Abstract
Article: Visualization of Blood Flow in an Undermined Pressure Ulcer Revealed by Sonographic Imaging and Clutter Suppression Post-Processing: A Case Report
Authors: Koichi Yabunaka, PhD, Gojiro Nakagami, PhD, Aya Kitamura, MHS, Tomomitsu Miyagaki, MD, Akitatsu Hayashi, MD, Sanae Sasaki, Hiromi Sanada, PhD
Category: Vascular [VT]
Credit: 1.0 SDMS CME Credit
Objectives: After studying the article entitled “Visualization of Blood Flow in an Undermined Pressure Ulcer Revealed by Sonographic Imaging and Clutter Suppression Post-Processing: A Case Report,” you will be able to:
Describe the pathophysiology of pressure ulcers
Describe the gray-scale and Doppler sonographic features of a pressure ulcer
Apply clutter suppression imaging techniques to enhance vascular imaging
The DESIGN-R system is used to evaluate Overall wound severity Vascularity of wounds Depth of pressure ulcers Size of pressure ulcers
In the case reported, a pressure ulcer was noted secondary to Stress from an early closed head injury An early spinal cord injury requiring wheelchair confinement Diabetes and poorly fitted shoes Severe atherosclerotic disease
Power Doppler imaging is typically somewhat more sensitive than color Doppler imaging for Elevated flow velocities in small blood vessels Elevated flow velocities in large, stenotic blood vessels Slow flow in small blood vessels Slow flow in aneurysmal blood vessels
Physical examination of pressure ulcers is limited by the inability to evaluate Ulcer size Associated deep-tissue injury Possible presence of infection Surrounding skin changes
Gray-scale sonographic features of the pressure ulcer reported included A hyperechoic region with indistinct borders A hyperechoic region with irregular borders A hypoechoic region with smooth, well-defined borders A hypoechoic region with irregular borders
Hypoechoic signals from the reported pressure ulcer bed were felt to be secondary to Granulation tissue associated with healing Fibrous connective tissue surrounding the ulcer Undermining of the ulcer Subcutaneous fatty tissue
Color and power Doppler sonographic features of the pressure ulcer reported included Absence of associated vascularity Minimal associated vascularity Vascularity within isolated nodular structures within the ulcer bed Prominent associated vascularity
Clutter suppression imaging potentially improves upon color Doppler imaging by Suppressing Doppler flow signals Enhancing gray-scale images of superficial structures Improving tissue–slow blood flow separation in the image Removing gray-scale information from the final image
A potential limitation of color Doppler and power Doppler imaging is Lack of associated gray-scale information Blooming of color outside the lumen of small vessels Poor sensitivity to stenotic flow signals Suppression of tissue motion artifacts
Studies have shown the utility of color Doppler and power Doppler in predicting the prognosis of pressure ulcers by evaluating the Degree of associated inflammation Surface area of the ulcer Depth of the ulcer Edema surrounding the ulcer
Footnotes