OBJECTIVE: To evaluate the pulsatility index of umbilical artery (UAPI) and middle cerebral artery (MCAPI), as well as the umbilical-cerebral pulsatility (UAPI/MCAPI) ratio in fetuses of hypertensive pregnant women and associated adverse perinatal outcomes. MATERIALS AND METHODS: The authors have analyzed UAPI, MCAPI and UAPI/MCAPI ratio in 289 fetuses of hypertensive women, correlating the results with the presence of adverse perinatal outcomes. Results were compared with and without adjustment for gestational age. RESULTS: Apgar score < 7 at the 5th minute was associated with altered outcomes after adjustment for gestational age. The risk for small-for-gestational-age infant increased three times after such adjustment, with statistical significance for all the Doppler parameters. The increase in risk for neonatal hypoxia after adjustment for gestational age was statistically significant for UAPI and UAPI/MCAPI ratio. No increase was observed in the risk for respiratory distress syndrome in the adjusted analysis. A three-time higher risk for perinatal mortality and altered UAPI with statistical significance was observed after adjustment. CONCLUSION: In fetuses of hypertensive pregnant women, UAPI demonstrated better correlations with perinatal outcomes than MCAPI and UAPI/MCAPI ratio. The risk for adverse gestational outcome should be evaluated taking the gestational age into consideration.

Keywords: Doppler velocimetry, Hypertension, Perinatal outcome

OBJECTIVE: To determine uterine artery resistance index (RI) and pulsatility index (PI) during the first and second trimesters of pregnancy. MATERIALS AND METHODS: The authors developed a prospective longitudinal study with 44 healthy women at their 8th-12th and 22nd gestational weeks. Doppler velocimetry was utilized for evaluating RI and PI of both uterine arteries, with a sample volume of 1 to 2 mm, a 50-70 Hz filter, and an insonation angle < 60°. RESULTS: At 8th-12th gestational weeks, the uterine artery RI and PI were higher than at the 22nd gestational week. At the first trimester uterine artery RI and PI were, respectively, 0.83 ± 0.07 and 2.32 ± 0.79 with a notch, and 0.71 ± 0.16 and 1.61 ± 0.78, without a notch. At the second trimester, uterine artery RI and PI were, respectively, 0.59 ± 0.09 and 1.03 ± 0.32 with a notch, and 0.44 ± 0.09 and 0.63 ± 0.19 without a notch. CONCLUSION: Reference values for uterine arteries RI and PI at the first and second trimesters of pregnancy were established.

Keywords: Doppler effect, Uterine artery, Preeclampsia

OBJECTIVE: The present field research was aimed at identifying sonographic and hemodynamic findings indicative of the presence of schistosomiasis mansoni in endemic areas. MATERIALS AND METHODS: Doppler sonography was performed in 554 patients with schistosomiasis in three areas with different endemicity levels: low (n = 109), medium (n = 255) and high endemicity (n = 190). The World Health Organization (Niamey Working Group, 2000) protocol was adopted for sonographic evaluation. Doppler study included portal vessels, hepatic and splenic arteries, hepatic veins and collateral vessels. RESULTS: A significant correlation was observed between the frequency of sonographic findings, except for left lobe hypertrophy, and the areas endemicity levels. Altered hepatic veins flow pattern was observed in 23.7% of cases, such abnormality being related to the presence and intensity of periportal thickening. Hepatic arteries did not present any alteration as related to the evaluated parameters. Collateral vessels were identified only in the patients from the high-endemicity area. The splenic artery presented alterations (increase in caliber, flow velocity and resistive index), most frequently in the high-endemicity area, with significant difference between groups. CONCLUSION: Doppler sonography has shown to be a relevant auxiliary tool in the study of the morbidity related to schistosomiasis mansoni, contributing for a more accurate description of the disease profile in endemic areas.

Keywords: Schistosomiasis mansoni, Doppler sonography

OBJECTIVE: To estimate which is the best period to realize uterine artery Doppler for the prediction of pregnancy complications. MATERIALS AND METHODS: A prospective study was conducted with 45 women without a history of chronic diseases and in their first pregnancy. The uterine artery Doppler was performed between the pregnancy weeks 18-20, 24-26, 28-30 and 34-36, with determination of the resistance index, the pulsatility index, the A/B ratio and presence or absence of notch on the flow velocity waveform, as well as the result of the pregnancy. RESULTS: The Doppler index showed decrease in the course of the pregnancy, more pronounced in the normal pregnancies in comparison with the complicated pregnancies. This was most noticed in the examinations performed between the weeks 24-26. The best sensitivity/specificity relation for detecting pregnancy complications was achieved in the examination performed in this same period. CONCLUSION: The best period to perform uterine artery Doppler for prediction of pregnancy complications is between weeks 24-26 of gestation.

Keywords: Doppler, Uterine artery, Preeclampsia, Intrauterine growth restriction

OBJECTIVE: To determine the role of transrectal ultrasound, especially in association with color Doppler, in the diagnosis of prostate cancer. MATERIALS AND METHODS: Eighty-four cases of patients who underwent transrectal biopsy were prospectively analyzed. In all patients, besides the traditional gray-scale sonogram, color Doppler study was performed in search of hypervascular foci. The results were compared with the histopathologic diagnosis. RESULTS: The gray-scale sonogram showed a 67.7% sensitivity, 52.8% specificity, positive predictive value of 45.6% and negative predictive value of 73.6%. The association with color Doppler increased the specificity (from 52.8% to 79.2%) and the positive predictive value (from 45.6% to 62.0%) although it has caused a decrease in the sensitivity (from 67.7% to 58.0%). Besides, the study had 32.2% of missed cancers by both methods, and these patients, although having less extensive cancers all of them were clinically significant (Gleason 6 or more). CONCLUSION: Transrectal ultrasound findings, even in association with color Doppler, are not sufficiently accurate to determine whether a patient should or not be submitted to biopsy.

Keywords: Prostate, Prostatic cancer, Transrectal ultrasound, Color Doppler, Prostate biopsy

Ultrasonography and Doppler ultrasonography have dramatically improved the diagnosis of portal hypertension thanks to the noninvasive visualization of the liver, spleen and splanchnic blood flow. In this article the authors discuss some important issues raised by the use of ultrasound and Doppler in the evaluation of portal hypertension.

Keywords: Portal hypertension, Liver, Ultrasound, Doppler

Recent advances in ultrasound have optimized the detection of liver tumors and helped to improve the prognosis of patients with this condition as newly developed and improved therapeutic modalities have been established. The authors review important Doppler findings which may help in the identification and characterization of some hepatic tumors through the evaluation of color Doppler, pulsed Doppler and power Doppler features. New imaging methods such as the use of harmonics imaging are also reviewed.

Keywords: Liver, Liver tumors, Doppler

Uterine arteriovenous malformations are rare and the clinical features quite variable. Gynecologists and radiologists must be aware of this diagnostic possibility in order to indicate a fast and accurate treatment. The aim of the present paper is to present a case of uterine arteriovenous malformation acquired after trophoblastic gestational disease for which diagnosis was well established by means of color Doppler ultrasonography and correlation to magnetic angioresonance.

Keywords: Angiography, Doppler, Embolization, Ultrasonography, Uterus, Vascular malformation

BACKGROUND: The diversity of existing techniques for the measurement of the spleen using Doppler ultrasound (Doppler-US) as well as the lack of biometrical and Doppler velocimetry reference values make the evaluation of this organ and its hemodynamics quite difficult. OBJECTIVES: To establish biometrical and hemodynamics Doppler-US standard values for healthy adult individuals. MATERIALS AND METHODS: This is a prospective study involving 44 healthy individuals (19 males and 25 females) with mean age of 37.4 ± 9.6 years (23-60 years). Morphometry (US-B mode): spleen: longitudinal (L), transversal (T) and anteroposterior (AP) axes; splenic artery diameter (AD) and splenic vein diameter (VD). Morphometrical spleen indexes: uniplanar (UI), biplanar (BI) and the splenic volume (SV). Doppler velocimetry (US-Doppler): a) splenic artery: systolic peak velocity (SPV), mean of the highest flow speeds (TAMax); pulsability index (PI) and vascular impedance resistivity index(RI); b) splenic vein: mean of the highest flow speeds (TAMax). RESULTS: Morphometry: L = 9.3 ± 1.3 cm; T= 3.9 ± 0.7 cm; AP = 8.4 ± 1.2 cm; AD = 0.3 ± 0.07 cm; VD: 0.5 ± 0.12 cm. Morphometrical spleen indexes: UI = 33.5 ± 9.9; BI = 36.7 ± 10.3; SV = 164.3 ± 62.9 cm³. Doppler velocimetry: a) splenic artery: SPV = 59.8 ± 23.6 cm/s; TAMax = 40.2 ± 15.9 cm/s; PI = 0.86 ± 0.30; RI = 0.55 ± 0.09; b) splenic vein: TAMax = 16.8 ± 8.3 cm/s. CONCLUSION: Report of biometrical and Doppler velocimetry standard values of the spleen in healthy individuals.

Keywords: Spleen, Splenic biometry, Ultrasound, Doppler

The authors report a case of a 24 year-old female patient with a three-month history of pain and enlargement of the left halux. Ultrasound showed a heterogeneous, hypoechoic solid soft tissue mass with cystic areas and calcification in the dorsum of the left halux. A tendinous structure was identified within the lesion but no evidence of involvement of adjacent osseous structures was found. Doppler ultrasound revealed central and peripheral hypervascularization of the lesion. Magnetic resonance imaging demonstrated a solid soft tissue mass containing a tendinous structure. The lesion appeared as an intermediate signal intensity structure on T1 images, high signal intensity on T2 images, and showed marked enhancement after intravenous administration of gadolinium. No osseous lesions were identified. The patient was submitted to surgical resection of the lesion in the dorsum of the left halux and the pathology results revealed a monophasic fibrous synovial sarcoma.

Keywords: Synovial sarcomas, Soft-tissue tumors, Ultra-sonography, Magnetic resonance imaging

The authors review the Doppler imaging methods and their evolution for the study of the fetal circulation emphasizing safety and bioeffects. Ultrasound machines work with thermal and mechanical indexes that are automatically kept under 1.0. Up to date, there have been no reports on biological lesions in human fetuses caused by diagnostic Doppler. Consequently, color, pulsed and power Doppler sonography are considered safe in prenatal exposure.

Keywords: Doppler velocimetry, Safety, Bioeffects, Prenatal

The advent of high-resolution transvaginal ultrasound scanning introduced new research possibilities for patients with polycystic ovaries. The knowledge of the ovarian hemodynamics is a prerequisite for understanding the pathophysiological behaviour of polycystic ovaries. The authors consider the possibility of using color Doppler for a better definition of polycystic ovaries. The findings suggest that increased stromal blood vessels with low resistance and increased pulsatility index of the uterine arteries are to be new parameters to assist in the ultrasound diagnosis of polycystic ovary syndrome. This is a preliminary conclusion and further investigations are necessary to confirm this proposition.

Keywords: Polycystic ovary, Ultrasonography, Color Doppler, Blood flow

PURPOSE: The purpose of this study was to evaluate the relationship between diffuse hypoechoic appearance of the prostate, which is characterized by indistinguishable boundaries between the peripheral zone and the inner gland, and the diagnosis of prostate adenocarcinoma established by transrectal prostate biopsies. MATERIALS AND METHODS: We performed transrectal ultrasonography in 143 male patients with serum prostate specific antigen levels above 4 ng/ml. Randomized biopsies were carried out in all patients. RESULTS: Prostate adenocarcinoma was diagnosed in 36.4% of the patients. Twenty-one (95.4%) out of 22 patients with diffuse hypoechoic appearance of the prostate had positive biopsies for prostate adenocarcinoma. CONCLUSION: Ultrasound diffuse hypoechoic appearance of the prostate is a significant criterion for suspecting adenocarcinoma, since 95.4% of the patients exhibiting this ultrasound findings presented positive biopsies.

Keywords: Ultrasound. Transrectal ultrasound. Prostate carcinoma.

The functional assessment of the fetal heart has been incorporated into cardiac ultrasound screening as a routine procedure, encompassing fetuses with and without structural heart diseases. It has long been known that various cardiac and extracardiac conditions, such as fetal growth restriction, fetal tumors, twin-to-twin transfusion syndrome, fetal anemia, diaphragmatic hernia, arteriovenous fistula with high cardiac output, and congenital heart diseases (valvular regurgitation and primary myocardial disease), can alter hemodynamic status and fetal cardiac function. Several ultrasound and Doppler echocardiographic parameters of fetal cardiovascular disease have been shown to correlate with perinatal mortality. However, it is still difficult to identify the signs of fetal heart failure and to determine their relationship with prognosis. The aim of this study was to review the main two-dimensional Doppler ultrasound parameters that can be used in the evaluation of fetal cardiac function, with a focus on how to perform that evaluation and on its clinical applicability.

Keywords: Fetal heart; Ultrasonography, Doppler; Echocardiography, Doppler; Echocardiography/methods.

OBJECTIVE: To determine whether the degree of microvascular flow on Doppler ultrasound correlates with the aggressiveness of prostate cancer, as defined by the Gleason score.
MATERIALS AND METHODS: This was a prospective cohort study including 88 patients evaluated between November 2023 and July 2024. We included men between 48 and 85 years of age with a prostate-specific antigen (PSA) level between 0.3 ng/mL and 21.0 ng/mL and an imaging finding with Prostate Imaging-Reporting and Data System (PI-RADS) category between 2 and 5. Patients with indeterminate biopsy results were excluded, as were those for whom PSA values were missing, those who did not undergo microvascular Doppler assessment, and those previously diagnosed with prostate cancer. In each case, we performed systematic 10-core transrectal biopsy, guided by 1.5-T magnetic resonance imaging–ultrasound fusion, as well as performing Doppler ultrasound with microvascular flow imaging. Vascularization was qualitatively assessed and categorized as absent/minimal, moderate, or marked. The Gleason score was classified as clinically significant (≥ 7) or not (≤ 6)..
RESULTS: A significant association was found between the degree of microvascular flow and the Gleason score (p = 0.0384). Spearman's correlation was moderate (r = 0.377), and Kendall's tau was 0.300, indicating a positive relationship between higher microvascular flow and greater tumor aggressiveness.
CONCLUSION: Microvascular Doppler shows potential as a complementary tool in prostate biopsy, enabling more precise targeting of regions with increased vascularity, which might be associated with greater tumor aggressiveness.

Keywords: Prostatic neoplasms; Ultrasonography, Doppler; Neoplasm grading; Biopsy, needle; Neoplasms/diagnosis.