Dynamic Flow US, Color Doppler US, and Power Doppler US in the Assessment of Vessel Signals of Thoracic Lesions Abutting Pulsatile Organs

Rationale and Objectives

Dynamic flow ultrasound (DFUS) is a new color Doppler imaging method with better B-mode imaging and fewer blooming effects and color noises. This study was designed to compare the imaging quality of vessel signals in thoracic lesions using DFUS, color Doppler US (CDUS), and power Doppler US (PDUS).

Materials and Methods

Thirty-four patients with thoracic lesions abutting pulsatile organs [heart ( n = 13), aorta ( n = 14) and pulmonary artery ( n = 7)] and undergoing complete chest US examinations were included to assess the imaging quality about vessel signals, blooming effect, color noise, and the influence of decision in needle biopsy between different US modes.

Results

Our results showed that DFUS, CDUS, and PDUS could all demonstrate the vessel signals clearly (all P > .05). However, when focusing on the blooming effect and color noise, DFUS showed the more superior imaging quality than CDUS and PDUS (all P ≤ .001); and acceptable blooming effects/color noise were found with 100% (34/34)/97% (33/34), 35% (12/34)/68% (23/34), and 26% (9/34)/38% (13/34) in DFUS, CDUS, and PDUS, respectively. Especially, in the assessment of decision making for percutaneous needle biopsy, DFUS had the less influence than CDUS and PDUS (3% [1/33] versus 29% [10/34] and 3% [1/33] versus 38% [13/34], both P < .01).

Conclusions

We concluded that DFUS has a clearly more superior imaging quality than CDUS and PDUS in demonstrating the vessel signals of thoracic lesions, with less blooming effect and color noise.

Chest ultrasound (US) examination and US-guided needle biopsy have been widely used to assess and diagnose thoracic lesions abutting the chest wall with promising results, even in critically ill patients ( ). However, the use of conventional gray-scale US only is often limited in the assessment of vessel signals in thoracic lesions because US-guided needle biopsy for pulmonary lesions is somewhat risky, especially the biopsy of uncommon and unknown mediastinal tumors and pulmonary consolidations ( ). Thus the real-time visualization of vessel signals during the performance of US-guided needle biopsy becomes more important, useful, and valuable ( ).

For the evaluation of vessel signals in normal tissues, organs, and pathologic lesions, color Doppler US (CDUS) and Power Doppler US (PDUS) have been used to assess vessel signals, including those of the cardiovascular system, abdominal lesions, obstetric and gynecologic lesions, breast lesions, carotid and intracranial vessels, and pulmonary lesions ( ). Nevertheless, CDUS and PDUS can easily produce blooming effects of vessels and color noises in demonstrating the lesions abutting pulsatile organs ( ). The blooming effects of vessels render the US assessment of vessel signals not so real, and color noises lower confidence in the US demonstration of vessel signals.

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Materials and methods

Patients

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Chest US Examinations

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Definition of Vessel Signal, Blooming Effect and Color Noise of Sonographic Appearances

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Imaging Data Interpretation, Comparison, and Statistical Analysis

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Results

Demographic Data

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Table 1

Demographic Data and Clinical Diagnoses in 34 Patients with Thoracic Lesions

Items Number ( n ) Patient no. 34 Sex (M/F) 28/6 Age (Mean ± SD) 58.6 ± 16.9 (23–86) Clinical diagnoses Lung cancer 18 Squamous cell carcinoma 11 Adenocarcinoma 5 Small-cell lung cancer 2 Metastatic colon cancer 1 Metastatic breast cancer 1 Anterior mediastinal tumor 4 Thymoma 1 Malignant lymphoma 2 Germ cell tumor 1 Benign lesions 9 Tuberculosis 4 Lung abscess 2 Pneumonia 3 Unknown diagnosis 1

Table 2

Lesion Sizes, Locations, and Abutting Pulsatile Organs in 34 Thoracic Lesions

Items Number ( n ) Locations Left upper lobe 15 Right upper lobe 9 Left lower lobe 3 Right middle lobe 3 Anterior mediastinum 4 Lesion size <5 cm 2 5–10 cm 21 10–15 cm 9 ≥15 cm 2 Abutting pulsatile organ Heart 13 Aorta 14 Pulmonary artery 7

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Comparison of Vessel Signals, Blooming Effect, Color Noises, and Influence of Needle Biopsy Decision between Different US Modes

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Table 3

Imaging Quality Comparison between DFUS, CDUS, and PDUS in 34 Thoracic Lesions

US Mode Imaging Quality DFUS n (%) CDUS n (%) PDUS n (%) Vessel Signals Clear 31 (91) 31 (91) 29 (85) Cloudy 3 (9) 1.00 ⁎ ‡ 3 (9) 0.71 ⁎ § 5 (15) 0.71 ⁎ ∥ Blooming effect Prominent 0 (0) 22 (65) 25 (74) Acceptable 34 (100) <0.001 † ‡ 12 (35) 0.431 † § 9 (26) <0.001 † ∥ Color noise Prominent 1 (3) 11 (32) 21 (62) Acceptable 33 (97) 0.001 † ‡ 23 (68) 0.015 † § 13 (38) 0.001 † ∥ Needle biopsy Affect or change decision 1 (3) 0.003 † ‡ 10 (29) 0.442 † § 13 (38) No influence 33 (97) 24 (71) 21 (62) <0.001 † ∥

DFUS, dynamic flow ultrasound; CDUS, color Doppler ultrasound; PDUS, power Doppler ultrasound.

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Illustrative Cases

Patient 1

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Patient 2

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Patient 3

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Discussion

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References

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Dynamic Flow US, Color Doppler US, and Power Doppler US in the Assessment of Vessel Signals of Thoracic Lesions Abutting Pulsatile Organs

Rationale and Objectives

Materials and Methods

Results

Conclusions

Materials and methods

Patients

Chest US Examinations

Definition of Vessel Signal, Blooming Effect and Color Noise of Sonographic Appearances

Imaging Data Interpretation, Comparison, and Statistical Analysis

Results

Demographic Data

Comparison of Vessel Signals, Blooming Effect, Color Noises, and Influence of Needle Biopsy Decision between Different US Modes

Illustrative Cases

Patient 1

Patient 2

Patient 3

Discussion

References

Further Reading

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