A 28-year-old Japanese woman had an invasive hydatidiform mole which was diagnosed by means of transvaginal ultrasonography. After the two initial courses of systemic methotrexate (MTX) therapy given over a period of weeks, the tumor was 14 mm in diameter and the surrounding blood supply remained rich. In addition to the two initial courses of systemic MTX therapy, local ultrasound-guided injection of MTX therapy was given three times, once per week. After the local MTX treatment, the betahCG level, which had been as high as 240 ng/mL, dropped to less than 0.1 ng/mL. We then gave two additional courses of systemic MTX therapy (once per week). More than 3 years have passed since the final systemic MTX therapy, and the patient's serum betahCG levels continue to be less than 0.1 ng/mL. An invasive mole can be treated with an ultrasound-guided local injection of MTX in addition to the established systemic MTX treatment.

Vaginal bleeding is a leading cause of presentation for emergency care during the first trimester of the pregnancy. Clinical assessment of the pregnancy outcome at this stage is less reliable. US examination is crucial in establishing IUP and early pregnancy failure and to exclude other causes of bleeding, such as ectopic pregnancy and molar pregnancy. Diagnosis of a normal IUP at this stage not only assists the physician in an expectant management, but also gives a psychologic boost to the patient. With recent advances in US technology and the availability of high-frequency transvaginal transducers, reliable diagnosis of early pregnancy failure can be made even before the embryo is visible.

Ten women, referred because of a strong suspicion of gestational trophoblastic neoplasia, were examined by abdominal real-time ultrasound and color Doppler. The results were compared to those of pelvic angiography. In all but one case color Doppler examination revealed areas of increased vascularity. In all cases the findings of color Doppler and pelvic angiography agreed. Real-time ultrasound failed to detect abnormal uterine echoes in three of the patients where the other methods indicated tumor. The present study indicates that color Doppler could be of great value in a non-invasive assessment of trophoblastic tumors.

Three women with gestational trophoblastic disease were examined using transvaginal color Doppler at the initial diagnosis and after each course of chemotherapy. In all cases, the examination before chemotherapy revealed hypoechoic areas surrounded by irregular echogenic areas and numerous intramyometrial flow signals. Pulsed Doppler examination revealed a low pulsatility index (PI) in the uterine arteries. After the completion of chemotherapy, a decrease in the vascularity and increase in the PI of the uterine arteries were demonstrated in two cases. These findings were closely consistent with the decrease in serum levels of beta-human chorionic gonadotropin. However, in the patient who developed permanent arteriovenous communication, hypervascularity persisted and the PI of the uterine arteries remained low, even after clinical remission was achieved. The present study indicates that transvaginal color Doppler ultrasonography is useful for the evaluation of gestational trophoblastic disease, both at the time of diagnosis and after chemotherapy.

Color Doppler imaging was employed to assess the uteroplacental circulation in abnormal first-trimester gestations. Included in the study were 40 blighted ova, 35 missed abortions, 10 trophoblastic diseases, and 3 ectopic gestations. Normal gestations served as a control group. Flow was detected more frequently in the blighted ova than in the missed abortions. Flow was detected in all cases of trophoblastic disease and ectopic gestations. Resistance to flow was significantly lower in the trophoblastic group as compared to the other groups.

OBJECTIVE To assess the uterine hemodynamics in gestational trophoblastic tumors and to correlate them with response to chemotherapy. METHODS Using transvaginal color Doppler ultrasound, we measured the peak systolic velocity and the resistance index (RI) of the uterine arteries in 23 women with gestational trophoblastic tumors before each course of chemotherapy. Fifty-five nonpregnant women and another 15 women who had uneventful molar evacuation were enrolled as controls. Two-tailed Student t test was used for statistical analysis. RESULTS A hyperdynamic uterine circulation was noticed at diagnosis in all gestational trophoblastic tumors, manifested as higher peak systolic velocity (mean +/- standard deviation 57.5 +/- 20.4 cm/second) of the uterine arteries compared to nonpregnant (28.3 +/- 3.41 cm/second; P <.0001) and uneventful post-mole uteri (26.8 +/- 3.08 cm/second; P <.0001). The RI values of the uterine arteries in gestational trophoblastic tumors at diagnosis ranged from 0.21-0.80. However, the mean value (0.56 +/- 0.19) was lower than those of nonpregnant (0.80 +/- 0.05; P <.0001) and post-mole uteri (0.75 +/- 0.06; P <.0001). A higher pre-treatment uterine artery RI (mean 0.71 +/- 0.09) was noted in ten patients with gestational trophoblastic tumors requiring fewer than five courses of chemotherapy, compared with the mean in 13 patients requiring longer courses of treatment (0.47 +/- 0.14; P <.0001). There was a marked decrease of peak systolic velocity during the first three courses of treatment in the former group (54.2 to 23.6 cm/second; P <.001), in contrast to no change in the latter group (60.1 to 60.5 cm/second). CONCLUSION Uterine hemodynamic characteristics assessed by color Doppler ultrasound might predict and monitor the response to chemotherapy in gestational trophoblastic tumors.

BACKGROUND Destruction of uterine vasculature is a common phenomenon in gestational trophoblastic tumors. The authors categorized such uterine vasculature by color Doppler ultrasound and studied its clinical significance. METHODS Color Doppler ultrasound was performed in 28 patients with gestational trophoblastic tumors. The vascular morphologic manifestations were recorded, and the peak systolic velocity and resistance index of uterine artery were calculated. Serum beta-human chorionic gonadotropin (hCG) levels were measured periodically to monitor chemotherapy response. Seventeen uneventful postmole uteri were used as controls. Two-tailed Student's t-test and Fisher's exact test were used for statistical analysis. RESULTS The gestational trophoblastic tumors were categorized as diffuse type (N = 7), lacunar type (N = 16), and compact type (n = 5) according to their vascular patterns. The mean serum beta-hCG level at diagnosis in diffuse type lesions (6608 +/- 6320 mIU/mL) was significantly lower than in the lacunar type (40462 +/- 39735 mIU/mL; P = 0.04) and compact type (212114 +/- 205126 mIU/mL; P = 0.02), whereas the level in compact type lesions was significantly higher than in the lacunar type (P = 0.003). Lacunar type lesions exhibited a significantly lower uterine artery resistance index (0.51 +/- 0.13) than diffuse type (0.66 +/- 0.10; P = 0.03) or compact type lesions (0.70 +/- 0.06; P = 0.02). All lesions exhibited significantly higher peak systolic velocity than control subjects (P < 0.001); however, no significant difference was observed among them. Brief courses (< 5 cycles) of chemotherapy cured more diffuse type (6 of 7) than lacunar type (3 of 15, P = 0.006) or compact type lesions (0 of 5, P = 0.008). Histopathologic diagnosis was available for 11 lesions. They were invasive mole in seven lacunar type lesions and choriocarcinoma in four compact type lesions. CONCLUSION Vascular morphologic patterns of gestational trophoblastic tumors by color Doppler ultrasound correlated well with beta-hCG levels, uterine hemodynamics, chemotherapy response, and possibly the histopathologic diagnosis.

One-hundred and eleven Doppler echocardiographic examinations were performed on 88 normal fetuses, ranging from 16 to 41 weeks of gestation. Aortic and pulmonary maximal velocity (MV), acceleration time (AT), ejection time (ET), MV/AT (acceleration velocity: AV) and AT/ET ratio in systole were assessed on each blood flow velocity waveform. Aortic MV and pulmonary MV correlated well with gestational age, respectively. Good correlations between aortic AT, pulmonary AT and gestational age were evident. There were correlations between aortic AT/ET ratio, pulmonary AT/ET ratio and gestational age, respectively. However, there was no correlation between aortic AV, aortic ET, pulmonary AV, pulmonary ET and gestational age, respectively. These findings may relate to alterations in pulmonary and placental vascular resistance with advance in gestation.

Transvaginal Doppler color flow mapping was performed on 8 Japanese women (normal, 1; menopause, 2; uterine myoma, 1; endometriosis, 2; pregnant, 2). In all 8, bilateral uterine arteries and branches could be clearly identified in shades of blue and/or red. The color flows were abundant in the pregnant women. Transvaginal Doppler color flow mapping is expected to be an important diagnostic tool for assessing uterine arterial blood flows in physiologic and pathologic conditions of the pelvis.

Blood flow velocity waveforms from the umbilical artery of 126 normal fetuses with no evident complications at 20-42 weeks of gestation and 15 fetuses with various abnormalities at 25-42 weeks were recorded using pulsed Doppler ultrasound. The resistance index (RI) was assessed on each blood flow velocity waveform. In 9 fetuses with a slight abnormality, the values of RI were within the mean +/- 2 SD of normal fetuses, and the outcome was good. In 3 of 6 fetuses with a serious abnormality, the values of the RI were high, and 2 of these fetuses died in utero within a few days after the recording. Another fetus with a high RI and 3 with a normal RI died neonatally. Therefore, Doppler ultrasound assessments of the umbilical artery blood flow velocity waveform in utero aid in predicting the outcome for fetuses with major abnormalities.

Ultrasonographic examinations, done to measure the fetal transverse cerebellar diameter (FCD), were performed in 116 women with regular menstrual cycles, at 17-40 weeks of gestation. FCD correlated well with gestational age (r = 0.96, p less than 0.001). The 95% confidence interval of the linear regression was also given. FCD may be a more useful indicator of the accurate gestational age in case of dolichocephaly or brachycephaly, and facilitate antenatal detection of congenital disorders.

Real-time two-dimensional and pulsed-wave Doppler ultrasonic examinations were performed on 8 normal volunteers and 97 patients with various gynecologic disorders; the objective was to assess uterine and tumor vascularities. Each arterial blood flow velocity wave-form was classified into two types. The resistance indices of normal and abnormal flows were greater than .7 and less than .7, respectively. In normal volunteers, abnormal flows were nil. In 8 of 44 patients with benign tumors (18.2%), abnormal flows were evident and all proved to be cases of leiomyoma or adenomyosis. Doppler signals were not detected in 18 of 36 patients with cervical carcinoma (50%) and abnormal flows were noted in only 6 (16.7%). In all cases of endometrial carcinoma, ovarian carcinoma, and trophoblastic disease, typically abnormal flows were noted. Moreover, in most subjects a decrease in blood flows was observed after chemotherapy by anticancer drugs or irradiation. Therefore, Doppler ultrasound is a pertinent and noninvasive tool that can be used repeatedly for assessing the tumor vascularity in gynecologic disorders.

Blood flow velocity waveforms from the umbilical artery of 126 normal fetuses with no complications at 20-41 weeks and in 31 growth-retarded fetuses, were recorded using pulsed Doppler ultrasound. A total of 140 examinations were performed on normal fetuses and 49 on growth-retarded fetuses. The resistance index (RI) was used as an index of blood flow resistance. In 30 of the 31 growth-retarded fetuses (96.8%), the values of RI were within the mean +/- 2 S.D. of normal fetuses. Placental/fetal weight ratio (P/F ratio) was assessed. All values of P/F ratio of growth-retarded fetuses were within the mean +/- 2 S.D. of normal values. Small placentas expressed as a normal P/F ratio almost always associated with normal RI values. Therefore, measurement of RI on umbilical artery blood flow velocity waveform by Doppler ultrasound cannot serve as a valid diagnostic index to predict growth retardation of the fetus in utero.

Transrectal ultrasonographic examinations were performed on 30 patients with uterine cervical cancer to assess parametrial invasion. The findings were compared with data obtained by manual rectal examination. Forty-six parametria in 23 patients were histologically examined following surgery. Sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy of transrectal ultrasonography and rectal examination were 1.0 and 0.25 (P less than 0.05), 0.9 and 0.93, 0.5 and 0.25, 1.0 and 0.93, and 0.91 and 0.87, respectively. Therefore, transrectal ultrasonography may prove to be a useful diagnostic tool to determine the preoperative staging of uterine cervical cancer.

Ovarian arterial velocimetry, using real-time two-dimensional and pulsed Doppler ultrasound, was performed on 36 occasions in nine healthy women with regular menstrual cycles. The change in ovarian arterial compliance was based on the calculation of pulsatility index (PI). In the active ovary carrying a dominant follicle or corpus luteum, the PI in the early follicular phase (mean 6.97, SD 2.01) was significantly higher than that in the late follicular phase (mean 2.36, SD 0.31)(P less than 0.001), and the PI in the early luteal phase (mean 0.68, SD 0.09) was significantly lower than that in the late follicular phase (P less than 0.001). The PI in the late luteal phase (mean 0.93, SD 0.16) was significantly higher than that in the early luteal phase (P less than 0.01). In the inactive ovary, no cyclical changes were seen in the values of PI. There was a significant difference between the values of PI in the active ovary and the inactive ovary in the late follicular, the early and the late luteal phases [2.36 (SD 0.31)] vs [6.29 (SD 1.02)],[0.68 (SD 0.09)] vs [6.18 (SD 1.33)],[0.93 (SD 0.16) vs [6.57 (SD 1.72)](P less than 0.001), respectively. Use of non-invasive Doppler ultrasound to study physiology of ovarian haemodynamics during the menstrual cycle is of great clinical relevance and paves the way for further investigations on sterility.

BACKGROUND: Information in the literature on the hemodynamic characteristics of priapism, especially after therapeutic intervention, is very limited. We analyzed our colour Doppler ultrasound (CDU) studies performed for patients with various durations of priapism before and after therapeutic intervention. METHODS: We reviewed 52 CDU studies for 24 patients with priapism before and after treatment for the period 1997-2007. The duration of priapism ranged from 4 hours to 8 days. We performed 17 CDU studies in 8 patients who presented with a duration of priapism of 7 hours or less, 9 studies in 4 patients who presented with duration of priapism of more than 20 hours, 23 studies in 11 patients referred to us after they had failed prior therapeutic intervention at other institutions and 3 studies in 1 patient with priapism related to perineal trauma. RESULTS: Among the 8 patients who presented with a duration of priapism of 7 hours or less, CDU studies on presentation showed detectible cavernosal arterial flow in all except 1 study. Among the 4 patients who presented with a duration of more than 20 hours, the studies showed no detectible cavernosal arterial blood flow. We repeated CDU studies after therapeutic intervention, and they showed restoration of cavernosal arterial flow with relief of veno-occlusive status. Among the 11 patients in whom prior treatments failed before they were referred to us, CDU studies performed on presentation showed no detectible cavernosal arterial flow in 10 of the 11 patients. We performed 12 CDU studies in 8 patients after placing a penile cavernosa-dorsal vein (CD) shunt. We observed the presence of blood flow in the CD shunt, indicating its patency in all 8 patients. Some patients showed high cavernosal arterial flow (peak systolic velocity [PSV] up to 27.6 cm/s) after surgery. These patients appeared to have residual priapism of primarily arteriogenic status that improved after observation. CONCLUSION: After therapeutic intervention, CDU study is useful to assess the relief of arteriogenic and veno-occlusive status and the decision for further treatment.

We report the sonographic findings in a case of lymphoma, which mimicked chronic inflammation. Scrotal gray-scale sonography revealed an irregularly margined, hypoechoic mass in the right testis and epididymis. Color Doppler sonography showed increased blood flow within the hypoechoic lesions in both testis and epididymis. Pathologic examination revealed a diffuse involvement of the testis and epididymis.

OBJECTIVE: An intrauterine device (IUD) is one of the most frequently used methods of birth control around the world. Although a relationship between its use and menstrual disorders has been well documented, only a few studies have tried to show whether there are any vascular modifications. The aim of our study was to evaluate the influence of an IUD on uterine artery blood flow using Doppler assessment. METHODS: A total of 100 patients selected for IUD use were prospectively evaluated with Doppler analysis before and 30 days after insertion. The resistive index (RI) and pulsatility index (PI) were used to evaluate uterine artery vascular resistance. Patients were allocated in 2 groups according to whether they were (group 2) or were not (group 1) lactating.RESULTS: The PI and RI of the patients in groups 1 and 2 before and after IUD insertion were not statistically significantly different (P =.298 and .23). When we compared uterine artery blood flow indices before and after IUD insertion for groups 1 and 2 separately, we observed in group 1 that the mean +/- SD PI values were 2.45 +/- 0.62 and 2.55 +/- 0.55 (P =.38) and the RI values were 0.87 +/- 0.08 and 0.87 +/- 0.06 (P =.88) before and after IUD insertion, respectively. In group 2, the PI values were 2.31 +/- 0.55 and 2.37 +/- 0.69 (P =.68) and the RI values were 0.85 +/- 0.07 and 0.86 +/- 0.07 (P =.44) before and after IUD insertion. Finally, we used the mean blood flow indices of the uterine arteries of all patients to compare the effect of IUD insertion. Results were also not statistically significant when we compared PI and RI before and after IUD insertion. CONCLUSIONS: The presence of an IUD does not interfere with the vascular resistance of the uterine arteries that can be shown by Doppler flow assessments 1 month after insertion.

OBJECTIVE To detect possible changes in main blood vessels within leiomyomas after uterine artery ligation using color Doppler sonography. METHOD Blood flow in main leiomyoma blood vessels was measured before and after the procedure in 14 women who also had abnormal uterine bleeding, pelvic pain or pressure, and/or anemia. RESULTS Of the 14 patients, 13 reported complete disappearance of preoperative pain or pressure and 1 reported significant relief. Within 1 week to 4 months after uterine artery ligation, major blood flow within leiomyomas had significantly decreased in all patients. Eight months after the procedure, 1 of the women became pregnant. CONCLUSION Laparoscopic uterine artery ligation via a lateral retroperitoneal technique is a safe and effective treatment for leiomyomas. Color Doppler sonography verified the ability of the procedure to diminish blood flow within leiomyomas in all patients.

A case of placenta previa/accreta focalis was diagnosed at 29 weeks gestation in a 40 year-old patient using color Doppler ultrasound. A picture of intense blood flow within the placental sonolucent spaces, with vessels crossing from the placenta into the uterine wall was evident. A Cesarean section was performed. The macroscopic examination of the uterus during the operation revealed a focal invasion of the placental villi throughout the myometrium.

OBJECTIVE To observe the changes of endothelium-dependent dilation (EDD) of patients with congestive heart failure (CHF) before and after Kanli Decoction treatment. METHODS Thirty-five CHF patients were treated with Kanli Decoction. We used color Doppler ultrasound to monitor the flow-mediated dilation (FMD), pulsatile index (PI), resistance index (RI), baseline blood flow (BF), ejection fraction (EF) before and after the treatment. RESULTS FMD after treatment (9.26+/-3.19) were obviously higher than that before the treatment (7.06+/-2.58)(P<0.05), but BF, PI and RI were not improved. CONCLUSION Applying color Doppler ultrasound into observation on EDD of patients suffering from CHF and treated by the Kanli Decoction shows that the CHF could be treated by traditional Chinese medicine.

OBJECTIVES To study the correlation between Doppler blood flow and beta-human chorionic gonadotropin (hCG), to assess the course of the disease and the follow up evaluation. SETTING This study was conducted in Assiut University Hospital, Department of Obstetrics and Gynecology. DESIGN Longitudinal study. SUBJECTS AND METHODS Fifteen cases of vesicular mole were recruited and followed up. The patients were evaluated the day before evacuation of the uterus. This included clinical assessment, Doppler uterine artery blood flow velocity waveforms using the Doppler indices and assessment of the serum level of beta-hCG. These cases were followed up every 2 weeks in the first 2 months, and every month thereafter until the 6 month. RESULTS Twelve patients showed continuous decrease in beta-hCG level from 1192+/-697 to 6+/-11 IU/ml by the end of the second month. Systolic-diastolic (S/D) increased from (2.57+/-1.13) to (15.9+/-2.07)(P<0.0001), RI increased from 0.55+/-0.15 to 1.0+/-0.26(P<0.0001) and PI increased from 1.02+/-0.47 to 6.12+/-2.34 (P<0.0001). One patient showed a fluctuating level of beta-hCG around the same level, and two showed a slowed decrease. Doppler indices showed similar results. There is a strong correlation between beta-hCG and all Doppler indices throughout the course of follow up: beta-hCG and S/D r<0.01, beta-hCG and RI r<0.01 and beta-hCG and PI r<0.01. CONCLUSION Doppler ultrasound can be used as an adjuvant tool in the follow up of cases of vesicular mole and can predict the progress in the course of the disease.

The effects of Chinese medicines on micro-circulation and blood flow velocity in arteries of the lower limbs were observed in 33 patients with arteriosclerotic obliteration (ASO). The results showed that the integral values of micro-circulation after treatment were obviously higher than those before treatment (P < 0.05 or P < 0.01). Blood flow velocity in arteries of the lower limbs determined with the color Doppler ultrasound detecting method after treatment were also obviously higher than those before treatment (P < 0.05 or P < 0.01). In this series of 33 ASO patients, the markedly effective rate was 36.36%, and the total effective rate was 63.64%. The observation indicates that the recipe prescribed according to the principle of supplementing qi and activating blood circulation can effectively improve micro-circulation in ASO patients, and accelerate blood flow in arteries of the lower limbs.

Blood flow characteristics were measured in patients with histologically proved cervical cancer and compared to normal values. Flow parameters were derived by color and pulsed Doppler ultrasound. The results showed a significant difference in the mean values of resistance index and pulsatility index among the diseased patients and healthy controls. However, the method does not have the required sensitivity for screening purposes, so that its value may mainly be in the follow-up of patients treated conservatively with radiation and chemotherapy.

A case of placenta previa/accreta was diagnosed at 23 weeks' gestation using color Doppler ultrasound. Imaging showed an unusually intense blood flow within the placental sonolucent spaces and the hypervascularization patterns within the placental and the non-placental tissues. Highly pulsatile venous flow patterns were detected within the placental blood lakes and the subplacental venous complex. A strong association between the lacunar flow pattern and the abnormally adherent placentation was confirmed by the color Doppler sonographic findings.