificity, positive and negative predictive values. SPSS 20.0 and Microsoft Excel were used for the data analysis and presentation. Results: Among 40 patients the most common diagnosis was tuberculosis nodes followed by reactive nodes, metastatic nodes and lymphomatous nodes. The sensitivity and specificity for reactive nodes is very high 92% and 89% respectively for B-mode and for color Doppler ultrasound it is 82% and 90%. For TB nodes and metastatic nodes B-mode and color Doppler ultrasound has low sensitivity and high specificity 72% and 71% sensitivity for TB and metastatic nodes respectively and 91% and 94% specificity for TB and metastatic nodes respectively. Conclusions: B mode and color Doppler sonography is very helpful to accurately diagnose the cause of cervical lymphadenopathy with high specificity and sensitivity. However, the differentiation between the tubercular, metastatic and lymphomatous nodes by sonography is very difficult and requires FNAC/biopsy correlation.

Objective: To compare the diagnostic accuracy of color Doppler ultrasound with computed tomography angiography in patients with lower limb ischemia and to assess the severity of stenosis. Study Design: Cross Sectional Analytical study. Setting: Shalamar Hospital, Lahore. Period: May 2020 to October 2020. Material & Methods: Data were collected according to the Age, Height, Weight, BMI, Duration of diabetes, Total Cholesterol, LDL, HDL, Triglyceride, Gender, Socioeconomic status, Diabetes, Hypertension, Stenosis, Collateral, calcification. Sample size of46 patients were included in this research comprising 32 males (69.6%) and 14 females (30.4%).Data entry and analysis will be done by using SPSS version-23. Results: Total numbers of 46 patients were included in this research comprising 32 males (69.6%) and 14 females (30.4%). According to the result analysis 34 patients had shown peripheral arterial disease at color Doppler and 12 patients had not shown peripheral arterial disease at color doppler. 38 patients had shown peripheral arterial disease at CTA and 8 patients had not shown peripheral arterial disease at CTA. Conclusion: This study concludes that computed tomography angiography for detection of peripheral arterial disease as the gold standard, MDCT angiography shows higher sensitivity (82.6%) than color-coded Doppler ultrasonography (73.9%) in the assessment of peripheral arterial disease.

Objectives: To assess the frequency of radial artery occlusion (RAO) in patients undergoing percutaneous cardiac catheterization. Methodology: A descriptive cross sectional study was carried out at cardiology department Jinnah hospital, Lahore from April – October 2018. One hundred thirty one consecutive patients who had undergone percutaneous cardiac catheterization via the trans-radial approach were enrolled in the study. Post procedure patients were followed in the ward and after 24 hours, Allen’s test was used for checking the patency of the radial artery. Color Doppler USG was performed in the patients with absent radial artery and RAO was confirmed. Data was entered and analysed in SPSS version 21.0. Results: Out of 131 patients who had undergone for percutaneous cardiac catheterization 63.4% were male and 36.6% were female. Among these cases radial artery occlusion was detected in 52 (39.7%) patients. No statistically significant difference was found with effect modifiers like age, gender, duration of procedure and type of intervention statistically insignificant difference was observed (P>0.05). Conclusion: A considerable number of patients were observed with radial artery occlusion with trans-radial approach thought statistically insignificant difference was noted among all ages, gender or type of intervention suggesting a detailed evaluation of radial artery patency should be done before hospital discharge.

Research goal: evaluation of the possibility of using an ultrasound twinkling artifact in the detection of breast calcifications as a diagnostic criterion for breast cancer.Material and methods. A targeted ultrasound study using color Doppler mapping was performed to determine the presence of a twinkling artifact in 112 patients who had calcifications detected during X-ray mammography.Results. According to the ultrasound examination, the twinkling artifact was registered only in 10 of the 112 women examined. A pronounced twinkling artifact was registered in 3 patients, the calcifications were single, mainly lobular, with a size of more than 1 mm. In 5 cases, the flicker artifact was determined to be of moderate severity, and the distribution pattern was also dominated by single ones, more than 1 mm. Two patients with grouped calcinates had a weakly expressed twinkling artifact, their dimensions were also more than 1 mm.Conclusion. The data obtained indicate that the Doppler twinkling artifact in the mammary glands occurs only in macrocalcinates (larger than 1 mm) and, mainly, single ones. Modern ultrasound devices do not allow registering a twinkling artifact in calcinates smaller than 1 mm, which indicates that it is impossible to use Doppler color coding to detect microcalcinates as a predictor of breast cancer.

Accurate assessment of mitral regurgitation (MR) severity is critical in clinical diagnosis and treatment. No single echocardiographic method has been recommended for MR quantification thus far. We sought to define the feasibility and accuracy of the mask regions with a convolutional neural network (Mask R-CNN) algorithm in the automatic qualitative evaluation of MR using color Doppler echocardiography images. The authors collected 1132 cases of MR from hospital A and 295 cases of MR from hospital B and divided them into the following four types according to the 2017 American Society of Echocardiography (ASE) guidelines: grade I (mild), grade II (moderate), grade III (moderate), and grade IV (severe). Both grade II and grade III are moderate. After image marking with the LabelMe software, a method using the Mask R-CNN algorithm based on deep learning (DL) was used to evaluate MR severity. We used the data from hospital A to build the artificial intelligence (AI) model and conduct internal verification, and we used the data from hospital B for external verification. According to severity, the accuracy of classification was 0.90, 0.89, and 0.91 for mild, moderate, and severe MR, respectively. The Macro F1 and Micro F1 coefficients were 0.91 and 0.92, respectively. According to grading, the accuracy of classification was 0.90, 0.87, 0.81, and 0.91 for grade I, grade II, grade III, and grade IV, respectively. The Macro F1 and Micro F1 coefficients were 0.89 and 0.89, respectively. Automatic assessment of MR severity is feasible with the Mask R-CNN algorithm and color Doppler electrocardiography images collected in accordance with the 2017 ASE guidelines, and the model demonstrates reasonable performance and provides reliable qualitative results for MR severity.

Background: Chest ultrasound (US) and color Doppler sonography play important roles in the diagnosis and charac-terization of different pathologies of peripheral lung lesions, especially in the emergency setting. Aim of Study: The aim of this study is to assess the role of chest US and Doppler examination in the assessment of peripheral lung lesions in comparison with chest CT, which is the gold standard for chest diagnosis. Subjects and Methods: This cross-sectional study involved 120 patients who underwent chest CT examination, full chest US, and Doppler. Results were assessed blindly and compared with CT. Results: The main lung lesions assessed by US and Doppler were lung collapse, consolidation, interstitial lung changes, and peripheral pulmonary nodules, with the estimated sensi-tivity, specificity, positive predictive value, negative predictive value, and accuracy of detection ranging from 63.9%-76.9%, 94%-95%, 79.2%-95%, 85.9%-91.5%, and 85%-93.3% re-spectively. There was a significant correlation between US and Doppler in comparison with CT. Conclusion: Chest US proved its value as a complementary tool for the diagnosis of peripheral lung lesions, with high specificity and accuracy. This finding was enforced by Doppler, history, and clinical suspicion, although the use of CT to obtain the final diagnosis would be more applicable.

Introduction and aim Endometrial polyps (EPs) are a common gynecologic condition, associated with abnormal uterine bleeding (AUB), infertility, and premalignant and malignant conditions. Technologies for diagnosis and treatment of EPs are constantly evolving. We aim to provide an updated review on diagnosis and management options for patients with EPs. Material and methods We conducted an electronic search in databases including MEDLINE, PubMed, Cochrane Central Register and others. We included 68 publications regarding EPs, their clinical burden, diagnostic modalities, treatment options and new technologies. Results Transvaginal ultrasound (TVS) is the common modality for EP detection and color doppler increases its diagnostic accuracy. Dilation and curettage (D&C) should be avoided for diagnosis and treatment of EPs. Hysteroscopy shows high diagnostic value in EPs and allows for both histological diagnosis and effective treatment. Office hysteroscopy and see and treat hysteroscopy without anesthesia is feasible and safe for EP diagnosis and treatment, gaining more trained surgeons globally. Effective and safe technological tools for EP resection include Laser, resectoscopes, morcellators, MyoSure, Truclear and scissors\graspers. Conclusions EPs are safely and effectively diagnosed and treated with the hysteroscopic tools reviewed in this article. More research is needed to define the best treatment modality.

Everett F Magann,1 Julie R Whittington,1 John C Morrison2 ,†Suneet P Chauhan3 1Departments of Obstetrics and Gynecology of the University of Arkansas for the Medical Sciences, Little Rock, AR, USA; 2Department of Obstetrics and Gynecology of the University of Mississippi Medical Center, Jackson, MS, USA; 3Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Texas Health Sciences Center at Houston, Houston, TX, USA†Dr John C. Morrison passed away on September 1, 2019Correspondence: Everett F MagannDepartment of Obstetrics and Gynecology of the University of Arkansas for the Medical Sciences, 4301 W. Markham St. Slot # 518, Little Rock, AR, 72205, USATel +1 501-686-8345Fax +1 501-526-7820Email efmagann@uams.eduAbstract: Actual AFV can be determined by a dye-dilution technique or be directly measured at cesarean. This allows investigators to correlate estimated and actual AFVs. Lessons learned by assessing the relationship of estimated to actual AFVs. 1) Ultrasound estimates normal actual AFVs well, but abnormal AFVs poorly. 2) Quantile regression is a better statistical methodology to create a normal AFV curve across pregnancy. 3) There is no difference in the accuracy of the subjective (visualization without measurements) compared with the objective (visualization with measurements) technique in identifying normal and abnormal AFVs. 4) Color Doppler use leads to the over-diagnosis of oligohydramnios. 5) Intravenous hydration increases actual AFVs. 6) The estimation of AFV can be done with the transducer held perpendicular to the floor or perpendicular to the uterine contour. 7) The single deepest pocket should be used for identifying low AFVs. 8) The AFI should be used for identifying high AFVs.Keywords: amniotic fluid volume, oligohydramnios, polyhydramnios, color Doppler, subjective assessment, objective assessment

Purpose: Color Doppler ultrasonography (CD) has been used to employ in Achilles tendinopathy, there is a need to measure neovascularization in Achilles tendinopathy to reach a consensus for CD application. The object of this systematic retrospect is to summarize the literature regarding whether is a relationship between the neovascularization and Achilles tendinopathy by CD detecting. Method: The databases search of PubMed, Scopus, and Embase extracted 543 articles for title and abstract review. After deleting duplicate papers and evaluating which one meets the inclusion criteria, a total of 8 articles were selected. Results and conclusion: Differentiate a physiological and pathological color Doppler flow in Achilles tendon is important to further clinically diagnose, since neovascularization in tissue structure can be influenced by variation reasons. The standardized tenoangiography protocol be supposed to develop when assessment asymptomatic or symptomatic tendons.

Everett F Magann,1 Julie R Whittington,1 John C Morrison2 ,† Suneet P Chauhan3 1Departments of Obstetrics and Gynecology of the University of Arkansas for the Medical Sciences, Little Rock, AR, USA; 2Department of Obstetrics and Gynecology of the University of Mississippi Medical Center, Jackson, MS, USA; 3Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Texas Health Sciences Center at Houston, Houston, TX, USA†Dr John C. Morrison passed away on September 1, 2019Correspondence: Everett F MagannDepartment of Obstetrics and Gynecology of the University of Arkansas for the Medical Sciences, 4301 W. Markham St. Slot # 518, Little Rock, AR, 72205, USATel +1 501-686-8345Fax +1 501-526-7820Email efmagann@uams.eduAbstract: Actual AFV can be determined by a dye-dilution technique or be directly measured at cesarean. This allows investigators to correlate estimated and actual AFVs. Lessons learned by assessing the relationship of estimated to actual AFVs. 1) Ultrasound estimates normal actual AFVs well, but abnormal AFVs poorly. 2) Quantile regression is a better statistical methodology to create a normal AFV curve across pregnancy. 3) There is no difference in the accuracy of the subjective (visualization without measurements) compared with the objective (visualization with measurements) technique in identifying normal and abnormal AFVs. 4) Color Doppler use leads to the over-diagnosis of oligohydramnios. 5) Intravenous hydration increases actual AFVs. 6) The estimation of AFV can be done with the transducer held perpendicular to the floor or perpendicular to the uterine contour. 7) The single deepest pocket should be used for identifying low AFVs. 8) The AFI should be used for identifying high AFVs.Keywords: amniotic fluid volume, oligohydramnios, polyhydramnios, color Doppler, subjective assessment, objective assessment

Background The aims of this study were to investigate the dynamic changes in the vena contracta (VC) and proximal isovelocity surface area (PISA) through systole in patients with hypoplastic left heart syndrome and tricuspid regurgitation and to identify the stage of systole (early, mid, or late) in which VC and PISA radius are optimal. Methods Twenty-eight patients with hypoplastic left heart syndrome were prospectively studied using continuous two-dimensional (2D) and three-dimensional (3D) echocardiography. Two-dimensional VC width, 3D VC area, and PISA radii (2D and 3D) were measured frame by frame throughout systole. The maximal 2D VC width, 3D VC area, and PISA radii in the first, middle, and last thirds of systole were compared, and correlations were explored with 3D tricuspid annular areas, right atrial volumes, and right ventricular volumes. Results In all, 35 data sets that met inclusion criteria were analyzed. On frame-by-frame analysis, maximal 2D VC width and 3D VC area were found in the first third of systole in 17% and 20% of studies, in the second third in 34% and 31%, and in the final third in 49% and 49%. Similarly, the maximal 2D and 3D PISA radii were found in the first third of systole in 26% and 17% of studies, in the second third in 28% and 34%, and in the final third in 46% and 49%. Conclusions In hypoplastic left heart syndrome, detailed temporal analysis of tricuspid regurgitation–associated VC and PISA by 2D and 3D echocardiography reveals no reliable pattern predicting when in systole these parameters peak. Frame-by-frame measurement is necessary for identification of maximal VC and PISA radius on 2D and 3D color Doppler echocardiography because the severity of tricuspid regurgitation could be underestimated because of temporal variability in VC and PISA.

In the last years, the systematic use of ultrasound mapping of the upper limb vascular network before the arteriovenous fistula (AVF) implantation, access maturation, and clinical management of late complications is widespread and expanding. Therefore, a good knowledge of theoretical outlines, instrumentation, and operative settings is undoubtedly required for a thorough examination. In this review, the essential Doppler parameters, B-Mode setting, and Doppler applications are considered. Basic concepts on the Doppler shift equation, angle correction, settings on pulse repetition frequency, operative Doppler frequency, gain are reported to ensure adequate and correct sampling of blood flow velocity. A brief analysis of the Doppler inherent artefacts (as random noise, blooming, aliasing, and motion artefacts) and the adjustment setting to minimize or eliminate the confounding artefacts are also considered. Doppler aliasing occurs when the pulse repetition frequency is set too low. This artefact is particularly frequent in vascular access sampling due to the high velocities range registered in the fistula’s different segments. Aliasing should be recognized because its correction is crucial to analyse the Doppler signals correctly. Recent advances in instrumentation are also considered about a potential purchase of a portable ultrasound machine or a top-of-line, high-end, or mid-range ultrasound system. Last, the pulse wave Doppler setting for vascular access B-Mode and Doppler assessment is summarized.

Background and Objectives: There are many causes of erectile dysfunction (ED) like congenital anomalies, neurological, endocrinal, pharmacological, psychological, pathological or hemodynamic. Penile doppler ultrasound provides real-time evaluation of cavernosal vascular flow dynamics. Purpose of our study was to evaluate and compare the baseline penile ultrasound and color doppler vascular parameters in patients of ED to see if there was any significant difference between patients of psychogenic and vasculogenic ED (diagnosed on post Papaverine injection color doppler) without the use of intracavernosal Papaverine injection. To best of our knowledge such detailed comparison of baseline penile ultrasound and doppler parameters have not been published in literature. Methods: We have prospectively studied 32 patients of ED who underwent ultrasound, and color doppler pre-and post-papaverine intracavernosal injection. Baseline pre papaverine diameters of right and left cavernosal arteries were measured on grey scale ultrasound. Peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of right and left cavernosal arteries were measured on color doppler before and after injecting intracavernosal papaverine injection. Patients were divided into normal study group (psychogenic ED), arterial insufficiency and venous leakage groups (vasculogenic ED) on the basis of post papaverine color doppler findings. Results: Eighteen patients showed normal study, 11 showed arterial insufficiency and 3 patients had venous leakage on post Papaverine injection color doppler. When base line prepapaverine vascular diameters and color doppler parameters were compared statistically, no significant difference was detected between and within these study groups. We have also compared Ed duration and IIEF scores among various study groups and found statistically significant difference between and within the groups. Conclusion: Use of a vasoactive agent like Papaverine with color Doppler is must to diagnose the vasculogenic ED.

Hepatic sinusoidal obstruction syndrome (SOS)/veno-occlusive disease is a life-threatening complication after hematopoietic stem cell transplantation (HSCT). We previously reported the efficacy of the Hokkaido Ultrasonography (US)-based scoring system (HokUS-10) for US findings. To establish easier-to-use criteria, we retrospectively evaluated US findings from 441 patients, including 30 patients with SOS using the HokUS-10 scoring system. Using logistic regression analysis, we established the novel diagnostic criteria HokUS-6. In the presence of ascites, US diagnosis was made in the presence of two of the following 6 parameters: moderate amount of ascites, the appearance of a paraumbilical vein blood flow signal, gallbladder wall thickening, portal vein dilatation, portal vein velocity decrease, and hepatic artery resistive index increase. The AUC, sensitivity, and specificity of HokUS-6 were 0.974 (95% confidence interval 0.962-0.990), 95.2%, and 96.9%, respectively. The scores were significantly higher in patients with severe SOS than in those with non-severe SOS (p = 0.013). Furthermore, the scores before HSCT were significantly higher in patients who developed SOS than in controls (p = 0.001). The HokUS-6 is an easy and useful way to diagnose and identify the risk of SOS.

Crohn’s disease is one of the two most common types of inflammatory bowel disease. Current medical therapies are based on the use of glucocorticoids, exclusive enteral nutrition, immunosuppressors such as azathioprine and methotrexate, and biological agents such as infliximab, adalimumab, vedolizumab, or ustekinumab. International guidelines suggest regular disease assessment and surveillance through objective instruments to adjust and personalize the therapy, reducing the overall rates of hospitalization and surgery. Although endoscopy represents the gold-standard for surveillance, its frequent use is strongly bordered by associated risks and costs. Consequently, alternative non-invasive tools to objectify disease activity and rule active inflammation out are emerging. Alongside laboratory exams and computed tomography or magnetic resonance enterography, intestinal ultrasonography (IUS) shows to be a valid choice to assess transmural inflammation and to detect transmural healing, defined as bowel wall thickness normalization, no hypervascularization, normal stratification, and no creeping fat. Compared to magnetic resonance imaging (MRI) or computed tomography, CT scan, IUS is cheaper and more widespread, with very similar accuracy. Furthermore, share wave elastography, color Doppler, and contrast-enhanced ultrasonography (CEUS) succeed in amplifying the capacity to determine the disease location, disease activity, and complications. This review aimed to discuss the role of standard and novel ultrasound techniques such as CEUS, SICUS, or share wave elastography in adults with Crohn’s disease, mainly for therapeutic monitoring and follow-up.

The objective of the current study was to investigate the echotextural and hemodynamic changes of ewes entering the dry period with or without subclinical mastitis. B-mode and color Doppler ultrasonography were applied to 12 Chios ewes (6 with healthy udders (group A) and 6 with subclinical mastitis (group B)) before the dry period, during the dry period (the involution phase, steady state, and transition phase), and postpartum. The color Doppler of the mammary arteries was used to evaluate them according to the pulsatility index (PI), resistive index (RI), end-diastolic velocity (EDV), time-averaged maximum velocity (TAMV), blood flow volume (BFV), and artery diameter (D). Udder parenchyma images, analyzed by Echovet v2.0, were used to evaluate the mean value (MV), standard deviation (SD), gradient mean value (GMV), gradient variance (GV), contrast (Con), entropy (Ent), gray value distribution (GVD), run length distribution (RunLD), and long run emphasis (LRunEm). In the involution phase, the PI was higher in group B compared to group A (p ≤ 0.05). The PI and RI were higher postpartum, whereas the EDV, TAVM, and D were higher in the transition phase (p ≤ 0.05). Neither the period nor the ewe group affected the MV, SD, GMV, GV, Con, and GVD values (p ≤ 0.05). In the steady state, the LRunEm was higher in group B, but postpartum, it was higher in group A (p ≤ 0.05). In conclusion, B-mode and Doppler can reveal differences (i) between healthy ewes and ewes with subclinical mastitis and (ii) among the different periods studied. Further research is needed on the blood flow and echotexture indices of the udders of ewes with unilateral subclinical mastitis.

The effective diagnosis and management of procedural complications remains an important challenge for electrophysiology operators. Intracardiac echocardiography provides a real-time imaging modality with spectral and color Doppler capabilities that integrates directly with electroanatomic mapping systems. It provides detailed characterization of anatomic variants, which allows the operator to optimize the ablation strategy to the individual thereby avoiding the inherent risk of excessive or ineffective lesions. Complications, such as intracardiac thrombus or pericardial effusion, can be detected and managed before the onset of clinical symptoms. Intracardiac echocardiography facilitates the diagnosis and management of intraoperative hypotension.

Objective Development of an ultrasound diagnostic matrix for predicting the severity of proliferative changes in the ovarian focal lesion.Material and Methods The research was conducted on the basis of the Clinical Oncology Center, Regional Clinical Hospital no. 2. Echography (B-mode), color Doppler mapping, energy Doppler mapping (pulsation index, resistance index) on GE Voluson E8 and Aloka SSD 3500 devices were used as research methods. Retrospectively, 81 patients of reproductive age from 18 to 45 years were examined. Depending on the histological structure of ovarian lesion, the results of surgical treatment, dynamic observation and the outcome of the disease, were divided into 4 clinical groups: I (n = 12; 14,8%) – controls with no changes in the structure of the ovaries; II (n = 20; 24,7%) – patients with retention ovarian lesions; III (n = 20; 24,7%) – with benign tumors; IV (n = 29; 35,8%) – with malignant tumors.Results A large number of diagnostic parameters does not always allow to formulate an instrumental diagnosis correctly because they have different diagnostic significance. That is why we made an attempt to create a diagnostic matrix. For each of the 18 parameters, three answers were offered. When analyzing the results of the study, there was an increase in the number of pathological parameters from II to IV clinical groups. Thus, in group III, the combination of 2 pathological signs was found in 65% of cases, and 3 signs – in 25% of the examined women. In group IV, the combination of 2 signs was determined in 82% of the subjects, and 3 signs in 65%.Conclusion Thus, we found out that in-depth ultrasound examination (color Doppler imaging, pulsed Doppler) allowed to identify the severity of the proliferative changes and to give the prognosis of the disease.

INTRODUCTION Erectile dysfunction (ED) is a condition that is very common all over the world, concerns about men and causes very important social problems. The aim of this study is to perform quantitative penile corpus cavernosum (CC) stiffness measurements by using SWE for patients with both types of vascular ED. METHODS In our study, we handled the data of 101 participants in total. The average age of the participants was 56.36. We divided the participants after color Doppler US (CDUS) into three groups: normal group (n = 30), arterial insufficiency (n = 51), and venous insufficiency (n = 20). SWE measurements were made in both groups in the CC flaccid (f) and rigid (r) positions, and the results were noted. International Index of Erectile Function (IIEF-5) questionnaire and Erection score (ES) were evaluated. RESULTS The mean CC f SWE and r SWE measurement values were 20.2 ± 0.8 and 17.15 ± 0.54 kPa, 3.84 ± 0.13 and 2.78 ± 0.11 m/s in the arterial insufficiency group; 15.72 ± 0.58 and 12.52 ± 0.33 kPa, 2.88 ± 0.06 and 2.09 ± 0.11 m/s in the venous insufficiency group; 14.75 ± 0.51 and 13.41 ± 0.36 kPa, 2.63 ± 0.1 and 2.34 ± 0.11 m/s in the control group, respectively. The CC measurement of f SWE and r SWE values as kPa showed significant differences between the groups (P

The Ovarian-Adnexal Reporting and Data System (O-RADS) is a lexicon and risk stratification tool designed for the accurate characterization of adnexal lesions and is essential for optimal patient management. O-RADS is a recent addition to the American College of Radiology (ACR) reporting and data systems and consists of ultrasound (US) and MRI arms. Since most ovarian or adnexal lesions are first detected with US, O-RADS US is considered the primary assessment tool. Application of O-RADS US is recommended whenever a nonphysiologic lesion is encountered. Lesion characterization may be streamlined by use of an algorithmic approach focused on relevant features and an abbreviated version of the lexicon. Resources to expedite O-RADS US categorization and determination of a management recommendation include easy online access to the ACR color-coded risk stratification scorecards and an O-RADS US calculator that is available as a smartphone app. Reporting should be concise and include relevant features for risk stratification that adhere to lexicon terminology. Technical considerations include optimization of gray-scale and color Doppler technique and performance of problem-solving maneuvers to help avoid common pitfalls. This review provides a user-friendly summary of O-RADS US with practical tips for everyday clinical use.

Anterior neck masses are common and such patients commonly present to ultrasonography units for further evaluation of underlying pathology. We encountered an atypical case of pulsatile anterior neck swelling in a 45-year-old lady. Evaluation of the swelling using neck ultrasonography and color doppler study revealed that the mass was of vascular origin and contrast-enhanced computed tomography of neck confirmed the presence of an aberrant high riding innominate artery. Knowledge of such variants is of great importance and should be reported by the concerned radiologist. Lack of knowledge of such variants may lead to inadvertent surgical complications during procedures and can be life-threatening to the patient.

Background Differentiating Graves’ disease from thyroiditis can be at times clinically challenging. The gold standard test (thyroid nuclear imaging scan) is expensive, not routinely available, and has radiation exposure. Color Doppler ultrasonography of thyroid represents a suitable alternate which can be used for differentiating these conditions by studying thyroid blood flow parameters. Aim We aimed to investigate the use of thyroid blood flow parameters’ assessment of the superior thyroid artery (STA) and common carotid artery (CCA) with color Doppler ultrasonography for differentiating Graves’ disease from thyroiditis. Materials and Methods This is a cross-sectional study on 111 patients with newly diagnosed thyrotoxicosis (82 with Graves’ disease and 29 with thyroiditis) and 45 years of age and sex-matched healthy controls. All patients underwent detailed clinical and necessary investigations. Color Doppler ultrasonography of the thyroid gland and spectral flow analysis of both superior thyroid arteries was done using standard protocol. Sensitivity and specificity for mean peak systolic velocity of STA (STA-PSV) cut-offs were calculated using receiver operating characteristic curves. Results Patients with Graves’ disease have significantly higher free tri-iodothyronine (FT3) levels, free thyroxine (FT4) levels, antithyroid stimulating hormone receptor antibody (TRAb) levels, and thyroid volume as compared with those with thyroiditis. The mean STA-PSV of patients with Graves’ disease was significantly higher than thyroiditis and control group. Mean STA-PSV greater than 54.3 cm/s had 82.9% sensitivity and 86.2% specificity in diagnosing Graves’ disease. Mean PSV-STA/PSV-CCA ratio of 0.40 was 80.5% sensitive and 86.2% specific for Graves’ disease. Conclusion Mean STA-PSV has high sensitivity and specificity in differentiating Graves’ disease from thyroiditis and can be used routinely in clinical practice as a cheap and invaluable diagnostic tool.

The increasing incidence of cardiovascular diseases (CVDs) is reflected in additional costs for healthcare systems all over the world. To date, pulse transit time (PTT) is considered a key index of cardiovascular health status and for diagnosis of CVDs. In this context, the present study focuses on a novel image analysis-based method for PTT estimation through the application of equivalent time sampling. The method, which post-processes color Doppler videos, was tested on two different setups: a Doppler flow phantom set in pulsatile mode and an in-house arterial simulator. In the former, the Doppler shift was due to the echogenic properties of the blood mimicking fluid only, since the phantom vessels are non-compliant. In the latter, the Doppler signal relied on the wall movement of compliant vessels in which a fluid with low echogenic properties was pumped. Therefore, the two setups allowed the measurement of the flow average velocity (FAV) and the pulse wave velocity (PWV), respectively. Data were collected through an ultrasound diagnostic system equipped with a phased array probe. Experimental outcomes confirm that the proposed method can represent an alternative tool for the local measurement of both FAV in non-compliant vessels and PWV in compliant vessels filled with low echogenic fluids.

Objective To analyze and classify arterial supply and venous drainage of postcatheterization femoral arteriovenous fistulas (AVFs). Methods A review of extremity Doppler reports identified 77 femoral AVFs in 75 patients. Doppler exams were reviewed retrospectively. Fistulas were classified as above or below the common femoral artery bifurcation and subclassified based on the location of arterial inflow and venous outflow. Results Arterial inflow originated above the femoral bifurcation in 32 cases. The communication was between the common femoral artery and the superficial circumflex iliac vein in 25 of 32 cases and between a branch of the common femoral or external iliac artery and the common femoral or external iliac vein in 4 of 32 cases. In 3 of 32 cases, AVFs arose from the common femoral artery, but the venous outflow was not determined. Arterial inflow originated from the superficial femoral artery in 23 cases. Venous outflow originated from the common femoral vein in 10 of 23 cases, the femoral vein in 7 of 23 cases, and the lateral circumflex femoral vein in 6 of 23 cases. Arterial inflow originated from the deep femoral artery in 12 cases. Venous outflow originated from the common femoral vein in 6 of 12 cases and from the lateral circumflex femoral vein 6 of 12 cases. In 8 cases, the AVF originated below the bifurcation, but the arterial inflow was not classified. In 2 cases, it was impossible to determine if the AVF originated above or below the bifurcation. Conclusions Iatrogenic femoral AVFs arise above the femoral bifurcation more often than previously recognized. Classification based on the arterial inflow and venous outflow provides a straightforward means of describing these fistulas.

Background: Nuchal cords are very common, with prev-alence rates ranging from 18% to 25%. Color Doppler sonog-raphy is a noninvasive method that can be used for nuchalcord diagnosis.Aim of Study: In this study, we investigated the diagnosticaccuracy of color Doppler ultrasound (US) in the detectionof nuchal cord among full term pregnant women.Material and Methods: We conducted a prospective studyon 250 full term pregnant women, who were examined bytwo-dimensional US and color Doppler US to detect nuchalcord presence. Only women with cephalic presentation andsonographicaly detected nuchal cord were included.Results: The mean age of studied group was 26.86±5.53years and the mean parity was 1.59±1.21. The mean gestational age was 38.24±1.218 weeks and the estimated fetal weight was 3.236±0.378Kg. Overall, the two-dimensional US detected 64% of the nuchal cord loops; while the color Doppler US detected 100% of the loops. Besides, the frequency of loops of cord around the neck detected after delivery was 94%; which was one loop in 83% of the cases. Accuracy of 2D US in detecting cord around the neck was 61.2%, while that of color Doppler is 94%.Conclusions: In conclusion, the accuracy of detecting thenuchal cord is more with color Doppler US than two-dimensional US.

Background: Nuchal cord is a defined as a full twist ofumbilical cord around fetal neck for at least one round. Whilemost nuchal cords have no adverse clinical consequences,emerging reports have demonstrated significant associationsbetween the presence of nuchal cord and maternal/fetal out-comes, which appears to be correlated with the tightness andnumber of cords around the neck.Aim of Study: In this study, we investigated the associationbetween nuchal cord detection during labor and perinataloutcome among full term pregnant women.Material and Methods: We conducted a prospective studyon 250 full term pregnant women, who were examined bytwo-dimensional US and color Doppler US to detect nuchalcord presence. Only women with cephalic presentation andsonographicaly detected nuchal cord were included. Thestudy's outcomes included mode of delivery, APGAR scoringat 1 and 5min, need for admission in neonatal Intensive careunit (NICU), and blood gases of the newborn.Results: The mean age of studied group was 26.86±5.53years and the mean parity was 1.59±1.21. Overall, 83% ofthe women had one loop.Conclusions: In conclusion, the presence of two or morenuchal loops may affect the mode of delivery and earlyneonatal outcome.

Aliasing is one of the most common artifacts in 2D color Doppler echocardiography. Existing methods are approximate and the most precise of them require considerable amount of computations. In the proposed paper, we describe an algorithm that modifies only areas with submaximal velocities — areas most prone to aliasing, leaving other untouched in order to facilitate the process of analysis for the radiologist. Algorithm was tested on 10 in-vivo datasets of large animals and have shown the considerable precision and computation efficiency, which made it real-time compatible.

RESUMEN TRAP describe la perfusión crónica de un gemelo "acardíaco" por un gemelo "de bomba" a través de canales vasculares entrelazados permeables. La secuencia TRAP ocurre en 1 de cada 35.000 nacimientos o en 1 de cada 100 pares de gemelos monocigóticos. Se diagnostica mediante los hallazgos ecográficos de un feto de desarrollo normal y una masa amorfa con frecuencia con partes fetales perceptibles. El Doppler color revela el flujo sanguíneo reverso hacia el gemelo acardíaco dentro de la arteria umbilical lo que lleva a las complicaciones típicas del cuadro. El manejo expectante es razonable en ausencia de características pronósticas deficientes. El propósito de este artículo es revisar los aspectos básicos y el estado actual de esta condición, haciendo énfasis en el diagnóstico y el manejo expectante.

Background Fibular flaps have been widely used for mandibular and maxillary reconstructions. On occasion, anatomical variants of fibular arteries (FA) will be encountered. Purpose Although anatomical variants of FA during fibular harvest have been reported, controversy exists regarding whether simple color Doppler ultrasonography (CDU) and physical examinations (PE) are sufficient for early preoperative detection. Material and Methods A 10-year retrospective analysis in our department was performed to find the patients with various FA anomalies confirmed by computed tomography angiography (CTA) or intraoperative findings. Results A total number of 19 FA anomalies were found either pre- or intraoperatively in 16 patients, in whom three cases were with bilateral FA variants. Type IIIC variants, also called arteria peronea magna (great peroneal artery), were confirmed in two legs, while the majority (13 legs) had type IIIA hypoplastic/aplastic posterior tibialis arteries (PTA). Four legs had new type IIID (low FA and PTA bifurcations). Preoperative CDU and PE only suspected anomalies in two legs. Six cases proceeded with using the affected fibulas, within whom vascular grafts were used in half of them for lengthening the FA pedicle. Local ischemia, partial soleus muscle necrosis, and claudication were reported in one. Conclusions Routine CTA before every fibular harvest, rather than simple PE and CDU, should be added for screening contraindications and ensuring safety for fibular flap harvest.

Breast pseudoaneurysm is an extremely rare complication of interventional breast procedures. Pregnancy and lactation are associated with increased breast vascularization, which may act as a risk factor. We present the case of a 36-year-old woman in the third trimester of a spontaneous twin pregnancy, who presented with a newly-detected BI-RADS 4 mass in her right breast. The patient requested not to defer a biopsy until after the pregnancy, and an ultrasound-guided breast core biopsy was performed. The patient presented bleeding during the procedure, but no hematomas or other vascular lesions were immediately detected. During follow-up, a breast ultrasound revealed an anechoic circumscribed mass and high‐velocity blood flow. The color Doppler showed a spiral blood flow with the Yin-Yang sign, together with a communication channel between the sac and feeding artery. A diagnosis of breast pseudoaneurysm was made. The patient was managed conservatively, and breastfeeding continued normally. This case report highlights the importance of color Doppler in the detection of pseudoaneurysms, and the need to consider deferring invasive breast procedures in pregnant women when possible.

Diagnostic ultrasound (DUS) is, arguably, the most common technique used in obstetrical practice. From A mode, first described by Ian Donald for gynecology in the late 1950s, to B mode in the 1970s, real-time and gray-scale in the early 1980s, Doppler a little later, sophisticated color Doppler in the 1990s and three dimensional/four-dimensional ultrasound in the 2000s, DUS has not ceased to be closely associated with the practice of obstetrics. The latest innovation is the use of artificial intelligence which will, undoubtedly, take an increasing role in all aspects of our lives, including medicine and, specifically, obstetric ultrasound. In addition, in the future, new visualization methods may be developed, training methods expanded, and workflow and ergonomics improved.