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Journal Cover Ultrasound in Medicine & Biology
  [SJR: 0.885]   [H-I: 106]   [8 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 0301-5629
   Published by Elsevier Homepage  [3038 journals]
  • Ultrasonographic Identification of Fibromuscular Bands Associated with
           Neurogenic Thoracic Outlet Syndrome: The “Wedge-Sickle” Sign
    • Authors: Zsuzsanna Arányi; Anita Csillik; Josef Böhm; Thomas Schelle
      Pages: 2357 - 2366
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Zsuzsanna Arányi, Anita Csillik, Josef Böhm, Thomas Schelle
      Thoracic outlet syndrome (TOS) is a disorder characterized by compression of the lower trunk of the brachial plexus, most often in association with anomalous congenital fibromuscular bands in the scalenic region. Early diagnosis is important, because the neurologic deficit associated with TOS may be irreversible. Using high-resolution ultrasound, we investigated 20 consecutive patients with clinical signs suggestive of TOS (all females, average age: 40.4 ± 14.9 y) and 25 control patients. In 19 patients, we identified a hyper-echoic fibromuscular structure at the medial edge of the middle scalene muscle, which indented the lower trunk of the brachial plexus (“wedge-sickle sign”). It was associated with the significant enlargement (p < 0.0001) and hypo-echogenicity of the lower trunk. This novel and distinctive ultrasonographic sign allows pre-surgical identification of anomalous fibromuscular bands causing TOS. It is especially useful in patients without neurologic deficit, in whom the diagnosis may not be as straightforward.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.005
  • Mammographically Occult Asymptomatic Radial Scars/Complex Sclerosing
           Lesions at Ultrasonography-Guided Core Needle Biopsy: Follow-Up Can Be
    • Authors: Vivian Youngjean Park; Eun-Kyung Kim; Min Jung Kim; Jung Hyun Yoon; Hee Jung Moon
      Pages: 2367 - 2371
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Vivian Youngjean Park, Eun-Kyung Kim, Min Jung Kim, Jung Hyun Yoon, Hee Jung Moon
      An increasing number of radial scars are detected by ultrasound (US), but their management is controversial. This study investigated the upgrade rate in mammographically occult radial scars/complex sclerosing lesions without epithelial atypia at US-guided 14-gauge core needle biopsy in asymptomatic patients. Nineteen mammographically occult benign radial scars/complex sclerosing lesions (median size, 7 mm; range, 3–23 mm) were included. Patients underwent surgical excision (n = 10) or vacuum-assisted excision, with follow-up US at least 6 mo after benign vacuum-assisted excision results (n = 8), or underwent US follow-up for 2 y after core needle biopsy (n = 1). Any cases with change in diagnosis to high-risk lesions or malignancy at excision were considered upgrades. The upgrade rate was 0.0%. Based on US findings, 15.8% (3/19) were Breast Imaging Reporting and Data System (BI-RADS) category 3, 68.4% (13/19) were BI-RADS category 4a and 15.8% (3/19) were BI-RADS category 4b. Follow-up with US can be considered for mammographically occult benign radial scar/complex sclerosing lesions diagnosed by US core needle biopsy in asymptomatic patients.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.004
  • Anisotropic Properties of Breast Tissue Measured by Acoustic Radiation
           Force Impulse Quantification
    • Authors: JianQiao Zhou; ZhiFang Yang; WeiWei Zhan; YiJie Dong; Chun Zhou
      Pages: 2372 - 2382
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): JianQiao Zhou, ZhiFang Yang, WeiWei Zhan, YiJie Dong, Chun Zhou
      The goal of our study was to investigate the anisotropy of normal breast glandular and fatty tissue with acoustic radiation force impulse (ARFI) quantification. A total of 137 breasts in 137 women were enrolled. These breasts were divided into the duct-apparent group and the duct-inapparent group, divided into the ligament-apparent group and the ligament-inapparent group. Shear wave velocity (SWV) in the radial (SWVr) and anti-radial (SWVa-r) directions was measured. The elastic anisotropy of glandular tissue and fatty tissue was evaluated as the ratio between SWVr and SWVa-r. The SWV ratio was 1.30 ± 0.45 for glandular tissue and 1.27 ± 0.53 for fatty tissue in the total group. In glandular tissue, the SWV ratio of the duct-apparent group was higher than that of the duct-inapparent group (p = 0.011). In both glandular and fatty tissue, the SWV ratio was higher in the ligament-apparent group than in the ligament-inapparent group (p < 0.05 for both). SWVr was higher than SWVa-r in both glandular tissue and fatty tissue in all groups (p < 0.05 for all) except in breast fatty tissue in the ligament-inapparent group (p = 0.913). It is concluded that both breast glandular tissue and fatty tissue exhibited anisotropy of elastic behavior. To improve the diagnostic power of elastography in breast lesions, the elastic anisotropy of glandular tissue and fatty tissue should be taken into account in calculating strain ratio or elasticity ratio.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.012
  • Ultrasound Strain Elastography for Circumscribed Solid Thyroid Nodules
           without Malignant Features Categorized as Indeterminate by B-Mode
    • Authors: Minjung Seong; Jung Hee Shin; Soo Yeon Hahn
      Pages: 2383 - 2390
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Minjung Seong, Jung Hee Shin, Soo Yeon Hahn
      The aim of this study was to evaluate the diagnostic performance of ultrasound strain elastography (USE) for circumscribed solid thyroid nodules without malignant or benign features seen on US. This retrospective study included 197 thyroid nodules in 196 patients who underwent USE with color mapping and strain ratio measurement between 2010 and 2014. Of the 197 nodules, 24 (12.2%) were malignant. No significant differences in color mapping or strain ratio were observed between benign and malignant nodules. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 29.2% (95% confidence interval [CI]: 13.8%–49.4%), 77.5% (95% CI: 75.3%–80.3%), 15.2% (95% CI: 7.2%–25.8%), 88.7% (95% CI: 86.3%–92.0%), and 71.6% (95% CI: 67.8%–76.5%) for color mapping and 50.0% (95% CI: 30.%–69.5%), 57.2% (95% CI: 54.5%–59.9%), 14.0% (95% CI: 8.5%–18.4%), 89.2% (95% CI: 85.0%–93.4%) and 56.3% (95% CI: 51.6%–61.1%) for strain ratio measurement, respectively. USE with color mapping and strain ratio measurement has a limited ability to differentiate benign from malignant nodules for circumscribed solid thyroid nodules without definite malignant features categorized as indeterminate by B-mode US.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.011
  • Feasibility Study of Ultrasonographic Criteria for Microscopic and
           Macroscopic Extra-Thyroidal Extension Based on Thyroid Capsular Continuity
           and Tumor Contour in Patients with Papillary Thyroid Carcinomas
    • Authors: Jee Hyun Rim; Semin Chong; Han Suk Ryu; Bo Mi Chung; Hye Shin Ahn
      Pages: 2391 - 2400
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Jee Hyun Rim, Semin Chong, Han Suk Ryu, Bo Mi Chung, Hye Shin Ahn
      Our purpose was to evaluate the feasibility of using ultrasonographic criteria of thyroid capsular continuity and tumor contour to differentiate macroscopic extra-thyroidal extension (ETE) from microscopic ETE, as well as non-ETE from ETE. On ultrasonography, we evaluated thyroid capsular continuity (C0 = continuous, C1 = discontinuous, C2 = invisible), and thyroid tumor contour (P0 = in normal parenchyma, P1 = abutting, P2 = bulging), which were grouped into type 1–9 classifications. Either C1–2 or P1–2 was more prevalent in ETE than non-ETE. C1 and P2 tended to be associated with macroscopic ETE, whereas C0 and P1 were significantly associated with microscopic ETE. Types 6, 8 and 9 were more likely to have ETE than non-ETE; type 6 (C1 P2) and type 9 (C2 P2) were significantly associated with macroscopic ETE, whereas type 8 (C2 P1) was associated more with microscopic ETE. Macroscopic and microscopic ETE, as well as non-ETE and ETE, can be differentiated using these pre-operative ultrasonographic criteria.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.014
  • AdipoScan: A Novel Transient Elastography-Based Tool Used to
           Non-Invasively Assess Subcutaneous Adipose Tissue Shear Wave Speed in
    • Authors: Magali Sasso; Yuejun Liu; Judith Aron-Wisnewsky; Jean-Luc Bouillot; Mériem Abdennour; Michel Clet; Laurent Sandrin; Gilles le Naour; Pierre Bedossa; Joan Tordjman; Karine Clément; Véronique Miette
      Pages: 2401 - 2413
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Magali Sasso, Yuejun Liu, Judith Aron-Wisnewsky, Jean-Luc Bouillot, Mériem Abdennour, Michel Clet, Laurent Sandrin, Gilles le Naour, Pierre Bedossa, Joan Tordjman, Karine Clément, Véronique Miette
      We describe a novel device called the AdipoScan that was adapted from the FibroScan to specifically assess shear wave speed (SWS) in human abdominal subcutaneous adipose tissue (scAT). Measurement reproducibility was assessed on tissue-mimicking phantoms with and without repositioning, with resultant coefficients of variation of 1% and 0%, respectively, as well as in vivo (14% and 7%, respectively). The applicability of the AdipoScan was tested on 19 non-obese volunteers, and a scAT thickness >2 cm was found to be mandatory to perform a valid measurement. Abdominal scAT SWS was assessed in 73 severely obese subjects, all candidates for bariatric surgery. Subcutaneous AT SWS was positively associated with scAT fibrosis and obesity-related co-morbidities such as hypertension, glycemic status, dyslipidemia and liver dysfunction. These results suggest that the AdipoScan could be a useful non-invasive tool to evaluate scAT fibrosis and metabolic complications in obesity. Further investigation is required to evaluate the relevance of using the AdipoScan to predict patient weight trajectories and metabolic outcomes after bariatric surgery.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.016
  • Intra-Operative Vector Flow Imaging Using Ultrasound of the Ascending
           Aorta among 40 Patients with Normal, Stenotic and Replaced Aortic Valves
    • Authors: Kristoffer Lindskov Hansen; Hasse Møller-Sørensen; Jesper Kjaergaard; Maiken Brit Jensen; Jens Teglgaard Lund; Mads Møller Pedersen; Theis Lange; Jørgen Arendt Jensen; Michael Bachmann Nielsen
      Pages: 2414 - 2422
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Kristoffer Lindskov Hansen, Hasse Møller-Sørensen, Jesper Kjaergaard, Maiken Brit Jensen, Jens Teglgaard Lund, Mads Møller Pedersen, Theis Lange, Jørgen Arendt Jensen, Michael Bachmann Nielsen
      Stenosis of the aortic valve gives rise to more complex blood flows with increased velocities. The angle-independent vector flow ultrasound technique transverse oscillation was employed intra-operatively on the ascending aorta of (I) 20 patients with a healthy aortic valve and 20 patients with aortic stenosis before (IIa) and after (IIb) valve replacement. The results indicate that aortic stenosis increased flow complexity (p < 0.0001), induced systolic backflow (p < 0.003) and reduced systolic jet width (p < 0.0001). After valve replacement, the systolic backflow and jet width were normalized (p < 0.52 and p < 0.22), but flow complexity was not (p < 0.0001). Flow complexity (p < 0.0001), systolic jet width (p < 0.0001) and systolic backflow (p < 0.001) were associated with peak systolic velocity. The study found that aortic stenosis changes blood flow in the ascending aorta and valve replacement corrects some of these changes. Transverse oscillation may be useful for assessment of aortic stenosis and optimization of valve surgery.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.009
  • Shear Wave Elastography Quantifies Stiffness in Ex Vivo Porcine Artery
           with Stiffened Arterial Region
    • Authors: Erik Widman; Elira Maksuti; Carolina Amador; Matthew W. Urban; Kenneth Caidahl; Matilda Larsson
      Pages: 2423 - 2435
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Erik Widman, Elira Maksuti, Carolina Amador, Matthew W. Urban, Kenneth Caidahl, Matilda Larsson
      Five small porcine aortas were used as a human carotid artery model, and their stiffness was estimated using shear wave elastography (SWE) in the arterial wall and a stiffened artery region mimicking a stiff plaque. To optimize the SWE settings, shear wave bandwidth was measured with respect to acoustic radiation force push length and number of compounded angles used for motion detection with plane wave imaging. The mean arterial wall and simulated plaque shear moduli varied from 41 ± 5 to 97 ± 10 kPa and from 86 ± 13 to 174 ± 35 kPa, respectively, over the pressure range 20–120 mmHg. The results revealed that a minimum bandwidth of approximately 1500 Hz is necessary for consistent shear modulus estimates, and a high pulse repetition frequency using no image compounding is more important than a lower pulse repetition frequency with better image quality when estimating arterial wall and plaque stiffness using SWE.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.05.021
  • Systematic Performance Evaluation of a Cross-Correlation-Based Ultrasound
           Strain Imaging Method
    • Authors: He Li; Yuexin Guo; Wei-Ning Lee
      Pages: 2436 - 2456
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): He Li, Yuexin Guo, Wei-Ning Lee
      Estimation of tissue motion in the lateral direction remains a major challenge in 2-D ultrasound strain imaging (USI). Although various methodologies have been proposed to improve the accuracy of estimation of in-plane displacements and strains, the fundamental limitations of 2-D USI and how to choose optimal algorithmic parameters in various tissue deformation paradigms to retrieve the full strain tensor of acceptable accuracy are scattered throughout the literature. Thus, this study attempts to provide a systematic investigation of a 2-D cross-correlation-based USI method in a theoretical framework. Our previously developed cross-correlation-based USI method was revisited, and additional estimation strategies were incorporated to improve in-plane displacement and strain estimation. The performance of the presented method using different matching kernel sizes (axial: from 1λ to 14λ, where λ = wavelength; lateral: from 1 to 13 pitches) and two data formats (radiofrequency and envelope) in various kinematic scenarios (normal, shear or hybrid deformation) was investigated using Field II simulations, in which coherent plane wave compounding with 64 steered angles was realized. For radiofrequency-based USI, smaller axial and larger lateral kernel sizes were preferred in scenarios with normal strains, whereas larger kernel sizes along the shearing direction and smaller ones orthogonal to the shearing direction were more suitable in scenarios with shear strains. For envelope-based USI, in contrast, the kernel size requirement was relatively relaxed. A compromise between optimal kernel sizes and estimation accuracy of various strain components was required in complex kinematic scenarios. These practical strategies for accurate motion estimation using 2-D cross-correlation-based USI were further tested in a tissue-mimicking phantom under quasi-static compression and in a preliminary in vivo examination of a normal human median nerve at the wrist during active finger motion.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.015
  • Influence of Skin and Subcutaneous Tissue on High-Intensity Focused
           Ultrasound Beam: Experimental Quantification and Numerical Modeling
    • Authors: Anthony Grisey; Marc Heidmann; Veronique Letort; Pauline Lafitte; Sylvain Yon
      Pages: 2457 - 2465
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Anthony Grisey, Marc Heidmann, Veronique Letort, Pauline Lafitte, Sylvain Yon
      High-intensity focused ultrasound (HIFU) enables the non-invasive thermal ablation of tumors. However, numerical simulations of the treatment remain complex and difficult to validate in clinically relevant situations. In this context, needle hydrophone measurements of the acoustic field downstream of seven rabbit tissue layers comprising skin, subcutaneous fat and muscle were performed in different geometrical configurations. Increasing curvature and thickness of the sample were found to decrease the focusing of the beam: typically, a curvature of 0.05 mm−1 decreased the maximum pressure by 45% and doubled the focal area. A numerical model based on k-Wave Toolbox was found to be in very good agreement with the reported measurements. It was used to extrapolate the effect of the superficial tissues on peak positive and peak negative pressure at focus, which affects both cavitation and target heating. The shape of the interface was found to have a strong influence on the values, and it is therefore an important parameter to monitor or to control in the clinical practice. This also highlights the importance of modeling realistic configurations when designing treatment procedures.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.013
  • Visualizing the Histotripsy Process: Bubble Cloud–Cancer Cell
           Interactions in a Tissue-Mimicking Environment
    • Authors: Eli Vlaisavljevich; Adam Maxwell; Lauren Mancia; Eric Johnsen; Charles Cain; Zhen Xu
      Pages: 2466 - 2477
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Eli Vlaisavljevich, Adam Maxwell, Lauren Mancia, Eric Johnsen, Charles Cain, Zhen Xu
      Histotripsy is a non-invasive ultrasonic ablation method that uses cavitation to mechanically fractionate tissue into acellular debris. With a sufficient number of pulses, histotripsy can completely fractionate tissue into a liquid-appearing homogenate with no cellular structures. The location, shape and size of lesion formation closely match those of the cavitation cloud. Previous work has led to the hypothesis that the rapid expansion and collapse of histotripsy bubbles fractionate tissue by inducing large stress and strain on the tissue structures immediately adjacent to the bubbles. In the work described here, the histotripsy bulk tissue fractionation process is visualized at the cellular level for the first time using a custom-built 2-MHz transducer incorporated into a microscope stage. A layer of breast cancer cells were cultured within an optically transparent fibrin-based gel phantom to mimic cells inside a 3-D extracellular matrix. To test the hypothesis, the cellular response to single and multiple histotripsy pulses was investigated using high-speed optical imaging. Bubbles were always generated in the extracellular space, and significant cell displacement/deformation was observed for cells directly adjacent to the bubble during both bubble expansion and collapse. The largest displacements were observed during collapse for cells immediately adjacent to the bubble, with cells moving more than 150–300 μm in less than 100 μs. Cells often underwent multiple large deformations (>150% strain) over multiple pulses, resulting in the bisection of cells multiple times before complete removal. To provide theoretical support to the experimental observations, a numerical simulation was conducted using a single-bubble model, which indicated that histotripsy exerts the largest strains and cell displacements in the regions immediately adjacent to the bubble. The experimental and simulation results support our hypothesis, which helps to explain the formation of the sharp lesions formed in histotripsy therapy localized to the regions directly exposed to the bubbles.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.05.018
  • The Application of Clinical Lithotripter Shock Waves to RNA Nucleotide
           Delivery to Cells
    • Authors: Sandra Nwokeoha; Robert Carlisle; Robin O. Cleveland
      Pages: 2478 - 2492
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Sandra Nwokeoha, Robert Carlisle, Robin O. Cleveland
      The delivery of genes into cells through the transfer of ribonucleic acids (RNAs) has been found to cause a change in the level of target protein expression. RNA-based transfection is conceptually more efficient than commonly delivered plasmid DNA because it does not require division or damage of the nuclear envelope, thereby increasing the chances of the cell remaining viable. Shock waves (SWs) have been found to induce cellular uptake by transiently altering the permeability of the plasma membrane, thereby overcoming a critical step in gene therapy. However, accompanying SW bio-effects include dose-dependent irreversible cell injury and cytotoxicity. Here, the effect of SWs generated by a clinical lithotripter on the viability and permeabilisation of three different cell lines in vitro was investigated. Comparison of RNA stability before and after SW exposure revealed no statistically significant difference. Optimal SW exposure parameters were identified to minimise cell death and maximise permeabilisation, and applied to enhanced green fluorescent protein (eGFP) messenger RNA (mRNA) or anti-eGFP small interfering RNA delivery. As a result, eGFP mRNA expression levels increased up to 52-fold in CT26 cells, whereas a 2-fold decrease in GFP expression was achieved after anti-eGFP small interfering RNA delivery to MCF-7/GFP cells. These results indicate that SW parameters can be employed to achieve effective nucleotide delivery, laying the foundation for non-invasive and high-tolerability RNA-based gene therapy.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.001
  • Plane-Wave Compounding in Automated Breast Volume Scanning: A
           Phantom-Based Study
    • Authors: Branislav Holländer; Gijs A.G.M. Hendriks; Ritse M. Mann; Hendrik H.G. Hansen; Chris L. de Korte
      Pages: 2493 - 2503
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Branislav Holländer, Gijs A.G.M. Hendriks, Ritse M. Mann, Hendrik H.G. Hansen, Chris L. de Korte
      The goal of this study was to assess whether it is viable to implement plane-wave imaging in the Automated Breast Volume Scanner (ABVS) to speed up the acquisition process. This would allow breath-hold examinations, thus reducing breathing artifacts without loss of imaging quality. A calibration phantom was scanned in an Automated Breast Volume Scanner-mimicking setup using both dynamic receive focusing with a fixed transmit focus and unfocused plane-wave compounding. Contrast-to-noise ratio and lateral resolution were compared using two beamforming schemes, delay-and-sum and Stolt's f–k algorithm. Plane-wave compounding using only 11 compounding angles and Stolt's f–k algorithm provided image quality similar to that of focused transmission with dynamic receive focusing (contrast-to-noise ratios = 10.3 and 10.8 dB for Stolt's f–k migration with Hann apodization and focused transmission, respectively; full width at half-maximum = 0.38 and 0.4 mm, respectively; all at 30-mm depth with transmit focus at 30 mm) with a higher signal-to-noise ratio at all depths. Furthermore, a full 3-D volume of a breast-mimicking phantom was scanned using this optimal set of compounding angles and different speeds (10, 20 and 50 mm/s) to assess the impact of scanning time on image quality. Only minor differences in contrast-to-noise ratio were found (cyst 1: 6.0 ± 0.3 dB, cyst 2: 5.5 ± 0.2 dB, cyst 3: 5.7 ± 0.5 dB). These differences could not be correlated to the movement speeds, indicating that acquisition speed does not significantly affect image quality. Our results suggest that plane-wave imaging will enable breath-hold automated breast volume scanning examinations, eliminating breathing artifacts while otherwise preserving similar image quality.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.05.017
  • Fully Automated and Robust Tracking of Transient Waves in Structured
           Anatomies Using Dynamic Programming
    • Authors: Zeynettin Akkus; Mahdi Bayat; Mathew Cheong; Kumar Viksit; Bradley J. Erickson; Azra Alizad; Mostafa Fatemi
      Pages: 2504 - 2512
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Zeynettin Akkus, Mahdi Bayat, Mathew Cheong, Kumar Viksit, Bradley J. Erickson, Azra Alizad, Mostafa Fatemi
      Tissue stiffness is often linked to underlying pathology and can be quantified by measuring the mechanical transient transverse wave speed (TWS) within the medium. Time-of-flight methods based on correlation of the transient signals or tracking of peaks have been used to quantify the TWS from displacement maps obtained with ultrasound pulse-echo techniques. However, it is challenging to apply these methods to in vivo data because of tissue inhomogeneity, noise and artifacts that produce outliers. In this study, we introduce a robust and fully automated method based on dynamic programming to estimate TWS in tissues with known geometries. The method is validated using ultrasound bladder vibrometry data from an in vivo study. We compared the results of our method with those of time-of-flight techniques. Our method performs better than time-of-flight techniques. In conclusion, we present a robust and accurate TWS detection method that overcomes the difficulties of time-of-flight methods.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.002
  • Ultrasound-Guided Percutaneous Tenotomy of Biceps Tendon: Technical
           Feasibility on Cadavers
    • Authors: Luca Maria Sconfienza; Giovanni Mauri; Carmelo Messina; Alberto Aliprandi; Francesco Secchi; Francesco Sardanelli; Pietro Simone Randelli
      Pages: 2513 - 2517
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Luca Maria Sconfienza, Giovanni Mauri, Carmelo Messina, Alberto Aliprandi, Francesco Secchi, Francesco Sardanelli, Pietro Simone Randelli
      We tested the technical feasibility of ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon (LHBT) in cadavers. Both shoulders of two fresh cadavers were scanned anteriorly to evaluate the extra-articular portion of the LHBT. Under ultrasound monitoring, a scalpel was advanced obliquely up to touch the superficial medial side of the LHBT, cutting it until the tendon was not visible anymore. Ultrasound evaluation was repeated after the procedure, and anatomic dissection was performed. The procedure was 100% feasible: four cuts were made to completely sever the tendon; the duration was less than 1 min. Skin incision measured 5 mm in two cases and 6 mm in two cases. Anatomic dissection confirmed complete tendon cut in all cases with proximal and distal tendon stumps very close to each other. Ultrasound-guided percutaneous LHBT tenotomy was 100% technically feasible in cadavers with a quick procedure and minimal cutaneous incision.

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.008
  • Reply to a Letter to the Editor regarding “High-Frequency, Low-Intensity
           Pulsed Ultrasound Enhances Alveolar Bone Healing of Extraction Sockets in
           Rats: A Pilot Study”
    • Authors: Kyung Lhi Kang
      Pages: 2518 - 2519
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): Kyung Lhi Kang

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.05.019
  • Letter to the Editor regarding “High-Frequency, Low-Intensity Pulsed
           Ultrasound Enhances Alveolar Bone Healing of Extraction Sockets in Rats: A
           Pilot Study”
    • Authors: S.M.J. Mortazavi; Ghazal Mortazavi; Maryam Paknahad
      First page: 2518
      Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10
      Author(s): S.M.J. Mortazavi, Ghazal Mortazavi, Maryam Paknahad

      PubDate: 2016-09-01T06:20:39Z
      DOI: 10.1016/j.ultrasmedbio.2016.02.021
  • Therapeutic Pulsed Ultrasound Promotes Revascularization and Functional
           Recovery of Rat Skeletal Muscle after Contusion Injury
    • Authors: Areeya Chongsatientam; Tossaporn Yimlamai
      Abstract: Publication date: Available online 21 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Areeya Chongsatientam, Tossaporn Yimlamai
      The mechanism by which therapeutic pulsed ultrasound (TPU) promotes the repair of damaged gastrocnemius muscle was investigated. Male Wistar rats were divided into uninjured, sham-treated injured and TPU-treated injured (TPU) groups. Injury was induced by mass-drop technique. TPU was applied to the injured muscle for 5 min, daily, started at day 1 post-injury and continuing for 3, 7 and 14 d. For 3 d post-injury, a significant reduction in muscle force was observed in both the sham-treated injured and TPU groups. TPU treatment significantly increased recovery force of the injured muscle after day 7 post-injury. This effect of TPU is associated with increased centronucleated fibers and cross-sectional area, mRNA expression of the vascular endothelial growth factor and capillary density of the regenerated fibers, but not with mRNA expression of nitric oxide synthase. We conclude that TPU hastens muscle recovery, at least in part, by upregulating angiogenesis.

      PubDate: 2016-09-24T19:13:14Z
      DOI: 10.1016/j.ultrasmedbio.2016.08.004
  • Does Exposure to Diagnostic Ultrasound Modulate Human Nerve Responses to
           Magnetic Stimulation'
    • Authors: Neil W. Bailey; Philip M. Lewis; Richard H.S. Thomson; Jerome J. Maller; Paul Junor; Paul B. Fitzgerald
      Abstract: Publication date: Available online 19 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Neil W. Bailey, Philip M. Lewis, Richard H.S. Thomson, Jerome J. Maller, Paul Junor, Paul B. Fitzgerald
      Ultrasound (US) at diagnostic frequency and power is known to alter nerve potentials; however, the precise mechanism of action is unknown. We investigated whether US alters resting nerve potential to lower the threshold for magnetic nerve stimulation. Seventeen healthy subjects were recruited. For each subject, a 1.5 MHz US imaging probe was placed onto the elbow with the beam directed at the ulnar nerve. The probe was coupled to the skin using standard acoustic coupling gel as would be done for a routine clinical US scan. Ulnar nerve stimulation was performed simultaneously with magnetic stimulation (MS). Successful magnetic stimulation of the ulnar nerve was confirmed with nerve potentials measured by electromyography. There was no significant change in electromyography signal when MS was performed during US exposure. US at the diagnostic frequency and power tested does not alter nerve thresholds with MS. Testing at other frequencies is required, however, before US is negated as a technique to modify MS thresholds.

      PubDate: 2016-09-21T17:20:25Z
      DOI: 10.1016/j.ultrasmedbio.2016.08.003
  • Effect of Background Parenchymal Enhancement on Pre-operative Breast
           Magnetic Resonance Imaging: How It Affects Interpretation and the Role of
           Second-Look Ultrasound in Patient Management
    • Authors: Soo-Yeon Kim; Hye Sun Lee; Eun-Kyung Kim; Min Jung Kim; Hee Jung Moon; Jung Hyun Yoon
      Abstract: Publication date: Available online 19 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Soo-Yeon Kim, Hye Sun Lee, Eun-Kyung Kim, Min Jung Kim, Hee Jung Moon, Jung Hyun Yoon
      Background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) may either obscure or mimic malignancy. We evaluated the impact of BPE on the diagnostic performance of pre-operative MRI in breast cancer patients, and how second-look ultrasound (US) can help in guiding patient management. Two hundred fifty-three breast cancer patients with pre-operative MRI were included. In moderate or marked BPE, abnormal interpretation rate (38.9% vs. 12.2%) and biopsy rate (27.8% vs. 8.3%) were higher, and specificity (64.7% vs. 89.8%) was lower, compared with minimal or mild BPE (all p < 0.001). Visibility of MRI-detected additional suspicious lesions on second-look US did not differ between the two groups (86.7% in minimal or mild BPE vs. 77.1% in moderate or marked BPE, p = 0.296). Increased BPE was related to increased abnormal interpretation rate, additional biopsy rate and decreased specificity. Second-look US was useful in visualization of MRI-detected additional suspicious lesions, regardless of BPE.

      PubDate: 2016-09-21T17:20:25Z
      DOI: 10.1016/j.ultrasmedbio.2016.08.008
  • Comparison of Ultrasound, Pathologic and Prognostic Characteristics of the
           Follicular Variant of Papillary Thyroid Cancer According to Fine-Needle
           Aspiration Cytology
    • Authors: Jieun Koh; Eun-Kyung Kim; Ji-Ye Kim; Jin Young Kwak; Jung Hyun Yoon; Hee Jung Moon
      Abstract: Publication date: Available online 19 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Jieun Koh, Eun-Kyung Kim, Ji-Ye Kim, Jin Young Kwak, Jung Hyun Yoon, Hee Jung Moon
      The aim of the study described here was to compare ultrasound features, pathologic characteristics and prognoses of the follicular variant of papillary thyroid carcinoma (FVPTC) according to cytology results. Eighty-seven FVPTCs were classified according to the first cytology results as the surgery group (n = 66, follicular neoplasm/Hürthle cell neoplasm, suspicious for malignancy and malignancy) and the indeterminate group (n = 21, non-diagnostic and benign), for whom the management was follow-up. The indeterminate group had a longer mean interval to surgery (p = 0.020) and larger tumor size (p = 0.018). More tumors were assessed as probably benign in the indeterminate group than in the surgery group (p < 0.001). Extrathyroidal extension and lymph node metastasis did not significantly differ between the two groups, and no patient had a recurrence (mean follow-up interval: 54.9 ± 16.9 mo). The indeterminate group exhibited more probably benign features and larger size on ultrasound, with surgery being performed at a later date. However, aggressive pathologic characteristics and tumor recurrence did not significantly differ between the two groups.

      PubDate: 2016-09-21T17:20:25Z
      DOI: 10.1016/j.ultrasmedbio.2016.08.009
  • Mechanisms for Induction of Pulmonary Capillary Hemorrhage by Diagnostic
           Ultrasound: Review and Consideration of Acoustical Radiation Surface
    • Authors: Douglas L. Miller
      Abstract: Publication date: Available online 17 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Douglas L. Miller
      Diagnostic ultrasound can induce pulmonary capillary hemorrhage (PCH) in rats and other mammals. This phenomenon represents the only clearly demonstrated biological effect of (non-contrast enhanced) diagnostic ultrasound and thus presents a uniquely important safety issue. However, the physical mechanism responsible for PCH remains uncertain more than 25 y after its discovery. Experimental research has indicated that neither heating nor acoustic cavitation, the predominant mechanisms for bioeffects of ultrasound, is responsible for PCH. Furthermore, proposed theoretical mechanisms based on gas-body activation, on alveolar resonance and on impulsive generation of liquid droplets all appear unlikely to be responsible for PCH, owing to unrealistic model assumptions. Here, a simple model based on the acoustical radiation surface pressure (ARSP) at a tissue–air interface is hypothesized as the mechanism for PCH. The ARSP model seems to explain some features of PCH, including the approximate frequency independence of PCH thresholds and the dependence of thresholds on biological factors. However, ARSP evaluated for experimental threshold conditions appear to be too weak to fully account for stress failure of pulmonary capillaries, gauging by known stresses for injurious physiologic conditions. Furthermore, consideration of bulk properties of lung tissue suggests substantial transmission of ultrasound through the pleura, with reduced ARSP and potential involvement of additional mechanisms within the pulmonary interior. Although these recent findings advance our knowledge, only a full understanding of PCH mechanisms will allow development of science-based safety assurance for pulmonary ultrasound.

      PubDate: 2016-09-21T17:20:25Z
      DOI: 10.1016/j.ultrasmedbio.2016.08.006
  • Immediate Dose–Response Effect of High-Energy Versus Low-Energy
           Extracorporeal Shock Wave Therapy on Cutaneous Microcirculation
    • Authors: Robert Kraemer; Heiko Sorg; Vinzent Forstmeier; Karsten Knobloch; Eirini Liodaki; Felix Hagen Stang; Peter Mailaender; Tobias Kisch
      Abstract: Publication date: Available online 20 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Robert Kraemer, Heiko Sorg, Vinzent Forstmeier, Karsten Knobloch, Eirini Liodaki, Felix Hagen Stang, Peter Mailaender, Tobias Kisch
      Elucidation of the precise mechanisms and therapeutic options of extracorporeal shock wave therapy (ESWT) is only at the beginning. Although immediate real-time effects of ESWT on cutaneous hemodynamics have recently been described, the dose response to different ESWT energies in cutaneous microcirculation has never been examined. Thirty-nine Sprague–Dawley rats were randomly assigned to three groups that received either focused high-energy shock waves (group A: total of 1000 impulses, 10 J) to the lower leg of the hind limb, focused low-energy shock waves (group B: total of 300 impulses, 1 J) or placebo shock wave treatment (group C: 0 impulses, 0 J) using a multimodality shock wave delivery system (Duolith SD-1 T-Top, Storz Medical, Tägerwilen, Switzerland). Immediate microcirculatory effects were assessed with the O2C (oxygen to see) system (LEA Medizintechnik, Giessen, Germany) before and for 20 min after application of ESWT. Cutaneous tissue oxygen saturation increased significantly higher after high-energy ESWT than after low-energy and placebo ESWT (A: 29.4% vs. B: 17.3% vs. C: 3.3%; p = 0.003). Capillary blood velocity was significantly higher after high-energy ESWT and lower after low-energy ESWT versus placebo ESWT (group A: 17.8% vs. group B: −22.1% vs. group C: −5.0%, p = 0.045). Post-capillary venous filling pressure was significantly enhanced in the high-energy ESWT group in contrast to the low-energy ESWT and placebo groups (group A: 25% vs. group B: 2% vs. group C: −4%, p = 0.001). Both high-energy and low-energy ESWT affect cutaneous hemodynamics in a standard rat model. High-energy ESWT significantly increases parameters of cutaneous microcirculation immediately after application, resulting in higher tissue oxygen saturation, venous filling pressure and blood velocity, which suggests higher tissue perfusion with enhanced oxygen saturation, in contrast to low-energy as well as placebo ESWT. Low-energy ESWT also increased tissue oxygen saturation, albeit to a lower extent, and decreases both blood velocity and venous filling pressure. Low-energy ESWT reduced tissue perfusion, but improved oxygen saturation immediately after the application.

      PubDate: 2016-09-21T17:20:25Z
      DOI: 10.1016/j.ultrasmedbio.2016.08.010
  • Total Cerebral Blood Flow in Patients with Cardioembolic Stroke: Is It
           Clinically Meaningful'
    • Authors: Joan Martí-Fàbregas; Sebastián Figueroa; Eva Martínez-Lizana; Irati Zubizarreta; David Carrera; Alejandro Martínez-Domeño; Luis Prats-Sánchez; Pol Camps-Renom; Elena Jiménez-Xarrié; Raquel Delgado-Mederos
      Abstract: Publication date: Available online 17 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Joan Martí-Fàbregas, Sebastián Figueroa, Eva Martínez-Lizana, Irati Zubizarreta, David Carrera, Alejandro Martínez-Domeño, Luis Prats-Sánchez, Pol Camps-Renom, Elena Jiménez-Xarrié, Raquel Delgado-Mederos
      Chronic hypoperfusion may hinder the washout of emboli coming from the heart and facilitate the formation of intra-cavitary thrombi. We investigated whether a decreased total cerebral blood flow (tCBF) resulted in recurrence of stroke and other vascular events in consecutive patients with cardioembolic stroke. We excluded patients with extra-cranial carotid or vertebral stenosis. The recorded tCBF was the sum of blood flow in both the carotid and vertebral extra-cranial arteries as measured with ultrasonography. Patients were followed up to assess stroke recurrence, vascular events and mortality. We also recorded demographic data, vascular risk factors, treatment data, echocardiographic variables and the C congestive heart failure history H Hypertension history A Age D Diabetes S Sex S2 Stroke/TIA/Thromboembolism history Vasc Vascular Disease history (CHA2DS2-VASc) score. We studied 79 patients (age 77.9 ± 8.4 y). Mean tCBF was 65.5 ± 15.7 mL/100 g/min. Cox regression analysis found that CHA2 DS2-VASc score and ejection fraction were associated with tCBF. After a mean follow-up of 22 ± 8.5 mo, 7.6% of patients experienced a recurrent stroke, 12.7% experienced a vascular event and 21.5% of patients died. Clinical outcomes were not predicted by tCBF.

      PubDate: 2016-09-21T17:20:25Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.027
  • Re: Non-invasive Evaluation of Liver Fibrosis: 2-D Shear Wave
           Elastography, Transient Elastography or Acoustic Radiation Force Impulse
    • Authors: Ludmila Gerber; Mireen Friedrich-Rust
      Abstract: Publication date: Available online 16 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Ludmila Gerber, Mireen Friedrich-Rust

      PubDate: 2016-09-21T17:20:25Z
      DOI: 10.1016/j.ultrasmedbio.2016.04.009
  • Performance of Lung Ultrasound in Detecting Peri-operative Atelectasis
           after General Anesthesia
    • Authors: Xin Yu; Zhenping Zhai; Yongfeng Zhao; Zhiming Zhu; Jianbin Tong; Jianqin Yan; Wen Ouyang
      Abstract: Publication date: Available online 14 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Xin Yu, Zhenping Zhai, Yongfeng Zhao, Zhiming Zhu, Jianbin Tong, Jianqin Yan, Wen Ouyang
      The aim of this prospective observational study was to evaluate the performance of lung ultrasound (LUS) in detecting post-operative atelectasis in adult patients under general anesthesia. Forty-six patients without pulmonary comorbidities who were scheduled for elective neurosurgery were enrolled in the study. A total of 552 pairs of LUS clips and thoracic computed tomography (CT) images were ultimately analyzed to determine the presence of atelectasis in 12 prescribed lung regions. The accuracy of LUS in detecting peri-operative atelectasis was evaluated with thoracic CT as gold standard. Levels of agreement between the two observers for LUS and the two observers for thoracic CT were analyzed using the κ reliability test. The quantitative correlation between LUS scores of aeration and the volumetric data of atelectasis in thoracic CT were further evaluated. LUS had reliable performance in post-operative atelectasis, with a sensitivity of 87.7%, specificity of 92.1% and diagnostic accuracy of 90.8%. The levels of agreement between the two observers for LUS and for thoracic CT were both satisfactory, with κ coefficients of 0.87 (p < 0.0001) and 0.93 (p < 0.0001), respectively. In patients in the supine position, LUS scores were highly correlated with the atelectasis volume of CT (r = 0.58, p < 0.0001). Thus, LUS provides a fast, reliable and radiation-free method to identify peri-operative atelectasis in adults.

      PubDate: 2016-09-15T14:47:44Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.010
  • Ultrasonographic Changes after Indirect Revascularization Surgery in
           Pediatric Patients with Moyamoya Disease
    • Authors: Shin-Joe Yeh; Sung-Chun Tang; Li-Kai Tsai; Ya-Fang Chen; Hon-Man Liu; Ying-An Chen; Yu-Lin Hsieh; Shih-Hung Yang; Yu-Hsuan Tien; Chi-Cheng Yang; Meng-Fai Kuo; Jiann-Shing Jeng
      Abstract: Publication date: Available online 14 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Shin-Joe Yeh, Sung-Chun Tang, Li-Kai Tsai, Ya-Fang Chen, Hon-Man Liu, Ying-An Chen, Yu-Lin Hsieh, Shih-Hung Yang, Yu-Hsuan Tien, Chi-Cheng Yang, Meng-Fai Kuo, Jiann-Shing Jeng
      The marked cerebral hypoperfusion of moyamoya disease (MMD) can be treated with encephaloduroarteriosynangiosis (EDAS), an indirect revascularization surgery. Collateral establishment after the surgery is a gradual process; thus, easy access to serial assessment is of great importance. We prospectively recruited 15 pediatric moyamoya patients who underwent EDAS surgeries on a total of 19 hemispheres. Ultrasonography of extracranial and intracranial arteries was performed pre-operatively and post-operatively at 1, 3 and 6 mo. Among the extracranial arteries, the superficial temporal artery had the most pronounced increase in flow velocity and decrease in flow resistance from 1 mo post-surgery (p < 0.01). Among the large intracranial arteries, a significant increase in peak systolic velocity was observed in the anterior cerebral artery from 3 mo post-surgery (p < 0.05). These findings indicate significant hemodynamic changes on ultrasonography in pediatric moyamoya patients after indirect revascularization surgery.

      PubDate: 2016-09-15T14:47:44Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.016
  • Visualizing the Vibration of Laryngeal Tissue during Phonation Using
           Ultrafast Plane Wave Ultrasonography
    • Authors: Bowen Jing; Shanshan Tang; Liang Wu; Supin Wang; Mingxi Wan
      Abstract: Publication date: Available online 12 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Bowen Jing, Shanshan Tang, Liang Wu, Supin Wang, Mingxi Wan
      Ultrafast plane wave ultrasonography is employed in this study to visualize the vibration of the larynx and quantify the vibration phase as well as the vibration amplitude of the laryngeal tissue. Ultrasonic images were obtained at 5000 to 10,000 frames/s in the coronal plane at the level of the glottis. Although the image quality degraded when the imaging mode was switched from conventional ultrasonography to ultrafast plane wave ultrasonography, certain anatomic structures such as the vocal folds, as well as the sub- and supraglottic structures, including the false vocal folds, can be identified in the ultrafast plane wave ultrasonic image. The periodic vibration of the vocal fold edge could be visualized in the recorded image sequence during phonation. Furthermore, a motion estimation method was used to quantify the displacement of laryngeal tissue from hundreds of frames of ultrasonic data acquired. Vibratory displacement waveforms of the sub- and supraglottic structures were successfully obtained at a high level of ultrasonic signal correlation. Moreover, statistically significant differences in vibration pattern between the sub- and supraglottic structures were found. Variation of vibration amplitude along the subglottic mucosal surface is significantly smaller than that along the supraglottic mucosal surface. Phase delay of vibration along the subglottic mucosal surface is significantly smaller than that along the supraglottic mucosal surface.

      PubDate: 2016-09-15T14:47:44Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.023
  • Automatic Differential Diagnosis of Melanocytic Skin Tumors Using
           Ultrasound Data
    • Authors: Kristina Andrėkutė; Gintarė Linkevičiūtė; Renaldas Raišutis; Skaidra Valiukevičienė; Jurgita Makštienė
      Abstract: Publication date: Available online 13 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Kristina Andrėkutė, Gintarė Linkevičiūtė, Renaldas Raišutis, Skaidra Valiukevičienė, Jurgita Makštienė
      We describe a novel automatic diagnostic system based on quantitative analysis of ultrasound data for differential diagnosis of melanocytic skin tumors. The proposed method has been tested on 160 ultrasound data sets (80 of malignant melanoma and 80 of benign melanocytic nevi). Acoustical, textural and shape features have been evaluated for each segmented lesion. Using parameters selected according to Mahalanobis distance and linear support vector machine classifier, we are able to differentiate malignant melanoma from benign melanocytic skin tumors with 82.4% accuracy (sensitivity = 85.8%, specificity = 79.6%). The results indicate that high-frequency ultrasound has the potential to be used for differential diagnosis of melanocytic skin tumors and to provide supplementary information on lesion penetration depth. The proposed system can be used as an additional tool for clinical decision support to improve the early-stage detection of malignant melanoma.

      PubDate: 2016-09-15T14:47:44Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.026
  • Investigation of Microbubble Cavitation-Induced Calcein Release from Cells
           In Vitro
    • Authors: Martynas Maciulevičius; Mindaugas Tamošiūnas; Baltramiejus Jakštys; Rytis Jurkonis; Mindaugas Saulius Venslauskas; Saulius Šatkauskas
      Abstract: Publication date: Available online 13 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Martynas Maciulevičius, Mindaugas Tamošiūnas, Baltramiejus Jakštys, Rytis Jurkonis, Mindaugas Saulius Venslauskas, Saulius Šatkauskas
      In the present study, microbubble (MB) cavitation signal analysis was performed together with calcein release evaluation in both pressure and exposure duration domains of the acoustic field. A passive cavitation detection system was used to simultaneously measure MB scattering and attenuation signals for subsequent extraction efficiency relative to MB cavitation activity. The results indicate that the decrease in the efficiency of extraction of calcein molecules from Chinese hamster ovary cells, as well as cell viability, is associated with MB cavitation activity and can be accurately predicted using inertial cavitation doses up to 0.18 V × s (R 2 > 0.9, p < 0.0001). No decrease in additional calcein release or cell viability was observed after complete MB sonodestruction was achieved. This indicates that the optimal exposure duration within which maximal sono-extraction efficiency is obtained coincides with the time necessary to achieve complete MB destruction. These results illustrate the importance of MB inertial cavitation in the sono-extraction process. To our knowledge, this study is the first to (i) investigate small molecule extraction from cells via sonoporation and (ii) relate the extraction process to the quantitative characteristics of MB cavitation acoustic spectra.

      PubDate: 2016-09-15T14:47:44Z
      DOI: 10.1016/j.ultrasmedbio.2016.08.005
  • Focused Ultrasound Treatment of Cervical Lymph Nodes in Rats with EAE: A
           Pilot Study
    • Authors: Anthony Podkowa; Rita J. Miller; Robert W. Motl; Raymond Fish; Michael L. Oelze
      Abstract: Publication date: Available online 14 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Anthony Podkowa, Rita J. Miller, Robert W. Motl, Raymond Fish, Michael L. Oelze
      In this pilot study, focused ultrasound (FUS) was used to produce hyperthermia in cervical lymph nodes of rats having experimental autoimmune encephalomyelitis (EAE) to alleviate symptoms associated with EAE. EAE was induced in dark agouti rats, and EAE scores were recorded over 21 d. At the onset of EAE symptoms, rats were treated with FUS to induce temperatures of 43–44°C for 20 min in the superficial cervical lymph nodes. An EAE remittance score was tallied for all rats, defined as the maximum EAE score observed minus the minimum EAE score observed after the maximum EAE was reached. On average, the peak remittance score for FUS-treated rats was 1.14 ± 0.48 versus 0.33 ± 0.27 for sham-treated rats. These differences were statistically significant (p = 0.037). Therefore, FUS treatment of cervical lymph nodes in rats with EAE resulted in a significant reduction in EAE score.

      PubDate: 2016-09-15T14:47:44Z
      DOI: 10.1016/j.ultrasmedbio.2016.08.007
  • Transbulbar B-Mode Sonography in Multiple Sclerosis: Clinical and
           Biological Relevance
    • Authors: Roberto De Masi; Stefania Orlando; Aldo Conte; Sergio Pasca; Rocco Scarpello; Pantaleo Spagnolo; Antonella Muscella; Antonella De Donno
      Abstract: Publication date: Available online 15 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Roberto De Masi, Stefania Orlando, Aldo Conte, Sergio Pasca, Rocco Scarpello, Pantaleo Spagnolo, Antonella Muscella, Antonella De Donno
      Optic nerve sheath diameter quantification by transbulbar B-mode sonography is a recently validated technique, but its clinical relevance in relapse-free multiple sclerosis patients remains unexplored. In an open-label, comparative, cross-sectional study, we aimed to assess possible differences between patients and healthy controls in terms of optic nerve sheath diameter and its correlation with clinical/paraclinical parameters in this disease. Sixty unselected relapse-free patients and 35 matched healthy controls underwent transbulbar B-mode sonography. Patients underwent routine neurologic examination, brain magnetic resonance imaging and visual evoked potential tests. The mean optic nerve sheath diameter 3 and 5 mm from the eyeball was 22–25% lower in patients than controls and correlated with the Expanded Disability Status Scale (r = −0.34, p = 0.048, and r = −0.32, p = 0.042, respectively). We suggest that optic nerve sheath diameter quantified by transbulbar B-mode sonography should be included in routine assessment of the disease as an extension of the neurologic examination.

      PubDate: 2016-09-15T14:47:44Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.018
  • Sonographic Features of Endobronchial Ultrasound in Differentiation of
           Benign Lymph Nodes
    • Authors: Lei Wang; Weihua Wu; Jiajun Teng; Runbo Zhong; Baohui Han; Jiayuan Sun
      Abstract: Publication date: Available online 7 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Lei Wang, Weihua Wu, Jiajun Teng, Runbo Zhong, Baohui Han, Jiayuan Sun
      Endobronchial ultrasound (EBUS) features have been found to be a useful tool in differentiating malignant from benign lymph nodes, but the use of these features to distinguish benign intrathoracic lymphadenopathies, including tuberculosis, sarcoidosis and reactive lymphadenitis, has not been established. The goal of this study was to evaluate the use of EBUS features in predicting tuberculosis, sarcoidosis, and non-specific inflammation. One hundred eighty-eight patients with suspected benign lymphadenopathy were included in the study. The EBUS features studied were short axis, shape, calcification, central hilar structure, necrosis sign, margins, echogenicity, clustered formation and vascular patterns. The sonographic findings were confirmed by clinicopathologic results. EBUS-Guided transbronchial needle aspiration was performed on 452 lymph nodes. Thirty-seven tuberculous nodes, 193 sarcoid nodes and 150 reactive nodes were retrospectively analyzed. Excluded were 72 nodes. Multivariate analysis revealed that presence of the necrosis sign and absence of the clustered formation are independent factors predictive of tuberculous nodes. Short axis >1 cm, absence of central hilar structure, distinct margins, presence of clustered formation and non-hilar perfusion were predictive of sarcoid nodes. Presence of central hilar structure, absence of clustered formation and vascular pattern (hilar perfusion or avascularity) were predictive of reactive lymphadenitis. The sum score model of these combined predictive factors indicated that the best diagnostic accuracies for predicting tuberculous nodes, sarcoid nodes and reactive lymphadenitis were 77.1%, 89.2% and 87.1%, respectively. Sonographic features could be helpful in differentiating the type of benign intrathoracic lymphadenopathy during EBUS examination.

      PubDate: 2016-09-10T12:37:09Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.019
  • Diagnostic Performance of Shear Wave Elastography Parameters Alone and in
           Combination with Conventional B-Mode Ultrasound Parameters for the
           Characterization of Thyroid Nodules: A Prospective, Dual-Center Study
    • Authors: Katarzyna Dobruch-Sobczak; Elwira Bakuła Zalewska; Anna Gumińska; Rafał Zenon Słapa; Krzysztof Mlosek; Paweł Wareluk; Wiesław Jakubowski; Marek Dedecjus
      Abstract: Publication date: Available online 9 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Katarzyna Dobruch-Sobczak, Elwira Bakuła Zalewska, Anna Gumińska, Rafał Zenon Słapa, Krzysztof Mlosek, Paweł Wareluk, Wiesław Jakubowski, Marek Dedecjus
      The aims of our study were to determine whether shear wave elastography (SWE) can improve the conventional B-mode differentiation of thyroid lesions, determine the most accurate SWE parameter for differentiation and assess the influence of microcalcifications and chronic autoimmune thyroiditis on SWE values. We examined 119 patients with 169 thyroid nodules who prospectively underwent B-mode ultrasound and SWE using the same ultrasound machine. The parameters assessed using SWE were: mean elasticity within the entire lesion (SWE-whole) and mean (SWE-mean) and maximum (SWE-max) elasticity for a 2-mm-diameter region of interest in the stiffest portion of the lesion, excluding microcalcifications. The discriminant powers of a generalized estimating equation model including B-mode parameters only and a generalized estimation equation model including both B-mode and SWE parameters were assessed and compared using the area under the receiver operating characteristic curve, in association with pathologic verification. In total, 50 and 119 malignant and benign lesions were detected. In generalized estimated equation regression, the B-mode parameters associated with higher odds ratios (ORs) for malignant lesions were microcalcifications (OR = 4.3), hypo-echogenicity (OR = 3.13) and irregular margins (OR = 10.82). SWE-max was the only SWE independent parameter in differentiating between malignant and benign tumors (OR = 2.95). The area under the curve for the B-mode model was 0.85, whereas that for the model combining B-mode and SWE parameters was 0.87. There was no significant difference in mean SWE values between patients with and without chronic autoimmune thyroiditis. The results of the present study suggest that SWE is a valuable tool for the characterization of thyroid nodules, with SWE-max being a significant parameter in differentiating benign and malignant lesions, independent of conventional B-mode parameters. The combination of SWE parameters and conventional B-mode parameters does not significantly improve the diagnosis of malignant thyroid nodules. The presence of microcalcifications can influence the SWE-whole value, whereas the presence of chronic autoimmune thyroiditis may not.

      PubDate: 2016-09-10T12:37:09Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.010
  • Foreword to the Second Set of WFUMB Guidelines and Recommendations on the
           Clinical Use of Ultrasound Elastography
    • Authors: Richard G. Barr
      Abstract: Publication date: Available online 9 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Richard G. Barr

      PubDate: 2016-09-10T12:37:09Z
      DOI: 10.1016/j.ultrasmedbio.2016.08.027
  • Echocardiographic Characterization of the Inferior Vena Cava in Trained
           and Untrained Females
    • Authors: Kristofer Hedman; Eva Nylander; Jan Henriksson; Niclas Bjarnegård; Lars Brudin; Éva Tamás
      Abstract: Publication date: Available online 9 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Kristofer Hedman, Eva Nylander, Jan Henriksson, Niclas Bjarnegård, Lars Brudin, Éva Tamás
      The aim of the study was to explore the long- and short-axis dimensions, shape and collapsibility of the inferior vena cava in 46 trained and 48 untrained females (mean age: 21 ± 2 y). Echocardiography in the subcostal view revealed a larger expiratory long-axis diameter (mean: 24 ± 3 vs. 20 ± 3 mm, p < 0.001) and short-axis area (mean: 5.5 ± 1.5 vs. 4.7 ± 1.4 cm2, p = 0.014) in trained females. IVC shape (the ratio of short-axis major to minor diameters) and the relative decrease in IVC dimension with inspiration were similar for the two groups. The IVC long-axis diameter reflected short-axis minor diameter and was correlated to maximal oxygen uptake (r = 0.52, p < 0.01). In summary, the results indicate that trained females have a larger IVC similar in shape and respiratory decrease in dimensions to that of untrained females. The long-axis diameter corresponded closely to short-axis minor diameter and, thus, underestimates maximal IVC diameter.

      PubDate: 2016-09-10T12:37:09Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.003
  • Expanding Role of Contrast-Enhanced Ultrasound in Guidance and Monitoring
           of Percutaneous Thermal Ablation
    • Authors: Chiara De Angelis; Giovanni Mauri
      Abstract: Publication date: Available online 3 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Chiara De Angelis, Giovanni Mauri

      PubDate: 2016-09-06T09:09:16Z
      DOI: 10.1016/j.ultrasmedbio.2015.10.026
  • Principal Component Analysis of the Longitudinal Carotid Wall Motion in
           Association with Vascular Stiffness: A Pilot Study
    • Authors: Heikki Yli-Ollila; Mika P. Tarvainen; Tomi P. Laitinen; Tiina M. Laitinen
      Abstract: Publication date: Available online 3 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Heikki Yli-Ollila, Mika P. Tarvainen, Tomi P. Laitinen, Tiina M. Laitinen
      The longitudinal motion of the carotid wall during a heart cycle has a multiphasic waveform. Recent studies have examined the amplitude of this motion. Instead of amplitude measurements, we focus on making a detailed characterization of the motion waveform. Two-minute carotid ultrasound videos were obtained for 19 healthy volunteers, and a speckle tracking algorithm was used to measure the motion of the carotid wall. Principal component analysis revealed the characteristic features of wall motion and their relation to known arterial stiffness indices. By estimating two principal components, we could account for more than 92% of the variation in the motion graphs. The first principal component derived from the longitudinal motion curves was significantly correlated to pulse pressure, indicating that the main dominant base waveform of the longitudinal motion was related to blood pressure. The second principal component derived from the longitudinal motion curves had multiple significant correlations to known stiffness indices, indicating that the stronger biphasic structure of the motion curve, especially on the adventitia layer, was associated with higher distensibility and compliance, as well as reduced carotid artery stiffness. According to this study, the second principal component of the longitudinal motion may be a useful parameter reflecting vascular health.

      PubDate: 2016-09-06T09:09:16Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.020
  • Short Hairpin RNA Knockdown of Connective Tissue Growth Factor by
           Ultrasound-Targeted Microbubble Destruction Improves Renal Fibrosis
    • Authors: Shuping Wei; Chaoli Xu; Joshua J. Rychak; Alice Luong; Yu Sun; Zhijian Yang; Mingxia Li; Chunrui Liu; Ninghua Fu; Bin Yang
      Abstract: Publication date: Available online 3 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Shuping Wei, Chaoli Xu, Joshua J. Rychak, Alice Luong, Yu Sun, Zhijian Yang, Mingxia Li, Chunrui Liu, Ninghua Fu, Bin Yang
      The purpose of this study was to evaluate whether ultrasound-targeted microbubble destruction transfer of interfering RNA against connective tissue growth factor (CTGF) in the kidney would ameliorate renal fibrosis in vivo. A short hairpin RNA (shRNA) targeting CTGF was cloned into a tool plasmid and loaded onto the surface of a cationic microbubble product. A unilateral ureteral obstruction (UUO) model in mice was used to evaluate the effect of CTGF knockdown. Mice were administered the plasmid-carrying microbubble intravenously, and ultrasound was applied locally to the obstructed kidney. Mice undergoing a sham UUO surgery and untreated UUO mice were used as disease controls, and mice administered plasmid alone, plasmid with ultrasound treatment and microbubbles and plasmid without ultrasound were used as treatment controls. Mice were treated once and then evaluated at day 14. CTGF in the kidney was measured by quantitative reverse transcription polymerase chain reaction and Western blot. Expression of CTGF, transforming growth factor β1, α smooth muscle actin and type I collagen in the obstructed kidney was evaluated by immunohistochemistry. The cohort treated with plasmid-carrying microbubbles and ultrasound exhibited reduced mRNA and protein expression of CTGF (p < 0.01). Furthermore, CTGF gene silencing decreased the interstitial deposition of transforming growth factor β1, α smooth muscle actin and type I collagen as assessed in immunohistochemistry, as well as reduced renal fibrosis in pathologic alterations (p < 0.01). No significant changes in target mRNA, protein expression or disease pathology were observed in the control cohorts. A single treatment of ultrasound-targeted microbubble destruction is able to deliver sufficient shRNA to inhibit the expression of CTGF and provide a meaningful reduction in disease severity. This technique may be a potential therapy for treatment of renal fibrosis.

      PubDate: 2016-09-06T09:09:16Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.022
  • Ultrasound-Guided Spine Anesthesia: Feasibility Study of a Guidance
    • Authors: Alexander Seitel; Samira Sojoudi; Jill Osborn; Abtin Rasoulian; Saman Nouranian; Victoria A. Lessoway; Robert N. Rohling; Purang Abolmaesumi
      Abstract: Publication date: Available online 2 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Alexander Seitel, Samira Sojoudi, Jill Osborn, Abtin Rasoulian, Saman Nouranian, Victoria A. Lessoway, Robert N. Rohling, Purang Abolmaesumi
      Spinal needle injections are guided by fluoroscopy or palpation, resulting in radiation exposure and/or multiple needle re-insertions. Consequently, guiding these procedures with live ultrasound has become more popular, but images are still challenging to interpret. We introduce a guidance system based on augmentation of ultrasound images with a patient-specific 3-D surface model of the lumbar spine. We assessed the feasibility of the system in a study on 12 patients. The system could accurately provide augmentations of the epidural space and the facet joint for all subjects. Following conventional, fluoroscopy-guided needle placement, augmentation accuracy was determined according to the electromagnetically tracked final position of the needle. In 9 of 12 cases, the accuracy was considered sufficient for successfully delivering anesthesia. The unsuccessful cases can be attributed to errors in the electromagnetic tracking reference, which can be avoided by a setup reducing the influence of the metal C-arm.

      PubDate: 2016-09-06T09:09:16Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.008
  • Low-Intensity Pulsed Ultrasound Enhances Nerve Growth Factor-Induced
           Neurite Outgrowth through Mechanotransduction-Mediated
           ERK1/2–CREB–Trx-1 Signaling
    • Authors: Lu Zhao; Yi Feng; Hong Hu; Aiwei Shi; Lei Zhang; Mingxi Wan
      Abstract: Publication date: Available online 2 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Lu Zhao, Yi Feng, Hong Hu, Aiwei Shi, Lei Zhang, Mingxi Wan
      Enhancing the action of nerve growth factor (NGF) is a potential therapeutic approach to neural regeneration. To facilitate neural regeneration, we investigated whether combining low-intensity pulsed ultrasound (LIPUS) and NGF could promote neurite outgrowth, an essential process in neural regeneration. In the present study, PC12 cells were subjected to a combination of LIPUS (1 MHz, 30 or 50 mW/cm2, 20% duty cycle and 100-Hz pulse repetition frequency, 10 min every other day) and NGF (50 ng/mL) treatment, and then neurite outgrowth was compared. Our findings indicated that the combined treatment with LIPUS (50 mW/cm2) and NGF (50 ng/mL) promotes neurite outgrowth that is comparable to that achieved by NGF (100 ng/mL) treatment alone. LIPUS significantly increased NGF-induced neurite length, but not neurite branching. These effects were attributed to the enhancing effects of LIPUS on NGF-induced phosphorylation of ERK1/2 and CREB and the expression of thioredoxin (Trx-1). Furthermore, blockage of stretch-activated ion channels with Gd3+ suppressed the stimulating effects of LIPUS on NGF-induced neurite outgrowth and the downstream signaling activation. Taken together, our findings suggest that LIPUS enhances NGF-induced neurite outgrowth through mechanotransduction-mediated signaling of the ERK1/2–CREB–Trx-1 pathway. The combination of LIPUS and NGF could potentially be used for the treatment of nerve injury and neurodegenerative diseases.

      PubDate: 2016-09-06T09:09:16Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.017
  • Effect of Low-Intensity Pulsed Ultrasound after Mesenchymal Stromal Cell
           Injection to Treat Osteochondral Defects: An In Vivo Study
    • Authors: Shoki Yamaguchi; Tomoki Aoyama; Akira Ito; Momoko Nagai; Hirotaka Iijima; Junichi Tajino; Xiangkai Zhang; Kiyan Wataru; Hiroshi Kuroki
      Abstract: Publication date: Available online 3 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Shoki Yamaguchi, Tomoki Aoyama, Akira Ito, Momoko Nagai, Hirotaka Iijima, Junichi Tajino, Xiangkai Zhang, Kiyan Wataru, Hiroshi Kuroki
      We investigated the effect of low-intensity pulsed ultrasound (LIPUS) treatment combined with mesenchymal stromal cell (MSC) injection for cartilage repair and subchondral bone reconstitution for treatment of osteochondral defects. An osteochondral defect was created on both femur grooves of Wistar rats. Four weeks later, bone marrow MSCs were injected into the right knee joint. The rats were divided into two intervention groups: without or with LIPUS irradiation. Cartilage repair was evaluated histologically based on the Wakitani cartilage repair score. Subchondral bone reconstitution was evaluated as bone volume (BV)/tissue volume (TV) by micro-computed tomography analysis. MSC injection improved the cartilage repair score, and LIPUS irradiation improved BV/TV. Combination treatment promoted both cartilage repair and BV/TV improvement. Thus, MSC injection combined with LIPUS irradiation is more effective than either treatment alone in promoting concurrent cartilage repair and subchondral reconstitution.

      PubDate: 2016-09-06T09:09:16Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.021
  • Fractal Dimension of Tumor Microvasculature by DCE-US: Preliminary Study
           in Mice
    • Authors: Tamerlan Saidov; Carola Heneweer; Maarten Kuenen; Julian von Broich-Oppert; Hessel Wijkstra; Jean de la Rosette; Massimo Mischi
      Abstract: Publication date: Available online 2 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Tamerlan Saidov, Carola Heneweer, Maarten Kuenen, Julian von Broich-Oppert, Hessel Wijkstra, Jean de la Rosette, Massimo Mischi
      Neoangiogenesis, which results in the formation of an irregular network of microvessels, plays a fundamental role in the growth of several types of cancer. Characterization of microvascular architecture has therefore gained increasing attention for cancer diagnosis, treatment monitoring and evaluation of new drugs. However, this characterization requires immunohistologic analysis of the resected tumors. Currently, dynamic contrast-enhanced ultrasound imaging (DCE-US) provides new options for minimally invasive investigation of the microvasculature by analysis of ultrasound contrast agent (UCA) transport kinetics. In this article, we propose a different method of analyzing UCA concentration that is based on the spatial distribution of blood flow. The well-known concept of Mandelbrot allows vascular networks to be interpreted as fractal objects related to the regional blood flow distribution and characterized by their fractal dimension (FD). To test this hypothesis, the fractal dimension of parametric maps reflecting blood flow, such as UCA wash-in rate and peak enhancement, was derived for areas representing different microvascular architectures. To this end, subcutaneous xenograft models of DU-145 and PC-3 prostate-cancer lines in mice, which show marked differences in microvessel density spatial distribution inside the tumor, were employed to test the ability of DCE-US FD analysis to differentiate between the two models. For validation purposes, the method was compared with immunohistologic results and UCA dispersion maps, which reflect the geometric properties of microvascular architecture. The results showed good agreement with the immunohistologic analysis, and the FD analysis of UCA wash-in rate and peak enhancement maps was able to differentiate between the two xenograft models (p < 0.05).

      PubDate: 2016-09-06T09:09:16Z
      DOI: 10.1016/j.ultrasmedbio.2016.08.001
  • Accuracy of Tumor Sizing in Breast Cancer: A Comparison of Strain
           Elastography, 3-D Ultrasound and Conventional B-Mode Ultrasound with and
           without Compound Imaging
    • Authors: Angrit Stachs; Alexander Pandjaitan; Annett Martin; Johannes Stubert; Steffi Hartmann; Bernd Gerber; Änne Glass
      Abstract: Publication date: Available online 3 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Angrit Stachs, Alexander Pandjaitan, Annett Martin, Johannes Stubert, Steffi Hartmann, Bernd Gerber, Änne Glass
      The objective of this study was to compare the accuracy of strain elastography (SE), 3-D ultrasound (US), B-mode US with compound imaging (CI) and B-mode US without compound imaging for lesion sizing in breast cancer. The prospective study included 93 patients with invasive breast cancer. The largest tumor diameters measured by B-mode US, B-mode US with CI, SE and 3-D US were compared in Bland–Altman plots versus pathology as reference. A general linear model repeated measures (GLM Rep) was applied to investigate factors influencing tumor sizing. All methods underestimated pathologic size, with SE (−0.08 ± 7.7 mm) and 3-D US (−1.4 ± 6.5 mm) having the smallest mean differences from pathology. Bland–Altman plots revealed that B-mode US, B-mode US with CI and 3-D US systematically underestimated large tumor sizes, and only SE was technically comparable to pathology. The study indicates that sonographic underestimation of tumor size occurs mainly in tumors >20 mm; in this subgroup, SE is superior to other ultrasound methods.

      PubDate: 2016-09-06T09:09:16Z
      DOI: 10.1016/j.ultrasmedbio.2016.06.026
  • An Improved Algorithm for Coronary Bypass Anastomosis Segmentation in
           Epicardial Ultrasound Sequences
    • Authors: Alex Skovsbo Jørgensen; Samuel Emil Schmidt; Niels-Henrik Staalsen; Lasse Riis Østergaard
      Abstract: Publication date: Available online 2 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Alex Skovsbo Jørgensen, Samuel Emil Schmidt, Niels-Henrik Staalsen, Lasse Riis Østergaard
      Epicardial ultrasound (EUS) can be used for intra-operative quality assessment of coronary artery bypass anastomoses. To quantify the anastomotic quality from EUS images, the area of anastomotic structures has to be extracted from EUS sequences. Currently, this is done manually as no objective methods are available. We used an automatic anastomosis segmentation algorithm to extract the area of anastomotic structures from in vivo EUS sequences obtained from 16 porcine anastomoses. The algorithm consists of four major components: vessel detection, vessel segmentation, segmentation quality control and inter-frame contour alignment. The segmentation accuracy was assessed using m-fold cross-validation based on 830 manual segmentations of the anastomotic structures. A Dice coefficient of 0.879 (±0.073) and an absolute area difference of 16.95% (±17.94) were obtained. The proposed segmentation algorithm has potential to automatically extract the area of anastomotic structures.

      PubDate: 2016-09-06T09:09:16Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.014
  • Post-procedure Evaluation of Microwave Ablations of Hepatocellular
           Carcinomas Using Electrode Displacement Elastography
    • Authors: Wenjun Yang; Timothy J. Ziemlewicz; Tomy Varghese; Marci L. Alexander; Nicholas Rubert; Atul N. Ingle; Meghan G. Lubner; James L. Hinshaw; Shane A. Wells; Fred T. Lee; James A. Zagzebski
      Abstract: Publication date: Available online 2 September 2016
      Source:Ultrasound in Medicine & Biology
      Author(s): Wenjun Yang, Timothy J. Ziemlewicz, Tomy Varghese, Marci L. Alexander, Nicholas Rubert, Atul N. Ingle, Meghan G. Lubner, James L. Hinshaw, Shane A. Wells, Fred T. Lee, James A. Zagzebski
      Microwave ablation has been used clinically as an alternative to surgical resection. However, lack of real-time imaging to assess treated regions may compromise treatment outcomes. We previously introduced electrode displacement elastography (EDE) for strain imaging and verified its feasibility in vivo on porcine animal models. In this study, we evaluated EDE on 44 patients diagnosed with hepatocellular carcinoma, treated using microwave ablation. The ablated region was identified on EDE images for 40 of the 44 patients. Ablation areas averaged 13.38 ± 4.99 cm2 on EDE, compared with 7.61 ± 3.21 cm2 on B-mode imaging. Contrast and contrast-to-noise ratios obtained with EDE were 232% and 98%, respectively, significantly higher than values measured on B-mode images (p < 0.001). This study indicates that EDE is feasible in patients and provides improved visualization of the ablation zone compared with B-mode ultrasound.

      PubDate: 2016-09-06T09:09:16Z
      DOI: 10.1016/j.ultrasmedbio.2016.07.015
  • Calendar
    • Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10

      PubDate: 2016-09-01T06:20:39Z
  • Editorial Advisory Board
    • Abstract: Publication date: October 2016
      Source:Ultrasound in Medicine & Biology, Volume 42, Issue 10

      PubDate: 2016-09-01T06:20:39Z
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