OBJECTIVE. We describethe sonographic appearanceand vascularization of hemangio mas and determine if vessel density and peak systolic Doppler shifts distinguish hemangiomas from other superficial soft-tissue masses. SUBJECTSAND METHODS. Ourpilotstudyincluded 20 infants andchildren withhemangiomas who were to undergo biopsy before treatment with interferon alpha-2b. We used Doppler sonography to determine the number of vesselsper square centimeter, peak arterial Doppler shift, resistive index, and signs of arteriovenous shunting. All hemangiomas showed high vesseldensity (more than five per squarecentimeter) and high Doppler shifts (more than 2 kHz), and these two factors became our diagnostic criteria. A prospective study of I 16 pa tients was then carried out. One hundred sixteen consecutive pediatric patients with superficial soft-tissue masses were examined using Doppler sonography: sonographic findings were compared with the final diagnoses that were established by biopsy, CT, or clinical follow-up. and a peak arterial Doppler shift exceeding 2 kHz were correctly diagnosed as hemangiomas (sensitivity, 84%; specificity, 98%). One artenovenous malformation showed high vesselden sity and high Doppler shifts, but none of the other masses that were not hemangiomas did. RESULTS. The final diagnoses included70 hemangiomas, 20 venousmalformations,Eleven patients with hemangiomas who were being treated with interferon at the time of the study fulfilled only one of the two diagnostic criteria. CONCLUSION. Highvessel density andhighpeakarterial Dopplershiftcanbeusedtodistinguish hemangiomas from other soft-tissue masses.H emangiomas,which areamongthe most common soft-tissue tumors in infants [1â€"3), typically appearas slightly raised,bluish red subcutaneousmasses that resemblethe surface of a strawberry and regressasthe child grows older. Someheman giomasdo not havethis typical appearancebe cause part or all of the lesion is deep in the soft tissue and the overlying skin appears normal.These lesions are difficult to distinguish clini cally from more suspicioussoft-tissuemasses, such as vascularmalformations, soft-tissueUi mors (e.g., metastasesfrom neuroblastomaor rhabdomyosarcoma),and infantile myofibro matosis.Children with suchlesionsareusually referredfor imaging studies or biopsy.Blood flow in superficial vessels is readily discernible using Doppler sonography. We soughtto ascertainwhetherhemangiomashave characteristic features that can be seen using high-frequency gray-scale and Doppler sonog raphy and whether they can be distinguished from other superficial soft-tissuemassesin in fantsandchildren. Subjects and Methods PilotStudyTo determine the general appearanceand vascu

OBJECTIVE. Cavernous transformation of the portal vein is defined as the formation of venous channels within or around a previously thrombosed portal vein. The purpose of this work was to study the hemodynamic consequences of cavernous transformation of the portal vein in a group of afflicted patients by use of Doppler sonography. We wished to study the evolution from portal vein thrombosis to the formation of cavernous transformation, the extent of resulting extrahepatic collateral channels, and the patterns of splanchnic collateral circulation. MATERIALS AND METHODS. Seventy-five patients (48 adults and 27 children) with cavernous transformation of the portal vein were studied with color and/or pulsed Dop-pIer sonography. Blood flow in the extrahepatic portal vein, in its segmental branches, in the hepatic veins and artery, and in the splanchnic veins was examined. Collateral pathways were sought. For nine patients with acute thrombosis of the portal vein, serial examinations were performed during the formation of cavernous transformation. RESULTS. In nine patients, a fresh thrombus filled and distended the portal vein and became recanalized within a few days. Tortuous vessels appeared at the porta hepatis. These were characterized as veins or arteries with Doppler sonography. Soon the pertal vein could no longer be identified within the mass of tortuous vessels. The cavernous transformation developed within 6-20 days of the acute thrombosis. A spongelike

Vessel density in affected bowel loops, as estimated with Doppler US, and bowel wall thickness (>5 mm) reflect disease activity in patients with Crohn disease.

In pediatric patients, Doppler US is a noninvasive, easily available, and rapid mode of investigation of vascular lesions and can help confirm the diagnosis of VM when it shows a characteristic flow pattern.

The haemodynamic effects of a meal on the splanchnic and hepatic circulation were evaluated in 30 healthy volunteers, using Doppler ultrasonography. The resistance index (RI) of the superior mesenteric artery and of the left and right intrahepatic arteries, the portal vein blood flow as well as the ratio between maximal velocity in the left and right intrahepatic arteries and the adjacent portal vein were measured initially, then 15, 30, 45, and 60 min after the ingestion of a standard balanced liquid meal. Postprandial haemodynamic changes were maximal 30 min after the meal; at that time, mesenteric artery RI decreased significantly [mean -11% (SEM 14%)] whereas portal vein blood flow increased markedly [mean +79% (SEM 14%)]; a significant increase in hepatic artery RI was observed in both liver lobes. The ratio between maximal velocities of the intrahepatic artery and the intrahepatic portal vein was reduced significantly; this ratio decreased more markedly in the right lobe of the liver. These findings would suggest that there was an adaptation of hepatic artery to portal vein blood flow after a meal. The subsequent increase in intrahepatic portal vein flow velocity was found to be greater in the right lobe of the liver.

The accuracy of Doppler sonography in the evaluation of testicular torsion was tested in 65 boys (aged 0-18 years) with acute scrotal pain or swelling. All patients underwent pulsed Doppler sonography of both testes, followed by scintigraphy (n = 16) and/or surgery (n = 34) and a close clinical follow-up for 4-8 months (n = 31). Color Doppler sonography was performed in 29 patients. The testicular artery was deemed patent if Doppler shifts from branches within the parenchyma could be found. Surgery revealed 19 cases of testicular torsion, 17 of which were diagnosed with Doppler sonography. There were six technical failures, in which no signals could be found on either side. In four boys, no color signals were obtained in either testis but subsequent examination with a mechanical sector scanner and pulsed Doppler sonography yielded arterial signals. Doppler sonography was successful in 59 of 65 boys (91%) and yielded a sensitivity of 89% and specificity of 100%. Pulsed Doppler sonography with mechanical sector scanners was more sensitive than color Doppler sonography. Intermittent torsion was missed both with Doppler sonography and scintigraphy.

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Power Doppler sonography is a new technique that displays the strength of the Doppler signal in color, rather than the speed and direction information. It has three times the sensitivity of conventional color Doppler for detection of flow and is particularly useful for small vessels and those with low-velocity flow. Power Doppler sonography shows potential for detecting areas of ischemia in the kidney, brain, and prepubertal testis and for demonstrating hyperemia in areas of inflammation. Its increased sensitivity to motion and flash artifact, however, limits its application in children. Power Doppler is useful as an adjunct to conventional color and pulsed Doppler sonography.