Question:

Regarding spectral waveforms on color Doppler sonography, which of the following is/are true?
1. Resistive index is defined at S-D/D
2. A resistive index of 0.7 is considered normal for a testicle.
3. Reversal of diastolic flow is considered a high resistive index pattern
4. Reversal of diastolic flow on testicular ultrasound is diagnostic of infarction.
5. Reversal of diastolic flow indicates antegrade flow during systole and retrograde flow during diastole.





Answer:

The correct answers for the question "Regarding spectral waveforms on color Doppler sonography, which of the following is/are true?" are:

2. A resistive index of 0.7 is considered normal for a testicle.

3. Reversal of diastolic flow is considered a high resistive index pattern

5. Reversal of diastolic flow indicates antegrade flow during systole and retrograde flow during diastole.



Explanation

1. "Resistive index is defined as (S-D)/S where S is the height of the systolic peak and D is the height of the end diastolic peak."

2. "Normal resistive indices for a testicle are 0.48-0.75 with a mean of 0.62."

3. "Reversal of diastolic flow in a testicle is a high resistive index pattern…"

4. "…reversal of diastolic flow in the affected testicle is an ominous sign of impending infarction and the ordering physician should be notified as this may prompt a change in the patient`s treatment plan and/or surgical exploration."

5. "Reversal of diastolic flow in a testicle is a high resistive index pattern and indicates antegrade flow into the testicle during systole and retrograde flow during diastole, which causes resultant loss of tissue perfusion."



From the manuscript:
Significance of Reversal of Diastolic Blood Flow in the Evolution of Testicular Infarction as a Complication of Epididymo-Orchitis
Radiology Case. 2009 Jun; 3(6):21-25


This article belongs to the GU section.




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From the manuscript

Significance of Reversal of Diastolic Blood Flow in the Evolution of Testicular Infarction as a Complication of Epididymo-Orchitis

Free full text article: Significance of Reversal of Diastolic Blood Flow in the Evolution of Testicular Infarction as a Complication of Epididymo-Orchitis

Abstract
We report a case of a 50-year-old male who presented to the Emergency Department and was diagnosed with epididymo-orchitis. Sonographic evaluation of the testicle initially showed a normal, low resistance color Doppler waveform. The patient was admitted to the hospital. A follow up sonogram two days later demonstrated reversal of diastolic arterial flow on Pulse-Wave color Doppler imaging. Reversal of diastolic blood flow in testicular color Doppler sonography is a sign of impending infarction. On hospital day 6, the patient had a follow up ultrasound which demonstrated infarction of the testicle. Pathology confirmed the diagnosis and the tissue culture grew E. coli and Candida Albicans. This case documents the rapid progression of epididymo-orchitis with a normal spectral waveform to testicular infarction with reversal of diastolic blood flow on color Doppler imaging as a sign of impending infarction.






References



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