Contribution of power Doppler and gray-scale ultrasound of the median nerve in evaluation of carpal tunnel syndrome

Aim of the work

To assess the role of gray-scale and power Doppler ultrasound (US) of the median nerve at the wrist in evaluating carpal tunnel syndrome (CTS).

Materials and methods

Seventy-one wrists in 51 patients with CTS in addition to 50 healthy volunteers that served as the control group were enrolled in this study. The following sonographic parameters were evaluated in both patients and controls: cross sectional area of the median nerve just proximal to the tunnel inlet (CSA1), at the pisiform bone level (CSA2), the CSA difference (ΔCSA), flattening ratio of the median nerve and bowing of the flexor retinaculum. The power Doppler US was used to assess the number of nerve vessels with estimation of the vascularity score.

Results

The ΔCSA revealed an excellent discriminative ability (AUC = 0.988) in differentiating patients with CTS at an optimal cut-off value of 3.9 mm². Intraneural hypervascularization was significantly correlated with the ΔCSA of the median nerve (P < 0.001), while not significantly correlated with the age of patients, median nerve flattening ratio and bowing of flexor retinaculum.

Conclusion

The ΔCSA and vascularity score of the median nerve are important and useful sonographic parameters in evaluation of CTS.     

A comparison of the performance of anatomical MRI and DTI in diagnosing carpal tunnel syndrome

Purpose

To compare the performance of anatomical magnetic resonance imaging (MRI) with that of diffusion tensor imaging (DTI) in the diagnosis of carpal tunnel syndrome (CTS).

Materials and methods

We performed 3T anatomical MRI and DTI on 42 patients and 42 age-matched controls. The median nerve cross-sectional area (CSA), relative median nerve signal intensity, and palmar bowing of the flexor retinaculum, assessed with anatomical MRI, and fractional anisotropy (FA) and apparent diffusion coefficient of the median nerve, assessed with DTI, were measured at four locations: the hamate level, the pisiform level (P0), the level located 1 cm proximal to the P0 level (P1), and the distal radioulnar joint level (DR). Adding the ratios and differences of the median nerve parameters between the measurements at the DR and other locations to the diagnostic parameters, we evaluated the area under the receiver operating characteristic curves (AUCs) of all the diagnostic parameters of both scans.

Results

The AUCs of FA(P1) (0.814) and FA(P0) (0.824) in DTI were larger than the largest AUC for anatomical MRI, CSA(P1) (0.759). However, the receiver operating characteristics of the three parameters were not significantly different (P > 0.1). The sensitivity and specificity of CSA(P1) (76.2% and 73.8%) and FA(P1) (73.8% and 76.2%) increased after inclusive and exclusive combination to 90.5% each.

Conclusion

The individual performances of both scans were not significantly different in diagnosing CTS. Measuring both CSA and FA at P1 may be useful and efficient to utilize the merits of both scans and to increase the CTS diagnostic performance.     

Gray scale and color Doppler sonography in the diagnosis of carpal tunnel syndrome

Purpose

To determine the diagnostic accuracy of gray scale and color Doppler sonography in the diagnosis of patients with carpal tunnel syndrome.

Patients and methods

A total of 53 wrists in 41 consecutive patients with clinical suspicion of carpal tunnel syndrome, referred from the Department of Physical medicine, Rheumatology & Rehabilitation were examined with ultrasonography using a 12 MHz linear array transducer. The presence of median nerve edema, swelling, and bowing of the flexor retinaculum was evaluated by gray scale sonography, while intraneural hypervascularity was evaluated by color Doppler sonography. Sensitivity and specificity were calculated for each sonographic feature and compared with electrodiagnostic test (EDT) results.

Results

Electrodiagnostic tests confirmed carpal tunnel syndrome in 48 wrists. A median nerve cross sectional area (CSA) of 11 mm² was calculated as a definition of median nerve swelling. In comparison with electrodiagnostic tests, median nerve swelling showed the highest accuracy (89%) among the gray scale sonographic criteria, and the presence of median nerve hypervascularization showed the highest accuracy (94%) among all sonographic criteria. Median nerve edema and bowing of the flexor retinaculum showed accuracies of 81% and 77% respectively.

Conclusion

Median nerve intraneural hypervascularity detected by color Doppler sonography is more accurate in detection of median nerve involvement than gray scale sonography criteria in patients with suspected carpal tunnel syndrome.     

Evaluation of median nerve in children with type1 diabetes using ultrasonographic imaging and electrophysiology

Background

Diabetic peripheral neuropathy (DPN) is a worldwide costly complication of diabetes.

Objective

To evaluate the relationship between the sonographically measured cross-sectional area (CSA) of the median nerve and nerve conduction study (NCS) in children with type1 diabetes (T1DM) complaining of DPN.

Material and methods

Forty children with T1DM and 20 age-matched healthy subjects were enrolled in this study. The diabetic children were divided into 2 groups (without and with DPN). All participants underwent NCS and sonographic measurement of CSA for the median nerve in the carpal tunnel.

Results

The CSA of the median nerve in children with DPN was higher than that in the control subjects yet with no significant difference with that of children without DPN. The increased median nerve CSA in the carpal tunnel was considerably correlated with the median nerve motor latency and duration of diabetes, nevertheless, with no correlation with median nerve motor conduction velocity (MNCV).

Conclusion

Sonographic measurement of CSA of the median nerve in the carpal tunnel serves as a good discriminator for diabetic children from healthy individuals. Moreover, it has significant positive correlation with duration of disease and the nerve motor latency.     

Erratum to “Sonographic findings of the median nerve and prevalence of carpal tunnel syndrome in patients with Parkinson’s disease” [Eur. J. Radiol. 67 (3) (2008) 546–550]

Purpose

Parkinson’s disease (PD) is a chronic progressive disorder which is characterized by rest tremor, akinesia or bradykinesia and rigidity. Carpal tunnel syndrome (CTS) is caused by compression of median nerve and can occur as a result of repetitive trauma. The aim of this study was to estimate the prevalence of CTS in PD and evaluate the median nerve sonographically.

Materials and methods

Fifty-three wrist of 29 patients with PD were included in the study according to Hoehn and Yahr (H&Y) clinical stage and divided into two groups. The first group consisted of 29 wrists of patients with mild PD (H&Y stage I–II). The second group consisted of 24 wrists of patients with severe PD (H&Y stage III–IV). Thirty-six wrists of 20 age-matched patients were used as control group. Both of the patients with PD and control group underwent sonography and electromyography (EMG). Axial sonograms of the median nerve were obtained at the level of distal radioulnar joint (level 1) and at the level of pisiform bone in the carpal tunnel (level 2). At each level, the cross-sectional area of the median nerve and flattening ratio were calculated.

Results

There was no significant difference for all parameters, except one parameter, between the patients with PD and control group, and also among mild and severe groups of PD and control group (p > 0.05). Interestingly, amplitude of median nerve in the second finger was significantly lower in PD patients than control group within normal limits (p = 0.010). Of all wrists of PD patients, 13 (24.4%) have been diagnosed as CTS and 7 (19.4%) control wrists had CTS. Median nerve cross-sectional area of CTS patients were more than 10 mm² in 6 (46%) wrists of PD patients but in only 1 (14%) control wrist at each level. Although it was not statistically significant, there was higher cross-sectional area at each level in patients with severe PD (level 1: 10.43 ± 2.30 mm², level 2: 10.35 ± 3.19 mm²) than patients with mild PD (level 1: 9.93 ± 2.61 mm², level 2: 9.51 ± 2.83 mm²) and control group (level 1: 9.69 ± 3.19 mm², level 2: 9.07 ± 3.61 mm²).

Conclusion

PD may pose a risk for the development of CTS due to the repetitive movement of tremor. Although sonography is not an ideal method of diagnosis for CTS, it may take our attention for indicating CTS in patients with PD especially in severe ones.     

The feasibility of using high frequency ultrasound to assess nerve ending neuropathy in patients with diabetic foot

Objectives

The nerve ending problem is one of the major causes for diabetic feet. In this work, we explored the feasibilities of using high frequency ultrasound (US) in nerve ending problem evaluation for patients with diabetic foot.

Methods

The endings of the medial branch of deep peroneal nerves (mbDPN) were interrogated by US, and the nerve conduction characters were studied in a cohort of 19 clinically diagnosed diabetic feet patients and a control group of healthy volunteers.

Results

Distinct echoic appearances were consistently detected between the mbDPN nerves of diabetic feet patients and healthy volunteers. In healthy volunteers, hypoechoic bands were readily observed at the anatomical locations of mbDPNs. However, these hypoechoic bands of the mbDPNs were not clear in the diabetic feet patients, and the surfaces of the mbDPNs appeared obscure and irregular in these patients relative to those of healthy volunteers. In addition, the US echoes of mbDPN in patients with diabetic feet were more heterogeneous than those in healthy volunteers. The mean diameters of mbDPNs were 1.3 ± 0.4 mm in patients with diabetic foot and 0.8 ± 0.2 mm in the control group (P < 0.05). Finally, results from the nerve conduction studies (NCS) showed abnormalities in patients with diabetic feet syndrome.

Conclusion

High frequency US can be a useful modality for evaluating nerve ending problems in diabetic feet patient; and the mbDPN enlargement, obscurity, surface irregularity and heterogeneity in echo can serve as the markers indicating nerve ending problems in the diabetic feet patients under ultrasound interrogation.     

The roles of the liver and pancreas in renal nutcracker syndrome

Introduction

To assess the frequency and significance of presence of the liver and pancreas at the left renal vein (LRV) level in patients with suspected renal nutcracker syndrome (NCS).

Materials and methods

We included 101 patients with hematuria who underwent urography three-dimensional CT between April 2009 and November 2013. These patients were divided into NCS (n = 25) and non-NCS (n = 76) patients according to the following CT criteria: (1) the presence of beak sign and (2) hilar-aortomesenteric left renal vein diameter ratio >4. Patients were grouped according to the presence of the liver and pancreas at the LRV: group LP (both liver and pancreas), group L (only liver), group P (only pancreas), and group O (neither liver nor pancreas). The difference in the frequencies of groups was analyzed between NCS and non-NCS patients. Multivariate analysis was used to determine the independent factors between NCS and non-NCS patients.

Results

The frequencies of group LP, group L, group P, and group O in NCS vs. non-NCS were 88% vs. 5.3% (p < 0.001), 4.0% vs. 2.6% (p = 0.75), 4.0% vs. 11.8% (p = 0.45), 4.0% vs. 80.3% (p < 0.001), respectively. Multivariate analysis demonstrated that group was a predictor for differential diagnosis between NCS and non-NCS (p = 0.022), and group LP was an independent factor for the presence of NCS (odds ratio, 43.8; 95% confidence interval, 3.8–500.3; p < 0.002; reference, group O).

Conclusion

The presence of the liver and pancreas at the level of the LRV was frequently found in NCS and was the independent factor for NCS.     

Quantitative assessment of cross-sectional area of small pulmonary vessels in patients with COPD using inspiratory and expiratory MDCT

Objectives

Structural and functional changes in pulmonary vessels are prevalent at the initial stages of chronic obstructive pulmonary disease (COPD). These vascular alterations can be assessed using cross-sectional area (CSA) of small pulmonary vessels. However, neither in non-COPD smokers nor in COPD patients it has been defined whether the structural changes of pulmonary vessels detected by paired inspiratory and expiratory CT scans are associated with emphysematous changes. We quantified the CSA and low attenuation area (LAA) and evaluated the changes in these parameters in the inspiratory and expiratory phases.

Materials and methods

Fifty consecutive non-COPD smokers and COPD patients were subjected to multi detector-row CT and the percentage of vessels with a CSA less than 5 mm² as well as the percentage LAA for total lung area (%CSA < 5, %LAA, respectively) were calculated.

Results

The %CSA < 5 correlated negatively with %LAA. The %CSA < 5 was lower in COPD patients with emphysema as compared with non-COPD smokers and COPD patients with or without mild emphysema. In addition, the %CSA < 5 was lower in the no/mild emphysema subgroup as compared with non-COPD smokers. The respiratory phase change of %CSA < 5 in COPD patients was greater than that in non-COPD smokers.

Conclusion

The percentage of small pulmonary vessels decreased as emphysematous changes increase, and this decrease was observed even in patients with no/mild emphysema. Furthermore, respiratory phase changes in CSA were higher in COPD patients than in non-COPD smokers.     

Value of renal resistive index in hepatitis C virus related liver cirrhosis and its response to midodrine

Background

Hyperdynamic circulatory state in liver cirrhosis is characterized by increased splanchnic blood flow and renal vasoconstriction.

Aim

To evaluate the relationship between renal resistive indices (RI) and HCV liver cirrhosis severity and RI value in predicting 6 month survival of those patients. Also we aimed to assess the effect of midodrine on RI.

Patients and methods

120 patients with HCV liver cirrhosis and 40 healthy controls were enrolled in the study. INR, total bilirubin, albumin, creatinine and sodium were measured in all patients. Both patients and controls underwent abdominal ultrasound with duplex Doppler examination of the kidneys with RI calculated. Patients were followed for 6 months. Surviving patients with highest risk underwent renal duplex with RI calculation (RI2). They then received oral midodrine at a dose of 7.5 mg three times daily for 3 months with revaluation of RI (RI3).

Results

57 (47.5%) patients had high RI (RI > 0.7) while 63 (52.5%) patients had normal RI. Patients had significantly higher RI than healthy controls (P < 0.001). There was a significant positive correlation between RI and MELD, MELD-Na, and Child class (r = 0.859, r = 0.769, rho = 0.56 respectively and P < 0.001). Patients with RI > 0.73 are at higher risk of death within 6 months (P < 0.001). Administration of midodrine resulted in no significant difference in RI in the 37 surviving patients with baseline RI > 0.73 (P = 0.1605).

Conclusion

RI is strongly correlated with liver cirrhosis severity and had comparable prognostic value with MELD score. Midodrine had no significant effect on RI in high risk patients.     

Colour Doppler ultrasonography evaluation of vascularization in the wrist and finger joints in rheumatoid arthritis patients and healthy subjects

Objectives

To evaluate the presence of blood flow by colour Doppler ultrasonography (CDUS) in the wrist and finger joints of rheumatoid arthritis (RA) patients and healthy subjects and to define a cut-off value of CDUS resistive index (RI).

Methods

Forty-three patients with RA and 43 healthy controls were examined by CDUS. The wrists, second and third metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were evaluated in each patient and healthy subject. Spectral Doppler analysis was performed in order to characterize the type of flow and a mean RI was measured to define a cut-off level. The area under receiver operating characteristic curve was used to evaluate the screening method's performance.

Results

Flow was detected in 219 of the 430 total joints (50.9%) of RA patients (111 in the wrists, 49 in the MCP and 30 in the PIP joints). Healthy subjects had a quantifiable flow in 45 of the 430 joints (10.5%) and, in particular, 39 (86.4%) in the wrist, 5 (11.14%) in the MCP and 1 (2.2%) in the PIP joints. The intra- and inter-reader agreements for the detection of Doppler signal were very good (kappa 0.82 and 0.89, respectively). Mean RI values were 0.72 ± 0.06 in RA patients and 0.86 ± 0.06 in healthy subjects (p < 0.01). At cut-off point of RI < 0.79 the sensitivity was 89.6% and the specificity was 78.8% (positive likelihood ratio 4.22).

Conclusion

DUS is a useful tool for the detection of abnormal blood flow in inflammatory joints of RA patients.     

The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests

Purpose

The diagnosis of carpal tunnel syndrome (CTS) is established by electrodiagnostic testing (EDT). Nonetheless, in a portion of patients complaining of the typical signs and symptoms of CTS, the EDT is negative, and yet no paraclinical tool has been acknowledged for confirming the diagnosis. The aim of this study was to investigate the value of ultrasound imaging in diagnosing clinically suspicious patients with normal EDT findings.

Materials and methods

Thirty-four patients, with clinical evidence of CTS but without abnormal findings on electromyography, and 41 healthy controls were enrolled. Ultrasonography was performed in all participants, and cross-sectional area (CSA), hypoechogenicity and hypervascularity of the median nerve were evaluated. Multivariate logistic regression analysis was used to formulate a prediction model for CTS.

Results

CSA of the median nerve in the wrist and wrist-to-forearm ratio were significantly higher in patients compared with controls. Patients had significantly higher hypoechogenicity [odds ratio (OR) 4.317; 95% confidence interval (CI) 1.23?C15.11) and hypervascularity (OR 5.004,; 95% CI 1.02?C21.15) in the median nerve. Clinical evidence of CTS was predicted using a model comprising three ultrasonographic determinant factors, including hypoechogenicity, hypervascularity and wrist CSA of the median nerve. The probability of clinical evidence of CTS in a person with one, two, or three ultrasonographic signs of CTS was estimated to be 35%, 70%, and 90%, respectively.

Conclusions

Ultrasound imaging is a useful technique in diagnosing CTS patients when EDT results are not confirmatory and the patient is suspected of having neuropathy.     

Value of Power Doppler and Gray-Scale US in the Diagnosis of Carpal Tunnel Syndrome: Contribution of Cross-Sectional Area just before the Tunnel Inlet as Compared with the Cross-Sectional Area at the Tunnel

Objective

To determine the value of gray-scale and power Doppler ultrasonography in the evaluation of carpal tunnel syndrome (CTS).

Materials and Methods

Median nerves at the carpal tunnel were evaluated by using gray-scale and power Doppler ultrasonography and by using accepted and new criteria in 42 patients with CTS (62 wrists) confirmed by electromyogram and 33 control subjects. We evaluated the cross-sectional area of the nerve just proximal to the tunnel inlet (CSAa), and at mid level (CSAb). We then calculated the percentage area increase of CSAb, and area difference (CSAb-CSAa). We measured two dimensions of the nerve at the distal level to calculate the flattening ratio. The power Doppler ultrasonography was used to assess the number of vessels, which proceeded to give a score according to the vessel number, and lastly evaluated the statistical significance by comparing the means of patients with control subjects by the Student t test for independent samples. Sensitivities and specificities were determined for sonographic characteristics mentioned above. We obtained the receiver operating characteristic (ROC) curve to assess the optimal cut-off values for the diagnosis of CTS.

Results

A statistically significant difference was found between patients and the control group for mean CSAb, area difference, percentage area increase, and flattening ratio (p < 0.001, p < 0.001, p < 0.001, p < 0.05, respectively). From the ROC curve we obtained optimal cut-off values of 11 mm² for CSAb, 3.65 for area difference, 50% for the percentage of area increase, and 2.6 for the flattening ratio. The mean number of vessels obtained by power Doppler ultrasonography from the median nerve was 1.2. We could not detect vessels from healthy volunteers. Mean CSAbs related to vascularity intensity scores were as follows: score 0: 12.3 ± 2.8 mm², score 1: 12.3 ± 3.1 mm², score 2: 14.95 ± 3.5 mm², score 3: 19.3 ± 3.8 mm². The mean PI value in vessels of the median nerve was 4.1 ± 1.

Conclusion

Gray-scale and power Doppler ultrasonography are useful in the evaluation of CTS.     

Ultrasound guided lateral femoral cutaneous nerve block in meralgia paresthesia; review of 25 cases

Aim

To evaluate the feasibility and efficacy of ultrasound guidance technique for the treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy).

Methods

25 patients (10 males and 15 females); age 17–68 years; with meralgia paresthetica are diagnosed clinically by electromyography. A needle was inserted targeting the LFCN with ultrasound guidance, treatment with perineural injection of 2 mL of methylprednisolone acetate (40 mg/mL) and 8 mL of mepivacaine, 2%, under ultrasound guidance was performed.Main outcome measurements included the technical success of the procedure, regarding relief of symptoms (pain, burning sensation, and paresthesia) and change in the quality of life.

Results

Successful nerve block of the LFC nerve was achieved in 24 patients while 1 patient remained with mild VAS after third injection which disappeared two months later. Three patients underwent one injection, 6 two injections and 16 three injections with intervening period of 2 weeks between the first and second injections and one month between the second and third.

Conclusions

Ultrasound-guided perineural injection of the LFC nerve is quick, simple, economical, and effective in treatment of meralgia paresthetica.     

The diagnostic value of small bowel wall vascularity after sulfur hexafluoride-filled microbubble injection in patients with Crohn's disease. Correlation with the therapeutic effectiveness of specific anti-inflammatory treatment

Purpose

To assess the value of small bowel wall vascularity after microbubble contrast agent injection in evaluating the therapeutic effectiveness of specific anti-inflammatory treatment in patients with Crohn's disease.

Materials and methods

Fifteen patients (7 male and 8 female; mean age ± SD, 40 years ± 6) with a biopsy-proven diagnosis of Crohn's disease – Crohn's disease activity index (CDAI) > 150 (n = 12 patients) or <150 (n = 3) – involving the terminal loop of the small bowel (wall thickness >5 mm) were included. In each patient the terminal loop was scanned by contrast-enhanced ultrasound (CEUS) after sulfur hexafluoride-filled microbubble injection before and after 6-month anti-inflammatory treatment. The vascularity of the terminal loop was quantified in gray-scale levels (0–255) by a manually drawn ROI encompassing the thickened bowel wall and it was correlated with CDAI.

Result

Before the beginning of the specific treatment all patients revealed diffuse transparietal contrast enhancement after microbubble injection, except for 3 patients who revealed contrast enhancement limited to the submucosa. In 13 patients the slope of the first ascending tract and the area under the enhancement curve were significantly lower after anti-inflammatory treatment (P < 0.05; Wilcoxon test) with a significant correlation with the CDAI score (ρ = 0.85, P < 0.05). In 2 patients no significant vascularity changes were found even though a mild reduction of CDAI score was identified (from 200 to 150 gray-scale levels).

Conclusion

CEUS is a useful method to assess the therapeutic effectiveness of specific medical anti-inflammatory treatment in patients with Crohn's disease.     

MRI evidence for preserved regulation of intracranial pressure in patients with cerebral arteriovenous malformations

Purpose

The purpose of this study was to investigate intracranial pressure and associated hemo- and hydrodynamic parameters in patients with cerebral arteriovenous malformations AVMs.

Methods

Thirty consecutive patients with arteriovenous malformations (median age 38.7 years, 27/30 previously treated with radiosurgery) and 30 age- and gender-matched healthy controls were investigated on a 3.0 T MR scanner. Nidus volume was quantified on dynamic MR angiography. Total arterial cerebral blood flow (tCBF), venous outflow as well as aqueductal and craniospinal stroke volumes were obtained using velocity-encoded cine-phase contrast MRI. Intracranial volume change during the cardiac cycle was calculated and intracranial pressure (ICP) was derived from systolic intracranial volume change (ICVC) and pulse pressure gradient.

Results

TCBF was significantly higher in AVM patients as compared to healthy controls (median 799 vs. 692 mL/min, p = 0.007). There was a trend for venous flow to be increased in both the ipsilateral internal jugular vein (IJV, 282 vs. 225 mL/min, p = 0.16), and in the contralateral IJV (322 vs. 285 mL/min, p = 0.09), but not in secondary veins. There was no significant difference in median ICP between AVM patients and control subjects (6.9 vs. 8.6 mmHg, p = 0.30) and ICP did not correlate with nidus volume in AVM patients (ρ = −0.06, p = 0.74). There was a significant positive correlation between tCBF and craniospinal CSF stroke volume (ρ = 0.69, p = 0.02).

Conclusions

The elevated cerebral blood flow in patients with AVMs is drained through an increased flow in IJVs but not secondary veins. ICP is maintained within ranges of normal and does not correlate with nidus volume.     

Feasibility of H-MR Spectroscopy in evaluation of cervical spondylotic myelopathy

Purpose

To assess the diagnostic value of magnetic resonance spectroscopy (MRS) in the evaluation of cervical spinal cord biochemical changes in patients with cervical spondylotic myelopathy (CSM).

Materials and methods

Twenty-four patients with cervical spondylotic myelopathy (patient group) and eleven age matched neurologically free volunteers (control group) underwent magnetic resonance imaging. MRS was assessed for the main metabolites including N-acetylaspartate (NAA), Choline (Cho), Creatine (Cr) and Lactate (Lac). The MRS findings of both groups were compared.

Results

Significant reduction in NAA/Cr ratio of patients with CSM (mean = 1.34 ± 0.09) in comparison to controls (mean = 1.82 ± 0.08). No significant differences in Cho/Cr ratio between both groups. Lactate peak was detected in nine patients while it was not detected in any of the controls. The difference in NAA/Cr ratio between patients with Lac peak and those without Lac peak was insignificant.

Conclusion

MRS is a promising non invasive technique that can help to evaluate metabolic changes of the cervical cord in cervical spondylotic myelopathy even in normally looking-areas.     

Evaluation of the relationship between renal function and renal volume-vascular indices using 3D power Doppler ultrasound

Purpose

To investigate the relationship between renal function and total renal volume-vascular indices using 3D power Doppler ultrasound (3DPDUS).

Materials and methods

One hundred six patients with hypertensive proteinuric nephropathy (HPN) (49 male, 57 female) and 65 healthy controls (32 male, 33 female) were evaluated prospectively using 3DPDUS. Total renal volume (RV), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated using Virtual Organ Computer-aided Analysis (VOCAL). The estimated glomerular filtration rates (GFRs) of the patients with HPN and the control group were calculated. The patients with HPN were divided into two groups on the basis of GFR, normal (≥90) or reduced (<90). Differences between groups were compared using ANOVA. Correlations between GFR, renal volume and vascular indices were analyzed using Pearson's correlation analysis. Significance was set at p < 0.05.

Results

The mean total RV, VI, FI and VFI values in the reduced GFR, normal GFR and control groups were RV (ml): 234.7, 280.7 and 294.6; VI: 17.6, 27.6 and 46.8; FI: 79.1, 88.7 and 93.9 and VFI: 7.1, 12.7 and 23.8. There were statistically significant differences between the groups (p < 0.001). Total RVs and vascular indices exhibited significant correlations with estimated GFR (r = 0.53–0.59, p < 0.001)

Conclusion

Three-dimensional power Doppler ultrasound is a reliable predictive technique in renal function analysis.     

Preoperative sonographic and Doppler parameters predictors of semen analysis improvement after unilateral varicocelectomy

Objective

To assess the sonographic and Doppler parameters predicting varicocelectomy outcome.

Methods

This study included 86 infertile patients with abnormal semen analysis. All patients had preoperative ultrasound and color Doppler to calculate testicular volume, pampiniform vein caliber and duration of reflux in the dilated veins during sustained valsalva maneuver. The patients underwent unilateral varicocelectomy and had semen analysis 6 months after operation, improvement index of the semen analysis was calculated.

Results

The patients were classified into 2 groups: Group 1: 58 patients with normal-sized testes, and group 2 included 28 patients with subnormal testes (8–12 cm³), in the first group, the patients with improvement index >0.5 were 26 (44.8%), the group with subnormal testicular volume showed improvement in 5 patients (17.8%) , the difference between the two groups was statistically significant <0.05. There was a significant positive correlation between the degree of reflux preoperatively and the improvement index (P < 0.001), also there was a positive correlation between the vein diameter and the improvement index (P = 0.03).

Conclusions

The best preoperative sonographic parameters of success of unilateral varicocele repair are the presence of normal-sized testes, high grade reflux, and to lesser degree large vein diameter.     

The MRI finding of the nerve root sedimentation sign: Its clinical validity and operative relativity for patients with lumbar spinal stenosis

Background

Lumbar spinal stenosis (LSS) is increasingly being recognised as a cause of disabling low back and lower extremities pain in adult population. Advanced spinal imaging thought as confirmation tool for the diagnosis and as preoperative tool to delineate the extent and precise location of the pathology. Nerve roots normally sediment, due to gravity, to the dorsal part of the dural sac, which was known as negative sedimentation sign. If there is MRI finding of nerve roots in the ventral part of the dural sac the sedimentation sign is positive.

Objectives

To evaluate the presence of the MRI finding of positive sedimentation sign in patients clinically suspected to have lumbar spinal stenosis and to follow up operated cases to identify the absence of the radiological signs in the operated cases.

Material and methods

70 patients clinically suspected to have lumbar spinal stenosis evaluated by MRI lumbosacral spine in supine position. A panel of two radiologists reviewed radiological data. MRI features were agreed by both radiologists in 48 patients. Out of these 48 patients; 25 were operated upon for central decompressive laminectomy, partial medial facetectomy and foraminotomy with instrumented fusion and fixation if indicated. Visual analogue score (VAS) collectively preoperative and postoperative was compared and the walking distance postoperative was reported and follow up MRI studies were done one year after the operation.

Results

Operated patients’ mean age was 58.2 years; nineteen patients were operated upon for simple decompressive laminectomy for the affected levels. Walking distance preoperative range 100–700 metres, improved postoperative to be 1474.0 ± 601.1. VAS for pain preoperative was 9.28 ± 0.84, improved at 12 month follow up to be 0.84 ± 0.62. Postoperative MRI done to evaluate the cross sectional area (CSA) became more than 80 mm² in the absence of the sedimentation sign and was negative in 22 cases.

Conclusion

The MRI finding of positive sedimentation sign is a good positive sign to rule in lumbar spinal stenosis with high specificity and sensitivity; negative sedimentation sign can be used in postoperative follow up of decompression patients.