Glaucoma Surgery and Ocular Blood Flow in Colour Doppler Imaging: Is There a Link?

Glaucoma is a common cause of blindness worldwide. This disease is characterised by increased intraocular pressure (IOP) and the concomitant disruption of ocular haemodynamic. Several studies have demonstrated that trabeculectomy is associated with changes in extraocular blood flow. In this study, we reviewed the available evidence on the use of colour Doppler imaging to evaluate and manage patients with open-angle glaucoma. We present the detailed anatomy of ocular blood flow to provide a background for the research findings. We also discuss the physiological foundations of ocular blood flow and detailed flow characteristics of specific extraocular vessels. Finally, we reviewed published studies that analysed the effects of glaucoma surgery on the blood flow parameters of the eye.

Obesity-related parameters in carriers of some BDNF genetic variants may depend on daily dietary macronutrients intake

Some common single-nucleotide polymorphisms of the brain-derived neurotrophic factor (BDNF) gene have been associated not only with the neurodegenerative diseases but also with some eating disorders. The aim of this study was to assess the possible differences in the obesity-related and glucose metabolism parameters between some BDNF genotypes', that may depend on the daily energy and macronutrients intake. In 484 adult participants we performed the anthropometric measurements, body composition analysis, and body fat distribution. The daily dietary intake was assessed using the 3-day food intake diaries. Blood glucose and insulin concentrations were measured at fasting and during oral glucose tolerance tests. Moreover, the visceral adipose tissue/subcutaneous adipose tissue (VAT/SAT) ratio and homeostatic model assessment of insulin resistance were calculated. We noted that participants carrying the GG genotype had lower skeletal muscle mass and fat free mass (FFM) when carbohydrate intake was > 48%, whereas they presented higher fat-free mass (FFM), and surprisingly higher total cholesterol and LDL-C concentrations when daily fiber intake was > 18 g. Moreover, in these subjects we noted higher waist circumference, BMI, and fasting glucose and insulin concentrations, when > 18% of total daily energy intake was delivered from proteins, and higher VAT content and HDL-C concentrations when > 30% of energy intake was derived from dietary fat. Our results suggest that glucose homeostasis and obesity-related parameters in carriers of some common variants of BDNF gene, especially in the GG (rs10835211) genotype carriers, may differ dependently on daily energy, dietary macronutrients and fiber intake.

Normal tolerance limits for side-to-side differences in diameters of major lower limbs arteries of 228 healthy subjects

PURPOSE

To determine reference values and tolerance limits of between-side differences for the calibers of the common femoral artery (CFA), superficial femoral artery (SFA), popliteal artery (PA), dorsalis pedis artery (DPA), and posterior tibial artery (PTA).

MATERIALS AND METHODS

Calibers of arteries, defined as the largest distance between internal hyperechogenic lines of the intima-media complex of the arterial wall, were measured during the diastole phase determined from echo-tracking B mode ultrasound scanning and grey-scale ultrasound in 228 healthy volunteers aged 18-81 years (43.1 ± 16.7).

RESULTS

The mean, 95% confidence and tolerance limits covering 90% of population for left and right side of each artery were: CFA: 8.1 mm, 7.9-8.3 mm, 6.0-10.3 mm; 8.1 mm, 7.9-8.5 mm, 5.9-10.2 mm; SFA: 6.2 mm, 6.0-6.3 mm, 4.7-7.6 mm; 6.1 mm, 6.0-6.3 mm, 4.7-7.6 mm; PA: 6.1 mm, 6.0-6.2 mm, 4.6-7.6 mm; 6.1 mm, 5.9-6.2 mm, 4.5-7.6 mm; DPA: 2.0 mm, 1.9-2.0 mm, 1.2-2.7 mm; 2.0 mm, 1.9-2.0 mm, 1.2-2.8 mm; PTA: 2.1 mm, 2.0-2.1 mm, 1.4-2.8 mm; 2.1 mm, 2.1-2.2 mm, 1.4-2.8 mm, respectively. Tolerance limits for between-side differences and ratios were: CFA - 0.5-0.7 mm, 0.9-1.1; SFA - 0.5-0.6 mm, 0.9-1.1; PA - 0.5-0.5 mm, 0.9-1.1; DPA -0.4-0.4 mm, 0.8-1.2; PTA - 0.4-0.4 mm, 0.8-1.2. Regression analysis showed weight and age dependency of vessels diameters. There are no differences between men and woman in vessels size, except in DPA's, when body weight and age are taken into account in a regression analysis.

CONCLUSIONS

We estimated normal reference tolerance limits of side-to-side differences in diameters of lower limb arteries. The limits can inform an investigator what differences in diameters occur in healthy individuals, and hence can serve as cut-offs in diagnostic and screening strategies.

Limitations of Color Doppler Sonography in the Imaging of Ocular Vessels

PURPOSE

To describe a case where detection of blood flow in the central retinal artery and the central retinal vein was limited by an artifact evoked by the optic disc drusen. METHODS Case report.

RESULTS

During color Doppler sonography, examination of optic disc drusen may generate an artifact--the so-called twinkling artifact--which can simulate blood flow and make evaluation of the central retinal vessels impossible.

CONCLUSIONS

Twinkling artifact does not allow evaluation of color Doppler sonography in the imaging of ocular vessels.

Computerized tomography of the transverse pericardial sinus: Normal or pathologic?

The transverse pericardial sinus is a uniquely located structure subdivided into many parts. However, discrepancies still exist on the nomenclature and divisions. As noninvasive diagnostic technology such as CT and MR imaging improve, the transverse pericardial sinus and constituent recesses are visualized with more clarity, increasing the risk for misinterpretation. In this review, we will explore the anatomy of the transverse pericardial sinus and associated recesses with the goal of heightening awareness regarding the differential diagnosis between normal and pathological states as seen on CT. In addition, the inconsistencies of the right lateral superior aortic recess are also addressed. Last, we describe the clinical and surgical significance of the transverse pericardial sinus. Clin. Anat. 30:61-70, 2017. © 2016 Wiley Periodicals, Inc.

[Application of ultrasonography in central venous catheterization; access sites and procedure techniques]

Central venous catheterization is commonly performed in clinical practice. Traditional procedural technique is based on anatomical landmarks, but is associated with a high risk of failure and complications. To decrease their incidence European and American societies recommend application of ultrasonography. Preliminary ultrasonographic examination allows for assessment of local anatomical relations as well as vessel morphology (diameter, patency), while real-time ultrasonography increases chances of successful needle insertion. This paper presents the most common venous access sites and procedure techniques.

Ultrasound assessment of the jugular and vertebral veins in healthy individuals: selected physiological aspects and morphological parameters

Aim

Ultrasound assessment of morphological parameters of the internal jugular veins and vertebral veins in healthy individuals as well as their dependence on the patient's position.

Material

The examinations were conducted in 185 healthy individuals (101 females and 84 males) aged 18–89. Ultrasound examinations were conducted with the use of a linear probe with the frequency of 5–9 MHz in the supine (0°) and sitting position (90°).

Results

In 154 cases (83.2%) on the left side and in 150 cases (81.1%) on the right side, the jugular veins were completely closed in the sitting position. In 31 cases (16.8%) on the left side and in 35 cases (18.9%) on the right side, they were merely narrowed. By contrast with the jugular veins, the cross-sectional area (CSA) of the vertebral veins was greater in the sitting position than in the supine position in a statistically significant way. The CSA values of the jugular veins in the supine position ranged from 0 cm² to 4.3 cm². There were no statistically significant differences in the CSA between men and women. The cross-sectional area of the right jugular vein in the supine position was greater in a statistically significant way than that of the left jugular vein. In this study population, the ratio of the cross-sectional areas of the jugular veins on both sides amounted to 8.5:1.

Conclusions

The width of the jugular and vertebral veins significantly varies depending on the patient's position. The range of the CSA values for the jugular veins is broad, which should be taken into account when interpreting imaging findings. The internal jugular veins can show considerable asymmetry.

Internal jugular veins must be measured before catheterization

STUDY OBJECTIVE

The study objective is to determine the cross-sectional area (CSA) of the right and left internal jugular vein (IJV) in supine position in healthy subjects.

DESIGN

This is a prospective, nonrandomized study.

SETTING

The setting is a university hospital.

PATIENTS

The patients are 185 consenting healthy subjects.

INTERVENTIONS

B-mode ultrasonography examinations of the right and left IJV were performed with the use of a linear 14-MHz transducer at the level of the cricoid cartilage. The CSA of the examined vessels was measured in a supine position.

MEASUREMENTS AND MAIN RESULTS

The CSA on both sides differed by up to 850%. There were no statistically significant differences between CSA of IJVs in men and women. The CSA of the IJV on the right side was significantly greater than on the left side. The right IJV was more often classified as the "dominant" vessel (CSA being more than twice as large as the opposite side). A "small" vessel (CSA ≤ 0.4 cm(2)) was found in 54 cases (14.6%). In 9 subjects (4.9%), they were detected bilaterally.

CONCLUSION

The CSA of IJVs varies widely. Although the CSA was found to be often greater on the right than on the left side, a "small" vessel may occur on both sides.

Vasculitis and stroke due to Lyme neuroborreliosis - a review

Abstract Lyme neuroborreliosis (LNB) is a rare cause of vasculitis and stroke. It may manifest as subarachnoid hemorrhage, intracerebral hemorrhage, and most often ischemic stroke due to cerebral vasculitis. The vast majority of reported cases have been described by European authors. A high index of suspicion is required in patients who live or have traveled to areas with high prevalence of tick-borne diseases, and in the case of stroke-like symptoms of unknown cause in patients without cardiovascular risk factors. In this review, we also present four illustrative cases of vasculitis and stroke-like manifestations of LNB.

Infectious spondylodiscitis - a case series analysis

PURPOSE

We aimed to describe the clinical and laboratory features as well as diagnostic difficulties in the case series of spondylodiscitis.

MATERIALS/METHODS

We retrospectively reviewed 11 cases of spondylodiscitis. The diagnosis of spondylodiscitis was based on clinical, radiological and microbiological evidence and by the response to antimicrobial therapy.

RESULTS

There were 7 men and 4 women, and the age ranged from 21 to 74 years. Risk factors of spondylodiscitis were observed in 7 patients. The approximate time from onset of symptoms to diagnosis was from 2 to 7 months (median 45 days). Back pain was the most common symptom. The most frequent location of spondylodiscitis was lumbar spine. Pathogens were isolated in 6 cases and were as follows: Staphylococcus aureus (4 cases), Staphylococcus warneri (1 case) and Escherichia coli (1 case). After therapy, all patients had rapid regression of symptoms and no permanent neurological impairments and recurrence of infection were observed.

CONCLUSIONS

Diagnosis of spondylodiscitis is frequently delayed. This disease should be taken into consideration in differential diagnosis in patients with root syndromes accompanied by back pain and usually fever as well as increased values of CRP and ESR.

Tuberculoma of the central nervous system--a case report

Tuberculoma of the brain is a rare form of central nervous system (CNS) tuberculosis with non-specific clinical manifestation. Due to its similarity with many other infectious and non-infectious lesions, diagnosis is difficult. The study presents the case of a patient who developed CNS tuberculoma during the course of tuberculous meningitis.

Ultrasound assessment of the caliber of the arteries in the lower extremities in healthy persons - the dependency on age, sex and morphological parameters of the subjects

AIM

The aim of this paper was to evaluate the caliber of the following arteries in the lower extremities: the common femoral artery, superficial femoral artery, popliteal artery, posterior tibial artery and dorsalis pedis artery and to determine the relation of the calibers to age, sex and morphological parameters of the body such as weight, height and BMI of the subject.

MATERIAL

Two hundred and twenty-eight healthy persons aged 18-81 were examined (average ±SD; 43.1±16.71): 134 women aged 19-74 (43.2±15.63) and 94 men aged 18-81 (43±18.22).

METHODS

The study was conducted with the use of a linear probe of 7.5 MHz frequency. The vascular caliber was assessed after the color map (color Doppler) was placed on a B-mode image.

RESULTS

The average and standard deviation values for the calibers of examined vessels were determined. The calibers of all vessels examined in the group of men were statistically significantly larger than those in the group of women. No statistically significant differences between the calibers of the right and left sides were determined. The statistically significant correlations were specified between the age and the caliber of the examined vessels; positive for large femoral arteries and negative for the arteries of the crus and foot. Positive, statistically significant correlations between the caliber and the height, weight and BMI were also reported.

CONCLUSIONS

The reported calibers of the arteries in the lower extremities and their relation to age, sex and morphological parameters of the subjects enable the differentiation of the physiological remodeling of the vessels from the pathological processes in e.g. atherosclerosis or hypertension.

Blood flow disturbances in the central retinal artery in patients with traumatic optic neuropathy

BACKGROUND

Traumatic optic neuropathy (TON) is a serious sequel of head trauma, leading even to loss of vision. Experimental studies suggest that vascular factors contribute to the pathogenesis of TON. Thus the purpose of this study was to explore associations between blood flow Doppler parameters in the central retinal artery (CRA) and optic nerve function in patients after closed head trauma.

MATERIAL/METHODS

Blood flow was evaluated by color-coded duplex sonography (CCDS) in the CRA of 72 consecutive patients (57 males and 15 females, mean age: 40+/-14.5, range: 15-77 years) with a diagnosis of traumatic optic neuropathy. Of the 101 affected eyes, optic nerve atrophy was found in 87 whereas the optic disc had normal appearance in the remaining 14 eyes.

RESULTS

Both peak-systolic velocity (PSV) and end-diastolic velocity (EDV) in the eyes with TON were significantly lower (26% and 20%, respectively, p<0.01) than those in age- and gender-matched healthy subjects. A statistically significant decrease in PSV was also noted in the CRA of the contralateral unaffected eye (9%, p<0.05). A statistically significant positive association was found between blood flow velocities in the CRA and visual acuity (p<0.01) after controlling for sex, side of symptoms, and blood pressure.

CONCLUSIONS

Blood flow is significantly decreased in the central retinal artery of the affected eye and slightly in the unaffected eye in patients with traumatic optic neuropathy. Hemodynamic disturbances within the central retinal artery concur with functional nerve impairment.

Contrast-enhanced ultrasonography versus computed tomographic angiography in the monitoring of patients after endovascular repair of abdominal aortic aneurysm -- preliminary experience

BACKGROUND

Computed tomographic angiography (CTA) is routinely used in the monitoring of patients after endovascular repair of abdominal aortic aneurysm. The aim of the study was to determine if contrast-enhanced ultrasonography (CEUS) provides equivalent results to CTA in detection of endo-leaks in patients after abdominal aortic stentgraft placement.

MATERIAL AND METHODS

In a group of 7 patients (6 men and 1 woman; aged 71+/-7 years) after repair procedure, 16 CTA and 16 CEUS follow-up examinations were performed. Second-generation contrast agent (Sonovue) and low-mechanical index technique were used for ultrasonography imaging.

RESULTS

Computed tomographic angiography showed seven cases of type I, five cases of type II, and no endo-leaks in four examinations. In 15 out of 16 studies, the results of CEUS were consistent with the results of CTA. In one discrepant study, type II endo-leak was detected with CEUS while CTA was negative.

CONCLUSIONS

Contrast-enhanced ultrasonography and CTA examinations in patients after endovascular repair of abdominal aortic aneurysm provide comparable results. CEUS may be considered an alternative technique to CTA.

[Color Doppler ultrasound examinations of the eye and orbit--personal experience and literature review]

Color Doppler ultrasound examinations are effective and very useful to differentiate and diagnose ocular and orbital diseases. In the paper some aspects of these examinations are discussed: technique, examined vessels, blood flow parameters. Special attention is paid to patient's safety, drawbacks and limitations of presented technique.

[An application of Color Doppler ultrasonography in evaluate of brachytherapy in patients with uveal melanomas]

Uveal melanomas, even those of big size, are recently more readily treated conservatively, with radiotherapy, though the efficiency of this treatment has not been yet established.

PURPOSE

Of the study was the assessment of the usefulness of Color Doppler (CD) or Power Doppler (PD) examination in monitoring the effectiveness of brachytherapy in the management of melanomas.

MATERIAL AND METHODS

Examination was performed in 15 patients, who were treated because of medium size or large uveal melanomas, with plaque radiation (brachytherapy). CD/PD examination of blood flow within the tumor, with the use of SonoVue contrast agent in several cases, was performed before institution of the therapy and two times after the treatment, as follow-up.

RESULTS

Regression of the tumor and gradual atrophy of its neovascularisation was observed in all the examined patients. The enhancement of Color Doppler imaging with contrast agent helps in making decision to further therapeutic options as complex situation.

CONCLUSIONS

Color and Power Doppler ultrasonography is a helpful method in monitoring the effectiveness of brachytherapy in patients with uveal melanomas.

Carotid Artery Diameter in Men and Women and the Relation to Body and Neck Size

Background and Purpose— To explore relationships among gender, body size, neck size, and the diameters of the common carotid artery (CCA) and internal carotid artery (ICA).

Methods— Using multivariate regression, the best predictors of sonographic diameters of CCA and ICA were determined based on age, height, weight, body mass index, body surface area, neck circumference, neck length, and blood pressure.

Results— Measurements were obtained in 500 consecutive patients (age 52±15 years; 61% women). Mean diameters of ICA (4.66±0.78 mm) and CCA (6.10±0.80 mm) in women were significantly smaller than in men: 5.11±0.87 mm and 6.52±0.98 mm, respectively. Sex significantly influenced the diameters after controlling for body size, neck size, age, and blood pressure.

Conclusions— Carotid arteries are smaller in women even after adjusting for body and neck size, age, and blood pressure.

[Application of Color Doppler ultrasonography in the evaluation of the blood flow in the ocular vessels in patients with anterior ischemic optic neuropathy--the preliminary report]

PURPOSE

Anterior ischemic optic neuropathy (AION) is one of the most common causes of acute loss vision in the middle-aged and elderly persons. It occurs due to hypoperfusion in the short posterior ciliary arteries supplying the optic nerve head. The aim of our study was evaluation of the usefulness of colour Doppler ultrasonography in diagnostics of AION.

MATERIAL AND METHODS

Color Doppler imaging of the ophthalmic artery, central retinal artery and posterior ciliary arteries were performed in 10 patients with clinically evident AION. The peak-systolic velocity (PSV), end-systolic velocity (EDV) and resistance index (RI) were measured.

RESULTS

No significant differences in the mean values of PSV, EDV and RI of ophthalmic arteries and posterior ciliary arteries between the affected and non-affected eyes were found. Reduction of mean flow velocities as well as significantly increased resistance index were observed in the central retinal artery in eyes with AION.

CONCLUSIONS

The Color Doppler findings in the ciliary arteries do not reflect the ischemic changes in patients with AION. It is probably due to anatomical limitation of this method in evaluation of the blood flow in posterior ciliary arteries supplying the optic nerve head. Abnormal blood flow parameters in the central retinal artery are secondary changes due to optic disc oedema.

[Assessment of blood flow in the ocular circulation in type 2 diabetes patients with Color Doppler imaging]

PURPOSE

Color Doppler assessment of blood flow in ocular circulation in type 2 diabetes patients.

MATERIAL AND METHODS

Total of 56 patients were included in the study and divided into 3 groups: group I--control group, group II--type 2 diabetes patients without diabetic retinopathy, group III--type 2 diabetes patients with nonproliferative diabetic retinopathy. USG Color Doppler method was used in all patients to assess peak systolic blood velocity (PSV), end-diastolic blood velocity (ESV) and resistivity index (RI) in the following arteries: ophthalmic artery (OA), central retinal artery (CRA), short posterior ciliary artery (SPCA). In addition several clinical parameters including age, diabetes duration, blood pressure, body mass index (BMI) and blood glucose level with empty stomach were statistically analyzed.

RESULTS

Peak systolic blood velocity (PSV) and end-diastolic blood velocity (ESV) in ophthalmic artery (OA) in diabetic patients were significantly lower in comparison to the control group. Peak systolic blood velocity (PSV) and end-diastolic blood velocity (ESV) in central retinal artery (CRA) were significantly lower only in patients with diabetic retinopathy. In short posterior ciliary arteries (SPCA) only peak systolic blood velocity (PSV) was decreased in patients with diabetic retinopathy. Average age of patients was significantly higher in the group with diabetic retinopathy. Diabetes duration was significantly longer in group III in comparison to group II.

CONCLUSIONS

Color Doppler imaging method is useful for assessing blood flow in ocular circulation. Blood flow in ophthalmic artery is decreased in patients with diabetes. Reduction of blood flow in central retinal artery and short posterior ciliary arteries can be significant in the development of diabetic retinopathy.

[Difficulties in early diagnosis of Herpes simplex encephalitis]

Herpes simplex virus infection of the central nervous system is still a significant cause of morbidity and often mortality at relatively young people. Changes of central nervous system are results of primary infection or activation of latent HSV-1, HSV-2. Neurological deficits often follow encephalitis herpetica. CT, MRI and SPECT are usefull tools in early recognition of herpes encephalitis. The aplication of PCR is prompt and specific diagnosis of herpes simplex virus infections of the brain. Advances in treatment Herpes simplex encephalitis with acyclovir have improved outcome.

Normal reference intervals and ranges of side-to-side and day-to-day variability of ocular blood flow Doppler parameters

The study presents normal reference intervals and ranges of "normal" side-to-side and day-to-day variability of ocular blood flow Doppler parameters. Peak-systolic (PSV), end-diastolic velocity (EDV) and impedance indices in the ophthalmic artery (OA), the central retinal artery (CRA) and the short posterior ciliary artery (SPCA) of both orbits were determined with color-coded duplex sonography in 140 healthy volunteers (range 18 to 83 y; 68 men and 72 women). Decreases in flow velocities and concomitant increases in impedance indices were found in all arteries with advancing age. The PSV and the EDV values for the OA, the CRA and the SPCA in the age group less than 40 yr-old were 40.6 +/- 8.9 and 11.2 +/- 3.7, 9.9 +/- 1.8 and 3.7 +/- 0.9, 13.8 +/- 2.6 and 5.7 +/- 1.5 cm/s (mean +/- SD), respectively. In the 40 to 60 yr-old age group, the values were 35 +/- 7.9 and 10.7 +/- 4.3, 9.7 +/- 2 and 3.5 +/- 0.8, 13.5 +/- 2.9 and 5.3 +/- 1.5 cm/s. In the age group over 60 yr-old, the values were 34 +/- 8 and 8.4 +/- 3.3, 9.3 +/- 2 and 3 +/- 0.9, 12.8 +/- 2.4 and 4.3 +/- 1.2 cm/s. In the youngest age group, the EDV in the CRA and the SPCA was higher in women, while in the OA the PSV and the EDV were higher in men. Ranges of side-to-side variability in the OA, the CRA and the SPCA, determined with repeatability coefficient for the PSV and the EDV, were 24, 5.4, 7.5 cm/s and 11, 2.5, 4.2 cm/s, respectively, whereas the values for day-to-day variability were 16.8, 4.3, 6.7 cm/s and 5.6, 1.7 and 3.9 cm/s. Ocular blood flow Doppler parameters range widely and are significantly age and sex dependent. Ranges of "normal" side-to-side and day-to-day variability of the parameters can help to determine abnormal flow pattern.

Assessment of variability of renal blood flow Doppler parameters during the menstrual cycle in women

OBJECTIVE

To estimate variability of renal flow Doppler parameters during the menstrual cycle in young women, and to explore whether the parameters oscillate substantially throughout the cycle.

METHODS

The peak systolic, mean, and end-diastolic velocities, pulsatility (PI) and resistance (RI) indices, acceleration time (AT) and index (AI) of the right renal artery were measured nine times during the cycle with duplex sonography in 14 healthy women (age range, 23-25 years), and correlated with plasma concentrations of 17beta-estradiol and progesterone. Coefficient of variation (CV), interclass correlation (rho), and repeatability coefficients (RC) were used to measure the variability.

RESULTS

The measures of the variability for AI and AT were: CV = 45.4% and 37.3%; rho = 0.25 and 0.15; RC = 10.1 and 99.5, respectively. The CV for flow velocities varied from 24.1% to 25.5%, rho from 0.49 to 0.50, RC from 22.7 for end-diastolic to 63.3 for peak systolic velocity. The respective figures for PI and RI were: CV = 17% and 8.3%; rho = 0.21 and 0.29; RC = 0.53 and 0.15. Fluctuations of the flow parameters, hematocrit, hemoglobin, heart rate, and systolic blood pressure during the menstrual cycle were insignificant, while the diastolic blood pressure decreased by about 7 mmHg (P < 0.01) in the luteal phase.

CONCLUSION

The variability of renal flow Doppler parameters during the menstrual cycle in young healthy women is substantial. However, fluctuations of the values of the parameters throughout the cycle were non-significant.

[Diagnosis of middle cerebral artery spasm by determination of flow velocity and the Lindegaard index with transcranial color Doppler sonography]

BACKGROUND AND PURPOSE

Recent reports have demonstrated the high utility of transcranial color-coded duplex sonography (TCCS) in the diagnosis of advanced spasm of the middle cerebral artery, whereas its accuracy in the diagnosis of mild vasospasm is reported to be lower. Relation of blood flow velocity in the middle cerebral artery (MCA) to that in the extracranial internal carotid artery (VMCA/VICA index) is recommended as being helpful in the diagnosis of vasospasm (the so called Lindegaard Index). Nevertheless, the exact diagnostic value of this index using the TCCS method remains to be established. The purpose of this study is to estimate the accuracy of TCCS in the diagnosis of MCA vasospasm, as based on the VMCA/VICA index.

MATERIAL AND METHODS

The VMCA/VICA index was calculated in 195 patients (285 middle cerebral arteries) who were scheduled for cerebral arteriography. The TCCS study and color-coded duplex sonography of the internal carotid arteries were performed immediately before arteriography.

RESULTS

A mild grade of MCA spasm was diagnosed angiographically in 21, and moderate-to-severe spasm in 29 MCAs out of 285 successfully insonated arteries. Peak-systolic, mean and end-diastolic blood velocities were measured using transcranial color sonography in the MCA and related to the respective velocities in the ipsilateral extracranial internal carotid artery. Receiver-operating characteristic curves (ROC) were calculated for particular velocities and for the related VMCA/VICA indices. By comparison of the areas under the ROC curves it was shown that the use of the VMCA/VICA index does not improve the accuracy of TCCS in the diagnosis of advanced MCA spasm, whereas it improves accuracy in the diagnosis of mild vasospasm. In particular, accuracy can be improved by the use of the VMCA/VICA index based on the end-diastolic velocity. The optimal diagnostic threshold of the VMCA/VICA index was determined at 3.9.

CONCLUSIONS

The use of VMCA/VICA index improves the accuracy of TCCS in the diagnosis of mild vasospasm of the middle cerebral artery.

Evaluation of enhancement patterns of focal nodular hyperplasia in contrast-enhanced, wide-band phase-inversion harmonic power Doppler imaging of the liver

BACKGROUND

The purpose of the study was to assess the quality of performance of wideband, phase inversion harmonic power Doppler sonography in the diagnosis of focal nodular.

MATERIAL/METHODS

During a period of one year, thirty-one patients with FNH previously confirmed by ultrasound-guided biopsy, surgical resection, dynamic helical computed tomography or magnetic resonance imaging were examined. The study protocol consisted of B-mode gray scale sonography, color Doppler, power Doppler examinations, and helical CT scans. Then PI scans were performed after the injection of 2.5 g of Levovist intravenously.

RESULTS

The images obtained by the B-mode gray scale were typical for focal nodular hyperplasia in 13 lesions only (32.5%), and obtained by color, power Doppler sonography in 25 lesions (62%). On the contrary all patients with focal nodular hyperplasia were diagnosed based on the wide-band, phase inversion power Doppler sonography findings. The common enhancement pattern at pulseinversion harmonic US was filling in a central tumor artery with further centrifugal development of contrast. Then during early arterial phase, all typical anatomical features of FNH as 'star sign 'or 'spoke-wheel 'pattern were clearly visible .In 3 cases ,computed tomography and magnetic resonance imaging have failed to disclose pathology while phase inversion sonographic images were completely suggestive which was later confirmed by histologic examination.

CONCLUSIONS

Our data demonstrates the usefulness of wide-band, phase inversion harmonic power Doppler sonography in the differential diagnosis of hepatic focal nodular hyperplasia by visualizing all characteristic anatomical details.

Hemangiomas and focal nodular hyperplasia images in contrast-enhanced, wide-band phase-inversion harmonic power Doppler imaging

BACKGROUND

Contrast-enhanced, wide-band, phase inversion power Doppler sonography in the depiction of vasculature in hemangioma and focal nodular hyperplasia.

MATERIAL/METHODS

Fifty-one patients with liver lesions (40 FNHs,37 hemangiomas) were prospectively evaluated with conventional, color, power Doppler sonography, tissue harmonic, phase-inversion sonography and helical CT. Levovist was the standard contrast agent used and all examinations were performed on Siemens SONOLINE Elegra equipped with Ensemble Contrast Imaging (ECI) software.

RESULTS

Color and power Doppler scans were frequently not specific for these highly vasularized lesions. Images were not suggestive in 15 out of 40 FNHs and not positive in all of 37 hemangiomas). If peripheral enhancement in form of puddle enhancement, 'bloo pools' or rimlike followed by a slow centripetal fill-in is regarded as a positive finding for hemangiomas all lesions were depicted confidently with wide-band, phase inversion, contrast enhanced power Doppler scans. Moreover, all typical vascularity features of FNHs confluence firstly the feeding artery then centrifugal spread of contrast later forming wheel like pattern was obvious in all cases of diagnosed FNHs.

CONCLUSIONS

Contrast-enhanced, wide-band, PI ,power Doppler imaging is useful method for diagnosing the vascularity of FNHs and hemangiomas. Not only it overcomes the low prediction rate which was the main obstacle for routine use of sonography but it is cheap, portable, and free also from contrast media and radiation.

Carotid artery dissection - an important complication after fine-needle aspiration biopsy

BACKGROUND

Carotid artery dissection (CAD) is a frequent cause of ischemic stroke in patients under 40 years. It happen spontaneously or after various degree of trauma.

CASE REPORT

In this report we present a case of 33 years-old woman with dissection of the common carotid and internal carotid artery after 'blind ' fine-needle aspiration biopsy of the neck lymph node.

CONCLUSIONS

Fine-needle aspiration biopsy of the neck, close to carotid vessels should be always performed under control of imaging techniques.

[Recurrent choroidal detachment following phacotrabeculectomy imaged with Doppler ultrasonography--a case report]

The authors describe a case of 78-year-old women, who underwent uneventful facotrabeculectomy with posterior chamber intraocular lens implantation and experienced late and recurrent choroidal detachment. Color Doppler imaging of the ophthalmic artery, central retinal artery, short posterior cilliary arteries and vessels on surface of choroidal detachment was carried out. The parameters of blood flow in all arteries were normal. Spectrum of flow in the vessels on surface of choroidal detachment was similar to this of central retinal artery. Color Doppler ultrasonography is useful diagnostic method in evaluation of vascular bed in eye with choroidal detachment.

[Effect of pentoxifylline on Doppler blood flow parameters in the central retinal artery and the short posterior ciliary arteries in adolescents with progressive myopia]

PURPOSE

To evaluate the effect of pentoxifylline on blood flow in the central retinal artery and the short posterior ciliary arteries in patients with progressive myopia.

MATERIAL AND METHODS

48 eyes of 24 healthy patients aged between 12 and 18 years (mean 15.1 years) with myopia from -5.0 to -12.75 Dsph (mean -7.56 Dsph), were examined using color Doppler ultrasonography. The examination was performed before and after 10 days of intravenous administration of 200 mg of pentoxifylline. The peak-systolic, end-diastolic flow velocities, pulsatility, resistance and systolic/diastolic ratios were measured.

RESULTS

The use of pentoxifylline significantly increased PSV and EDV in the central retinal artery and in the short posterior ciliary arteries (p=0.0001) in patients with progressive myopia and in the same time decreased PI, RI and S/D (p=0.0001). There was no correlation between Doppler blood flow parameters and dioptres or axial length.

CONCLUSIONS

pentoxifylline increases retinal and choroidal blood flow in young patients with progressive myopia.

[Non-typical clinical course of the optic disc drusen--case report]

The authors describe a case of 63 old man with bilateral optic disc drusen, which is interesting because of its different natural course in the right and left eye. This paper also shows, that colour Doppler ultrasonography is the useful diagnostic method for patient with optic disc drusen, when the blood flow disturbances in orbital vessels occur.

Proton MR spectroscopy in neuroborreliosis: a preliminary study

We report results of a magnetic resonance spectroscopy (MRS) study in 12 patients with neuroborreliosis. We used a PRESS sequence, placing an 8 cm3 voxel in normal-appearing white matter of the frontal lobe. Peaks indicating N-acetylaspartate (NAA), choline (Cho), creatine (Cr), myo-inositol (mI), lipids (Lip) and lactate (Lac) were identified and ratios of NAA/Cr, Cho/Cr, mI/Cr, Lip/Cr, Lac/Cr calculated. Significant increases in Cho/Cr and Lip/Cr were noted. No abnormality was found in mean NAA/Cr and Lac/Cr, but in four patients there was a decreased NAA peak; mI/Cr ratio was slightly increased. Although the spectroscopic profile in patients with neuroborreliosis seems to be nonspecific, MRS might be useful for assessing tissue damage of the central nervous system.

[The role of vascular factors in the development of traumatic optic neuropathy in course of closed head injury]

PURPOSE

This study was undertaken to assess the pathogenesis of traumatic optic neuropathy as a consequence of closed head injury.

MATERIAL AND METHODS

The clinical material comprised 34 patients (4 women and 30 men, age 14-70 years), who developed clinical symptoms of optic neuropathy after head trauma. A full ophthalmologic survey and colour Doppler examination of the orbital vessels were performed in all patients.

RESULTS

Full blindness of the affected eye, persisting since the injury, was noted in 20 patients. Orbital fracture was diagnosed in 15 person, but 4 patients among them had fracture of the optic canal bones. In 16 cases a retrobulbar hematoma was present. In 8 patients, who displayed no light perception after trauma, no flow was observed in the central retinal artery. In 18 other persons there was decreased of blood flow parameters. Only 6 patients had the normal flow in the orbital vessels.

CONCLUSION

The reason of the development of optic neuropathy after head injury is not clear. Our results of the blood flow measurement in the orbital vessels suggest, that disturbance of circulation within the optic nerve is very serious factor in the pathogenesis of traumatic optic neuropathy.

[Neuroimaging in Lyme disease]

Imaging techniques are commonly used in the diagnostics of the central nervous system disorders. Abnormalities found using MRI and MRS in neuroborreliosis patients are described.

[The role of ultrasound examinations in diagnosis of massive suprachoroidal hemorrhage occurring as a postoperative complication of intraocular surgery ]

This article presents importance of the ultrasound examinations (standard A- and B-scan ultrasonography, Colour Doppler and Power Doppler ultrasonography) in early and late diagnosis of massive intraoperative suprachoroidal hemorrhage. Standardized echography can help establish an accurate diagnosis. Echography can determine the location and extent of expulsive hemorrhage, as well as determine the status of the retina and vitreous. Furthermore, differentiation between hemorrhagic choroidal detachment and serous choroidal effusion can be made only by A- and B-scans. Colour and Power Doppler imagings of orbital vessels are relatively new sonography methods of ocular diagnosis. Using them, we can evaluate all blood flow disturbance, which occur in eye with massive suprachoroidal hemorrhage. These methods are also useful in differentiation of retina from other tissues, especially in the presence of opaque media.

[Neuroborreliosis: CT and MRI findings in 14 cases. Preliminary communication]

Since 1987 when Januszkiewicz and Kieda first described borreliosis, it is commonly recognized as infection of the nervous system in Poland, especially in north-east region. The diagnosis of the disease is mainly based on typical clinical signs, supported by serological testing. In 14 patients with clinical symptoms of neuroborreliosis CT and MR were performed to evaluate CNS changes. MR examinations were abnormal in 36%. Most patients (60%) presented cerebral atrophy. In 2 cases areas of abnormal signal were identified within cerebral white matter as well as within the brain stem. In the first case it was, recognized as demyelination focus, in second one MR showed evidence of or were suggestive of vascular involvement. In one case symmetrical calcifications were also found in internal capsules. Neuroradiological signs in Lyme disease are not specific. Neuroborreliosis has to be considered when patients present foci of hyperintense signal (T2-weighted images) in white matter and brain stem.

[Variations of Doppler blood flow parameters in central retinal artery in relation to position of sample volume]

PURPOSE

To determine variability in measurements of Doppler blood flow parameters in central retinal artery in relation to sample volume location from the optic disc.

MATERIAL AND METHOD

Eighty central retinal arteries were examined using color Doppler ultrasonography in 40 healthy volunteers (22 female, 18 male), aged 45 +/- 9 with 7.5 MHz linear-array probe. The measurements of blood velocities and resistance indices in the arteries were obtained at points where distance from optic disc surface ranged from 1.5 mm to 6 mm.

RESULTS

Blood velocities increased significantly when sampled closer to the globe (r = -0.61, and r = -0.32 for peak-systolic and end-diastolic velocities, respectively). Mean peak-systolic velocities were 13.0 +/- 2.7 cm/s when distance 2.1 +/- 0.46 mm from optic disc, and 9.3 +/- 2.5 cm/s when distance 4.27 +/- 0.9 mm. Mean end-diastolic velocities were 4.3 +/- 1.2 cm/s and 3.6 +/- 1.1 cm/s, respectively. Resistance indices inclined to increase when the distance between the measurement site and the globe shortened. Resistance indices were 0.67 +/- 0.06 when measured closer to the globe and 0.60 +/- 0.06 when measured farther from it.

CONCLUSION

Position of sample volume in relation to optic disc has to be taken into account and defined if measurements of blood flow Doppler parameters of the central retinal artery are to be reproducible.

[Blood flow parameters in ocular vessels of patients with glaucoma]

PURPOSE

To determine Doppler flow parameters in ocular vessels of glaucomatous patients.

MATERIAL AND METHODS

38 glaucomatous patients, aged 64 +/- 16, and 57 healthy volunteers were examined with 7.5 MHz linear-array probe. Consistently identified arterial structures included ophthalmic artery, central retinal artery and short posterior ciliary arteries. The peak systolic, end-diastolic and mean velocities were measured from Doppler spectra. Resistance and pulsatility indices were also determined.

RESULTS

End-diastolic and mean velocities in central retinal artery of glaucomatous eyes were: 1.5 +/- 1.9 cm/s, 4.0 +/- 2.0 cm/s, whereas in healthy eyes they were significantly higher: 3.5 +/- 1.0 cm/s, 5.4 +/- 1.5 cm/s, respectively. These velocities in short posterior ciliary arteries in glaucomatous patients were significantly lower: 2.4 +/- 2.3 cm/s, 5.6 +/- 2.2 cm/s, comparing to healthy subjects: 4.8 +/- 1.7 cm/s, 7.3 +/- 2.2 cm/s. Resistance and pulsatility indices in central retinal artery and short posterior ciliary arteries were significantly higher in the group of patients: RI = 0.85 +/- 0.18, PI = 2.11 +/- 0.92--in central retinal artery and RI = 0.81 +/- 0.18, PI = 1.96 +/- 0.91--in short posterior ciliary arteries, comparing to healthy subjects: RI = 0.61 +/- 0.08, PI = 1.20 +/- 0.17--in central retinal artery, RI = 0.61 +/- 0.09, PI = 1.13 +/- 0.18--in short posterior ciliary arteries. Impedance indices were increasing progressively with intraocular pressure elevation. There were no significant differences of Doppler blood flow parameters in ophthalmic artery between patients and control group.

CONCLUSIONS

Blood flow velocities in central retinal and short posterior ciliary arteries are lower, and resistance and pulsatility indices are higher in glaucomatous eyes in comparison to healthy subjects, whereas in ophthalmic artery doppler parameters are similar in both groups.

[Color Doppler ultrasonography in diagnosis of post-traumatic optic neuropathy]

PURPOSE

To evaluate the parameters of blood flow in orbital arteries of patients with traumatic optic neuropathy.

MATERIAL AND METHODS

Colour Doppler imaging of the ophthalmic artery, central retinal artery and posterior ciliary arteries was carried out in 13 patients with traumatic injury of the optic nerve. The peak-systolic, end-diastolic flow velocities and resistance index were measured.

RESULTS

In 4 patients, whose vision was intact immediately after the injury and later deteriorated, the parameters of blood flow in the central retinal artery (CRA) were normal. Also in 3 patients with loss of vision to 1/50-3/50 after the injury the parameters of blood flow in the CRA were in the normal limit. In 3 other patients, who had only light perception after injury, there was decreased peak systolic blood flow and only trace or no flow was demonstrated in the CRA during the diastolic phase. In the remaining 3 patients, who displayed no light perception after the injury, no flow was observed in the CRA with Colour Doppler method.

CONCLUSION

Colour Doppler ultrasonography is a useful supplementary method in diagnostics of traumatic optic neuropathy. The Colour Doppler findings seem to correlate well with clinical pathologies of the optic nerve after its traumatic injury.

Transcranial color Doppler sonography of basal cerebral arteries in 182 healthy subjects: age and sex variability and normal reference values for blood flow parameters

OBJECTIVE

Only a limited number of transcranial color-coded Doppler studies have provided ranges for the normal reference values of cerebral hemodynamic parameters. These reports are not fully convergent in relation to the range of values or to the age and sex dependence of blood flow parameters. The aim of the present study was to provide data regarding normal reference ranges.

SUBJECTS AND METHODS

We examined 182 healthy volunteers (79 men and 103 women; age range, 20-86 years old) with color-coded Doppler sonography via a temporal acoustic window with a 2.5-MHz transcranial probe. The subjects were divided into three age groups: 20-40 years old (group 1), 41-60 years old (group 2), and more than 60 years old (group 3). Angle-corrected peak systolic, end-diastolic, and mean velocities as well as impedance indexes were determined in anterior, middle, and posterior cerebral arteries.

RESULTS

Mean velocity values for middle, anterior, and posterior cerebral arteries in age group 1 were 81+/-20, 56+/-14, and 52+/-12 cm/sec (mean +/- SD), respectively. In group 2, the values were 73+/-19, 53+/-16, and 51+/-12 cm/sec (mean +/- SD), and in group 3, the values were 59+/-11, 44+/-11, and 40+/-9 cm/sec (mean +/- SD). Decrease in blood flow velocities and a concomitant increase in impedance indexes were found in all vessels with advancing age-findings that were most pronounced in subjects who were more than 40 years old. In the 20- to 40-year-old group, mean velocities for all vessels were higher in women than in men, whereas impedance indexes were not significantly different.

CONCLUSION

Flow velocities in basal cerebral arteries range widely and are significantly age dependent. Age and sex matching of Doppler sonographic data is a prerequisite for clinically valuable conclusions.