3D Ultrasound Research Articles

RecON: Online learning for sensorless freehand 3D ultrasound reconstruction.

Sensorless freehand 3D ultrasound (US) reconstruction based on deep networks shows promising advantages, such as large field of view, relatively high resolution, low cost, and ease of use. However, existing methods mainly consider vanilla scan strategies with limited inter-frame variations. These methods thus are degraded on complex but routine scan sequences in clinics. In this context, we propose a novel online learning framework for freehand 3D US reconstruction under complex scan strategies with diverse scanning velocities and poses. First, we devise a motion-weighted training loss in training phase to regularize the scan variation frame-by-frame and better mitigate the negative effects of uneven inter-frame velocity. Second, we effectively drive online learning with local-to-global pseudo supervisions. It mines both the frame-level contextual consistency and the path-level similarity constraint to improve the inter-frame transformation estimation. We explore a global adversarial shape before transferring the latent anatomical prior as supervision. Third, we build a feasible differentiable reconstruction approximation to enable the end-to-end optimization of our online learning. Experimental results illustrate that our freehand 3D US reconstruction framework outperformed current methods on two large, simulated datasets and one real dataset. In addition, we applied the proposed framework to clinical scan videos to further validate its effectiveness and generalizability.

Three-Dimensional Ultrasound Evaluation of Lung Volume in Fetuses with Abdominal Wall Defect

Introduction: Abdominal wall defects (AWDs) interfere with postnatal respiratory parameters. We aimed to evaluate lung volume (LV) in fetuses with AWD using three-dimensional (3D) ultrasound (US) and to correlate AWD with the type (omphalocele and gastroschisis) and size of the defect and neonatal morbidity and mortality. Methods: This prospective observational study included 72 pregnant women with fetuses with AWD and a gestational age <25 weeks. The data on abdominal volume, 3D US LV, and herniated volume were acquired every 4 weeks up to 33 weeks. LV was compared with normal reference curves and correlated with abdominal and herniated volumes. Results: Omphalocele (p < 0.001) and gastroschisis (p < 0.001) fetuses had smaller LV than normal fetuses. LV was positively correlated with abdominal volume (omphalocele, r = 0.86; gastroschisis, r = 0.88), whereas LV was negatively correlated with omphalocele-herniated volume/abdominal volume (p < 0.001, r = −0.51). LV was smaller in omphalocele fetuses that died (p = 0.002), were intubated (p = 0.02), or had secondary closure (p < 0.001). In gastroschisis, a smaller LV was observed in fetuses discharged using oxygen (p = 0.002). Conclusion: Fetuses with AWD had smaller 3D LV than normal fetuses. Fetal abdominal volume was inversely correlated with LV. In omphalocele fetuses, a smaller LV was associated with neonatal mortality and morbidity.

Two-dimensional ultrasound results in underestimation of the ovarian follicle size compared to automated three-dimensional imaging in women undergoing IVF.

Traditionally, for the assessment of follicle growth during IVF, two-dimensional (2D) transvaginal ultrasound (US) is used. In the past few years three-dimensional (3D) US has also been introduced. To compare follicular sizes between 2 and 3D ultrasound imaging on the final day of controlled ovarian stimulation. A prospective observational cohort study including 121 women undergoing controlled ovarian stimulation (COS) between January 2017 and July 2018. All women were assessed by transvaginal 2D and 3D ultrasonography to measure ovarian follicle dimensions on the final day of COS. The mean difference in paired comparisons between the 3D and 2D US measurements in 25 women with monofollicular development was + 1.6 ± 2.5mm for the x-dimension and + 1.7 ± 2.4mm for the y-dimension; and in the total number of 1197 paired measurements of follicles the mean difference + 2.1 ± 3.3mm and + 1.8 ± 3.9mm for the x- and y-dimension respectively. In all cases the paired t-test showed that differences were statistically significant (p < 0.01). Further it was conjectured that the 2D underestimation results from the inherent difficulty to precisely place the US probe simultaneously on the perpendicular maximal of the x and y follicle diameters, leading to measurement errors that, by theory, are normally distributed. Running Monte-Carlo simulations based on these measurement errors it was found that both the mean difference and standard deviation are of the same magnitude as the ones found in real measurements, thus proving the conjecture. The utilisation of 3D US results in different measurements of the follicular dimensions, and volumes, when compared to conventional 2D US. The differences in the x- and y-dimensions may affect the outcome of an IVF cycle as they are used to define the day of triggering final oocyte maturation, which is associated with the yield of mature oocytes and the probability of live birth.

P-355 Thin endometrium is associated to higher risk of having a displaced window of implantation (WOI)

Abstract Study question Is thin endometrium (&amp;lt;6 mm) associated to an abnormal receptivity status? Summary answer Thin endometrium (&amp;lt;6 mm) is significantly associated with a displaced WOI. What is known already The measurement of endometrial thickness by 2D vaginal ultrasound (US) is a routine practice in Assisted Reproduction Techniques (ART). Thin endometrium (&amp;lt;6 mm) is associated with poor reproductive outcome; however, the potential reason is unknown. Study design, size, duration Retrospective cohorts study including 25,888 patients in which endometrial lining was measured by 2D US the day before progesterone supplementation in HRT cycles for frozen embryo transfers and Endometrial Receptivity Analysis (ERA) was performed after 5 days of progesterone administration. Endometrial thickness was classified as &amp;lt; 6 mm, 6-12 mm, or &amp;gt; 12 mm; ERA results were considered as receptive or displaced WOI (Pre-receptive, post-receptive, proliferative, and late-receptive) that needs a personalized embryo transfer (pET). Participants/materials, setting, methods Endometrial thickness was measured from one endometrial layer to the other on a longitudinal transvaginal scan at the site of maximum thickness evidenced by 2D US. For ERA analysis, RNA was extracted and sequenced by NGS. Then, the ERA computational predictor obtained the diagnosis as standard or displaced WOI. Main results and the role of chance RA results reveal that women with thin endometrium (&amp;lt;6mm) present significantly higher incidence of displaced WOI (47.49%) than 6-12mm (38.20%) (p = 0.0038), and &amp;gt;12mm (39.75%) (p = 0.026). No other differences were found. *Significant different against other two groups. Global Chi-square test for association P = 0.002. Limitations, reasons for caution This is a retrospective study, having innate limitations of its nature. Wider implications of the findings Thin endometrium (&amp;lt;6mm) is associated to a higher displaced WOI compared to normal lining or hypertrophic endometrium. Normal endometrial thickness (6-12 mm) considered as “receptive” does not preclude a transcriptomic receptivity status in 38.20% of the cases. This finding should be considered when embryo transfer is planned. Trial registration number Not applicable

Accelerated Measurement of Carotid Plaque Volume Using Artificial Intelligence Enhanced 3D Ultrasound

Carotid plaque volume (CPV) can be measured by 3D ultrasound and may be a better predictor of stroke than stenosis, but analysis time limits clinical utility. This study tested the accuracy, reproducibility, and time saved of using an artificial intelligence (AI) derived semiautomatic software to measure CPV ("auto-CPV"). Three-dimensional (3D) ultrasound images for 121 individuals were analyzed by 2 blinded operators to measure auto-CPV. Corresponding endarterectomy specimen volumes were calculated by the validated saline suspension technique. Inter-rater and intrarater agreement plus accuracy compared with the volume of the endarterectomized plaque were calculated. Measurement times were compared with previous manual CPV measurement. The mean difference between auto-CPV and surgical volume was small at (±s.d.) [95% confidence interval [CI]] 0.06 (0.24) [-0.41 to 0.54] cm3. The intraclass correlation (ICC) was strong at 0.91; 95% CI 0.86-0.94. Interobserver and intraobserver error was low with mean difference (±s.d.) [95%CI] 0.01 (0.26) [-0.5 to 0.5] cm3 and 0.03 (0.19) [-0.35 to 0.40] cm3 respectively. Both showed excellent ICC with narrow confidence intervals, ICC=0.90; 95% CI (0.85-0.94) and ICC=0.95; 95% CI (0.92-0.96). Auto-CPV measurement took 43% the time of manual planimetry; median (IQR) 05:39 (01:58) minutes compared to 13:05 (04:15) minutes, Wilcoxon rank-sum test, P<0.01. Auto-CPV assessment is accurate, reproducible, and significantly faster than manual planimetry. Improved feasibility means that the utility of CPV can be assessed in large population studies to stratify risk in asymptomatic carotid disease or assess response to medical treatment.

P-749 Increased accuracy in infertility workup by the additional use of new modern diagnostic methods (“diagnostic TRIO”): results from a large retrospective analysis

Abstract Study question Is there any positive effect of adding new modalities to the traditional infertility work-up, like 3D sonography, office hysteroscopy and endometrial biopsy? Summary answer During infertility workup conventional diagnostic tests should be combined with new approaches (3D-TVS, OHSC and endometrial biopsy) to achieve more accurate and less invasive diagnostics. What is known already Female infertility can be explained by functional or organic abnormalities affecting the reproductive system. The most common organic causes include abnormalities within the uterine cavity (e.g. endometrial polyp, submucosal fibroid, intrauterine adhesion), morphological disorders (e.g. dysmorphic uterus, uterine septum) and abnormalities of the endometrium (e.g. chronic endometritis). Study design, size, duration In our retrospective study, we examined patients with primary and secondary infertility. All the patients were assessed by 3D-TVS and OHSC to detect morphological and intrauterine disorders, and in special cases (repeated implantation failure – RIF), endometrial biopsies were carried out to detect endometrial disorders. Participants/materials, setting, methods Data of 606 patients examined between 2018 and 2022 were analyzed retrospectively. Main results and the role of chance In 606 cases 3D-TVS and OHSC were performed in patients (65.51 % primary, 34.49 % secondary infertility), who had unknown reason to infertility. By the combination of 3D-TVS and OHSC we could verify uterine disorders in 39.93 % of cases. Together these two diagnostic methods found the probable infertility causing lesion almost 40 % of our patients. In the subgroup of 40 repeated implantation failure (RIF) patients, the “diagnostic TRIO” confirmed a disorder in 57.50 % of the cases. Limitations, reasons for caution Number of patients should be more to conclude more accurate data. Wider implications of the findings The proper condition of the uterine milieu, through correction of uterine cavity if necessary, endometrial receptivity are of paramount importance for the success of the treatment; as a result, intrauterine surgery as a new subspecialty has been developing. Trial registration number DE RKEB/IKEB: H.0250-2020

Bridging the simulation-to-real gap for AI-based needle and target detection in robot-assisted ultrasound-guided interventions

BackgroundArtificial intelligence (AI)-powered, robot-assisted, and ultrasound (US)-guided interventional radiology has the potential to increase the efficacy and cost-efficiency of interventional procedures while improving postsurgical outcomes and reducing the burden for medical personnel.MethodsTo overcome the lack of available clinical data needed to train state-of-the-art AI models, we propose a novel approach for generating synthetic ultrasound data from real, clinical preoperative three-dimensional (3D) data of different imaging modalities. With the synthetic data, we trained a deep learning-based detection algorithm for the localization of needle tip and target anatomy in US images. We validated our models on real, in vitro US data.ResultsThe resulting models generalize well to unseen synthetic data and experimental in vitro data making the proposed approach a promising method to create AI-based models for applications of needle and target detection in minimally invasive US-guided procedures. Moreover, we show that by one-time calibration of the US and robot coordinate frames, our tracking algorithm can be used to accurately fine-position the robot in reach of the target based on 2D US images alone.ConclusionsThe proposed data generation approach is sufficient to bridge the simulation-to-real gap and has the potential to overcome data paucity challenges in interventional radiology. The proposed AI-based detection algorithm shows very promising results in terms of accuracy and frame rate.Relevance statementThis approach can facilitate the development of next-generation AI algorithms for patient anatomy detection and needle tracking in US and their application to robotics.Key points• AI-based methods show promise for needle and target detection in US-guided interventions.• Publicly available, annotated datasets for training AI models are limited.• Synthetic, clinical-like US data can be generated from magnetic resonance or computed tomography data.• Models trained with synthetic US data generalize well to real in vitro US data.• Target detection with an AI model can be used for fine positioning of the robot.Graphical

Sagittal Spinal Alignment in People with Chronic Spinal Cord Injury and Normal Individual: A Comparison Study Using 3D Ultrasound Imaging.

The aim of this study was to compare the sagittal spinal alignment of people with chronic spinal cord injury (SCI) with normal individuals and to determine whether transcutaneous electrical spinal cord stimulation (TSCS) could cause a change in the thoracic kyphosis (TK) and lumbar lordosis (LL) to re-establish normal sagittal spinal alignment. A case series study was conducted, wherein twelve individuals with SCI and ten neurologically intact subjects were scanned using 3D ultrasonography. In addition, three people with SCI having complete tetraplegia participated further to receive a 12-week treatment (TSCS with task-specific rehabilitation) after evaluation of sagittal spinal profile. Pre- and post-assessments were conducted to evaluate the differences in sagittal spinal alignment. The results showed that the TK and LL values for a person with SCI in a dependent seated posture were greater than those of normal subjects for: standing (by TK: 6.8° ± 1.6°; LL: 21.2° ± 1.9°), sitting straight (by TK: 10.0° ± 4.0°; LL: 1.7° ± 2.6°), and relaxed sitting (by TK: 3.9° ± 0.3°; LL: 7.7° ± 1.4°), respectively, indicating an increased risk for spinal deformity. In addition, TK decreased by 10.3° ± 2.3° after the TSCS treatment, showing a reversible change. These results suggest that the TSCS treatment could be used to restore normal sagittal spinal alignment for individuals with chronic SCI.

Longitudinal Study to Assess the Reliability and Predictive Validity of Ultrasound Measurements in Tracking Fetal Growth and Development Throughout Pregnancy

The utilization of ultrasound in obstetrics is extremely common due to its accurate fetal imaging capabilities. By early identifying anomalies such intrauterine growth restrictions and macrosomia, ultrasonography scanning during pregnancy primarily aims to reduce the risk of obstetric problems. Fetal weight is currently estimated using morphometric formulas. They employ fundamental biometric variables. Hadlock's formula, which is used for estimation of fetal weight, has 20 percent error rate, though. Due to this particular cause, the researchers from all around world had already searching for the additional sonographic characteristics having a stronger predictive value that correlate with fetal weight. According to recent scientific studies, assessing fetal weight can benefit from using novel parameters of sonograph such measurements of the thickness of soft tissue. The fetus's body can be measured in a number of locations, including upper arm, the thigh, abdomen, and the subscapular region. Diverse measurements have varying degrees of connection with some other anthropometric &amp; sonographic factors, including body mass &amp; gestational age. Numerous research using novel formulas for calculating fetal weight have been produced in response to the reports. For measuring fetal weight, measurements other than those including soft tissue, including such those lean and adipose tissue or utilising 3D ultrasonography are acquired. For the purpose of sonographic pregnancy assessment, ultrasound examination of the thicknesses of subcutaneous tissue in the several body regions might evidence to become reliable indicator of the fetal weight. Keywords: Pregnancy, postpartum hypoglycaemia, foetus, Intra-uterine, pregnancy ultrasound

Comparison of image quality of 3D ultrasound: motorized acquisition versus freehand navigated acquisition, a phantom study

PurposeIntra-operative assessment of resection margins during oncological surgery is a field that needs improvement. Ultrasound (US) shows the potential to fulfill this need, but this imaging technique is highly operator-dependent. A 3D US image of the whole specimen may remedy the operator dependence. This study aims to compare and evaluate the image quality of 3D US between freehand acquisition (FA) and motorized acquisition (MA).MethodsMultiple 3D US volumes of a commercial phantom were acquired in motorized and freehand fashion. FA images were collected with electromagnetic navigation. An integrated algorithm reconstructed the FA images. MA images were stacked into a 3D volume. The image quality is evaluated following the metrics: contrast resolution, axial and elevation resolution, axial and elevation distance calibration, stability, inter-operator variability, and intra-operator variability. A linear mixed model determined statistical differences between FA and MA for these metrics.ResultsThe MA results in a statistically significant lower error of axial distance calibration (p < 0.0001) and higher stability (p < 0.0001) than FA. On the other hand, the FA has a better elevation resolution (p < 0.003) than the MA.ConclusionMA results in better image quality of 3D US than the FA method based on axial distance calibration, stability, and variability. This study suggests acquiring 3D US volumes for intra-operative ex vivo margin assessment in a motorized fashion.

Ultrasound visualization of the central nervous system during embryonic and fetal periods: Neurosonoembryology utilizing multiple three-dimensional transvaginal ultrasound technology.

To study the ultrasonographic features of the central nervous system (CNS) in normally developing embryos and fetuses with a crown-rump length (CRL) of 10-84mm, utilizing a high-frequency transvaginal probe in conjunction with various three-dimensional (3D) imaging modes. From January 2020 to February 2021, 210 normally developing embryos and fetuses in early pregnancy were enrolled and classified based on their gestational age. A high-frequency transvaginal transducer was used to perform 2D and 3D ultrasounds, and the 3D images were saved. These images were then processed using multiple 3D technologies, such as HD live silhouette, OmniView, and TUI. Additionally, the circumference of the vermis was measured through the posterior fontanelle. Beginning at the 10mm CRL stage of embryonic development, high-frequency transvaginal 3D ultrasound imaging was able to clearly visualize the prosencephalon, mesencephalon, and rhombencephalon. Notable changes were observed in the rhombencephalon during the 16-22mm CRL stage, including the visualization of the pontine flexure and cerebellar primordium. At 23-40mm CRL, there was a distinct pontine flexure, and the developing cerebellum, the fourth ventricle, and choroid plexus of the fourth ventricle (4th VCP) could be observed. The roof of the rhombencephalon was partitioned by the 4th VCP into the anterior membranous area (AMA) located rostrally and the posterior membranous area situated caudally. Additionally, the original Blake's pouch was identifiable. Among fetuses measuring 41-84mm CRL, the AMA progressively decreased in size as the vermis developed. From the mid-sagittal view, the orientation of the 4th VCP seemed to shift from being perpendicular to the neural tube's long axis to being parallel to it. Furthermore, there was a significant correlation between CRL and vermis circumference. Using three-dimensional transvaginal ultrasound scanning, detailed visualization of the morphological changes in the CNS during normal embryonic development from 7 to 13+6 weeks is possible. This technology can aid in accurately characterizing the embryonic origin of the CNS.

Panoramic volumetric clinical handheld photoacoustic and ultrasound imaging

Photoacoustic (PA) imaging has gained much attention, providing structural and functional information in combination with clinical ultrasound (US) imaging systems. 2D PA and US imaging is easily implemented, but its heavy dependence on operator skills makes 3D imaging preferable. In this study, we propose a panoramic volumetric clinical PA and US imaging system equipping a handheld imaging scanner weighing 600 g and measuring 70 × 62 × 110 mm3. Multiple PA/US scans were performed to cover a large field-of-view (FOV), and the acquired PA/US volumes were mosaic-stitched after manually correcting the positions and rotations in a total of 6 degrees of freedom. PA and US maximum amplitude projection images were visualized online, while spectral unmixed data was quantified offline. The performance of the system was tested via tissue-mimicking phantom experiments. The system’s potential was confirmed in vivo by panoramically imaging vascular networks in human arms and necks, with FOVs of 331 × 38 and 129 × 120 mm2, respectively. Further, we quantified hemoglobin oxygen saturation levels in the radial artery, brachial artery, carotid artery, and jugular vein. We hope that this system can be applied for various clinical fields such as cardiovascular imaging, dermatology, vascular surgery, internal medicine, and oncology.

Changes of placental three-dimensional power Doppler ultrasonography in third trimester among hypertensive disorders complicating pregnancy and its predictive value for pregnant outcomes.

Hypertensive disorders complicating pregnancy (HDCP) represent a systemic condition specific to pregnant women. Three-dimensional (3D) power Doppler ultrasonography is a technique that utilizes erythrocyte density, scattered intensity, or energy distribution in the bloodstream for imaging purposes. This study aimed to compare the changes in 3D power Doppler ultrasonography parameters in late pregnancy between patients with HDCP and those without HDCP, and to evaluate the predictive value of these parameters for pregnancy outcomes in patients with HDCP. The study included 160 pregnant women diagnosed with HDCP and 100 pregnant women without HDCP, who served as the control group. 3D power Doppler ultrasonography was performed, and the values of the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured. In the HDCP group, the VI, FI, and VFI were all lower than those observed in patients without HDCP. In HDCP patients with positive outcomes, these three parameters were higher than those recorded in patients with negative outcomes. The area under the predicted curve (AUC) for VI, FI, VFI, and the combination of these three parameters were 0.69, 0.63, 0.66, and 0.75, respectively. The parameters of 3D power Doppler ultrasonography can reflect the perfusion status of the placenta and predict the outcome of pregnancy in patients with HDCP. By monitoring these relevant hemodynamic parameters, valuable information can be provided for the clinical diagnosis, objective evaluation, and treatment of HDCP.

Three-dimensional ultrasonography could be a potential non-ionizing tool to evaluate vertebral rotation of subjects with adolescent idiopathic scoliosis.

Three-dimensional (3D) ultrasonography is nonionizing and has been demonstrated to be a reliable tool for scoliosis assessment, including coronal and sagittal curvatures. It shows a great potential for axial vertebral rotation (AVR) evaluation, yet its validity and reliability need to be further demonstrated. Twenty patients with adolescent idiopathic scoliosis (AIS) (coronal Cobb: 26.6 ± 9.1°) received 3D ultrasound scan for twice, 10 were scanned by the same operator, and the other 10 by different operators. EOS Bi-planar x-rays and 3D scan were conducted on another 29 patients on the same day. Two experienced 3D ultrasonographic researchers, with different experiences on AVR measurement, evaluated the 3D ultrasonographic AVR of the 29 patients (55 curves; coronal Cobb angle: 26.9 ± 11.3°). The gold standard AVR was determined from the 3D reconstruction of coronal and sagittal EOS radiographs. Intra-class correlation coefficients (ICCs), mean absolute difference (MAD), standard error measurements (SEM), and Bland-Altman's bias were reported to evaluate the intra-operator and inter-operator/rater reliabilities of 3D ultrasonography. The reliability of 3D ultrasonographic AVR measurements was further validated using inter-method with that of EOS. ICCs for intra-operator and inter-operator/rater reliability assessment were all greater than 0.95. MAD, SEM, and bias for the 3D ultrasonographic AVRs were no more than 2.2°, 2.0°, and 0.5°, respectively. AVRs between both modalities were strongly correlated (R 2 = 0.901) and not significantly different (p = 0.205). Bland-Altman plot also shows that the bias was less than 1°, with no proportional bias between the difference and mean of expected and radiographic Cobb angles. This study demonstrates that 3D ultrasonography is valid and reliable to evaluate AVR in AIS patients. 3D ultrasonography can be a potential tool for screening and following up subjects with AIS and evaluating the effectiveness of nonsurgical treatments.

Towards transcervical ultrasound image guidance for transoral robotic surgery.

Trans-oral robotic surgery (TORS) using the da Vinci surgical robot is a new minimally-invasive surgery method to treat oropharyngeal tumors, but it is a challenging operation. Augmented reality (AR) based on intra-operative ultrasound (US) has the potential to enhance the visualization of the anatomy and cancerous tumors to provide additional tools for decision-making in surgery. We propose a US-guided AR system for TORS, with the transducer placed on the neck for a transcervical view. Firstly, we perform a novel MRI-to-transcervical 3D US registration study, comprising (i) preoperative MRI to preoperative US registration, and (ii) preoperative to intraoperative US registration to account for tissue deformation due to retraction. Secondly, we develop a US-robot calibration method with an optical tracker and demonstrate its use in an AR system that displays anatomy models in the surgeon's console in real-time. Our AR system achieves a projection error from the US to the stereo cameras of 27.14 and 26.03 pixels (image is 540[Formula: see text]960) in a water bath experiment. The average target registration error (TRE) for MRI to 3D US is 8.90mm for the 3D US transducer and 5.85mm for freehand 3D US, and the TRE for pre-intra operative US registration is 7.90mm. We demonstrate the feasibility of each component of the first complete pipeline for MRI-US-robot-patient registration for a proof-of-concept transcervical US-guided AR system for TORS. Our results show that trans-cervical 3D US is a promising technique for TORS image guidance.

Ultrasounds induced eutectic structure transition and associated mechanical property enhancement of FeCoCrNi2.1Al high entropy alloy

One dimensional (1D) and three dimensional (3D) ultrasound sources were applied to modulate the solidification process of FeCoCrNi2.1Al high entropy alloy whose liquidus temperature is up to 1614 K with the acoustic signal in liquid alloy in-situ measured. It was found that 1D ultrasound significantly refined the lamellar eutectic structure by decreasing both the eutectic cell width and the aligned α(B2)/γ(FCC) phase spacing. If ultrasound amplitude and dimension were increased, lamellar eutectic gradually transformed into anomalous eutectic without synergetic orientation. Meanwhile, a metastable σ phase enriched with Cr precipitated from γ phase in anomalous eutectic under 3D ultrasounds. Based on the combined analysis of eutectic structural evolution and sound field characteristics, the ultrasonic solidification mechanism was further clarified. The promoted dependent nucleation by stable cavitation and the fast growth rate caused by acoustic streaming were the main reasons for the significantly refined eutectic structure under 1D ultrasound. The induced independent eutectic nucleation and growth by transient cavitation, together with the enhanced solute and thermal diffusion by the intensive acoustic streaming under 3D ultrasounds were responsible for the formation of anomalous eutectic and the precipitation of metastable σ phase. The maximum ultimate strength and total elongation under ultrasound were simultaneously increased by 28% and 93%, showing comprehensive mechanical performance superior to those prepared by conventional approaches. The prominent strain hardening in γ phase and increase in α/γ interfaces induced by refining effect were the strengthening mechanisms, and the improvement of ductility was attributed to the intensified strain hardening in γ phase.

A robust and automatic CT-3D ultrasound registration method based on segmentation, context, and edge hybrid metric.

The fusion of computed tomography (CT) and ultrasound (US) image can enhance lesion detection ability and improve the success rate of liver interventional radiology. The image-based fusion methods encounter the challenge of registration initialization due to the random scanning pose and limited field of view of US. Existing automatic methods those used vessel geometric information and intensity-based metric are sensitive to parameters and have low success rate. The learning-based methods require a large number of registered datasets for training. The aim of this study is to provide a fully automatic and robust US-3D CT registration method without registered training data and user-specified parameters assisted by the revolutionary deep learning-based segmentation, which can further be used for preparing training samples for the study of learning-basedmethods. We propose a fully automatic CT-3D US registration method by two improved registration metrics. We propose to use 3D U-Net-based multi-organ segmentation of US and CT to assist the conventional registration. The rigid transform is searched in the space of any paired vessel bifurcation planes where the best transform is decided by a segmentation overlap metric, which is more related to the segmentation precision than Dice coefficient. In nonrigid registration phase, we propose a hybrid context and edge based image similarity metric with a simple mask that can remove most noisy US voxels to guide the B-spline transform registration. We evaluate our method on 42 paired CT-3D US datasets scanned with two different US devices from two hospitals. We compared our methods with other exsiting methods with both quantitative measures of target registration error (TRE) and the Jacobian determinent with paired t-test and qualitative registration imagingresults. The results show that our method achieves fully automatic rigid registration TRE of 4.895 mm, deformable registration TRE of 2.995 mm in average, which outperforms state-of-the-art automatic linear methods and nonlinear registration metrics with paired t-test's p value less than 0.05. The proposed overlap metric achieves better results than self similarity description (SSD), edge matching (EM), and block matching (BM) with p values of 1.624E-10, 4.235E-9, and 0.002, respectively. The proposed hybrid edge and context-based metric outperforms context-only, edge-only, and intensity statistics-only-based metrics with p values of 0.023, 3.81E-5, and 1.38E-15, respectively. The 3D US segmentation has achieved mean Dice similarity coefficient (DSC) of 0.799, 0.724, 0.788, and precision of 0.871, 0.769, 0.862 for gallbladder, vessel, and branch vessel,respectively. The deep learning-based US segmentation can achieve satisfied result to assist robust conventional rigid registration. The Dice similarity coefficient-based metrics, hybrid context, and edge image similarity metric contribute to robust and accurateregistration.

Adrenal congestion in perinatal hypoxia: Sonographic assessment and relationship with hypoxic ischemic encephalopathy

BackgroundDuring hypoxia, blood flow to the brain, myocardium, and adrenal glands is preserved or even increased to maintain homeostasis. Adrenal congestion occurs when venous return remains insufficient. Several different ultrasound measurements of adrenal glands in neonates have been reported in the literature. However, there is no data related on adrenal gland size in neonates with perinatal hypoxia. AimsTo evaluate the adrenal congestion using by ultrasound (US) measurements in perinatal hypoxia, and to reveal the relationship of adrenal congestion with hypoxic-ischemic encephalopathy (HIE) grades and magnetic resonance imaging (MRI) findings. Study designProspective cohort study. SubjectsInfants with perinatal hypoxia who met therapeutic hypothermia criteria and were being cooled were included in the present study. The control group was established from healthy neonates admitted to our center during the recruitment. Outcome measuresThe gland area was measured by tracing, and both the corpus and crura widths were measured. ResultsWe reported adrenal gland area data of 110 newborns with HIE and compared them with 56 normal neonates. The adrenal size was significantly higher in the HIE group than in the control group (p<0,01). The frequency of adrenal congestion was 72.7% based on the selected cut-off values. The adrenal gland measurements were increased in the patients with perinatal hypoxia than those of the controls. ConclusionsIn the systemic evaluation of newborns with perinatal hypoxia, additional care should be taken regarding adrenal congestion. The measurement of adrenal size with 2D US will help us to diagnose or confirm adrenal congestion and possible hemorrhagic changes. The morphological data and cut-off values given in our study will be useful for neonatologists and pediatric radiologists to evaluate the patient while managing perinatal hypoxia.

Hydrosalpingeal fluid leads to subfertility via endometrial TNF-α and IL-7 and NF-κB signaling pathways.

To determine the concentrations of the nuclear factor kappa B (NF-κB), tumor necrosis factor-alpha (TNF-α) and interleukin-7 (IL-7) in midluteal phase endometrial samples of infertile patients diagnosed with uni or bilateral hydrosalpinx (HX). A total of 24 patients who decided to undergo laparoscopic salpingectomy were included in the study. Salpingectomy indications consisted of patients with a diagnosis of hydrosalpinx (n=12) or ectopic pregnancy (n=12). Twelve healthy patients who underwent Pomeroy-type tubal ligation were considered as the second and healthy control group. The diagnosis of hydrosalpinges was made by transvaginal 2D ultrasonography or HSG. All patients in the hydrosalpinges or ectopic pregnancy group underwent laparoscopic salpingectomy. Just before salpingectomy, endometrial samples were obtained from all patients by Pipelle cannula. Endometrial sampling was performed 7-9 days after the LH surge in the control group. IL-7, NF-κB and TNF-α concentrations were measured by ELISA method in the endometrial samples of all three groups. The endometrial IL-7 concentration before salpingectomy of the patients in the hydrosalpinx group was 44.6±6.65 ng/mg wet-tissue. The IL-7 levels of the HX group were significantly higher than those of the patients in the ectopic pregnancy group (19.3±3.06 ng/mg wet tissue versus 44.6±6.65 ng/mg wet tissue, p<0.04). Similarly, IL-7 levels of the HX group were significantly higher than those of the tubal ligation group (6.08±1.48 ng/mg wet tissue versus 44.6±6.65 ng/mg wet tissue, p<0.03). The endometrial TNF-α concentration of the patients in the hydrosalpinx group was 33.20±5.40 ng/mg wet-tissue. The TNF-α value detected in the hydrosalpinx group was significantly higher than both the TNF-α value in the ectopic pregnancy group (11.8±1.07 ng/mg wet-tissue vs. 33.20±5.40 ng/mg wet-tissue, p<0.01) and the TNF-α value in the tubal ligation group (5.30±1.22 ng/mg wet-tissue vs. 33.20±5.40 ng/mg wet-tissue, p<0.01). The pre-salpingectomy endometrial NF-κB concentration of the patients in the hydrosalpinx group was 6.38±1.40 ng/mg wet-tissue. This value is higher than endometrial NF-κB levels in the ectopic pregnancy group (3.67±0.41 ng/mg wet-tissue vs. 6.38±1.40 ng/mg wet-tissue, p<0.02) and NF-κB levels in the tubal ligation group (1.07±0.38 ng/mg wet-tissue vs. 6.38±1.40 ng/mg wet-tissue, p<0.01). The presence of hydrosalpinx prevents successful implantation by increasing the levels of endometrial proinflammatory cytokines TNF-α, IL-7 and NF-κB.

Prenatal radiographic evaluation of congenital transverse limb deficiencies: A scoping review.

Congenital transverse deficiencies are horizontal deficiencies of the long bones that occur with a reported incidence as high 0.38%. They can occur alone or represent a manifestation of a various clinical syndromes. Diagnosis has traditionally comprised of conventional radiography and prenatal imaging studies. There has been much advancement regarding prenatal imaging modalities to allow for early diagnosis and appropriate treatment. To summarize the current state of knowledge on congenital transverse limb deficiencies and to provide an update regarding the radiographic evaluation of congenital transverse limb deficiencies. This IRB-exempt scoping review followed the PRISMA-ScR checklist for scoping reviews strictly. Five search engines were searched for a total of 265 publications. Four authors reviewed these during the screening process. Of these, 51 studies were included in our article. Prenatal magnetic resonance imaging (MRI), 3D Ultrasound, and multidetector Computed tomography (CT) exist are emerging modalities that have the potential to improve diagnosis. Use of the appropriate classification system, three-dimensional ultrasonography with a maximum intensity projection, and appropriate use of prenatal MRI and prenatal CT can improve diagnosis and inter-provider communication. Further scholarly efforts are required to develop improve standardized guidelines regarding the pre-natal radiographic evaluation of congenital limb deficiencies.