Study of effects of oligohydramnios on perinatal outcome

Background: Oligohydramnios has got a noteworthy influence on perinatal outcome. Hence, early detection and its timely management will aid in curtailing of perinatal morbidity and mortality and leading to decreased operative interventions. Therefore, the present study is conducted to look for the effects of oligohydramnios.Methods: This comparative study was a prospective observational study conducted at study institution. The women were divided into study and control groups based on AFI (amniotic fluid index), 100 cases were selected in each group.Results: Out of the 200 women, included in the present study, 35% of the patients in the study group had non-reactive non-stress test (NST) while in the control group 7% had it. Caesarean section was performed in 58% of cases in the study group as compared to 30% in the control group. Amongst these, Fetal distress was the most common indication for LSCS (lower segment caesarean section). There were no perinatal deaths in this study.Conclusions: Based on this study it has been observed that, amniotic fluid index of ≤5 cm was commonly associated with increased LSCS rates, intrauterine growth restriction, non-reactive NST, and abnormal Doppler velocimetry studies. Therefore, every case of oligohydramnios requires to be assessed meticulously. Prompt detection; timely management and treating the underlying condition improve outcome.

Perinatal outcome of term pregnancies with borderline amniotic fluid index: a prospective case control study

Background: It has been since antiquity that the importance of amniotic fluid and fetal growth with perinatal outcome is being documented. But the lacunae lies in studying the relationship between borderline amniotic fluid and perinatal outcome. The following study was undertaken to provide recent data that would help predict perinatal outcome in borderline AFI pregnancies.Methods: About 144 patients were considered in the study OPD/IPD patients in obstetrics and gynecology department in Bhabha Atomic Research Centre and Hospital, with about 72 cases with borderline amniotic fluid index (5-8 cm) and controls with amniotic fluid index ≥9-25 cm. Patients were selected and subjected to history taking, examination, ultrasound test with doppler studies and perinatal outcome documented over a period of one year.Results: The incidence of borderline AFI in my study was 16%. 58% were primigravidas. Meconium stained liquor was found in 18% cases compared to 7% controls. Low birth weight was found in 12.5% cases and 2.7% in controls. On applying statistical test analysis chi square test, it was found that borderline amniotic fluid index in relation to presence of meconium stained amniotic fluid and low birth weight, p value was found to be statistically significant (<0.05).Conclusions: Borderline amniotic fluid and perinatal outcome had significant relationship in terms of meconium stained liquor and birth weight while rest had no significance. Thus, borderline amniotic fluid patients require vigilant fetal surveillance.

Comparative study on the diagnostic accuracy of the different International Ovarian Tumor Analysis (IOTA) predictive model in discriminating between benign and malignant ovarian new growths: Logistic Regression 1 and 2 (LR1 and LR2) and assessment of the different Neoplasias of the Adnexa (ADNEX) model / Philippine Journal of Obstetrics and Gynecology

Objective@#To compare the diagnostic accuracy of the International Ovarian Tumor Analysis (IOTA)- Logistic Regression 1 and 2 (LR1 and LR2) and the Assessment of Different Neoplasias in the Adnexa (ADNEX) model in discriminating between benign and malignant ovarian new growths @*Methods@#The study was a prospective validation study. It included all patients admitted at the Gynecology ward of the Philippine General Hospital for elective surgery for ovarian new growths. Demographic information and clinical data were recorded for eligible patients. Two-dimensional ultrasonography with Doppler studies were performed. Ovarian new growths were classified based on IOTA LR1, LR2 and ADNEX model. Correlation of the ultrasound findings with the histopathology report and final staging based on Federation of Gynecology and Obstetrics (FIGO) classification was done. @*Results@#Sixty seven (67) patients were included in the final analysis. The mean age was 43 years old (range of 17-78). There were sixteen (16) nulligravid patients (22%). Eighteen (18) out of the 67 patients (27%) had malignant ovarian masses on histopathology. The IOTA LR1 had an area under the curve (AUC) of 0.96, sensitivity of 89% (95%CI, 74-100) and specificity of 92% (95%CI, 84-100). The IOTA LR2 had an AUC of 0.88, sensitivity of 61% (95%CI, 39-84) and specificity of 96% (95%CI, 90-100). The IOTA ADNEX had an AUC of 0.96, sensitivity of 89% (95%CI, 74-100) and specificity of 76% (95%CI, 63-88). Sensitivity and specificity of IOTA ADNEX for the diagnosis of specific malignant subtypes were as follows: Borderline, 80% and 76%, Stage I, 100% and 100, Stage II-IV, 86% and 100%. Accuracy values were not computed for the metastatic cancer since there was only one case seen. There was no significant difference in the accuracy values of IOTA ADNEX with or without CA 125. @*Conclusion@#In conclusion, IOTA LR1, LR 2 and ADNEX models were all useful tools in discriminating between benign and malignant ovarian masses. IOTA LR1 had the highest accuracy in differentiating between benign and malignant ovarian masses.

Quantitative Assessment of Synovial Vascularity Using Contrast-Enhanced Power Doppler Ultrasonography: Correlation with Histologic Findings and MR Imaging Findings in Arthritic Rabbit Knee Model

OBJECTIVE: To validate contrast-enhanced power Doppler ultrasonography (PD US) for the evaluation of synovial vascularity in an arthritic rabbit knee model in correlation with MR and histological findings. MATERIALS AND METHODS: Power Doppler ultrasonography was performed for carrageenin-induced arthritic left knee and control right knee of 13 rabbits, first without and then with sonic contrast agent enhancement (Levovist, Schering, Berlin Germany), followed by gadolinium-enhanced MR imaging. Synovial vascularity was quantitatively assessed by calculating the color pixel area in power Doppler sonography using a computer-aided image analysis program and by grading the enhancement on MR images: grade 1, enhancement of knee joint is less than one-third of the area; grade 2, one-third to two-thirds enhancement; and grade 3, more than two-thirds enhancement. Microvessel density (MVD) was measured on slides stained immunohistochemically for CD31 antigen for histological assessment. RESULTS: The mean area of color pixels in PD US changed from 4.37 to 16.42 mm2 in the arthritic knee after enhancement (p 0.05). CONCLUSION: Sonic contrast-enhanced PD US improves the visualization of synovial vascularity and allows quantitative measurement in experimentally induced rabbit arthritic knees.

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.

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.

Epididymitis Complicated by Testicular Infarction: A Case Report

Testicular infarction is caused most commonly by acute testicular torsion, but rarely by epididymitis. We report color Doppler sonographic findings and Doppler spectrum in a 56-year-old man with epididymitis that was complicated by testicular infarction.

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.

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.

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.

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 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.

The Use Contrast-Enhanced Color Doppler Ultrasonography in the Detection of Hepatocellular Carcinoma-Related Vessels

PURPOSE: To assess the value of contrast-enhanced color Doppler ultrasonography(US) in the detection of ves-sels related to hepatocellular carcinoma(HCC). MATERIALS AND METHODS: Between July 1997 and April 2000, 76 HCCs in 70 patients (50 men and 20 women; mean age, 57.8 years) were confirmed histologically or clinically. Tumor site and size at gray scale US, and afferent, intratumoral and efferent color signals at precontrast and postcontrast color Doppler US were deter-mined. Afferent signals were classified as basket or penetrating type, and intratumoral signals as spotty, linear or mixed. Efferent signals were categorized as signal to portal vein or signal to hepatic vein, and postcontrast color signal changes as focal, general or marginal spotty type. We also measured the color percentage of intra-tumoral signals as seen during precontrast and postcontrast study. RESULTS: The detection rate changed from 41(53.9%) to 60(78.9%) in cases with afferent signals, from 50(65.8%) to 64(84.2%) in those with intratumoral signals, and from 6(7.9%) to 9(11.8%) in those with efferent signals. Overall, 74(97.4%) cases showed positive findings at postcontrast color Doppler US. The most common enhancing pattern was general, occurring in 33(43.4%) cases. The color percentage of intratumoral signals increased from an average of 8.2% to 34.9%. The detection rate of intratumoral signals from tumors less than 3 cm in diameter increased from 56.8% to 100%, and that of deeply-located tumor-related signals (17 cas-es) increased from 47.1% to 94.1%. CONCLUSION: The use of contrast enhanced color Doppler US increased the detection rate of afferent, intratumoral, and efferent signals, especially that of intratumoral signals from tumors less than 3 cm in diameter and signals from deeply located tumors. In addition, the modality can aid the diagnosis of HCC by evaluating tumor dynamics.

Detection of Segmental Branch Renal Artery Stenosis by Doppler US: A Case Report

In stenosis of a segmental branch or among multiple renal arteries, Doppler sampling of intrarenal arteries in the upper, mid and lower poles demonstrates strikingly different waveform patterns that might otherwise be overlooked. We report a case of segmental branch renal artery stenosis in which a pulsus parvus et tardus waveform was observed in a segmental branch of a renal artery. In this case, systematic analysis of Doppler waveforms of intrarenal arteries at more than three different locations facilitated a rapid and confident diagnosis of seg-mental branch renal artery stenosis.

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.

Hepatic Hemangiomas: Spectrum of US Appearances on Gray-scale, Power Doppler, and Contrast-Enhanced US

Because US plays a key role in the initial evaluation of hepatic hemangiomas,knowledge of the entire spectrum of US appearances of these tumors is impor-tant. Most hemangiomas have a distinctive US appearance, and even with those with atypical appearances on conventional gray-scale US, specific diagnoses can be made using pulse-inversion harmonic US with contrast agents. In this essay,we review the spectrum of US appearances of hepatic hemangiomas on conven-tional gray-scale, power Doppler, and pulse-inversion harmonic US with contrast agents.