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Arterial pseudoaneurysm is a rare complication caused by damage to the arterial wall, resulting in a locally confined hematoma connected to the lumen of the artery. We report the case of a patient on anticoagulants who developed nodules at the surgical wound site after Mohs micrographic surgery for basal cell carcinoma. The initial clinical suspicion was the formation of a simple hematoma. However, Doppler ultrasound examination revealed the presence of pseudoaneurysms in the bilateral supratrochlear arteries. We believe this is the first reported case of supratrochlear artery pseudoaneurysm following dermatologic surgery.

Ovarian torsion is a common gynecologic emergency seen in women of all ages, mostly in reproductive women, resulting in ischemia and necrosis of the adnexal tissue. However, it is rare in premenarchal girls. This article reviews the limited published literature, and discusses special considerations about premenarchal ovarian torsion.

Background Fetal arteriovenous malformations may occur in all parts of the body and are mainly diagnosed by color Doppler ultrasound. However, there are few reports at home and abroad on the types of arteriovenous shunts explored by prenatal ultrasound. Objective To investigate the diagnosis value of prenatal ultrasonography in fetal arteriovenous malformation. Methods Pregnant women with fetal arteriovenous malformations who underwent prenatal ultrasound screening in the Department of Ultrasound, Changsha Hospital for Maternal and Child Health Care from August 2013 to August 2021 were recruited. Color Doppler ultrasonography was used for fetal systematical ultrasound screening. The location, size, shape, and internal echoes of fetal arteriovenous malformation lesions were detected and described. The ultrasonographic features and types of arteriovenous malformations in different parts of patients were analyzed, and the results of follow-up were tracked. Results Prenatal ultrasound screening in this study identified sixteen cases with fetal arteriovenous malformations, of which six lesions were located in the fetal sacrococcygeal region (diagnosed as sacrococcygeal teratoma) , four were located in the fetal intracranial region (including three intracranial cranberg hemangiomas with Galen's vein tumors, one Galen's vein tumor) , three were located in the fetal limbs, soft tissues (including one Parkes Weber syndrome, two soft tissue hemangiomas) , two were located in fetal liver (diagnosed as hepatic arteriovenous fistula) and one was located in fetal lung (diagnosed as isolated lung with pulmonary arteriovenous fistula) . Arteriovenous malformation typing: 10 patients had simple type Ⅱ (10/16) , 3 patients had both type Ⅱ and type Ⅲa (3/16) , 1 patient had type Ⅰ (1/16) , 1 patient had type Ⅳ (1/16) , 1 patient had simple type Ⅲa (1/16) . Follow up showed that 10 induced labor, 3 were lost to follow-up, 2 were born at term and treated surgically, and 1 was stillborn. Conclusion The prognosis of fetal arteriovenous malformation is closely related to the location of lesion and blood flow distribution within the lesion. Prenatal ultrasound can detect a fetus with or without a focus of arteriovenous malformation, which is valuable for diagnosis and prognosis, and can help to detect the potential threat caused by arteriovenous malformation to the fetus.

Background Microvascular ultrasonography (MVUS) is a third-generation Doppler technique that was developed to increase sensitivity compared to conventional Doppler. The purpose of this study was to compare MVUS with conventional color Doppler (CD) and power Doppler (PD) imaging to distinguish Graves’ disease (GD) from destructive thyroiditis (DT). Methods This prospective study included 101 subjects (46 GDs, 47 DTs, and eight normal controls) from October 2020 to November 2021. All ultrasonography examinations were performed using microvascular flow technology (MV-Flow). The CD, PD, and MVUS images were semi-quantitatively graded according to blood flow patterns. On the MVUS images, vascularity indices (VIs), which were the ratio (%) of color pixels in the total grayscale pixels in a defined region of interest, were obtained automatically. Receiver operating characteristic curve analysis was performed to verify the diagnostic performance of MVUS. The interclass correlation coefficient and Cohen’s kappa analysis were used to analyze the reliability of MVUS (ClinicalTrials.gov:NCT04879173). Results The area under the curve (AUC) for CD, PD, MVUS, and MVUS-VI was 0.822, 0.844, 0.808, and 0.852 respectively. The optimal cutoff value of the MVUS-VI was 24.95% for distinguishing GD and DT with 87% sensitivity and 80.9% specificity. We found a significant positive correlation of MVUS-VI with thyrotropin receptor antibody (r=0.554) and with thyroid stimulating immunoglobulin bioassay (r=0.841). MVUS showed high intra- and inter-observer reliability from various statistical method. Conclusion In a real time and quantitative manner, MVUS-VI could be helpful to differentiate GD from thyroiditis in thyrotoxic patients, with less inter-observer variability.

Objective To investigate the application value of carotid ultrasound quantitative parameters combined with serum glycosylated hemoglobin (HbA1c) and fibrinogen (FIB) in the assessment of acute anterior circulation cerebral infarction. Methods Ninety-three patients with acute anterior circulation cerebral infarction were collected as the cerebral infarction group, and 50 healthy individuals were used as the control group. The peak systolic flow velocity (PSV)，end)diastolic flow velocity (EDV) and carotid intima-media thickness (IMT) of internal carotid artery were measured by carotid ultrasound. Serum HbA1c and FIB levels were determined. The above-mentioned indicators in patients with cerebral infarction in different conditions were compared. The relationship between these indicators and cerebral infarction and its condition and these indicators alone or in combination in diagnosis and condition evaluation were analyzed. Results The PSV, EDV, IMT, serum HbA1c and FIB levels were significantly larger/higher in the cerebral infarction group than those of the control group (P＜0.05). Logistic regression analysis showed that the higher levels of EDV, IMT, HbA1c and FIB were risk factors for cerebral infarction (P＜0.05). The area under the curve values and 95%CI of EDV, IMT, HbA1c, FIB alone and combined to diagnose cerebral infarction were 0.770 (0.683-0.857), 0.852 (0.788-0.917), 0.799 (0.717-0.880), 0.829 (0.762-0.896) and 0.970 (0.947-0.992). The IMT and FIB were significantly higher in the moderate group and the severe group than those in the mild group. The HbA1c was significantly higher in the severe group than that in the mild group and the moderate group, and the FIB was higher than that in the moderate group (P＜0.05). Pearson correlation analysis showed that PSV, IMT, HbA1c and FIB were positively correlated with the NIHSS score (P＜0.05). Logistic regression analysis showed that the higher IMT and FIB were risk factors for moderate and severe cerebral infarction. The area under the curve values and 95%CI of IMT, FIB alone and combined to diagnose moderate to severe cerebral infarction were 0.840 (0.758- 0.923), 0.784 (0.687-0.880) and 0.882 (0.809-0.954). Conclusion Patients with anterior circulation cerebral infarction may be accompanied by changes in carotid artery ultrasound quantitative parameters and serum HbA1c and FIB levels. EDV, IMT, HbA1c and FIB are related to the occurrence of cerebral infarction, and IMT and FIB are related to the severity of cerebral infarction. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the role of sonography in revealing and characterizing liver transplant complications based on gray scale and color Doppler, describe the normal Doppler findings, and discuss the significance of distinguishing normal transient changes in the spectral waveform from findings that may suggests ominous complications., Methods: We carried out a retrospective cross-sectional study at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. The medical records and imaging studies of a total of 122 candidates who underwent transplantation between January 2016 to February 2022 were reviewed., Results: Our results showed that most patients were males with the most frequent age group being those between 54-71 years. Hepatitis B virus and hepatic cellular carcinoma were the most common indications for transplants. A total of 95 patients received a graft from a living related donor. Regarding complications, biliary issues (including leaks and ducts dilation) were the second most frequent complication after collections. Vascular complications represented 7.4% of all complications and was the leading cause of death in 4.8% of cases. Among all vascular issues encountered during liver transplant, portal vein thrombosis was the most predominant. In respect to Doppler findings, portal vein velocities and resistive index of hepatic artery had re-averaged within 7-10 post-operative days in most patients., Conclusion: Ultrasound plays crucial role in the post-operative management of compilations, facilitating early detection, which is substantial for the graft survival., (Copyright: © Saudi Medical Journal.)

Diabetic nephropathy (DN) is considered the most frequent cause of end-stage renal disease (ESRD). For early diagnosis and follow up of renal function in patient with established DN, Duplex Doppler Sonography can be used as noninvasive tool. The aim and objective of the study was to determine whether resistive index could remain higher in type 2 diabetic patients having nephropathy in comparison with that of non-diabetic controls. This case-control study was done in the department of Radiology and Imaging, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) from 1st Octy 2014 to 30th June 2015. Total 65 diabetic nephropathy patients were taken as study group and 65 healthy subjects were included as healthy control subjects. Duplex Color Doppler sonography of interlobar artery was carried out in both groups for the measurement of Peak systolic velocity, end diastolic velocity and arterial Resistive Index (RI). The RI of interlobar artery of left kidney in control group was 0.58±0.08 (mean±SD) and the mean RI of interlobar artery of left kidney in diabetic nephropathy patients was 0.74±0.53 (mean±SD). The difference of RI of interlobar artery of left kidney in the two groups was statistically significant and the RI of right kidney of control and that of case groups were 0.60±0.09 and 0.76±0.031 (mean±SD) respectively. In between control and case groups the RI of right kidney was statistically significant (p = <0.5). So, resistive index of interlobar artery was increased in type 2 diabetic nephropathy patients in comparison to control group. Study findings reveal that resistive index remains significantly higher in patients with diabetic nephropathy than control group. For this reason, RI can be used for early diagnosis of diabetic nephropathy by Duplex Doppler ultrasonography.

Aims: Our research aims to shed light on the connection between histopathological differences that affect the prognosis of endometrial cancer and Doppler indices measured in the uterine arteries., Methods: Seventy-four women with a confirmed diagnosis of endometrial cancer participated in this prospective study. The flow characteristics of the bilateral uterine arteries were evaluated and recorded using color Doppler sonography. After hysterectomy, a correlation analysis was performed between these factors and histological findings., Results: Patients who complained of menometrorrhagia had significantly higher uterine artery peak systolic flow (p = 0.020) than those who had postmenopausal vaginal bleeding. Endometrioid adenocarcinoma was the most common type (71.4%). Doppler pulsatility index and resistance index in the uterine arteries didn't show statistically significant differences between histologic subtypes, tumor grade, myometrial invasion, lymphovascular invasion, lymph node involvement, malignant peritoneal cytology, genetic mutation, or extrauterine involvement. Those without cervical involvement had higher uterine artery Doppler peak systolic flow/end diastolic flow (p = 0.024)., Conclusions: Endometrial cancer made uterine artery, myometrium and endometrium less resistant to blood flow. However, these blood flow indices have not been standardized enough to be utilized as diagnostic tests just yet. Standardization based on more advanced studies would make it possible to use ultrasonography for non-invasive diagnosis and would accelerate and facilitate clinical management., (© 2024 Japan Society of Obstetrics and Gynecology.)

Introduction and Objectives: Different degrees of testicular torsion result in varying degrees of testicular damage, which influences treatment options and outcomes. Therefore, establishing a testicular torsion model with different degrees is necessary for clinical diagnosis., Materials and Methods: Rabbits were randomly divided into four groups and their spermatic cords were twisted at 0 °, 180 °, 360 °, and 720 °, respectively. Color Doppler flow imaging (CDFI) were performed to evaluate the blood supply in testicles. The twisted testicles were surgically removed at six hours post-operation and were evaluated by morphological observation and Hematoxylin and Eosin staining., Results: CDFI signals were gradually decreased as the degree of testicular torsion increased, and scores of CDFI in the 360 ° and 720 ° groups were significantly decreased at postoperative six hours compared to pre-surgery. Compared to the sham, the testicle in the 180 ° group exhibited slight congestion, whereas the testicles in the 360 ° and 720 ° groups were dark red in color and had severe congestion and unrecognizable vessels. Hematoxylin and Eosin staining showed mild spermatogenic cell reduction and testicular interstitial hemorrhage in the 180 ° group. In the 360 ° and 720 ° groups, disordered seminiferous tubules, shed spermatogenic cells in tubules, inflammatory cell infiltration, and severe hemorrhage were found. In comparison with the sham, interstitial hemorrhage scores in the 360 ° and 720 ° groups were significantly higher, and scores of germinal epithelial cell thickness in the three testicular torsion groups were significantly decreased., Conclusions: Collectively, we successfully constructed a testicular torsion model with different degrees in rabbits., (Copyright © 2024 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: This study aimed to elucidate the impact of three different mapping methods on the outcomes of arteriovenous fistula (AVF), including the traditional physical examination (PE) method, color duplex ultrasonography (CDU) mapping conducted by a radiologist (CDU-R), and CDU mapping performed by the operating surgeon (CDU-S)., Patients and Methods: This retrospective study was conducted at a tertiary center in Jordan. Patients were divided into three groups based on the venous mapping method: PE, CDU-R, and CDU-S. Various outcomes were analyzed, including immediate technical success, clinical adequacy at 3 months, and 1-year patency rates. Additional demographic and clinical factors influencing access patency or contributing to early failure were also examined., Results: The study included 303 eligible patients: 100 in the PE group, 103 in the CDU-R group, and 100 in the CDU-S group. The overall immediate technical success rate was 72%, which was highest in the CDU-S group (95%, p < 0.001). Additionally, the CDU-S group had the highest clinical access adequacy rate (78%, p < 0.01). Notably, the mapping method also influenced the anatomical location of the AVF, as none of the patients in the radiologist group had a forearm AVF. CDU-R, forearm location, intraoperative arterial calcifications, and operative duration were identified as predictors of AVF failure., Conclusion: The results suggest that perioperative vascular mapping by the operating surgeon not only results in a higher rate of immediate success but also improves access adequacy and prevents unnecessary delays in providing an effective lifeline for hemodialysis patients. The present study highlights the burden of access failure in these patients and the evolving evidence surrounding preoperative vein mapping., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Aljarrah et al.)

An accurate diagnosis of lower limb deep vein thrombosis (DVT) recurrence is mandatory. The diagnosis is difficult and has not been well investigated. Our objective was to define the role of clinical probability assessment, D-dimer assay, venous ultrasound and other imaging methods in the diagnosis of this condition based on a review of published data. Our review did not find any clinical prediction rule (CPR) specific to the diagnosis of DVT recurrence. D-dimer assays have not been sufficiently validated or proved effective either alone or when combined with the assessment of clinical probability or with ultrasound. The only validated ultrasound criteria are a new non-compressible vein segment and a≥2mm or>4mm increase in diameter of the common femoral or popliteal vein under compression in the transverse plane between two examinations. Limitations of these criteria include poor inter-observer agreement, non-availability of previous ultrasound reports and measurements, a high percentage of non-diagnostic ultrasound results, lack of power in diagnostic accuracy and diagnostic management studies, and lack of external validation. The analysis of venous obstruction, thrombus appearance, vein diameter and blood flow based on colour Doppler ultrasound criteria has not yet been validated in studies. Magnetic resonance direct thrombus imaging (MRDTI) is a new promising diagnostic imaging method, but is hardly accessible, costly and needs large scale validation studies. Based on this review, an update of the guidance for clinical practice is proposed for the diagnostic management of patients with clinically suspected lower limb DVT recurrence., (Copyright © 2024. Published by Elsevier Masson SAS.)

Pelvic fracture is a serious injury, which has a profound impact on sexual function due to concurrent nervous and urethral injuries. In this case report, we describe a 29-year-old single man who had retrograde ejaculation as a result of a pelvic fracture-related posterior urethral stricture. The patient wanted to improve his ejaculatory ability after experiencing urethral stricture for 8 years and retrograde ejaculation for 3 years following the pelvic fracture. We precisely located and measured the patient's urethral stricture using a retrograde urethrogram, and we used transrectal color Doppler ultrasound to track the patient's ejaculation process in real time. Next, we used urethral balloon dilatation to relieve the urethral stricture. Urinary obstruction symptoms have completely resolved, and the patient was able to urinate without any obstructions. Meanwhile, the real-time transrectal color Doppler ultrasound result showed that some semen might ejaculate externally by passing through the initial stricture area, while some semen continued to flow retrogradely into the bladder., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: This study is to evaluate the correlation between retrobulbar perfusion deficits and glaucomatous visual field defects., Methods: Eighty-four patients with glaucoma and 17 normal subjects serving as controls were selected. Color Doppler imaging (CDI) was used to measure the changes in blood flow parameters in the retrobulbar ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (SPCAs). Visual field testing was performed using a Humphrey perimeter, categorizing the visual field deficits into four stages according to the Advanced Glaucoma Intervention Study (AGIS) scoring method. Subsequently, the correlation of retrobulbar hemodynamic parameter alterations among glaucomatous patients with varying visual field defects was examined., Results: The higher the visual field stage, the lower the peak systolic velocity (PSV) of the OA, CRA, and SPCAs in glaucomatous patients. The CRA had the highest sensitivity to changes in its PSV. The PSV of the temporal SPCA (TSPCA-PSV) was lower in advanced glaucoma than in early-stage glaucoma. The PSVs of the OA, CRA, and TSPCA, as well as the resistance index of the CRA (CRA-RI), were positively correlated with the visual field index and the mean deviation. Except for that of OA, the PSV of the retrobulbar vessels was negatively correlated with the pattern standard deviation (PSD). The OA-PSV and end-diastolic velocity (EDV) of the CRA and TSPCA were lower in patients with superior visual field defects than in those with inferior visual field defects., Conclusions: Greater severity of visual field defects corresponded to poorer retrobulbar blood flow in glaucomatous patients. Patients suffered significant perfusion impairments in the CRA at the early stage, accompanied by SPCA perfusion disorder at the advanced stage. The presence of a bow-shaped defect in the superior or inferior region of the visual field in moderate-stage glaucoma was closely correlated with retrobulbar vascular EDV., Trial Registration: ChiCTR2200059048 (2022-04-23)., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The study conducted retrospective analysis design, aiming to explore the use of Microvascular Imaging Technique (MVFI) to assess fetal cerebral microcirculation and analyze the relationship between Microvascular Index (MVI) and fetal growth and development. 100 pregnant women who met the criteria for fetal growth restriction (FGR) provided in the Expert Consensus on Fetal Growth Restriction (2019 Edition) and underwent routine prenatal examinations at the Obstetrics and Gynecology Department of Peking University Third Hospital from January 2021 to June 2023 were selected as the study subjects. A normal fetus with a fetal weight less than 10 % can be classified as FGR, Pregnant women with fetal umbilical artery (UA) systolic and diastolic (S/D) values ≥3 were included in the observation group, while 200 pregnant women with normal fetuses were selected as the control group during the same period. The fetuses' change in both groups were measured using color Doppler ultrasound, including bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). The cerebral microcirculation of the fetuses in both groups was evaluated using MVFI, and the MVI values were compared. The clinical characteristics of FGR fetuses with umbilical artery S/D ratio ≥ 3 were summarized, and the correlation between fetal cerebral microvascular status and fetal growth and development was analyzed using Pearson correlation analysis. The outcomes told that the BPD, HC, AC, and FL values of the fetuses in the control group were lower the other's value (P < 0.05), and the MVI and peak systolic velocity of the middle cerebral artery (MCA-PSV) values were also lower in the control group (P < 0.05). Pearson correlation analysis revealed a positive correlation between fetal growth and development and MVI and MCA-PSV values in FGR fetuses. In conclusion, MVFI can monitor and quantitatively analyze fetal intracranial microcirculation, visualize slow blood flow in microvascular structures, and this study provides preliminary evidence of the close relationship between fetal cerebral microcirculation and intrauterine growth and development., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: Giant cell arteritis (GCA) is the main systemic vasculitis in individuals aged ≥ 50 years. Color Doppler ultrasound (CDS) has an established role in GCA diagnosis and management. This study aims to assess the clinical characteristics associated with a positive CDS evaluation and the impact of additional axillary artery examination on diagnostic sensitivity., Material and Methods: We conducted a retrospective analysis of patients undergoing CDS of the superficial temporal arteries, with or without axillary artery assessment, at our hospital, between 2009 and 2023. Patients meeting the new 2022 diagnostic criteria for GCA were included and their characteristics were analyzed according to the presence of the halo sign on CDS., Results: Of the 135 included patients (54 % female, mean age 75 ± 8 years), the halo sign was observed in 57 %, correlating with higher systemic symptom prevalence (61 % vs 42 %, p = 0.035), lower hemoglobin (p < 0.001), and higher erythrocyte sedimentation rate (p = 0.028). The halo sign inversely related to prior corticosteroid therapy (p = 0.033). Patients with axillary halo sign had fewer external carotid symptoms and a higher vertebral halo sign prevalence. Vertebral halo sign was associated with posterior circulation ischemic stroke (65 %, p < 0.001). Axillary artery studies improved diagnostic sensitivity by 9 %., Conclusion: In our study, the halo sign correlated with higher systemic symptoms and analytical abnormalities. Axillary artery examination enhanced CDS sensitivity, linked to severe outcomes like stroke. Prior corticosteroid therapy reduced CDS sensitivity. The correlation of clinical, laboratory, and ultrasound findings provides a more comprehensive understanding of GCA pathogenesis and evolution., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Inc.)

Background and Aims: Acute-on-chronic liver failure (ACLF) is a severe complication of advanced liver disease. A significant number of ACLF patients have not clear precipitating factors. The aim of the study was to investigate the role of alterations in porto-hepatic hemodynamics, especially non-forward portal flow (NFPF), in ACLF and liver-related mortality., Methods: 233 cirrhotic patients were included in the study with a median follow-up of 24 months. Color-Doppler ultrasound was used to assess portal vein patency, flow direction and significant porto-systemic collaterals (>8 mm). Patients with active cancer, both at baseline and during follow-up and severe non liver-related comorbidities were excluded. ACLF and liver-related mortality were recorded during follow-up., Results: Fifty-six patients (24%) developed ACLF; 24 (10,3%) had baseline NFPF. In survival analysis, NFPF, but not portal vein thrombosis, was independently associated with ACLF development (HR 2.85 95% C.I. [1.49-5.42], p = 0.001) and liver-related mortality (HR 2.24 95% C.I. [1.16-4.28], p = 0.015), even after adjustment for liver disease severity scores, age and etiology of liver disease., Conclusion: NFPF is independently associated with ACLF development and liver-related mortality, regardless of etiology, severity disease scores and portal vein thrombosis. Although there is no specific measure to reverse NFPF, patients with NFPF should receive prompt intensive management and urgent prioritization for liver transplantation., Clinical Trial Number: 2730 CESC., Competing Interests: Conflict of interest This study was approved by the Ethical Committee of Verona (2730CESC-VR). We accept transfer of all copyright ownership of our manuscript to your Journal, in the event the work is published. We declare that the article is original, does not infringe upon any copyright or other proprietary right of any third party, is not under consideration by another journal, and has not been published previously. The final version of the paper has been seen and approved by the authors that are sure of the integrity of the work. No conflict of interest and financial interest exists. Furthermore, we declare that our study complies with the Declaration of Helsinki, that the locally appointed ethics committee has approved the research protocol and that informed consent has been obtained from all the recruited subjects., (Copyright © 2024 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Early diagnosis and appropriate management of Cesarean scar pregnancy (CSP) are crucial to prevent severe complications, such as uterine rupture, severe hemorrhage and placenta accreta spectrum disorders. In this article, we provide a step-by-step tutorial for the standardized sonographic evaluation of CSP in the first trimester. Practical steps for performing a standardized transvaginal ultrasound examination to diagnose CSP are outlined, focusing on criteria and techniques essential for accurate identification and classification. Key sonographic markers, including gestational sac location, cardiac activity, placental implantation and myometrial thickness, are detailed. The evaluation process is presented according to assessment of the uterine scar, differential diagnosis, detailed CSP evaluation and CSP classification. This step-by-step tutorial emphasizes the importance of scanning in two planes (sagittal and transverse), utilizing color or power Doppler and differentiating CSP from other low-lying pregnancies. The CSP classification is described in detail and is based on the location of the largest part of the gestational sac relative to the uterine cavity and serosal lines. This descriptive classification is recommended for clinical use to stimulate uniform description and evaluation. Such a standardized sonographic evaluation of CSP in the first trimester is essential for early diagnosis and management, helping to prevent life-threatening complications and to preserve fertility. Training sonographers in detailed evaluation techniques and promoting awareness of CSP are critical. The structured approach to CSP diagnosis presented herein is supported by a free e-learning course available online. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology., (© 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.)

Background:  The versatile musculocutaneous latissimus dorsi flap and the thoracodorsal artery (TDA) perforator flap have developed into indispensable approaches in reconstructive surgery. While the anatomy of the TDA is consistent, the skin perforators vary in location and course. Dynamic infrared thermography (DIRT) recently gained popularity for perforator identification; however, its use and accuracy in thoracodorsal artery perforator (TDAP) mapping is yet to be determined., Methods:  TDAPs were visualized in 50 cases by DIRT. Based on the thermographic hotspots, the corresponding perforators were then identified by color duplex ultrasound (CDU) and handheld Doppler in a blinded fashion by two separate examiners., Results:  The midpoint of all perforator fascia passages was localized 99.7 mm caudal and 13.5 mm medial of the posterior axillary fold. The positive predictive value of perforator identification by dynamic infrared thermography was 86.5% and the correlating perforator fascia passage was 9.9 ± 5.8 mm from the hotspot midpoint, with a maximum of 29 mm. The positive predictive value of perforator identification by handheld Doppler was 95% and the signal was 7.2 ± 5.1 mm from the perforator fascia passage., Conclusion:  DIRT precisely localizes TDAPs. The fusion with CDU combines both modalities' advantages. The combination with handheld Doppler is a fast way of perforator imaging, decreasing the handheld Dopplers' high false positive rate., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: The investigation of the fetal umbilical-portal venous system is based on the premise that congenital anomalies of this system may be related to adverse perinatal outcomes. Several small retrospective studies have reported an association between umbilical-portal-systemic venous shunts and intrauterine growth restriction. However, the prevalence of portosystemic shunts in the fetal growth restricted population is yet to be determined., Objective: The aims of this study were (1) to determine the prevalence of fetal umbilical-portal-systemic venous shunts in pregnancies complicated by intrauterine growth restriction and (2) to compare the perinatal and neonatal outcomes of pregnancies with intrauterine growth restriction with and without umbilical-portal-systemic venous shunts., Study Design: This was a prospective, cross-sectional study of pregnancies diagnosed with intrauterine growth restriction, as defined by the Society for Maternal-Fetal Medicine intrauterine growth restriction guidelines. All participants underwent a detailed anomaly scan, supplemented with a targeted scan of the fetal portal system. Venous shunts were diagnosed using color Doppler mode. The perinatal outcomes of pregnancies with intrauterine growth restriction with and without umbilical-portal-systemic venous shunts were compared., Results: A total of 150 cases with intrauterine growth restriction were recruited. The prevalence of umbilical-portal-systemic venous shunts in our cohort was 9.3% (n=14). When compared with the control group (intrauterine growth restriction without umbilical-portal-systemic venous shunts, n=136), the study group had a significantly lower mean gestational age at the time of intrauterine growth restriction diagnosis (29.7±5.6 vs 32.47±4.6 weeks of gestation; P=.036) and an earlier gestational age at delivery (33.50±6.0 vs 36.13±2.8; P=.005). The study group had a higher rate of fetal death (21.4% vs 0.7%; P<.001) and, accordingly, a lower rate of live births (71.4% vs 95.6%; P=.001). Additional associated fetal vascular anomalies were significantly more prevalent in the study group than in the control group (35.7% vs 4.4%; P≤.001). The rate of other associated anomalies was similar. The study group had a significantly lower rate of abnormal uterine artery Doppler indices (0% vs 40.4%; P=.011) and a higher rate of abnormal ductus venosus Doppler indices (64.3% vs 23%; P=.001). There were no cases of hypertensive disorders of pregnancy in the study group, whereas the control group had an incidence of 12.5% (P=.16). Other perinatal and neonatal outcomes were comparable., Conclusion: Umbilical-portal-systemic venous shunt is a relatively common finding among fetuses with growth restriction. When compared with pregnancies with intrauterine growth restriction with a normal portal system, these pregnancies complicated by intrauterine growth restriction and an umbilical-portal-systemic venous shunt are associated with a different Doppler flow pattern, an increased risk for fetal death, earlier presentation of intrauterine growth restriction, a lower gestational age at delivery, additional congenital vascular anomalies, and a lower rate of pregnancy-induced hypertensive disorders. Meticulous sonographic evaluation of the portal system should be considered in the prenatal workup of intrauterine growth restriction, as umbilical-portal-systemic venous shunts may affect perinatal outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The arteriovenous fistula constitutes the vascular access of first choice in hemodialysis. We present three clinical cases that highlight the resolution in interventional radiology of venous stenosis, one of the major complications. Clinical monitoring and instrumental diagnostics with color Doppler ultrasound have prevented the failure of the AVF due to high risk of thrombosis. The angiographic interventions, thanks to the collaboration between Spoke and Hub, were completed without complications., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Background: Crohn's disease (CD) is a chronic inflammatory disease of the digestive tract with unknown etiology. It follows a relapse-remission pattern, making disease activity assessment crucial for treatment. Our study aims to evaluate the diagnostic accuracy of various imaging modalities and to validate and compare the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS), the multidetector computed tomography enterography score (MDCTEs), and the simplified endoscopic activity score for Crohn's disease (SES-CD)., Methods: We assessed diagnostic performance using the CD Activity Index (CDAI). We first categorized patients into remission and active groups. For those in the active stage, we further categorized them into mild/moderate and severe activity groups. We used Spearman rank correlation to evaluate the relationships among IBUS-SAS, bowel wall thickness (BWT), Color Doppler imaging signal (CDS), inflammatory fat (i-fat), bowel wall stratification (BWS), and clinical inflammatory indicators., Results: A total of 103 CD patients were evaluated. The IBUS-SAS cut-off for remission and activity was 23.8, with an AUC of 0.923, sensitivity of 91.4%, and specificity of 84.8%. The SES-CD had an AUC of 0.801, sensitivity of 62.9%, and specificity of 84.4% at a cut-off of 4.5. The MDCTEs showed an AUC of 0.855, sensitivity of 77.1%, and specificity of 75.8% for a cut-off of 6.5. The Delong test revealed significant differences in diagnostic efficacy when comparing IBUS-SAS to SES-CD and IBUS-SAS to MDCTEs. In the group of mild or moderate-to-severe active, the IBUS-SAS had an AUC of 0.925, sensitivity of 83.7%, and specificity of 88.9% at a cut-off of 40. The SES-CD exhibited an AUC of 0.850, sensitivity of 90.7%, and specificity of 70.4% at a cut-off of 8.5. MDCTEs showed an AUC of 0.909, sensitivity of 83.7%, and specificity of 85.2% at a cut-off of 8.5. During Delong test, the IBUS-SAS, MDCTEs, and SES-CD showed no significant differences in assessing moderate-to-severe activity. Both IBUS-SAS and ultrasound parameters correlated with certain serum indicators (p < 0.05), although only weakly to moderately (all r < 0.5)., Conclusion: The IBUS-SAS, MDCTEs and SES-CD can evaluate disease remission/active and mild/moderate-to-severe active in CD, and IBUS-SAS offers the potential to precisely define CD activity., (© 2024. The Author(s).)

Objective: To investigate the impact of age, various hormonal levels, and biochemical markers on penile cavernous body vascular function in patients with erectile dysfunction (ED). Me-thods: A retrospective analysis of clinical data from male patients with ED who underwent color duplex Doppler ultrasonography (CDDU) and intracavernosal injection test (ICI) at the Reproductive Medicine Center of Peking University Third Hospital from January 2020 to August 2023. Data were managed and processed using SPSS 29.0, and a multivariable Logistic regression analysis was conducted., Results: A total of 700 ED patients were included, with 380 showing negative ICI results and 320 positive. In the study, 84 patients had a peak systolic velocity (PSV) < 25 cm/s, while 616 had PSV≥25 cm/s; 202 patients had end-diastolic velocity (EDV)>5 cm/s, and 498 had EDV≤5 cm/s. 264 patients had abnormal PSV and/or EDV results, and 436 had normal results for both. Patients with vascular ED had significantly lower estrogen levels ( t =-3.546, P < 0.001), lower testosterone levels ( t =-2.089, P =0.037), and a higher rate of hyperglycemia ( χ 2 =12.772, P =0.002) compared with those with non-vascular ED. The patients with arterial ED were older ( t =3.953, P < 0.001), had a higher rate of hyperglycemia ( χ 2 =9.518, P =0.009), and a higher estrogen/testosterone ratio ( t =2.330, P =0.020) compared with those with non-arterial ED. The patients with mixed arteriovenous ED had higher age ( t =3.567, P < 0.001), lower testosterone levels ( t =-2.288, P =0.022), a higher rate of hyperglycemia ( χ 2 =12.877, P =0.002), and a larger estrogen/testosterone ratio ( t =2.096, P =0.037) compared with those with normal findings. Multifactorial Logistic regression analysis indicated that higher levels of estrogen were a protective factor for vascular ED ( OR =1.009, 95% CI : 1.004-1.014), and glucose≥7.0 mmol/L was a risk factor ( OR =0.381, 95% CI : 0.219-0.661). Older age was a risk factor for arterial ED ( OR =0.960, 95% CI : 0.938-0.982). Additionally, older age ( OR =0.976, 95% CI : 0.958-0.993) and glucose levels of 5.6-6.9 mmol/L ( OR =0.591, 95% CI : 0.399-0.876) were also risk factors for mixed arterio-venous ED., Conclusion: Hyperglycemia and aging may impair penile cavernous body vascular function, while higher levels of estrogen may have a protective effect on it.

Background: Lugol solution is often administered to patients with Graves' disease before surgery. The aim is to reduce thyroid vascularization and surgical morbidity, but its real effectiveness remains controversial. The present study was designed to evaluate the effects of preoperative Lugol solution on thyroid vascularization and surgical morbidity in patients with Graves' disease undergoing total thyroidectomy., Methods: Fifty-six patients undergoing total thyroidectomy for Graves' disease were randomly assigned to receive 7 days of Lugol treatment (Lugol+ group, 29) or no Lugol treatment (LS- group, 27) before surgery in this single-centre and single-blinded trial. Preoperative hormone and colour Doppler ultrasonographic data for assessing thyroid vascularization were collected 8 days before surgery (T0) and on the day of surgery (T1). The primary outcome was intraoperative and postoperative blood loss. Secondary outcomes included duration of surgery, thyroid function, morbidity, vascularization, and microvessel density at final pathology., Results: No differences in demographic, preoperative hormone or ultrasonographic data were found between LS+ and LS- groups at T0. At T1, free tri-iodothyronine (FT3) and free thyroxine (FT4) levels were significantly reduced compared with T0 values in the LS+ group, whereas no such variation was observed in the LS- group. No differences between T0 and T1 were found for ultrasonographic vascularization in either group, nor did the histological findings differ. There were no significant differences between the LS+ and LS- groups concerning intraoperative/postoperative blood loss (median 80.5 versus 94 ml respectively), duration of surgery (75 min in both groups) or postoperative morbidity., Conclusion: Lugol solution significantly reduces FT3 and FT4 levels in patients undergoing surgery for Graves' disease, but does not decrease intraoperative/postoperative blood loss, thyroid vascularization, duration of surgery or postoperative morbidity., Registration Number: NCT05784792 (https://www.clinicaltrials.gov)., (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background:  There is limited data available regarding the prevalence of intracranial arterial stenosis (ICAS) among acute ischemic stroke (AIS) patients in Brazil and Latin America., Objective:  The present study sought to investigate the frequency and predictors of ICAS among patients with AIS or transient ischemic attack (TIA) in a Brazilian center, with transcranial color-coded duplex sonography (TCCS) technique., Methods:  Consecutive AIS and TIA patients, admitted to an academic public comprehensive stroke center in Brazil from February to December 2014, evaluated by TCCS were prospectively selected. Vascular narrowings > 50% were considered as ICAS, based on ultrasound criteria previously defined in the literature., Results:  We assessed 170 consecutive patients with AIS or TIA, of whom 27 (15.9%) were excluded due to an inadequate transtemporal acoustic bone window. We confirmed ICAS in 55 patients (38.5%). The most common location was the proximal segment of the middle cerebral artery (28.2%), followed by the vertebral (15.4%), posterior cerebral (13.6%), terminal internal carotid (9.1%) and basilar (8.2%) arteries. On multivariate models adjusting for potential confounders, systolic blood pressure (OR: 1.03, 95%CI: 1.01-1.04; p  = 0.008) was independently associated with ICAS., Conclusion:  We found significant ICAS in approximately ⅓ of patients admitted with symptoms of AIS or TIA in a public tertiary academic stroke center in Brazil. The TCCS is an accessible and noninvasive technique that can be used to investigate the presence of moderate and severe ICAS, especially in patients who cannot be exposed to more invasive exams, such as the use of intravenous contrast agents., Competing Interests: The authors have no conflict of interest to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).)

Background: Cryptorchidism and testicular torsion (TT) are relatively common conditions in clinical practice; however, sparse information about cryptorchid TT is available in the current literature., Methods: We retrospectively reviewed the clinical characteristics, treatment modalities, and long-term outcomes of pediatric patients treated for acute cryptorchid TT., Results: We found eight patients with unilateral acute cryptorchid TT with a prevalence of 8.9% (8/90) among all TT cases. The left testis was affected in six patients. The median age of patients at the time of the surgery was 65 months (interquartile range (IQR) 4-136 months). The median duration of symptoms was 16 h (IQR 9-25 h), while the median time to treatment was 60 min (IQR 59-63 min). The most common symptoms were pain (abdominal and inguinal) and inguinal mass with no palpable testis in the ipsilateral hemiscrotum. Preoperative color Doppler ultrasonography revealed absent or decreased testicular blood flow in the affected testes in 7/8 of patients. Various degrees of testicular torsion (median 540°, min 360°, max 1260°) were found during surgery. A necrotic testis that led to orchidectomy was found in 4/8 of patients. The median follow-up period was 42.6 months (IQR 12.5-71.2 months), revealing only one patient with testicular atrophy. The final testicular salvage rate was 35%., Conclusions: Greater awareness among caregivers and primary care physicians about acute cryptorchid TT is required to improve their timely diagnosis and treatment. A physical examination of the external genitalia and inguinal regions should be mandatory to attain a proper diagnosis and treatment without delay., Competing Interests: Declaration of competing interest Una Glamoclija is an employee of Bosnalijek d.d., Sarajevo. Other authors do not have a conflict of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: This study aims to assess the feasibility and effectiveness of color doppler flow imaging (CDFI) technology and the Slow Flow HD imaging technique in identifying fetal pulmonary veins (PVs) in the first trimester (11-13 + 6 weeks), and further explore the factors affecting fetal pulmonary vein identification in early pregnancy., Methods: Echocardiography and scanning of PVs were performed in 240 normal singleton fetuses in early pregnancy by using CDFI and slow flow HD techniques, to compare the ability of two methods to identify the PVs. Slow Flow HD technology was used to further investigate the difference of PVs identification at different gestational ages [group I (11-11 + 6 weeks), group II (12-12 + 6 weeks), group III (13-13 + 6 weeks)] and with different maternal body mass indices (BMI) (≥ 25 and < 25). In 31 cases of 240 fetuses, transvaginal ultrasonography was added due to maternal habitus or significant retroversion of the uterus, and the difference in PVs identification between transabdominal and transvaginal examination was analyzed., Results: Successful PVs identification rates via CDFI and Slow Flow HD were 32.0% and 88.3%, respectively (p < 0.05). The identification rate of at least one and two pulmonary veins in Slow Flow HD was 88.3% and 76.2%, and all four pulmonary veins in 11.6% (p < 0.05). The identification rate of group I, II and III were 76.4%, 88.9% and 96.0%, respectively. The identification rate was 45.1% in the transabdominal ultrasound group and 83.8% in the transvaginal ultrasound group. The identification rate was 62.5% in the BMI ≥ 25 group and 94.7% in the BMI < 25 group (p < 0.05)., Conclusions: Slow Flow HD can detect PVs in early pregnancy more often than using CDFI. Slow Flow HD is a feasible and effective imaging technique for evaluating PVs in early pregnancy., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Magnesium sulfate (MgSO 4 ) is one of the most commonly used agents for the treatment and prophylaxis of eclampsia in patients with severe preeclampsia. However, there is no international consensus regarding the optimal gestational age for MgSO4 treatment. The aim of this study was to assess the effect of MgSO4 on uterine (UtA), umbilical, and fetal middle cerebral arteries (MCA) by calculating the SD ratio (S/D), resistance index (RI), and pulsatility index (PI) at different gestational weeks., Methods: In total, 66 pregnant women as participants with severe preeclampsia were divided into two groups based on gestational age: Group 1 ( n  = 28, 26-30 weeks) and Group 2 ( n  = 38, 30-34 weeks). Color Doppler (Philip HD11) measurements were taken and compared before and after the MgSO4 loading dose., Results: Within-group analysis revealed significant differences in RI-UtA, PI-UtA, and S/D in UtA before and after MgSO4 administration in Group 1. Furthermore, the RI-UA and RI-MCA decreased statistically significantly after MgSO4 treatment, whereas the pulsatility index and S/D did not change in either the umbilical or middle cerebral arteries. After MgSO4 treatment, all Doppler parameters in the uterine and umbilical arteries in Group 2 showed significant changes when compared to before MgSO4 administration., Conclusion: MgSO4 can effectively improve umbilical and MCA blood flow at 30-34 gestational weeks but not at 26-30w. Meanwhile, using MgSO4 can improve uterine blood flow in severe preeclampsia, which may contribute to the management of reducing adverse events in pregnant women who have preeclampsia and fetal growth restriction.

The integration of imaging technologies such as computed tomography angiography and color Doppler ultrasonography are transforming soft tissue free flap reconstruction. The search for thinner and more refined flaps has expanded indications for flaps harvested from donor sites that were not commonly used in head and neck reconstruction. This article explores how these tools and techniques facilitate precise flap selection, thickness, and design customization based on detailed patient preoperative perforator anatomy and vascular configuration mapping. Optimizing outcomes with tailored flap designs improves surgical accuracy and patient-specific results in soft tissue reconstruction., Competing Interests: Disclosures None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. The study was not financially supported by any grants., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: There has been a large discussion in literature regarding the proper management of asymptomatic patients with significant carotid artery stenosis. This study aims to identify potential risk factors associated with high-risk carotid plaques., Methods: This is a retrospective study based on a prospective database. Eligible patients had medium to severe symptomatic or asymptomatic carotid stenosis (≥50%, North American Symptomatic Carotid Endarterectomy Trial criteria). This study will analyze patients recruited by our institution as part of the multicenter TAXINOMISIS project (NCT03495830). According to protocol, all patients underwent a colored Duplex ultrasound examination and a magnetic resonance angiography at baseline. Carotid plaques were classified according to Gray-Weale ultrasonographic criteria (types I-V). Main outcomes included the occurrence of symptoms, the high/low echogenicity of the plaque, the existence of intraplaque hemorrhage and the existence of lipidic/necrotic core. Secondary, risk factors associated with the aforementioned outcomes were evaluated., Results: A total of 62 patients (mean age: 68.7 ± 9.3 years, 66.1% males, 24.2% symptomatic) were recruited by our department. Mean carotid stenosis was 70.81% ± 13.53%. In multivariate regression analysis, C-reactive protein > 2 mg/l was strongly associated with symptomatic stenosis (odds ratio [OR] = 9.92 [1.12-88.178]; P = 0.039), and low high-density lipoprotein levels (<1200 mmol/l) were associated with lipidic/necrotic plaque core (OR = 16.88 [1.10-259.30]; P = 0.043). Low high-density lipoprotein levels (OR = 7.22 [1.00-51.95], P = 0.049) and HbA1c >7% (OR = 0.08 [0.01-0.93], P = 0.044) were associated with type III/IV plaques whereas HgAbc1 >7% (OR = 14.26 [1.21-168.34], P = 0.035) was associated with type V plaques., Conclusions: This preliminary study has revealed some potential risk factors associated with unstable carotid plaques. These data could help the future development of prognostic models for early detection patients that could benefit from further intervention., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective To explore the predictive value of microRNA-18a (miR-18a) combined with uterine artery blood flow parameters [resistance index (RI), pulse index (PI) and systolic phase velocity/diastolic phase velocity (S/D)] for the early-onset preeclampsia (E-PE). Methods A total of 628 pregnant women undergoing pregnancy checkups were selected in this study and divided into the E-PE group (n=34) and the control group (n=594) according to whether they developed E-PE. The relative expression of mir-18a was detected by real-time quantitative PCR, and RI, PI and S/D parameters were detected by color Doppler ultrasound diagnostic instrument. The predictive value of serum mir-18a, RI, PI and S/D to E-PE were analyzed by subject operating characteristic curve (ROC). Results The relative expression of miR- 18a in serum was lower in the E-PE group than that of the control group, and RI, PI, S/D were higher than those of the control group (P＜0.05). The relative expression of serum miR-18a was negatively correlated with RI, PI, and S/D in E-PE patients (P＜0.05). ROC analysis showed that serum miR-18a, RI and PI can be used to predict the risk of E-PE, and areas under the curve were 0.780 (95%CI: 0.727-0.832), 0.729 (95%CI: 0.644-0.814) and 0.782 (95%CI: 0.695-0.870), respectively. However, S/D had lower predictive value for E-PE, and the product under the curve was 0.602 (95%CI: 0.496- 0.708). miR-18a combined with PI showed a higher predictive value for E-PE, with a sensitivity of 82.35%, a specificity of 83.84%, and a Youden index of 0.662. Conclusion The serum expression of in miR-18a is abnormally low in E-PE patients, and its expression level is negatively correlated with uterine artery blood flow parameters such as RI, PI, and S/D. miR-18a combined with PI has a high predictive value for E-PE. [ABSTRACT FROM AUTHOR]

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Groin lesions can be classified as neoplastic or non-neoplastic. Neoplastic lesions include lipoma, epidermoid cyst, angiomyofibroblastoma-like tumor, liposarcoma, and synovial sarcoma, as well as metastases from lymphoma, neuroendocrine carcinoma, and carcinomas of the lung, breast, urinary bladder, ovary, vulva, and colon. Non-neoplastic lesions include hernias, round ligament varices, endometriosis, Kimura disease, Castleman disease, hematoma, and inflammation. Because the clinical implications and therapeutic strategies for groin lesions vary depending on the cause, the ability to noninvasively differentiate among etiologies is very important. Although there is substantial overlap in ultrasonographic findings across various groin lesions, some ultrasonographic features, along with clinical characteristics, may suggest a specific diagnosis. Familiarity with the ultrasonographic and clinical features of various groin lesions facilitates accurate diagnosis and treatment.

Background/Aim. Adverse pregnancy outcomes such as preeclampsia (PE), placental abruption (PA), fetal intrauterine growth restriction (IUGR) and stillbirth could be recognized by prenatal screening. The objective of this study was to predict IUGR by using first-trimester extremely low pregnancy-associated plasma protein-A (PAPP-A), extremely low free beta-human chorionic gonadotropin (free βhCG) levels, and extremely high Pulsatility-index (PI) of uterine arteries, as single and combined predictors for IUGR development. Methods. This was a prospective first-trimester study analyzing singleton pregnancies at 11–13+6 weeks’ gestation who underwent routine first-trimester screening at the Department of High Risk Pregnancy of the Clinic for Gynecology and Obstetrics „Narodni front“, University of Belgrade, Serbia. First-trimester screening for PAPP-A, free βhCG, and PI was performed in nulliparous, normotensive women with extremely low PAPP-A (PAPP-A ≤ 0.52 unit multiple of median – MoM) and/or extremely low free βhCG (free βhCG ≤ 0.56 MoM) and/or extremely high PI (PI ≥ 2.52). Results. Of 85 pregnant women included in the final analysis, 14 (16.5%) developed IUGR. PAPP-A ≤ 0.52 MoM and PI ≥ 2.52, as single categorical variables, found to be with high predictable values for IUGR development (odds ratio – OR = 3.064, 95% confidence interval – CI= 0.634-14.810, p = 0.046, and OR = 2.129, 95% CI = 0.449–10.713, p = 0.021, respectively). Furthermore, the receiver operating characteristic (ROC curve identified PAPP-A and PI as continuous variables to be significant predictors of IUGR (area under curve – AUC = 0.671, 95% CI = 0.521−0.820, p = 0.045, and AUC = 0.744, 95% CI = 0.587−0.902, p = 0.004, respectively). Conclusion. The present study suggests that the first trimester extremely low PAPP-A and increased Doppler-PI levels are single predictors of IUGR. Described model could be used in a routine daily clinical practice in resource limited settings where other parameters are not available for the prediction of IUGR development.

Purpose The purpose of this study was to compare the sensitivity of MicroFlow Imaging (MFI) with that of color and power Doppler imaging (CDI and PDI, respectively) in detecting the vascularity of hepatocellular carcinomas (HCCs). Methods This prospective study enrolled 51 patients diagnosed with HCC between August 2018 and December 2018. CDI, PDI, MFI, and contrast-enhanced ultrasound (CEUS) were performed. Two radiologists evaluated the presence and pattern of tumoral vascularity on CDI, PDI, and MFI. Vascular presence was graded on a 5-point scale (0, absent; 4, >50% of the tumor). The vascular pattern was chosen from following categories: basket, vessels in tumor, spot, detouring, mixed, or others. Two additional radiologists assessed CEUS images for the presence and pattern of tumoral vascularity, which served as the reference standard. If the tumoral vascular pattern on each examination matched that of the CEUS images, the Wilcoxon test and McNemar test, respectively, were used to compare the sensitivity for detecting tumoral vascularity between MFI and CDI, and between MFI and PDI. Logistic regression analysis was performed to identify factors associated with MFI detectability of tumoral vascularity. Results CEUS demonstrated tumoral vascularity in 98.0% (50 of 51) of patients. MFI (58.0%, 29 of 50) demonstrated a higher sensitivity than CDI (14.0%, 7 of 50) or PDI (14.0%, 7 of 50) (P

Background: This study aims to investigate the role of shear wave elastography (SWE) and connective tissue growth factor (CTGF) in the assessment of papillary thyroid carcinoma (PTC) prognosis., Methods: CTGF expression was detected with immunohistochemistry. Clinical and pathological data were collected. Parameters of conventional ultrasound combined with SWE were also collected. The relationship among CTGF expression, ultrasound indicators, the elastic modulus and the clinicopathological parameters were analyzed., Results: Univariate analysis showed that patients with high risk of PTC were characterized with male, Uygur ethnicity, increased expression of CTGF, convex lesions, calcified, incomplete capsule, intranodular blood flow, rear echo attenuation, cervical lymph node metastasis, lesions larger than 1 cm, psammoma bodies, advanced clinical stage, increased TSH and high value in the shear modulus (P < 0.05). Multivariate analysis demonstrated that the risk factors of high expression of CTGF according to contribution size order were irregular shape, aspect ratio ≥ 1, and increased TSH. The logistic regression model equation was Logit (P) = 1.153 + 1.055 × 1 + 0.926 × 2 + 1.190 × 3 and the Area Under Curve value of the logistic regression was calculated to be 0.850, with a 95% confidence interval of 0.817 to 0.883., Conclusion: SWE and CTGF are of great value in the risk assessment of PTC. The degree of fibrosis of PTC is closely related to the prognosis. The hardness of PTC lesions and the expression level of CTGF are correlated with the main indexes of conventional ultrasound differentiating benign or malignant nodules. Irregular shape, aspect ratio ≥ 1, and increased TSH are independent factors of CTGF., (© 2024. The Author(s).)

Objective: We investigated the feasibility and efficacy of assessing calf perforating veins (PVs) using the ankle pump in a sitting position (AP-sit) method by color Doppler ultrasound., Methods: We performed a multicenter prospective clinical trial between November 2022 and October 2023. Eligible patients with chronic venous disease and healthy controls were enrolled. The calf PVs were assessed using three different methods: manual compression in a standing position, manual compression in a sitting position, and AP-sit method. The reflux durations and detection rate of incompetent PVs (IPVs) were compared among the three methods. The number and diameter of calf PVs and distribution of IPVs were analyzed., Results: A total of 50 patients with chronic venous disease and 50 healthy controls were included. There were 173 calves analyzed, including 97 healthy calves and 76 calves with chronic venous disease. The number of PVs per calf was higher in the diseased calves (median, 7.0; interquartile range [IQR], 6.0-8.0) than in the healthy calves (median, 5.0; IQR, 3.0-6.0; P < .001). The diameter of IPVs (median, 2.3 mm; IQR, 2.0-3.1 mm) was larger than that of competent PVs (median, 1.4 mm; IQR, 1.2-1.7 mm). Most of the IPVs (78.8%) were located in the medial and posterior middle of the calf. The reflux duration induced by the AP-sit method was greater than that induced by the manual compression methods (P < .001). Although the AP-sit method had a higher detection rate (92.0%) of IPVs than the manual compression methods (71.7% and 74.3% for standing and sitting, respectively; P < .001), especially in the distal lower leg, the manual compression methods found IPVs not found using the AP-sit method., Conclusions: Diseased calves with chronic venous disease have more PVs than do healthy calves. IPVs are commonly larger than competent PVs, with most IPVs located in the medial and posterior middle of the calf. Most importantly, the AP-sit method provides a convenient and effective approach for assessing the calf PVs, especially those located in the distal calf, as an alternative or complementary method to traditional manual compression, which is valuable in the daily practice of sonographers., Competing Interests: Disclosures None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to evaluate the effects of local calf vibration on balance, blood flow, and nerve conductivity in patients with diabetic peripheral neuropathy (DPN)., Methods: An open-label controlled trial was designed. Patients with confirmed diagnoses of type 2 diabetes and DPN were enrolled in the study and underwent ten sessions of local calf vibration therapy for the dominant leg. The other leg was considered the control. Balance evaluation, nerve conduction studies, and color Doppler ultrasound were performed before and after the treatment course. The Wilcoxon signed rank test and the Mann-Whitney test were used to evaluate the differences between the test results before and after the intervention and between the intervention and control legs., Results: Seventeen patients with a mean age of 60.3 ± 5.6 years (11 males) participated in the study. Mean Brief BESTest total scores were significantly improved (14.06 vs. 17.35; P = .01, Cohen's d = 0.743). There were no significant differences between the treated and control legs regarding the nerve conduction and color Doppler ultrasound parameters before and after the intervention (P ≥ .054). Changes in the parameters were also not significantly different between legs (P ≥ .078), except for common peroneal nerve conduction velocity, for which there was a higher increase in its value in the treated legs compared to the control legs (4.17 vs. 0.9, P = .002)., Conclusion: Local calf vibration may positively affect balance and lower extremities nerve conduction in patients with DPN, and the findings of this study can be a basis for studies evaluating the efficacy of local calf vibration for treating DPN.

Background: Microvascular complications of diabetes mellitus (DM) include oral manifestations and complications, including xerostomia, reduced salivary flow, susceptibility to infection, periodontal disease and salivary gland enlargement., Objective: The present study aims to evaluate B-mode ultrasonography (USG) parameters such as size, volume and echogenicity of the submandibular and parotid salivary glands on both sides, shear-wave elastography (SWE) value and colour Doppler properties in patients with DM and healthy control groups., Methods: In total, 160 right and left submandibular glands and 160 right and left parotid glands of 80 patients, 40 patients (20 type 1 DM, 20 type 2 DM) and 40 healthy control group, between the ages of 18-70 were examined by USG. Echogenicity, parenchyma internal structure, margin and dimensional measurements (antero-posterior length, supero-inferior length, medio-lateral length and volume) and colour Doppler with 'ML 6-15-D Matrix Array (4-15 MHz)' probe, shear-wave elastography '9L-D (2-8 MHz)' probe was investigated., Result: Statistically significant difference was observed in echogenicity in the right submandibular gland, echogenicity in the right parotid gland, margin characteristics, parenchymal homogeneity and colour Doppler characteristics between the type 1 DM, type 2 DM and control groups (p < .05). It was observed that the size, volume and SWE values of both submandibular and parotid glands were higher in the DM patient group than in the control group. Higher values were observed in type 2 DM compared to type 1 DM in the patient group., Conclusion: USG is an effective imaging technique in investigating the effects of diabetes on the submandibular and parotid salivary glands., (© 2024 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Background and Purpose: Radiotherapy (RT) can damage neck vessels in patients with head and neck cancer (HNC). This study investigated the early effects of RT on carotid artery, including the internal media thickness (IMT) and carotid plaques of the common carotid artery (CCA)., Materials and Methods: This study included 69 patients with HNC who underwent RT at the First Hospital of Jilin University from March 2017 to September 2022, and 69 healthy participants as controls. Color Doppler ultrasound (CDUS) of the carotid artery was used to measure the CCA IMT and plaques., Results: Left CCA IMT increased from 0.60 mm (0.60, 0.70) before RT to 0.70 mm (0.60, 1.20) after RT (P < 0.0001). Right CCA IMT changed from 0.60 mm (0.60, 0.71) before RT to 0.60 mm (0.60, 1.10) after RT (P = 0.0002). CCA IMT was 0.60 mm (0.60, 0.70) and 0.80 mm (0.60, 1.20) in the ≤40 Gy and >40 Gy groups (P = 0.0004). The CCA plaques number increased significantly after RT on both the left and right sides (P left  < 0.0001; P right  <0.0001). The CCA plaques volume increased from 0 mm 3 (0, 11.35) and 0 mm 3 (0, 8.55) before RT to 8.8 mm 3 (0, 21.5) and 5.8 mm 3 (0, 16.1) on the left and right sides. Correlation analysis revealed a correlation between CCA IMT and age (r = 0.283, P = 0.001), smoking status (r = 0.179, P = 0.020), and radiation dose (r = 0.188, P = 0.028)., Conclusion: RT significantly increased CCA IMT, and the growth was related to the radiation dose. The number and volume of the CCA plaques also increased after RT., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background and Aims: Ultra-microangiography (UMA) is a novel Doppler technique with optimized wall filtering that provides high sensitivity to low-velocity blood flows and optimized visualization of microcirculation. The aim of this pilot study was to compare intestinal vascularization assessed by color Doppler signals (CDS) and UMA., Methods: We investigated intestinal vascularization using UMA and CDS in 13 patients with confirmed inflammatory bowel disease (IBD). A cohort of 28 patients without structural bowel disease served as the control., Results: Microcirculation and dysregulated microcirculation in patients without and with inflammatory bowel disease can be visualized and quantified using UMA. In 83 % of IBD patients and 76% of non-IBD patients, a high resolution of intestinal perfusion could be achieved using UMA., Conclusions: To the best of our knowledge, this is the first study to investigate intestinal vascularization using UMA in patients with and without structural bowel disease. Quantification and visualization of intestinal vascularization should be further investigated in prospective studies and could help guide our therapy of patients with IBD.

Background: Pelvic congestion syndrome (PCS) is associated with chronic pelvic pain (CPP). The efficacy of flavonoids for treating PCS symptoms is still a matter of debate, and little has been published. The aim of this study was to assess the efficacy of a mixture of diosmin, troxerutin, and hesperidin in improving symptoms of patients with PCS, observing a direct effect on circulation by specific color Doppler ultrasonography (CDU) evaluations., Methods: This was a pilot, prospective, independent, cross-over, daily-diary-based trial. Women were evaluated with CDU for 3 times (baseline, 60 days, 120 days). Data about N.=13 women who completed the study were analyzed., Results: During the treatment, we recorded a significant reduction of intermenstrual and menstrual pain intensity (total points) (P<0.05). The satisfaction after treatment was significantly higher than after placebo (P<0.0001). A significant reduction in the diameter of the major ovarian vein (P=0.004 compared to placebo), associated with an increase in peak systolic velocity (P=0.01) and a corresponding significant increase in the Resistivity Index (P<0.0001) were recorded during treatment., Conclusions: The use of a mixture of diosmin, troxerutin and hesperidin in women with PCS can significantly help to manage typical symptoms of pelvic pain and it is associated with an evident Doppler effect on pelvic microcirculation.

Background: Giant cell arteritis (GCA) is the most prevalent systemic vasculitis in people older than 50 years. Any delay in diagnosis impairs patients' quality of life and can lead to permanent damage, particularly vision loss., Objective: To evaluate a diagnostic strategy for GCA using color Doppler ultrasound of the temporal artery as a first-line diagnostic test, temporal artery biopsy (TAB) as a secondary test, and physician expertise as the reference method., Design: Prospective multicenter study with a 2-year follow-up. (ClinicalTrials.gov: NCT02703922)., Setting: Patients were referred by their general practitioner or ophthalmologist to a physician with extensive experience in GCA diagnosis and management in one of the participating centers: 4 general and 2 university hospitals., Patients: 165 patients with high clinical suspicion of GCA, aged 79 years (IQR, 73 to 85 years)., Intervention: The diagnostic procedure was ultrasound, performed less than 7 days after initiation of corticosteroid therapy. Only ultrasound-negative patients underwent TAB., Measurements: Bilateral temporal halo signs seen on ultrasound were considered positive. Ultrasound and TAB results were compared with physician-diagnosed GCA based on clinical findings and other imaging., Results: Diagnosis of GCA was confirmed in 44%, 17%, and 21% of patients by ultrasound, TAB, and clinical expertise and/or other imaging tests, respectively. Their diagnosis remained unchanged at 1 month, and 2 years for those with available follow-up data. An alternative diagnosis was made in 18% of patients. The proportion of ultrasound-positive patients among patients with a clinical GCA diagnosis was 54% (95% CI, 45% to 62%)., Limitation: Small sample size, no blinding of ultrasound and TAB results, lack of an objective gold-standard comparator, and single diagnostic strategy., Conclusion: By using ultrasound of the temporal arteries as a first-line diagnostic tool in patients with high clinical suspicion of GCA, further diagnostic tests for patients with positive ultrasound were avoided., Primary Funding Source: Tender "Recherche CH-CHU Poitou-Charentes 2014.", Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-3417.

Albeit rare, renal vein abnormalities on autopsy and in cases of abdominal surgery complications have been reported and should be kept in mind when performing invasive procedures, such as renal biopsy. We detected a rare renal vein abnormality on colour Doppler ultrasound before renal biopsy, thereby, avoiding a haemorrhagic complication. A 10-year-old boy presented to our department for the first time because of incidental findings of haematuria and proteinuria. We suspected chronic glomerulonephritis and scheduled an ultrasound-guided percutaneous renal biopsy. A simple screening ultrasound at the initial visit revealed no renal or vascular abnormalities. The day before the renal biopsy, we confirmed the biopsy site by performing a colour Doppler ultrasound, which showed abnormal blood flow from the lower pole of the left kidney, which was the planned puncture site; therefore, we changed the biopsy site to the right and completed the examination. Subsequent computed tomography angiography depicted two renal veins; one was the usual left renal vein draining from the kidney hilum, and the second was an accessory vein draining from the inferior pole of the left kidney and entering the inferior vena cava through the dorsal side of the aorta. Although rare, abnormalities in the renal vessels on the inferior pole of the kidney, which is the usual site of renal biopsy, are essential to rule out preoperatively by colour Doppler ultrasound, because these can cause significant bleeding during renal biopsy if not recognized., (© 2024 Asian Pacific Society of Nephrology.)

Background: Femoral pseudoaneursysm treatment is still controversial., Aims: The aim of this study was to evaluate the anatomic features related to femoral pseudoaneurysm (FPA) closure failure for ultrasound-guided compression (USGC)., Methods: This was a single-center, prospective, cohort study. FPA patients admitted to the radiology department for USGC were included in the study. Age, sex, duration of FPA, thrombosis, ratio of thrombosis to FPA diameter, feeding artery, tortiosity, connection properties, length and width of the neck, volume, and fistula-to-common femoral artery (CFA) speed ratio were reported during color Doppler ultrasonography (CDUS) scanning., Results: The study was completed with 192 patients. FPA compression therapy was successful in 155 patients and failed in 37 patients. FPA without a narrow connection (p < 0.001), FPA without existing thrombosis (p < 0.001), a lower thrombosis ratio (p < 0.001), a longer duration of FPA (p = 0.035), a shorter neck length, a wider neck width (p < 0.001), and a higher fistula-to-CFA speed rate (p < 0.001) were related to FPA closure failure with USGC. ROC analysis of the fistula-to-CFA speed ratio showed that a ratio of 1.01 had 47% sensitivity and 63% specificity for USGC treatment failure (AUC, 0.72; p < 0.05)., Conclusions: Failure of FPA closure with USGC is closely related to anatomic features of FPA. Evaluating the anatomical features of FPA before deciding the treatment method can be beneficial for patients and clinicians., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Introduction: Differentiating malignant thyroid nodules from benign ones is challenging. Sonography is a non-invasive modality that can be helpful in this regard and is far better than invasive methods like fine needle aspiration (FNA). This study aimed to assess the diagnostic value of colour Doppler ultrasonography in distinguishing malignant and benign nodules of thyroid gland., Methods: The study involved patients with thyroiditis and thyroid nodules, who underwent sonography. Ultrasound findings were assessed. All the nodules were classified according to the FNA into malignant, follicular nodules and lymphatic. Then, sonography findings were compared between these three groups., Results: There were 216 nodules, including 108 (50%) malignant nodules, 80 (37%) benign and 28 (13%) lymphatic follicles, were evaluated. Micro-calcification was present in 50 (46.3%) malignant cases, 11 (13.7%) benign cases and 2 (2.1%) lymphatic follicles. Decreased or mixed vascularity was reported in 43 (69%) malignant nodules, 4 (5%) benign cases and 7 (25%) lymphatic follicles. Also, 9.7% and 42% of malignant and benign nodules had peripheral circular vascularity, respectively; however, none of the lymphatic follicles had this finding. With 89% specificity, 49% sensitivity and 73.5% accuracy, calcification with or without decreased or mixed vascularity could differentiate benign and malignant nodules., Conclusion: Decreased or mixed vascularity with or without calcification shows high sensitivity in differentiating malignant and benign nodules., (© 2024 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Aims: While hormonal assays are commonly used for thyroid function assessment, Doppler sonography provides valuable information on vascularization and blood flow. This study aimed to examine the potential associations between Doppler parameters and clinical characteristics of hypothyroid patients, such as the autoimmune nature of the disease and adequacy of LT4 replacement., Methods: A total of 338 patients with hypothyroidism, primarily caused by autoimmune thyroiditis (AT), were enrolled in this study. Exclusion criteria comprised specific medical conditions, medication history, and nodular abnormalities of the thyroid gland. Patient demographics (age, sex, BMI), treatment parameters (LT4 daily dose), and thyroid hormone levels (TSH, fT4) were recorded., Results: Among the enrolled patients, 85.2% had autoimmune thyroiditis. Suboptimal levothyroxine (LT4) replacement was observed in 20.1% of patients at the time of enrollment. Patients with autoimmune thyroiditis had increased elastography ratios compared to those without autoimmune disease and present a positive association of elastography ratios with vascularity. In patients without autoimmune thyroiditis, those with suboptimal LT4 replacement had lower total thyroid volume. Patients with suboptimal LT4 replacement had higher peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the inferior thyroid artery and lower resistive index (RI). The severity of hypothyroidism, as indicated by LT4 dose/body mass index (BMI), was negatively correlated with thyroid volume and EDV values of superior and inferior thyroid arteries. PSV of the inferior thyroid artery can predict suboptimal LT4 replacement (sensitivity 81.8%, specificity 42%)., Conclusions: In situations where obtaining blood tests may be challenging, utilizing color Doppler ultrasound can serve as an alternative method to assess treatment responses and identify patients who require further hormonal examinations., (© 2024. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Purpose: The aim of this article is to present our experience with minimally-invasive treatment for nulliparous patients with pelvic venous congestion syndrome (PVCS) with special attention to anatomical considerations, procedural and clinical outcome., Materials and Methods: In this retrospective, monocentric study, 21 patients with PVCS treated from January 2014 to June 2023 were included. The preprocedural imaging evaluation of PVCS was based on color Doppler ultrasound, contrast-enhanced CT and/or MRI. In all cases insufficient ovarian veins and/or internal iliac branches were occluded with coils and sclerosant. Procedural and clinical outcomes were measured 30 and 90 days after the procedure., Results: Average duration of pelvic pain was 44.8 ± 54.2 months (from 6 to 200) with the mean VAS-recorded pain intensity of 8.5 ± 1.1 (range from 7 to 10 where 0 was "no pain" and 10 "worst pain possible"). Most common symptoms included dysmenorrhea, dyspareunia and dysuria. Complete embolization was observed in in all cases. Targeted vessels included left ovarian vein (13/21, 62%), both ovarian veins (7/21, 33%) and left pudendal with left ovarian (1/21, 5%). Residual PVCS was noted in 1 patient. Mean VAS at 90-days after the procedure was 2.4 ± 1.4 (range from 0 to 6, p < 0.001). Nineteen patients (90%) were satisfied with the clinical outcome (13 "very satisfied", 6 "satisfied") and reported improvement in quality of life. Two patients (9.5%) reported to be "neutral" as the VAS reduction was less than 50%., Conclusion: Our study confirms that endovascular coil embolization is safe and effective in treatment of nulliparous patients with PVCS that provides very high rate of clinical success and overall satisfaction., (© 2024. The Author(s).)

Objective: To analyze the ultrasonic features of tonsillar lymphoma to improve the diagnostic accuracy. Methods: The clinical, pathological and ultrasonic data of nine patients with tonsillar lymphoma confirmed by pathology at Tianjin Medical University Cancer Institute and Hospital during June 2015 and June 2022 were analyzed retrospectively, and the characteristics of their ultrasonic images were summarized. Results: All 9 cases of tonsil lymphoma were unilateral tonsil disease, including 4 cases on the left side and 5 cases on the right side. The average maximum diameter of tonsil lymphoma in 9 cases was 4.32 cm. There were 3 cases with simultaneous involvement of tonsil and cervical lymph nodes, all of which were ipsilateral lymph nodes. Gray scale ultrasound showed that the lesions were hypoechoic, with clear boundaries in 7 cases and unclear boundaries in 2 cases. The shape was full and irregular in 5 cases and oval in 4 cases. The echo was uniform in 7 cases and uneven in 2 cases. Color Doppler ultrasonography showed abundant internal blood flow signal in 1 case, a little dotted linear internal blood flow signal in 5 cases, and no obvious internal blood flow signal in 3 cases. Conclusions: The ultrasonic features of tonsillar lymphoma include hypoechoic area, clear boundary, full shape, irregular and uniform internal echo, no or low linear signal of internal blood flow. Ultrasonography is of great value in the diagnosis of this disease and can help clinical decision-making.

Introduction and Objectives: Functional and durable vascular access is needed for adequate hemodialysis. Arteriovenous fistula is preferred over prosthetic grafts or central venous catheters, but it is associated with high rates of primary failure and maturation failure. Preoperative mapping of arm vessels with color Doppler ultrasound (CDU) has been shown to be helpful in achieving better short and long-term outcomes. Unfortunately, is more time-consuming than a physical examination and requires an experienced examiner and special equipment; some authors defend that CDU should not be part of the routine preoperative assessment. We reported our experience in preoperative vessel mapping using color Doppler ultrasound to purpose a vascular access to the surgical team, surveillance of vascular access, and evaluation of main outcomes (primary failure, maturation failure, and patency)., Methods: This is a single-center retrospective study that includes patients who attended a specific appointment for vascular access planning consultation between January 2019 and December 2021. A nephrologist performed the physical exam and vascular mapping and proposed to the vascular surgeon team a specific type and location of vascular access. Patients were followed until one month after the first hemodialysis through functioning vascular access., Results: In this study, 167 patients were evaluated (114 incident patients - chronic kidney disease stage 4 or 5 - and 53 prevalent patients - under hemodialysis through central venous catheter). The vascular accesses proposed by nephrologist were radial-cephalic arteriovenous fistula in 70 patients (41.9%), brachio-cephalic arteriovenous fistula in 50 patients (29.9%), brachio-basilic arteriovenous fistula in 34 patients (20.4%), arteriovenous graft in 8 patients (4.8%) and central venous catheter in 2 patients (1.2%). Vascular access was constructed in 141 patients: distal arteriovenous fistula in 57 patients (40.4%), brachio-cephalic arteriovenous fistula in 54 patients (38.3%), brachio-basilic AVF in 27 patients (19.1%), and arteriovenous graft in 3 patients (2.1%). The created access corresponds to the proposed access in 129 patients (91.5%). Twenty-two (15.6%) primary failures were registered. Distal arteriovenous fistulas and diabetes mellitus were associated with a higher risk of primary failure (OR=3.929 (1.485-10.392), p=0.004; OR=3.867 (1.235-12.113), p=0.014, respectively). The incidence of maturation failure at eight weeks was 4.8%. The primary patency at 6, 12 and 24 months was 76.3%, 70.4% and 49.2%. Primary assisted patency was 84.8% at 6 and 12 months and 81.3% at 24 months., Conclusions: This study demonstrates that the study of the entire vascular territory performed with color Doppler ultrasound, within a multidisciplinary team of nephrologists and vascular surgeons, is associated with high rates of autologous access and very low rates of primary failure and maturation failure (almost unprecedented in the literature)., (Copyright © 2023 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)