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Background and Objectives Evaluation of amniotic fluid is one of the main variables of examining fetal health in the second and third trimesters of pregnancy. An increase in amniotic fluid can affect the health of the fetus. The aim of this study is to compare the severity of blood flow disorder in the umbilical artery and MCA of the fetus in idiopathic polyhydramnios (IP) and diabetic polyhydramnios (DP). Subjects and MethodsIn this study, singleton pregnancies with a calendar age of 31 to 40 weeks along with DP and IP were included in the study from June 2019 to June 2019, following the inclusion and exclusion criteria. First, the patients were divided into two groups, diabetic and non-diabetic, and then each group was divided into three groups with mild, moderate, and severe polyhydramnios. In all cases, the amniotic fluid index and after fetal Doppler cytometry, pulsation index, systolic to diastolic ratio of the umbilical artery, and pulsation index, maximum systolic velocity, systolic to diastolic ratio of the middle cerebral artery were measured. Results In this study, 138 pregnant mothers with polyhydramnios in the third trimester (70 in the IP group and 68 in the DP group) were studied. Compared to the standard values, 14 (20%) of the patients in the IP group and 10 (14.7%) in the DP group had abnormal fetal Doppler indices. In the idiopathic group, Doppler indices of the umbilical artery differed significantly only in the severe subgroup compared to the other two subgroups. Doppler indices of the middle cerebral artery, except for maximum systolic velocity, differed significantly in the moderate and severe polyhydramnios subgroups compared to the other subgroups. The impairment of fetal umbilical and middle cerebral artery Doppler indices, except for the umbilical artery systolic-to-diastolic ratio, was not associated with whether the polyhydramnios was diabetic or idiopathic. There was no significant difference between the two groups for the other indices, and this impairment was only related to the severity of polyhydramnios. Conclusion Disturbance in fetal Doppler indices in mothers with polyhydramnios is related to the severity of this complication and has no relation with its cause. Therefore, maintenance treatments can be useful to reduce the relative volume of amniotic fluid in both groups. [ABSTRACT FROM AUTHOR]

Background: The surgical goals of gender reassignment surgery of the breast in female-to male transsexuals (FMT) is the aesthetic shaping of a male thoracic wall with minimal scarring, while preserving the sensitivity of the nipple-areola complex (NAC). For large and ptotic breasts, we perform a mastectomy over an inframammary access with inferior pedicled NAC under color Doppler visualization of the perforators. This paper presents the technique, including complications and assessment of quality of life, as part of a unicentric analysis. Methods: This was a retrospective analysis of 23 patients (46 mastectomies) performed between September 2014 and September 2020. The complication rate and the number of corrective surgeries were recorded for quality assessment. A semiquantitative score was used to evaluate aesthetic outcome, nipple sensitivity, quality of life, and sexuality. Results: A total of 46 mastectomies were performed in 23 patients. The patient survey showed high patient satisfaction. Loss of nipple sensitivity was observed after one mastectomy (2.17%). In 91.67% of cases, patients reported that their appearance reflected how they feel on the inside. In 75% of cases, patients reported feeling equal to other men. The overall complication rate was 10.87%. Shape correction due to persistent excess of volume was rare (2.17%, equivalent to one mastectomy). Conclusion: Subcutaneous mastectomy with inferior nipple pedicle can be performed with a high degree of safety and satisfaction in FMT. Color Doppler-guided visualization of the perforator vessels is helpful in allowing a thin pedicle preparation, thus reducing the need for secondary surgeries to optimize the shape. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Abstract Accurate selection of sampling positions is critical in renal artery ultrasound examinations, and the potential of utilizing deep learning (DL) for assisting in this selection has not been previously evaluated. This study aimed to evaluate the effectiveness of DL object detection technology applied to color Doppler sonography (CDS) images in assisting sampling position selection. A total of 2004 patients who underwent renal artery ultrasound examinations were included in the study. CDS images from these patients were categorized into four groups based on the scanning position: abdominal aorta (AO), normal renal artery (NRA), renal artery stenosis (RAS), and intrarenal interlobular artery (IRA). Seven object detection models, including three two-stage models (Faster R-CNN, Cascade R-CNN, and Double Head R-CNN) and four one-stage models (RetinaNet, YOLOv3, FoveaBox, and Deformable DETR), were trained to predict the sampling position, and their predictive accuracies were compared. The Double Head R-CNN model exhibited significantly higher average accuracies on both parameter optimization and validation datasets (89.3 ± 0.6% and 88.5 ± 0.3%, respectively) compared to other methods. On clinical validation data, the predictive accuracies of the Double Head R-CNN model for all four types of images were significantly higher than those of the other methods. The DL object detection model shows promise in assisting inexperienced physicians in improving the accuracy of sampling position selection during renal artery ultrasound examinations.

(1) Background: Accurate hepatic artery (HA) depiction following pediatric liver transplantation (LT) is essential for graft surveillance but challenging on ultrasound (US). This study assesses if improved HA delineation can be achieved by recording two-dimensional US volumes in Color Doppler (CD) and B-flow technique. (2) Methods: Of 42 consecutive LT, 37 cases were included, and HA delineation was retrospectively rated using a four-point score (0 = HA not detectable, 3 = HA fully detectable, separable from portal vein) within 48 h post-LT (U1) and before discharge (U2). (3) Results: Adding B-flow compared with CD alone showed superior results at neohilar (U1: 2.2 ± 1.0 vs. 1.1 ± 0.8, p < 0.0001; U2: 2.5 ± 0.8 vs. 1.5 ± 0.9, p < 0.0001) and segmental levels (U1: 2.8 ± 0.6 vs. 0.6 ± 0.8, p < 0.0001; U2: 2.8 ± 0.6 vs. 0.7 ± 0.5, p < 0.0001). (4) Conclusions: Standardized US volume recordings combining B-flow and CD can effectively delineate the HA along its vascular course in pediatric LT. The technique should be further evaluated as a standard monitoring instrument to rule out vascular complications after LT. [ABSTRACT FROM AUTHOR]

Purpose: Diagnosing Renal artery stenosis (RAS) presents challenges. This research aimed to develop a deep learning model for the computer-aided diagnosis of RAS, utilizing multimodal fusion technology based on ultrasound scanning images, spectral waveforms, and clinical information. Methods: A total of 1485 patients received renal artery ultrasonography from Peking Union Medical College Hospital were included and their color doppler sonography (CDS) images were classified according to anatomical site and left-right orientation. The RAS diagnosis was modeled as a process involving feature extraction and multimodal fusion. Three deep learning (DL) models (ResNeSt, ResNet, and XCiT) were trained on a multimodal dataset consisted of CDS images, spectrum waveform images, and individual basic information. Predicted performance of different models were compared with senior physician and evaluated on a test dataset (N = 117 patients) with renal artery angiography results. Results: Sample sizes of training and validation datasets were 3292 and 169 respectively. On test data (N = 676 samples), predicted accuracies of three DL models were more than 80% and the ResNeSt achieved the accuracy 83.49% ± 0.45%, precision 81.89% ± 3.00%, and recall 76.97% ± 3.7%. There was no significant difference between the accuracy of ResNeSt and ResNet (82.84% ± 1.52%), and the ResNeSt was higher than the XCiT (80.71% ± 2.23%, p < 0.05). Compared to the gold standard, renal artery angiography, the accuracy of ResNest model was 78.25% ± 1.62%, which was inferior to the senior physician (90.09%). Besides, compared to the multimodal fusion model, the performance of single-modal model on spectrum waveform images was relatively lower. Conclusion: The DL multimodal fusion model shows promising results in assisting RAS diagnosis. [ABSTRACT FROM AUTHOR]

Cervix is an important part of the uterus in obstetrics because that anatomical part withstands the pressure of the pregnant uterus until the moment of childbirth. Many mechanisms play a role in the beginning of labor, and it is fascinating how it is a harmonized mechanism. Unfortunately, under the influence of various factors, it leads to preterm labor (PTL) or preterm premature rupture of the fetal membranes (PPROM). Ultrasound is an ideal tool in detecting the status of the cervix during pregnancy. Vaginal ultrasound has shown better sensitivity and predictability than abdominal ultrasound. Regarding vaginal ultrasonography of the cervix in gynecology, recent studies show the effectiveness of vaginal ultrasound in the detection of cervical pathology. Not only in detection but transvaginal ultrasound (TVU), especially new techniques such as three-dimensional (3D) color Doppler, also helps clinicians in choosing the right therapeutic approach for malignant diseases of the cervix. [ABSTRACT FROM AUTHOR]

Uterine cervical varix is a rare finding during pregnancy, and it can cause significant bleeding during pregnancy. We present here a case report of cervical varix coexisting with placenta previa. In this case report, we describe the clinical course, diagnosis, and follow-up of a 33-year-old woman at 31 weeks of gestation with placenta previa complicated by cervical varix, when she presented for the first time with antepartum hemorrhage. Speculum examination, followed by transvaginal ultrasonography with color Doppler, confirmed the diagnosis of huge cervical varices. A healthy baby was successfully delivered at 36 weeks of gestation by cesarean section. Clinicians should be aware of this entity, to avoid misdiagnosis and be vigilant to prevent maternal morbidity.

(1) Background: Accurate hepatic artery (HA) depiction following pediatric liver transplantation (LT) is essential for graft surveillance but challenging on ultrasound (US). This study assesses if improved HA delineation can be achieved by recording two-dimensional US volumes in Color Doppler (CD) and B-flow technique. (2) Methods: Of 42 consecutive LT, 37 cases were included, and HA delineation was retrospectively rated using a four-point score (0 = HA not detectable, 3 = HA fully detectable, separable from portal vein) within 48 h post-LT (U1) and before discharge (U2). (3) Results: Adding B-flow compared with CD alone showed superior results at neohilar (U1: 2.2 ± 1.0 vs. 1.1 ± 0.8, p < 0.0001; U2: 2.5 ± 0.8 vs. 1.5 ± 0.9, p < 0.0001) and segmental levels (U1: 2.8 ± 0.6 vs. 0.6 ± 0.8, p < 0.0001; U2: 2.8 ± 0.6 vs. 0.7 ± 0.5, p < 0.0001). (4) Conclusions: Standardized US volume recordings combining B-flow and CD can effectively delineate the HA along its vascular course in pediatric LT. The technique should be further evaluated as a standard monitoring instrument to rule out vascular complications after LT.

Objectives: To establish a simple-to-use nomogram based on quantification of color Doppler sonography data from a region of interest (ROI) to diagnose minimal change disease (MCD) promptly and non-invasively, and to evaluate the prediction capability of the nomogram. Methods: We recruited 564 patients with pathology-proven renal disease who were admitted to our hospital from July 2020 to July 2021 (388 patients in the training dataset and 176 patients in the validation dataset), and their color Doppler sonography data were acquired from a ROI and underwent ipsilateral renal biopsy. The collected clinical features and ultrasonic features were imported into Rstuido and statistically significant features were selected by stepwise regression using the forward–backward method. Multivariate Logistic regression analysis was combined with clinical analysis to obtain the final modeling features. General and dynamic nomogram models were constructed with the selected features, depending on whether they were MCD or not. Bootstrapping and internal validation were used for internal and external validation of the nomogram, respectively. The performance of the nomogram was assessed by C-index, calibration curve, and receiver operating characteristic (ROC) curve. Results: Age and VI were independent factors in predicting MCD. The value of Age (Best cut-off value: 33.5 years) combined with VI (Best cut-off value: 40.50 points) in the diagnosis of MCD was significantly higher than that of single diagnosis (AUC 0.901, 95% CI 0.863–0.938). The C-index of the nomogram constructed with age and VI in the training and validation datasets was 0.915 [95% confidence interval (CI) 0.874–0.956 and 0.875 95% CI 0.783–0.967], respectively. Calibration curves were fitted well. The sensitivity, specificity, and accuracy were 76.1%, 95.6%, and 78.3%, respectively, in the training dataset, and 74.1%, 94.4%, and 76.1% in the validation dataset, respectively. Conclusion: The nomogram constructed with age and VI showed a satisfactory degree of differentiation and accuracy, which is of great significance for early, non-invasively, and individually analysis of the risk of MCD. [ABSTRACT FROM AUTHOR]

AIM:To investigate the characteristics of color Doppler sonography and MRI in orbital solitary fibrous tumor(SFT). METHODS: It was a retrospective case series study. A total of 12 cases of orbital solitary fibrous tumors were recruited from April 2013 to August 2018 in Tianjin Medical University Eye Hospital. Color Doppler sonography and MRI plain scan and DCE-MRI were applied in all cases. RESULTS: Of 12 cases, 7 cases were males and 5 were females, with the duration of symptoms ranged from 3mo-20y, with an average course of 3.2y; 6 cases were the primary cases and 6 cases were relapse cases. All lesions involved one side of the orbit, of which 8 cases were in the left orbit and 4 in the right. Of 12 cases, there were 5 tumors in intraconal space, 3 in the extraconal space, and 4 in intra and extraconal space. Well-circumscribed lesions showed oval shape in 9 cases and the left 3 were irregular. 12 cases showed hypoechoic and 2 cases heterogeneous signal on color Doppler sonography; All cases had flow signals on CDFI, and showed arterial spectrum on PW. On T1WI, all lesions demonstrated isointense. On T2WI, 5 lesions showed hypointense, 3 lesions showed isointense and 4 lesions slight hyperintense, of which 3 lesions showed heterogeneous signal. After contrast enhancement, all cases demonstrated markedly enhancement, with homogeneous enhancement in 10 cases and heterogeneous enhancement in 2 cases. The time-intensity curves(TIC)of 7 cases exhibited a rapid washout pattern, and 5 cases a rapid plateau pattern on DCE-MRI. CONCLUSION: Color Doppler sonography features of orbital SFT include hypoechoic and flow signals. Heterogeneous signals on T2WI, marked enhancement, and a rapidly enhancing and slow washout pattern TIC on DCE-MRI are the typical MRI features of orbital SFT.

Mahnaz Ranjkesh,1,2 Farid Hajibonabi,2– 4 Fatemeh Seifar,5 Mohammad Kazem Tarzamni,1,2 Behzad Moradi,1,2 Zhila Khamnian6 1Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran; 2Radiology Department, Tabriz University of Medical Sciences, Tabriz, Iran; 3Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; 4Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran; 5Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 6Social Determinant of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IranCorrespondence: Zhila Khamnian Email Zhila.khamnian@gmail.comPurpose: The aim of this study was to investigate the sensitivity, specificity, and diagnostic accuracy of sonoelastography (SE), strain ratio (SR), elasticity to B-mode (E/B) ratio, and color Doppler ultrasonography (US) in suspected breast lesions.Materials and Methods: This prospective study was conducted on women referred to Alzahra university hospital of Tabriz for annual screening of breast cancer between May 2017 and December 2018. B-mode US, SE, and color Doppler imaging were conducted in females with suspected mammography reports. The lesions in B-mode were classified according to the Breast Imaging Reporting and Data System (B-RADS). The results of SE imaging were graded based on five-grade SE score. SR and E/B ratio of each lesion were also analyzed in SE images. Color Doppler findings were categorized from 0 (no visible vessel) to 2 (> two vessels) based on the vascularity of the tumor. Pathology results were used as the gold standard to measure the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and diagnostic accuracy of each modality.Results: One-hundred and ten breast lesions of 104 women aged 42.05± 10.33 years were included in the study. Seventy-seven of the lesions were benign and 3 were malignant. Sensitivity and specificity of 97.0% and 77.9% for B-mode US, 93.9% and 87.0% for SE score, 81.8% and 66.2% for color Doppler US, 72.7% and 77.6% for E/B ratio (cutoff: 1.05), and 77.3% and 79.6% for SR (cutoff: 1.90) were obtained, respectively. Addition of SE score to B-mode US increased the sensitivity to 93.9%, specificity to 93.5%, and AUC from 0.95 to 0.97. Cumulative color Doppler US with B-mode US did not enhance the diagnostic accuracy of B-mode US.Conclusion: SE was more effective than color Doppler US for distinguishing malignant from benign breast lesion. Among the three different SE features, five-grade SE score was superior to E/B ratio and SR.Keywords: breast cancer, elastography, color Doppler sonography, strain ratio, B-mode ultrasonography

Background and Objective: The main objective is to study the correlation between color Doppler ultrasound and multidetector computed tomography (MDCT) angiography in evaluating peripheral arterial disease. Settings and Design: Prospective observational study. Materials and Methods: The study was conducted in the Department of Radio Diagnosis, SVIMS, over a period of 18 months from March 2018 to July 2019. All of the 80 consecutive patients who were referred to the Department of Radio Diagnosis with clinical suspicion of peripheral arterial disease (PAD) were studied. Color Doppler ultrasound followed by MDCT angiography were done in all of the patients. Results: Out of the total 1680 vessel segments in 80 patients, color Doppler sonography (CDS) was able to detect 545 (32.4%) positive segments, in comparison to the CTA which was able to detect 732 (43.5%) bilaterally, with 11.1% of cases detected more on MDCT angiography predominantly grade-2, 3, 4, except for grade-1. On overall except for wall thickness, MDCT angiography was better in detecting wall calcification, occlusion, and thrombus on comparison with CDS. Conclusion: CDS and MDCT angiography showed good agreement for grade-0, 1 PAD when compared to grade-2, 3, 4. CDS with an advantage of no risk of radiation, contrast related complications should be considered as a preliminary screening test in all patients with clinical suspicion of PAD. MDCT angiography should be considered for grade-2, 3, 4 stenosis assessments for selecting an appropriate treatment.

Major salivary gland ultrasonography (SGUS) is increasingly being recognized as having critical roles in differentiating primary Sjögren's syndrome (pSS) from other connective tissue disorders. Contrast-enhanced ultrasonography (CEUS) has been reported to evaluate microvascularity of lesions in different tissues with objective angiographic index, eliminating the observer-dependent defect of ultrasonography. However, there are few relevant studies concentrating on the application of CEUS in the diagnosis and assessment for pSS, and their clinical utility prospect remains uncertain. In this study, a total of 227 eligible patients were enrolled, including 161 pSS and 66 non-pSS patients with comprehensive ultrasonographic evaluation of the parotid and submandibular glands, including grayscale ultrasonography, color Doppler sonography (CDS), and CEUS. Compared with non-pSS, pSS patients had significantly higher grayscale ultrasound (US) scores and CDS blood grades in the parotid gland and significantly higher grayscale US and CEUS scores in the submandibular glands. Diagnostic model combining ultrasonographic signatures, anti-SSA/Ro60, and keratoconjunctivitis sicca (KCS) tests showed a remarkable discrimination [mean area under the curve (AUC)0.963 in submandibular glands and 0.934 in parotid glands] for pSS, and the nomogram provided excellent prediction accuracy and good calibration in individualized prediction of pSS. A combination of multiple ultrasonographical examinations of the major salivary glands (SGs) is a promising technique that may be used as a practical alternative to minor SG biopsy in the detection of pSS. [ABSTRACT FROM AUTHOR]

Major salivary gland ultrasonography (SGUS) is increasingly being recognized as having critical roles in differentiating primary Sjögren’s syndrome (pSS) from other connective tissue disorders. Contrast-enhanced ultrasonography (CEUS) has been reported to evaluate microvascularity of lesions in different tissues with objective angiographic index, eliminating the observer-dependent defect of ultrasonography. However, there are few relevant studies concentrating on the application of CEUS in the diagnosis and assessment for pSS, and their clinical utility prospect remains uncertain. In this study, a total of 227 eligible patients were enrolled, including 161 pSS and 66 non-pSS patients with comprehensive ultrasonographic evaluation of the parotid and submandibular glands, including grayscale ultrasonography, color Doppler sonography (CDS), and CEUS. Compared with non-pSS, pSS patients had significantly higher grayscale ultrasound (US) scores and CDS blood grades in the parotid gland and significantly higher grayscale US and CEUS scores in the submandibular glands. Diagnostic model combining ultrasonographic signatures, anti-SSA/Ro60, and keratoconjunctivitis sicca (KCS) tests showed a remarkable discrimination [mean area under the curve (AUC)0.963 in submandibular glands and 0.934 in parotid glands] for pSS, and the nomogram provided excellent prediction accuracy and good calibration in individualized prediction of pSS. A combination of multiple ultrasonographical examinations of the major salivary glands (SGs) is a promising technique that may be used as a practical alternative to minor SG biopsy in the detection of pSS.

Purpose: Diagnosing Renal artery stenosis (RAS) presents challenges. This research aimed to develop a deep learning model for the computer-aided diagnosis of RAS, utilizing multimodal fusion technology based on ultrasound scanning images, spectral waveforms, and clinical information., Methods: A total of 1485 patients received renal artery ultrasonography from Peking Union Medical College Hospital were included and their color doppler sonography (CDS) images were classified according to anatomical site and left-right orientation. The RAS diagnosis was modeled as a process involving feature extraction and multimodal fusion. Three deep learning (DL) models (ResNeSt, ResNet, and XCiT) were trained on a multimodal dataset consisted of CDS images, spectrum waveform images, and individual basic information. Predicted performance of different models were compared with senior physician and evaluated on a test dataset (N = 117 patients) with renal artery angiography results., Results: Sample sizes of training and validation datasets were 3292 and 169 respectively. On test data (N = 676 samples), predicted accuracies of three DL models were more than 80% and the ResNeSt achieved the accuracy 83.49% ± 0.45%, precision 81.89% ± 3.00%, and recall 76.97% ± 3.7%. There was no significant difference between the accuracy of ResNeSt and ResNet (82.84% ± 1.52%), and the ResNeSt was higher than the XCiT (80.71% ± 2.23%, p < 0.05). Compared to the gold standard, renal artery angiography, the accuracy of ResNest model was 78.25% ± 1.62%, which was inferior to the senior physician (90.09%). Besides, compared to the multimodal fusion model, the performance of single-modal model on spectrum waveform images was relatively lower., Conclusion: The DL multimodal fusion model shows promising results in assisting RAS diagnosis., (© 2024 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.)

Background and Objective: The main objective is to study the correlation between color Doppler ultrasound and multidetector computed tomography (MDCT) angiography in evaluating peripheral arterial disease. Settings and Design: Prospective observational study. Materials and Methods: The study was conducted in the Department of Radio Diagnosis, SVIMS, over a period of 18 months from March 2018 to July 2019. All of the 80 consecutive patients who were referred to the Department of Radio Diagnosis with clinical suspicion of peripheral arterial disease (PAD) were studied. Color Doppler ultrasound followed by MDCT angiography were done in all of the patients. Results: Out of the total 1680 vessel segments in 80 patients, color Doppler sonography (CDS) was able to detect 545 (32.4%) positive segments, in comparison to the CTA which was able to detect 732 (43.5%) bilaterally, with 11.1% of cases detected more on MDCT angiography predominantly grade-2, 3, 4, except for grade-1. On overall except for wall thickness, MDCT angiography was better in detecting wall calcification, occlusion, and thrombus on comparison with CDS. Conclusion: CDS and MDCT angiography showed good agreement for grade-0, 1 PAD when compared to grade-2, 3, 4. CDS with an advantage of no risk of radiation, contrast related complications should be considered as a preliminary screening test in all patients with clinical suspicion of PAD. MDCT angiography should be considered for grade-2, 3, 4 stenosis assessments for selecting an appropriate treatment. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the clinical significance of color Doppler sonography (CDS) in the diagnosis of spontaneous isolated superior mesenteric artery dissection (SISMAD). The ultrasonographic images of 19 patients with SISMAD confirmed by computed tomography angiography (CTA) were retrospectively analyzed and the ultrasonographic features were summarized. The paired t-test was used to statistically analyze the differences in parameters determined by CTA vs. CDS, including the minimal inner diameter (MID), cross-sectional area (CSA), diameter and area stenosis rate, and flow rate of the true lumen. Of the 19 patients, 18 (94.7%) were diagnosed with SISMAD with correct classification by CDS. There was no significant difference between CTA and CDS with regard to minimal ID, CSA, diameter stenosis and area stenosis rate, and flow rate of the true lumen (all P>0.05). CDS was indicated to be an effective imaging modality for the diagnosis of SISMAD. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the role of color Doppler sonography (CDS) in the diagnosis of extracranial vertebral artery dissections (EVADs). One hundred and fifty consecutive patients (age range 21-51 years, mean 44 years) with a clinical suspicion of vertebral artery dissection (VAD) were included in this study. All patients underwent CDS of vertebral arteries as the first-line imaging modality. Cervical T1-weighted fat-saturated axial MR images served as the gold standard. Of the 150 patients with a clinical suspicion of VAD, 27 patients were ultimately diagnosed with EVADs based on fat-saturated T1-weighted MR imaging. MR imaging was considered positive when crescentic hyperintensity (methemoglobin signal) was demonstrated at the wall of the vertebral artery. CDS was positive in 21 of these 27 patients and revealed either intramural hematoma or a dissecting membrane with two lumina. The most frequent site of involvement was the V1 to proximal V2 segment. The sensitivity, specificity, and positive and negative predictive values of CDS in the diagnosis of EVADs were 77.8, 98.4, 91.3, and 95.3%, respectively. CDS is a reliable diagnostic tool in the diagnosis of EVADs. [ABSTRACT FROM AUTHOR]

Color Doppler sonography is a useful tool for examining blood flow and related indices. However, it should be done by welltrained operator, that is, operator subjectivity exists. In this paper, we propose an automatic blood flow area extraction method from brachial artery that would be an essential building block of computer aided color Doppler analyzer. Specifically, our concern is to examine hypertension suspicious (prehypertension) patients who might develop their symptoms to established hypertension in the future. The proposed method uses fuzzy C-means clustering as quantization engine with careful seeding of the number of clusters from histogram analysis. The experiment verifies that the proposed method is feasible in that the successful extraction rates are 96% (successful in 48 out of 50 test cases) and demonstrated better performance than K-means based method in specificity and sensitivity analysis but the proposed method should be further refined as the retrospective analysis pointed out. [ABSTRACT FROM AUTHOR]

Background: Although the plain radiograph and computed tomography remain undoubtedly the primary imaging modalities in the investigation of pneumonia, ultrasound can play an important complementary role, in the diagnostic workup of the patients, and in their subsequent management. Objective: To compare the accuracy of LUS with those of CXR and CT imaging in the diagnosis of pneumonia and compare color Doppler sonography and computed tomography (CT) for predicting necrotizing pneumonia. Methods: Thirty-one patients with clinical suspicion of pneumonia were assessed by chest radiography, CT and sonography. Quantitative and qualitative sonographic examinations of the lesions were performed using grayscale and color Doppler imaging. The correlation between the color Doppler and CT findings was determined. Results: LUS showed a high sensitivity (100%) and specificity (93.8%) and diagnostic accuracy was 96.8% in the diagnosis of pneumonia “which extend to pleural line”. It was almost a perfect agreement with CT findings (K = 0.93). The sensitivity of chest X-ray was low (60%). It was moderately in agreement with CT findings (K = 0.608). A significant change was seen in the flow pattern in comparison to the severity of necrosis by CT (P value = 0.038). Conclusions: Lung ultrasound imaging for the detection of pneumonia is highly accurate. Based on our results, LUS is a valid alternative for the diagnosis of pneumonia. By combined qualitative and quantitative impedance measurement, PA and bronchial artery (BA) can be differentiated from each other. Flow pattern of pulmonary arteries which was found in most of our cases was an indicative of benign lesions.

مقدمه: سندرم Carpal tunnel (Carpal tunnel syndrome یا CTS)، شایع‌ترین نوروپاتی فشاری اندام فوقانی می‌باشد که در نتیجه‌ی تحت فشار قرار گرفتن عصب Median درون Carpal tunnel به علل مختلف ایجاد می‌شود. هدف از انجام این مطالعه، بررسی حساسیت (Sensitivity) و ویژگی (Specificity) سونوگرافی داپلر رنگی به عنوان یک روش تصویربرداری غیر تهاجمی در مقایسه با روش‌های الکترودیاگنوستیک (Electrodiagnostic testing یا EDT) در تشخیص این بیماری می‌باشد. روش‌ها: 84 بیمار که از نظر بالینی مشکوک به سندرم Carpal tunnel بودند و سابقه‌ی تروما و عمل جراحی مچ دست نداشتند، وارد مطالعه شدند و برای آن‌ها، روش‌های الکترودیاگنوستیک به عنوان روش استاندارد تشخیص و سونوگرافی داپلر رنگی انجام شد. سپس، نتایج با هم مقایسه و حساسیت، ویژگی و ارزش اخباری مثبت و منفی این روش در تشخیص سندرم Carpal tunnel محاسبه گردید. یافته‌ها: حساسیت روش سونوگرافی داپلر رنگی در تشخیص سندرم Carpal tunnel، 73 و ویژگی آن 81 درصد به دست آمد. همچنین، حساسیت و ویژگی این روش، در گروه با تشخیص سندرم Carpal tunnel خفیف در روش الکترودیاگنوستیک، به ترتیب 55 و 81 درصد، در گروه با تشخیص سندرم Carpal tunnel متوسط، 71 و 81 درصد و در گروه با تشخیص سندرم Carpal tunnel شدید 83 و 81 درصد محاسبه شد. نتیجه‌گیری: با توجه به کافی بودن حساسیت و ویژگی سونوگرافی داپلر رنگی در مقایسه با الکترودیاگنوستیک، در تشخیص سندرم Carpal tunnel، این روش می‌تواند روشی مناسب و غیر تهاجمی برای تشخیص این بیماری باشد. همچنین، حساسیت و ویژگی این روش در موارد سندرم Carpal tunnel شدید، بیش از موارد متوسط و در هر دو حالت، بیشتر از موارد خفیف می‌باشد.

Aims and Objectives: To evaluate the use of ultrasonography as a diagnostic tool in determining the state of infection, i.e., cellulitis or abscess, in the superficial space infection of odontogenic origin. Materials and Methods: A total of 35 patients visiting the department and having an inflammatory swelling of odontogenic origin were chosen. Thorough history and clinical examination of patients was done to reach a clinical diagnosis of cellulitis or abscess. Ultrasonography was performed with the help of transducing gel using a linear probe to determine the state of infection, i.e., cellulitis or abscess. Results: Out of 35 patients, 19 patients were clinically diagnosed as abscess whereas the remaining 16 patients were clinically diagnosed as cellulitis. For the 19 patients who were clinically diagnosed as abscess, ultrasonography revealed focal accumulation of fluid suggestive of abscess cavity in all the 19 cases, and ultrasound-guided aspiration was positive in all the cases. For the 16 patients who were clinically diagnosed as cellulitis, ultrasonography revealed focal areas of fluid accumulation suggestive of abscess formation in 5 cases, and ultrasound-guided aspiration was positive all these 5 cases. Sensitivity (100%) and negative predictive value (100%) of ultrasound is much better than that of clinical diagnosis, which is 79% and 69%, respectively, in the detection of state of infection. Conclusion: Ultrasonography was found to be a valuable adjunct to clinical diagnosis in determining the state of infection, i.e., cellulitis or abscess.

In avian medicine, Doppler sonographic techniques are used to visualize and estimate blood flow in the heart. In the literature there is a lack of standardized studies of the use of color Doppler flow on healthy avian species. For this purpose, we examined blood flow in the heart in the four-chamber view of clinically healthy awake racing pigeons (n = 43) by color flow Doppler sonography. With this technique the diastolic and systolic blood flow in the heart chambers and the heart valve regions were well visualized. However, the pulse repetition frequency must be adapted to the specific blood flow velocities of the heart region to be measured to reduce aliasing in higher velocities and to visualize blood flow of lower velocities. With the help of color Doppler imaging in the four-chamber view, typical physiological atrial and ventricular blood flow vortex formations were visualized in the avian heart for the first time. In the left ventricle an asymmetric vortex ring in the passive and active ventricular filling, in the right ventricle a great counter-clockwise blood vortex in the active ventricular filling, in the left atrium a vortex clockwise, and in the right atrium counter-clockwise were observed. The knowledge of these physiological blood flow vortices is important to identify pathological blood flow.

Color Doppler ultrasound-guided regional block like brachial plexus block lately changed other anesthesia and analgesia practice because of the accuracy and simplicity of practice to view the anatomy of blood vessels and nerves. With color Doppler ultrasound-guided regional block you can follow needle track to nerves and prevent any vessel puncture. It can be the standard for any regional block. The patient was a 64 years Iranian who had diabetes mellitus and hypertension and planned as an urgent right upper limb amputation surgery. Because of the acute exacerbation of COPD due to pneumonia we decided to use regional anesthesia for this patient. On the first physical examination there was no peripheral pulse in patient’s right hand. With ultra-sonographic color Doppler the pulselessness of right hand artery were monitored. With the anatomic and awareness of grey-scaled ultrasonography the nerves and vessels were found. Axillary brachial plexus block with guidance of grey-scaled ultrasonography were done and the surgery was successfully performed and patient transferred to ICU for post operation care after surgery.

Penil ereksiyon bir çok klinik araştırmaya konu olacak kadar geniş ve kompleks nörovasküler bir olaydır. Psikojenikorganik impotans ayrımında noktürnal penis tümesansı (NPT), vaskülojenik impotans tanısında anjiografi ve farmakokavernozometri altın standart olarak bilinen yöntemlerdir. Son zamanlarda renkli Doppler sonografi ile küçük damarların görüntülenmesi kolaylaşmış ve Doppler açısının düzeltilmesi ile daha hızlı ve kesin veri elde edilebilmesi mümkün olmuştu

Penile erection results from a complex interplay between central nerveus system and local factors. Several aspects of these interactions have been the subject of many reviews. Nocturnal penile tumescence (NPT) monitoring is the best single non-invasive examination to differentiate organic from psychogenic impotence. Angiography and pharmaco-cevernosometry are accepted as gold standard modalities in the assesment of vasculojenic impotence. Recently color Doppler sonography made the detection of vessels easier and the correction of the Doppler angle more accurate, resulting in more rapid and accurate acquisition of data. [Cukurova Med J 2015; 40(2.000): 208-211]

The aim of this study was to identify the role of transvaginal color Doppler and gray-scale ultrasonography findings in managing first- and second-trimester miscarriges. Methods: A prospective interventional study was conducted from March 2009 to April 2010 in our center in which 77 women with first- and second-trimester abortion were recruited. All women were evaluated by transvaginal grayscale and color Doppler ultrasonography. Blood flow within the endometrium was measured using color Doppler. Pulsed Doppler was performed to evaluate blood flow impedance by calculating the resistance index (RI). Results: Forty-six patients underwent dilation and curettage of which 67.4% were proven to have retained products of conception (RPOC). Thirty-one patients were followed up through expectant management. Endometrial thickness (ET) was greater in the group with RPOC (p 10 mm. The combination of vascular pattern and endometrial echogenic mass was the most sensitive and specific ultrasonographic feature for detecting RPOC (88%; 95% confidence intervals: 79–95). Conclusion: Transvaginal color Doppler ultrasonography can be used to verify the presence of RPOC after spontaneous miscarriges.

Aim: This study was intended to explore the effect of various drugs used to treat fatty liver on intimal-media thickness in patients with NAFLD. Background: Nonalcoholic fatty liver disease (NAFLD) is an indicator of a broad spectrum of pathologic disorders, which is characterized with macro vesicular steatosis in the absent of alcohol use. It has a wide range of laboratory, clinical and pathological presentations such as simple steatosis to the diseases like non-alcoholic steatohepatitis, fibrosis, and cirrhosis and hepatocellular cancer. Methods: In this cross - sectional study, as a part of a 10-year cohort study (from 2007-2017) at Tabriz University of Medical Sciences, a group of 100 patients with NAFLD were studied. They were examined by color doppler sonography of the carotid arteries to detect any carotid intima- media thickness, before and one year after treatment with various drugs. The effect of treatment on right and left carotid intima- media thickness (IMT) was examined by using SPSS. V21. Results: Over all, 36 (36%) patients were male and 64 (64%) were female. The mean age of the patients was a 43.5±10.3 year, ranging from 16 to 64. The decrease in patients' intima- media thickness in both right and left carotids was statistically significant (P<0.0001). Conclusion: Treatment of patients with nonalcoholic fatty liver has a significant role in reduction of their carotid intima -media thickness and consequently in reducing cerebrovascular events such as stroke. [ABSTRACT FROM AUTHOR]

The use of B- and M-mode sonography for detection of pneumothorax has been well described and studied. It is now widely incorporated by sonographers, emergency physicians, trauma surgeons, radiologists, and critical care specialists worldwide. Lung sonography can be performed rapidly at the bedside or in the prehospital setting. It is more sensitive, specific, and accurate than plain chest radiography. The use of color and power Doppler sonography as an adjunct to B- and M-mode imaging for detection of pneumothorax has been described in a small number of studies and case reports but is much less widely known or used. Color and power Doppler imaging may be used for confirmation of the presence or absence of lung sliding detected with B-mode sonography. In this article, we examine the physics behind Doppler sonography as it applies to the lung, technique, an actual case, and the past literature describing the use of color and power Doppler sonography for the detection of pneumothorax. [ABSTRACT FROM AUTHOR]

Objectives To determine whether color Doppler sonography increases the detection of pregnancies at risk for adverse outcomes. Methods Participants admitted to labor and delivery with the anticipation of a vaginal delivery underwent measurements of amniotic fluid volume (AFV) using amniotic fluid index (AFI) and single deepest pocket (SDP) techniques by grayscale followed by color Doppler sonography. Oligohydramnios was defined as an AFI of less than 5 cm or an SDP of less than 2 cm. Intrapartum and perinatal outcomes were compared between participants with a diagnosis of a low AFV by grayscale and color Doppler sonography. Results Over 42 months, 428 women were enrolled in the study. Color Doppler sonography resulted in lower AFV estimates (mean ± SD by the AFI, 10.7 ± 3.7 cm by grayscale sonography and 8.6 ± 3.6cm by color Doppler sonography; P < .0001). For the SDP, the mean AFVs were 4.6 ± 2.0 cm by grayscale sonography and 3.4 ± 1.4 cm by color Doppler sonography ( P < .0001). The level of agreement between grayscale and color Doppler sonography in estimating the AFV was fair, with κ = 0.32 for the AFI and 0.28 for the SDP. Outcome measures of AFVs classified as low based on color Doppler sonography (normal by grayscale sonography) and those classified as low by grayscale sonography (low by color Doppler sonography) were compared. There was no difference in composite perinatal complications, mode of delivery, or composite neonatal complications. Conclusions The use of color Doppler sonography leads to the overdiagnosis of low AFVs and does not appear to increase the detection of pregnancies destined for adverse intrapartum or perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objectives We retrospectively studied hemodynamic changes in the interlobar artery to assess the clinical value of color Doppler sonography for detecting preclinical obesity-related nephropathy. Methods Color Doppler renal sonography was performed in 52 children with obesity-related nephropathy and 51 control children with simple obesity. The interlobar artery resistive index (RI) was measured and compared with clinical data and laboratory indicators. Results The left RI (mean ± SD, 0.65 ± 0.05 versus 0.60 ± 0.08; t = 3.85), right RI (0.64 ± 0.03 versus 0.59 ± 0.02; t = 10.00), and mean RI (0.64 ± 0.05 versus 0.59 ± 0.06; t = 5.00) revealed large statistically significant increases in the obesity-related nephropathy group (all P < .01). In the obesity-related nephropathy group, a positive correlation was found between the mean RI and 24-hour urine trace albumin ( r = 0.47; P < .01), triglycerides ( r = 0.98; P < .01), and body mass index ( r = 0.28; P < .05). The 24-hour urine trace albumin and triglycerides were higher in the obesity-related nephropathy group than the control group ( P < .05). In the control group, a mild positive correlation was also found between the mean RI and body mass index ( r = 0.24; P < .05). Conclusions Color Doppler sonography successfully indicated renal hemodynamic changes and has diagnostic value for early-stage obesity-related nephropathy. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the association between antral follicular blood flow velocity and the response of ewes to hormonal ovarian superstimulation. Ten Santa Inês ewes were subjected to a short- (7 days; Group 1) or long-term (13 days; Group 2) progesterone (CIDR ® ; InterAg, Hamilton, New Zealand) priming, and a superovulatory treatment with porcine follicle-stimulating hormone (pFSH; Folltropin ® -V; Bioniche Animal Health, Belleville, ON, Canada), given twice daily for four consecutive days in decreasing doses and initiated four or ten days after CIDR insertion, respectively. Embryos were recovered surgically seven days after the last pFSH dose. From one day prior to until the end of the pFSH regimen (Days −1 to 3), all ewes underwent daily transrectal ultrasonography of ovaries. The number of high-velocity pixels (HVPs; 0.055–0.11 m/s or upper 50% of recordable velocities) on Day 1 correlated directly with the number of corpora lutea (CL; r = 0.92, P = 0.0002) and of viable embryos ( r = 0.77, P = 0.01). Correlations were also recorded between the number of HVPs on Day 3 and the recovery rate ( r = −0.69, P = 0.03), viability rate ( r = −0.64, P = 0.05), and percentage of degenerated embryos (r = 0.65, P = 0.04). The percentage of HVPs relative to the total area of ovarian cross section on Day 1 was correlated with the number of CL ( r = 0.95, P < 0.001) and of viable embryos ( r = 0.85, P = 0.002). This parameter on Day 3 was also correlated with the recovery rate ( r = −0.69, P = 0.03). The percentage of HVPs relative to the total Doppler area on Day 0 was correlated with the recovery rate ( r = 0.72, P = 0.02). It can be concluded that sonographic assessment of high-velocity antral follicular blood flow has the makings of a useful non-invasive method to predict the outcome of the superovulatory treatment in ewes. [ABSTRACT FROM AUTHOR]

Renal transplantation is the therapy of choice in children with ESKD. Radiological investigations are required in both pre- and post-transplant assessment, although there is paucity of both consensus-based statements and evidence-based imaging guidelines in pediatric renal transplantation. The phases of pediatric ESKD management that require imaging are pretransplantation recipient assessment and post-transplantation surveillance for detection of potential complications. We present suggestions for imaging algorithms for both pre- and post-transplant assessment in pediatric renal transplant recipients. [ABSTRACT FROM AUTHOR]

Arterial color duplex sonography (CDUS) of the extremities is routinely analyzed in the field of emergency radiology. A retrospective review of 500 consecutive arterial CDUS extremity studies was performed in our emergency department. Abnormal CDUS examinations were classified into two groups according to their primary etiology: 1) traumatic arterial injuries (accidents or post-operative complications) and 2) acute arterial ischemia (thrombosis or embolism outside of the setting of acute trauma). This article reviews common CDUS imaging findings in a busy emergency radiology division including traumatic pseudoaneurysm, secondary pseudoaneurysm, arteriovenous fistula, acute ischemic arterial disease and chronic peripheral arterial disease. This essay highlights the crucial role of CDUS in the diagnosis of vascular abnormalities in the emergency setting. CDUS provides several advantages over other imaging modalities including high accuracy, rapid results, portability, lack of radiation, and low cost. [ABSTRACT FROM AUTHOR]

Primary testicular lymphoma is rare and appears with nonspecific findings on grayscale and color Doppler sonography. We present 8 patients further examined with contrast-enhanced sonography, strain elastography, and histologic analysis after orchiectomy. Seven of 8 patients had a diagnosis of large B-cell lymphoma, and 1 of 8 had a diagnosis of granulocytic sarcoma, with solitary lesions (2 of 8), multiple lesions (3 of 8), or entire testicular involvement (3 of 8). Lesions appeared hypoechoic (7 of 8) or isoechoic (1 of 8), all with increased vascularity on color Doppler sonography and a nonbranching linear pattern of intratumoral vessels (7 of 8). Contrast-enhanced ultrasound (CEUS) confirmed this pattern and showed increased enhancement in all lesions. On strain elastography, all lesions were hard, with an elasticity score of greater than 4. Multiparametric sonography of testicular lymphoma identifies increased vascularity on color Doppler and contrast-enhanced ultrasound and increased lesion stiffness on strain elastography. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite the introduction of new immunosuppressive agents, the incidence of allograft rejection after renal transplantation is still high. Color Doppler Sonography (CDS) is the imaging technique which is safe for the evaluation of a renal allograft. It provides rapid recovery room examination. If warranted, the patient can immediately return to surgery, be referred for testing, or undergo other interventional procedures. OBJECTIVE: It is aim of present study to determine diagnostic accuracy of color doppler sonography in acute renal transplant rejection with support of histopathological findings as gold standard. METHODS: Total 88 patients of either gender with age 20 years or more and suspected of renal transplant rejection within one week to one month after transplantation were included in this study. Color doppler sonography was performed and abdominal, serial longitudinal and transverse images were assessed. Resistive index >0.8 was considered graft rejection. Sensitivity, specificity, PPV, NPP, and diagnostic accuracy were calculated taking histopathology as gold standard. The data were analyzed using SPSS and p values of >0.05 were considered as significant. RESULTS: Male patients were 51.1% and female were 48.9%. Mean age was 36.5 ± 10 years. Acute renal transplant rejection was diagnosed in 46.5% patients using color doppler sonography and on histopathology it was observed in 55.6% patients. The sensitivity of CDS was 79.2%, while we observed 95% specificity and diagnostic accuracy was found 86.3%. CONCLUSION: We propose that color doppler sonography (CDS) is an accurate test for diagnosis of acute renal transplant rejection. It is non-invasive and helps to avoid unnecessary surgeries in such patients. [ABSTRACT FROM AUTHOR]

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Ovarian torsion is a rare entity and the diagnosis is commonly missed. Here we present a series of two cases of ovarian torsion. First case followed the in vitro fertilization treatment, along with ovarian hyperstimulation syndrome, where even with timely intervention and laparoscopy, we had to compromise one ovary. Second case followed the ovulation induction and intrauterine insemination - where timely intervention helped us to save the ovary.