Colour Doppler ultrasound mapping of chest wall lesions

Abstract

Spectral curve-analysis of arterial flow signals (FS) in patients with pulmonary lesions is able to discriminate FS of bronchial arteries (BA) from FS of pulmonary arteries (PA). In patients with chest wall lesions a different FS from that of the BA/PA can be obtained. The aim of the study was to evaluate and characterize arterial supply of chest wall lesions using quantitative colour Doppler ultrasound (CDS). Between September 2002 and June 2003, 29 consecutive patients with chest wall lesions were examined by CDS. 16 lesions were located strictly to the chest wall (group I). 13 lesions had a chest wall lesion with pulmonary extension (group II). The following parameters were prospectively determined: (1) qualitative CDS (absence or evidence of vascularity); (2) quantitative CDS of intercostal or non-intercostal located arterial FS (resistive index (RI) and pulsatility index (PI)); (3) number of different arterial FS in one lesion using CDS-mapping. In a control group of 17 healthy volunteers quantitative measurement of RI and PI of the intercostal artery (ICA) was performed. 4 of 29 patients (14%) had no FS by CDS mapping. Quantitative CDS parameters of the control group were mean RI of ICA 0.88 (¡0.056); mean PI of ICA 2.88 (¡0.643); of group I mean RI of ICA 0.79 (¡0.127) mean PI of ICA 1.93 (¡0.641), and of group II mean RI of ICA 0.79 (¡0.144), mean PI of ICA 2.1 (¡1.015), mean RI of non-ICA 0.68 (¡0.675) mean PI of non-ICA 2.5 (¡2.506). Median RI as well as PI- value obtained within the chest wall (ICA) do not differ between group I, group II, and the control group. Within group II impedance measurements discriminates intercostal from non-intercostal arterial supply. In 29 patients 37 different arterial FS were obtained. None of the 16 patients in group I and 8 of the 13 patients in group II had 2 or more different FS. Lesions strictly located to the chest wall had an arterial supply characteristic for ICA by quantitative CDS. Chest wall lesions with pulmonary extension demonstrate a complex arterial supply by quantitative CDS. Colour Doppler ultrasound (CDS) can be used as a qualitative or a quantitative method to describe flow patterns in pleurally based pulmonary lesions. Qualitative CDS pattern show characteristic findings in various pulmonary lesions (1-6). Quantitative CDS of arterial flow signals (FS) enables discrimination of FS of bronchial arteries (BA) characterized by a monophasic low impe- dance flow pattern from FS of pulmonary arteries (PA) characterized by a triphasic high impedance flow pattern (4-8). In a recent study (9) of chest wall based pulmonary lesions a variable impedance, monophasic flow pattern could discrimate from FS of PA and FS of central BA by spectral analysis. The aim of the present study is to evaluate and characterize arterial supply of chest wall lesions with quantitative CDS.