Abstracts
was not affected by sex (r⫽0.10, p⫽0.19), diabetes history (r⫽0.11),
smoking (r⫽0.04), GPT (r⫽0.04), LDL and TG. Multiple regression
analysis showed stiffness beta was affected mainly by age, sex, HAI
score, HOMA-IR. While PWV was by age, waist circumference,
HOMA-IR and hypertension history.
Conclusion: Histology Activity Index score were associated with the
carotid stiffness beta and pulse wave velocity.
1532
Intrarenal Color Doppler Sonography in Studying Patients
Affected by Systemic Sclerosis
Sperandeo Marco, Unit of Internal Medicine; “Casa Sollievo della
Sofferenza”, San Giovanni Rotondo (FG), Italy
D Amico G, Unit of Internal Medicine; “Casa Sollievo della
Sofferenza”, San Giovanni Rotondo (FG), Italy
A De Cata, Unit of Internal Medicine; “Casa Sollievo della
Sofferenza”, San Giovanni Rotondo (FG), Italy
Sperandeo Giuseppe, Unit of Radiology; “Casa Sollievo della
Sofferenza”, San Giovanni Rotondo (FG), Italy
Piattelli Maria Luisa, Unit of Internal Medicine; “Casa Sollievo
della Sofferenza”, San Giovanni Rotondo (FG), Italy
Terracciano Fulvia, Unit of Endoscopy; “Casa Sollievo della
Sofferenza”, San Giovanni Rotondo (FG), Italy
A De Matthaeis, Unit of Internal Medicine; “Casa Sollievo della
Sofferenza”, San Giovanni Rotondo (FG)
Vendemmiale G, Unit of Internal Medicine; “Casa Sollievo della
Sofferenza”, San Giovanni Rotondo (FG), Italy
Systemic sclerosis is a generalized disorder affecting the connective
tissue of the skin and internal organs associated with alterations of the
microvasculature. Scleroderma renal crisis involves almost 50% of
patients with a 25% of which developing renal failure.
In our study we evaluated utility of intrarenal quantitative parameters
(Resistive Index: R.I.; Pulsatility Index: P.I.) during renal color Dopp-
ler sonography, as prognostic indicators of renal involvement in sys-
temic sclerosis.
Methods: The study was conducted between January 2003 and No-
vember 2008, in the Casa Sollievo della Sofferenza Hospital in San
Giovanni Rotondo, Italy, referral center for patients with autoimmune
disease. We examinated 101 patients (92 females and 9 males) (median
age 67 year) affected by systemic sclerosis and 100 controls, with an
Esaote Technos MPX scanner equipped a 3.5 MHz convex scanner. All
subjects underwent intrarenal color Doppler sonography with evalua-
tion of R.I. and P.I. every 12 mounths. Correlated these parameters with
renal functional tests (creatinine clearance and GFR), microalbumin-
uria and urine test.
Results: We found a significantly higher R.I. (average 0.83⫾10) in 94
patients (93 females and 1 male) in respect to controls (p⬍0.05).
Conclusions: Even if our preliminary findings have to be confirmed in
larger patient groups, they suggest that evaluation of R.I. by color
Doppler sonography in patients with systemic sclerosis could allow a
selection of those patients at major risk of developing renal vascular
involvement and, by consequence, renal crisis as a complication of
systemic sclerosis.
1533
The Usefulness of Ultrasonography for the Initial Diagnosis of
Deep Vein Thrombosis in Patients with Swollen Extremities
HIroshi Matsuo, Matsuo Clinic, Matsuo Cardiovascular Clinic,
Japan
Miyuki Matsuo, Matsuo Clinic, Japan
Pulmonary embolism (PE) causes respiratory distress and often fatal.
Detecting deep vein thrombosis (DVT), as a source of embolisms, is
S245
helpful as a prevention of aggravation or recurrence. We will present
the usefulness of ultrasonography(US) for diagnosing DVT noninva-
sively in patients with swollen or painful limbs, and for diagnosing
recurrent DVT or post-thrombotic syndrome. For 9 years, 45 patients
(female: 35) with DVT (acute stage: 16, Complicated with PE: 6 ,
Location of thrombus: Iliac vein 9, Femoral 26, Popleteal 5, calf/soleal
vein 5) were diagnosed in 968 patients visited at our medical office due
to swollen limbs. Chronic venous insufficiency, thrombophlebitis, cel-
lulitis, ruptured Baker’s cyst, subcutaneous or intra-muscle hematoma,
torn gastrocunemial muscle, disuse edema and lymphedema are diag-
nosed finally by noninvasive US after having differentiated from sys-
temic edema (i.e. congestive heart failure, nephrotic syndrome, hepatic
failure, etc). Also calf vein thrombus, which extend to involve the
proximal veins and cause PE, is identified reliably by US. Because
noninvasive US can be easily performed in medical office, it is ex-
tremely useful in the screening examination for patients with swollen
limbs.
1534
Ultrasound Guided Scleortherapy of Congenital Venous
Malformations with Foam: A Report of 17 Cases
Thu Hoai Nguyen, Medic Center - Ho Chi Minh City, Vietnam
Hai Thanh Phan, Medic Center - Ho Chi Minh City, Vietnam
Objective: Treatment of congenital venous malformations is more
difficult and various approaches have been tried.The purpose of this
presentation is to describe strategies for sclerotherapy with foam and
report of the middle-term outcome of 17cases.
Methods: All patients was classified according to the Hamburg clas-
sifications.Diagnosis was based on clinical examination- Duplex Ul-
trasonography - MRA or MRV- MSCT study with contrast and 3D
reconstruction and directly punctured under Ultrasound Doppler guid-
ance.The volume, concentration and number of sessions from one
patient to another , with Lauromacrogol foam varied from 0,5% to 3%.
Results: Technican success was achieved in 100% of patients : 17
cases (11 cases males and 6 cases females) with an age range of 7-34
years . In most cas, sclerotherapy succeeded in the partial involution of
the congenital venous malformations . No major complications were
observed.
Conclusions: Ultrasound guided sclerotherapy is a less-invasive, safe
and effective treatment for congenital venous malformations.However-
,the long-term outcome still needs to be assessed.
1535
Usefulness of B-Flow Imaging in Carotid Artery Ultrasound
Examination
Susumu Nishio, Tokushima University Hospital, Japan
Hirotsugu Yamada, The University of Tokushima, Japan
Kenya Kusunose, The University of Tokushima, Japan
Noriko Tomita, The University of Tokushima, Japan
Yoko Tadatsu, The University of Tokushima, Japan
Mitsuyo Sato, Tokushima University Hospital, Japan
Hazuki Hiraoka, Tokushima University Hospital, Japan
Masataka Sata, The University of Tokushima, Japan
Backgrounds: B-Flow imaging is the novel ultrasound technology
which allows B-mode echogram to visualize blood flow on it. This
image is basically produced by enhancing faint echoes from red
blood cells and enables real-time visualization of blood flow on
B-mode image. We are reporting some cases in which the B-Flow
imaging provides clinically useful information. Case 1: A 78-year-
old men with severe stenosis of right internal carotid artery. Color
Doppler imaging showed mosaic signals in the stenotic lesion,
however it was difficult to identify endothelium of that portion.
S246 Ultrasound in Medicine and Biology
B-Flow imaging could visualize clear border between blood and
vessels. Case 2: A 54-year-old woman with fibromuscular dysplasia.
Irregular endothelium was observed in bilateral common carotid
arteries. B-Flow imaging but color Doppler imaging showed spiral
stenosis. Case 3: A 76-year-old men with left internal carotid artery
stenosis. There was mobile small plaque on isoechoic plaque with
high echoic spots, which could be detected as a mobile high echoic
tissue by B-Flow imaging. Case 4: A 77-year-old men who had
carotid endarterectomy of left internal carotid artery. B-Flow imag-
ing revealed an intimal flap presenting as a mobile high echoic
speckle. Case 5: A 82-year-old men who had carotid endarterectomy
of left internal carotid artery. Intimal flap could be detected by only
B-Flow imaging but conventional color Doppler imaging.
Conclusions: B-Flow imaging provides clear visualization of vascular
structure with high temporal and spatial resolution, and it becomes
clinically useful tool for the assessment of carotid artery abnormalities.
1536
Lower Extremity Venous Duplex Examinations
Susanna L Ovel, Radiological Associates of Sacramento, United
States
Objectives: Describe normal and abnormal lower extremity venous
hemodynamics.
Differentiate acute, subacute, and chronic deep vein thrombosis.
Explain venous insufficiency and the importance of its detection.
Describe a routine duplex examination to rule out venous insufficiency.
Results: This course will cover gray scale and common Doppler
findings in the normal and abnormal lower extremity venous circula-
tion. The participants will have a basic understanding of lower extrem-
ity venous hemodynamics.
Conclusion: On completion of this course, participants will be able to
differentiate normal and abnormal gray-scale and Doppler characteris-
tics of the lower extremity venous circulation.
Length: 40 – 50 minutes
1537
Diabetes as a Determinant of High-Grade Carotid Artery
Stenosis: Evaluation of 258 Cases by Doppler Sonography in
Bangladeshi Population
Sharmin Quddus, 1. Centre for Nuclear Medicine & Ultrasound,
Dhaka Medical College Campus, Bangladesh
Mahbub Rahman, 1. Centre for Nuclear Medicine & Ultrasound,
Dhaka Medical College Campus, Bangladesh
Sanowar Hussain, Bangladesh
Shahana Afroz, 2. Bangladesh Atomic Energy Commission (BAEC).,
Bangladesh
Objective: To investigate the association of risk factors, especially
diabetes mellitus, with high-grade carotid artery stenosis.
Method: The study group was chosen from the patients who were sent
to our Doppler ultrasonography laboratory for detecting the vascular
anatomy. Doppler sonography was performed in 258 patients.
Results: High-grade carotid artery stenosis(70% - 99% diameter re-
duction) was detected in 74 patients. In the moderate(40% -69%) and
mild stenosis (0% - 39%) groups, we had 35 and 149 patients, respec-
tively. Parameters of age, sex, alcohol, smoking, ischemic heart dis-
ease, hypertension, and diabetes were considered potential risk factors
for stenosis. Multivariate logistic regression model was used as the
statistical test in comparing the 3 groups. In the high-grade stenosis
group, sex distribution was 24.8% female and 75.2% male with a mean
age of 54.42 ⫾ 10.18 years. In the second and third groups these
distributions were 53.4% female and 46.6% male with a mean age of
62.15 ⫾ 8.61 years, and 47.30% female and 52.70% male with a mean
Volume 35, Number 8S, 2009
age 62.56 ⫾ 12.34, respectively. Diabetes mellitus (odds ratio [OR] ⫽
2.68), ischemic heart disease (OR ⫽ 1.54), age (OR ⫽ 1.05), and male
gender (OR ⫽ 1.72) were found to be significantly associated with
high-grade carotid stenosis.
Conclusion: As a cost-effective, noninvasive, easily performed, and
fast technique, Doppler sonography is used in vascular evaluation of
patients. Early diagnosis of carotid artery disease in patients with
modifiable risk factors like diabetes may play an important role in the
prevention of a consequent stroke.
1538
Ultrasound Assessment of Endothelial Function in Women with
Pre-Eclampsia Compared to Women with Gestational
Hypertension
Ann E Quinton, University of Sydney at Nepean Hospital, Australia
Colleen M Cook, University of Sydney at Nepean Hospital, Australia
Michael J Peek, University of Sydney at Nepean Hospital, Australia
Objective: To assess endothelial function using the vascular ultrasound
technique of flow mediated dilatation (FMD) in women with pre-
eclampsia (PE) versus gestational hypertension (GH).
Method: Pregnant women were recruited when admitted to hospital
with hypertension (BP ⱖ140/90mmHg). Women who also had pro-
teinuria ⱖ3⫹ or ⱖ300mg/24 hours were defined as PE, the non-
proteinuric group as GH. Ultrasound measurements of the brachial
artery diameter pre and post induced reactive hyperaemia were used to
calculate FMD, a marker of stimulated endothelial function.
Results: The FMD of the PE women (7.4 ⫾ 4.5) (mean ⫾ SD) was
similar to our normal range (9.3 ⫾ 5.0) (P⫽0.09) but the FMD in the
GH women was abnormally low (4.7 ⫾ 3.6), indicating endothelial
dysfunction. The difference in FMD between the GH women and the
PE women was statistically significant (P⫽0.003). No significant dif-
ferences were seen between the PE group (n⫽40) and the GH group
(n⫽41) in gestational age at time of study (33.8 ⫾ 3.2 vs. 34.9 ⫾
3.3weeks), number of smokers (6 vs.4) or number treated with antihy-
pertensive medication (27 vs. 27). Further, no differences were found
in body mass index, blood pressure, or maternal heart rate.
Conclusion: The ultrasound technique of FMD was well tolerated
and successfully performed on pregnant women. In women with
GH, endothelial dysfunction was detected whereas the PE group was
similar to our normal range in pregnancy. Interestingly, hyperten-
sion has been associated with endothelial dysfunction in non-preg-
nant adults. We hypothesise PE may therefore be a different disease
to GH.
1539
Carotid Artery Intima-Media Thickness (IMT) in Patients with
NIDDM and in Nondiabetic Controls
Mahbub Rahman, 1. Centre for Nuclear Medicine & Ultrasound,
Dhaka Medical College Campus, Bangladesh
Sharmin Quddus, 1. Centre for Nuclear Medicine & Ultrasound,
Dhaka Medical College Campus, Bangladesh
Sanowar Hussain, Bangladesh
Shahana Afroz, Bangladesh Atomic Energy Commission (BAEC).,
Bangladesh
Background and Purpose: The risk of atherosclerotic vascular disease
is increased in subjects with non–insulin-dependent diabetes mellitus
(NIDDM) compared with nondiabetic subjects. Carotid artery intima-
medial thickness (IMT), a marker of subclinical atherosclerosis, is a
strong predictor of subsequent cardiovascular morbidity. The purpose
of this study was to investigate the carotid intimal-medial thicknesses