The renal arteries of 62 children and adolescents aged 1-16 years without renal or renovascular disease were examined by computer Doppler duplex sonography (DDS) to measure absolute renal blood flow velocities. Maximum systolic velocity (Vmax) and time average velocity (TAV) were not age-dependent. In addition, absolute values of renal artery and renal blood flow were measured. Renal blood flow was 4.1 +/- 1.2 ml/min per gram kidney (two standard deviations), independent of age and comparable to commonly accepted physiological values. The coefficient of variation of blood flow calculations was 6%-15% depending on vessel diameter.

Computed duplex sonography was used to examine the renal arteries in 36 hypertensive children and adolescents (ages 4-17 years) with arterial hypertension of either renal or non-renal origin. Time-averaged flow velocities, maximum blood flow velocities as well as absolute renal blood flow and renal blood flow per gram kidney weight were measured. Normal flow velocities and normal to elevated renal blood flow volume was found in patients with acute glomerulonephritis and those with signs of chronic glomerulonephritis onset. Patients having advanced stages of chronic glomerulonephritis, on the other hand, were characterized by lower levels of all parameters. Unilateral renal artery stenosis was diagnosed correctly in four patients, although one intra-renal artery stenosis escaped imaging. Scarred kidneys exhibited low-normal or reduced flow velocities and renal blood flow volumes corresponded roughly to kidney size and preservation of normal kidney structure. Hypertension in some patients with normal kidneys showed a tendency to cause higher renal blood flow without consistent acceleration of blood flow velocities. We conclude that duplex sonography is a suitable primary diagnostic tool in measuring blood flow velocities and absolute renal blood flow volume in hypertensive children, thus facilitating the choice of the next diagnostic step.

Transcranial color Doppler sonography is a new diagnostic technique which allows real-time, color-coded imaging of basal cerebral arteries, with simultaneous demonstration of parenchymal structures in the B-mode scan. With this technique we were able noninvasively to show a giant fusiform aneurysm of the middle cerebral artery (MCA) in an 11-year-old boy. Transcranial color Doppler sonography through the intact temporal bone demonstrated the size and location of the aneurysm and provided real-time imaging of the pulsating intra-aneurysmal flow. Additionally, duplex sonographic measurements of intravascular flow velocities within the aneurysm and the feeding and draining artery were possible. Postoperatively, patency of the MCA with reduced flow velocities after excision of the aneurysm could be shown. This is the first transcranial color Doppler report in a patient with an intracerebral aneurysm. In our opinion, transcranial color Doppler sonography offers new diagnostic possibilities in patients with cerebrovascular disorders.

To investigate early signs of hepatobiliary disease in CF, we measured portal, splenic, superior mesenteric vein and hepatic artery diameters, maximal flow velocity (Vmax) and time average velocity (TAV) in 25 males and 17 females with CF. Hepatic artery resistance, regional blood flow and liver perfusion were calculated. According to liver enzyme data (aminotransferases raised greater than 30 U/l) and sonographic findings (nodular changes), there were 17 CF-patients (mean age 11.4 yrs; range 0.75-31) with and 25 CF-patients (mean age 7.8 yrs; range 0.25-32) without liver involvement (L+/L-). No patient had clinical signs of portal hypertension. 61 healthy children were studied for control. Diameter of portal vein (PVD) and flow data for portal vein showed consistent abnormalities (mean +/- SD): CF-L+ CF-L- Control PVC (mm/m2) 10.7 +/- 3.9*** 10.5 +/- 3.4*** 7.2 +/- 1.3 Vmax (m/sec) 0.23 +/- 0.06*** 0.30 +/- 0.06*** 0.40 +/- 0.14 TAV (m/sec) 0.12 +/- 0.04*** 0.16 +/- 0.04* 0.18 +/- 0.05 Differences were statistically significant (* p less than 0.05, *** p less than 0.001) for CF-patients versus controls. Data for splenic and mesenteric veins and for hepatic artery were moderately alterated, with a significant reduction in TAV and Vmax of splenic vein for CF-L+ versus controls. Liver perfusion and portal vein flow showed no relevant differences in CF-patients versus controls. It is concluded that portal system abnormalities, especially a decrease in Vmax and TAV of portal vein shown by duplex sonography, may be earlier indicators of CF liver disease than biochemical and clinical signs.

Transcranial duplex scanning as a new diagnostic procedure is described for the first time. This method allows Doppler sonographic registration of flow profiles of basal cerebral arteries through the intact skull with simultaneous demonstration of pulsating vessels and cerebral structures in the B-mode scan. The exact localisation of the registered Doppler profile can be demonstrated under direct visual control in a clearly defined section of the cerebral artery. Therefore, an angle correction of the recorded Doppler-shift is possible allowing determination of true flow velocity. Occlusion of basal cerebral arteries can be diagnosed visually with this method. The use procedure in 51 children and adolescents aged 18 months to 19 years is described.