title: Visualization and hypervascularization of the haemorrhoidal plexus in vivo using power Doppler imaging transanal ultrasonography and three-dimensional power Doppler angiography.
abstract: OBJECTIVE
  The purpose of this study was to demonstrate the distribution of haemorrhoidal arteries and the relationship between vascularity and growth of haemorrhoids.
  
  
  METHODS
  One-hundred and three patients with haemorrhoids were studied. Using power Doppler imaging (PDI) transanal ultrasound and three-dimensional power Doppler angiography (3D-PDA), the course of the arteries supplying the haemorrhoids was identified. Measurement of the PDI area was made using the cursor to outline the power Doppler signal of the haemorrhoid, approximately 1 cm above the dentate line.
  
  
  RESULTS
  The haemorrhoidal arteries were seen as branches of the superior rectal artery and were detected in 75.7, 71.8, 68.0 and 62.1% of the 11, 7, 3 and 1 o'clock positions in the lithotomy position. The median number of haemorrhoidal arteries significantly increased from three to six with progression of the Goligher classification from Grade 1 to Grade 4 (P < 0.0001). The PDI areas in Grades 1, 2, 3 and 4 were 0.04 ± 0.03, 0.18 ± 0.07, 0.38 ± 0.18 and 0.96 ± 0.32 cm(2) (P < 0.05).
  
  
  CONCLUSIONS
  The distribution of haemorrhoidal arteries varies widely in both number and position. Using PDI transanal ultrasonography and 3D-PDA it was possible to visualize the haemorrhoid plexus and the course of the haemorrhoidal artery in vivo.
authors.affiliation: Department of Surgery and Proctologic Surgery, Miyamoto Hospital, Anan, Japan; Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Miyamoto
authors.forename: M
authors.initials: M
authors.lastname: Asanoma
authors.forename: H
authors.initials: H
authors.lastname: Miyamoto
authors.forename: C
authors.initials: C
authors.lastname: Takasu
authors.forename: K
authors.initials: K
authors.lastname: Masamune
authors.forename: M
authors.initials: M
authors.lastname: Shimada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000098:blood supply* / Q000000981:diagnostic imaging*; D001158:Arteries / Q000000981:diagnostic imaging; D019160:Endosonography; D005260:Female; D006484:Hemorrhoids / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D012007:Rectum / Q000098:blood supply* / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult
keywords: Haemorrhoidal artery; internal haemorrhoid; power Doppler imaging; three-dimensional power Doppler angiography