Comparison of contrast-enhanced ultrasonography with grey-scale ultrasonography and contrast-enhanced computed tomography in diagnosing focal fatty liver infiltrations and focal fatty sparing.

PURPOSE: Fatty liver infiltrations and fatty sparing impair diagnostic performance of grey-scale ultrasonography in differentiating malignant and benign focal liver lesions. In the study, we present our experience in diagnosing focal fatty liver infiltrations and focal fatty sparing with contrastenhanced ultrasonography (CEUS) in comparison to grey-scale ultrasonography and contrast-enhanced computed tomography (CECT). MATERIAL AND METHOD: The retrospective study group (n=82 patients), included 44 (53.7%) men, 38 (46.3%) women (aged 29- 81 years, mean 55.8 years) with 48 focal fatty liver infiltrations and 34 focal fatty sparing. All patients underwent grey-scale ultrasonography (US), CEUS using SonoVue® and CECT executed within the 7 days. RESULTS: With US, CEUS and CECT focal fatty liver infiltrations were diagnosed in 22, 46 and 44 cases, respectively. The following values were obtained: sensitivity - 45.8%, 95.8% and 91.7%, specificity - 100% for all, accuracy - 95.2%, 99.6% and 99.3%, respectively. Focal fatty sparing was diagnosed in 16, 31 and 30 cases, respectively. The following values were obtained: sensitivity - 47.1%, 91.2% and 88.2%, specificity - 99.8%, 100% and 100%, accuracy - 95.6%, 99.4% and 99.3%, respectively. No statistically significant differences were found in sensitivity of diagnosing focal fatty liver infiltrations and focal fatty liver sparing between CEUS and CECT. Sensitivity of grey-scale ultrasonography was significantly lower when compared to those of CEUS and CECT (p<0.001). CONCLUSION: CEUS is as sensitive as CECT in focal fatty infiltrations and focal fatty sparing diagnosing. However, CEUS provides more information than CECT about the vasculature and enhancement pattern of focal fatty liver infiltrations.

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.

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.

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.

[Neuroborreliosis: CT and MRI findings in 14 cases. Preliminary communication]. / Neuroborelioza: badania obrazowe OUN (CT i MR) u 14 chorych. Doniesienie wstepne.

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.

[Color Doppler ultrasonography in diagnosis of post-traumatic optic neuropathy]. / Ultrasonografia dopplerowska z kolorowym odwzorowaniem w diagnostyce pourazowej neuropatii nerwu wzrokowego.

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.

[Variations of Doppler blood flow parameters in central retinal artery in relation to position of sample volume]. / Zmiennosc parametrów dopplerowskich przeplywu krwi w srodkowej tetnicy siatkówki w zaleznosci od miejsca pomiaru.

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]. / Parametry dopplerowskie przeplywu krwi w naczyniach krwionosnych oka u chorych na jaskre.

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.