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PubMed1986

[A method of venous study by real time ultrasonography associated with directional and continuous Doppler ultrasonography].

The authors propose a method of investigation of the superficial and deep venous axes of the limbs, neck, abdomen and pelvis by using successively directional and continuous wave Doppler and real time high resolution echotomography. The principle is to recognise normal and pathological venous flow by the Doppler technique and to detect the intrinsic (thrombus, agenesis) or extrinsic abnormalities causing local haemodynamic disturbances or distal emboli even in the absence of flow disturbance by echotomography. If the suggested protocol is strictly observed, the method allows diagnosis of the majority of pathologies, not only their haemodynamic consequences but also the underlying causes.

Hemodynamics↗
PubMed1994

[Neonatal screening for congenital hip dislocation. Indication of ultrasonography from a systematic study correlating clinical findings and ultrasonography].

INTRODUCTION: The aim of our study was to verify the correlation between clinical and sonographic screening for CDH. MATERIALS AND METHODS: Clinical and sonographic screening was carried out in 1000 newborns (2000 hips) during the first week of life. Anamnestic risk factors were evaluated and clinical examination was performed using the BARLOW, Le DAMANY and ORTOLANI maneuvers. We also took into account a possible limitation of abduction due to adductor hypertonia and the presence of a hip crepitation. All hips were evaluated by ultrasound examination using Graf's morphologic method. We considered as clinically pathological the positive BARLOW, Le DAMANY and ORTOLANI hips and "doubtful" the stable hips having "crepitation" or "hypertonia of the adductors". The hips considered pathological with the ultrasound were the hips 2c, 3a and 3b according to GRAF. RESULTS: 1) Hips clinically pathological (BARLOW, Le DAMANY and ORTOLANI): 150 (7.5 per cent). 2) The clinically stable hips but "doubtful":--crepitation: 105 (5.25 per cent); adductor hypertonia: 86 (4.3 per cent), total 191 (9.55 per cent). 3) Hips clinically normal but with at least anamnestic risk factor: 198 (9.9 per cent); 4) Hips clinically normal but without anamnestic risk factor: 1461 (73.05 per cent). 5) Hips echographically pathological, that is 2c, 3a and 3b according to Graf: 124 (6.2%) and particularly 2c: 61 (3.05 per cent), 3a: 61 (3.05 per cent) and 3b: 2 (0.1 per cent). DISCUSSION: 1) In the clinically pathological hips (BARLOW positive) 36 were echographically pathological with a clinical-sonographic correlation of 28.3 per cent (36 out of 127); all the ORTOLANI positive hips, were echographically pathological (100 per cent (23 out of 23)). In doubtful hips, sonograms were pathological in 17 of 105 hips with "crepitation" (0.85 per cent) and in 13 of 86 hips with "adductor hypertonia" (0.65 per cent). 2) The clinically and echographically pathological hips at birth, that is 2c, 3a and 3b, must be followed for months. At follow up they showed in almost all the cases an evolution towards normality. It is, therefore, indicated to repeat the clinical and sonographic examination in the first month, before undertaking any kind of treatment. 3) Finally, 12 hips, 0.6 per cent, presenting pathological sonographic type 2c and 3a, were found clinically normal. Nevertheless, almost all of these hips evolved normally. From this study only 0.05 per cent of clinically normal hips presented, later, a dysplasia of the acetabulum. Analysis of the results clearly showed that ultrasound examination may be an excellent help to clinical examination which, if well performed, has top priority for early diagnosis of C.D.H. CONCLUSION: The clinical examination, carefully performed in the first days of life, has priority because it allows discovering a pathological hip or a hip at risk. The sonographic examination is a useful image complementing the clinical examination because it allows confirmation of the diagnosis and follow up of the morphologic evolution of the hip with an inoffensive method and it can give indications for possible treatment. From our study we may conclude that at birth a clinical screening is preferable and that the ultrasound study is to be reserved for pathological, doubtful or at risk hips.

Data Interpretation, Statistical↗
PubMed1993

[Transvaginal ultrasonography in the diagnosis of abnormal uterine bleeding in women of reproductive age. Comparison with transvesical ultrasonography].

We undertook this study to compare the diagnostic value of endovaginal sonography and transvesical sonography in the diagnosis of abnormal uterine bleeding in reproductive age women in Yaoundé (Cameroon). 130 consecutive patients were included in this prospective study. Inclusion criteria were the presence of a missed period and abnormal uterine bleeding, absence of local or vaginal lesion on speculum examination, and the performance of transvaginal and transabdominal sonography within 12 hours. The results of each technique were compared for image quality and diagnostic information. The diagnoses included ovarian cyst (33), abnormal intra-utérine pregnancy (22), ectopic gestation (14), endometrial abnormality (14), fibroids (11), normal intra-uterine pregnancy (4), appendicitis (1), no abnormality (12). Transvaginal sonogram was of better image quality in 108 patients (83.1%). It provided more diagnostic information in 99 patients (76.1%). For 38 patients (29.2%), it provided pertinent information which altered the diagnosis made after transvesical sonography. Our results suggest that endovaginal sonography should be considered the first sonographic technique to use for reproductive age patients with abnormal uterine bleeding in Yaoundé (Cameroon).

Adolescent↗
PubMed2003

Comparison of contrast-enhanced harmonic ultrasonography and power Doppler ultrasonography for depicting vascularity of hepatocellular carcinoma identified by angiography-assisted CT.

The sensitivity of contrast-enhanced harmonic gray scale imaging was compared with that of power Doppler sonography in depicting tumor vascularity and contrast enhancement of hepatocellular carcinoma (HCC) identified by angiography-assisted computed tomography (CT). One hundred thirty-nine classic HCC nodules (108 patients), each appearing as a high-attenuation mass on early-phase CT during hepatic arteriography and as a perfusion defect on CT during arterial portography, were evaluated. Vascular findings and contrast enhancement patterns were evaluated by contrast-enhanced harmonic gray scale imaging. Arterial pulsatile flow into each nodule was checked by power Doppler sonography. Sensitivity of each modality for depicting tumor vascularity was examined by angiography-assisted CT findings as the gold standard. The sensitivity of contrast-enhanced harmonic gray scale imaging (134/139, 96.4%) was significantly greater than that of power Doppler sonography (96/139, 69.1%) (P<0.05). Twenty-six of twenty-seven nodules (96.3%) in the lateral segment, in which motion artifact is likely, were enhanced by contrast-enhanced harmonic gray scale imaging. Contrast-enhanced harmonic gray scale imaging is more sensitive than power Doppler sonography and is a noninvasive method that can be used as effectively as angiography-assisted CT to evaluate tumor vessels and contrast enhancement of HCC.

Journal Article↗
PubMedDate not supplied

Clinical implications of power Doppler three-dimensional ultrasonography.

Power Doppler ultrasonography displays an estimate of the entire power contained in that part of the received radiofrequency ultrasound signal for which a phase shift corresponding to the motion of the target is detected. In contrast, conventional color Doppler imaging displays Doppler frequency shift information. Few reports have been published on the clinical utility of three-dimensional power Doppler ultrasonography in vascular patients. This study analyzed our experience of the clinical utility of this technology. Fifty-three patients selected out of 281 who were referred to our vascular laboratory underwent both conventional color duplex ultrasonography and power Doppler ultrasonography for the following indications: the question of subtotal versus total arterial occlusion, tortuous artery with limited imaging on color duplex ultrasonography, the presence of significant disease by Doppler ultrasonography with limited imaging, deep-lying arteries with an obscure orifice (e.g., renal artery), and heavily calcified arteries. The power Doppler ultrasonography portion of the examination was considered of positive diagnostic value if the final impression was different from that of conventional color duplex ultrasonography. A positive diagnostic value was achieved in 22 of 29 (76%) carotid artery examinations, 10 of 14 (71%) peripheral artery examinations, 4 of 5 (80%) renal artery examinations, and 3 of 5 (60%) aortoiliac examinations. Overall, positive diagnostic value was achieved by adding power Doppler ultrasonography in 39 of 53 patients (74%). Five of six patients (83%) who were felt to have carotid occlusion by color duplex ultrasonography were confirmed to have subtotal occlusion by power Doppler ultrasonography. Similarly, 6 of 8 patients (75%) with questionable subtotal versus total peripheral arterial occlusion by color duplex ultrasonography were confirmed to have subtotal occlusion by power Doppler ultrasonography. Four of five patients' (80%) renal examinations had a positive diagnostic value, which included three patients in whom the orifice of renal arteries was not seen by color duplex ultrasonography. Three-dimensional power Doppler ultrasonography can be more readily applied to clinical practice. Power Doppler ultrasonography is capable of defining the severity or extent of vascular disease, particularly in differentiating subtotal from total arterial occlusion.

Arterial Occlusive Diseases↗
PubMed2002

Intraoperative ultrasonography in hepatobiliary surgery.

OBJECTIVE: To assess the value of intraoperative ultrasonography in hepatobiliary surgery. METHODS: Aloka-650 and Aloka-500 with a 3.5 MHz probe were used in preoperative ultrasonography and those with 5 MHz or 7.5 MHz probes in intraoperative ultrasonography. All patients with carcinoma were confirmed pathologically. RESULTS: In 44 patients with liver cancer (76 tumors), the diagnostic rate of intraoperative ultrasonography was 97% (74/76), which was markedly higher than 84% (64/76) of preoperative ultrasonography (P<0.05). The diagnostic rate (92%; 22/24) of intraoperative ultrasonography for tumors </=2 cm in diameter was markedly higher than that (54%; 13/24) of preoperative ultrasonography (P<0.01). The diagnostic rate (94%; 16/17) of intra-operative ultrasonography for tumor embulus of the vein was also markedly higher than that (53%; 9/17) of preoperative ultrasonography (P<0.01). The diagnostic rates of intraoperative and preoperative ultrasonography for cholelithiasis were 99% (108/109) and 97% (106/109) respectively (P>0.05). Yet the diagnostic rate (100%; 12/12) of intraoperative ultrasonography for gallbladder carcinoma was markedly higher than that (66.7%; 8/12) of pre-operative ultrasonography (P<0.05). The diagnostic rates of intraoperative ultrasonography for choledocholith and biliary tract cancer were all 100%, markedly higher than those (83%; 20/24 and 75%; 12/16) of preoperative ultrasonography (P<0.05). CONCLUSIONS: Intraoperative ultrasonography can raise the detective rate of the liver occupying lesions comparing with that of preoperative untrasonography. It is of valuable in selecting operative scheme and locating small lesions.

Adult↗
PubMed2001

Application of three-dimensional ultrasonography in the evaluation of the fetal heart.

The objectives of this study were to determine whether three-dimensional ultrasonography can provide more cardiac views than two-dimensional ultrasonography and to develop a standard technique. Eighteen women, 16 to 26 weeks' gestation, were scanned with two-dimensional ultrasonography for 10 minutes or less to obtain fetal heart views. Three-dimensional ultrasonography was used (< or =10 minutes) to obtain up to 4 acquisitions of the fetal heart: 4-chamber view, left parasagittal, transverse, and longitudinal nonstandard. Views were later extracted from saved volume data, comparing the yields of two- and three-dimensional ultrasonography. The 4-chamber view was obtained in 15 (93%) of 16 cases on both two- and three-dimensional ultrasonography. On two-dimensional ultrasonography, the left outflow tract was obtained in 68% of the cases; on three-dimensional ultrasonography, the left outflow tract was obtained in 46% from the 4-chamber view acquisition and in 100% from the left parasagittal acquisition. On two-dimensional ultrasonography, the right outflow tract was obtained in 68% of the cases; on three-dimensional ultrasonography, the right outflow tract was obtained in 86% from the 4-chamber view acquisition and in 71% from the left parasagittal acquisition. Aortic and ductal arches were obtained in 12% and 18%, respectively, on two-dimensional ultrasonography. On three-dimensional ultrasonography the aortic and ductal arches were obtained in 66% and 86%, respectively, from the 4-chamber view acquisition and in 57% and 71%, respectively, from the left parasagittal acquisition. Three-dimensional ultrasonography permitted a greater number of cardiac views to be extracted from volume data than did two-dimensional ultrasonography.

Echocardiography, Three-Dimensional↗
PubMed2001

Intraoperative ultrasonography by high-resolution annular array transducer for intraductal papillary mucinous tumors of the pancreas.

BACKGROUND: Intraductal papillary mucinous tumors of the pancreas (IPMT) spread along the main pancreatic duct (MPD) or branch duct, or both. It is important to intraoperatively determine the extent of IPMT lesions in the MPD to perform a successful operation. METHODS: This study included 27 consecutive patients with IPMT who were referred for operation and who had undergone endoscopic ultrasonography, endoscopic retrograde pancreatography, and computed tomography as a diagnostic examination. Intraoperative ultrasonography with a 7.5-MHz annular array transducer and a 7. 5-MHz conventional transducer was performed. All patients underwent operation, and the pathology was confirmed. Endoscopic ultrasonography, endoscopic retrograde pancreatography, intraoperative conventional ultrasonography, and intraoperative annular array ultrasonography results were correlated with those from a pathologic examination of the resected specimens. The diagnostic accuracy of these 4 modalities in the detection of IPMT lesions in the MPD and the branch duct was confirmed. RESULTS: The diagnostic criterion of IPMT lesions by intraoperative annular array ultrasonography was the presence of echogenic masses with irregular margins in the MPD or branch duct, or both. An IPMT lesion in the MPD was found in 22 of the 27 patients. Intraoperative annular array ultrasonography detected 5 cases of IPMT lesions in the MPD that could not be detected by endoscopic ultrasonography or endoscopic retrograde pancreatography. In 3 of 5 patients, pancreatic resection was extended to remove IPMT lesions. Intraoperative annular array ultrasonography detected 3 multifocal lesions that could not be detected by preoperative examinations. For the diagnosis of IPMT lesions in the MPD, the respective sensitivity, specificity, and overall accuracy of intraoperative annular array ultrasonography were 86%, 100%, and 89%; the respective values were 50%, 100%, and 59% for endoscopic retrograde pancreatography; 59%, 100%, and 67% for endoscopic ultrasonography, and 32%, 100%, and 44% for intraoperative conventional ultrasonography. For the diagnosis of IPMT lesions in the branch duct, the respective sensitivity, specificity, and overall accuracy of intraoperative annular array ultrasonography were 95%, 100%, and 96%. CONCLUSIONS: Intraoperative annular array ultrasonography is suitable for longitudinal scanning of the MPD, useful for accurate diagnosis of the extent of IPMT in the pancreas, and valuable for planning surgical strategy and successful operations for IPMT.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Endoscopic diagnosis of pancreatic cancer using intraductal ultrasonography.

BACKGROUND/AIMS: At present developed modalities are not sufficient for detecting early stage pancreatic cancer. We previously reported the clinical usefulness of intraductal ultrasonography in various pancreatobiliary diseases. In the present study we assessed the usefulness of intraductal ultrasonography in diagnosing pancreatic cancer. METHODOLOGY: Thirty-one patients with pancreatic cancer were examined by intraductal ultrasonography. We approached the main pancreatic duct (pancreatic duct-intraductal ultrasonography) in 24 of 31 patients and the bile duct (bile duct-intraductal ultrasonography) in 20 patients with pancreatic cancer. We compared the diagnostic ability of pancreatic duct-intraductal ultrasonography with that of extracorporeal ultrasonography, computed tomography, endoscopic ultrasonography or endoscopic retrograde pancreatography. We examined the usefulness of bile duct-intraductal ultrasonography in diagnosing tumor invasion to the bile duct. RESULTS: Pancreatic duct-intraductal ultrasonography was able to demonstrate a tumor in 22 of 24 patients. Extracorporeal ultrasonography, computed tomography, endoscopic ultrasonography or endoscopic retrograde pancreatography detected tumors in 26, 27, 29, 29 of 31 patients, respectively. In two patients, only intraductal ultrasonography could demonstrate a tumor, which was not detected by any other modalities. We examined bile duct invasion of the tumor according to our grading system. The overall accuracy rate was 90%. No complications were noted in any patients throughout the study period. CONCLUSIONS: Intraductal ultrasonography is useful to diagnose pancreatic cancer, and it is suggested that it should be actively performed after endoscopic retrograde pancreatography.

Aged↗
PubMed2002

Prospective study of color duplex ultrasonography compared with contrast venography in patients suspected of having deep venous thrombosis of the upper extremities.

BACKGROUND: The optimal strategy for diagnosis of deep venous thrombosis (DVT) is less well established for the upper extremities than for the lower extremities. Duplex color ultrasonography can be difficult to perform in the upper extremities because of their anatomy, and contrast venography is often indicated. Moreover, limited data exist on the use of duplex color ultrasonography in this setting. OBJECTIVE: To determine the accuracy of duplex ultrasonography for diagnosis of DVT of the upper extremities. DESIGN: Prospective study of duplex ultrasonography compared with venography. SETTING: A teaching hospital in Amsterdam, the Netherlands. PATIENTS: 126 consecutive inpatients and outpatients with suspected DVT of the upper extremities. MEASUREMENTS: Contrast venography was obtained after duplex ultrasonography and was judged independently. A three-step protocol, involving compression ultrasonography, color ultrasonography, and color Doppler ultrasonography, was used. Sensitivity, specificity, and likelihood ratios for ultrasonography as a whole were calculated. The independent value of each step was assessed. RESULTS: Venography and ultrasonography were not feasible in 23 of 126 patients (18%) and 1 of 126 patients (0.8%), respectively. Results of ultrasonography were inconclusive in 3 patients. Venography demonstrated thrombosis in 44 of 99 patients (44%); in 36 patients (36%), thrombosis was related to intravenous catheters or malignant disease. Sensitivity and specificity of duplex ultrasonography were 82% (95% CI, 70% to 93%) and 82% (CI, 72% to 92%), respectively. Venous incompressibility correlated well with thrombosis, whereas only 50% of isolated flow abnormalities proved to be thrombosis-related. CONCLUSIONS: Duplex ultrasonography may be the method of choice for initial diagnosis of patients with suspected thrombosis of the upper extremities. However, in patients with isolated flow abnormalities, contrast venography should be performed.

Adolescent↗
PubMed2006

What does 2-dimensional imaging add to 3- and 4-dimensional obstetric ultrasonography?

OBJECTIVE: The purpose of this study was to determine whether 2-dimensional (2D) ultrasonography adds diagnostic information to that provided by the examination of 3-dimensional/4-dimensional (3D/4D) volume data sets alone. METHODS: Ninety-nine fetuses were examined by 3D/4D volume ultrasonography. Volume data sets were evaluated by a blinded independent examiner who, after establishing an initial diagnostic impression by 3D/4D ultrasonography, performed a 2D ultrasonographic examination. The frequency of agreement and diagnostic accuracy of each modality to detect congenital anomalies were calculated and compared. RESULTS: Fifty-four fetuses with no abnormalities and 45 fetuses with 82 anomalies diagnosed by 2D ultrasonography were examined. Agreement between 3D/4D and 2D ultrasonography occurred for 90.4% of the findings (123/136; intraclass correlation coefficient, 0.834; 95% confidence interval, 0.774-0.879). Six anomalies were missed by 3D/4D ultrasonography when compared to 2D ultrasonography (ventricular septal defect [n = 2], interrupted inferior vena cava with azygous continuation [n = 1], tetralogy of Fallot [n = 1], horseshoe kidney [n = 1], and cystic adenomatoid malformation [n = 1]). There were 2 discordant diagnoses: transposition of the great arteries diagnosed as a double-outlet right ventricle and pulmonary atresia misinterpreted as tricuspid atresia on 3D/4D ultrasonography. One case of occult spinal dysraphism was suspected on 3D ultrasonography but not confirmed by 2D ultrasonography. When compared to diagnoses performed after delivery (n = 106), the sensitivity and specificity of 3D/4D ultrasonography (92.2% [47/51] and 76.4% [42/55], respectively) and 2D ultrasonography (96.1% [49/51] and 72.7% [40/55]) were not significantly different (P = .233). CONCLUSIONS: Information provided by 2D ultrasonography is consistent, in most cases, with information provided by the examination of 3D/4D volume data sets alone.

Female↗
PubMed2001

The impact on clinical practice of endoscopic ultrasonography used for the diagnosis and staging of pancreatic adenocarcinoma.

CONTEXT: Endoscopic ultrasonography is considered a highly accurate procedure for diagnosing small pancreatic tumors and assessing their locoregional extension. OBJECTIVE: To evaluate the impact of endoscopic ultrasonography on the management of pancreatic adenocarcinoma in clinical practice. PATIENTS: Sixty-four consecutive patients (mean age 70.5 plus/minus 11.9 years) hospitalized for staging or diagnosis of pancreatic adenocarcinoma were retrospectively (from January 1995 to November 1997) or prospectively studied (from December 1997 to August 1999). SETTING: Group 1 consisted of 52 patients with pancreatic adenocarcinoma which was discovered using computerized tomography scanning and/or ultrasound. Endoscopic ultrasonography was utilized for staging purposes only in patients who were considered to be operable and the tumor to be resectable based on computerized tomography scanning criteria. Group 2 consisted of 12 patients who were diagnosed as having a pancreatic adenocarcinoma using endoscopic ultrasonography whereas computerized tomography scanning and ultrasound was negative. MAIN OUTCOME MEASURES: The impact of endoscopic ultrasonography was analyzed on the basis of the number of patients requiring endoscopic ultrasonography as a staging procedure (Group 1) and by evaluating the performance of endoscopic ultrasonography in determining resectability (Groups 1 and 2) based on the surgical and anatomopathological results. RESULTS: Endoscopic ultrasonography was performed in 20 out of 64 patients (31.3%): 8/52 in Group 1 (15.4%) and all 12 patients of Group 2. Endoscopic ultrasonography correctly assessed an absolute contraindication to resection in 11 cases. Resection was confirmed in 8 of the 9 cases selected by endoscopic ultrasonography. The positive predictive value, negative predictive value and overall accuracy of endoscopic ultrasonography for determining resection were 89%, 100%, and 95%, respectively. CONCLUSIONS: The impact of endoscopic ultrasonography seems especially relevant for the detection of pancreatic tumors after negative computerized tomography scanning, and for the prevention of unnecessary laparotomies as complementary staging after ultrasonography and computerized tomography scanning.

Adenocarcinoma↗