Color Doppler ultrasound

Fig. 7.7 Two-dimensional color Doppler ultrasound images show a dog lymph node treated with administered L-selectin ligand-specific USCA. (A) Four selected images from the first scan. (B) Image from the second scan of the same lymph node, which was performed immediately after the first scan. The images in (A) show typical micro-bubble-based SAE signals in the paracortex,...

Fig. 19.1. a Sonographic features of a gastric carcinoid. A round-shaped hypoechoic tumor is demonstrated. Wall stratification is not demonstrated clearly in this figure, b Color Doppler ultrasound shows the rich vascularity of the tumor, c Contrast-enhanced ultrasound of the tumor also reveals the rich blood perfusion... 

Fig. 19.9. a Sonography of the jejunal GIST. An oval-shaped tumor with a deep ulcer is demonstrated. The tumor is well demarcated and the contour of the tumor is smooth, b Color Doppler ultrasound of the tumor shows the rich vascularity, c Contrast-enhanced ultrasound reveals the rich perfusion with a focal perfusion defect inside the tumor (asterisk), d Endoscopic feature of the tumor. A submucosal tumor with a deep ulcer at the center is demonstrated... 

Chiou RK, Anderson JC, Wobig RK, Rosinsky DE, Mat-amoros A Jr, Chen WS, Taylor RJ (1997) Color Doppler ultrasound criteria to diagnose varicoceles correlation of a new scoring system with physical examination. Urology... 

Color Doppler ultrasound (CDUS) is a noninvasive and cost-effective imaging modality. It is highly dependent on the operator and has limitations in obese patients and those with excessive bowel gas. Patients should be evaluated after 5-6 h fasting in supine and lateral position. The aorta is evaluated both transversally and longitudinally Leak is suspected when a reproducible color and Doppler signal inside the aneurysm is visualized. 

Color Doppler ultrasound is the primary imaging modality in patients with suspected ovarian vein thrombosis. Especially in the postpartal period, its performance is often limited due to uterine enlargement, postoperative changes, or obesity. This is why CT or MRI are commonly performed to rule out ovarian vein thrombosis. 

Kubik-Huch RA, Hebisch G, Huch R et al (1999) Role of duplex color Doppler ultrasound, computed tomography, and MR angiography in the diagnosis of septic puerperal ovarian vein thrombosis. Abdom Imaging 24 85-91... 

Hakim LS (2002) Peyronie s disease an update. The role of diagnostics. Int J Impot Res 14 321-323 Hatzichristou D, Hatzimouratidis K, Bekas M et al (2002) Diagnostic steps in the evaluation of patients with erectile dysfunction. J Urol 168 615-620 Kadioglu A, Tefekli A, Erol H et al (2000) Color Doppler ultrasound assessment of penile vascular system in men with Peyronie s disease. Int J Impot Res 12 263-267 Lobo JR, Nehra A (2005) Clinical evaluation of erectile dysfunction in the era of PDE-5 inhibitors. Urol Clin North Am 32 447-455, vi... 

Fig. 5.5a-c. Anatomical variations of cavernosal arteries at color Doppler ultrasound, a-c Longitudinal scans on the ventral aspect of the penis showing a bifurcated cavernosal artery (arrowheads), b recurrent cavernosal branch (curved arrow), and c accessory cavernosal artery (open arrow)... 

At color Doppler ultrasound multiple branches of variable location are recognized feeding the bulb of the corpus spongiosum (Kishore et al. 2005). Visualization of a main trunk entering the bulb is inconstant. 

Fig. 5.7. Color Doppler ultrasound appearance of urethral arteries. Axial scan on the ventral aspect of the penis showing the paired urethral arteries (arrowheads) running within the corpus spongiosum...

Fig. 5.8a,b. Color Doppler ultrasound anatomy. Arrangement of the distal portion of the dorsal arteries, a Axial scan showing communication of the dorsal arteries behind the glans through a transverse anastomosis (open arrow), b Longitudinal scan showing a small dorsal collateral (arrowhead) feeding the corpus cavernosum... 

At color Doppler ultrasound cavernosal-spongiosal communications are recognized as vessels branching from the cavernosal artery that run to-... 

Fig.5.11a-c. Depiction of penile veins (arrowheads) at color Doppler ultrasound, a Longitudinal scan showing deep dorsal vein. b,c Axial scans showing a large vein b in the ventral aspect of the penis between the corpora cavernosa and c portions of the emissary and circumflex veins... 

Technical requirements for grey-scale and color Doppler ultrasonography of the penis are described in detail in Chapter 1. In particular, high frequency small-parts transducers are mandatory, preferably with high density crystals so that an elevated spatial resolution is possible both at grey-scale and color-Doppler ultrasound (Bertolotto and Neumaier 1999). 

Following identification at color Doppler ultrasound, the cavernosal vessels are interrogated. Pulse-wave (PW) duplex Doppler is turned on putting the sample volume on the cavernosal arteries. The spectral analysis is preferably performed at the base of the penis where the Doppler angle is particularly favorable (between 30° and 50°) and the flow velocity shows major reproducibility and correctness (Mills and Sethia 1996). The flow velocity must be measured repeatedly (at least three times) at the same level and the mean value reported. Functional studies have shown a progressive decrease of blood velocity in the cavernosal arteries from the base to the glans penis... 

Fig. 8.10a,b. Color Doppler ultrasound scans. Calcified dorsal plaques ( ). Normal penile vessels simulating plaque vascularization. a Axial scan showing left dorsal artery (open arrow) and an emissary vein passing through the plaque (arrowhead). b Communication between the cavernosal and the dorsal artery (arrowhead) passing though the plaque... 

Low-flow priapism is suggested by finding low oxygen tension, high carbon dioxide and low pH in the blood gas analysis of the aspirate. When a high-flow state is suspected based on the bright red appearance or blood gas analysis of the corporal aspirate, color Doppler ultrasound is indicated to identify the arterial sinusoidal fistula. 

During the follow-up of patients with high-llow priapism, we recommend color Doppler ultrasound 1-2 months after embolization to confirm the absence of recurrent fistula. Recanalization of the em-bolized cavernosal artery can be observed also when non-reabsorbable embolization material has been used (Savoca et al. 2004). In patients with erectile dysfunction, the study should be performed after in-tracavernosal prostaglandin injection to determine whether the functional impairment is caused by insufficient penile blood flow or not. 

In patients with penile fracture, injury can occasionally involve the cavernosal tissue deeply, and associated cavernosal artery tear can be detected at color Doppler ultrasound (Fig. 12.7). High-flow priapism, however, does not develop in these patients, probably because of blood leakage from the albugineal tear. In our experience no attempt should be made during the operation to repair the arterial... 

In patients with circumscribed fibrotic changes leakage pathways are often identified as color Doppler ultrasound adjacent to the region in which the cavernosal tissue is replaced by a fibrotic scar (Fig. 18.8). Scar-related arterial insufficiency can be associated when cavernosal arteries are encased by the scar. In... 

Chang SC, Yeh CH (1992) The applications of dynamic tran-srectal ultrasound in the lower urinary tract of men and women. Ultrasound Quarterly 10 185-223 Chiou RK, Anderson JC, Tran T et al (1996) Evaluation of urethral strictures and associated abnormalities using high-resolution and color Doppler ultrasound. Urology 47 102-107... 

In addition, the functional changes in penile blood flow as seen in erectile dysfunction can be studied appropriately with color Doppler ultrasound methods. 

Color Doppler ultrasound is increasingly used in clinical practice by both radiologists and clinicians. The advantages of new machines are particularly evident when imaging superficial structures since submillimetric anatomical details can be investigated and flow in very small vessels can be evaluated in real time without radiation. 

In contrast, in a prospective study of 87 postmenopausal women who took a dry extract of black cohosh 40 mg/day for 12 months total hepatic blood fiow, assessed by color Doppler ultrasound, was unaffected as were prothrombin time and concentration, serum albumin and bilirubin concentrations, and gamma-glutamyltransferase, alkaline phosphatase, and aminotransferase activities [33 ]. However, these results do not rule out an incidence of hepatotoxicity of up to 3.4%. 

Fig. 6.1. Color Doppler ultrasound of the groin shows a pseudoaneurysm (asterisk) with a diameter of 2 cm and color flow centrally in the pseudoaneurysmal cavity. Duplex scanning of the pseudoaneurysmal neck demonstrates a typical to-and-fro signal...

Fig. 6.2a-c. a Color Doppler ultrasound shows color flow centrally in the pseudoaneurysmal cavity (asterisk), which has a diameter of 1.7 cm. b Under gray-scale ultrasound the spinal needle (arrow) is positioned in the middle of the pseudoaneurysmal cavity, c Color Doppler ultrasound after thrombin embolization shows absence of color signal in the thrombosed pseudoaneurysm (asterisk). The femoral arteries remain normally patent... 

Fig.6.3a-c. a Color Doppler ultrasound demonstrates color flow in the most proximal (to the femoral artery) pseudoaneu-rysmal cavity asterisk) and partial opacification of the distal cavity arrow), b After puncturing the most proximal cavity using a spinal needle arrow), c thromhin injection resulted in complete occlusion of both proximal asterisk) and distal cavities... 

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