Color Doppler and Microvascular Flow Imaging to Evaluate the Degree of Inflammation in a Case of Hidradenitis Suppurativa

Microvascular Flow Imaging is a new ultrasound technique with better ability than Color Doppler Imaging to identify small vessels that have slow blood flow, and it permits better evaluation of the features, especially microvascular architecture, of various lesions. We describe a case of inguinal hidradenitis suppurativa in a patient with positive risk factors (young age, female, smoker, and obese), diagnosed by ultrasonography using B-Mode, Color Doppler, and finally also with Microvascular Flow Imaging. Our aim is to demonstrate the usefulness of this new technique in characterization of lesions.

Procedure and Clinical Success of Drug-Coated Balloon Fistuloplasty of the Drainage Vein in Dysfunctional Native Arteriovenous Fistulas

Purpose. Native arteriovenous fistulas (AVFs) are the most effective vascular access (VA) for haemodialysis. We aimed to evaluate the results of balloon angioplasty (fistuloplasty) from drainage vein performed for the treatment of AVF dysfunction in haemodialysis patients and examine potential patient and AVF-associated factors that might affect such results. Methods. This is a nonrandomized, retrospective, and single-centred study. A total of 105 balloon fistuloplasties were performed for dysfunctional AVFs of 82 haemodialysis patients. Patients were treated with a drug-coated balloon according to standard procedures. Evaluations were performed by physical examinations and if needed by color Doppler imaging in every 6 months. The primary endpoint was patency by balloon fistuloplasty. Patency was evaluated clinically by detecting the thrill in AVF and by the adequacy of the dialysis. Multidimensional scaling (MDS) technique was used as a method for the statistical analysis. Results. The success of the procedure after the first attempt was 85.3% with 70 patients. Patency in the 6th, 12th, 18th, and 24th months were 63 (76.8%), 60 (73.1%), 53 (64.6%), and 44 (54%), respectively. The procedure was considered successful when the thrill was detected in AVF and when dialysis was adequate. The statistical analysis by MDS revealed that patients’ age was the most effective factor acting on the procedure success followed by the age of AVF. Other patient-associated and AVF-associated factors were not found as effective statistical evaluation. Conclusions. Haemodialysis through native AVFs with restored functionality contributes positively to the life span and the quality of life of the patient. Probably, advanced age and high fistula age are unfavourable factors leading to the development of neointimal hyperplasia and venous stenosis. Balloon fistuloplasty of the draining vein is an effective and safe method regardless of patient age and the age of AVF.

A Rare Case of Epithelioid Trophoblastic Tumor Presenting as Hematoma of a Caesarean Scar in the Lower Uterine Segment

Epitheliod trophoblastic tumor (ETT) account for only 1–2% of all the cases of gestational trophoblastic neoplasia (GTN), with a reported mortality rate of 10–24%. ETT is derived from chorionic type intermediate trophoblastic cells, which appears to be the reason for the only slightly elevated βhCG levels in these patients. We present a case of a 42-year-old patient who was admitted to the clinic eight months after Caesarean delivery, for irregular vaginal bleed with normal values of beta-human chorionic gonadotropin (βhCG). A 6 × 5 cm hematoma was evacuated from the isthmic uterine segment during the operation, and the histopathological exam of the tissue surrounding the hematoma revealed ETT. There were no metastatic lesions on the thoracal, abdominal, and pelvic CT. The second ultrasonographic exam revealed tumefaction of 5 cm at the site from the previous surgical procedure. Color Doppler imaging revealed no central nor peripheral blood flow. The patient underwent a total abdominal hysterectomy with bilateral adnexectomy without adjuvant chemotherapy. This appears to be one of the shortest intervals from the anteceded gestational event until the diagnosis of this tumor, along with the absence of the significant ultrasonographic feature of the ETT-peripheral Doppler signal pattern. We underline that, even with normal values of βhCG, irregular vaginal bleeding following the antecedent gestational event should always arouse suspicion of GTN.

Color Doppler Evaluation of Arterial Resistive Index in Infantile Hemangioma: A Useful Parameter to Monitor the Response to Oral Propranolol?

Infantile hemangioma (IH) is the most common benign vascular tumor in childhood. In more than 85% of all cases, IHs undergo spontaneous involution, but nearly 10–12% of IHs develop complications and require immediate therapy. Oral propranolol is currently the first-line treatment for IHs. Color Doppler ultrasound is the gold standard in the diagnosis of deep IH, and it is used to evaluate the morphological change and the modification of vascularization that occur during its evolution and treatment. To date, only few data in the literature described the changes of intralesional arterial resistive index (RI) during treatment with propranolol; particularly, some authors have shown an increase of intralesional arterial RI in IHs with clinical regression during treatment with propranolol. The objective of this paper is to evaluate the changes of RI of the intralesional arteries of the IHs during the treatment with oral propranolol. We retrospectively analyzed a total of 64 IHs in 60 patients treated with oral propranolol with a good clinical response. Gray-scale ultrasonography and color Doppler imaging were performed before and during the therapy. The intralesional RIs were measured before and during the treatment. For each lesion, we recorded the RI values, and then we calculated the mean RI value for any single lesion. We compared the mean RI value observed at the baseline with the mean RI value of the last detectable sampling at color Doppler. We also compared between them the mean RI values observed during intermediate ultrasound. The RI values were compared in 44 lesions, with at least two significant samplings of RI. In the 44 lesions compared, we did not find statistically significant variations in the mean RI values between the baseline control and the values recorded at the last post-treatment control. The time trend of mean RI values of the intermediate color Doppler analysis performed between the first pre-treatment control and the last measurable control did not show any statistically significant variation in the trend of mean RI values. Contrarily to what has been described by some authors, in our experience, we have not observed an increase of RI in IHs treated with oral propranolol.

Ultrasound Technologies and the Diagnosis of Giant Cell Arteritis

Giant cell arteritis (GCA) is a primary autoimmune vasculitis that specifically affects medium-sized extracranial arteries, like superficial temporal arteries (TAs). The most important data to be considered for the ultrasound (US) diagnosis of temporal arteritis are stenosis, acute occlusions and “dark halo” sign, which represent the edema of the vascular wall. The vessel wall thickening of large vessels in GCA can be recognized by the US, which has high sensitivity and is facile to use. Ocular complications of GCA are common and consist especially of anterior arterial ischemic optic neuropathies or central retinal artery occlusion with sudden, painless, and sharp loss of vision in the affected eye. Color Doppler imaging of the orbital vessels (showing low-end diastolic velocities and a high resistance index) is essential to quickly differentiate the mechanism of ocular involvement (arteritic versus non-arteritic), since the characteristics of TAs on US do not correspond with ocular involvement on GCA. GCA should be cured immediately with systemic corticosteroids to avoid further visual loss of the eyes.

Possibilities of Multiparametric Ultrasound Study with Contrast Enhanced in the Diagnostics of Cistic Kidney Lesions

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

Correlation of N-Ras Gene Expression in Hepatocellular Carcinoma with Color Doppler Ultrasound Findings

Objective: This study aims to study the N-ras gene expression in hepatocellular carcinoma (HCC) and its correlation with color Doppler imaging manifestations. Methods: The tumors of 145 HCC patients were evaluated via color Doppler ultrasonography before operation and N-ras level in tissue specimens obtained after operation were detected via RT-PCR, Western blotting and immunohistochemistry along with correlation analysis. Results: N-ras mRNA in para-carcinoma tissues was significantly reduced compared with carcinoma tissues (P < 0.05). Western blotting and immunohistochemistry showed a significant difference of N-ras protein level between para-carcinoma tissues and carcinoma tissues (P < 0.05). Moreover, N-ras gene expression was siginificantly correlated with the number of tumor nodules, the integrity of tumor capsule, vascular invasion, blood flow classification, RI (P < 0.05). Conclusion: Our data demonstrate the elevation of N-ras in the carcinoma tissues of HCC patients and its correlation with color Doppler imaging manifestations, which lays foundation for the development of the diagnosis of hepatocellular carcinoma.

Method of Morphometry of Cartilaginous Part of Ribs for Planning of Auricle Reconstruction

Ultrasound examination of the skin was performed on 63 women, using a 10–22 MHz high frequency linear transducer on the scanning surface in B-mode and Color Doppler Imaging (CDI) mode with the scanning depth of 7 mm, as well as a 6–18 MHz transducer in B-mode with the scanning depth of 15 mm. The thickness of the dermis was measured between the epidermis and the subcutaneous adipose tissue in the middle and lower third of the face at standard points. To determine the border between the dermis and hypodermis, we used the subdermal vascular plexus as an additional anatomical landmark, which was well visualized in the CDI mode. Comparison of three or more groups of independent quantitative parameters was carried out using ANOVA (Analysis of Variance) for looking for dependencies in the data obtained by determining the significance of differences in means. The level of significance was presented according to F. Fisher’s criterion. As a result of the analysis of variance, a significance level was 0.15, based on which it was concluded that there is no difference in measuring the thickness of the dermis with 6–18 MHz and 10–22 MHz high frequency transducers. The optimal scanning depth for measuring the skin thickness is 7–15 mm. Evaluation of the skin microcirculation should be carried out in the Doppler mode at a pulse recurrence frequency of less than 1 kHz.

Dural Sinus Arteriovenous Malformation in the Fetus. Case Report and Discussion of the Literature

Sonographic findings of cerebral arteriovenous malformations in the fetus are uncommon and usually regard aneurysm of the Galen vein. Outcome of arteriovenous malformations is usually severe. We report a case of a fetus at 21 weeks’ gestation with a rarer arteriovenous malformation, referred to us for echocardiography on account of a suspicious cardiomegaly at obstetrical scan. Upon examination, we found cardiomegaly, together with an associated moderate tricuspid regurgitation, however, there were no clear features of tricuspid dysplasia. Considering an unusually dilated superior vena cava, we found via color Doppler imaging a systodiastolic flow at Color Doppler progressing. Subsequent MRI of the central nervous system determined the localization in the sinus dura mater. Due to an already evident hemodynamic impact, the parents opted for the termination of the pregnancy. Autopsy confirmed a voluminous arteriovenous malformation of the transverse sinus of the dura mater, severe cardiomegaly, mainly of the ventricles, and hypoplasia of the lungs.