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Journal Cover Ultrasound in Medicine & Biology
   Journal TOC RSS feeds Export to Zotero [8 followers]  Follow    
   Full-text available via subscription Subscription journal
     ISSN (Print) 0301-5629
     Published by Elsevier Homepage  [2570 journals]   [SJR: 0.864]   [H-I: 85]
  • Ultrasound-Based Measurement of Molecular Marker Concentration in Large
           Blood Vessels: A Feasibility Study
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Shiying Wang , F. William Mauldin Jr. , Alexander L. Klibanov , John A. Hossack
      Ultrasound molecular imaging has demonstrated efficacy in pre-clinical studies for cancer and cardiovascular inflammation. However, these techniques often require lengthy protocols because of waiting periods or additional control microbubble injections. Moreover, they are not capable of quantifying molecular marker concentration in human tissue environments that exhibit variable attenuation and propagation path lengths. Our group recently investigated a modulated acoustic radiation force-based imaging sequence, which was found to detect targeted adhesion independent of control measurements. In the present study, this sequence was tested against various experimental parameters to determine its feasibility for quantitative measurements of molecular marker concentration. Results indicated that measurements obtained from the sequence (residual-to-saturation ratio, Rresid) were independent of acoustic pressure and attenuation (p > 0.13, n = 10) when acoustic pressures were sufficiently low. The Rresid parameter exhibited a linear relationship with measured molecular marker concentration (R2 > 0.94). Consequently, feasibility was illustrated in vitro, for quantification of molecular marker concentration in large vessels using a modulated acoustic radiation force-based sequence. Moreover, these measurements were independent of absolute acoustic reflection amplitude and used short imaging protocols (3 min) without control measurements.


      PubDate: 2014-10-12T23:27:04Z
       
  • Acoustic Structure Quantification Ultrasound Software Proves Imprecise in
           Assessing Liver Fibrosis or Cirrhosis in Parenchymal Liver Diseases
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Christiane Krämer , Natalie Jaspers , Dirk Nierhoff , Kathrin Kuhr , Andrea Bowe , Tobias Goeser , Guido Michels
      The present study was conducted to assess the diagnostic accuracy of Acoustic Structure Quantification (ASQ) ultrasound software in liver biopsy of patients with liver fibrosis and cirrhosis. Eighty patients (47 ± 14 y, 41 men) with chronic liver diseases underwent ultrasound examination of the liver and liver biopsy. In addition to the standard-care ultrasound examination, three valid gray-scale images were obtained for each patient. With the ASQ software, the average and peak values ( C m 2 ) of each ultrasound gray-scale image were calculated and then compared with histologic fibrosis staging (F0–F4). No correlation was found between ASQ values and histologic fibrosis stage (p > 0.05). Areas under the curve for the diagnosis of no or mild fibrosis (F0 and F1), moderate/severe fibrosis (F2 and F3) and cirrhosis (F4) using average/peak C m 2 values of small regions of interest were 0.46/0.43, 0.62/0.68 and 0.38/0.33. Determination of liver fibrosis with ASQ in its present form as an alternative approach to liver biopsy is too imprecise.


      PubDate: 2014-10-12T23:27:04Z
       
  • Application of 3-D Echocardiography and Gated Micro-Computed Tomography to
           Assess Cardiomyopathy in a Mouse Model of Duchenne Muscular Dystrophy
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Andrew B. Bondoc , Sarah Detombe , Joy Dunmore-Buyze , Kelly M. Gutpell , Linshan Liu , Amanda Kaszuba , Seongryoung Han , Rebecca McGirr , Jennifer Hadway , Maria Drangova , Lisa M. Hoffman
      The purpose of this study was to measure changes in cardiac function as cardiomyopathy progresses in a mouse model of Duchenne muscular dystrophy using 3-D ECG-gated echocardiography. This study is the first to correlate cardiac volumes acquired using 3-D echocardiography with those acquired using retrospectively gated micro-computed tomography (CT). Both were further compared with standard M-mode echocardiography and histologic analyses. We found that although each modality measures a decrease in cardiac function as disease progresses in mdx/utrn –/– mice (n = 5) compared with healthy C57BL/6 mice (n = 8), 3-D echocardiography has higher agreement with gold-standard measurements acquired by gated micro-CT, with little standard deviation between measurements. M-Mode echocardiography measurements, in comparison, exhibit considerably greater variability and user bias. Given the radiation dose associated with micro-CT and the geometric assumptions made in M-mode echocardiography to calculate ventricular volume, we suggest that use of 3-D echocardiography has important advantages that may allow for the measurement of early disease changes that occur before overt cardiomyopathy.


      PubDate: 2014-10-12T23:27:04Z
       
  • Gel Phantom Study with High-Intensity Focused Ultrasound: Influence of
           Metallic Stent Containing Either Air or Fluid
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Koung Mi Kang , Jae Young Lee , Haeri Kim , Joon Koo Han , Byung-Ihn Choi
      We aimed to investigate whether a cylindrical structure containing either air or fluid and with or without a metallic stent affects the volume and density of cavitation produced by high-intensity focused ultrasound via a gel phantom study. Sixteen tissue-mimicking phantoms based on a polyacrylamide gel mixed with bovine serum albumin with a cylindrical hole 1 cm in diameter and 7.5 cm in length were divided into four groups of four phantoms with air in the holes (group 1), four phantoms with fluid in the holes (group 2), four phantoms with air-containing metallic stents (group 3) and four phantoms with fluid-containing metallic stents (group 4). A pulsed high-intensity focused ultrasound beam (50% duty cycle, 40-Hz pulse repetition frequency) at 75 W of acoustic power was directed perpendicularly to the longitudinal axis of the hole, with its focus at the posterior wall of the hole. The size of the cavitation on the x-, y-, and z-axes was measured, and the volumes of cavitation and coagulation were calculated using the formula for the volume of an elliptical cone. The density of cavitation was measured in the tissue phantom anterior to the hole with a 1 × 1-cm square region of interest. For statistical analysis, the Kruskal–Wallis test and Mann–Whitney U-test were used. The phantoms with air-containing holes (groups 1 and 3) developed larger and denser cavitations anterior to the focus, without unnecessary coagulation posterior to the focus, compared with the phantoms with fluid-containing holes (groups 2 and 4), regardless of the presence of stents. All of the axes and volumes of the anterior cavitations were significantly larger than those of the posterior cavitations in groups 1 and 3 (all p-values <0.05). The results of this study might be applied to maximize cavitation to enhance drug delivery into tumors.


      PubDate: 2014-10-12T23:27:04Z
       
  • Molecular Ultrasound Imaging Using Contrast Agents Targeting Endoglin,
           Vascular Endothelial Growth Factor Receptor 2 and Integrin
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Ingrid Leguerney , Jean-Yves Scoazec , Nicolas Gadot , Nina Robin , Frédérique Pénault-Llorca , Steeve Victorin , Nathalie Lassau
      Expression levels of endoglin, αv integrin and vascular endothelial growth factor receptor 2 (VEGFR2) were investigated using targeted, contrast-enhanced ultrasonography in murine melanoma tumor models. Microvasculature and expression levels of biomarkers were investigated using specific contrast agents conjugated with biotinylated monoclonal antibodies. Ultrasound signal intensity from bound contrast agents was evaluated in two groups of mice: control mice and mice treated with sorafenib. Expression levels were analyzed by immunohistochemistry. Endoglin biomarkers were more highly expressed than αv integrin and VEGFR2. Endoglin decreased in the sorafenib group, whereas it tended to increase with time in the control group. Targeted ultrasound contrast agents may be used for non-invasive longitudinal evaluation of tumor angiogenesis during tumor growth or therapeutic treatment in preclinical studies. Endoglin protein, which plays an important role in angiogenesis, seems to be a target of interest for detection of cancer and for prediction of therapeutic efficacy.


      PubDate: 2014-10-12T23:27:04Z
       
  • Comparison of Acoustic Radiation Force Impulse Imaging and Transient
           Elastography for Non-invasive Assessment of Liver Fibrosis in Patients
           with Chronic Hepatitis B
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Dakun Zhang , Min Chen , Ruifang Wang , Yang Liu , Dedong Zhang , Liping Liu , Guangde Zhou
      The aims of this study were to compare the performance of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in the assessment of liver fibrosis in patients with chronic hepatitis B and to evaluate the impact of elevated alanine transaminase levels on liver stiffness assessment using ARFI elastography. One hundred eighty consecutive patients with chronic hepatitis B were enrolled in this study and evaluated with respect to histologic and biochemical features. All patients underwent ARFI elastography and TE. ARFI elastography and TE correlated significantly with histologically assessed fibrosis (r = 0.599, p < 0.001, for ARFI elastography; r = 0.628, p < 0.001, for TE) and necro-inflammatory activity (r = 0.591, p < 0.001, for ARFI elastography; r = 0.616, p < 0.001, for TE). Areas under the receiver operating characteristic curves for ARFI elastography and TE were 0.764 and 0.813 (p = 0.302, ≥stage 2), 0.852 and 0.852 (p = 1.000, ≥stage 3) and 0.825 and 0.799 (p = 0.655, S = 4), respectively. The optimum cutoff values for ARFI elastography were 1.63 m/s for stage ≥2, 1.74 m/s for stage ≥3 and 2.00 m/s for stage 4 in patients for whom alanine transaminase levels were evaluated. The cutoff values decreased to 1.24 m/s for ≥ stage 2, 1.32 m/s for ≥ stage 3 and 1.41 m/s for stage 4 in patients with normal alanine transaminase levels. ARFI elastography may be a reliable method for diagnosing the stage of liver fibrosis with diagnostic performance similar to that of TE in patients with chronic hepatitis B. In addition, liver stiffness values obtained with ARFI elastography, like those obtained with TE, may be influenced by alanine transaminase levels.


      PubDate: 2014-10-12T23:27:04Z
       
  • Assessment of In Vitro Dental Implant Primary Stability Using an
           Ultrasonic Method
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Romain Vayron , Vincent Mathieu , Adrien Michel , Guillaume Haïat
      Dental implants are used for oral rehabilitation. However, there remain risks of failure that depend on the implant stability. The objective of this study is to investigate whether quantitative ultrasound technique can be used to assess the amount of bone in contact with dental implants. Ten implants are first inserted in the bone samples. The 10 MHz ultrasonic response of each implant is measured using a dedicated device and an indicator I is derived based on the amplitude of the signal. Then, the implant is unscrewed by 2 π radians and the measurement is realized again. A statistical analysis of variance was carried out and revealed a significant effect of the amount of bone in contact with the implant on the values of I (p value < 10−5). The results indicates the feasibility of quantitative ultrasound techniques to assess implant primary stability in vitro.


      PubDate: 2014-10-12T23:27:04Z
       
  • Reliability of Contrast-Enhanced Ultrasound for the Assessment of Muscle
           Perfusion in Health and Peripheral Arterial Disease
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Kate N. Thomas , James D. Cotter , Samuel J.E. Lucas , Brigid G. Hill , André M. van Rij
      We investigated the reliability of contrast-enhanced ultrasound (CEUS) in assessing calf muscle microvascular perfusion in health and disease. Response to a post-occlusive reactive hyperaemia test was repeated on two occasions >48 h apart in healthy young (28 ± 7 y) and elderly controls (70 ± 5 y), and in peripheral arterial disease patients (PAD, 69 ± 7 y; n = 10, 9 and 8 respectively). Overall, within-individual reliability was poor (coefficient of variation [CV] range: 15–87%); the most reliable parameter was time to peak (TTP, 15–48% CV). Nevertheless, TTP was twice as long in elderly controls and PAD compared to young (19.3 ± 10.4 and 22.0 ± 8.6 vs. 8.9 ± 6.2 s respectively; p < 0.01), and area under the curve for contrast intensity post-occlusion (a reflection of blood volume) was ∼50% lower in elderly controls (p < 0.01 versus PAD and young). Thus, CEUS assessment of muscle perfusion during reactive hyperaemia demonstrated poor reliability, yet still distinguished differences between PAD patients, elderly and young controls.


      PubDate: 2014-10-12T23:27:04Z
       
  • Effects of Extracorporeal Shock Wave Therapy on Functional and Strength
           Recovery of Handgrip in Patients Affected by Epicondylitis
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Angela Notarnicola , Livio Quagliarella , Nicola Sasanelli , Giuseppe Maccagnano , Maria Rosaria Fracella , Maria Immacolata Forcignanò , Biagio Moretti
      Extracorporeal shock wave therapy (ESWT) is effective in the treatment of tendinopathy. We designed a prospective observational clinical study to assess the correlation between clinical and functional measures and recovery of strength after ESWT for epicondylitis. We analyzed 26 patients. We measured progressive improvement in visual analogue scale values (p < 0.0005) and Mayo Elbow Performance Index scores (p = 0.004) for the pathologic limb. Monitoring of handgrip failed to reveal changes in values at any follow-up (p > 0.05). We found no correlation between degree of clinical function and muscle deficit during follow-up. After ESWT, there was a tendency toward a decrease in grip strength, especially in the dominant limb. This could be related to the effects of ESWT, which reduces spasticity in painful hypertonic muscles. These data may be useful in defining the expectations for function during ESWT for epicondylitis, particularly for elite athletes.


      PubDate: 2014-10-12T23:27:04Z
       
  • Duplex Ultrasound Findings Before and After Surgery in Children and
           Adolescents with Renovascular Hypertension
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Adina Voiculescu , Andreas Heusch , Philip Düppers , Siamak Pourhassan , Dirk Klee , Lars C. Rump , Wilhelm Sandmann
      We report our experience with duplex ultrasound in young patients with renal artery stenosis (RAS) or middle aortic syndrome (MAS) before and after surgery (1995 and 2009). Of 36 patients (mean age: 13 ± 7 y), 21 had RAS and 15 had MAS. For patients with RAS, the V max in the affected artery was 350 ± 111 cm/s before surgery and 145 ± 55 cm/s after surgery. The resistance index was 0.46 ± 0.1 in the post-stenotic kidney and increased to 0.60 ± 0.08 after revascularization. Determination of the flow profile in the iliac artery revealed triphasic flow. In individuals with MAS, V max in the aorta was 323 ± 98 and the resistance index in both kidneys was low, even in the absence of RAS. The flow profile in the iliac arteries was monophasic before surgery and became triphasic after surgery. Duplex ultrasound is useful for the evaluation of children and young adults both pre- and post-surgery. Duplex ultrasound criteria for RAS in adults appear to be applicable in children and young adults also. The diagnostic evaluation of suspected renal vascular disease should include assessment of the aorta and the flow profile in the iliac arteries, as this could help differentiate between aortic and isolated renal artery stenosis.


      PubDate: 2014-10-12T23:27:04Z
       
  • Ultrasound Speckle Tracking Strain Estimation of in Vivo Carotid
           Artery Plaque with in Vitro Sonomicrometry Validation
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Erik Widman , Kenneth Caidahl , Brecht Heyde , Jan D’hooge , Matilda Larsson
      Our objective was to validate a previously developed speckle tracking (ST) algorithm to assess strain in common carotid artery plaques. Radial and longitudinal strain was measured in common carotid artery gel phantoms with a plaque-mimicking inclusion using an in-house ST algorithm and sonomicrometry. Moreover, plaque strain by ST for seven patients (77 ± 6 y) with carotid atherosclerosis was compared with a quantitative visual assessment by two experienced physicians. In vitro, good correlation existed between ST and sonomicrometry peak strains, both radially (r = 0.96, p < 0.001) and longitudinally (r = 0.75, p < 0.01). In vivo, greater pulse pressure-adjusted radial and longitudinal strains were found in echolucent plaques than in echogenic plaques. This illustrates the feasibility of ultrasound ST strain estimation in plaques and the possibility of characterizing plaques using ST strain in vivo.


      PubDate: 2014-10-12T23:27:04Z
       
  • Ultrasound Tissue Characterization Does Not Differentiate Genotype, But
           Indexes Ejection Fraction Deterioration in Becker Muscular Dystrophy
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Vincenzo Giglio , Paolo Emilio Puddu , Mark R. Holland , Giovanni Camastra , Gerardo Ansalone , Enzo Ricci , Julia Mela , Federico Sciarra , Marco Di Gennaro
      The aims of the study were, first, to assess whether myocardial ultrasound tissue characterization (UTC) in Becker muscular dystrophy (BMD) can be used to differentiate between patients with deletions and those without deletions; and second, to determine whether UTC is helpful in diagnosing the evolution of left ventricular dysfunction, a precursor of dilated cardiomyopathy. Both cyclic variation of integrated backscatter and calibrated integrated backscatter (cIBS) were assessed in 87 patients with BMD and 70 controls. The average follow-up in BMD patients was 48 ± 12 mo. UTC analysis was repeated only in a subgroup of 40 BMD patients randomly selected from the larger overall group (15 with and 25 without left ventricular dysfunction). Discrimination between BMD patients with and without dystrophin gene deletion was not possible on the basis of UTC data: average cvIBS was 5.2 ± 1.2 and 5.5 ± 1.4 dB, and average cIBS was 29.9 ± 4.7 and 29.6 ± 5.8, respectively, significantly different (p < 0.001) only from controls (8.6 ± 0.5 and 24.6 ± 1.2 dB). In patients developing left ventricular dysfunction during follow-up, cIBS increased to 31.3 ± 5.4 dB, but not significantly (p = 0.08). The highest cIBS values (34.6 ± 5.3 dB, p < 0.09 vs. baseline, p < 0.01 vs BMD patients without left ventricular dysfunction) were seen in the presence of severe left ventricular dysfunction. Multivariate statistics indicated that an absolute change of 6 dB in cIBS is associated with a high probability of left ventricular dysfunction. UTC analysis does not differentiate BMD patients with or without dystrophin gene deletion, but may be useful in indexing left ventricular dysfunction during follow-up.


      PubDate: 2014-10-12T23:27:04Z
       
  • Pocket-Size Imaging Devices Allow for Reliable Bedside Screening for
           Femoral Artery Access Site Complications
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Dominika Filipiak-Strzecka , Błażej Michalski , Jarosław D. Kasprzak , Piotr Lipiec
      The aim of this study was to validate pocket-size imaging devices (PSIDs) as a fast screening tool for detecting complications after femoral artery puncture. Forty patients undergoing femoral artery puncture for arterial access related to percutaneous coronary intervention were enrolled. Twenty-four hours after percutaneous coronary intervention, the involved inguinal region was assessed with PSIDs enabling 2-D gray-scale and color Doppler imaging. Subsequently, examination with a stationary high-end ultrasound system was performed to verify the findings of bedside examination in all patients. In 37 patients, PSID imaging had good diagnostic quality. False aneurysms (one asymptomatic) occurred in four patients, and all were recognized during bedside screening with PSID. One case of femoral artery thrombosis was confirmed with PSID and during standard ultrasonographic examination. Physical examination augmented with the quick bedside PSID examination had a sensitivity of 100% and specificity of 91%. PSID facilitated rapid bedside detection of serious access site complications in the vast majority of patients, including asymptomatic cases.


      PubDate: 2014-10-12T23:27:04Z
       
  • Fully Automatic Detection of Salient Features in 3-D Transesophageal
           Images
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Ariel H. Curiale , Alexander Haak , Gonzalo Vegas-Sánchez-Ferrero , Ben Ren , Santiago Aja-Fernández , Johan G. Bosch
      Most automated segmentation approaches to the mitral valve and left ventricle in 3-D echocardiography require a manual initialization. In this article, we propose a fully automatic scheme to initialize a multicavity segmentation approach in 3-D transesophageal echocardiography by detecting the left ventricle long axis, the mitral valve and the aortic valve location. Our approach uses a probabilistic and structural tissue classification to find structures such as the mitral and aortic valves; the Hough transform for circles to find the center of the left ventricle; and multidimensional dynamic programming to find the best position for the left ventricle long axis. For accuracy and agreement assessment, the proposed method was evaluated in 19 patients with respect to manual landmarks and as initialization of a multicavity segmentation approach for the left ventricle, the right ventricle, the left atrium, the right atrium and the aorta. The segmentation results revealed no statistically significant differences between manual and automated initialization in a paired t-test (p > 0.05). Additionally, small biases between manual and automated initialization were detected in the Bland–Altman analysis (bias, variance) for the left ventricle (−0.04, 0.10); right ventricle (−0.07, 0.18); left atrium (−0.01, 0.03); right atrium (−0.04, 0.13); and aorta (−0.05, 0.14). These results indicate that the proposed approach provides robust and accurate detection to initialize a multicavity segmentation approach without any user interaction.


      PubDate: 2014-10-12T23:27:04Z
       
  • Clinical Evaluation of Synthetic Aperture Sequential Beamforming
           Ultrasound in Patients with Liver Tumors
    • Abstract: Publication date: Available online 11 October 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Peter Møller Hansen , Martin Hemmsen , Andreas Brandt , Joachim Rasmussen , Theis Lange , Paul Suno Krohn , Lars Lönn , Jørgen Arendt Jensen , Michael Bachmann Nielsen
      Medical ultrasound imaging using synthetic aperture sequential beamforming (SASB) has for the first time been used for clinical patient scanning. Nineteen patients with cancer of the liver (hepatocellular carcinoma or colorectal liver metastases) were scanned simultaneously with conventional ultrasound and SASB using a commercial ultrasound scanner and abdominal transducer. SASB allows implementation of the synthetic aperture technique on systems with restricted data handling capabilities due to a reduction in the data rate in the scanner by a factor of 64. The image quality is potentially maintained despite the data reduction. A total of 117 sequences were recorded and evaluated blinded by five radiologists from a clinical perspective. Forty-eight percent of the evaluations were in favor of SASB, 33% in favor of conventional ultrasound and 19 % were equal, that is, a clear, but non-significant trend favoring SASB over conventional ultrasound (p = 0.18), despite the substantial data reduction.


      PubDate: 2014-10-12T23:27:04Z
       
  • Normal Liver Stiffness in Healthy Adults Assessed By Real-Time Shear Wave
           Elastography and Factors That Influence This Method
    • Abstract: Publication date: November 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 11
      Author(s): Zeping Huang , Jian Zheng , Jie Zeng , Xiaoli Wang , Tao Wu , Rongqin Zheng
      Real-time shear wave elastography (SWE) is a novel two-dimensional elastographic method that is used to estimate the severity of liver fibrosis. However, the normal range of liver stiffness (LS) and the possible factors that influence SWE are not well understood. The aims of the current study are to define the normal range of LS in healthy subjects and to explore the factors that may affect SWE. A total of 509 healthy subjects underwent SWE to determine the stiffness of their livers, and the effects of gender, age and body mass index (BMI) on LS were analyzed. The effects of different factors on SWE, including the testing position, measurement depth and size of the region of interest (ROI), were analyzed in 137 subjects. SWE imaging was successfully performed in 502 healthy subjects (98.6%, 502/509). The mean value of the SWE measurements in 502 individuals was 5.10 ± 1.02 kPa, and the 95% confidence interval was 5.02–5.19 kPa (range: 2.4–8.7 kPa). We found that the detective position within the liver had a significant impact on the liver stiffness measurement (LSM), and the lowest coefficient of variation (CV = 8%) was obtained for LSMs made at segment V. LS was greater at a depth >5 cm (5.78 ± 1.66 kPa) compared with depths ≤5 cm (4.66 ± 0.77 kPa, p < 0.001); LS was also greater in men than in women (5.45 ± 1.02 kPa vs. 4.89 ± 0.96 kPa, p < 0.001). However, there were no significant differences in the LS values regarding the size of the ROI, age or BMI (all p > 0.05). The mean LS value in all 502 healthy subjects was 5.10 ± 1.02 kPa. The mean LS value obtained by SWE was not influenced by the size of the ROI, age or BMI, but the mean value was significantly influenced by the different segments of the liver, the detection depth and gender.


      PubDate: 2014-10-05T22:00:18Z
       
  • Breast Ultrasound Despeckling Using Anisotropic Diffusion Guided by
           Texture Descriptors
    • Abstract: Publication date: November 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 11
      Author(s): Wilfrido Gómez Flores , Wagner Coelho de Albuquerque Pereira , Antonio Fernando Catelli Infantosi
      Breast ultrasound (BUS) is considered the most important adjunct method to mammography for diagnosing cancer. However, this image modality suffers from an intrinsic artifact called speckle noise, which degrades spatial and contrast resolution and obscures the screened anatomy. Hence, it is necessary to reduce speckle artifacts before performing image analysis by means of computer-aided diagnosis systems, for example. In addition, the trade-off between smoothing level and preservation of lesion contour details should be addressed by speckle reduction schemes. In this scenario, we propose a BUS despeckling method based on anisotropic diffusion guided by Log–Gabor filters (ADLG). Because we assume that different breast tissues have distinct textures, in our approach we perform a multichannel decomposition of the BUS image using Log–Gabor filters. Next, the conduction coefficient of anisotropic diffusion filtering is computed using texture responses instead of intensity values as stated originally. The proposed algorithm is validated using both synthetic and real breast data sets, with 900 and 50 images, respectively. The performance measures are compared with four existing speckle reduction schemes based on anisotropic diffusion: conventional anisotropic diffusion filtering (CADF), speckle-reducing anisotropic diffusion (SRAD), texture-oriented anisotropic diffusion (TOAD), and interference-based speckle filtering followed by anisotropic diffusion (ISFAD). The validity metrics are the Pratt’s figure of merit, for synthetic images, and the mean radial distance (in pixels), for real sonographies. Figure of merit and mean radial distance indices should tend toward ‘1’ and ‘0’, respectively, to indicate adequate edge preservation. The results suggest that ADLG outperforms the four speckle removal filters compared with respect to simulated and real BUS images. For each method—ADLG, CADF, SRAD, TOAD and ISFAD—the figure of merit median values are 0.83, 0.40, 0.39, 0.51 and 0.59, and the mean radial distance median results are 4.19, 6.29, 6.39, 6.43 and 5.88.


      PubDate: 2014-10-05T22:00:18Z
       
  • Hepatic Perfusion Parameters of Contrast-Enhanced Ultrasonography
           Correlate With the Severity of Chronic Liver Disease
    • Abstract: Publication date: November 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 11
      Author(s): Dong Liu , Linxue Qian , Jinrui Wang , Xiangdong Hu , Lanyan Qiu
      In the study described here, we introduced a new ratio acquired with contrast-enhanced ultrasonography (CEUS): a liver parenchyma blood supply ratio that differentiates arterial and portal phases. Our purpose was to determine whether this ratio and other liver parenchyma perfusion parameters acquired with CEUS can be correlated with the severity of chronic liver disease. Twelve patients with non-cirrhotic chronic liver disease, 35 patients with cirrhosis (child class A: n = 10; child class B: n = 13; child class C: n = 12) and 21 healthy volunteers were examined by CEUS. Time–intensity curves were drawn for regions of interest located in liver parenchyma and right kidney cortex using QLAB quantification software. The arterial and portal phases were differentiated by the time to the maximum enhancement of right kidney and liver parenchyma perfusion data acquired from the time–intensity curves: the intensity of liver parenchyma perfused by hepatic arterial flow (I ap), the intensity of total perfusion of liver parenchyma (I peak), the intensity of liver parenchyma perfused by portal venous flow (I pp) and the ratio of portal perfusion to total perfusion of liver parenchyma expressed by the parameters I pp/I peak, I peak, I pp and I pp/I peak significantly decreased in patients with cirrhosis and in patients with non-cirrhotic chronic liver disease, whereas I ap increased. The parameters I pp, I peak, I pp/I peak and I ap correlated with the severity of chronic liver disease (r = −0.938, p < 0.001; r = −0.790, p < 0.001; r = −0.931 p < 0.001; r = 0.31, p < 0.05). The diagnostic accuracy rates for cirrhosis expressed as areas under receiver operating characteristic curves were 0.93 for I peak, 0.98 for I pp, 0.98 for I pp/I peak, and 0.69 for I ap. Liver parenchyma perfusion parameters obtained by CEUS were correlated with the severity of chronic liver disease and have the potential to assess cirrhosis non-invasively.


      PubDate: 2014-10-05T22:00:18Z
       
  • Masthead
    • Abstract: Publication date: November 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 11




      PubDate: 2014-10-05T22:00:18Z
       
  • Editorial Advisory Board
    • Abstract: Publication date: November 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 11




      PubDate: 2014-10-05T22:00:18Z
       
  • Contents
    • Abstract: Publication date: November 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 11




      PubDate: 2014-10-05T22:00:18Z
       
  • Calendar
    • Abstract: Publication date: November 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 11




      PubDate: 2014-10-05T22:00:18Z
       
  • Volume Flow in Arteriovenous Fistulas Using Vector Velocity Ultrasound
    • Abstract: Publication date: November 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 11
      Author(s): Peter Møller Hansen , Jacob Bjerring Olesen , Michael Johannes Pihl , Theis Lange , Søren Heerwagen , Mads Møller Pedersen , Marianne Rix , Lars Lönn , Jørgen Arendt Jensen , Michael Bachmann Nielsen
      Volume flow in arteriovenous fistulas for hemodialysis was measured using the angle-independent ultrasound technique Vector Flow Imaging and compared with flow measurements using the ultrasound dilution technique during dialysis. Using an UltraView 800 ultrasound scanner (BK Medical, Herlev, Denmark) with a linear transducer, 20 arteriovenous fistulas were scanned directly on the most superficial part of the fistula just before dialysis. Vector Flow Imaging volume flow was estimated with two different approaches, using the maximum and the average flow velocities detected in the fistula. Flow was estimated to be 242 mL/min and 404 mL/min lower than the ultrasound dilution technique estimate, depending on the approach. The standard deviations of the two Vector Flow Imaging approaches were 175.9 mL/min and 164.8 mL/min compared with a standard deviation of 136.9 mL/min using the ultrasound dilution technique. The study supports that Vector Flow Imaging is applicable for volume flow measurements.


      PubDate: 2014-10-05T22:00:18Z
       
  • Imaging Ultrasonic Dispersive Guided Wave Energy in Long Bones Using
           Linear Radon Transform
    • Abstract: Publication date: November 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 11
      Author(s): Tho N.H.T. Tran , Kim-Cuong T. Nguyen , Mauricio D. Sacchi , Lawrence H. Le
      Multichannel analysis of dispersive ultrasonic energy requires a reliable mapping of the data from the time–distance (t–x) domain to the frequency–wavenumber (f–k) or frequency–phase velocity (f–c) domain. The mapping is usually performed with the classic 2-D Fourier transform (FT) with a subsequent substitution and interpolation via c = 2πf/k. The extracted dispersion trajectories of the guided modes lack the resolution in the transformed plane to discriminate wave modes. The resolving power associated with the FT is closely linked to the aperture of the recorded data. Here, we present a linear Radon transform (RT) to image the dispersive energies of the recorded ultrasound wave fields. The RT is posed as an inverse problem, which allows implementation of the regularization strategy to enhance the focusing power. We choose a Cauchy regularization for the high-resolution RT. Three forms of Radon transform: adjoint, damped least-squares, and high-resolution are described, and are compared with respect to robustness using simulated and cervine bone data. The RT also depends on the data aperture, but not as severely as does the FT. With the RT, the resolution of the dispersion panel could be improved up to around 300% over that of the FT. Among the Radon solutions, the high-resolution RT delineated the guided wave energy with much better imaging resolution (at least 110%) than the other two forms. The Radon operator can also accommodate unevenly spaced records. The results of the study suggest that the high-resolution RT is a valuable imaging tool to extract dispersive guided wave energies under limited aperture.


      PubDate: 2014-10-05T22:00:18Z
       
  • Transfection of wtp53 and Rb94 Genes Into Retinoblastomas of Nude Mice by
           Ultrasound-Targeted Microbubble Destruction
    • Abstract: Publication date: November 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 11
      Author(s): Ruiqi Gao , Xiyuan Zhou , Yingxue Yang , Zhigang Wang
      Using ultrasound-targeted microbubble destruction (UTMD), we transfected both wild-type p53 (wtp53) and Rb94 genes into retinoblastomas (RBs) of nude mice to investigate the inhibitory role of these two genes in RB development. The 40 tumor-bearing mice, which had been established by sub-retinal injection of an HXO-Rb44 cell suspension, were randomly divided into five groups: blank control group (C); blank plasmid group (M); wtp53 plasmid group (p53); Rb94 plasmid group (Rb94); wtp53 + Rb94 plasmid group (p53 + Rb94). For preparation of the DNA-loaded microbubbles, a pre-determined amount of blank plasmid, pVIVO1-p53, pVIVO1-Rb94 or pVIVO1-p53-Rb94 was added and mixed with the microbubbles. Then, these DNA-loaded microbubbles were respectively transfected into the animal model by UTMD. Vascular endothelial growth factor level and microvessel density of the tumor were determined by immunohistochemical staining. Apoptosis of tissues was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling staining. Expression of wtp53 and Rb94 at both the gene and protein levels was detected by RT-PCR (reverse transcription polymerase chain reaction) and Western blot, respectively. Transfection of both genes had greater inhibitory effects on RB development and resulted in lower levels of vascular endothelial growth factor, lower microvessel density and more obvious apoptosis than single-gene transfection (p < 0.05). The results indicate that the transfection of both genes into the RB by UTMD more strongly inhibited RB growth than transfection of a single gene.


      PubDate: 2014-10-05T22:00:18Z
       
  • Effects of Noradrenaline and Adenosine Triphosphate on the Degree on
           Contrast Enhancement in a Rabbit Model of Atherosclerosis during
           Contrast-Enhanced Ultrasonography
    • Abstract: Publication date: November 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 11
      Author(s): Jie Sun , You-Bin Deng , Kun Liu , Yu-Bo Wang
      The aim of the study is to assess the effects of vasoactive agents on the degree of contrast enhancement in experimental atherosclerotic plaque during contrast-enhanced ultrasonography (CEUS). Abdominal aortic atherosclerosis was induced in 25 New Zealand white rabbits by a combination of cholesterol-rich diet and balloon endothelial denudation. Standard ultrasonography and CEUS were performed at baseline and during intravenous infusion of noradrenaline or adenosine triphosphate (ATP). The degree of contrast enhancement of the plaque after injection of contrast material was quantified by calculating the enhanced intensity in the plaque. The infusion of noradrenaline induced significant increase in systolic blood pressure (84 ± 13 mm Hg vs. 112 ± 20 mm Hg, p = 0.011) and significant decrease in the enhanced intensity in the plaque (7.52 ± 1.32 dB vs. 5.88 ± 1.33 dB, p < 0.001) during CEUS. The infusion of ATP resulted in the significant decrease in systolic blood pressure (80 ± 13 mm Hg vs. 65 ± 11 mm Hg, p = 0.005) and increase in the enhanced intensity in the plaque (7.52 ± 1.32 dB vs. 8.84 ± 1.55 dB, p < 0.001) during CEUS. The degree of contrast enhancement within an experimental atherosclerotic plaque during CEUS can be influenced by vasoactive agents and hemodynamic status.


      PubDate: 2014-10-05T22:00:18Z
       
  • An In Vitro Comparison of Embolus Differentiation Techniques for
           Clinically Significant Macroemboli: Dual-Frequency Technique versus
           Frequency Modulation Method
    • Abstract: Publication date: November 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 11
      Author(s): Caroline Banahan , Zach Rogerson , Clément Rousseau , Kumar V. Ramnarine , David H. Evans , Emma M.L. Chung
      The ability to distinguish harmful solid cerebral emboli from gas bubbles intra-operatively has potential to direct interventions to reduce the risk of brain injury. In this in vitro study, two embolus discrimination techniques, dual-frequency (DF) and frequency modulation (FM) methods, are simultaneously compared to assess discrimination of potentially harmful large pieces of carotid plaque debris (0.5–1.55 mm) and thrombus-mimicking material (0.5–2 mm) from gas bubbles (0.01–2.5 mm). Detection of plaque and thrombus-mimic using the DF technique yielded disappointing results, with four out of five particles being misclassified (sensitivity: 18%; specificity: 89%). Although the FM method offered improved sensitivity, a higher number of false positives were observed (sensitivity: 72%; specificity: 50%). Optimum differentiation was achieved using the difference between peak embolus/blood ratio and mean embolus/blood ratio (sensitivity: 77%; specificity: 81%). We conclude that existing DF and FM techniques are unable to confidently distinguish large solid emboli from small gas bubbles (<50 μm).


      PubDate: 2014-10-05T22:00:18Z
       
  • Ultrasound in Assessing the Efficacy of Propranolol Therapy for Infantile
           Hemangiomas
    • Abstract: Publication date: Available online 12 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Huijuan Shi , Hongbin Song , Jianjun Wang , Li Xia , Jing Yang , Yuanyuan Shang , Hui Zhou
      This study was aimed at assessing the efficacy of propranolol treatment in infantile hemangiomas (IHs) by ultrasound. Thirty-one patients with IHs were administered propranolol and were assessed by ultrasound before treatment, 3 mo after treatment and at the end of treatment. Longitudinal and transverse diameters, as well as thickness of hemangiomas measured by clinical observation differed significantly (p < 0.05) from measurements obtained by ultrasound. Ultrasound also revealed that longitudinal and transverse diameters, thickness, vascular density, blood flow velocity (arterial and venous) and arterial peak systolic blood flow velocity of hemangiomas were significantly decreased (p < 0.05) after treatment compared with before treatment. The resistive index and systolic/diastolic blood flow velocity in IHs were significantly higher (p < 0.05) after treatment than before treatment. In conclusion, ultrasound can evaluate the efficacy of propranolol at the termination of therapy.


      PubDate: 2014-09-12T19:57:57Z
       
  • Middle Cerebral Artery Blood Flows by Combining TCD Velocities and MRA
           Diameters: In Vitro and In Vivo Validations
    • Abstract: Publication date: Available online 11 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): K.A. Yonan , E.R. Greene , J.M. Sharrar , A. Caprihan , C. Qualls , C.A. Roldan
      Non-invasive transcranial Doppler (TCD) is widely used for blood velocity (BV, cm/sec) measurements in the human middle cerebral artery (MCA). MCABV measurements are accepted as linear with MCA blood flow (MCABF). Magnetic resonance angiography (MRA) provides measurements of MCA lumen diameters that can be combined with TCD MCABV to calculate MCABF (mL/min). We tested the precision and accuracy of this method against a flow phantom and in vivo proximal internal carotid artery blood flow (ICABF). In vitro precision (repeated measures) and accuracy (vs. time collection) gave correlations coefficients of 0.97 and 0.98, respectively (both p < 0.05). In vivo precision (repeated measures) and accuracy (vs. ICABF) gave correlation coefficients of 0.90 (left and right), 0.94 (left) and 0.93 (right) (all p < 0.05). Bilateral MCABF in 35 adults were similar (left, 168 ± 72 mL/min; right, 180 ± 69 mL/min; p > 0.05). Results suggest that blood velocity by TCD and lumen diameter by MRA can be combined to estimate absolute values of MCABF.


      PubDate: 2014-09-12T19:57:57Z
       
  • An Improved Tissue-Mimicking Polyacrylamide Hydrogel Phantom for
           Visualizing Thermal Lesions with High-Intensity Focused Ultrasound
    • Abstract: Publication date: Available online 12 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Sitaramanjaneya Reddy Guntur , Min Joo Choi
      A recipe was created to improve the tissue-mimicking (TM) bovine serum albumin (BSA) polyacrylamide hydrogel (PAG) reported in our previous study (Choi MJ, Guntur SR, Lee KI, Paeng DG, Coleman AJ. Ultrasound Med Biol 2013; 29:439–448). In that work, the concentration of acrylamide in TM BSA PAG was increased to make its attenuation coefficient the same as that of a tissue. However, this increase made the PAG stiffer and less homogeneous. In addition, the increase in acrylamide caused a significant increase in temperature over the denaturation threshold of BSA during polymerization, which required forced cooling so that the PAG did not become opaque at room temperature after polymerization. To eliminate those shortcomings, we substituted the increased acrylamide with a viscous polysaccharide liquid (corn syrup). The concentration of corn syrup was optimized to 20% (w/v, tested in the volume of 50 mL), so that the acoustic properties of the PAG would be close to those of human liver. The improved TM (iTM) BSA PAG constructed in this study had a speed of sound of 1588 ± 9 m/s, an attenuation coefficient of 0.51 ± 0.06 dB cm−1 at 1 MHz and a backscattering coefficient of 0.22 ± 0.09 × 10−3 sr−1 cm−1 MHz−1. The density and acoustic impedance were 1057 kg/m3 and 1.68 MRayl, respectively, and the non-linear parameter (B/A) was 5.9 ± 0.3. The thermal, optical and mechanical properties were almost the same as those of the BSA PAG (Lafon et al.2005). Experimental verification indicated that the thermal lesions visualized in the proposed iTM BSA PAG by high-intensity focused ultrasound were highly reproducible. In conclusion, iTM BSA PAG was proven to eliminate TM BSA PAG shortcomings effectively and is expected to be a promising test phantom for clinical high-intensity focused ultrasound device.


      PubDate: 2014-09-12T19:57:57Z
       
  • Ultrasound Visibility of Spinal Structures and Local Anesthetic Spread in
           Children Undergoing Caudal Block
    • Abstract: Publication date: Available online 12 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Seokyung Shin , Ji Young Kim , Won Oak Kim , Seung Hyun Kim , Hae Keum Kil
      This study assessed ultrasound visibility of spinal structures in children and observed the extent of local anesthetic spread within the epidural space during caudal block. Spinal structures were evaluated with ultrasound from the sacral area to the thoracic area in 80 children, and drug spread levels were observed after caudal injection of 0.5, 1.0, 1.25 and 1.5 mL/kg local anesthetic. The conus medullaris, dural sac and dura mater were easily identified with ultrasound in most children. However, ligamentum flavum visibility declined with increasing vertebral level and markedly decreased at the thoracic level in children older than 7 mo or heavier than 8.5 kg. Drug spread was higher with increasing volume (p < 0.001) and in children ≤12 mo more than children >12 mo (p < 0.001); drug spread was significantly correlated with age (R 2 = 0.534). Spread levels assessed with ultrasound were roughly two to three segments lower than those in previous radiologic studies.


      PubDate: 2014-09-12T19:57:57Z
       
  • Standard Plane Localization in Ultrasound by Radial Component Model and
           Selective Search
    • Abstract: Publication date: Available online 12 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Dong Ni , Xin Yang , Xin Chen , Chien-Ting Chin , Siping Chen , Pheng Ann Heng , Shengli Li , Jing Qin , Tianfu Wang
      Acquisition of the standard plane is crucial for medical ultrasound diagnosis. However, this process requires substantial experience and a thorough knowledge of human anatomy. Therefore it is very challenging for novices and even time consuming for experienced examiners. We proposed a hierarchical, supervised learning framework for automatically detecting the standard plane from consecutive 2-D ultrasound images. We tested this technique by developing a system that localizes the fetal abdominal standard plane from ultrasound video by detecting three key anatomical structures: the stomach bubble, umbilical vein and spine. We first proposed a novel radial component-based model to describe the geometric constraints of these key anatomical structures. We then introduced a novel selective search method which exploits the vessel probability algorithm to produce probable locations for the spine and umbilical vein. Next, using component classifiers trained by random forests, we detected the key anatomical structures at their probable locations within the regions constrained by the radial component-based model. Finally, a second-level classifier combined the results from the component detection to identify an ultrasound image as either a “fetal abdominal standard plane” or a “non- fetal abdominal standard plane.” Experimental results on 223 fetal abdomen videos showed that the detection accuracy of our method was as high as 85.6% and significantly outperformed both the full abdomen and the separate anatomy detection methods without geometric constraints. The experimental results demonstrated that our system shows great promise for application to clinical practice.


      PubDate: 2014-09-12T19:57:57Z
       
  • Kidney Transplant: Usefulness of Real-Time Elastography (RTE) in the
           Diagnosis of Graft Interstitial Fibrosis
    • Abstract: Publication date: Available online 11 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Antonio Orlacchio , Fabrizio Chegai , Costantino Del Giudice , Alessandro Anselmo , Giuseppe Iaria , Giampiero Palmieri , Elena Di Caprera , Daniela Tosti , Elisa Costanzo , Giuseppe Tisone , Giovanni Simonetti
      The aim of this study is to evaluate the usefulness of real-time elastography (RTE) in the diagnosis of graft interstitial fibrosis. We prospectively enrolled 50 patients clinically suspected of graft fibrosis. RTE was performed with a broadband linear transducer using a dedicated ultrasound machine. Tissue mean elasticity (TME) was calculated by two blinded operators. All patients underwent biopsy after RTE. To determine cortical fibrosis Banff score was used. The receiver operating characteristic curves analysis was performed to evaluate the accuracy of TME to discriminate between patients with mild fibrosis (F1) versus patients with moderate to severe fibrosis (F2–F3). Inverse correlation between TME values and the degree of fibrosis has been shown (p < 0.05). Patients with F1 had mean TME values significantly higher compared with TME in patients with F2 (p = 0.005) and F3 (p = 0.004). The diagnostic accuracy of TME measurement for F2–F3 evaluated by area under the curve–receiver operating characteristic analysis was 0.95. RTE was able to evaluate kidney fibrosis in a non-invasive way and could be used as complementary imaging during follow-up of renal transplant patients.


      PubDate: 2014-09-12T19:57:57Z
       
  • Adding Blood to Agitated Saline Significantly Improves Detection of
           Right-to-Left Shunt by Contrast-Transcranial Color-Coded Duplex Sonography
           
    • Abstract: Publication date: Available online 12 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Mauro Gentile , Alessandro De Vito , Cristiano Azzini , Carmine Tamborino , Ilaria Casetta
      Contrast-transcranial Doppler and contrast-transcranial color-coded duplex sonography (c-TCCD) have been reported to have high sensitivity in detecting patent foramen ovale as compared with transesophageal echocardiography. An international consensus meeting (Jauss and Zanette 2000) recommended that the contrast agent for right-to left-shunt (RLS) detection using contrast-transcranial Doppler be prepared by mixing 9 mL of isotonic saline solution and 1 mL of air. The aim of our study was to determine whether adding blood to the contrast agent results in improved detection of RLS. We enrolled all consecutive patients admitted to our neurosonology laboratory for RLS diagnosis. For each patient, we performed c-TCCD both at rest and during the Valsalva maneuver using two different contrast agents: ANSs (1 mL of air mixed with 9 mL of normal saline) and ANSHBs (1 mL of air mixed with 8 mL of normal saline and 1 mL of the patient's blood). To classify RLS, we used a four-level visual categorization: (i) no occurrence of micro-embolic signals; (ii) grade I, 1–10 signals; (iii) grade II, >10 signals but no curtain; grade III, curtain pattern. We included 80 patients, 33 men and 47 women. RLS was detected in 18.8% at rest and in 35% during the Valsalva maneuver using ANSs, and in 31.3% and in 46.3% using ANSHBs, respectively (p < 0.0001). There was a statistically significant increase in the number of micro-embolic signals with the use of ANSHBs. The use of blood mixed with saline solution and air as a c-TCCD contrast agent produced an increase in positive tests and a higher grade of RLS compared with normal saline and air alone, either with or without the Valsalva maneuver.


      PubDate: 2014-09-12T19:57:57Z
       
  • Clinical and Imaging Characteristics of Papillary Neoplasms of the Breast
           Associated with Malignancy: A Retrospective Cohort Study
    • Abstract: Publication date: Available online 12 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Seon Hyeong Choi , Sangwon Jo , Dong-Hoon Kim , Jeong Seon Park , Yoonjung Choi , Shin-Ho Kook , Eun Chul Chung , So-Yeon Lee
      Papillary neoplasms of the breast comprise a broad range of pathologies ranging from papillomas to papillary carcinomas and have been associated with breast cancers. In this study, we evaluated the clinical, mammographic and sonographic features of papillary breast neoplasms from benign papillary breast lesions to malignancy-associated papillary lesions. A total of 194 lesions in 179 patients were analyzed, including 117 benign papillomas, 24 atypical papillomas, 41 benign papillomas with malignancies and 12 papillary carcinomas found between January 2003 and August 2011 in our institution. Statistically significant clinical factors included patient age (p = 0.001), lesion multiplicity (p = 0.009) and peripheral location (p = 0.003). Among these factors, the odds ratio for malignancy was 8.9 for bilateral multiple lesions. Visibility (p = 0.001) and density (p = 0.039) were significant factors for malignancy in mammograms, and echo patterns (p = 0.006), boundary (p = 0.001) and vascularity (p = 0.005) were significant features on ultrasound that differentiated malignancies from benign lesions. Overall, when papillary breast lesions are located bilaterally and peripherally in older patients, they are correlated with breast cancers. Additionally, for papillary breast lesions that appear highly dense on mammograms and/or exhibit positive vascularity on ultrasound, the probability of malignancy is relatively high.


      PubDate: 2014-09-12T19:57:57Z
       
  • Sonodynamically Induced Anti-tumor Effect of 5-Aminolevulinic Acid on
           Pancreatic Cancer Cells
    • Abstract: Publication date: Available online 12 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Yan Jing Li , Peng Huang , Cai Ling Jiang , De Xin Jia , Xiao Xue Du , Jian Hua Zhou , Yu Han , Hong Sui , Xiao Li Wei , Lei Liu , Heng Heng Yuan , Ting Ting Zhang , Wen Jie Zhang , Rui Xie , Xiao Hui Lang , Li Ying Wang , Tao Liu , Yu Xian Bai , Ye Tian
      Sonodynamic therapy (SDT), a promising modality for cancer treatment, involves the synergistic interaction of ultrasound and some chemical compounds termed sonosensitizers. However, its effect on pancreatic cancer cells remains unclear. In our study, we sought to identify the cytotoxic effects of ultrasound-activated 5-aminolevulinic acid on human pancreatic cancer Capan-1 cells. Cell viability was determined by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide) analysis; mitochondrial membrane potential was assessed using the fluorescent probe jc-1; apoptosis was evaluated by flow cytometry; cell morphology was investigated by scanning electron microscopy; apoptosis-related protein expression was analyzed by Western blot assay. We found that SDT significantly decreased the survival rate of cells, and this effect increased with 5-aminolevulinic acid concentration and ultrasound exposure time. The mechanism underlying the effect of SDT involves, in part, the induction of a conspicuous loss in mitochondrial membrane potential and, in part, the induction of apoptosis through upregulation of Bax expression, downregulation of Bcl-2 and increased activation of procaspase-3. These results indicate that the ultrasonically induced cell killing effect could be enhanced by 5-ALA and that the mitochondrial pathway might be involved in the cell damage process. We conclude that SDT is a promising new methodology for pancreatic cancer treatment.


      PubDate: 2014-09-12T19:57:57Z
       
  • Computerized Quantification of Ultrasonic Heterogeneity in Thyroid Nodules
    • Abstract: Publication date: Available online 11 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Kuen-Yuan Chen , Chiung-Nien Chen , Ming-Hsun Wu , Ming-Chih Ho , Hao-Chih Tai , Wen-Hong Kuo , Wen-Chang Huang , Yu-Hsin Wang , Argon Chen , King-Jen Chang
      To test whether computerized quantification of ultrasonic heterogeneity can be of help in the diagnosis of thyroid malignancy, we evaluated ultrasonic heterogeneity with an objective and quantitative computerized method in a prospective setting. A total of 400 nodules including 271 benign thyroid nodules and 129 malignant thyroid nodules were evaluated. Patient clinical data were collected, and the grading of heterogeneity on conventional gray-scale ultrasound images was retrospectively reviewed by a thyroid specialist. Quantification of ultrasonic heterogeneity (heterogeneity index, HI) was performed by a proprietary program implemented with methods proposed in this article. HI values differed significantly between benign and malignant nodules, diagnosed by a combination of fine-needle aspiration and surgical pathology results (p < 0.001, area under the curve = 0.714). The ultrasonic heterogeneity of these samples, as assessed by an experienced clinician, could not significantly differentiate between benign and malignant thyroid nodules. However, nodules with marked ultrasonic heterogeneity had higher HI values than nodules with homogeneous nodules. These results indicate that the new computer-aided diagnosis method for evaluation of the ultrasonic heterogeneity of thyroid nodules is an objective and quantitative method that is correlated with conventional ultrasonic heterogeneity assessment, but can better aid in the diagnosis of thyroid malignancy.


      PubDate: 2014-09-12T19:57:57Z
       
  • Therapeutic Ultrasound in Physical Medicine and Rehabilitation:
           Characterization and Assessment of Its Physical Effects on Joint-Mimicking
           Phantoms
    • Abstract: Publication date: Available online 12 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Elisa Edi Anna Nadia Lioce , Matteo Novello , Gianni Durando , Alessandro Bistolfi , Maria Vittoria Actis , Giuseppe Massazza , Chiara Magnetto , Caterina Guiot
      The aim of the study described here was to quantitatively assess thermal and mechanical effects of therapeutic ultrasound (US) by sonicating a joint-mimicking phantom, made of muscle-equivalent material, using clinical US equipment. The phantom contains two bone disks simulating a deep joint (treated at 1 MHz) and a superficial joint (3 MHz). Thermal probes were inserted in fixed positions. To test the mechanical (cavitational) effects, we used a latex balloon filled with oxygen-loaded nanobubbles; the dimensions of the oxygen-loaded nanobubbles were determined before and after sonication. Significant increases in temperature (up to 17°C) with fixed field using continuous waves were detected both in front of and behind the bones, depending on the US mode (continuous wave vs. pulsed wave) and on the treatment modality (fixed vs. massage). We found no significant differences in mechanical effects. Although limited by the in vitro design (no blood perfusion, no metabolic compensation), the results can be used to guide operators in their choice of the best US treatment modality for a specific joint.


      PubDate: 2014-09-12T19:57:57Z
       
  • Submental Ultrasound Measurement of Dynamic Tongue Base Thickness in
           Patients with Obstructive Sleep Apnea
    • Abstract: Publication date: Available online 12 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Jeng-Wen Chen , Chun-Hsiang Chang , Shou-Jen Wang , Yen-Teh Chang , Chih-Chung Huang
      Dynamic tongue base thickness (TBT) may be an important anatomic factor in airway narrowing in patients with obstructive sleep apnea (OSA). The development of an accurate clinical assessment of the retroglossal airway in patients with OSA is still evolving. Submental ultrasound was used to investigate the association between measurements of TBT in response to negative airway pressure and the existence of OSA. Twenty OSA patients and 20 control participants underwent ultrasound measurement of TBT on eupneic breathing and with the Mueller maneuver, as well as clinical and polysomnographic assessments. Logistic regression analyses indicated that after adjustment for confounding factors, independent predictors of OSA included TBT in response to negative airway pressure, as measured by submental ultrasound with the Mueller maneuver (odds ratio: 2.11, 95% confidence interval: 1.15–3.87, p < 0.05), and the difference between TBT with the Muller maneuver and that without the Mueller maneuver (odds ratio: 2.47, 95% confidence interval: 1.09–5.58, p < 0.05). Ultrasound measurement of TBT during the Mueller maneuver provides a quantitative assessment of the retroglossal airway in OSA patients with minimal invasiveness and easy accessibility.


      PubDate: 2014-09-12T19:57:57Z
       
  • Ultrasonographic Evaluation of Renal Resistive Index in Patients with
           Lupus Nephritis: Correlation with Histologic Findings
    • Abstract: Publication date: Available online 12 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Fabrizio Conti , Fulvia Ceccarelli , Antonietta Gigante , Biagio Barbano , Carlo Perricone , Laura Massaro , Francesco Martinelli , Francesca Romana Spinelli , Kostantinos Giannakakis , Guido Valesini , Rosario Cianci
      We analyzed the association between the renal arterial resistive index (RI) and the histologic features of lupus nephritis. All consecutive patients with systemic lupus erythematosus (SLE) who required a kidney biopsy were enrolled. The study protocol included ultrasonographic assessment to measure the RI and kidney biopsy (International Society of Nephrology/Renal Pathology Society classification). A RI > 0.7 was considered pathologic. Patients with non-renal SLE and healthy patients were studied as control groups. We enrolled 42 patients with renal SLE, 10 with non-renal SLE and 14 healthy patients: their mean (±standard deviation) RI values were 0.64 ± 0.08, 0.60 ± 0.04 and 0.59 ± 0.01, respectively (p = not significant). RIs > 0.7 were recorded only in patients with renal SLE (5/42, 11.9%). The percentage of patients with a pathologic RI was significantly higher in class IV nephritis in comparison with other classes (p < 0.009). In conclusion, we found a significant correlation between pathologic RI and class IV nephritis, suggesting a role for RI as a severity marker.


      PubDate: 2014-09-12T19:57:57Z
       
  • Novel Flow Quantification of the Carotid Bulb and the Common Carotid
           Artery with Vector Flow Ultrasound
    • Abstract: Publication date: Available online 11 September 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Mads Møller Pedersen , Michael Johannes Pihl , Per Haugaard , Kristoffer Lindskov Hansen , Theis Lange , Lars Lönn , Michael Bachmann Nielsen , Jørgen Arendt Jensen
      Abnormal blood flow is usually assessed using spectral Doppler estimation of the peak systolic velocity. The technique, however, only estimates the axial velocity component, and therefore the complexity of blood flow remains hidden in conventional ultrasound examinations. With the vector ultrasound technique transverse oscillation the blood velocities of both the axial and the transverse directions are obtained and the complexity of blood flow can be visualized. The aim of the study was to determine the technical performance and interpretation of vector concentration as a tool for estimation of flow complexity. A secondary aim was to establish accuracy parameters to detect flow changes/patterns in the common carotid artery (CCA) and the carotid bulb (CB). The right carotid bifurcation including the CCA and CB of eight healthy volunteers were scanned in a longitudinal plane with vector flow ultrasound (US) using a commercial vector flow ultrasound scanner (ProFocus, BK Medical, Denmark) with a linear 5 MHz transducer transverse oscillation vector flow software. CCA and CB areas were marked in one cardiac cycle from each volunteer. The complex flow was assessed by medical expert evaluation and by vector concentration calculation. A vortex with complex flow was found in all carotid bulbs, whereas the CCA had mainly laminar flow. The medical experts evaluated the flow to be mainly laminar in the CCA (0.82 ± 0.14) and mainly complex (0.23 ± 0.22) in the CB. Likewise, the estimated vector concentrations in CCA (0.96 ± 0.16) indicated mainly laminar flow and in CB (0.83 ± 0.07) indicated mainly turbulence. Both methods were thus able to clearly distinguish the flow patterns of CCA and CB in systole. Vector concentration from angle-independent vector velocity estimates is a quantitative index, which is simple to calculate and can differentiate between laminar and complex flow.


      PubDate: 2014-09-12T19:57:57Z
       
  • Masthead
    • Abstract: Publication date: October 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 10




      PubDate: 2014-09-04T18:52:57Z
       
  • Contents
    • Abstract: Publication date: October 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 10




      PubDate: 2014-09-04T18:52:57Z
       
  • Editorial Advisory Board
    • Abstract: Publication date: October 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 10




      PubDate: 2014-09-04T18:52:57Z
       
  • Transcranial Sonography and 123I-FP-CIT Single Photon Emission Computed
           Tomography in Movement Disorders
    • Abstract: Publication date: October 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 10
      Author(s): Petra Bártová , Otakar Kraft , Jaromír Bernátek , Martin Havel , Pavel Ressner , Kateřina Langová , Roman Herzig , David Školoudík
      Diagnosis of Parkinson's disease (PD) can be difficult in the early stages of the disease. The aim of the study described here was to assess the correlation between transcranial sonography (TCS) and 123I-FP-CIT ([123I]ioflupane, N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-[123I]iodophenyl)nortropane) SPECT (single photon emission computed tomography) findings and the diagnosis of PD. A total of 49 patients were enrolled in the study: 29 patients with PD, 7 patients with other parkinsonian syndromes, 11 patients with essential tremor and 2 with psychogenic movement disorder. Substantia nigra echogenicity was measured using TCS. SPECT was performed using DaTSCAN ([123I]ioflupane). TCS and SPECT findings were correlated in 84% of patients, with κ = 0.62 (95% confidence interval: 0.38–0.86). TCS-measured substantia nigra echogenicity and SPECT-measured striatal binding ratio were negatively correlated (r = –0.326, p = 0.003). TCS/SPECT sensitivity, specificity and positive and negative predictive values for the diagnosis of PD were 89.7%/96.6%, 60.0%/70.0%, 76.5%/82.4% and 80.0%/93.3%, respectively. Both positive TCS and SPECT findings correlated significantly with the diagnosis of PD (κ = 0.52, 95% confidence interval: 0.27–0.76, and κ = 0.69, 95% confidence interval: 0.49–0.90, respectively).


      PubDate: 2014-09-04T18:52:57Z
       
  • Reliability of Automatic Vibratory Equipment for Ultrasonic Strain
           Measurement of the Median Nerve
    • Abstract: Publication date: October 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 10
      Author(s): Yuichi Yoshii , Tomoo Ishii , Fumihiko Etou , Shinsuke Sakai , Toshikazu Tanaka , Naoyuki Ochiai
      The objective of this study was to test the reliability of ultrasonic median nerve strain measurements using automatic vibratory equipment. Strain ratios of the median nerve in the carpal tunnel model and the reference coupler were measured at three different settings of the transducer: 0, +2 and +4 mm (+ = compressing the model down 2–4 mm initially). After measurement of the carpal tunnel model, a +4-mm setting was chosen for in vivo measurement. The median nerve strains of 30 wrists were measured by two examiners using the equipment. Intra- and inter-examiner correlation coefficients (CCs) for the strain ratios were calculated. The closest ratio was found in the +4-mm placement (strain ratio: 0.73, Young's modulus ratio: 0.79). The intra-examiner CC was 0.91 (p < 0.01), and the inter-examiner CCs were 0.72–0.78 (p < 0.01). The automatic vibratory equipment was useful in quantifying median nerve strain at the wrist.


      PubDate: 2014-09-04T18:52:57Z
       
  • Visual Screening of Muscle Ultrasound Images in Children
    • Abstract: Publication date: October 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 10
      Author(s): Rick Brandsma , Renate J. Verbeek , Natasha M. Maurits , Johannes H. van der Hoeven , Oebele F. Brouwer , Wilfred F.A. den Dunnen , Huibert Burger , Deborah A. Sival
      In children, non-invasive muscle ultrasound (MU) imaging has become increasingly important for the detection of neuromuscular pathology, by either quantitative or visual assessment. MU quantification requires time, expertise and equipment. If application of visual MU screening provides reliable results, ubiquitous application could be advocated. Previously, we found that visual MU screening can reliably detect segmental neuromuscular alterations within a patient. Analogously, we reasoned that visual MU screening could discern pathologic MU images from healthy controls. We therefore investigated visual screening results by 20 clinical observers (involving 100 MU images, with [n = 53] and without [n = 47] neuromuscular pathology). MU screening revealed adequate sensitivity, specificity and negative predictive value (85%, 75% and 82%, respectively). MU-experienced observers revealed higher specificity than MU-inexperienced observers (86% vs. 69%, p = 0.005). We conclude that clinical observers can identify neuromuscular pathology by visual screening. To enhance specificity, a secondary view by an expert appears advisory.


      PubDate: 2014-09-04T18:52:57Z
       
  • Comparison of Strain and Shear Wave Elastography for the Differentiation
           of Benign From Malignant Breast Lesions, Combined With B-mode
           Ultrasonography: Qualitative and Quantitative Assessments
    • Abstract: Publication date: October 2014
      Source:Ultrasound in Medicine & Biology, Volume 40, Issue 10
      Author(s): Ji Hyun Youk , Eun Ju Son , Hye Mi Gweon , Hana Kim , Yun Joo Park , Jeong-Ah Kim
      Our aim was to compare the diagnostic performance of strain elastography (SE) and shear-wave elastography (SWE), combined with B-mode ultrasonography (US), in breast cancer. For 79 breast lesions that underwent SE and SWE, two radiologists reviewed five data sets (B-mode US, SWE, SE and two combined sets). Qualitative and quantitative elastographic data and Breast Imaging Reporting and Data System (BI-RADS) categories were recorded. The area under the receiver operating characteristic curve (AUC) was evaluated. No significant difference in the AUC between the two elastography methods was noted. After subjective assessment by reviewers, the AUC for the combined sets was improved (SWE, 0.987; SE, 0.982; B-mode US, 0.970; p < 0.05). When SE and SWE were added, 38% and 56% of benign BI-RADS category 4a lesions with a low suspicion of cancer were downgraded without false-negative results, respectively. SE and SWE performed similarly. Therefore, addition of SE or SWE improved the diagnostic performance of B-mode US, potentially reducing unnecessary biopsies.


      PubDate: 2014-09-04T18:52:57Z
       
  • Relationship between CHADS2 Score and Complex Aortic Plaques by
           Transesophageal Echocardiography in Patients with Nonvalvular Atrial
           Fibrillation
    • Abstract: Publication date: Available online 9 July 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Kenichi Sugioka , Suwako Fujita , Shinichi Iwata , Asahiro Ito , Yoshiki Matsumura , Akihisa Hanatani , Atsushi Doi , Masahiko Takagi , Takahiko Naruko , Makiko Ueda , Minoru Yoshiyama
      The CHADS2 score is widely used for risk stratification of thromboembolism in patients with non-valvular atrial fibrillation (NVAF). Although the correlation of CHADS2 score with left atrial (LA) abnormality as detected by transesophageal echocardiography (TEE) has been reported in previous studies, the relationship between CHADS2 score and complex aortic plaque, which is also a significant risk factor for thromboembolism, has not been fully investigated. We assessed aortic plaques by TEE in 150 patients age ≥ 55 y with NVAF. The prevalence of complex aortic plaques increased along with increases in CHADS2 score (p = 0.001). In a multivariate analysis that included atherosclerotic risk factors and LA abnormality, a CHADS2 score ≥2 was independently associated with the presence of complex aortic plaques (odds ratio [OR] 3.39; 95% confidence interval [CI], 1.29–8.90). A high CHADS2 score is closely associated with the presence of complex aortic plaques, which explains, in part, the increased risk of thromboembolism in NVAF patients with high CHADS2 score.


      PubDate: 2014-07-25T19:18:46Z
       
  • Elastography Can Effectively Decrease the Number of Fine-Needle Aspiration
           Biopsies in Patients with Calcified Thyroid Nodules
    • Abstract: Publication date: Available online 9 July 2014
      Source:Ultrasound in Medicine & Biology
      Author(s): Min-Hee Kim , Si Luo , Sun Hee Ko , So-Lyung Jung , Dong-Jun Lim , Yongmin Kim
      When calcification, frequently found in both benign and malignant nodules, is present in thyroid nodules, non-invasive differentiation with ultrasound becomes challenging. The goal of this study was to evaluate the utility of elastography in differentiating calcified thyroid nodules. Consecutive patients (165 patients with 196 nodules) referred for fine-needle aspiration who had undergone both ultrasound elastography and B-mode examinations were analyzed retrospectively. Calcification was present in 45 benign and 20 malignant nodules. On 65 calcified nodules, elastography had 95% sensitivity, 51.1% specificity, 46.3% positive predictive value and 95.8% negative predictive value in detecting malignancy. Twenty-three of 45 benign calcified nodules were correctly diagnosed with elastography compared with 4 of 45 by B-mode ultrasound. Although it is difficult to differentiate benign and malignant calcified thyroid nodules solely with B-mode ultrasound, elastography has the potential to reduce the number of fine-needle aspiration biopsies performed on calcified nodules.


      PubDate: 2014-07-25T19:18:46Z
       
 
 
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