Background: The purpose of our study was to assess the potential of color Doppler (CD) and Power Doppler Imaging (PDI) to differentiate benign from malignant solid breast masses. Materials and Methods: Seventy-one biopsy proven solid breast masses were evaluated with CD and PDI using 7.5MHz Transducer. Vascularity, Resistive Index (RI) and patterns of vascular distribution of masses were assigned before biopsy. Results: There were 22 cancers and 49 benign lesions. All malignant masses had vascularity in some degrees, except 3 cancers which were less than 10 mm in diameter. Most of cancers were hypervascular (15 cancers) and had penetrating or diffuse vessels (14 cancers). Most of benign lesions and fibro adenomas were avascular (35 masses). 12 cancers, 2 fibro adenomas and all vascular benign lesions had RI>0.6. 7 cancers and 6 fibro adenomas had RI<0.6. By using hypervascularity to indicate malignancy sensitivity for CD and PDI was 68 percent and specificity was 90 percent and by using penetrating and diffuse vessels sensitivity was 64 percent and specificity was 82 percent. By using RI<0.6 sensitivity was 32 percent and specificity was 88 percent and by using these three criteria together sensitivity was 73 percent and specificity was 82 percent (p<0.00001). Conclusion: The vascularity and pattern of distribution and morphology of blood vessels in solid breast masses seen at PDI and CD is a potentially important feature to predict the likelihood of malignancy. But RI appears to be of limited value.

Background: Diagnosis of transient ischemic attack within the territory of vertebral arteries is difficult owing to diversity of clinical symptoms. CT scans or MRI may be of little help in arriving at diagnosis. Although angiography can detect vertebral artery lesions, it is an invasive and expensive procedure. Doppler echo sonography of the vertebral artery can provide useful information regarding the presence and extent of ischemia, as well as the velocity and flow of blood in the artery.Patients and Method: This observational case-control study was conducted between 1995 and 1999 at AIZahra Hospital, Isfahan, in order to investigate the status of vertebral artery in patients with transient ischemic attacks within the perfusion territory of the vertebral arteries. Carotid artery diameter, as well as the velocity and blood flow were measured by Doppler echo sonography in 100 patients presenting with vertebrobasilar artery insufficiency and 100 controls.Results: Mean diameter of right common carotid, left common carotid, right vertebral and left vertebral artery in the control group measured 6.8 mm, 6.9 mm, 3.3 mm and 6.0 mm. Vertebral artery blood flow in the case group was significantly higher than in the control group (P<0.005).The ratio of measured parameters in the two groups also showed significant differences between the two groups (P>0.001). The carotid/vertebral ratio index was also significantly different (P>0.001).Discussion: The sensitivity and specificity of the aforesaid indices in detecting vertebrobasilar artery ischemia measured (77.8% and 90% respectively) suggests that Doppler sonography of carotid and vertebral arteries is a reliably sensitive and specific method for detection of ischemia within the perfusion territory of the vertebral arteries.

Introduction: The aim of this prospective study was to assess the ocular hemodynamic changes in patients with Behcet’s disease and to compare them with patients with idiopathic uveitis and the normal control group.Materials and Methods: The present study was carried out on 20 patients (40 eyes) with ocular Behcet’s disease, 20 patients (40 eyes) with idiopathic uveitis and 20 (40 eyes) healthy cases (healthy control group). In order to detect the hemodynamic changes in ocular Behcet’s disease, the peak systolic and end-diastolic velocities (PSV, EDV), the resistive index (RI) of the central retinal artery (CRA) and the ophthalmic artery (OA) and the velocity of the central retinal vein (CRV) were determined.Results: The mean PSV and EDV (9.3 and 2.4 cm/sec, respectively) in the CRA were significantly lower in patients with Behcet’s disease than in healthy controls (11.5 and 3.5 cm/sec, respectively), and also lower than in patients with idiopathic uveitis (11.2 and 3.3 cm/sec, respectively). In the patients with Behcet's disease, a statistically significant decrease compared to the control group and the patients with idiopathic uveitis was detected in the mean PSV of the OA (31.8 compared with 36.1 and 35.2 cm/sec, respectively).Conclusions: These results demonstrate the presence of some circulatory difference in the flow velocities of the CRA and OA in patients with Behcet’s disease when compared with control group and patients with uveitis.

Background: Carpal tunnel syndrome (CTS) is the most common upper extremity impingement neuropathy caused by median nerve compression within the carpal tunnel due to various conditions such as bone abnormalities, inflammation, trauma, neoplastic lesions and endocrinopathies. Increase in carpal tunnel pressure of more than 20 to 30 mmHg blocks the epineural blood flow; so, the nerve function is damaged. Carpal tunnel syndrome is primarily a clinical diagnosis supported by electrodiagnostic studies; in recent years, different imaging modalities, including magnetic resonance imaging (MRI) and ultrasound, are suggested for diagnosis of carpal tunnel syndrome.Methods: During November 2011 and May 2013, 84 patients clinically suspicious for carpal tunnel syndrome were enrolled in our study; the age of patients ranged from 19 to 66 with the average of 43 years and the sex ratio of women to men was 2.7: 1. All the patients underwent electerodiagnostic tests (EDT) as the gold standard diagnostic modality and the results of color Doppler sonography (CDS) were compared with electerodiagnostic findings.Findings: According to the ecterodiagnostic tests, patients with positive results of carpal tunnel syndrome were divided into three groups of severity including mild with 9 patients (11%), moderate with 14 cases (17%) and severe with 18 patients (21%). Sensitivity of color Doppler sonography for diagnosis of carpal tunnel syndrome was almost 83%, 71% and 55% in severe, moderate and mild groups of carpal tunnel syndrome, respectively.Specificity of this imaging modality was determined near to 81% in all three groups of the patients.Conclusion: In addition to electerodiagnostic tests, which are considered as the modality of choice for diagnosis of carpal tunnel syndrome, Doppler ultrasound can be a non-invasive imaging procedure for evaluation of patients that are clinically suspicious to this syndrome. Considering three groups of carpal tunnel syndrome based on severity of electerodiagnostic signs, results of color Doppler sonography is more reliable in patients with severe signs.

Infertility is defined as the failure to conceive a desired pregnancy after 12 months of unprotected intercourse, and affects 10 percent of married couples.The causes of infertility can involve one or both partners.Causes of female infertility:• Fallopian tube factors (damage or blockage due to salpingitis, EP)• Ovulation disorders (PCOS, Early menopause )• Uterine factors• Intrauterine lesions (fibroids, polyps, synechiae)• Structural pathology (mullerian duct anomalies)• Pelvic adhesions• Endometriosis• Elevated prolactin.Sonography is commonly regarded as the preferred imaging modality in the study of the female pelvis. It is widely available, noninvasive. Relatively cheap, does not use ionizing radiations, and is able to provide definitive diagnostic information in a large variety of clinical settings.Different types of sonography:• Trans abdominal• Trans vaginal• Trans rectal• Hysterosonography• Color Doppler and pulsed Doppler sonography• Three-dimensional sonography.Transvaginal sonography (TVS) has a vital role in the management of infertility disorders related to a variety of gynecologic disorders.The addition of color Doppler capabilities to transvaginal probes permits visualization of small intraovarian and endometrial vessels, allowing depiction of normal and abnormal physiologic changes in the ovary and uterus.Ultrasound is commonly regarded as the first approach to the infertile patient and is employed for four main purpose: identification and documentation of the integrity of the reproductive tract as a conduit for the passage of gametes and embryos; detection of pathological processes that may be a cause of or a contributing factor to infertility; monitoring cyclic changes of the uterus and ovary to document normal physiology or pathological situations; and monitoring and guiding infertility treatment.

Testicular ultrasound should be performed in every patient with unexplained infertility and abnormal sperm analysis. It allows diagnosis of more pathologic conditions than physical examination.Varicocele, whose association with male infertility has been clearly documented in the literature, is a common finding in adolescents and adult men, being diagnosed in 20-40% of infertile patients. A correct and early diagnosis of this affliction is of great importance because, in most cases, a timely correction usually performed using percutaneous sclerotherapy, leads to an improvement in semen quality. Currently, physical examination is the mainstay of diagnosis, but this is affected by a low sensibility and specificity, especially in cases of low grade varicocele.Colour Doppler ultrasound (CDU) is a new, reliable and non-invasive diagnostic method for the evaluation of varicocele of testes which allows the detection of even subclinical varicocele thanks to its capacity for measuring the diameter of the pampiniform plexus veins and blood flow parameters of the spermatic veins.Besides a rapid varicocele screening, colour Doppler ultrasound allows us to evaluate its hemodynamic repercussion, by studying the spectral display, colour and response to Valsalva's. It also provides an exact measure of testicular volume, allows detecting the presence of dystrophic changes in the testicle, as well as anomalies of the epididymis and vas deferens, such as cystic dilations. It is also the test of choice to detect non descended testicles. Ultrasound may also detect non palpable testicular tumors which are more prevalent in this group of patients.Colour Doppler study of testicular mass can help to physicians to distinguish between benign and malignant tumor and hypo or hyper malignant mass.AS well as other modality for erectile dysfunction diagnosis and following colour Doppler ultrasound has a excellent roll.

Background/Objective: Thyroid nodules are a common finding, especially in our country. In this study, we evaluated the role of conventional ultrasonography (US) and color doppler sonography (CDS) in assessment of cold thyroid nodules. Materials and Methods: Ninety-seven patients with a cold thyroid nodule were examined by US and CDS before thyroidectomy .On US, the presence of a halo sign, hypoechogenicity or microcalcification was evaluated .The vascular pattern on CDS was classified as follows: Type 1, absence of blood flow; Type 2, perinodular blood flow; Type 3, intranodular blood flow. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasound and color doppler findings were evaluated. Ultrasound findings have been compared with postoperative pathological result. Results: In 38 patients, thyroidal carcinoma was found. Absence of halo sign, presence of microcalcification and hypoechogenicity were predictive of malignancy (P < 0.001). Presence of intranodular hyper-vascularity and perinodular hypervascularity were in favor of malignancy (P < 0.001) and benignity (P < 0.01), respectively. An avascular pattern could not differentiate between benign and malignant nodules. Conclusion: US and CDS findings can predict malignant nodules, especially when multiple signs are simultaneously present.

Background: Determination whether spectral Doppler ultrasound parameters, including resistance index (RI) and pulsatility index (PI), or vascular pattern can be used to distinguish malignant from benign thyroid nodules.Methods: This study was done in 1388.120 patients with thyroid nodules were selected from our patients attending Al-zahra hospital, in Isfahan. We prospectively examined 120 thyroid nodules in patients undergoing surgery. The flow pattern seen via power Doppler examination was ranked for each nodule on a scale of 0 to 4 as follows: absent, perinodular alone, mixed with perinodularprominency, mixed with intranodularprominency, and exclusively intranodular, respectively. For each nodule, the RI and PI values were recorded as the average of the recordings obtained. Pathological examination were used as a proof of final diagnosis to categorize all nodules as benign or malignant. The data collected in check list then the data analyzed by Chi-square with SPSS15.Finding: The mean age in patients was 45.44±14.3 years. The malignant nodules had a mean RI of 61% +/- 0.05. These values were significantly higher than those associated with benign nodules (P=.000). Shifting to intranodular vascularization had a significant correlation with malignancy (P=.001).Conclusion: Spectral parameter and vascular pattern are useful to distinguish malignant from benign thyroid nodules, especially for those with suspicious or undetermined fine-needle aspiration biopsy.

Chorionic villus sampling (CVS) is an invasive method for identifying genetic and metabolic diseases, which is done in the first trimester of pregnancy and can cause many complications. The aim of this study is the evaluation of the correlation between Transabdominal chorionic villus sampling and fetal distress in color Doppler sonography. This study is experimental (before and after). All pregnant women with minor thalassemia in which their husbands were suffering from minor thalassemia or have a history of a child with major thalassemia and after the 12th week of pregnancy were referred to the ultrasound department. RI for fetal Middle Cerebral Artery (MCA) and Umbilical Artery (UA) before and after of CVS were measured and then statistically analyzed using SPSS 22. CVS did not cause a significant increase in RI for the fetal middle cerebral artery (P>0. 05). CVS did cause a significant increase in RI for the umbilical artery (P<0. 05). Then, CVS did cause a significant decrease in the ratio of RI for fetal Middle Cerebral Artery to RI for Umbilical Artery (P<0. 05). Based on these results, it seems that CVS can cause distress in the fetus.