الرحمن الله الرحمن بسم الله بسم الرحيمالرحيم

Clinical applications of Doppler USClinical applications of Doppler US..

ByBy

Dr. Talaat KhaterDr. Talaat Khater

Radiology specialist, HNHRadiology specialist, HNH..

““Small ideas Small ideas

can make a big can make a big

differencedifference”.”.

Story of DopplerStory of Doppler

Advantages of DopplerAdvantages of Doppler Available.Available. Quick and real time with immediate interpretation.Quick and real time with immediate interpretation. Non-invasive and safe.Non-invasive and safe. Relatively of low cost.Relatively of low cost. Mobile for poly trauma and unstable patients.Mobile for poly trauma and unstable patients. High sensitivity. High sensitivity.

Disadvantages of DopplerDisadvantages of Doppler Operator dependant.Operator dependant. Not easy.Not easy. Limitations (calcifications, air, obesity, etc..). Limitations (calcifications, air, obesity, etc..).

The Doppler clinical applicationsThe Doppler clinical applications

The extremitiesThe extremities Arterial system.Arterial system.

Ischemia (occlusion/stenosis).Ischemia (occlusion/stenosis). Aneurysm/pseudo-aneurysm.Aneurysm/pseudo-aneurysm. Dissection.Dissection. Others (arteritis, compression).Others (arteritis, compression).

Venous system.Venous system. DVT.DVT. Thrombophlebitis.Thrombophlebitis. VV.VV. Venous mapping.Venous mapping.

Normal appearance

Limb IschemiaLimb Ischemia

Severe stenosis SFA.

SFA origin occlusion. EIA occlusion.

CFA stent with intimal hyperplasia.

Aneurysm

Permenant localized dilation

VENOUS DISORDERSVENOUS DISORDERS

DVT.DVT.

Varicose veins.Varicose veins.

Thrombophlebitis. Thrombophlebitis.

Renal DopplerRenal Doppler

HTN esp. in young age (most common cause).HTN esp. in young age (most common cause).

Renal impairment (Important indices):Renal impairment (Important indices): S/D ratio.S/D ratio. RI.RI. PI. PI.

Post transplantation. Post transplantation.

Reno-vascular diseaseReno-vascular disease

NephropathyNephropathy

Renal graft integrityRenal graft integrity

Norm

AVF

RV Th

Fail

Dialysis AVFDialysis AVF

Pre-operative evaluation of arm vessels (site, Pre-operative evaluation of arm vessels (site,

caliber and patency).caliber and patency).

Post-operative evaluation.Post-operative evaluation. Follow up.Follow up.

Hepatic vesselsHepatic vessels

Portal vein thrombosis.Portal vein thrombosis.

Portal hypertension.Portal hypertension.

Budd chiari syndrome.Budd chiari syndrome.

Carotid atherosclerosis.Carotid atherosclerosis.

Carotid arterial stenosis/occlusion.Carotid arterial stenosis/occlusion.

Carotid dissection.Carotid dissection.

Carotid aneurysms.Carotid aneurysms.

Carotid body tumor.Carotid body tumor.

External arterial compression. External arterial compression.

Carotid artery DopplerCarotid artery Doppler

Carotid artery stenosisCarotid artery stenosis

Male genital systemMale genital system

Scrotal Doppler:Scrotal Doppler:

Varicocele.Varicocele.

Inflammations.Inflammations.

Torsion.Torsion.

Tumors.Tumors.

Penile Doppler Penile Doppler (vasogenic ED).(vasogenic ED).

Gynecological applicationsGynecological applications Diagnosis of corpus lutium Diagnosis of corpus lutium (ring of fire).(ring of fire). Masses (uterine, ovarian and adnexal).Masses (uterine, ovarian and adnexal). Ovarian artery Doppler and infertility.Ovarian artery Doppler and infertility.

Distinguish dominant ovary (low impedance). Distinguish dominant ovary (low impedance). If ovary with If ovary with CL and its RI>0.5) CL and its RI>0.5) non-viable outcome. non-viable outcome.

Active follicle (faint ring of fire).Active follicle (faint ring of fire).

Uterine artery Doppler and infertility.Uterine artery Doppler and infertility. Normal uterine artery (high impedance) high PI.Normal uterine artery (high impedance) high PI. Vascularity at proliferative endomtrium (zone 3).Vascularity at proliferative endomtrium (zone 3). Medium PI values (PI < 2), best prediction for pregnancy.Medium PI values (PI < 2), best prediction for pregnancy.

Obstetric applicationsObstetric applications Detection of fetal pulse in early pregnency.Detection of fetal pulse in early pregnency. Detects blood flow within umbilical cord.Detects blood flow within umbilical cord. Uterine artery Doppler and predictable Uterine artery Doppler and predictable

pregnancy outcome.pregnancy outcome. Umbilical artery Doppler and predictable Umbilical artery Doppler and predictable

pregnancy outcome.pregnancy outcome. Middle cerebral artery Doppler and predictable Middle cerebral artery Doppler and predictable

pregnancy outcome.pregnancy outcome.

Fetal well-beingFetal well-being

Important indices:Important indices: S/D ratio.S/D ratio. RI.RI. PI.PI.

Umbilical artery indices.Umbilical artery indices.

MCA indices. MCA indices.

Doppler in inflammatory changesDoppler in inflammatory changes

Hypervascularity (acute inflammations).Hypervascularity (acute inflammations).

Normo- or hypovasculairty (granulomatous or Normo- or hypovasculairty (granulomatous or

chronic inflammatory changes).chronic inflammatory changes).

Ring of fire (abscess) Ring of fire (abscess) = hyper vascular peripheral walls = hyper vascular peripheral walls

with non-vascular necrotic centerwith non-vascular necrotic center. .

Doppler characterization of massesDoppler characterization of masses Simple cysts (no vascularity). Simple cysts (no vascularity). Atypical cysts (wall or septal vessels).Atypical cysts (wall or septal vessels). Mixed tumors (vascular bed within the soft Mixed tumors (vascular bed within the soft

tissue component).tissue component). Solid masses:Solid masses:

Benign circulation = high impedance vascularity. Benign circulation = high impedance vascularity. Malignant circulation = low impedance vascularity.Malignant circulation = low impedance vascularity. Borderline (inconclusive). Borderline (inconclusive).

Last wordsLast words The principle of Doppler greatly widened the The principle of Doppler greatly widened the

field of radiological diagnosis.field of radiological diagnosis. Doppler is a safe, rapid and low cost investigation Doppler is a safe, rapid and low cost investigation

with great potential. with great potential. Although Doppler is operator dependant; it can Although Doppler is operator dependant; it can

help in diagnosis of plenty of medical and help in diagnosis of plenty of medical and surgical conditions with high sensitivity.surgical conditions with high sensitivity.

And finallyAnd finally

Where are the Doppler cases in this hospital ?????

Any Any questionsquestions

??????