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: To compare the effectiveness of uterine artery Doppler and maternal serum screening in the prediction of pregnancy complications. MATERIALS AND METHODS: Prospective study with 49 primigravidae at their 18th gestational week, when a blood sample was collected for serum dosage by chemiluminescence (alpha-fetoprotein, human chorionic gonadotropin and nitric oxide) and radioimmunoassay (atrial natriuretic peptide). Uterine artery Doppler was performed between the 24th and 26th gestational weeks, for determining the presence or absence of notch in the flow velocity waveform. The non-parametric Mann-Whitney test was utilized for statistical analysis, and the Fisher exact test for analysis of qualitative parameters. RESULTS: Sensitivity, specificity, positive and negative predictive values were, respectively, 8.3%, 97.0%, 50.0% and 74.4% for alpha-fetoprotein; 8.3%, 87.9%, 20.0% and 72.5% for human chorionic gonadotropin; 16.7%, 97.0%, 33.3% and 76.2% for atrial natriuretic peptide; and 16.7%, 93.9%, 50.0% and 75.6% for nitric oxide. The uterine artery Doppler sensitivity was 75.0%, specificity 63.6%, positive predictive value 57.1%, and negative predictive value 87.5%. CONCLUSION: Uterine artery Doppler is an effective method for prediction of pregnancy complications as compared with maternal serum screening in low risk populations.

Keywords: Doppler, Serum screening, Preeclampsia, Complications, Pregnancy

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 determine a reference curve for the peak systolic velocity of fetal middle cerebral artery. MATERIALS AND METHODS: The authors developed a cross-sectional study with 143 healthy pregnant women between the 23rd and 35th gestational weeks. A bidimensional axial scan of the fetal skull was performed, including the thalami and pellucid septum. Subsequently, the middle cerebral artery was visualized with the color Doppler mode. The pulsed-wave Doppler transducer was positioned over the origin of this vessel, at < 20° insonation angle. The correlation between the peak systolic velocity of the middle cerebral artery and gestational age was evaluated by means of the Pearson's correlation coefficient (r). Regression models were utilized in the construction of a table with multiples of the medians of the middle cerebral artery peak systolic velocity for each gestational age. Additionally, reference values for this variable were determined. RESULTS: A strong correlation was observed between the middle cerebral artery peak systolic velocity and gestational age (r = 0.70; p < 0.001). Values of middle cerebral artery peak systolic velocity were calculated for the following multiples of the medians: 1.0, 1.29, 1.5, 1.55. The 2.5th and 97.5th percentiles were determined for the middle cerebral artery peak systolic velocity ranging between 24.33 cm²/s and 78.36 cm²/s. CONCLUSION: A nomogram for the fetal middle cerebral artery peak systolic velocity during the second half of pregnancy was generated.

Keywords: Middle cerebral artery, Doppler, Ultrasonography, Nomogram, Fetus

Pathological processes of the testis are very frequently found, and include non-tumoral and tumoral lesions. Ultra-sonography performed with a high-frequency transducer has become the imaging modality of choice for examination of these organs. This method is of help to improve intratesticular lesions characterization, and in many instances the findings suggest a more specific diagnosis, especially in the presence of similar clinical manifestations such as pain, swelling and local increase in volume. Color Doppler is an invaluable tool for demonstrating anomalous patterns of testicular perfusion and aids in the diagnosis of acute clinical conditions. In the present iconographic essay, the authors summarize the most frequent clinical, pathological findings as well as the main diagnostic features of benign intratesticular lesions such as microlithiasis, simple cysts, spermatocele, varicocele, tubular ectasia of the rete testis, orchitis, hematomas and more rare conditions. Familiarity with clinical and sonographic features is essential for the correct diagnosis and starting of the most effective therapy, as necessary.

Keywords: Testis, Benign testicular lesions, Ultrasonography, Color Doppler

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: The present study had as its objective to compare the findings of voiding cystourethrography with those of duplex color Doppler in patients with suspected vesicoureteral reflux. MATERIALS AND METHODS: The research was developed through the study of ureterovesical jet angles, both in axial and longitudinal planes. Also, the distance (in cm) between ureteral meatuses was analyzed. RESULTS: From a total sample of 32 patients (mean age of five years and two months), 18 presented with vesicoureteral reflux (10 with unilateral reflux - 4 right-sided and 6 left-sided -, and 8 with bilateral reflux) and 14 patients did not presented with reflux. The angles of ureterovesical jet and distances between the ureteral meatuses were measured in all patients, and mean values, standard deviation and coefficient of variance were calculated. CONCLUSION: Data showed that a trend towards meatus lateralization is a sign of predisposition to vesicoureteral reflux. Non-parametric Mann-Whitney statistical analysis did not show significant differences (p > 0.05) between groups (inclination angles of ureterovesical jet and distance between urinary meatuses).

Keywords: Vesicoureteral reflux, Ureterovesical jet, Color Doppler ultrasound, Voiding cystourethrography

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 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

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.