Ultrasound in Medicine (KSUM). How to cite this article: Rübenthaler J, Reiser M, Clevert DA. Diagnostic vascular ultrasonography with the. Doppler ultrasonography of the lower extremity arteries is a valuable technique, although it is less frequently indicated for peripheral arterial. Vascular ultrasound uses sound waves to evaluate the body's circulatory system and help identify blockages in the arteries and veins and detect blood clots.
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Competent use of Doppler ultrasound techniques requires an understanding of three Ultrasound images of flow, whether color flow or spectral Doppler, are. for abdominal ultrasound. The present atlas attempts to fill this gap. Color Atlas of Ultrasound Anatomy Atlas of musculoskeletal ultrasound anatomy. Principles of vascular ultrasound Performing a scan Setting up a vascular diagnostic service Vascular physiology Vascular pathology Extracranial.
The findings of the ultrasonographic study of the stenoses and obstructions of the renal arteries were compared with the arteriographic findings.
The minimum sample size was calculated for the inclusion of 50 renal arteries in the study. Results Based on previously defined criteria, of the renal arteries assessed on vascular color Doppler ultrasound, 43 The arteriographic findings were as follows: 50 After excluding the inconclusive examinations 7 arteries , the comparison of the methods in the remaining arteries showed Of the arteries with concordant results, 40 were considered normal, 6 were moderately stenotic, 63 were hemodynamically significantly stenotic, and 7 were obstructed fig.
Of the 14 renal arteries with discordant results, 9 were false-positive and 5 false-negative on vascular color Doppler ultrasound as compared with arteriography. The arteries whose results were considered false-negative had renal-aorta indices lower than 3.
The overall accuracy of the procedure as compared with that of arteriography was The 6 4. In 1 case, the presence of an aneurysm of the juxtarenal abdominal aorta caused difficulties in the study of the renal artery on arteriography.
Discussion The major objective of the complementary examinations in the investigation of patients with renovascular hypertension is to identify the anatomic lesions in the renal arteries and their branches, and to determine which of these lesions will be physiologically significant, ie, responsible for the activation of the renin-angiotensin system.
However, in addition to not providing hemodynamic information, a 1. Therefore, a noninvasive method of selection that may identify the anatomic and hemodynamically significant lesions of the renal arteries is required.
The use of vascular color Doppler ultrasound for the diagnosis of vascular diseases has been extended in recent decades with improvement in the sensitivity of the equipment and use of color-flow mapping. The direct criteria of the examinations for the diagnosis of renovascular hypertension are based on measurement of the velocities in the renal arteries, on the renal-aorta index, and on renal size.
Settings and artefacts relevant for Doppler ultrasound in large vessel vasculitis
Our results of vascular color Doppler ultrasound compared with those of arteriography for identifying hemodynamically significant stenoses showed indices of quality, indicating sensitivity, specificity, positive and negative predictive values, and overall accuracy of Still in our study, the results of 14 renal arteries found on vascular color Doppler ultrasound and arteriography disagreed, 9 being false-positive and 5 false-negative.
These values, therefore, met the criteria required for the diagnosis of hemodynamically significant stenosis, although they were not confirmed on arteriography. The arteries whose results were false-negative had renal-aorta indices lower than 3.
Previous gastrointestinal preparation, ability of the examiner, and time for performing the examination are factors that contribute to reducing the percentage of inconclusive examinations Our inconclusive cases 4. In conclusion, the experience of the vascular ultrasonographer with the direct technique for renal artery evaluation, the adequate use of diagnostic criteria and the use of sensitive equipment enable the reliable study of most patients suspected of having renovascular hypertension.
Because vascular color Doppler ultrasound is a direct noninvasive diagnostic method that has good accuracy, it may be used as a routine examination for selecting patients suspected of having renovascular hypertension for undergoing arteriography. References 1.
Strandeness DE Jr.
Duplex scanning in diagnosis of renovascular hypertension. Surg Clin North Am , Haimovici H, Zinicola N. Experimental renal artery stenosis: diagnostic significance of arterial hemodinamics. J Cardiovasc Surg. Inter-observer variability in the angiographic assessment of renal artery stenosis. J Hyperten , Sigstedt B, Lunderquist A. Complications of angiography examinations.
Am J Roentegenol , Complications of angiography. Radiology , Vaugh JR, Sacharias N.
Arteriography complications in DAS era. Complications of peripheral arteriography: A new system to identify patients at increased risk.
J Vasc Surg , Random noise and blooming artefacts can be eliminated by lowering the Doppler gain. Some artefacts, like mirror and reverberation artefacts, cannot be eliminated and should therefore be recognised when they occur.
The commonly encountered artefacts, their importance for image interpretation and how to adjust Doppler setting in order to eliminate or minimize them are explained thoroughly with imaging examples in this review. Keywords: Ultrasound, Doppler ultrasound, Large vessel vasculitis, Giant cell arteritis Background Diagnosis and monitoring of large vessel vasculitis LVV are part of most rheumatology clinics.
LVV includes giant cell arteritis with and without large vessel involvement and Takayasu arteritis. A distinctive part of LVV is an increase of the intima-media vessel wall thickness, which may result in stenosis or even occlusion altering the flow profile and changing the blood velocity in the affected areas of the vessels. Several publications have highlighted the use of ultrasound for diagnosing LVV and monitoring disease activity [ 1 — 6 ] and in some institutions it has even substituted for temporal artery biopsy [ 6 , 7 ].
Some of the vasculitis features, such as increased intima-media vessel wall thickness, are diagnosed with greyscale GS ultrasound alone but Doppler ultrasound plays a role by aiding in visualising the vessel and the wall swelling and pinpointing the areas of stenosis or occlusion and, hence, the importance of changes in flow velocity and direction.
Though Doppler ultrasound is used routinely in most rheumatology departments for patients with arthritis, the Doppler settings for ultrasound in large vessels and the resulting artefacts are very different.
In arthritic joints the type of vascularization is characterised by slow flow, and the vessels of interest are invisible without the Doppler mode with minimal movement of the vessel wall during the cardiac cycle.
The type of flow in arteries affected by LVV is fast flow. Large vessels have considerable movement of the vessel wall during the cardiac cycle.
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These differences in flow for arthritis and vasculitis have an impact on the optimal Doppler settings for each. The correct interpretation of flow requires knowledge of physical and technical factors influencing the Doppler signal. Artefacts caused by physical limitations of the modality or inappropriate equipment settings may result in flow characteristics that differ considerably from the actual physiologic situation, consequently leading to misinterpretation of flow information.Indicate on the worksheet or report whether the examination was excellent, good or poor.
Keywords: Ultrasound, Doppler ultrasound, Large vessel vasculitis, Giant cell arteritis Background Diagnosis and monitoring of large vessel vasculitis LVV are part of most rheumatology clinics.
The information is clear and precise, and being in point form adds great clarity with the simple to understand instructions. The time it takes for the echo to travel back to the probe is measured and used to calculate the depth of the tissue interface causing the echo. Transforming the received signal into a digital image may be explained by using a blank spreadsheet as an analogy. Adjust TGC throughout the duration of the scan. PI is variable.
Patient surveillance There is no agreement as to how to follow the patient after a DVT is confirmed. Carotid siphon forms an S-shape curving forwards then backwards. It should be considered in young patients with hypertension from decreased renal perfusion, an aortic bruit and lower limb ischaemia.
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