Tehran University Medical Journal

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This is retrospective double-blind research, which was carried out in Imam Khomeini hospital in order to study the accuracy of color Doppler ultrasonography for detecting the site and grade of stenosis in cervical carotid artery. 40 patients with mean age of 62 years studied with color Doppler before DSA angiography. The most common sites of stenosis were left internal carotid (39.5%) and right internal carotid arteries (38.4%). We measured peak systolic and end-diastolic velocities (PSA and EDV) and ratios of PSA and EDV at stenosis sites to CCA (PSV ratio and EDV ratio). Results showed that PSA has the highest sensitivity and accuracy in all grades of stenosis: Mild to moderate stenosis: Sensitivity (90.5%), accuracy (89.5%) Severe stenosis: Sensitivity (82.1%), accuracy (92.8%) Total occlusion: Sensitivity (93.8%), accuracy (96.5%). There is no difference between accuracy of Doppler parameters for detection of total occlusion (96.5%) but in other grades after PSV, EDV (Mild-moderate 86%, severe 87.2%). EDV ratio and PSV ratio (Mild-moderate both 84.8%, severe both 86%) have the highest accuracies. We concluded that color Doppler sonography can reliability detect stenosis in carotid arteries & PSV has the highest accuracy.

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Background: The purpose of our study was to assess the potential of color Doppler (CD) and Power Doppler Imaging (PDI) to differentiate benign from malignant solid breast masses.

Materials and Methods: Seventy-one biopsy proven solid breast masses were evaluated with CD and PDI using 7.5 MHZ Transducer. Vascularity, Resistive Index (RI) and patterns of vascular distribution of masses were assigned before biopsy.

Results: There were 22 cancers and 49 benign lesions. All malignant masses had vascularity in some degrees, except 3 cancers which were less than 10 mm in diameter. Most of cancers were hypervascular (15 cancers) and had penetrating or diffuse vessels (14 cancers). Most of benign lesions and fibro adenomas were avascular (35 masses). 12 cancers, 2 fibro adenomas and all vascular benign lesions had RI>0.6. 7 cancers and 6 fibro adenomas had RI<0.6. By using hypervascularity to indicate malignancy sensitivity for CD and PDI was 68 percent and specificity was 90 percent and by using penetrating and diffuse vessels sensitivity was 64 percent and specificity was 82 percent. By using RI<0.6 sensitivity was 32 percent and specificity was 88 percent and by using these three criteria together sensitivity was 73 percent and specificity was 82 percent (P<0.00001).

Conclusion: The vascularity and pattern of distribution and morphology of blood vessels in solid breast masses seen at PDI and CD is a potentially important feature to predict the likelihood of malignancy. But RI appears to be of limited value.

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Background: Cirrhosis and portal hypertension influence the hepatic circulation. The purpose of this study was to evaluate the diagnostic accuracy of liver Doppler ultrasonography parameters in cirrhosis.

Methods: This case-control study involved 118 subjects. All case subjects had biopsy-proven hepatic cirrhosis. The controls were healthy people, case-matched for age and gender. All cases and controls underwent Doppler ultrasonographic evaluation. We compared the area under the ROC curve of each parameter for cases vs. controls using Fisher's exact test, with p <0.5 indicating significance.

Results: The means of the following parameters for case vs. control subjects were: frequency of portal venous flow inversion, portal vein diameter 12.67±2.72 vs. 10.59±1.69, and hepatic arterial resistance index 0.81±0.07 vs. 0.74±0.09. The mean hepatic artery pulsatility index (1.87±0.48 vs. 1.34±0.23), was significantly higher among the case subjects (P=0.001). The maximum flow rate of the portal vein was also significantly lower in the case subjects (16.50±5.59 vs. 36.74±8.74 cm/s, P=0.001). We did not observe significant differences in the means of the hepatic artery maximum flow rate and end-diastolic flow rate. For diagnosing cirrhosis, the application of 24.1 cm/s as the cutoff point for the portal vein maximum flow rate, we obtain an accuracy of 95.45% (91.23%-97.70%, CI=95%), whereas a cutoff point of 1.54 or more for the hepatic artery pulsatility index yields an accuracy of 85.71% (79.48%-90.29%, CI=95%). Utilizing a hepatic arterial resistance index of 0.765 or greater is associated with an accuracy of 71.05% (62.81%-78.11%, CI=95%) in diagnosing cirrhosis.

Conclusions: Doppler ultrasonography and assessment of hepatic artery and portal vein parameters are accurate methods in the diagnosis of cirrhosis.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: The prevalence of Rh alloimmunization has decreased following the use of anti-D immunoglobulin. With serial amniocentesis, Doppler sonography of the middle cerebral artery and treatment of anemia with intrauterine blood transfusion, perinatal mortality has declined. However, Rh alloimmunization in twin pregnancies poses a diagnostic and therapeutic challenge.
Case report: We are reporting, for the first time in Iran, the successful treatment of severe Rh alloimmunization in a dichorionic- diamnionic twin pregnancy leading to the live births of both neonates. Before treatment, the fetal hemoglobin levels were 3.1g/dL and 3.9g/dL, with ascites in both fetuses. The fetuses were treated with several IUTs.
Results: After treatment, the neonates were delivered, weighing 2200 and 2300g, with good Apgar scores, at a gestational age of 34 weeks.
Conclusion: 10% of population in Iran is Rh-negative, although Prophylaxis for Rh alloimmunization is universal, as other part of the world it cannot irrigated. For the best management of these cases, we need a well-equipped referral center.

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Duplex Doppler ultrasonography (US) has newly suggested, being an important diagnostic technique in the non-invasive evaluation of hepatic vasculature and some hepatic parenchymal diseases. New findings suggest that diffuse fatty infiltration of liver can alter normal hepatic vein and artery doppler indices. The following study has been performed to evaluate the effect of fatty infiltration on hepatic artery resistance index and hepatic vein waveform patterns.
Methods: Sixty patients with various degrees of fatty infiltration on liver biopsy and twenty normal subjects without any sign of hepatic fat infiltration in ultrasonography examined using standard colour and spectral doppler sonography. The waveforms of Hepatic Vein were classified into three groups: regular triphasic waveform, biphasic waveform without a reverse flow, and monophasic or flat waveform. The hepatic artery resistance index was calculated as the mean of three different measurements.
Results: The mean BMI in Nonalcoholic fatty liver disease group and normal subjects was 26.9(SD=3.3) and 22.4(SD=1.7) Kg/m², respectively with a range of 22 up to 44 Kg/m². Abnormal Hepatic Vein waveforms (biphasic and monophasic) were found more frequently in doppler sonography (p<0.001) in patients with Nonalcoholic fatty liver disease (12 biphasic and 17 monophasic) compared to normal subjects. Hepatic artery resistance index was significantly lower in Nonalcoholic fatty liver disease patients [0.7(SD=0.1)] compared to normal ones [0.8(SD=0.0)] (p<0.001).
Conclusions: The incidence of abnormal hepatic vein waveforms is significantly higher in patients with fatty infiltration compared to those who had no abnormality in liver ultrasonography and these patients had a significant lower hepatic artery resistance index. supportFields]> ADDIN EN.CITE  ADDIN EN.CITE.DATA l> 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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: It is a well known fact that language functions are primarily related to the left hemisphere in right handed individuals, there is still no agreement about hemispheric language dominance in left handers. The aim of this study is to evaluate the possibility of using functional Transcranial Doppler ultra sonography (TCD), as a non-invasive method for investigation of hemispheric language dominance and also to explore possible gender influence on hemispheric language representation.
Methods: We performed functional TCD during a word generation task, in 62 healthy volunteers (30 right handers and 32 left handers, 50% male and 50% female). All subjects were medical students in the age range of 22-29 years. Right or left handedness was determined using Edinburgh questionnaire. Two subjects were excluded from the study because of poor temporal windows. Mean blood flow velocity was measured in both right and left middle cerebral arteries (MCA) at rest and during a word generation task, and changes in flow velocities were compared.

Results: Increase of MCA blood flow velocity was observed in 55% (33 subjects) of the students in the left side, and in 45% (27 subjects) of them in the right side. Right hemispheric dominance was observed in 43.3% of right handers and 46.7% of left handers. Left hemispheric dominance was observed in 56.7% of right handers and 53.3% of left handers. Our results showed no significant right hemispheric language dominance in left handed subjects.
Conclusion: This study does not show significant difference in hemispheric language dominance between right and left handers, using functional TCD

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Background: Estimation of Left Ventricular End Diastolic Pressure (LVEDP) among patients with Mitral Stenosis (MS) helps to diagnose diastolic dysfunction and to explain their symptoms. However, Conventional Doppler measurements have limitation in predicting of LVEDP. This study sought to establish whether the correlation between measurements derived from Tissue Doppler echocardiography and LVEDP remains valid in the setting of severe mitral stenosis.

Methods: Thirty three patients with moderate to severe MS who had indication for left heart catheterization enrolled during 1387-88 in Imam Khomeini Hospital in Tehran, Iran. The mean diastolic transmitral pressure gradient and mitral valve area (MVA) were calculated, and Two-dimensional, M-mode, color Doppler and tissue Doppler Imaging indices such as: early diastolic mitral inflow velocity (E), annular early diastolic velocity (Ea), E/A ratio, Isovolemic relaxation time (IVRT), Pulmonary Vein systolic and diastolic flow velocities, Velocity Propagation, LA size, TE-Ea, Tei Index were obtained in maximum three hours before cardiac catheterization. The echocardiography analysis was performed offline without knowledge of hemodynamic data Linear correlation and multiple linear regression were used for analysis. p< 0.05 was considered significant.

Results: In univariate analysis, E/Ea was associated with LVEDP significantly (p = 0.04, r = 0.38). There was also a significant correlation between TE-Ea and LVDP (p = 0.01, r = -0.44). In multiple linear regression Tei Index (ß = 0.4, p< 0.02), and TE-Ea (ß = 0.5, p = 0.02) were showed as independent predictors of LVEDP (R2 = 49%).

Conclusion: Although we observed a moderate correlation between Doppler measurements and LVEDP in patients with severe MS, more similar studies are required.

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Background: Nonalcoholic Fatty Liver Disease (NAFLD) is one of the most wide-spread human diseases that can impair liver function and sometimes progresses to cir-rhosis. Recently NAFLD has been identified as an independent risk factor for cardio-vascular disease. The aim of this study was to investigate the correlation of fatty liver disease and its sonographic severity on the resistance of the intracranial arteries. Methods: This study was a cross-sectional study of 55 patients referred from Gastroen-trology clinic with diagnosis of NAFLD to Sonodoppler department of Iranian Center of Neurological Research. Pulsaltile index as a Hemodynamic parameter of Middle Cerebral (MCA) and basilar Arteries of NAFLD Patients was measured by Trans Cra-nial Doppler (TCD) sonography and the measurements were compared with normal values. Also the association of these indices with serum liver enzymes and sonographic grading of liver involvement was assessed. The analysis was done by SPSS 16. Fre-quency distribution, mean and standard deviation were used in descriptive analysis and statistical test 2 to compare qualitative variables. Results: Pulsatile Index (PI) were normal (MCA, P= 0.166, Basilar, P= 0.053) and there was no significant difference with relation to severity of fatty liver based on so-nography findings (P= 0.789), but serum liver enzyme levels were inversely correlated with basilar artery PI (P= 0.014). Conclusion: Considering the increase of cerebral arteries PI in advanced liver disease, absence of increase in vascular PI of patients in the present study could be attributed to the short duration of disease from diagnosis to perform TCD, lack of advanced liver involvement (absence of liver dysfunction) and the response effect to treatment before the TCD. Therefore, to assess vascular changes over time, repeating the TCD with assess other parameters such as Fibroscan and K18 factor that has more compatibility of liver function, could help to understand the pathophysiology of liver diseases and its effect on vascular resistance.

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