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pulsed wave Doppler ultrasound pulsed Doppler ultrasound [keywords]
- Ultrasound physics. [Journal Article]
- Crit Care Clin 2014 Jan; 30(1):1-24.
Bedside ultrasound has become an important modality for obtaining critical information in the acute care of patients. It is important to understand the physics of ultrasound in order to perform and interpret images at the bedside. The physics of both continuous wave and pulsed wave sound underlies diagnostic ultrasound. The instrumentation, including transducers and image processing, is important in the acquisition of appropriate sonographic images. Understanding how these concepts interplay with each other enables practitioners to obtain the best possible images.
- Evaluation of effects of Extracorporeal Shock Wave Lithotripsy on renal vasculature with Doppler ultrasonography. [Journal Article]
- Med Ultrason 2013 Dec; 15(4):273-7.
In this prospective study, we aimed to demonstrate the effects of Extracorporeal Shock Wave Lithotripsy (ESWL) on renal blood flow in patients treated for renal/ ureteral stones.The study group comprised 41 patients (26 males, 15 females, aged between 18-63 years, mean age 45 years), 23 with renal and 18 with ureteral stones, who underwent ESWL between March 2010 and January 2011. Colour Doppler ultrasonography and pulsed wave spectral analysis was performed before, 1 hour, and 7 days after ESWL to both ipsilateral and contralateral kidneys in order to measure resistive index (RI), pulsatility index (PI) and acceleration time (AT) values.One hour after ESWL, RI and PI values showed significant increase from pre-ESWL values in both ipsilateral and contralateral kidneys. However, no significant change was found in AT values. Seven days after ESWL, PI in both ipsilateral and contralateral kidneys and RI in contralateral kidney returned to pre-ESWL values. But, 7 days after ESWL, RI in the ipsilateral kidney did not return to pre-ESWL values, although decrease in RI values were observed. CONCLUSİON: Spectral Doppler analysis can provide valuable information as a non-invasive method to assess the hemodynamic changes and renal microcirculation status in cases managed with ESWL.
- Are Levels of NT-proBNP and SDMA Useful to Determine Diastolic Dysfunction in Chronic Kidney Disease and Renal Transplant Patients? [Journal Article]
- J Clin Lab Anal 2013 Nov; 27(6):461-70.
The aim of the study was to determine the clinical usefulness of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and symmetric dimethylarginine (SDMA) for detection of renal and left ventricular (LV) diastolic dysfunction in chronic kidney disease (CKD) patients and renal transplant (RT) recipients.We included 98 CKD and 44 RT patients. We assessed LV function using pulsed-wave Doppler ultrasound. Diastolic dysfunction was defined when the E:A ratio was <1.Independent predictors of NT-proBNP levels were age, creatinine, and albumin in CKD patients and age and urea in RT patients. Determinants of SDMA in CKD patients were glomerular filtration rate (GFR) and NT-proBNP and creatinine in RT patients. In RT patients with diastolic dysfunction, NT-proBNP and SDMA were significantly higher than in patients without diastolic dysfunction (F = 7.478, P < 0.011; F = 2.631, P < 0.017). After adjustment for GFR, the differences were not seen. In CKD patients adjusted NT-proBNP and SDMA values for GFR were not significantly higher in patients with diastolic dysfunction than in patients without diastolic dysfunction.NT-proBNP is useful for detection of LV diastolic dysfunction in RT recipients. When evaluating both NT-proBNP and SDMA it is necessary to consider GFR as a confounding factor.
- Uterine artery Doppler study in second trimester of pregnancy. [Journal Article]
- Pan Afr Med J 2013.:87.
The uterine artery Doppler has potentials for screening for complications of impaired placentation. This study examines the indices of uterine artery impedance at 22-23 weeks gestation and their relationship with maternal age and parity.Uterine artery colour imaging and pulsed wave Doppler ultrasound was conducted between 22nd and 23rd weeks in 430 pregnancies. The pregnancies were classified into 2 groups: normal and abnormal outcomes. The indices of impedance recorded were pulsatility index, resistance index and the systolic/diastolic ratio. Relevant obstetric information was retrieved from the antenatal records. The student t- test and Pearson's product moment were used for statistical analysis.Fifty eight (13.5%) out of 430 pregnancies had complications of impaired placentation, mainly intrauterine growth restriction and preterm birth (24 or 41.4% each). The indices in normal pregnancies were similar to presently used values. There was no statistically significant difference in the 2 pregnancies groups. The Pulsatility Index (PI) in the right uterine artery was statistically different from the left (t-test 32.8, p < 0.05). Maternal age and parity demonstrate statistically significant positive correlation with PI (r =0.9, p < 0.05; r =0.8, p < 0.05).The indices in normal pregnancies were similar to values from previous studies. The values are however not significantly different in pregnancies with abnormal outcome.
- Investigation of endothelial dysfunction and arterial stiffness in children with type 1 diabetes mellitus and the association with diastolic dysfunction. [JOURNAL ARTICLE]
- Diab Vasc Dis Res 2013 Oct 29.
Objective:The objective of this study is to investigate endothelial dysfunction (ED) and arterial stiffness (AS) and determine the association with diastolic dysfunction in children with type 1 diabetes mellitus (DM).Methods:A total of 42 patients without diabetic complications (mean age: 13.21 years) and 40 healthy (mean age: 13.07 years) children were included in this study. AS was assessed with ascending aorta M-mode measurements, diastolic dysfunction with pulsed wave (PW) Doppler and tissue Doppler echocardiography measurements and flow-mediated dilatation (FMD) and carotid intima-media thickness (CIMT) with high-resolution ultrasonography.Results:Results of diabetic group and healthy children were compared. In diabetic group, aortic strain (8.40 ± 2.98, 20.12 ± 5.04; p < 0.001), aortic distensibility (7.36 ± 2.92, 16.59 ± 4.25; p < 0.001) and FMD% (7.70 ± 2.83, 11.33 ± 2.85; p < 0.001) were found decreased, and CIMT (0.52 ± 0.09 mm, 0.47 ± 0.08 mm; p < 0.05) was found increased. Additionally, left ventricular lateral segment and right ventricular free-wall isovolumic relaxation time (IVRT) and myocardial performance index (MPI) were found increased. Correlation analyses demonstrated a negative correlation between FMD and IVRT and MPI.Conclusions:ED and AS were found in type 1 DM patients without diabetic complications. Additionally, correlation was shown between increased AS and ED and right and left ventricular diastolic dysfunctions.
- CLOTBUST-Hands Free: Pilot Safety Study of a Novel Operator-Independent Ultrasound Device in Patients With Acute Ischemic Stroke. [Journal Article]
- Stroke 2013 Dec; 44(12):3376-81.
The Combined Lysis of Thrombus in Brain Ischemia With Transcranial Ultrasound and Systemic T-PA-Hands-Free (CLOTBUST-HF) study is a first-in-human, National Institutes of Health-sponsored, multicenter, open-label, pilot safety trial of tissue-type plasminogen activator (tPA) plus a novel operator-independent ultrasound device in patients with ischemic stroke caused by proximal intracranial occlusion.All patients received standard-dose intravenous tPA, and shortly after tPA bolus, the CLOTBUST-HF device delivered 2-hour therapeutic exposure to 2-MHz pulsed-wave ultrasound. Primary outcome was occurrence of symptomatic intracerebral hemorrhage. All patients underwent pretreatment and post-treatment transcranial Doppler ultrasound or CT angiography. National Institutes of Health Stroke Scale scores were collected at 2 hours and modified Rankin scale at 90 days.Summary characteristics of all 20 enrolled patients were 60% men, mean age of 63 (SD=14) years, and median National Institutes of Health Stroke Scale of 15. Sites of pretreatment occlusion were as follows: 14 of 20 (70%) middle cerebral artery, 3 of 20 (15%) terminal internal carotid artery, and 3 of 20 (15%) vertebral artery. The median (interquartile range) time to tPA at the beginning of sonothrombolysis was 22 (13.5-29.0) minutes. All patients tolerated the entire 2 hours of insonation, and none developed symptomatic intracerebral hemorrhage. No serious adverse events were related to the study device. Rates of 2-hour recanalization were as follows: 8 of 20 (40%; 95% confidence interval, 19%-64%) complete and 2 of 20 (10%; 95% confidence interval, 1%-32%) partial. Middle cerebral artery occlusions demonstrated the greatest complete recanalization rate: 8 of 14 (57%; 95% confidence interval, 29%-82%). At 90 days, 5 of 20 (25%, 95% confidence interval, 7%-49) patients had a modified Rankin scale of 0 to 1.Sonothrombolysis using a novel, operator-independent device, in combination with systemic tPA, seems safe, and recanalization rates warrant evaluation in a phase III efficacy trial.http://www.clinicaltrials.gov. Unique identifier: CLOTBUST-HF NCT01240356.
- Trends in diagnostic ultrasound acoustic output from data reported to the US Food and Drug Administration for device indications that include fetal applications. [Journal Article]
- J Ultrasound Med 2013 Nov; 32(11):1921-32.
A survey was conducted of acoustic output data received by the US Food and Drug Administration for diagnostic ultrasound devices whose indications for use include fetal applications to assess trends in maximum available acoustic output over time.Data were collected from 124 regulatory submissions received between 1984 and 2010. Data collection excluded transducers not indicated for diagnostic fetal imaging. The output parameters of ultrasonic power, mean center frequency, and bone thermal index (TIB) were extracted or computed from the submissions for 3 periods: 1984-1989, 1992-1997, and 2005-2010. The data were stratified according to the following imaging modes: M-mode, B/M-mode, pulsed wave Doppler, color flow Doppler, and continuous wave Doppler.Ultrasonic power and maximum TIB values have increased roughly an order of magnitude from pre-1991 to post-1991 periods; the center frequency has decreased somewhat (4.2 to 3.4 MHz). The percentage of Doppler-mode transducers has increased substantially over time, with the majority of the diagnostic fetal imaging transducers currently designed to operate in Doppler modes; this increase is particularly important, since Doppler modes generate much higher TIB levels than B/M-modes. Color flow Doppler ultrasound currently operates at the highest mean ultrasonic power level (with a 14-fold increase over time).The observed trends in increased acoustic output for both Doppler and non-Doppler modes underscore the widely recognized importance of adherence to the ALARA (as low as reasonably achievable) principle and prudent use in fetal ultrasound imaging.
- Automated Estimation of Fetal Cardiac Timing Events from Doppler Ultrasound Signal Using Hybrid models. [JOURNAL ARTICLE]
- IEEE J Biomed Health Inform 2013 Oct 17.
In this paper a new noninvasive method is proposed for automated estimation of fetal cardiac intervals from Doppler Ultrasound (DUS) signal. This method is based on a novel combination of Empirical Mode Decomposition (EMD) and hybrid support vector machines - Hidden Markov Models (SVM/HMM). EMD was used for feature extraction by decomposing the DUS signal into different components (IMFs), one of which is linked to the cardiac valve motions, i.e. opening (o) and closing (c) of the Aortic (A) and Mitral (M) valves . The non-invasive fetal electrocardiogram (fECG) was used as a reference for the segmentation of the IMF into cardiac cycles. The hybrid SVM/HMM was then applied to identify the cardiac events, based on the amplitude and timing of the IMF peaks as well as the sequence of the events. The estimated timings were verified using pulsed doppler images. Results show that this automated method can continuously evaluate beat-to-beat valve motion timings and identify more than 91% of total events which is higher than previous methods. Moreover the changes of the cardiac intervals were analysed for three fetal age groups: 16- 29, 30-35 and 36-41 weeks. The time intervals from Q-wave of fECG to Ac (Systolic Time Interval, STI), Ac to Mo (Isovolumic Relaxation Time, IRT), Q-wave to Ao (Pre-ejection Period, PEP) and Ao to Ac (Ventricular Ejection Time, VET) were found to change significantly (p < 0:05) across these age groups. In particular, STI, IRT and PEP of the fetuses with 36-41 week were significantly (p < 0:05) different from other age groups. These findings can be used as sensitive markers for evaluating the fetal cardiac performance.
- Quantitation of Fetal Heart Function With Tissue Doppler Velocity Imaging-Reference Values for Color Tissue Doppler Velocities and Comparison With Pulsed Wave Tissue Doppler Velocities. [JOURNAL ARTICLE]
- Artif Organs 2013 Oct 3.
Quantitative assessment of fetal heart function has been difficult. Increasingly, tissue Doppler imaging (TDI) is used to measure fetal cardiac function noninvasively. There are two principal techniques, spectral pulsed wave (PW) TDI and color TDI (CTDI). Published reference values for fetal myocardial velocities are based on spectral PW TDI only. However, previous phantom, adult, and animal studies have shown that PW TDI velocities are systematically higher than CTDI velocities. There are no fetal studies so far. We hypothesized that myocardial velocities derived by PW TDI and CTDI are significantly different in the fetus. This prospective observational study included 91 fetuses (gestational age 28.6 ± 6.6 weeks; range 19-40 weeks) seen for routine prenatal ultrasound. From apical 4-chamber views, tricuspid ring (right ventricle), lateral and septal mitral ring were sampled by PW TDI and CTDI. Bland-Altman analysis was used for comparisons. PW and CTDI S' velocities correlated strongly in all three cardiac segments (r = 0.6 to 0.9; P < 0.01). There was a systematic bias toward higher velocities with PW TDI versus CTDI (bias 0.96 cm/s; 95% CI 1.08-0.85 cm/s). However, the strength of the correlation and bias varied depending on the region of the fetal heart sampled. PW TDI and CTDI velocity measurements are feasible in the fetus and correlate well. However, PW TDI velocities are higher than CTDI velocities with significant regional variation. This precludes a mathematical conversion of PW to CTDI in vivo. As PW TDI and color TDI vary, different reference values for fetal CTDI velocities were generated.
- Doppler ultrasonographic assessment of uterine arteries during normal canine puerperium. [Journal Article, Research Support, Non-U.S. Gov't]
- Anim Reprod Sci 2013 Oct; 141(3-4):172-6.
The aim of this study was to describe Doppler ultrasonographic changes of uterine arteries during normal canine puerperium. Eight healthy, pure-bred bitches, were ultrasonographically assessed during the postpartum period on Days -3, 3, 10, 17, 24, 38, 52 and 80 (Day 0 defined as the day of parturition). Total horn diameters (TD) and endometrium thickness (E) were evaluated. Color Doppler was used to localize uterine arteries at both sides of the body and pulsed-wave Doppler was performed to obtain the waveforms. Peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured. Resistance index [(PSV-EDV)/PSV] was automatically calculated. Values of TD, E, PSV, EDV and RI were analyzed by repeated measures ANOVA followed by LSD test (SPSS 18.0; SPSS, Chicago, IL, USA). A correlation analysis was also carried out between RI and TD. A progressive decrease of TD (P<0.01) and E (P<0.01) was found in the course of the study. A gradual diminution of PSV (P<0.01) and EDV (P<0.01) and an increase of RI (P<0.01) were also found throughout the study period. The resistance index negatively correlated with TD (r=-0.46; P<0.01) and E (r=-0.44; P<0.01) while the ultrasonographic and vascular changes in this period are concurrent with regenerative changes in the glandular and epithelial structures of the uterus. It is concluded that uterine artery RI progressively increased during normal canine puerperium, associated to the two-dimensional ultrasonographic regression of the organ.