Jianchu Li

Evaluation of renal artery stenosis with velocity parameters of Doppler sonography.

Objective. The purpose of this study was to evaluate the accuracy of velocity parameters for the diagnosis of renal artery stenosis (RAS) with color Doppler sonography and to determine the optimal threshold values for these parameters. Methods. The study group was composed of 187 renal arteries, which were examined by color Doppler sonography and angiography. Four Doppler parameters, including the peak systolic velocities (PSVs) in the renal and interlobar arteries, the renal‐aortic ratio, and the renal‐interlobar ratio (RIR), were measured. Receiver operating characteristic curve analysis was performed to determine the optimal parameter. The sensitivity, specificity, and negative and positive predictive values at various threshold values were calculated. Results. Doppler sonographic examination was technically successful in 96% of renal arteries (180/187). The RIR was determined to be the best parameter. With threshold values of RIR greater than 5, PSV greater than 150 cm/s in the renal artery, renal‐aortic ratio greater than 2, and PSV less than 25 cm/s in the interlobar artery, the sensitivity values were 88%, 81%, 70%, and 74%, respectively. An RIR greater than 5 and PSV less than 15 cm/s in the interlobar artery provided the optimal combination of parameters, with sensitivity and specificity of 91% and 87%, respectively. Conclusions. The RIR is the best velocity parameter in the detection of RAS (≥50%), and its best cutoff is 5. Valuing influencing factors of PSV in the renal artery will help reduce misdiagnosis. The combination of RIR greater than 5 and PSV less than 15 cm/s in the interlobar artery provides the best diagnostic efficiency of RAS.

Evaluation of renal artery stenosis with hemodynamic parameters of Doppler sonography

OBJECTIVE The purpose of this study was to determine the values of the hemodynamic parameters of Doppler sonography in the diagnosis of renal artery stenosis (RAS) (diameter reduction >/=50%) and to investigate their possible influencing factors. METHODS Five Doppler parameters, including renal peak systolic velocity (RPSV), renal-aortic ratio (RAR), renal-renal ratio (RRR), renal-segmental ratio (RSR), and renal-interlobar ratio (RIR), were measured in 81 patients before arteriography. Arteries with >/=50% diameter reduction were considered stenosed at renal arteriography. Receiver operating characteristic curve analysis was performed to determine the optimal parameters. The sensitivity, specificity, positive and negative predictive values, and accuracy at various threshold values were calculated. RESULTS Sixteen accessory renal arteries (15 normal, one mild stenosis) were identified at arteriography. Of the 153 main renal arteries demonstrated at arteriography, 79 were normal or demonstrated stenosis <50%, 68 demonstrated moderate stenosis (50%-99%), and 6 demonstrated total occlusion. Doppler sonographic examination was technically successful in 91.7% (154/168) of main and accessory renal arteries. The optimal threshold values of RPSV, RAR, RRR, RSR, and RIR were 170 cm/s, 2.3, 2.0, 4.0, and 5.5, respectively. The parameters RPSV, RSR, and RIR showed good diagnostic results with accuracies equal to or greater than 88%, whereas RAR and RRR presented a sensitivity of only 76.47%. The diagnostic accuracies of RPSV, RAR, and RRR were approximately 3% higher after exclusion of the eight patients with abdominal aorta stenosis. CONCLUSION It should be feasible and necessary to measure three representative hemodynamic parameters (RAR, RPSV, and RIR or RSR) in the diagnosis of >/=50% RAS. The PSVs in the abdominal aorta and renal artery can be affected by factors other than RAS, which may decrease the accuracy of RAR. However, post-PSV ratios are minimally affected by PSV in the abdominal aorta or by an equal proportional change in PSVs in the renal artery trunk and its intrarenal renal arteries; therefore, use of post-PSV ratios dramatically overcomes some limitations of RAR.

Contrast-enhanced ultrasound study of primary hepatic angiosarcoma: a pitfall of non-enhancement.

OBJECTIVE To investigate the contrast-enhanced ultrasound (CEUS) characteristics of primary hepatic angiosarcoma (PHA). METHODS The sonographic findings and CEUS images of PHA in three patients were retrospectively analyzed. RESULTS In our study, 3 cases of PHA (2 multiple nodules and 1 solitary mass) showed similar enhancement pattern on CEUS, characterized by remarkable central non-enhancement and peripheral irregular enhancement in the arterial and portal phase, and complete wash-out in the late phase. Furthermore, we unexpectedly found that abundant neoplastic tissues were present in the central area of non-enhancement on pathological evaluation. Based on literature review, we supposed that the unusual finding may be associated with the very low velocity of blood flow in the central region of tumors. CONCLUSION CEUS could well depict PHA with some common features, which may provide valuable clues in diagnosis of this rare disease. And non-necrotic tumor tissue of PHA could also demonstrate non-enhancement on CEUS, which warrant further investigations.

Evaluation of the Tardus-Parvus Pattern in Patients With Atherosclerotic and Nonatherosclerotic Renal Artery Stenosis

The aim of this study was to evaluate the differences in the tardus‐parvus pattern between atherosclerotic and nonatherosclerotic renal artery stenosis (RAS) and to explore the causes of these differences.

Evaluation of acute renal artery thrombosis or embolism with color Doppler sonography

OBJECTIVE This study aimed to evaluate the value of color Doppler sonography (CDS) in the diagnosis of acute renal artery thrombosis or embolism (ARATE). METHODS We retrospectively reviewed the CDS findings of 10 patients with ARATE, which were confirmed by the clinical data and digital subtraction angiography or computed tomography (n=8) or by the results of surgical pathology (n=2). We analyzed the echogenicity and size of the kidneys on gray-scale images and blood flow parameters of the main renal artery, renal vein, and the intrarenal artery (segmental or interlobar artery) of the kidneys on CDS in all cases. RESULTS Four patients with acute main renal artery thrombosis (two transplanted kidneys and two native kidneys) correctly detected by CDS underwent emergency thrombolysis via renal artery. The results of CDS in six native kidneys with renal artery embolism included two cases with satisfactory CDS demonstrations, two cases with undetermined CDS findings, one case interpreted as severe renal artery stenosis, and one misdiagnosed case. CONCLUSIONS CDS is a useful imaging tool in the diagnosis of large renal infarcts caused by thrombosis or embolism in the main renal artery. However, small infarcts, which need other imaging modalities for further evaluation and confirmation, may be neglected by CDS.

Polyarteritis nodosa with multiple aneurysms and renal arteriovenous fistula successfully diagnosed by colour Doppler sonography

Polyarteritis nodosa (PAN) is a vasculitis that typically affects small- and middle-sized arteries of multiple organs. The kidney is most commonly involved. To date, few cases of PAN involving the celiac artery and no cases of iliac artery or internal carotid artery involvement have been published. The most frequent lesions reported were due to occlusions and aneurysms. Finally, no cases of PAN causing arteriovenous fistula have been reported. Here we present a case of PAN with multiple aneurysms and renal arteriovenous fistula that was successfully diagnosed and followed-up by ultrasound. This case report describes the challenges in diagnosing PAN and highlights the importance of a holistic approach when encountering patients with multiple vascular diseases. Ultrasound should be considered the first-line approach in the diagnosis of PAN.

Diagnosis of Extrarenal Arteriovenous Fistula by Color Doppler Flow Imaging

Pulsed Doppler ultrasonography has been applied to various renal vascular lesions to diagnose renal artery stenosis, renal arterial aneurysm, renal vein thrombosis, and renal arteriovenous fistula (AVF) caused by biopsy or injury. 1-10 It is useful for detecting vascular lesions noninvasively and simply. Arteriovenous fistula between major abdominal vessels is an uncommon entity that occurs usually between the abdominal aorta and the inferior vena cava. Arteriovenous fistula involving the extrarenal vessels has until recently been considered rare. Current methods of detection used for diagnosing this condition include physical examination, arteriography, intravenous digital subtraction angiography, ultrasonography, computed tomography, magnetic resonance imaging, and surgical exploration. In this report, we described a case of extrarenal renal AVF that was diagnosed on the basis of color Doppler flow imaging and confirmed by digital subtraction angiography and at surgery afterward.

Role of Superb Micro‐Vascular Imaging in the Preoperative Evaluation of Thyroid Nodules: Comparison With Power Doppler Flow Imaging

To evaluate whether Superb Micro‐Vascular Imaging (SMI; Toshiba Medical Systems Corporation, Tochigi, Japan) is superior to power Doppler flow imaging (PDFI) in depicting thyroid nodular vascularity and to primarily explore the diagnostic performance of vascularity on SMI integrated with grayscale sonographic features for diagnosis of malignant thyroid nodules.

Automated Breast Volume Scanning: Identifying 3-D Coronal Plane Imaging Features May Help Categorize Complex Cysts

The study described here sought to identify specific ultrasound (US) automated breast volume scanning (ABVS) features that distinguish benign from malignant lesions. Medical records of 750 patients with 792 breast lesions were retrospectively reviewed. Of the 750 patients, 101 with 122 cystic lesions were included in this study, and the results ABVS results were compared with biopsy pathology results. These lesions were classified into six categories based on ABVS sonographic features: type I = simple cyst; type II = clustered cyst; type III = cystic masses with thin septa; type IV = complex cyst; type V = predominantly cystic masses; and type VI = predominantly solid masses. Comparisons were conducted between the ABVS coronal plane features of the lesions and histopathology results, and the positive predictive value (PPV) was calculated for each feature. Of the 122 lesions, 90 (73.8%) were classified as benign, and 32 (26.2%) were classified as malignant. The sensitivity, specificity and accuracy associated with ABVS features for cystic lesions were 78.1%, 74.4% and 75.4%, respectively. The 11 cases (8.9%) of type I-IV cysts were all benign. Of the 22 (18.0%) type V cysts, 16 (13.1%) were benign and 6 (4.9%) were malignant. Of the 89 (72.9%) type VI cysts, 63 (51.7%) were benign and 26 (21.3%) were malignant. The typical symptoms of malignancy on ABVS include retraction (PPV = 100%, p < 0.05), hyper-echoic halos (PPV = 85.7%, p < 0.05), microcalcification (PPV = 66.7%, p < 0.05), thick walls or thick septa (PPV = 62.5%, p < 0.05), irregular shape (PPV: 51.2%, p < 0.05), indistinct margin (PPV: 48.6%, p < 0.05) and predominantly solid masses with eccentric cystic foci (PPV = 46.8%, p < 0.05). ABVS can reveal sonographic features of the lesions along the coronal plane, which may be of benefit in the detection of malignant, predominantly cystic masses and provide high clinical values.

Sonographic and Clinical Features of Papillary Thyroid Microcarcinoma Less than or Equal to Five Millimeters: A Retrospective Study.

Objective To retrospectively compare the sonographic and clinical features of papillary thyroid microcarcinoma (PTMC) ≤5 mm and PTMC >5 mm to improve the diagnostic value of ultrasonography. Methods A total of 367 cases of PTMC between January 2013 and December 2014 was included in this study. The patients were classified into group A (≤5 mm, n = 181) or group B (>5 mm, n = 186), and the sonographic and clinical features were reviewed and compared between the two groups. Results There was no significant difference in the shape, ratio of length/width, boundary, peripheral halo ring, echogenicity, cystic change and accompanying Hashimotos thyroiditis between these two groups. However, the calcification (61.3% vs. 72.6%) and hypervascularity (13.8% vs. 24.7%) were more frequent in group B (p = 0.026 and 0.008, respectively). The patients were younger, and more patients were aged less than 45 years (41.4% vs. 57.0%) in group B. Capsular invasion (7.2% vs. 34.4%), multifocality (21.5% vs. 48.9%), bilaterality (17.1% vs. 39.8%), central lymph node metastasis (13.8% vs. 38.2%) and lateral lymph node metastasis (1.1% vs. 5.4%) were more frequent in group B. No clinical or sonographic feature was related to cervical lymph node metastasis in group A, while less than 45 years in age (p = 0.010), male gender (p = 0.040), capsular invasion (p<0.001), multifocality (p = 0.016) and calcification (p = 0.042) were related to cervical lymph node metastasis in group B. Conclusions The sonographic features of PTMC ≤5 mm were similar to those of PTMC >5 mm, including an irregular shape, a length/width ratio of ≥1, an unclear boundary, no peripheral halo ring, hypoechogenicity, no cystic change, calcification, no hypervascularity and no accompanying Hashimotos thyroiditis. The clinical features of PTMC ≤5 mm were less aggressive than those of PTMC >5 mm.