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OBJECTIVES: The Salivary Gland Committee of the American Academy of Otolaryngology-Head and Neck Surgery seeks to standardize terminology and technique for ultrasonograpy used in the evaluation and treatment of salivary gland disorders. METHODS: Development of expert opinion obtained through interaction with international practitioners representing multiple specialties. This committee work includes a comprehensive literature review with presentation of case examples to propose a standardized protocol for the language used in ultrasound salivary gland assessment. RESULTS: A multiple segment proposal is initiated with this focus on the submandibular gland. We provide a concise rationale for recommended descriptive language highlighted by a more extensive supplement that includes an extensive literature review with additional case examples. CONCLUSION: Recommendations are provided to improve consistency both in performing and reporting submandibular gland ultrasound.

Background: The radial artery is the most preferred access for coronary interventions. Radial artery occlusion (RAO) is a common complication and serious concern after transradial approach (TRA). The current study assessed the clinical, angiographic, and Doppler ultrasound correlation of RAO and its predictors after TRA. Methods: This was a prospective, observational study done on 300 patients who underwent elective diagnostic coronary examination, and elective percutaneous coronary intervention (PCI) through TRA was included. Baseline, clinical, and procedure-related data were recorded, and radial artery patency was assessed by radial pulse examination. Radial artery diameter was measured by Color Doppler Ultrasonography (USG) and angiography, and it was estimated one day before the procedure, within 24 hours, and three months after the procedure. The incidence of RAO and their predictors were evaluated after TRA. Results: The mean age of the study cohort was 53 ± 11 years, mainly males (69%). The mean radial arterial diameter on USG and radial angiography were 2.6 ± 0.36 mm and 2.55 ± 0.42 mm, respectively. After the procedure, the incidence of RAO (n=62, 20.66%) was confirmed via USG and 10 (16.12%) patients underwent recanalization after TRA. Weight, height, mid-arm circumference (MAC), and shoe size had a significant positive correlation (p<0.01) with pre-procedural radial artery diameter. On multivariate logistic regression analysis, females (p<0.001), smoking habits (p<0.001), height (p=0.01), and chronic kidney disease (CKD) (p=0.01) were found as independent predictors of the RAO. Conclusion: Weight, height, MAC, and shoe size can be correlated with radial artery diameter. Females, smoking habit, height, and CKD were found to an independent predictor of RAO. However, the predictors of RAO following TRA are not well-defined; therefore, a proper understanding of the predictors of RAO can be beneficial for its prevention. [ABSTRACT FROM AUTHOR]

Introduction: The complex nature of Sjögren's Disease (SjD) necessitates a comprehensive and patient-centered approach in both diagnosis and management. This narrative review emphasizes the need for a holistic understanding of the connection between salivary gland inflammation and oral symptoms in SjD. Areas covered: The intricate relationship between salivary gland inflammation and dry mouth is explored, highlighting the variability in associations reported in studies. The association of the severity of xerostomia and degree of inflammation is also discussed. The frequent presence of recurrent sialadenitis in SjD further accentuates the connection of compromised salivary gland function and inflammation. The review additionally discusses local inflammatory factors assessed through salivary gland biopsies, which could potentially serve as predictors for lymphoma development in SjD. Insights into compromised quality of life and hypercoagulable state and their association with salivary gland inflammations are provided. Advancements in noninvasive imaging techniques, particularly salivary gland ultrasonography and color Doppler ultrasound, offer promising avenues for noninvasive assessment of inflammation. Expert opinion: There is a need for longitudinal studies to unravel the connections between salivary gland inflammation and oral symptoms. This will enhance management strategies and optimize treatment outcomes for SjD patients. [ABSTRACT FROM AUTHOR]

Venous obstructions and thrombosis can present diagnostic challenges due to their varied presentations and potential for significant complications if untreated. Pulse wave doppler ultrasound via identification of damping or loss of cardiac pulsatility and/ or respiratory phasicity of venous waveforms serves as a practical, noninvasive, fast, and efficient diagnostic tool for identifying venous obstructions in the presence of compressible veins beyond the point of evaluation. We present two cases demonstrating the effectiveness of pulse wave doppler ultrasound in identifying significant and life-threatening venous obstructions. The first case involves a 68-year-old male with an incidental finding of a compressible left subclavian vein showing a monophasic waveform. Further investigation revealed significant compression of the left brachiocephalic vein by an aortic arch aneurysm. The second case describes a 65-year-old male with a compressible right femoral vein but a monophasic waveform, leading to the discovery of extensive thrombosis from the iliac veins to the inferior vena cava. This series proposes to always assess cardiac pulsatility and respiratory phasicity during doppler ultrasound procedure such as thyroid ultrasounds, deep vein thrombosis (DVT) evaluations, and pre-central vein catheterizations for identifying any venous obstructions, whether they are intrinsic or extrinsic, and for reducing the risk of thromboembolic complications. [ABSTRACT FROM AUTHOR]

Background: Intestinal changes in inflammatory bowel disease (IBD) are frequently observed on ultrasound. Invasive diagnostic procedures are often employed to differentiate between the main types of IBD and detect complications. Ultrasound Strain Elastography (SE) is a promising non-invasive technique for detecting intestinal changes and assessing inflammatory activity in pediatric IBD. Aim of the study: This research aims to evaluate the diagnostic performance of conventional ultrasound, color Doppler, and SE in assessing inflammatory bowel disease in pediatric patients, both separately and in combination as additional tools. Patients and methods: Forty patients (18 females and 22 males) initially diagnosed with IBD through clinical and endoscopic biopsy, along with 20 healthy controls, underwent conventional ultrasound, color Doppler, SE, and laboratory evaluations, including CBC, ESR, CRP, Fecal calprotectin, and assessment of IBD activity using PIBDAI. Results: Conventional ultrasound, color Doppler, and SE significantly contributed to detecting disease activity and intestinal changes in IBD (p < 0.001; 95% CI 0.79–1.100), demonstrating better sensitivity in combination compared to each method individually. The combined approach showed 100% sensitivity, 84% specificity, 78.6% precision (Positive Predictive Value), 100% Negative Predictive Value, and an overall accuracy of 92%. Conclusion: The addition of Color Doppler and SE parameters to grayscale ultrasound provides diagnostic value comparable to endoscopy, histopathology, and laboratory markers in detecting inflammatory activity and intestinal changes in IBD. This combined approach can help avoid unnecessary invasive techniques for follow-up. [ABSTRACT FROM AUTHOR]

Objectives: To detect ultrasonographic anatomical alterations in all the skin layers in patients with vitiligo. Methods: A prospective observational color Doppler ultrasound study was performed in nonsegmental face and/or neck vitiligo patients without a history of previous treatments. Two sites, a lesional area and a contralateral clinically healthy region, were ultrasonographically studied and compared in the same patient. All cases were studied in high‐frequency (24 MHz) and ultra‐high‐frequency (70 MHz) ultrasound devices with the highest axial spatial resolution available in the market. Demographic data of the sample, ultrasound grayscale, and color Doppler features were recorded and analyzed. Results: Ten patients met the study criteria (60% females; mean age 49 years). All cases presented ultrasonographic undulation of the epidermis in the affected zones vs 50% in the healthy control regions, being more prominent in the vitiligo areas. Eighty percent demonstrated intense hypoechoic thin plaques in the upper dermis (subepidermal). All vitiligo areas presented thickening and hypoechogenicity of the regional hair follicles and/or pilosebaceous units. Ninety percent showed prominent sebaceous glands, and 20% demonstrated a hypoechoic cap surrounding the sebaceous glands in the lesional areas. Dermal hypervascularity was detected in 100% of the affected regions and 40% of the clinically healthy areas. Conclusion: Ultrasound can identify subclinical inflammatory cutaneous patterns in the epidermis, dermis, hair follicles, pilosebaceous units, and sebaceous glands in vitiligo. This noninvasive information can support early detection, monitoring, and research, including the clinical trials of drugs used to manage this devastating disease. [ABSTRACT FROM AUTHOR]

Simple Summary: This study explores kidney disease in young dogs, focusing on early diagnosis, management, and the importance of staging for effective treatment. Highlighting mineral metabolism imbalances and complications like nephrocalcinosis, the study presents a case of severe renal failure with uremic syndrome and bilateral nephrocalcinosis in a 50-day-old puppy. Despite intensive care, the puppy's condition worsened rapidly, leading to euthanasia. The study underscores the challenges in diagnosing and managing canine nephrocalcinosis in young animals. It emphasizes the need for further research to improve the understanding and treatment outcomes in such cases, enhancing the quality of life for animals suffering from this rare condition. This study explores kidney disease in young dogs, focusing on early diagnosis, management, and the importance of staging for effective treatment. Highlighting mineral metabolism imbalances and complications such as nephrocalcinosis, the study presents a case of severe renal failure with uremic syndrome and bilateral nephrocalcinosis in a 50-day-old puppy. Despite intensive care, the puppy's condition deteriorated rapidly, leading to euthanasia. The study underscores the challenges in diagnosing and managing canine nephrocalcinosis in young animals. It emphasizes the need for further research to improve the understanding and treatment outcomes in such cases, ultimately enhancing the quality of life for animals suffering from this rare condition. [ABSTRACT FROM AUTHOR]

Background: Biliary atresia is a congenital biliary condition that is defined by an absence or severe deficit of the extrahepatic biliary tree. Objective: To detect the role of color Doppler and gray scale ultrasonography as possible tools in evaluation of cases of neonatal jaundice for biliary atresia in comparison to intraoperative cholangiography as a golden test in the diagnosis of biliary atresia. Patients and Methods: This is a prospective study that included assessment of 100 cases, over a period of two years from the outpatient clinic and the inpatient department of Pediatric Hepatology, gastroenterology and nutrition Department, National Liver Institute, Menoufia University, diagnosed by neonatal cholestaisis. Results: US score and total biliary atresia score were higher in biliary atresia cases (7.40± 3.69 and 21.73± 3.79, respectively) than non-biliary atresia cases diagnosed by intraoperative cholangiography. Conclusion: We found that US serves as an important non-invasive imaging modality in diagnosis of BA. In addition to US imaging features as gall bladder abnormalities (small, rudimentary or absent gall bladder), positive TC sign and associated congenital anomalies, color Doppler play an important role in diagnosis of BA as it was found that enlargement of the hepatic artery diameter can be highly suggestive of biliary atresia. [ABSTRACT FROM AUTHOR]

Aim: To explore whether ultrasound (US) can be employed to identify the underlying characteristics associated with pain in patients with podagra by evaluating the relationship between ultrasound findings and clinical pain. Material and methods: Patients with podagra were recruited and grouped into a pain group (G1, 82 patients) and a non pain group (G2, 123 patients). US features were collected and compared. US data were analyzed by binary logistic regression analysis and ROC analysis. Interobserver reliability was assessed, too. Results: A total of 205 patients (196 male and 9 female) were enrolled in this study. In multivariate analysis, the thickness of the synovium (OR=1.928, CI=1.074-3.463), CD (color Doppler) signal of the synovium (OR=1.458, CI=1.011-2.103), and CD signal of the tophi (OR=1.576, CI=1.142-2.177) were identified as risk factors for clinical pain. Areas under the ROC curves (AUC) were 0.713, 0.686 and 0.641 for the three indicators, respectively. The best cutoff points were 1 mm for the thickness of the synovium, grade 1 for the CD signal of the synovium and grade 2 for the CD signal of the tophi. Conclusions: Ultrasound can provide valuable information for determining underlying features associated with pain in patients with podagra. [ABSTRACT FROM AUTHOR]

Femoral vein is increasingly used for venous cannulation procedures. Its anomalies in the femoral triangle could complicate these procedures. We report an extremely rare type of femoral venous ladder observed during routine cadaveric dissections. The variation was found in the left lower limb of an adult male cadaver aged 70 years. The femoral vein was a single vein in initial 3 cm and terminal 4 cm of its course. The middle part of the vein showed a duplication and a complex ladder pattern and encircled the femoral artery in the femoral triangle. This anomaly could predispose the vein for deep vein thrombosis. Knowledge of this anomaly could be useful during radiological procedures, femoral hernia repair and femoral triangle abscess and lymph node clearance. [ABSTRACT FROM AUTHOR]

Objective: To investigate the value of the sonographic identification of deep infiltrating endometriosis (DIE) in women presenting with complaints suggestive of DIE. Sonography findings were correlated with subsequent surgical exploration, and histologic verification. Methods: A retrospective observational case series was investigated to document the ability of the use of sonography to accurately detect the presence of deep infiltrating endometriosis. The clinical observations were performed consistent with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations for observational studies. Recognizing the real‐world office setting for this may introduce the importance of the practical clinical aspects of diagnostic procedures in general. Results: Three‐dimensional transvaginal sonography was able to accurately identify deep invasive endometriosis in 92% of the 100 women subjectively complaining of the associated symptoms of endometriosis, who underwent sonography, surgical exploration, and pathologic analysis. Additional sonographic evidence of pelvic pathology was found during the course of this investigation, perhaps complementing other means for diagnosing endometriosis. Conclusion: Three‐dimensional transvaginal sonography is a diagnostic tool that can effectively identify deep infiltrating endometriosis, which may otherwise go undetected and untreated. These findings should encourage the use of sonography for the detection of this subtype of endometriosis. Synopsis: A series of cases is described of sonographically detected deep infiltrating endometriosis with three‐dimensional transvaginal sonography, which were all surgically explored and histologically examined. [ABSTRACT FROM AUTHOR]

Koray Özbay, Altu&gbreve; Semiz Department of Obstetrics and Gynecology, Memorial &Scedil;i&scedil;li Hospital, Istanbul, TurkeyCorrespondence: Koray Özbay, Department of Obstetrics and Gynecology, Gebze Yüzy&inodot;l Hospital, Ilyas Bey Cad. No:38, Gebze/Kocaeli, Turkey, Tel +90-5394737958, Email ozbaykoray@gmail.comPurpose: We aimed to assess uterine and arcuate artery Doppler indices in patients with mild primary dysmenorrhea.Patients and Methods: A total of 55 patients were included, consisting of women without dysmenorrhea (n=26, group A) and women with mild primary dysmenorrhea (n=29, group B). Doppler measurements of the uterine and arcuate arteries were performed in both groups on the 1st-2nd days and 21st-24th days (midluteal phase) of the menstrual cycle using transvaginal ultrasound and compared between the groups. The severity of dysmenorrhea was assessed using visual analog scale scores.Results: Doppler measurements of the uterine and arcuate arteries performed on the 1st-2nd days of the menstrual cycle and the midluteal phase were similar between the groups (p> 0.05). There was a significant decrease in the intragroup measurements of uterine and arcuate arteries performed on the first day of menstruation and the luteal phase in both groups (p< 0.01).Conclusion: Doppler findings of the uterine and arcuate arteries did not differ between patients with and without mild primary dysmenorrhea. The etiology of primary dysmenorrhea mainly involves ischemia and vasoconstriction, but mild primary dysmenorrhea appears to be associated with a different etiology other than decreased tissue perfusion.Keywords: color Doppler, primary dysmenorrhea, ultrasonography, blood circulation, menstruation

Aim: To explore the performance of single or combined ultrasound (US) in diagnosing malignant breast lesions, and then compare the results with a magnetic resonance imaging (MRI) aspect. Material and methods: Patients’ demographics, tumor markers, and imaging examination were collected. Diagnostic models based on B-mode, color Doppler ultrasounds (CDU), strain elastography (SE), MRI, B-mode US + CDU, B-mode US + SE, and B-mode US + CDU + SE were developed using logistic regression analysis. The performance was assessed using the area under the curve (AUC) with 95% confidence intervals (CIs). Performance of MRI and B-mode US + CDU was compared using DeLong analysis. Results: For single imaging modality, MRI showed the best performance, with AUC of 0.938 (95%CI: 0.888-0.988). For combined US modalities, combination of B-mode US and CDU had the best performance, with AUC of 0.948 (95%CI: 0.877-1.000). There was no significant difference in the diagnostic performance between the combination of B-mode US and CDU and MRI (p>0.05). Conclusions: Our study found the performance of B-mode + CDU was comparable to MRI. Our findings suggested that the combination of B-mode US and CDU was recommended to diagnose malignant breast lesions in order to save time and expense and provide guidance to make decisions for a biopsy. [ABSTRACT FROM AUTHOR]

The color Doppler twinkling artifact has been attributed to existing microbubbles or cavitation occurring on rough objects such as kidney stones, some breast biopsy clips, catheter guidewires and sandpaper. The objective was to investigate the correlation between the surface characteristics of helical constructs with different groove geometries and the occurrence of twinkling, as well as to identify locations conducive to bubble retention and/or cavitation. Six half-cylinders were created with a microscale 3-D printer with 5 µm resolution to replicate the geometry of twinkling helical constructs resembling catheter guidewires. Four copies of each marker including a non-twinkling control were printed. The half-cylinders had pitch (peak-to-peak distance) values ranging from 87.5 to 343 µm and amplitude (groove depth) values ranging from 41.5 to 209 µm. The half-cylinders were submerged in degassed water and optically imaged before and after ultrasound insonification to visualize bubbles on the cylinders. The cylinders remained submerged while scanning with the color Doppler mode at frequencies from 3.1 to 6.3 MHz using a GE Logiq E9 scanner and 9L linear array transducer. Two markers exhibited twinkling: one with pitch-to-amplitude ratio of 174/210 µm/µm (0.8) that twinkled only with pre-existing bubbles on the marker; the other had a ratio of 87/87 µm/µm (1.00) that twinkled without pre-existing bubbles on the marker. This work provides strong evidence that both existing bubbles and either cavitation or ultrasound wave interactions with patterned or rough surfaces are significant factors in producing the twinkling signature. [ABSTRACT FROM AUTHOR]

Breast cancer is the leading cause of cancer mortality in women, and it is on the rise in Iran. Therefore, an early-stage diagnosis of breast cancer is of critical importance. Because ultrasound is one of the available, inexpensive, and minimally invasive techniques for distinguishing malignant from benign masses, a comparison of conventional ultrasound, color Doppler, and spectral Doppler findings can be useful. The purpose of this study was to determine the diagnostic value of sonographic indices, specifically Doppler parameters, in identifying the nature of breast masses. This is a cross-sectional study, with diagnostic value analysis. Before undergoing a biopsy, 80 patients with breast masses underwent B-mode and Doppler breast ultrasound. The ultrasound findings were then compared to pathologic results to determine which groups were malignant or benign. The resulting data were analyzed using statistical tests and diagnostic values with SPSS 22 software. B-mode grey-scale ultrasound indices such as mass shape, mass margin, mass orientation, and posterior features, as well as Doppler indices such as vascularity, RI (Resistive Index), PI (Pulsatility Index), and PSV (Peak Systolic Velocity), were found to be statistically significant with pathological findings. Color Doppler revealed vascularity in 65% of benign and 84% of malignant masses. The diagnostic value results revealed that mass shape, mass margin, mass orientation, and posterior features all play a significant role in predicting lesion malignancy, with a sensitivity of 92%, 58%, 64%, 56%, and specificity of 59%, 66%, 82%, and 84%, respectively. The RI, PI, and PSV indices were significantly higher in malignant masses, and all of them had remarkable diagnostic values in predicting malignancy, with a (Area Under The Curve) AUC of 0.863, 0.882, 0.702, a sensitivity of 84% and 84%, 68%, and a specificity of 83%, 86%, and 62%, respectively, at the optimal cut-off points (0.65, 1.32, 12.40) obtained from the Receiver Operating Characteristics (ROC) curves. [ABSTRACT FROM AUTHOR]

Context and Aim: The purpose of antenatal ultrasonography (USG) is to identify women at risk of complications due to various medical conditions such as pregnancy-induced hypertension (PIH) and preeclampsia. Our aim was to describe the practical application of Doppler indices of the uterine, umbilical, and fetal middle cerebral artery (MCA) in patients with PIH by comparing them with perinatal outcome. Materials and Method: A prospective longitudinal study of 50 pregnant women with a clinical diagnosis of PIH referred for USG and color Doppler and followed for any adverse perinatal outcome till 7 days after delivery was done. Patients were examined using the convex probe of 1–5 MHz frequency on the IU22 (Philips) machine. Results: In this study, 46% of patients were in the age group of 26–30 years and 64% were multiparous. Out of 50 patients, 43 were live births and 7 stillbirths. Out of live births, 35 required neonatal intensive care unit admission and five had neonatal mortality. Umbilical artery Doppler indices were altered in 42, uterine artery in 26, and fetal MCA in nine patients. Absent and reversed end‑diastolic flow in the umbilical artery, the persistence of diastolic notch in the uterine artery, and the brain‑sparing effect in fetal MCA represented the most ominous signs. Doppler indices were abnormal in more than one artery in stillbirths and neonatal deaths. Conclusion: The knowledge of the uterine, umbilical, and fetal cerebral artery waveforms helps to assess compromised uteroplacental and fetoplacental circulation in patients with PIH at the earliest. Hence, the detection of altered indices should be an alerting signal for intensive fetal monitoring and prompt intervention. [ABSTRACT FROM AUTHOR]

This study aimed to describe using Doppler ultrasonography to detect non-pregnant cows on day 19 post-AI in Chitagá, Norte de Santander, Colombia. A cross-sectional study was conducted, involving 46 multiparous Holstein cows. It was found that embryonic death for the period 19-35 post-AI was 15%. The reported Kappa value for Color Doppler and Power Mode Ultrasonography (USG) about the gold standard (B-Mode USG on day 35 post-AI) was 58% and 54%, respectively. The sensitivity and specificity of the Color Doppler test were 97.9% and 64.6%, respectively, while for Power Mode USG, the sensitivity and specificity were 94% and 62%, respectively. Finally, the area under the curve for the parallel combination of the diagnosis of B-Mode USG on day 35 post-AI as a cutoff point for the detection of pregnant cows on day 19 post-AI (Color Doppler and Power Mode) was 0.83 and 0.58, respectively. It is concluded that Color Doppler USG showed better sensitivity, specificity, Kappa index, and a higher area under the curve compared to Power Mode Doppler USG, and it could potentially be a valuable tool for the early detection of nonpregnant cows on day 19 post-AI. [ABSTRACT FROM AUTHOR]

Abstract Background Dermatofibrosarcoma protuberans (DFSP) has a high recurrence rate after resection. Because of the lack of specific manifestations, recurrent DFSP is easily misdiagnosed as post-resection scar. A few series have reported ultrasound findings of recurrent DFSP; moreover, the usefulness of contrast-enhanced ultrasound in differentiating recurrent DFSP has not been studied. Objective We investigated conventional and contrast-enhanced ultrasound in the differential diagnosis of recurrent DFSP and post-resection scar. Methods We retrospectively evaluated the findings of conventional and contrast-enhanced ultrasound in 34 cases of recurrent DFSP and 38 postoperative scars examined between January 2018 and December 2022. Results The depth and vascular density of recurrent DFSP were greater than those of postoperative scars (P

Context and Aim: The purpose of antenatal ultrasonography (USG) is to identify women at risk of complications due to various medical conditions such as pregnancy-induced hypertension (PIH) and preeclampsia. Our aim was to describe the practical application of Doppler indices of the uterine, umbilical, and fetal middle cerebral artery (MCA) in patients with PIH by comparing them with perinatal outcome. Materials and Method: A prospective longitudinal study of 50 pregnant women with a clinical diagnosis of PIH referred for USG and color Doppler and followed for any adverse perinatal outcome till 7 days after delivery was done. Patients were examined using the convex probe of 1–5 MHz frequency on the IU22 (Philips) machine. Results: In this study, 46% of patients were in the age group of 26–30 years and 64% were multiparous. Out of 50 patients, 43 were live births and 7 stillbirths. Out of live births, 35 required neonatal intensive care unit admission and five had neonatal mortality. Umbilical artery Doppler indices were altered in 42, uterine artery in 26, and fetal MCA in nine patients. Absent and reversed end-diastolic flow in the umbilical artery, the persistence of diastolic notch in the uterine artery, and the brain-sparing effect in fetal MCA represented the most ominous signs. Doppler indices were abnormal in more than one artery in stillbirths and neonatal deaths. Conclusion: The knowledge of the uterine, umbilical, and fetal cerebral artery waveforms helps to assess compromised uteroplacental and fetoplacental circulation in patients with PIH at the earliest. Hence, the detection of altered indices should be an alerting signal for intensive fetal monitoring and prompt intervention.

Monitoring blood flow in a buried flap is often challenging. In cases of free jejunal transfer, although exteriorization of a minor jejunal segment has become the standard method, there remain issues such as intestinal fluid management, the need for separation of the monitored jejunum, and high false positive rates. In this study, we performed monitoring using handheld ultrasound (Vscan Extend™; GE Healthcare, Japan) in four patients who had undergone free jejunal transfer between August 2022 and December 2022. The blood flow in the anastomosed vessels and the peristalsis of the jejunum were observed in all patients. There were no cases of reoperation due to early failure such as thrombosis of vascular anastomosis or vessel spasm. The handheld ultrasound made it possible to adequately evaluate both the blood flow in the anastomosed vessels and the peristalsis of the transplanted jejunum. Handheld ultrasound can be useful for monitoring blood flow in a buried flap.

Objectives: The objective of the study was to correlate color Doppler with the vascularization of choroidal melanoma (CM) observed in histopathological sections and also to analyze the vascular histopathological prognostic factors of these tumors. Patients, Materials, and Methods: This was an experimental, cross-sectional, and analytical study carried out at Escola Paulista de Medicina - UNIFESP (São Paulo) and at the Ocular Pathology and Translational Research Laboratory of McGill University (Montreal/Canada). Twenty-five enucleated eyes of patients with CM were studied, 10 patients studied at UNIFESP and 15 patients studied at McGill University. The first 10 patients (Brazil), before enucleation, were submitted to color Doppler, all performed at UNIFESP. The resistance index (RI) and maximum systolic velocity of each tumor were calculated. The inclusion criteria of this study were as follows: CMs >8 mm in thickness, enucleation as primary treatment, histopathological blocks sufficient for hematoxylin-eosin staining, periodic acid-Schiff, and CD34 immunohistochemistry. Exclusion criteria included tumors smaller than 8 mm and/or previous treatments such as laser or brachytherapy. Regarding the histopathology of each CM, cell-type classification, vessel diameter measurements, count of the number of mitoses, and vascular clefts were carried out. The latter are considered vessels because they are lined by endothelium (CD34 positive) and surrounded by melanoma cells. Results: There was a statistical correlation between RI and cell type (P < 0.05). Tumors with a better prognosis (spindle cell) showed higher RI compared to epithelioid tumors, with a worse prognosis. The number of mitoses and vascular clefts correlated with the cell type, with a statistically significant difference (P < 0.001). Tumors of worse prognosis (epithelioid) showed an increase in the number of mitoses and in the number of vascular clefts. There was no difference between vessel diameter and cell type. Conclusions: The number of vascular clefts has a positive prognostic correlation with the malignancy of CM. Doppler RI showed a positive prognostic correlation with CM malignancy. For the first time, the usefulness of vascular clefts as prognostic factors was proven, and a new classification of the vascular network in CMs was proposed. [ABSTRACT FROM AUTHOR]

Introduction: The brain-sparing (BS) phenomenon is considered an adaptive mechanism of the fetus, which is activated to protect the fetal brain in adverse conditions. The current challenge is, therefore, to identify vulnerable fetuses at risk of hypoxic complications, particularly within an apparently low-risk cohort before the onset of labor. The cerebroplacental ratio (CPR) is emerging as an important predictor of adverse pregnancy outcomes, and this has implications for assessment of the well-being of SGA and AGA fetuses close to term. Materials and methods: It was a hospital-based prospective observational study. After obtaining informed consent from the patient, she was subjected to detailed history-taking and examination and underwent antenatal USG with color Doppler for CPR calculation. Observations and results: The mean age of females enrolled in the study was 25.95 ± 3.50 years. About 63.5% patients had normal vaginal delivery, 35.0% had cesarean delivery, and 1.5% had instrumental delivery for intrapartum fetal compromise. Patients were divided into groups on the basis of Doppler findings, i.e., CPR ≤1.08 (n = 50) and CPR >1.08 (n = 150), adverse outcomes were significantly higher in groups with CPR ≤1.08 than in groups with CPR >1.08. CPR ≤1.08 was found to be 56.25% sensitive and 95.83% specific in predicting the poor outcome. Conclusion: With the high specificity and positive predictive value of CPR, it is likely that those having normal CPR will have very less chance of adverse perinatal outcomes and, therefore, their delivery can be conducted at a peripheral center, and those with low CPR should be timely referred to a higher center where there are facilities for extensive fetal monitoring during the intrapartum period with availability of the neonatal unit (NNU). [ABSTRACT FROM AUTHOR]

Objectives: Our institution introduced universal vasa previa (VP) screening utilizing transabdominal ultrasound with color Doppler for all pregnancies at the second trimester anatomy scan. Our study sought to describe the clinical impact of this intervention. Methods: Radiology records from the 12 months pre‐ and post‐intervention were queried for "vasa previa." Records included for analysis were those with a first‐time diagnosis or discussion of VP at the anatomy scan. Cases were categorized by outcome: (Group 1) True VP, with subgroups A, unresolved by time of delivery and B, resolved by delivery; (Group 2) False positives; (Group 3) Possible VP without definitive diagnosis; and (Group 4) VP ruled out, for example, "no features of VP." Group size was expressed as a percentage of total anatomy scans during pre‐ or post‐intervention periods respectively. Absolute and relative percent change were calculated for each group. Results: In the pre‐intervention period, 1 case (0.36% of total scans) was categorized in Group 1A, 1 case (0.36%) in Group 3, and 7 cases (2.53%) in Group 4. In the post‐intervention period, 2 cases (0.30%) were in Group 1A, 4 cases (0.61%) in Group 1B, 2 cases (0.30%) in Group 2, 1 case (0.15%) in Group 3, and 7 cases (1.06%) in Group 4. There was a +153% relative change in true positives, from 0.36 to 0.91%. Conclusions: Universal color Doppler screening may have increased detection (sensitivity) while simultaneously increasing false positives (decreased specificity). While decreasing sensitivity is not ideal, this is acceptable given the potential catastrophic outcome of a missed VP. [ABSTRACT FROM AUTHOR]

With the Superb Micro-Vascular Imaging (SMI), the established Doppler technology has been extended by another mode. With this technique, microvascular structures with slow blood flow can now also be displayed in real time. As with the introduction of Doppler ultrasound, this new technique opens further diagnostic fields for the examiner, which were previously reserved for magnetic resonance imaging (MRI), computed tomography (CT) or contrast ultrasound (CEUS). Focal nodular hyperplasia (FNH) of the liver is characterized by a typical spoke-wheel vascular malformation (spoke-wheel sign, SWS) and a good example using SMI for the diagnostic profit of our patients. The aim of this report is to describe the use of SMI as a new non-invasive, quick, and probably cost-effective diagnostic imaging tool. [ABSTRACT FROM AUTHOR]

Objective: We describe transvaginal color Doppler, HDlive, and HDlive Silhouette features of an umbilical cord cyst (UCC) before 11 weeks of gestation. Methods: In this cohort study, 135 transvaginal dating scans were performed at 7 to 10 + 6 weeks of gestation, and 17 UCCs were identified (12.6%). UCC was evaluated using color Doppler, HDlive, and HDlive Silhouette. The clinical characteristics, pregnancy courses, and outcomes were also investigated. Results: UCC location was on the fetal side in six cases, at the free loop in 10 cases, and on the placental side in one case. There were seven single and 10 multiple cysts. Cyst diameters ranged from 3.3 to 11.3 mm (mean, 5.6; standard deviation, ±2.1). Blood flow inside the cyst was noted in three cases (17.6%). HDlive clearly showed the spatial relationships among UCC, the umbilical cord, midgut herniation, yolk sac, and embryo. Location of UCC could be clearly identified with HDlive. HDlive Silhouette showed central cysts inside UCCs in seven cases (41.2%). HDlive Silhouette also clearly demonstrated the sac of midgut herniation in the umbilical cord in 12 cases (70.6%). All UCCs resolved before 15 weeks (mean, 11.1 weeks; standard deviation, ±1.5). All fetuses with UCCs showed good neonatal outcomes. Conclusion: The incidence of UCC was high compared with that in previous reports. Color Doppler, HDlive, and HDlive Silhouette may provide information on the nature and origin of UCCs before 11 weeks of gestation. UCC before 11 weeks of gestation may be a common, transient, and benign finding. Synopsis: An umbilical cord cyst before 11 weeks of gestation is a common, transient, and benign finding in utero. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to objectively assess the long-term results of laparoscopic orchidopexy in patients who were diagnosed clinically to have nonpalpable undescended testis (UDT). Materials and Methods: All operated cases of nonpalpable UDT from January, 2000, to January, 2014, were reviewed. After informed consent, all patients were subjected to a color Doppler ultrasound examination to assess the location of the testis, its size, blood supply, and consistency. The size of the testis, operated and nonoperated, was noted down in volume using the formula of 0.71 x length x breath x height. Results: A total of 114 patients could be identified, who had undergone laparoscopy for nonpalpable UDT in the study period. Of these, 44 patients (54 units) underwent a color Doppler study to assess the testes. All the testes were found to lie in the scrotum with preserved blood supply. The volume of the operated unilateral testes (mean = 1.605 cm³) was smaller than the normal nonoperated side (mean = 2.524 cm³). The smaller testicular volume was observed in spite of maintained blood supply to the testes. In cases of bilateral UDT, both the testes were smaller in size (mean = 2.2 cm³), but were comparable to each other. In addition, the ultrasound examination revealed the presence of normal homogenous parenchyma of all the testes similar to the nonoperated side. Conclusion: Laparoscopic orchidopexy is a safe and effective option in the treatment of nonpalpable UDT. On a long-term basis, it is possible to achieve scrotal position along with preserved blood flow following laparoscopic orchidopexy in all patients suffering from nonpalpable UDT. [ABSTRACT FROM AUTHOR]

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Conventional ultrasound (B-Mode) allows a diagnosis of pregnancy to be made from 28 days, whereas cDoppler allows a diagnosis of non-pregnancy from 22-23 days. This method, however, is conditional on the re-synchronisation of all cows, which, in essence, is only justifi ed (cost-benefi t) in a breeding season. [ABSTRACT FROM AUTHOR]

Introduction: Acute testicular torsion is a surgical emergency due to acute testicular ischemia. Manual testicular detorsion is a testis-saving, bedside therapeutic when performed correctly and in a timely fashion. This procedure is most commonly performed blindly with pain relief as the endpoint for detorsion. However, up to one-third of patients continued to show signs of residual torsion in the operating room even using pain relief as the stopping point for the procedure.Case Report: We present a case demonstrating the utility of color Doppler ultrasound to confirm complete manual detorsion in a 14-year-old male with acute testicular torsion. The patient underwent 360-degree detorsion and had relief of pain; however, color Doppler demonstrated incomplete return of flow to the testis. After an additional 180-degree turn was made, color Doppler demonstrated complete return of normal vascular flow to the torsed testis.Conclusion: When it comes to testicular viability, timely restoration of blood flow to the testicle is of utmost importance. Manual detorsion is a non-invasive intervention that can be quickly and effectively performed at the bedside. Moreover, using color Doppler ultrasound guidance can ensure that physicians detorse in the proper direction and to completion, by providing instant visualization of restorative flow and ensuring reperfusion of the testis while awaiting definitive surgical management.

Tariq Alasbali Department of Ophthalmology, Faculty of Medicine, College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi ArabiaCorrespondence: Tariq Alasbali, Department of Ophthalmology, Faculty of Medicine, College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia, Email taalasbali@imamu.edu.saAbstract: Glaucoma is a multifactorial disease that is dependent on Intra Ocular Pressure (IOP) and associated with risk factors related to reduced ocular blood flow (OBF). In clinical practice, it is instrumental to update and review the considerable evidence of the current imaging technologies utilized in the investigation of OBF involved in both the onset and progression of glaucoma. Bibliographic databases, including PubMed and Google Scholar, were searched for articles on OBF techniques published between 2018 and 2023 using keywords such as “ocular blood flow”, “glaucoma”, “invasive ocular blood flow measurement”, and “non-invasive ocular blood flow measurement”. All types of methodologies were considered, except for editorials, letters to the editor, and animal studies. This review provides comprehensive information on the recent state-of-the-art imaging innovations used to monitor and measure the ocular blood flow in glaucoma.Keywords: ocular blood flow, glaucoma, laser speckle, color Doppler, Doppler Fourier domain optical coherence tomography, optical coherence tomography

Abstract Background Conventional ultrasound is used as an imaging modality for differentiation between benign and malignant lymph nodes, but with different accuracy, sensitivity, and specificity between different studies. A biopsy is the gold standard diagnosis modality but has a drawback due to its invasive nature. In general, metastatic lymph nodes present with a higher stiffness than benign lymph nodes, so ultrasound elastography could be used as an imaging modality for lymphadenopathy differentiation based on its ability to assess tissue stiffness. However, more studies should be done to assess its accuracy. Therefore, we aimed to assess the accuracy of B-mode, Doppler ultrasound, strain elastography, and 2D shear wave elastography criteria in differentiation between benign from malignant lymph nodes. Methods A cross-sectional study included 60 patients with lymphadenopathy. B-mode, Doppler ultrasound, strain elastography, and 2D shear wave elastography criteria were assessed for accuracy, sensitivity, and specificity compared to the final histopathological diagnosis, whether by core biopsy, fine needle aspiration, or excision biopsy. Results We assessed 60 patients in our study (20 benign and 40 malignant). Of these ultrasound criteria that achieved statistical significance, the highest accuracy was for elasticity ratio 88.9%, followed by strain ratio 83.8%. Also, the highest specificity was for an elasticity ratio of 80%, followed by strain score and strain ratio of 75% and 70%, respectively. Cortical asymmetry achieved the highest sensitivity, 100%, followed by strain ratio and elasticity ratio, with a sensitivity of 90% and 87.5%, respectively. However, cortical asymmetry had an extremely low specificity of 25%. Conclusions Ultrasound elastography criteria achieved higher accuracy compared to conventional ultrasound. So it can be used as an effective imaging modality to differentiate between benign and malignant lymph nodes.

Breast cancer is the leading cause of cancer mortality in women, and it is on the rise in Iran. Therefore, an early-stage diagnosis of breast cancer is of critical importance. Because ultrasound is one of the available, inexpensive, and minimally invasive techniques for distinguishing malignant from benign masses, a comparison of conventional ultrasound, color Doppler, and spectral Doppler findings can be useful. The purpose of this study was to determine the diagnostic value of sonographic indices, specifically Doppler parameters, in identifying the nature of breast masses. This is a cross-sectional study, with diagnostic value analysis. Before undergoing a biopsy, 80 patients with breast masses underwent B-mode and Doppler breast ultrasound. The ultrasound findings were then compared to pathologic results to determine which groups were malignant or benign. The resulting data were analyzed using statistical tests and diagnostic values with SPSS 22 software. B-mode grey-scale ultrasound indices such as mass shape, mass margin, mass orientation, and posterior features, as well as Doppler indices such as vascularity, RI (Resistive Index), PI (Pulsatility Index), and PSV (Peak Systolic Velocity), were found to be statistically significant with pathological findings. Color Doppler revealed vascularity in 65% of benign and 84% of malignant masses. The diagnostic value results revealed that mass shape, mass margin, mass orientation, and posterior features all play a significant role in predicting lesion malignancy, with a sensitivity of 92%, 58%, 64%, 56%, and specificity of 59%, 66%, 82%, and 84%, respectively. The RI, PI, and PSV indices were significantly higher in malignant masses, and all of them had remarkable diagnostic values in predicting malignancy, with a (Area Under The Curve) AUC of 0.863, 0.882, 0.702, a sensitivity of 84% and 84%, 68%, and a specificity of 83%, 86%, and 62%, respectively, at the optimal cut-off points (0.65, 1.32, 12.40) obtained from the Receiver Operating Characteristics (ROC) curves.

Abstract Objectives The Salivary Gland Committee of the American Academy of Otolaryngology‐Head and Neck Surgery seeks to standardize terminology and technique for ultrasonograpy used in the evaluation and treatment of salivary gland disorders. Methods Development of expert opinion obtained through interaction with international practitioners representing multiple specialties. This committee work includes a comprehensive literature review with presentation of case examples to propose a standardized protocol for the language used in ultrasound salivary gland assessment. Results A multiple segment proposal is initiated with this focus on the submandibular gland. We provide a concise rationale for recommended descriptive language highlighted by a more extensive supplement that includes an extensive literature review with additional case examples. Conclusion Recommendations are provided to improve consistency both in performing and reporting submandibular gland ultrasound.