Mobil Monitoring Doppler Ultrasound (MoMDUS) study: protocol for a prospective, observational study investigating the use of artificial intelligence and low-cost Doppler ultrasound for the automated quantification of hypertension, pre-eclampsia and fetal growth restriction in rural Guatemala.

INTRODUCTION: Undetected high-risk conditions in pregnancy are a leading cause of perinatal mortality in low-income and middle-income countries. A key contributor to adverse perinatal outcomes in these settings is limited access to high-quality screening and timely referral to care. Recently, a low-cost one-dimensional Doppler ultrasound (1-D DUS) device was developed that front-line workers in rural Guatemala used to collect quality maternal and fetal data. Further, we demonstrated with retrospective preliminary data that 1-D DUS signal could be processed using artificial intelligence and deep-learning algorithms to accurately estimate fetal gestational age, intrauterine growth and maternal blood pressure. This protocol describes a prospective observational pregnancy cohort study designed to prospectively evaluate these preliminary findings. METHODS AND ANALYSIS: This is a prospective observational cohort study conducted in rural Guatemala. In this study, we will follow pregnant women (N =700) recruited prior to 18 6/7 weeks gestation until their delivery and early postpartum period. During pregnancy, trained nurses will collect data on prenatal risk factors and obstetrical care. Every 4 weeks, the research team will collect maternal weight, blood pressure and 1-D DUS recordings of fetal heart tones. Additionally, we will conduct three serial obstetric ultrasounds to evaluate for fetal growth restriction (FGR), and one postpartum visit to record maternal blood pressure and neonatal weight and length. We will compare the test characteristics (receiver operator curves) of 1-D DUS algorithms developed by deep-learning methods to two-dimensional fetal ultrasound survey and published clinical pre-eclampsia risk prediction algorithms for predicting FGR and pre-eclampsia, respectively. ETHICS AND DISSEMINATION: Results of this study will be disseminated at scientific conferences and through peer-reviewed articles. Deidentified data sets will be made available through public repositories. The study has been approved by the institutional ethics committees of Maya Health Alliance and Emory University.

Serum macrophage stimulating protein α-chain and uterine artery Doppler ultrasound in the first trimester for the prediction of preeclampsia.

To assess how effective macrophage stimulating protein α-chain (MSP-α) combined with uterine artery Doppler is in predicting preeclampsia in singleton pregnancies during 11-13+6 weeks of gestation. This prospective observational study included singleton pregnant women who attended antenatal care at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University between December 2021 and April 2023, during 11-13+6 weeks of gestation. Serum MSP-α levels were collected and uterine artery Doppler ultrasound was performed. Pregnancy outcomes were recorded, and the predictive values of these tests were determined to predict preeclampsia. A total of 365 patients, with 21 cases of preeclampsia (5.8%), were analyzed. Serum MSP-α levels were higher in pregnant women who developed preeclampsia than those who did not (899.7 ± 550.1 ng/ml vs 642.5 ± 466.1 ng/ml, p = 0.016). The mean pulsatility index of the uterine artery and the presence of diastolic notching were not significantly different between the groups. As a cut-off value for predicting preeclampsia, using serum MSP-α levels higher than 1.0 multiple of median for gestational age, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 71.4%, 50.3%, 8.1%, and 96.7%, respectively. Additionally, when abnormal serum MSP-α levels were combined with a uterine artery Doppler pulsatility index above the 95th percentile and bilateral notching as predictive values for preeclampsia, the sensitivity was 85.7%, specificity was 18.3%, PPV was 6.0%, and NPV was 95.5%. Serum MSP-α alone at 11-13+6 weeks of gestation was effective in predicting preeclampsia. However, the use of serum MSP-α in combination with uterine artery Doppler increased sensitivity but reduced specificity for the prediction of preeclampsia.

Use of intraoperative microvascular Doppler during subinguinal microsurgical varicocelectomy in children reduces complications.

Background/Aim: This study assessed the impact of intraoperative microvascular Doppler ultrasonography (MDU) during microsurgical subinguinal varicocele correction in children. Materials and methods: Nineteen patients who underwent intraoperative MDU during subinguinal microsurgical varicocelectomy between 2021 and 2023 were included in this study. Each patient's age, varicocele side, clinical examination findings, preoperative ultrasonography results, intraoperative findings, spermatic artery counts and findings in terms of MDU use, postoperative complications, and results were evaluated. Results: All varicoceles were on the left side and the average age of the patients was 15.2 years. The indications for varicocelectomy were testicular hypotrophy (n = 10) and scrotal pain or fullness (n = 9). When a surgical microscope was used, testicular artery pulsation was detected in only five patients, whereas it was detected in all cases when MDU was used. In 16 cases, a single testicular artery was identified, and two arteries were identified in three cases. Additionally, in a case where a spermatic vein was suspected, it was not ligated due to the detection of pulsation with an arterial pattern using MDU. Two to three lymphatic channels were isolated and preserved, an average of 7.5 vessels were ligated, and five external spermatic veins were identified and ligated. There were no complications, and six of the patients with testicular hypotrophy showed signs of the catch-up growth phenomenon. Conclusion: The use of MDU during subinguinal microsurgical varicocelectomy in children not only increases the success rate but also minimizes complications such as hydrocele and recurrence.

Emergency department management of acute scrotal pain in pediatric patients.

Testicular torsion is a urologic emergency, accounting for up to 15% of cases of acute scrotal pain. Rapid recognition and management are essential to ensure viability of the testis. Doppler ultrasound can be used to confirm the diagnosis of testicular torsion; however, recent studies suggest that a more judicious use of ultrasound may be safe, decrease delays in surgical management, and avoid unnecessary utilization of resources. This issue reviews the epidemiology and historical and physical examination findings of testicular torsion and other common causes of acute scrotal pain. The existing literature is reviewed and recommendations are provided to guide the emergency clinician in appropriate management and disposition of boys with acute scrotal pain.

Dynamic mode decomposition based Doppler monitoring of de novo cavitation induced by pulsed HIFU: an in vivo feasibility study.

Pulsed high-intensity focused ultrasound (pHIFU) has the capability to induce de novo cavitation bubbles, offering potential applications for enhancing drug delivery and modulating tissue microenvironments. However, imaging and monitoring these cavitation bubbles during the treatment presents a challenge due to their transient nature immediately following pHIFU pulses. A planewave bubble Doppler technique demonstrated its potential, yet this Doppler technique used conventional clutter filter that was originally designed for blood flow imaging. Our recent study introduced a new approach employing dynamic mode decomposition (DMD) to address this in an ex vivo setting. This study demonstrates the feasibility of the application of DMD for in vivo Doppler monitoring of the cavitation bubbles in porcine liver and identifies the candidate monitoring metrics for pHIFU treatment. We propose a fully automated bubble mode identification method using k-means clustering and an image contrast-based algorithm, leading to the generation of DMD-filtered bubble images and corresponding Doppler power maps after each HIFU pulse. These power Doppler maps are then correlated with the extent of tissue damage determined by histological analysis. The results indicate that DMD-enhanced power Doppler map can effectively visualize the bubble distribution with high contrast, and the Doppler power level correlates with the severity of tissue damage by cavitation. Further, the temporal characteristics of the bubble modes, specifically the decay rates derived from DMD, provide information of the bubble dissolution rate, which are correlated with tissue damage level-slower rates imply more severe tissue damage.

Imaging and Quantification of the Hepatic Vasculature of Mice Using Ultrafast Doppler Ultrasound.

Non-invasive in vivo imaging of the vasculature is a powerful tool for studying disease mechanisms in rodents. To achieve high sensitivity imaging of the microvasculature using Doppler ultrasound methods, imaging modalities employing the concept of ultrafast imaging are preferred. By increasing the frame rate of the ultrasound scanner to thousands of frames per second, it becomes possible to improve the sensitivity of the blood flow down to 2 mm/s and to obtain functional information about the microcirculation in comparison to a sensitivity of around 1 cm/s in conventional Doppler modes. While Ultrafast Doppler ultrasound (UFUS) imaging has become adopted in neuroscience, where it can capture brain activity through neurovascular coupling, it presents greater challenges when imaging the vasculature of abdominal organs due to larger motions linked to breathing. The liver, positioned anatomically under the diaphragm, is particularly susceptible to out-of-plane movement and oscillating respiratory motion. These artifacts not only adversely affect Doppler imaging but also complicate the anatomical analysis of vascular structures and the computation of vascular parameters. Here, we present a qualitative and quantitative imaging analysis of the hepatic vasculature in mice by UFUS. We identify major anatomical vascular structures and provide graphical illustrations of the hepatic macroscopical anatomy, comparing it to an in-depth anatomical assessment of the hepatic vasculature based on Doppler readouts. Additionally, we have developed a quantification protocol for robust measurements of hepatic blood volume of the microvasculature over time. To contemplate further research, qualitative vascular analysis provides a comprehensive overview and suggests a standardized terminology for researchers working with mouse models of liver disease. Furthermore, it offers the opportunity to apply ultrasound as a non-invasive complementary method to inspect hepatic vascular defects in vivo and measure functional microvascular alterations deep within the organ before unraveling blood vessel anomalies at the micron scale levels using ex vivo staining on tissue sections.

Evaluation of vascular changes in cavernous arteries by penile doppler ultrasound in patients undergoing laparoscopic radical prostatectomy.

Patients undergoing radical prostatectomy for prostate cancer may experience erectile dysfunction (ED). Age of patients, experience of the surgeons and existence of ED before surgery are factors related to its appearance. The objective of the study was to assess the hemodynamic changes produced in the cavernous arteries in patients undergoing laparoscopic radical prostatectomy (LRP) measured with penile Doppler ultrasound (PDUS). A prospective database of 83 patients undergoing LRP was analysed. PDUS were performed at baseline and twelve months after surgery. International Index of Erectile Function (IIEF) and Erectile Hardness Score (EHS) questionnaires were also evaluated. A 12-month decrease in all hemodynamic parameters of both cavernous arteries was found except for the end diastolic velocity (EDV) on the left cavernous artery. Only changes between baseline and twelve-months mean values of the diameter (0.725 vs. 0.67 mm; p= 0.033) and peak systolic velocity (PSV) of the right cavernous artery (32.6 vs. 27.22 cm/s; p = 0.004) presented significant variations. The rest of the parameters were close to statistical significance, except for EDV of the right cavernous artery (p = 0.887). The erectile function domain of the IIEF showed a significant decrease (median at baseline: 26 vs. post-surgery: 7; p < 0.0001) as well as the EHS test (grade I at baseline: 2.4% vs. 12-months: 31.3%; p < 0.0001). Our study supports the idea that LRP produces local vascular injuries. A decrease in the PSV and in the diameter of both cavernous arteries was observed with PDUS and it may explain the vascular origin of ED.

Efficient use of penile Doppler ultrasound for investigating men with erectile dysfunction.

BACKGROUND: Vasculogenic erectile dysfunction is the most common type of erectile dysfunction, and penile Doppler ultrasound (PDUS) is a useful tool to assess erectile hemodynamics in the clinician's effort to discuss prognosis and management strategies with the patient. AIM: We herein describe the PDUS protocol used at our center, including indications, technique, and data interpretation. METHODS: We describe our institutional experience with PDUS and discuss it in the context of a contemporary review of the literature for this investigation. OUTCOME: Our institutional PDUS protocol. RESULTS: To perform PDUS properly, adequate training, equipment, setting, technique, and interpretation are critical. The accuracy of PDUS is entirely predicated on achieving complete cavernosal smooth muscle relaxation. A redosing protocol optimizes the reliability and reproducibility of the hemodynamic data acquired during PDUS. A rigidity-based assessment is performed, and patients are scanned according to the erection rigidity achieved (full hardness) or by administration of maximum dose of the vasoactive agent. Peak systolic velocity is considered a measure of arterial inflow (normal, >30 cm/s), while end diastolic velocity evaluates the veno-occlusive mechanism (normal, <5 cm/s). After the procedure, the patient is evaluated to confirm detumescence. If the patient has a persistent penetration rigidity erection, intracavernosal phenylephrine is administered; however, if detumescence is not achieved with intracavernosal phenylephrine injections alone, corporal aspiration is potentially performed. CONCLUSION: PDUS is a valuable minimally invasive tool for erectile hemodynamics assessment and an accurate assessment of such, provided that complete cavernosal smooth muscle relaxation is achieved.

Imaging light fluence in blood vessels by combining photoacoustic fluctuation imaging and ultrasound power Doppler.

Objectives.Numerous optical biomedical imaging or therapeutic modalities suffer from unknown light fluence distribution at depths. Photoacoustic (PA) imaging, which enables imaging blood vessels at the acoustic resolution, probes the product between the fluence and effective optical absorption that depends on the size or density of blood vessels. In the case of unresolved vessels, fluence and absorption can not be decoupled using PA imaging alone without the use of inverse problems. Thus, we propose combining two modalities that are sensitive to blood vessels to directly image fluence maps within vascularized areas, including in unresolved vessels.Approach.To achieve fluence imaging, the combination of photoacoustic fluctuation (PAFI) and Ultrasound Power Doppler (UPD) images is considered. After exposing a new theoretical expression of the UPD image, we establish a fluence imaging method giving quantitative fluence in blood vessels. Fluence imaging involves resolution compensation with a PSF filter that is compared to alternative simpler corrections.Main results.This method universally applies to arbitrary hematocrit and multi-scale vessel imaging. Using a spherical sparse array, we demonstrate 3D fluence imaging within blood vessels in simulation and experiments which is not possible with PAFI alone.Significance.Overall, we show that combining PAFI and UPD has the potential for real-time light dosimetry or could enhance quantitative inverse problems in PA imaging.

The Incidence and Characteristics of Pelvic-Origin Varicosities in Patients with Complex Varices Evaluated by Ultrasonography.

OBJECTIVE: The purpose of this study was to evaluate the incidence of gonadal vein refluxes associated with lower-extremity varicose veins with Doppler ultrasonography (DUS). METHOD: A total of 6279 patients with venous disease-related symptoms of the lower extremity were evaluated with DUS in the vascular lab. Gonadal vein reflux using abdominal ultrasound was further evaluated in patients with unusual varices, defined as varices in the inguinal, inner or upper thigh and the vulvar area without refluxes in the saphenofemoral junction (SPJ). Those patients who showed gonadal vein reflux were diagnosed as having pelvic-origin varicosity. RESULTS: Unusual varices were found in a total of 237 patients (3.8%), and of these patients, pelvic-origin varicosity was discovered with transabdominal ultrasound in 156 (65.8%). A total of 66.7% (n = 38/57) of unusual varix patients with pelvic pain had gonadal vein reflux. The measurement of gonadal vein diameter was larger in ultrasonography than CT scans (8.835 vs. 8.81, p < 0.001). Two patients with severe symptoms but no obstructive venous diseases were treated with gonadal vein embolization. CONCLUSION: The incidence of pelvic-origin varicosities was 2.5% (n = 156/6279). However, more than half of the patients with unusual varices had gonadal vein reflux and 24.4% of these patients also presented with pelvic pain. The evaluation of pelvic-origin varicosities should be performed in patients who present with unusual forms of varices of the lower extremity.

Noninvasive microvascular imaging in newborn rats using high-frequency ultrafast ultrasound.

Ultrasound imaging stands as the predominant modality for neonatal health assessment, with recent advancements in ultrafast Doppler (µDoppler) technology offering significant promise in fields such as neonatal brain imaging. Combining µDoppler with high-frequency ultrasound (HF-µDoppler) presents a potential efficient avenue to enhance in vivo microvascular imaging in small animals, notably newborn rats, a crucial preclinical animal model for neonatal disease and development research. It is necessary to verify the imaging performance of HF-µDoppler in preclinical trials. This study investigates the microvascular imaging capabilities of HF-µDoppler using a 30 MHz high-frequency linear array probe in newborn rats. Results demonstrate the clarity of cerebral microvascular imaging in rats aged 1 to 7 postnatal days, extending to whole-body microvascular imaging, encompassing the central nervous system, including the brain and spinal cord. In conclusion, HF-µDoppler technology emerges as a reliable imaging tool, offering a new perspective for preclinical investigations into neonatal diseases and development.

A study on the correlation of Doppler ultrasound in the diagnosis of cervical lymph nodes in patients with laryngeal and hypopharyngeal cancers: An observational study.

The objective was to assess the diagnostic efficacy of Doppler ultrasound in detecting cervical lymph nodes in patients diagnosed with laryngeal and hypopharyngeal cancers. Patients undergoing surgery for laryngeal and hypopharyngeal cancers in the Otolaryngology Department from January 2021 to January 2023 were included. Two groups, with equal numbers, underwent ultrasound examination and intensive CT examination in the experimental and control groups, respectively, along with routine cervical lymph node dissection. A resident with over 6 years of clinical experience in the otolaryngology department performed routine bilateral cervical lymph node palpation. Sensitivity, specificity, and validity were compared among different examination methods. The McNemar test assessed specificity and sensitivity between palpation, color Doppler ultrasonography, and enhanced CT, while the Kappa concordance test evaluated the concordance between the 2 examination methods. Data were statistically analyzed using SPSS 23.0. Palpation showed a diagnostic sensitivity (DS) of 52.83% and specificity of 91.11% for all patients with cervical lymph node metastasis. Ultrasonography demonstrated a DS of 77.78% and specificity of 81.82% in patients with cervical lymph node metastasis, while intensive CT had a DS of 75.86% and specificity of 60.00%. Statistical significance (P < .05) was observed in the sensitivity between palpation and ultrasonography, and between palpation and enhanced CT. The specificity between enhanced CT and ultrasonography (P = .021) and between palpation and enhanced CT scan (P = .003) both showed statistical significance (P < .05). Doppler ultrasound yields diagnostic results highly consistent with pathological diagnoses in patients with laryngeal and hypopharyngeal cancers. Utilizing Doppler ultrasound can enhance the accuracy of diagnosing these cancers, aiding physicians in devising more suitable treatment plans for patients.

Technical Note: Impact of Linear Array Transducer Doppler Aperture Location on Spectral Peak Velocity Measurements - A Phantom Study.

OBJECTIVE: Ultrasound beams sometimes need to be steered from the edge of linear array transducers to reach the sample volume with a desired Doppler angle in vascular exams. This phantom study aims to evaluate the impact of apertures located at the array edge on peak velocity (PV) measurements. METHODS: Three ultrasound scanner systems equipped with eight transducers from 3 major ultrasound vendors were tested using a flow phantom with a horizontal tube. Five spectral Doppler measurements with the aperture positioned at one edge of the array and 5 with the aperture at the center of the array were obtained using all available scanner-transducer combinations while maintaining all scan parameters and the sample volume in the same tube location. Differences in PVs between center and edge apertures were compared across 4 constant flow rates. RESULTS: The averaged PVs for all phantom flow rates ranged from 24.4 cm/s to 138.2 cm/s from the array center. The averaged PVs from the center aperture were significantly greater than the corresponding measurements from the edge aperture for each flow rate (all p < 0.001). The relative PV differences ranged from 6.7% to 19.4% across all transducers and flow rates. CONCLUSION: Significantly lower PVs were consistently shown with the Doppler beam aperture at the array edge compared to center among all tested systems. This may be due to a narrower aperture width, shifted central axis, and less intrinsic spectral broadening error at the array edge. Controlling variations in Doppler aperture location is important in clinical applications which depend on consistent velocity measurements.

Predictive value of ultrasound doppler parameters in neoadjuvant chemotherapy response of breast cancer: Prospective comparison with magnetic resonance and mammography.

BACKGROUND: Neoadjuvant chemotherapy (NACT) is a treatment option for breast cancer patients that allows for the assessment of tumor response during treatment. This information can be used to adjust treatment and improve outcomes. However, the optimal imaging modalities and parameters for assessing tumor response to NACT are not well established. METHODS: This study included 173 breast cancer patients who underwent NACT. Patients were imaged with ultrasound (US), mammography (MMG), and magnetic resonance imaging (MRI) at baseline, after two cycles of NACT, and before breast surgery. US parameters included lesion morphology, Doppler variables, and elastography measurements. MMG and MRI were evaluated for the presence of nodules and tumor dimensions. The pathological response to NACT was determined using the residual cancer burden (RCB) classification. RESULTS: The US parameter with the highest power for predicting pathological complete response (pCR) was shear wave elastography (SWE) maximum speed inside the tumor at baseline. For nonluminal tumors, the end diastolic velocity measured by US after two cycles of NACT showed the highest predictive value for pCR. Similarly, SWE maximum speed after two cycles of NACT had the highest discriminating power for predicting RCB-III in luminal tumors, while the same parameter measured at baseline was most predictive for nonluminal tumors. CONCLUSIONS: This study provides evidence that mid-treatment Doppler US and other imaging modalities can be used to predict the response to NACT in breast cancer patients. Functional parameters, such as blood flow velocities and SWE measurements, demonstrated superior predictive value for pCR, while morphological parameters had limited value. These findings have implications for personalized treatment strategies and may contribute to improved outcomes in the management of breast cancer.

Effects of the Cold Pressor Test on Popliteal Vein Diameter, Flow Velocity, and Blood Flow in the Lower Limb in 60 Healthy Individuals.

BACKGROUND In various situations such as pain, exposure to hot or cold, and mental stress, where physiological stress occurs, the increased excitatory response in the sympathetic efferent neurons leads to an increased return of blood flow from the peripheral veins to the right atrium. The cold pressor test (CPT) is based on the effects of a cold stimulus that activates afferent sensory pathways to trigger a sympathetic response, resulting in an increase in blood pressure. This study aimed to evaluate the effects of the cold pressor test on popliteal vein diameter, flow velocity, and blood flow in the lower limbs in 60 healthy individuals. MATERIAL AND METHODS We included 30 men and 30 women age 18-40 years. Baseline vein diameter, flow velocity, and blood flow of the left popliteal vein were measured by Doppler ultrasound, then the left hand was immersed in a bucket of cold water. After immersing the hand in cold water for 1 minute (CPT-1), 3 measurements of vein diameter, flow velocity, and blood flow were taken again, and their averages were calculated. RESULTS In the study, data obtained from the individuals were statistically analyzed. At CPT-1, venous diameter and flow values showed significant increase compared to baseline (P=0.001, P<0.001, respectively). CONCLUSIONS In healthy volunteers, CPT increases venous flow in the popliteal veins. However, our study did not provide evidence for the hypothesis that the increase in venous return is due to venoconstriction mechanisms.

Measurement of arterial occlusion pressure using straight and curved blood flow restriction cuffs.

Arterial occlusion pressure (AOP) is influenced by the characteristics of the cuff used to measure AOP. Doppler ultrasound was used to measure AOP of the brachial and superficial femoral arteries using straight and curved blood flow restriction cuffs in 21 males and 21 females. Vessel diameter and blood flow were evaluated as independent predictors of AOP. Overall, there were no significant differences in AOP when using the straight and curved cuffs in the brachial (129 mmHg vs. 128 mmHg) or superficial femoral artery (202 mmHg vs. 200 mmHg), respectively. Overall, AOP was greater (p < 0.05) in males than in females in the arm (135 mmHg, 123 mmHg) and leg (211 mmHg, 191 mmHg). Brachial (0.376 mm, 0.323 mm) and superficial femoral (0.547 mm, 0.486 mm) arteries were larger (p = 0.016) in males than in females, respectively. Systolic blood pressure (SBP) and arm circumference were predictive of brachial artery AOP, whereas SBP, diastolic blood pressure, thigh circumference, and vessel diameter were predictive of superficial femoral artery AOP. Straight and curved cuffs are efficacious in the measurement of AOP in the arm and leg. Differences in vessel size may contribute to sex differences in AOP but this requires further investigation.

Portal Vein Doppler Is a Sensitive Marker for Evaluating Venous Congestion in End-Stage Kidney Disease.

INTRODUCTION: Determining ultrafiltration volume in patients undergoing intermittent hemodialysis (IHD) is an essential component in the assessment and management of volume status. Venous excess ultrasound (VExUS) is a novel tool used to quantify the severity of venous congestion at the bedside. Given the high prevalence of pulmonary hypertension in patients with end-stage kidney disease (ESKD), venous Doppler could represent a useful tool to monitor decongestion in these patients. METHODS: This is a prospective observational study conducted in ESKD patients who were admitted to the hospital requiring IHD and ultrafiltration. Inferior vena cava maximum diameter (IVCd), portal vein Doppler (PVD), and hepatic vein Doppler (HVD) were performed in all patients before and after a single IHD session. RESULTS: Forty-one patients were included. The prevalence of venous congestion was 88% based on IVCd and 63% based on portal vein pulsatility fraction (PVPF). Both mean IVCd and PVPF displayed a significant improvement after ultrafiltration. The percent decrease in PVPF was significantly larger than the percent decrease in IVCd. HVD alterations did not significantly improve after ultrafiltration. CONCLUSIONS: Our study revealed a high prevalence of venous congestion in hospitalized ESKD patients undergoing hemodialysis. After a single IHD session, there was a significant improvement in both IVCd and PVPF. HVD showed no significant improvement with one IHD session. PVPF changes were more sensitive than IVCd changes during volume removal. This study suggests that, due to its rapid response to volume removal, PVD, among the various components of the VExUS grading system, could be more effective in monitoring real-time decongestion in patients undergoing IHD.

Doppler ultrasound protocol for patients with hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that leads to the formation of nodules, abscesses and fistulas, with the formation of scars and fibrosis, causing significant impairment in patient quality of life. The diagnosis is clinical, using scores to classify the severity of the condition; currently the most recommended classification is the International Hidradenitis Suppurativa Severity Scoring System (IHS4). Doppler ultrasound has been used to complement the clinical evaluation of patients with HS. It is possible to observe subclinical lesions that change the staging, the severity of the case, and its treatment, either clinical or surgical. Correct treatment is essential to minimize the consequences of this disease for the patient. OBJECTIVE: To establish an outpatient protocol for the use of Doppler ultrasound in the care of patients with HS. METHODS: A narrative review of the literature was carried out on the use of Doppler ultrasound in patients with hidradenitis suppurativa; a referring protocol and technique orientations for imaging assessment in HS were created. RESULTS: Recommendation to perform ultrasound evaluation of symptomatic areas eight weeks after using antibiotics and four, 12, and 24 weeks after starting immunobiologicals; apply SOS-HS ultrasound severity classification. STUDY LIMITATIONS: The review did not cover all literature on ultrasound and HS; no systematic review was carried out, but rather a narrative one. CONCLUSIONS: The correct assessment of patients staging must be carried out using dermatological ultrasound to avoid progression to scars and fibrosis, which compromise patients quality of life.

How much different is the semi-quantification of synovitis according to the ultrasound system and the blood flow detection technology?

AIM: To compare synovial blood flow scoring between different technologies and ultrasound (US) systems in active and inactive rheumatoid arthritis (RA). MATERIAL AND METHODS: Fifty-nine RA patients underwent B-mode, power Doppler (PD), colour Doppler (CD), B-Flow and High-Resolution (High-Res) PDI assessments of 6 joints with two US systems at two European centres. Each joint was semi-quantitatively scored for all ultrasound parameters. PD, CD and High-Res PDI synovial signal was also quantitatively scored. RESULTS: Correlations between the total score of SH with system 1 and 2 were very high (≥ 0.90, p<0.0001). Baseline correlations between systems for PD and CD total scores were moderate to very high (0.44-0.96, p<0.05). At baseline, there were no significant differences between ultrasound systems for PD or CD semiquantitative-based total scores in active or inactive patients (p>0,05). B-Flow and High-Res total scores were significantly lower than PD or CD total scores (p<0.05). CONCLUSION: A high-end and an entry-level US system were interchangeable for scoring SH and showed similar sensitivity and responsiveness in scoring synovial blood flow by PD and CD but not interchangeability. B-Flow and High-Res PDI were responsive, but they showed different sensitivity to detect synovial blood flow compared to conventional Doppler.