OBJECTIVE: To investigate the clinical application of high-frequency color Doppler ultrasound (HFCDU) in detecting perforators in the deep adipose layers for harvesting super-thin anterolateral thigh flap (ALTF). METHODS: Between August 2019 and January 2023, 45 patients (46 sides) with skin and soft tissue defects in the foot and ankle were treated, including 29 males and 16 females, aged from 22 to 62 years, with an average of 46.7 years. The body mass index ranged from 19.6 to 36.2 kg/m ², with an average of 23.62 kg/m ². The causes of injury included traffic accident injury in 15 cases, heavy object crush injury in 20 cases, mechanical injury in 8 cases, heat crush injury in 1 case, and chronic infection in 1 case. There were 20 cases on the left side, 24 cases on the right side, and 1 case on both sides. After thorough debridement, the wound size ranged from 5 cm×4 cm to 17 cm×11 cm. All patients underwent free super-thin ALTF transplantation repair. HFCDU was used to detect the location of the perforators piercing the deep and superficial fascia, as well as the direction and branches of the perforators within the deep adipose layers before operation. According to the preoperative HFCDU findings, the dimensions of the super-thin ALTF ranged from 6 cm×4 cm to 18 cm×12 cm. The donor sites of the flaps were directly sutured. RESULTS: A total of 55 perforators were detected by HFCDU before operation, but 1 was not found during operation. During operation, a total of 56 perforators were found, and 2 perforators were not detected by HFCDU. The positive predictive value of HFCDU for identifying perforator vessels was 98.2%, and the sensitivity was 96.4%. Among the 54 perforators accurately located by HFCDU, the orientation of the perforators in the deep adipose layers was confirmed during operation. There were 21 perforators (38.9%) traveled laterally and inferiorly, 12 (22.2%) traveled medially and inferiorly, 14 (25.9%) traveled laterally and superiorly, 5 (9.3%) traveled medially and superiorly, and 2 (3.7%) ran almost vertically to the body surface. Among the 54 perforators accurately located by HFCDU, 35 were identified as type 1 perforators and 12 as type 2 perforators (HFCDU misidentified 7 type 2 perforators as type 1 perforators). The sensitivity of HFCDU in identifying type 1 perforators was 100%, with a positive predictive value of 83.3%. For type 2 perforators, the sensitivity was 63.2%, and the positive predictive value was 100%. The surgeries were successfully completed. The super-thin ALTF had a thickness ranging from 2 to 6 mm, with an average of 3.56 mm. All super-thin ALTF survived, however, 1 flap experienced a venous crisis at 1 day after operation, but it survived after emergency exploration and re-anastomosis of the veins; 1 flap developed venous crisis at 3 days after operation but survived after bleeding with several small incisions; 3 flaps had necrosis at the distal edge of the epidermis, which healed after undergoing dressing changes. All 45 patients were followed up 6-18 months (mean, 13.6 months). Three flaps required secondary defatting procedures, while the rest had the appropriate thickness, and the overall appearance was satisfactory. CONCLUSION Preoperative application of HFCDU to detect the perforator in the deep adipose layers can improve the success and safety of the procedure by facilitating the harvest of super-thin ALTF.
Male ; Female ; Humans ; Thigh/surgery* ; Plastic Surgery Procedures ; Prospective Studies ; Skin Transplantation ; Free Tissue Flaps ; Burns ; Soft Tissue Injuries/surgery* ; Ultrasonography, Doppler, Color ; Crush Injuries/surgery* ; Perforator Flap ; Treatment Outcome

BACKGROUND: Right ventricular (RV)-arterial uncoupling is a powerful independent predictor of prognosis in heart failure with preserved ejection fraction (HFpEF). Coronary artery disease (CAD) can contribute to the pathophysiological characteristics of HFpEF. This study aimed to evaluate the prognostic value of RV-arterial uncoupling in acute HFpEF patients with CAD. METHODS: This prospective study included 250 consecutive acute HFpEF patients with CAD. Patients were divided into RV-arterial uncoupling and coupling groups by the optimal cutoff value, based on a receiver operating characteristic curve of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP). The primary endpoint was a composite of all-cause death, recurrent ischemic events, and HF hospitalizations. RESULTS: TAPSE/PASP ≤0.43 provided good accuracy in identifying patients with RV-arterial uncoupling (area under the curve, 0.731; sensitivity, 61.4%; and specificity, 76.6%). Of the 250 patients, 150 and 100 patients could be grouped into the RV-arterial coupling (TAPSE/PASP >0.43) and uncoupling (TAPSE/PASP ≤0.43) groups, respectively. Revascularization strategies were slightly different between groups; the RV-arterial uncoupling group had a lower rate of complete revascularization (37.0% [37/100] vs . 52.7% [79/150], P <0.001) and a higher rate of no revascularization (18.0% [18/100] vs . 4.7% [7/150], P <0.001) compared to the RV-arterial coupling group. The cohort with TAPSE/PASP ≤0.43 had a significantly worse prognosis than the cohort with TAPSE/PASP >0.43. Multivariate Cox analysis showed TAPSE/PASP ≤0.43 as an independent associated factor for the primary endpoint, all-cause death, and recurrent HF hospitalization (hazard ratios [HR]: 2.21, 95% confidence interval [CI]: 1.44-3.39, P <0.001; HR: 3.32, 95% CI: 1.30-8.47, P = 0.012; and HR: 1.93, 95% CI: 1.10-3.37, P = 0.021, respectively), but not for recurrent ischemic events (HR: 1.48, 95% CI: 0.75-2.90, P = 0.257). CONCLUSION RV-arterial uncoupling, based on TAPSE/PASP, is independently associated with adverse outcomes in acute HFpEF patients with CAD.
Humans ; Prognosis ; Prospective Studies ; Stroke Volume/physiology* ; Echocardiography, Doppler/adverse effects* ; Coronary Artery Disease/complications* ; Heart Failure ; Pulmonary Artery/diagnostic imaging* ; Ventricular Function, Right/physiology* ; Ventricular Dysfunction, Right

Background: Pelvic arteriovenous malformations (AVMs) are rare but carries life-threatening consequences. Case Report: A 47-year-old multipara who had previously undergone four cesarean sections came for re-evaluation of a malignant ovarian new growth. She was asymptomatic. Repeat ultrasound revealed normal ovaries, and a cystic structure at the left adnexa with abundant mixing of colors, turbulent flow and pulsative waveforms on spectral Doppler. It arises from serpentine tubular structures from the uterine isthmus. Uterine artery aneurysm was considered. Magnetic resonance angiography confirmed the findings of aneurysm and pelvic arteriovenous malformation. The patient underwent a hysterectomy with ligation and excision of aneurysm. Histopathologic findings showed pelvic AVM and a true aneurysm of the uterine artery. Conclusion Ultrasound with color Doppler is a low-cost and readily available tool for gynecologists for the diagnosis and management of pelvic AVM.
Ultrasonography, Doppler

Background: Gestational trophoblastic neoplasia (GTN) presents as vascular mass of varying morphology on ultrasound and confirmed through quantitative serum β subunit human chorionic gonadotrophin (β‑hCG). In regions with limited access to β‑hCG, ultrasound plays a crucial role in the initial diagnosis for timely management. Objectives: This study aimed to investigate the associations between ultrasound vascular morphologic features, serum β‑hCG levels, and histopathology in GTN cases. Methodology: A cross‑sectional review was conducted on 113 cases with ultrasound impression of GTN over an 8‑year period. The patient data were extracted from case records, and ultrasound images were categorized based on the distinct features. Associations with β‑hCG levels and histopathology were analyzed using the Chi‑square test and Mann–Whitney U‑test. Statistical significance was set at P < 0.05. Results: A significant association was observed between ultrasound category and serum β‑hCG (P < 0.0001). The compact and diffuse types were more prevalent with β‑hCG levels between 104 to <105 mIU/mL, while the lacunar type was common among patients with ≥105 mIU/mL. However, there was no significant association between ultrasound categories and mean β‑hCG levels. Regarding histopathology, the lacunar type was more common in invasive moles, whereas the compact and diffuse types tended to be seen with choriocarcinoma, although these were not statistically significant (P = 0.182). Conclusions Morphologic types of GTN by gray scale and Doppler ultrasound vary across the different levels of serum β‑hCG and may suggest the histopathological diagnosis. This study provides valuable insights into the ultrasonographic characteristics of GTN, which can aid in its diagnosis and management.
Gestational Trophoblastic Disease ; Ultrasonography, Doppler

Objective: To study the diagnostic value of immediate color Doppler ultrasonography on traumatic hepatic hemorrhage after tissue sampling with ultrasound-guided liver biopsy and the clinical effect of its-directed local compression hemostasis at puncture-site. Methods: 132 hospitalized patients with various liver diseases underwent ultrasound-guided hepatic puncture-biopsies, including 61 cases with diffuse parenchymal and 71 cases with focal liver lesions. Immediate postoperative color Doppler ultrasonography was performed following liver biopsy. Abnormal blood flow signal was observed at hepatic puncture biopsy site, and if there were hemorrhagic signals, ultrasound-directed local compression hemostasis was performed until the bleeding signal disappeared. F-test and Chi-square test were used for statistical analysis. Results: Immediate color Doppler ultrasonography showed traumatic hemorrhage in 36.1% (22/61) and 40.8% (29/71) cases of diffuse liver disease and focal liver disease group, respectively. All hemorrhagic signals were eventually disappeared after ultrasound-directed local compression hemostasis. The median hemostasis time was 2 min in both groups, and there was no statistically significant difference in bleeding rate and hemostasis time between the two groups (P>0.05). There were no serious complications and deaths. Conclusion: Traumatic hepatic hemorrhage along the needle puncture tract is a common accompanying condition during liver biopsy. Immediate postoperative color Doppler ultrasonography can trace bleeding signals in timely manner and direct effective compression hemostasis, so it should be used routinely to help avoid occurrence of severe hemorrhagic complications.
Biopsy ; Hemorrhage/etiology* ; Hemostasis/physiology* ; Humans ; Liver/pathology* ; Liver Diseases/pathology* ; Ultrasonography ; Ultrasonography, Doppler, Color/adverse effects*

Placenta accreta syndrome (PAS) is rare in first-trimester abortions with an unscarred uterus. It is this rarity that makes diagnosis and management difficult and challenging. This is a case report of a multigravid with an early incomplete abortion complicated by PAS (placenta increta) manifesting as an ill-defined hypervascular uterine cavity mass on transvaginal ultrasound, with decreasing trends of serum beta-human chorionic gonadotropin. PAS was successfully diagnosed preoperatively, and an uneventful hysterectomy was performed. A curettage that could potentially lead to catastrophic hemorrhage was prevented. This case highlights the diagnostic dilemma in early trimester PAS, the importance of early accurate diagnosis, and a good correlation with ancillary diagnostics to provide prompt and appropriate management.
Pregnancy ; Placenta Accreta ; Ultrasonography, Doppler, Color

The best tip position of PICC is located in the inferior 1/3 of superior vena cava to the junction between superior vena cava and right atrium. Ensuring the best tip position of PICC is very important for the treatment of patients. In this paper, the applications of X-ray positioning, electrocardiograph, ultrasound, electrocardiograph Doppler ultrasound guidance, and electromagnetic navigation system in PICC tip positioning technology are reviewed. The future development of PICC tip positioning technology is prospected.
Catheterization, Central Venous ; Central Venous Catheters ; Electrocardiography ; Heart Atria ; Humans ; Ultrasonography, Doppler ; Vena Cava, Superior ; X-Rays

Doppler ultrasound technique. It uses an advanced clutter filter that can remove clutter artifacts and preserve the low-velocity microvascular flow signal. The potential advantages of microvascular ultrasonography are its superiority in detection and visualization of the small blood vessels in tissues, providing radiologists with more information on the vascular structures. Therefore, it has shown particular value in the clinical fields. The aim of this study was to provide microvascular ultrasonographic images for the tissue microvasculature, including the brain, thyroid gland, kidney, urinary bladder, small bowel, ovary, testis, lymph node, and hemangiomas in children, focusing on the comparison with conventional color Doppler ultrasonographic images.]]>
Artifacts ; Blood Vessels ; Brain ; Child ; Female ; Hemangioma ; Humans ; Kidney ; Lymph Nodes ; Microvessels ; Ovary ; Testis ; Thyroid Gland ; Ultrasonography ; Ultrasonography, Doppler, Color ; Urinary Bladder

ultrasonography (CEUS) in a canine osteotomy model to determine the applicability of CEUS in the assessment of neovascularization during fracture healing and to compare the vascular signals on CEUS between external skeletal fixation and cast-applied dogs. In 6 Beagle dogs, a simple transverse osteotomy was performed at the left tibial shaft and external skeletal fixation (n = 3) or a cast (n = 3) was applied. Radiography, power Doppler ultrasonography (power Doppler), and CEUS were performed until complete union was achieved. On CEUS, vascular changes were quantitatively evaluated by measuring peak intensity (PI) and time to PI in the soft tissue and callus and by counting the vascular signals. Vascular signals from the soft tissue were detected on power Doppler and CEUS on day 2. Significantly more vascular signals were detected by CEUS than by power Doppler. On CEUS, PI in the surrounding soft tissue was markedly increased after the fracture line appeared indistinctively changed on radiography in all dogs. In the cast-applied dogs, vascular signals from the periosteal and endosteal callus were detected on CEUS before mineralized callus was observed on radiography. CEUS was useful in assessing the vascularity of soft tissue and callus, particularly in indirect fracture healing, and provided indications of a normally healing fracture.]]>
Animals ; Bony Callus ; Diagnostic Imaging ; Dogs ; Fracture Fixation ; Fracture Healing ; Microbubbles ; Miners ; Muscle, Skeletal ; Osteotomy ; Perfusion ; Radiography ; Ultrasonography ; Ultrasonography, Doppler

Adult ; Asthenozoospermia/complications* ; Azoospermia/surgery* ; Humans ; Male ; Microsurgery/methods* ; Oligospermia/complications* ; Orchiectomy ; Seminoma/surgery* ; Testicular Neoplasms/surgery* ; Ultrasonography, Doppler, Color/methods* ; Urologic Surgical Procedures, Male/methods* ; Varicocele/surgery*