Diagnostic efficacy of SonoVue, a second generation contrast agent, in the assessment of extracranial carotid or peripheral arteries using colour and spectral Doppler ultrasound: a multicentre study.

The purpose of this study was to demonstrate the improvement in diagnostic quality and diagnostic accuracy of SonoVue microbubble contrast-enhanced ultrasound (CE-US) versus unenhanced ultrasound imaging during the investigation of extracranial carotid or peripheral arteries. 82 patients with suspected extracranial carotid or peripheral arterial disease received four SonoVue doses (0.3 ml, 0.6 ml, 1.2 ml and 2.4 ml) with Doppler ultrasound performed before and following each dose. Diagnostic quality of the CE-US examinations was evaluated off-site for duration of clinically useful contrast enhancement, artefact effects and percentage of examinations converted from non-diagnostic to diagnostic. Accuracy, sensitivity and specificity were assessed as agreement of CE-US diagnosis evaluated by an independent panel of experts with reference standard modality. The median duration of clinically useful signal enhancement significantly increased with increasing SonoVue doses (p< or =0.002). At the dose of 2.4 ml of SonoVue, diagnostic quality evaluated as number of inconclusive examinations significantly improved, falling from 40.7% at baseline down to 5.1%. Furthermore, SonoVue significantly (p<0.01) increased the accuracy, sensitivity and specificity of assessment of disease compared with baseline ultrasound. SonoVue increases the diagnostic quality of Doppler images and improves the accuracy of both spectral and colour Doppler examinations of extracranial carotid or peripheral arterial disease.

Investigation of peripheral arterial disease--the expanding role of echo-enhanced color flow doppler and duplex sonography.

Contrast angiography is widely regarded as the gold standard investigation in peripheral artery disease (PAD). It produces images that are diagnostically valuable, but is limited by its inability to image the vessel walls or the dynamics of blood flow in the lumen. Color duplex sonography is increasingly used in PAD to replace or pre-empt angiography. It is a simple non-invasive technique that gives information about both structural and dynamic anomalies in the peripheral arteries, with an accuracy close to that of angiography. Certain situations are difficult to visualize using this technique. Arteries that are deep-lying, calcified, obscured by fat or bowel gas, or that contain low-velocity blood flow, will generate sub-optimal scans due to inadequate returning signal strength. This can be corrected by the use of microbubble echo-enhancing agents, which increase the strength of the returning signal, generating a clear image from which a diagnosis can be made. Results of multicenter studies of echo-enhanced color duplex sonography in PAD are reviewed and the impact of the technique on the diagnostic work-up of PAD is assessed.

Colour coded duplex sonography in ischemic finger artery disease--a comparison with hand arteriography.

BACKGROUND: A reliable non-invasive diagnostic procedure is desirable to exclude arterial pathology in patients with pain in their fingers. PATIENTS AND METHODS: The results of colour coded duplex sonography (CCDS) in 450 finger arteries (45 hands/41 patients) were compared with findings obtained by intra-arterial digital subtraction arteriography (i.a.-DSA). The population consisted of symptomatic patients with a high risk for finger artery pathologies. RESULTS: Arteriography of the hand documented finger artery occlusion in 35.6% of these patients. CCDS is capable of detecting pathological alterations in finger arteries with high accuracy and can differentiate them from regular arteries. In patients with several diseases of the finger arteries, the ultrasound diagnosis concurred with arteriography in 93.1% of patent arteries. In patients with occluded arteries the accuracy of CCDS was 86.3%. CONCLUSION: When assessing diseases of finger arteries non-invasive CCDS should be used routinely before referring the patient to arteriography. The latter is only indicated when there is a need to image the whole arterial trunk of the upper extremity or the hand, or in case of equivocal results of CCDS.

[Color-coded duplex ultrasound of lower leg arteries--image reliability with reference to Fontaine stages]. / Farbkodierte Duplexsonographie von Unterschenkelarterien--Darstellbarkeit in Zuordnung zu Fontainestadien.

We examined the accuracy of colour flow detection of lower limb arteries in relation to Fontaine's criteria of obstructed peripheral circulation. Assessments were conducted in relation to stages I and II as well as to stages III and IV and compared to the corresponding i. a.-DSA: On comparing the total of all ultrasound results in stages (I-IV) with those of arteriography (92 calf arteries) we found a sensitivity between 80 and 90% and a specificity between 90 and 97%. Results did not differ from these values in the subgroups Fontaine II-IV. Especially in the stages III/IV in comparison to stage II we could not find any disadvantages of colour coded vessel imaging. With sufficient reliability we succeeded in demonstrating calf arteries in endangiitis (Bürger's disease) and in diabetics with mediasclerosis.

[Pulsatile flow model with elastic blood vessels for duplex ultrasound studies]. / Pulsatiles Strömungsmodell mit elastischen Gefässen für duplexsonographische Untersuchungen.

Using ultrasound duplex technique flow phenomena in patients' circulation can be examined. For the interpretation of these examinations it is necessary to have extensive knowledge on flow influencing parameters. This can be easily obtained from simplified flow models. This article describes the components of a flow model that allows examination of ultrasonic contrast media flowing through an artificial heart and vessel mimicking tubes. The artificial heart is the drive which pumps a water glycerol cellulose mixture through the circulation in a pulsatile manner. The shape of the ventricle, the compliance of the aorta, the viscosity of the flow medium and the wall elasticity of the examination vessel were taken into account. The attenuation caused by the surrounding tissue is simulated by a variable layer of castor oil. The flow model is suitable to produce flow profiles that are very similar to physiological profiles.

[Sonographic diagnosis of deep pelvic/leg venous thrombosis: is color-coded Duplex sonography "superfluous"?]. / Sonographische Diagnose der tiefen Becken-/Beinvenenthrombose: Ist die farbkodierte Duplexsonographie "überflüssig"?

In the diagnosis of deep vein thrombosis compression B-mode sonography and colour coded Duplex-sonography both are reported to give excellent results in sensitivity and specificity in comparison to phlebography. Therefore value and cost effectiveness of colour coded Duplex-sonography versus compression B-mode sonography are questionable. In our examinations with colour coded Duplex-scanning done one 116 patients in comparison to phlebography we achieved corresponding results to the values of present publications (sensitivity in the leg was 100%, in the calf 89%; specificity in the leg was 94%, in the calf 91%). In earlier examinations with compression B-mode sonography done on 64 patients we were less successful in gaining these results in comparison to phlebography: sensitivity was 76% and specificity was 88% in the iliaco-, femoro-, popliteal region. We discuss the limitations of the compression test in our experiences and point out the advantages of colour coding under special situations.

[Mucoid cystic adventitial degeneration of the popliteal artery with simultaneous arteriosclerosis]. / Mukoid-zystische Adventitiadegeneration der Arteria poplitea bei gleichzeitiger Arteriosklerose.

A 56-year-old male patient presented with intermittent claudication due to cystic adventitial degeneration of the popliteal artery. In addition independent symptomatic arteriosclerotic alterations of several arteries distal and proximal of the popliteal artery were detected. The etiologic, diagnostic and differential-diagnostic aspects in general and the therapeutic implications of this uncommon case are discussed.