, Color Doppler Imaging of the Iliofemoral
Region1
Ji-Bin Liu, MD Daniel A. Merton, BS, RDMS Donald G. Mitchell, MD Laurence Needleman, MD Alfred B. Kurtz, MD Barry B. Goldberg, MD
Color
Doppler
malities how
use
moral
has
of color
fistulas
and
been
used
region.
Doppler
fluid
malformations, masses
to
This
aids
a variety essay
in the
collections,
venous
including
evaluate
pictorial
techniques
pseudoaneurysms,
soft-tissue
.
imaging
in the iliofemoral
diagnoses
and
arteriovenous
vascular
benign
abnor-
of iliofe-
aneurysms,
thrombosis,
tumors
of
demonstrates
grafts,
and
lymphadenopathy.
INTRODUCTION
Because
color
Doppler
imaging
techniques
allow
simultaneous
acquisition
of two-
dimensional and Doppler information, the modality provides a real-time, two-dimensional image of blood flow. With the color image used as a guide, spectral analysis can be performed to demonstrate flow characteristics over time. We used color Doppler imaging with spectral analysis to evaluate abnormalities of suspect-
ed vascular formed
with
ment Wash)
pathogenesis in the iliofemoral region. 5- or 7.5-MHz linear-array transducers AngioDynography
(QAD-1
In all cases,
.
the imaging
system;
Quantum
findings
were
quent surgery and clinical follow-up. This pictorial essay demonstrates how diagnosis or evaluation of pseudoaneurysms,
venous
fistulas,
sue
tumors,
Index
terms:
studies,
Arteries,
93.12984,
RadloGraphics I
From
ferson
the
arteriovenous
vascular
Department
ceivedjanuary print requests cRSNA 1990
92.12984,
98.
Systems,
with
Doppler flow fluid collections,
Issaqua,
those
from
subse-
imaging aids aneurysms,
lymphadenopathy,
in the arterio-
primary
soft-tis-
thrombosis.
1 2984
#{149} Ultrasound
(US),
Doppler
studies,
9. 1 2984
#{149} Veins,
US
98.12984 1990;
Medical
and venous
Medical
correlated
malformations,
grafts,
US studies,
color
All examinations were peron Doppler imaging equip-
of Radiology’.
College, 19,
10:403-412
1990;
10th
and
revision
Division Sansom requested
of Diagnostic
Sea, Philadelphia, February
Ultrasound, PA 19107.
6 and
received
ThomasJefferson From February
the
1989
University RSNA
20; accepted
annual February
Hospital meeting. 26.
and Je( Re-
Address
re-
to B.B.G.
403
a. Figure 1. (a) Color Doppler mixture of red and blue. Note (arrows). FA = femoral artery. distinctive to-and-fro pattern.
b. image demonstrates pseudoaneurysm as a focal mass containing a complex the communicating tract from the affected artery to the pseudoaneurysm (b) Spectral waveform of flow in the communicating tract demonstrates a
Figure 2. Color Doppler image of posttraumatic hematoma demonstrates no flow within the mass overlying the femoral artery.
Figure 3. Color Doppler image of partially thrombosed pseudoaneurysm shows swirling flow within a small portion of a hypoechoic mass, while the larger component exhibits no flow. The absence of flow is the result of thrombus filling a portion of the cavity. Spectral waveform (not shown) displayed a to-and-fro pattern in the communicating tract. The pseudoaneurysm clotted spontaneously,
and
no flow
was
noted
at follow-
up examination.
404
U
RadioGrapbics
U
Liu
Ct
a!
Volume
10
Number
3
a.
b.
Figure onstrate
U
4. Color Doppler images of a fluid collection color noise artifact (a) that is eliminated with
PSEUDOANEURYSM
AND
HEMATOMA Pseudoaneurysm is an uncommon complica. tion of arterial punctures made during transfemoral arteriography; the frequency of pseudoaneurysm development is increased by anticoagulative therapy, hypertension, or improper technique (1 ,2) A pseudoaneurysm usually begins as a hematoma: If the leakage from the disrupted arterial wall does not stop, a fistulous tract may form between the initial hematoma and the femoral artery, producing a pseudoaneurysm. Blood flows into and out of the pseudoaneurysm through this tract. With color Doppler imaging, the pseudoaneurysm can be diagnosed almost immediately: The images depict swirling flow and facilitate identification of the communicating tract (Fig 1 a) distinctive Doppler spectral waveform reflects the characteristic pattern of flow into and out of the pseudoaneurysm (Fig ib) (3-5). It is often difficult to differentiate a hematoma from a pseudoaneurysm clinically, since a hematoma overlies the artery and can appear pulsatile on palpation due to transmitted pulsations. Color Doppler imaging .
.
May
1990
A
surrounding an axillary-femoral use of proper color gain settings
simplifies mas can
this differentiation, be demonstrated
Doppler (Fig
2)
.
examined
bypass (b).
easily
graft dem-
since hematoon color
images as focal masses without flow However, the entire mass must be for absence of flow. In some cases,
only a portion of the pseudoaneurysm may exhibit flow on Doppler images because it is partially thrombosed (Fig 3). Occasionally, color Doppler images may demonstrate “color noise” within an an-
echoic
region,
such
as a hematoma
or fluid
collection. This artifact occurs because of processing algorithms that inhibit color in regions with strong echoes to prevent color from being assigned to moving tissues (6).
The swirling flow of a pseudoaneurysm easily be differentiated from the artifact, since
mixture
the
latter
generally
of red and blue
produces
with
can
a uniform
random-appear-
ing change. When a Doppler spectrum is obtamed, no flow will be demonstrated, a fact that confirms the artifactual nature of this pattern. Changing the color threshold and gain will eliminate this possible pitfall of color Doppler imaging (Fig 4).
Liu
Ct
a!
U
RadioGraphics
U
405
406
U
Radic
I.
1 II’.’
U
-
.
.
-
a.
1 5’
Figure 6. (a) Color Doppler image of arteriovenous fistula demonstrates the direct communicalion (arrowheads) between the artery and adja. cent vein. A postprocessing feature on the QAD. 1 AngioDynography system, called green tag, allows green to be assigned to the highest mean frequen. cy shifts. The color Doppler image demonstrates the flow at the site of the arteriovenous fistula in green, while the disturbed flow is shown as a mixture of red and blue within the affected vein. (b) Spectral waveform shows that the venous flow distal to the arteriovenous fistula is turbulent and pulsatile. (c) Arteriogram helps confirm the presence of an arteriovenous fistula (arrow) by demonstrating early filling of the common femoral vein (V) following aortic injection. A = femoral artery. (Reprinted, with permission, from reference 8.)
C.
May
1990
Liu et a!
U
RadioGrapbics
U
407
Figure 7. (a) Color Doppler image demonstrates a complex tangle of dilated vessels indicating an arteriovenous maLformation involving the profunda femoral artery. LT left. (b) On this view, a diffuse mixture of red and blue surrounds the affected profunda femoral artery. This represents tissue vibration (bruit) created by the increased amount of flow through the artery from the arteriovenous shunt. SPA = superficial femoral artery, CPA = common femoral artery.
Figure 8. (a) Color Doppler image of benign lymphadenopathy demonstrates blood vessels entering and exiting at a hilum (arrow) Normal anatomy is maintained in the lymph node. (b) Cross-sectional drawing shows the internal architecture of a lymph node. Note the correlation of this diagram with the color Doppler image (a). (Adapted from reference 10.) .
U ARTERIOVENOUS MALFORMATION Arteriovenous malformation is a congenital abnormality in which there is direct commu-
408
U
nication
between
causes Doppler
dilatation imaging
RadioGraphics
U
arteries of arteries demonstrates
Liu et a!
and veins.
This
and veins. Color a complex
swirling sels,
color
as well
the increased
pattern as the
within
tissue
the dilated
vibration
yes-
created
by
amount
of flow caused by the arteriovenous shunt (9) Color Doppler imaging also allows identification of the vessels .
affected
(Fig
7).
Volume
10
Number
3
.w
---a -
.
Figure 9. (a) Color Doppler image of metastatic melanoma. With malignant lymphadenopathy, the architecture of the node is usually obliterated; thus, the branching radial pattern typical of benign nodes is not seen. In this example, vessels are primarily peripheral, surrounding a largely necrotic tumor. (b) Spectral waveform of signals obtained from a vessel in the periphery of the mass indicates continuous flow throughout diastole (top). Compare this waveform with a triphasic waveform typically found in vessels supplying tissues with high vascular resistance, such as skeletal muscle (bottom). a.
U
SOFT-TISSUE
Color
Doppler
MASS
imaging
determine whether cular or nonvascular.
include lymph
benign nodes
the
strating radial
May
performed
can depict of a mass
can help suggest lymphadenopathy
tumor. the morand its re-
the diagby demonseen exiting
hilum (Fig 8). Malignant tends to cause disruption (Fig 9a), but infiltrative ic benign lymphadenopathy.
waveform
enlarged
soft-tissue
normal nodal architecture, blood vessels entering and
1990
to
cause of a mass is vasSolid vascular masses
and malignant or primary
Color Doppler imaging phologic characteristics lationship to the vessel.
The technique nosis of benign
is often
obtained
lymphadenopathy of normal anatomy lymphoma can mimA spectral
from
soft-tissue
masses
typically demonstrates a monophasic, continuous pattern consistent with less downstream resistance than found in vessels supplying skeletal muscle (Fig 9b). Attention to vascular configuration and the presence of continuous forward flow throughout diastole
as at a
Liu
et a!
U
RadioGrapbics
U
409
should prevent confusion between solid vascular mass and pseudoaneurysm (10). Small blood vessels of the tumor can be demonstrated
with
more
readily
duplex
Doppler
with
color
imaging
Doppler
(Fig
than
10).
U VENOUS THROMBOSIS Thrombus within the peripheral
veins can be delineated with color Doppler imaging (1 1). The triad of findings of noncompressibility, low-level echoes within the vein, and lack of color flow information in the area of the defect
indicates
thrombus.
Color
Doppler
im-
aging can also demonstrate small channels in nonocclusive states (Fig 11). Serial examinations can be used to follow up cases of deep venous thrombosis without the potential side effects raphy.
410
U
RadioGrapbics
of invasive
U
studies
Liu et a!
such
as venog-
Figure 10. (a) Color Doppler image of a patient with a large mass in the posterior aspect of the thigh demonstrates the presence of vessels randomly distributed within the mass. (b) Spectral analysis of the tumor vessels demonstrates a monophasic continuous waveform, not consistent with a normal peripheral artery. LT = left. (C) Magnetic resonance image of the mass (M) adds little to the diagnosis of a neoplasm but helps confirm the location and extent of the tumor. Pathologic diagnosis of a poorly differentiated liposarcoma was made following surgical resection.
Volume
10
Number
3
a.
C.
Figure 11. (a) Color Doppler image demonstrates the cephalic extent of thrombus (T) in the superficia! femoral vein (SW) (b) Venogram helps confirm the findings shown in a. Arrows indicate thrombus. A metastasis is seen in the femoral shaft. (C) Color Doppler image of the calf shows the anterior tibia! vein (ANT. TIB. V.) is uninvolved, while the clot extends into the peronea! veins (CLOT). POP. V. = popliteal vein. (d) Venogram helps confirm the findings shown in C. Arrow indicates clot in the peroneal veins. .
May
1990
Liu et al
U
RadioGraphics
U
411
Figure 12. (a) Color Doppler image obtained before surgery demonstrates complete thrombosis of a femoral-to-femoral arterial graft (arrowheads). (b) Another color Doppler image obtained after thrombectomy and before the patient left the operating room shows adequate flow through the graft. Flow velocities may be measured to provide a baseline for follow-up examinations. CPA = common femoral artery.
VASCULAR Color Doppler operatively
2.
GRAfT
U
imaging
has been
to document
adequate
used
intra-
patency
of
vascular grafts before the patient leaves the operating room (Fig 1 2). Grafts can also be followed up with serial examinations to ensure good function and perfusion to the lower extremities. Complications ofgrafts such as perigraft fluid collections can also be imaged with
color
Doppler
techniques
(Fig
3.
4.
diology
4b). 5
CONCLUSION Although the information U
Doppler
im-
aging provides could be obtained with ventional Doppler and two-dimensional
conim-
aging
techniques,
color
color
Doppler
provide this information more with a lesser degree of operator With the color Doppler image guide,
document
spectral
analysis
flow
ly. In our experience, has been a valuable imaging techniques
moral
can
characteristics
be performed
to
precise-
region.
1988;
Abu-Yousof “to-and-fro” of femoral
8.
150:632-634.
DG, Burns P, Needleman L. Color artifact in anechoic regions. J Ultrasound Med (in press). Gooding GAW. B-mode and duplex examination of the aorta, iliac arteries, and the portal vein. In: Zwiebel WJ, ed. Introduction to vascular ultrasonography, 2nd ed. New York: Grune & Stratton, 1 986; 421-444. Igidbashian VW, Mitchell DG, Middleton, WD, et al. latrogenic femoral arterlovenous fistula diagnosis with color Doppler Imag-
Middleton
WD,
Perivascular
U
1.
412
U
RadioGrapbks
We thank Larry Waldroup, Ross, and Kenneth Goodman in the preparation of the arti-
REFERENCES Rapoport S, Sniderman KW, Morse SS, Proto MH, Ross GR. Pseudoaneurysm: complication of faulty technique in femoral arterial puncture. Radiology 1985; 154:529-530.
U
Liu
et a!
AR. The evidence AJR
Mitchell
ing. Radiology
9.
Acknowledgments: BS, RDMS, Fredericj. for their assistance cle.
170:363-366.
MM, Wiese JA, Shamma sign: duplex Doppler artery pseudoaneurysm.
Doppler
7.
color Doppler imaging adjunct to conventional for evaluating the iliofe-
.
1988;
6.
techniques
rapidly and dependence. used as a more
Hessel SJ, Adams DF, Abrams HL. Complicaiions ofangiography. Radiology 1981; 138: 273-281. Mitchell DG, Needleman L, Bezzi M, et al. Femoral artery pseudoaneurysm: diagnosis with conventional duplex and color DopplerUS. Radiology 1987; 165:687-690. PolakJF, Donaldson MC, Whittemore AD. Pulsatile masses surrounding vascular prostheses: real-time US color flow imaging. Ra-
icance 10.
11.
1989;
170:749-752.
Erickson S, Melson color artifact: pathologic
and appearance
on color
GL.
signif-
Doppler
US
images. Radiology 1989; 171:647-652. Morton Ml, CharboneaujW, Banks PM. Inguinal lymphadenopathy simulating a false aneurysm on color-flow Doppler sonography.AJR 1988; 151:115-116. PolakJF, Culter SS, O’Leary DH. Deep veins of the calf: assessment with color Doppler flow imaging. 485.
Radiology
Volume
1989;
171:481-
10
Number
3
Region1
Ji-Bin Liu, MD Daniel A. Merton, BS, RDMS Donald G. Mitchell, MD Laurence Needleman, MD Alfred B. Kurtz, MD Barry B. Goldberg, MD
Color
Doppler
malities how
use
moral
has
of color
fistulas
and
been
used
region.
Doppler
fluid
malformations, masses
to
This
aids
a variety essay
in the
collections,
venous
including
evaluate
pictorial
techniques
pseudoaneurysms,
soft-tissue
.
imaging
in the iliofemoral
diagnoses
and
arteriovenous
vascular
benign
abnor-
of iliofe-
aneurysms,
thrombosis,
tumors
of
demonstrates
grafts,
and
lymphadenopathy.
INTRODUCTION
Because
color
Doppler
imaging
techniques
allow
simultaneous
acquisition
of two-
dimensional and Doppler information, the modality provides a real-time, two-dimensional image of blood flow. With the color image used as a guide, spectral analysis can be performed to demonstrate flow characteristics over time. We used color Doppler imaging with spectral analysis to evaluate abnormalities of suspect-
ed vascular formed
with
ment Wash)
pathogenesis in the iliofemoral region. 5- or 7.5-MHz linear-array transducers AngioDynography
(QAD-1
In all cases,
.
the imaging
system;
Quantum
findings
were
quent surgery and clinical follow-up. This pictorial essay demonstrates how diagnosis or evaluation of pseudoaneurysms,
venous
fistulas,
sue
tumors,
Index
terms:
studies,
Arteries,
93.12984,
RadloGraphics I
From
ferson
the
arteriovenous
vascular
Department
ceivedjanuary print requests cRSNA 1990
92.12984,
98.
Systems,
with
Doppler flow fluid collections,
Issaqua,
those
from
subse-
imaging aids aneurysms,
lymphadenopathy,
in the arterio-
primary
soft-tis-
thrombosis.
1 2984
#{149} Ultrasound
(US),
Doppler
studies,
9. 1 2984
#{149} Veins,
US
98.12984 1990;
Medical
and venous
Medical
correlated
malformations,
grafts,
US studies,
color
All examinations were peron Doppler imaging equip-
of Radiology’.
College, 19,
10:403-412
1990;
10th
and
revision
Division Sansom requested
of Diagnostic
Sea, Philadelphia, February
Ultrasound, PA 19107.
6 and
received
ThomasJefferson From February
the
1989
University RSNA
20; accepted
annual February
Hospital meeting. 26.
and Je( Re-
Address
re-
to B.B.G.
403
a. Figure 1. (a) Color Doppler mixture of red and blue. Note (arrows). FA = femoral artery. distinctive to-and-fro pattern.
b. image demonstrates pseudoaneurysm as a focal mass containing a complex the communicating tract from the affected artery to the pseudoaneurysm (b) Spectral waveform of flow in the communicating tract demonstrates a
Figure 2. Color Doppler image of posttraumatic hematoma demonstrates no flow within the mass overlying the femoral artery.
Figure 3. Color Doppler image of partially thrombosed pseudoaneurysm shows swirling flow within a small portion of a hypoechoic mass, while the larger component exhibits no flow. The absence of flow is the result of thrombus filling a portion of the cavity. Spectral waveform (not shown) displayed a to-and-fro pattern in the communicating tract. The pseudoaneurysm clotted spontaneously,
and
no flow
was
noted
at follow-
up examination.
404
U
RadioGrapbics
U
Liu
Ct
a!
Volume
10
Number
3
a.
b.
Figure onstrate
U
4. Color Doppler images of a fluid collection color noise artifact (a) that is eliminated with
PSEUDOANEURYSM
AND
HEMATOMA Pseudoaneurysm is an uncommon complica. tion of arterial punctures made during transfemoral arteriography; the frequency of pseudoaneurysm development is increased by anticoagulative therapy, hypertension, or improper technique (1 ,2) A pseudoaneurysm usually begins as a hematoma: If the leakage from the disrupted arterial wall does not stop, a fistulous tract may form between the initial hematoma and the femoral artery, producing a pseudoaneurysm. Blood flows into and out of the pseudoaneurysm through this tract. With color Doppler imaging, the pseudoaneurysm can be diagnosed almost immediately: The images depict swirling flow and facilitate identification of the communicating tract (Fig 1 a) distinctive Doppler spectral waveform reflects the characteristic pattern of flow into and out of the pseudoaneurysm (Fig ib) (3-5). It is often difficult to differentiate a hematoma from a pseudoaneurysm clinically, since a hematoma overlies the artery and can appear pulsatile on palpation due to transmitted pulsations. Color Doppler imaging .
.
May
1990
A
surrounding an axillary-femoral use of proper color gain settings
simplifies mas can
this differentiation, be demonstrated
Doppler (Fig
2)
.
examined
bypass (b).
easily
graft dem-
since hematoon color
images as focal masses without flow However, the entire mass must be for absence of flow. In some cases,
only a portion of the pseudoaneurysm may exhibit flow on Doppler images because it is partially thrombosed (Fig 3). Occasionally, color Doppler images may demonstrate “color noise” within an an-
echoic
region,
such
as a hematoma
or fluid
collection. This artifact occurs because of processing algorithms that inhibit color in regions with strong echoes to prevent color from being assigned to moving tissues (6).
The swirling flow of a pseudoaneurysm easily be differentiated from the artifact, since
mixture
the
latter
generally
of red and blue
produces
with
can
a uniform
random-appear-
ing change. When a Doppler spectrum is obtamed, no flow will be demonstrated, a fact that confirms the artifactual nature of this pattern. Changing the color threshold and gain will eliminate this possible pitfall of color Doppler imaging (Fig 4).
Liu
Ct
a!
U
RadioGraphics
U
405
406
U
Radic
I.
1 II’.’
U
-
.
.
-
a.
1 5’
Figure 6. (a) Color Doppler image of arteriovenous fistula demonstrates the direct communicalion (arrowheads) between the artery and adja. cent vein. A postprocessing feature on the QAD. 1 AngioDynography system, called green tag, allows green to be assigned to the highest mean frequen. cy shifts. The color Doppler image demonstrates the flow at the site of the arteriovenous fistula in green, while the disturbed flow is shown as a mixture of red and blue within the affected vein. (b) Spectral waveform shows that the venous flow distal to the arteriovenous fistula is turbulent and pulsatile. (c) Arteriogram helps confirm the presence of an arteriovenous fistula (arrow) by demonstrating early filling of the common femoral vein (V) following aortic injection. A = femoral artery. (Reprinted, with permission, from reference 8.)
C.
May
1990
Liu et a!
U
RadioGrapbics
U
407
Figure 7. (a) Color Doppler image demonstrates a complex tangle of dilated vessels indicating an arteriovenous maLformation involving the profunda femoral artery. LT left. (b) On this view, a diffuse mixture of red and blue surrounds the affected profunda femoral artery. This represents tissue vibration (bruit) created by the increased amount of flow through the artery from the arteriovenous shunt. SPA = superficial femoral artery, CPA = common femoral artery.
Figure 8. (a) Color Doppler image of benign lymphadenopathy demonstrates blood vessels entering and exiting at a hilum (arrow) Normal anatomy is maintained in the lymph node. (b) Cross-sectional drawing shows the internal architecture of a lymph node. Note the correlation of this diagram with the color Doppler image (a). (Adapted from reference 10.) .
U ARTERIOVENOUS MALFORMATION Arteriovenous malformation is a congenital abnormality in which there is direct commu-
408
U
nication
between
causes Doppler
dilatation imaging
RadioGraphics
U
arteries of arteries demonstrates
Liu et a!
and veins.
This
and veins. Color a complex
swirling sels,
color
as well
the increased
pattern as the
within
tissue
the dilated
vibration
yes-
created
by
amount
of flow caused by the arteriovenous shunt (9) Color Doppler imaging also allows identification of the vessels .
affected
(Fig
7).
Volume
10
Number
3
.w
---a -
.
Figure 9. (a) Color Doppler image of metastatic melanoma. With malignant lymphadenopathy, the architecture of the node is usually obliterated; thus, the branching radial pattern typical of benign nodes is not seen. In this example, vessels are primarily peripheral, surrounding a largely necrotic tumor. (b) Spectral waveform of signals obtained from a vessel in the periphery of the mass indicates continuous flow throughout diastole (top). Compare this waveform with a triphasic waveform typically found in vessels supplying tissues with high vascular resistance, such as skeletal muscle (bottom). a.
U
SOFT-TISSUE
Color
Doppler
MASS
imaging
determine whether cular or nonvascular.
include lymph
benign nodes
the
strating radial
May
performed
can depict of a mass
can help suggest lymphadenopathy
tumor. the morand its re-
the diagby demonseen exiting
hilum (Fig 8). Malignant tends to cause disruption (Fig 9a), but infiltrative ic benign lymphadenopathy.
waveform
enlarged
soft-tissue
normal nodal architecture, blood vessels entering and
1990
to
cause of a mass is vasSolid vascular masses
and malignant or primary
Color Doppler imaging phologic characteristics lationship to the vessel.
The technique nosis of benign
is often
obtained
lymphadenopathy of normal anatomy lymphoma can mimA spectral
from
soft-tissue
masses
typically demonstrates a monophasic, continuous pattern consistent with less downstream resistance than found in vessels supplying skeletal muscle (Fig 9b). Attention to vascular configuration and the presence of continuous forward flow throughout diastole
as at a
Liu
et a!
U
RadioGrapbics
U
409
should prevent confusion between solid vascular mass and pseudoaneurysm (10). Small blood vessels of the tumor can be demonstrated
with
more
readily
duplex
Doppler
with
color
imaging
Doppler
(Fig
than
10).
U VENOUS THROMBOSIS Thrombus within the peripheral
veins can be delineated with color Doppler imaging (1 1). The triad of findings of noncompressibility, low-level echoes within the vein, and lack of color flow information in the area of the defect
indicates
thrombus.
Color
Doppler
im-
aging can also demonstrate small channels in nonocclusive states (Fig 11). Serial examinations can be used to follow up cases of deep venous thrombosis without the potential side effects raphy.
410
U
RadioGrapbics
of invasive
U
studies
Liu et a!
such
as venog-
Figure 10. (a) Color Doppler image of a patient with a large mass in the posterior aspect of the thigh demonstrates the presence of vessels randomly distributed within the mass. (b) Spectral analysis of the tumor vessels demonstrates a monophasic continuous waveform, not consistent with a normal peripheral artery. LT = left. (C) Magnetic resonance image of the mass (M) adds little to the diagnosis of a neoplasm but helps confirm the location and extent of the tumor. Pathologic diagnosis of a poorly differentiated liposarcoma was made following surgical resection.
Volume
10
Number
3
a.
C.
Figure 11. (a) Color Doppler image demonstrates the cephalic extent of thrombus (T) in the superficia! femoral vein (SW) (b) Venogram helps confirm the findings shown in a. Arrows indicate thrombus. A metastasis is seen in the femoral shaft. (C) Color Doppler image of the calf shows the anterior tibia! vein (ANT. TIB. V.) is uninvolved, while the clot extends into the peronea! veins (CLOT). POP. V. = popliteal vein. (d) Venogram helps confirm the findings shown in C. Arrow indicates clot in the peroneal veins. .
May
1990
Liu et al
U
RadioGraphics
U
411
Figure 12. (a) Color Doppler image obtained before surgery demonstrates complete thrombosis of a femoral-to-femoral arterial graft (arrowheads). (b) Another color Doppler image obtained after thrombectomy and before the patient left the operating room shows adequate flow through the graft. Flow velocities may be measured to provide a baseline for follow-up examinations. CPA = common femoral artery.
VASCULAR Color Doppler operatively
2.
GRAfT
U
imaging
has been
to document
adequate
used
intra-
patency
of
vascular grafts before the patient leaves the operating room (Fig 1 2). Grafts can also be followed up with serial examinations to ensure good function and perfusion to the lower extremities. Complications ofgrafts such as perigraft fluid collections can also be imaged with
color
Doppler
techniques
(Fig
3.
4.
diology
4b). 5
CONCLUSION Although the information U
Doppler
im-
aging provides could be obtained with ventional Doppler and two-dimensional
conim-
aging
techniques,
color
color
Doppler
provide this information more with a lesser degree of operator With the color Doppler image guide,
document
spectral
analysis
flow
ly. In our experience, has been a valuable imaging techniques
moral
can
characteristics
be performed
to
precise-
region.
1988;
Abu-Yousof “to-and-fro” of femoral
8.
150:632-634.
DG, Burns P, Needleman L. Color artifact in anechoic regions. J Ultrasound Med (in press). Gooding GAW. B-mode and duplex examination of the aorta, iliac arteries, and the portal vein. In: Zwiebel WJ, ed. Introduction to vascular ultrasonography, 2nd ed. New York: Grune & Stratton, 1 986; 421-444. Igidbashian VW, Mitchell DG, Middleton, WD, et al. latrogenic femoral arterlovenous fistula diagnosis with color Doppler Imag-
Middleton
WD,
Perivascular
U
1.
412
U
RadioGrapbks
We thank Larry Waldroup, Ross, and Kenneth Goodman in the preparation of the arti-
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Radiology
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1989;
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10
Number
3
