Pulsed and Color Doppler Sonographic Findings of Penile Mondor's Disease

This report describes the color and pulsed Doppler US findings of penile Mondor's disease. The pulsed Doppler US findings of penile Mondor's disease have not been previously published, so we report here for the first time on the cavernosal arterial flow signal pattern of penile Mondor's disease. Penile Mondor's disease is rare disease that's characterized by thrombosis in the dorsal vein of the penis. The previous reports on penile Mondor's disease are concerned with the color Doppler US finding without the flow signals in this area, but these findings are insufficient to understand the hemodynamics in penile Mondor's disease. We report for the first time on a cavernosal artery flow signal pattern of low peak systolic velocity and high-resistance.

Evaluation of Deep Vein Thrombosis with Multidetector Row CT after Orthopedic Arthroplasty: a Prospective Study for Comparison with Doppler Sonography

OBJECTIVE: This prospective study evaluated the ability of indirect 16-row multidetector CT venography, in comparison with Doppler sonography, to detect deep vein thrombosis after total hip or knee replacement. MATERIALS AND METHODS: Sixty-two patients had undergone orthopedic replacement surgery on a total of 30 hip joints and 54 knee joints. The CT venography (scan delay time: 180 seconds; slice thickness/increment: 2/1.5 mm) and Doppler sonography were performed 8 to 40 days after surgery. We measured the z-axis length of the beam hardening artifact that degraded the image quality so that the presence of deep vein thrombosis couldn't be evaluated on the axial CT images. The incidence and location of deep vein thrombosis was analyzed. The diagnostic performance of the CT venograms was evaluated and compared with that of Doppler sonography as a standard of reference. RESULTS: The z-axis length (mean +/- standard deviation) of the beam hardening artifact was 4.5 +/- 0.8 cm in the arthroplastic knees and 3.9 +/- 2.9 cm in the arthroplastic hips. Deep vein thrombosis (DVT) was found in the popliteal or calf veins on Doppler sonography in 30 (48%) of the 62 patients. The CT venography has a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 90%, 97%, 96%, 91% and 94%, respectively. CONCLUSION: The ability of CT venography to detect DVT was comparable to that of Doppler sonography despite of beam hardening artifact. Therefore, CT venography is feasible to use as an alternative modality for evaluating post-arthroplasty patients.

Gray-Scale and Color Doppler US Features Corresponding to Histological Subtypes of Papillary Thyroid Carcinoma

PURPOSE: To compare the gray-scale and color or power Doppler ultrasonographic (US) features according to the histological subtypes of a papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: The gray-scale and color or power Doppler US features of 159 surgically confirmed PTC (classic type of PTC, 69; classic type of papillary microcarcinoma [PMC], 67; and follicular variant of PTC [FVPTC], 23) in 118 patients were analyzed retrospectively. The following US characteristics were evaluated: the type of vascularization, echogenicity, outline, ratio of anteroposterior/transverse (AP/T) diameters, as well as the presence or absence of halo signs, cystic changes, and microcalcification. RESULTS: The most common type of vascularization was penetrating or central (75.4%) for the classic type of PTC, avascular (56.7%) for PMC, and peripheral and central (82.6%) for FVPTC. The echogenicity was most commonly hypoechoic (47.8%) for the classic type, hypoechoic (74.6%) for PMC, and isoechoic (30.4%) for FVPTC. The outline was most often irregular (60.9%) for the classic type, irregular (86.6%) for PMC, and regular (91.3%) for FVPTC. The ratio of the AP/T diameters was 1.0 or more in 31.9%, 55.2%, and 13.0%, a halo sign was observed in 30.4%, 6.0%, and 78.3%, cystic changes was present in 1.4%, 0%, and 21.7%, and microcalcifications were present in 55.1%, 28.4%, and 13.0% of those with the classic type, PMC, and FVPTC, respectively. CONCLUSION: The gray-scale and color Doppler US features corresponding to the histological subtypes of PTC are significantly different from one another. The US features of FVPTC appear to be significantly different from the other subtypes in that they tend to have more benign US characteristics than those of the classic type or PMC.

Gray-Scale and Color Doppler US Features Corresponding to Histological Subtypes of Papillary Thyroid Carcinoma

PURPOSE: To compare the gray-scale and color or power Doppler ultrasonographic (US) features according to the histological subtypes of a papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: The gray-scale and color or power Doppler US features of 159 surgically confirmed PTC (classic type of PTC, 69; classic type of papillary microcarcinoma [PMC], 67; and follicular variant of PTC [FVPTC], 23) in 118 patients were analyzed retrospectively. The following US characteristics were evaluated: the type of vascularization, echogenicity, outline, ratio of anteroposterior/transverse (AP/T) diameters, as well as the presence or absence of halo signs, cystic changes, and microcalcification. RESULTS: The most common type of vascularization was penetrating or central (75.4%) for the classic type of PTC, avascular (56.7%) for PMC, and peripheral and central (82.6%) for FVPTC. The echogenicity was most commonly hypoechoic (47.8%) for the classic type, hypoechoic (74.6%) for PMC, and isoechoic (30.4%) for FVPTC. The outline was most often irregular (60.9%) for the classic type, irregular (86.6%) for PMC, and regular (91.3%) for FVPTC. The ratio of the AP/T diameters was 1.0 or more in 31.9%, 55.2%, and 13.0%, a halo sign was observed in 30.4%, 6.0%, and 78.3%, cystic changes was present in 1.4%, 0%, and 21.7%, and microcalcifications were present in 55.1%, 28.4%, and 13.0% of those with the classic type, PMC, and FVPTC, respectively. CONCLUSION: The gray-scale and color Doppler US features corresponding to the histological subtypes of PTC are significantly different from one another. The US features of FVPTC appear to be significantly different from the other subtypes in that they tend to have more benign US characteristics than those of the classic type or PMC.

The Value of Renal Artery Resistive Indices: Association with Esophageal Variceal Bleeding in Patients with Alcoholic Cirrhosis

PURPOSE: To determine whether resistive indices of the renal artery (RIR) or the splenic artery (RIS) can be used as predictors of bleeding in patients with alcoholic liver cirrhosis. MATERIALS AND METHODS: According to esophageal variceal bleeding episodes, 33 patients with cirrhosis were divided into two groups, a bleeder group (n=17) and a non-bleeder group (n=16). These two groups were compared with respect to five variables (age, spleen size, Child's score, RIS, and RIR). Sensitivity, specificity, and accuracy for the detection of bleeders were calculated using a cutoff value of 0.7 for RIR. RESULTS: The mean values of variables were higher for bleeders than for non-bleeders. With the exception of age, four variables were significantly correlated with bleeding (r=0.43 for spleen size; r=0.36 for Child's score; r=0.37 for RIS; p<0.05, respectively; r=0.63 for RIR, p<0.01). Only RIR was found to be significantly a predictive variable for bleeders (adjusted Odds ratio=19.9; 95% confidence interval: 1.3-306, p<0.05) when the RIR was more than 0.7. RIR had a sensitivity of 88.3% and a specificity of 75% with an accuracy of 81.8% at a cutoff value of 0.7 for identifying bleeders. CONCLUSION: A high RIR value will be useful in predicating esophageal variceal bleeding in patients with alcoholic liver cirrhosis.

Doppler Ultrasonographic Parameters for Predicting Cerebral Vascular Reserve in Patients with Acute Ischemic Stroke

PURPOSE: We investigated Doppler ultrasonographic (US) parameters of patients with acute stroke to predict the cerebral vascular reserve (CVR) measured by SPECT. MATERIALS and METHODS: We reviewed the flow velocity and cross-sectional area of the circular vessel at the common, external, and internal carotid arteries (ICA) and the vertebral arteries (VA) in 109 acute stroke patients who underwent SPECT. Flow volume (FV) of each artery was calculated as the product of the angle-corrected time-averaged flow velocity and cross-sectional area of the circular vessel. Total cerebral FV (TCBFV) was determined as the sum of the FVs of the right and left ICA and VA. We compared the Doppler US parameters between 44 cases of preserved and 65 cases of impaired CVR. RESULTS: In the preserved CVR group, ICA FV, anterior circulating FV (ACFV) and TCBFV were higher than in the impaired CVR group (p < 0.05, independent t-test). In the impaired CVR group, the ROC curves showed ACFV and TCBFV were suitable parameters to predict CVR (p < 0.05). CONCLUSION: Doppler US was helpful for understanding the hemodynamic state of acute stroke. FV measurement by Doppler US was useful for predicting CVR.

The Use of Color Doppler Sonography to Avoid Misinterpretation of the Intrahepatic Portal Vein in Gray-Scale Sonographic Diagnosis of Cysts: Two Case Reports

The Use of Color Doppler Sonography Avoids Misinterpretation of the Intrahepatic Portal Vein in the Gray-Scale Sonographic Diagnosis of Cysts. When gray-scale US shows an intrahepatic cystic lesion with weak or no posterior acoustic enhancement in close proximity to the portal vein, especially at the bifurcation area, a detailed color Doppler US should be subsequently performed to evaluate its vascular nature.

The Usefulness of Venous Color Doppler with Valsalva Maneuver for Varicose Vein

PURPOSE: We wanted to evaluate the usefulness of venous color Doppler with performing a Valsalva maneuver for chassifing primary varicose vein of the lower extremity. MATERIALS AND METHODS: From September 2002 to March 2005, 207 patients and 288 extremities that were clinically suggestive of primary varicose vein in the lower extremity underwent venous color Doppler with performing a Valsalva maneuver. The patients included 133 women and 74 men aged between 20-79 years (mean age: 51 year). Color Doppler study was performed in the great and small saphenous veins. We used a 5 point grading system, Grade (Gr.) 0 was no evidence of reflux, Gr. I was early reflux within 3 seconds after the Valsalva maneuver, Gr. II was continuous reflux without dilatation during the Valsalva maneuver, Gr. III was continuous reflux with dilatation during the Valsalva maneuver and Gr. IV was reflux at a resting state. To find a relationship between the rate of operation and the grading system, we retrospectively reviewed the patient's medical records and the grading system. RESULTS: In the great saphenous vein, Gr. 0 was noted in 42 cases, Gr. I was noted in 68 cases, Gr. II was noted in 23 cases, Gr. III was noted in 104 cases and Gr. IV was noted in 51 cases. In the small saphenous vein, Gr. 0 was noted in 98 cases, Gr. I was noted in 60 cases Gr. II was noted in 38 cases, Gr. III was noted in 36 cases and Gr. IV was noted 56 cases. Among these cases, 2 cases of Gr. 0, 9 cases of Gr. I, 3 cases of Gr. II, 85 cases of Gr. III and 44 cases of Gr. IV of the great saphenous vein were operated on. 3 cases of Gr. 0, 4 cases of Gr. I, 4 cases of Gr. II, 23 cases of Gr. III and 37 cases of Gr. IV of the small saphenous vein were also operated on. Consequently, the operation rate was 76.5% in the severe cases over Gr. III. CONCLUSION: Color Doppler with performing a Valsalva maneuver and our new grading system is a useful method to determine the rate of operation for the patients suffering with primary varicose vein.

The Usefulness of Pulsatile Flow Detection in Measuring Resistive Index in Renal Doppler US

OBJECTIVE: To assess the usefulness of pulsatile flow detection (PFD), a newly developed function of color Doppler US, in measuring resistive index (RI) in renal Doppler US and to compare it with conventional color Doppler (CCD). MATERIALS AND METHODS: Fifty-six kidneys in 31 patients were randomly selected and divided into two groups. In group A, RI was measured first with the aid of CCD, and then with PFD. In group B, data were obtained in the reverse order. The time required for each RI measurement was recorded in seconds. The quality of the Doppler spectral waveform was subjectively graded as 0, 1, or 2 and examination time and waveform quality were compared between PFD and CCD. RESULTS: The time required to measure RI with PFD (PFD time) was less than with CCD (CCD time) (mean 42.7 secs vs. mean 70.3 secs; p = 0.031). There was no significant difference in PFD time between group A and B, but CCD time was shorter in group B (70.3 secs vs. 24.6 secs; p = 0.0004). Spectral waveform quality was not significantly different between PFD and CCD. CONCLUSION: The time required to measure RI in kidneys can be shortened with the aid of the PFD function in color Doppler US without affecting the quality of the examination.

Correlation of Power Doppler Ultrasonographic Findings and Histopathologic Maximum Microvessel Density of Solid Breast Masses

PURPOSE: To compare the power Doppler ultrasonographic (PDUS) findings of angiogenesis occurring in solid breast with the histopathologic findings. MATERIALS AND METHODS: Thirty-one cases of pathologically proven solid breast lesions (eight benign, 23 malignant) were retrospectively reviewed, focusing on tumor size (= 3 cm), the amount (none, mild, marked), morphology (none/linear, branching, disordered) and pattern (none/peripheral, central, penetrating), as demonstrated by power Doppler ultrasonography. We compared the PDUS findings with microscopic micro- vessel density (Max-MVD, the number of micro-vessels revealed at pathologic examination after factor-VIII staining). Statistical significance was determined using the x2-test. RESULTS: Max-MVD tended to increase according to fumor size, but the relationship was not statistically significant. In solid breast lesions there was close correlation between the observed increase in the intensity of Doppler signals and increased Max-MVD (p < 0.05). Morphologically, branching and disordered vessels were more often seen in malignant lesions, though the relationship between this finding and increased Max-MVD was not statistically significant. Penetrating and central Doppler signals were more frequent in malignant lesions and showed close correlation with increased Max-MVD (p < 0.05). CONCLUSION: The increased intensity of Doppler signals and the central and penetrating pattern of solid breast lesions seen at power Doppler sonography were closely related with increases in Max-MVD.

Tumor Vascularity of Experimentally Induced VX2 Carcinoma in the Rabbit Thigh: Evaluation with Enhanced Power Doppler Sonography and DSA Correlated with Histopathologic Findings

PURPOSE: To describe findings of enhanced power Doppler sonography and DSA in experimentally induced VX2 carcinomas in rabbit thigh and to correlate the imaging findings with the histopathologic features. MATERIALS AND METHODS: A total of 30 VX2 carcinomas were implanted in rabbit thigh, and after conventional and enhanced power Doppler sonography and DSA, histopathologic examination was performed. Enhanced power Doppler sonography and DSA, were used to determine the distribution pattern of tumor vascularity; to assess its grade and the percentage of a tumor area occupied by vessels, conventional and enhanced power Doppler sonography, as well as DSA, were used. The grade of necrosis and the development of fibrovascular stroma and capsule were histopathologically determined. The findings of power Doppler sonography were compared with those of DSA and the imaging features were correlated with the histopathologic features. RESULTS: At enhanced power Doppler sonography, the signal was either avascular (n=9), peripheral (n=15) or diffuse (n=6), while at DSA, the corresponding totals were eight, fourteen and eight. There was statistically significant corelation between enhanced power Doppler sonography and DSA, both in their depiction of the distribution of patterns of tumor vascularity and as regards their findings of grade and percentage of vascular area. As determined by both conventional and enhanced power Doppler sonography, and by DSA, grade of necrosis and the development of fibrovascular stroma and a capsule correlated with grade and the percentage of vascular area. CONCLUSION: Experimentally induced VX2 carcinomas in rabbit thigh demonstrated various patterns of tumor vascularity, and the findings of enhanced power Doppler sonography correlated with those of DSA. Tumor vascularity, as demonstrated by two imaging modalities, correlated closely with grade of necrosis and the development of fibrovascular stroma and a capsule, as revealed by histopathologic examination.

The Use of Contrast-Enhanced Color Doppler Ultrasound in the Differentiation of Retinal Detachment from Vitreous Membrane

OBJECTIVE: To compare the clinical utility of contrast-enhanced color Doppler US in the differentiation of retinal detachment (RD) from vitreous membrane (VM) with that of various conventional US modalities, and to analyze the enhancement patterns in cases showing an enhancement effect. MATERIALS AND METHODS: In 32 eyes examined over a recent two-year period, RD (n=14) and VM (n=18) were confirmed by surgery (n=28) or clinical follow-up (n=4). In all cases, gray-scale, color Doppler, and power Doppler US were performed prior to contrast injection, and after the intravenous injection of Levovist (Schering, Berlin) by hand for 30 seconds at a dose of 2.5 g and a concentration of 300 mg/mL via an antecubital vein, contrast-enhanced color Doppler US was performed. At Doppler US, the diagnostic criterion for RD and VM was whether or not color signals were visualized in membranous structures. RESULTS: Diagnostic accuracy was 78% at gray-scale US, 81% at color Doppler US, 59% at power Doppler US, and 97% at contrast-enhanced color Doppler US. The sensitivity of color Doppler US to color signals in RD increased from 57% to 93% after contrast enhancement. The enhancement patterns observed were signal accentuation (n=3), signal extension (n=2), signal addition (n=3), and new signal visualization (n=5). CONCLUSION: Contrast-enhanced color Doppler US was the most accurate US modality for differentiating RD from VM, showing a significantly increased signal detection rate in RD.

The Usefulness of Color Doppler Ultrasonography In the Evaluation of Breast Mass

PURPOSE: To evaluate the usefulness of color Doppler ultrasonography in the differential diagnosis of breast masses. MATERIALS AND METHODS: We prospectively evaluated to pathologically proven breast lesions. Forty-three were benign (39 fibroadenomas, two papillomas and two lipoma) and 27 were malignant (25 infiltrating ductal cardinomas, one mucinous carinoma and one atypical medullary caricinoma). In 32 cases, we categorized color signal from 0 to III, according to the degree of vascularity, and analysed peak systolic velocity (PSV) and resistive index (RI). RESULTS: Color signals of malignant lesions tended to be high grade (II, III), whereas those of benign lesions tended to be low (0, I), and the difference was statistically significant (P<0.005). In the analysis of spectral waveform , correlation between RI, PSV and malignancy was statistically significant (P<0.02). RI above 0.7 and PSV above 10 were the highest recorded values for sensitivity and specificity. CONCLUSION: Color Doppler ultrasound is a useful modality to distinguish benign from malignant breast masses. Malignancy is suggested when the color signal is grade II or III, the resistive index is higher than 0.7, and peak systolic velocity is higher than 10cm/sec.

MR Imaging of Multiple Fibroadenoma in Breast: Comparison with Color Doppler Images and Histologic Findings

PURPOSE: To understand the different signal intensities seen on contrast enhanced magnetic resonance imaging (MRI) in multiple fibroadenoma of the breast, and to compare these with color Doppler ultrasonographic (CDUS) and histologic findings. MATERIALS AND METHODS: MRI (1.0 Tesla, T1WI, T2WI, 3D-gradient echo dynamic contrast enhancement study) findings of 24 histologically proven cases of fibroadenoma in five patients were evaluated and compared with the histologic components (myxoid, adenomatous, fibrous). In addition, vascular flow, as seen on CDUS and histologic section, was compared. RESULTS: The observed degree of signal intensity was classified into three groups, as follows: negative, 8.3%, mild to moderate, 54.2%; marked, 37.5%. On histologic section, the greater the fibrotic component, the higher the intensity of MRI enhancement, the greater the glandular component, and the intensity. CDUS showed vascular flow in only one tumor larger than 3cm in diameter. Vascular patterns of tumors on CDUS were dots in mass and detouring pattern, but in this case and in strongly enhanced cases, tumor vascularity-as seen on histologic section-showed no significant increase. CONCLUSION: Different signal intensities seen on contrast enhanced MRI in multiple fibroadenoma of the breast may be related more to the amount of glandular and fibrotic component than to increased tumor vascularity.

Color Doppler Ultrasound in Chronic Venous Insufficiency

PURPOSE: To analyse Doppler findings in patients with chronic venous insufficiency, and evaluate the usefulness of color Doppler ultrasonography. MATERIALS AND METHODS: Thirty-seven limbs in 29 patients were evaluated with color Doppler ultrasound for suspected chronic venous insufficiency. To determine luminal patency and valvular competence, the venous system was examined; more than 1 sec of reflux flow during Valsalva maneuver and after release of distal compression in the popliteal vein indicated incompetence. RESULTS: Venous insufficiency was seen in 30 cases (81%), and was Superficial in 14 (38%), deep in eight (21.5%), and combined in eight (21.5%). In seven limbs (19%), veins were normal. Six cases of insufficiency, four of which were deep, were combined with deep venous thrombosis. CONCLUSION: In cases of chronic venous insufficiency, color Doppler ultrasound is useful for defining the exact site of venous incompetence and evaluating venous luminal patency.

A Study of Doppler Waveform Using Pulsatile Flow Model

PURPOSE: Through the construction of a pulsatile flow model using an artificial heart pump and stenosis to demonstrate triphasic Doppler waveform, which simulates in vivo conditions, and to evaluate the relationship between Doppler waveform and vascular compliance. MATERIALS AND METHODS: The flow model was constructed using a flowmeter, rubber tube, glass tube with stenosis, and artificial heart pump. Doppler study was carried out at the prestenotic, poststenotic, and distal segments; compliance was changed by changing the length of the rubber tube. RESULTS: With increasing proximal compliance, Doppler waveforms show decreasing peak velocity of the first phase and slightly delayed acceleration time, but the waveform itself did not change significantly. Distal compliance influenced the second phase, and was important for the formation of pulsus tardus and parvus, which without poststenotic vascular compliance, did not develop. The peak velocity of the first phase was inversely proportional to proximal compliance, and those of the second and third phases were directly proportional to distal compliance. CONCLUSION: After constructing this pulsatile flow model, we were able to explain the relationship between vascular compliance and Doppler waveform, and also better understand the formation of pulsus tardus and parvus.

The Value of Intrarenal Resistive Index in Patients with Liver Cirrhosis

PURPOSE: To determine whether the value of the intrarenal resistive index (RI) can be used to identify early kidney vasoconstriciton in patients with nonazotemic liver cirrhosis MATERIALS AND METHODS: The intrarneal resistive index(RI), kidney and liver function and plasma renin activity were measured in 12 healthy control subjects, 13 cirrhotic patients without ascites and 29 cirrhotic patients with ascites. To evaluate the development of hepatorenal syndrome, patients were followed up for six months. RESULTS: RI was significantly higher in patients with cirrhosis (0.68+/-0.06) than in healthy subjects(0.59+/-0.04). In 42 cirrhotic patients, it was significantly higher in those with ascites (0.69+/-0.05) than in those without ascites(0.64+/-0.05) and correlated with creatinine clearance. Plasma renin activity was significantly highter in cirrhotic patients with ascites than in those without ascites and healthy subjects(p<0.05). During the six-month follow-up period, kidney dysfunction developed in 16% (7/42) of cirrhotic patiens, and in 37% (6/16) of those with an elevated RI. In contrast, only 4% (1/26) of patients with a normal RI has kidney dysfunction. CONCLUSION: The measurement of intrarenal resitive index (RI) using duplex Doppler ultrasound is a simple, noninvasive method of detecting even subtle derangements of renal hemodynamics in liver cirrhosis patients; the procedure can be used to identify those who are at higher risk of overt renal failure and to help decide whether a therapeutic approach involving paracentesis, diuretics, or nephrotoxic agents is most appropriate.

Intratumoral Vascularity of Experimentally Induced VX2 Carcinoma: Comparison of Power Doppler Sonography and Microangiography

PURPOSE: To evaluate the usefulness and limitations of power Doppler sonography in determining the tumor vascularity. MATERIALS AND METHODS: Power Doppler sonography was performed on VX2 carcinomas present in rabbit thighs, and the findings were compared with those of microangiography in an almost identical plane. Tumor vascularity was qualitatively analysed on the basis of tumor vessel distribution and density, and the presence of thick and thin vesels ; for a comparison of tumor vascularity as seen on microangiography, tumor blood flow signals shown by power Doppler sonography were graded 3, 2, 1, 0. For quantitative analysis, a comparison was made of the percentage of tumor area occupied by vessels, as shown in each study. Data analysis utilized the Wilcoxon signed-rank test and Spearman correlation test. RESULTS: Mean tumor vascularity scores, as seen on power Doppler sonography and relating to tumor vessel distribution and density, and the presence of thick and thin vessels, were 2.87, 2.73, 2.93 and 2.73, respectively. The means and medians of the percentages of tumor area occupied by vessels were 22.7% & 23.5% and 36.4% & 34.7% on microangiography and power Doppler sonography, respectively. Thus, there was good correlation between these two modes. CONCLUSION: Power doppler sonography could demonstrate the tumor vascularity on microangiography relatively well but tend to overestimate it.

Diagnostic Value of Double Injection of Vasoactive Drug in Penile Doppler Ultrasonography

PURPOSE: To evaluate the usefulness of double injection of a vasoactive drug in penile Doppler ultrasonography for the diagnosis of vasculogenic impotence. MATERIALS AND METHODS: Eighty-four consecutive cases (bilateral sides) of 42 patients with suspected vasculogenic impotence were included in our study. We used computed sonography (Acuson, USA), with a 7 MHz linear array transducer. After the first intracavernosal injection of the vasoactive drug (10 ug of prostagladin E1), peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured three times. According to mean PSV and EDV, the patients were classified into four groups : arteriogenic impotence (AI;N=29), venogenic impotence (VI;N=28), AI associated with VI(N=14), and normal(N=13).After the second injection, PSV and EDV were remeasured, using the same method. Mean velocities of the first injection were compared with those of the second, and the paired t-test was used to analyze the results. the extent to which patients were reclassified after the scecond injection we noted. RESULTS: In all four groups, PSV measured after the second injection was significantly different from PSV after the first (p=0.0001, 0.0001, 0.0010, 0.0072); except in the normal group, EDV measured after the second injection was not different from EDV after the first (P=0.9815, 0.0654, 0.0950, 0.0057). After the second injection, the numbers of patients reclassified into other groups were as follows : AI, 11 (38%); VI, 6 (21%); AI associated with VI, 11 (79%); normal, 1 (8%). CONCLUSION: Double injection of a vasoactive drug affected PSV, and therefore, appears to be a useful adjunctive procedure for the evaluation of patients in whom classification based on the results of the first injection is difficult.

Dupplex Doppler Sonography in Patients with Medical Renal Diseases: Correlation with Clinical and Histopathologic Findings

PURPOSE: To compare the RI (resistive index) of renal artery with serum creatinine level and histological change in 50 patients with renal parenchymal disease. MATERIALS AND METHODS: To measure RI in each patient, Doppler studies were performed three times in each kidney at the level of the interlobar arteries, and the average value of RI was taken. The study was performed 1-3 days after renal biopsy and the time interval between blood sampling for serum creatinine and duplex study was also 1-3 days. The RI of patients with renal disease was also correlated with patient's age, sex and serum creatinine level, and RI was also correlated with the degree of severity of glomerular, interstitial, and vascular change in the kidneys. Statistical analysis was performed using Student's t test and Pearson's correlation method. RESULTS: The RI of the normal control and renal disease group was 0.566+/-0.037 and 0.584+/-0.038, respectively with no statistical significance (p=0.444). In the group with renal disease, there was no significant correlation between RI and a patient's age, sex, and serum creatininelevel (p>0.05). RI was not significantly different between predominantly glomerular disease (n=45) and nonglomerular or mixed disease (n=5) (p=0.558), and did not correlate with the severity of glomerular sclerosis, interstitial fibrosis, or atherosclerosis (p>0.05). CONCLUSION: The authors conclude that RI is not helpful for the diagnosis and differential diagnosis of renal parenchymal diseases and does not correlate with serum creatinine levels. In order to define the role of the RI, further clinical experience with more cases is required.