Advanced Ultrasound Techniques Research Articles

Clinical audit of diagnostic results from perinatal autopsy

Aim To assess the contribution of the perinatal autopsy to the diagnosis and investigation of fetal and placental disease in an era of advanced prenatal ultrasound and molecular diagnostic techniques. Method This is a 1 year retrospective study that reviewed all autopsy results from fetuses of 20 weeks gestation and above, for diagnostic information and data regarding fetal or placental findings. All autopsies were performed at the sole tertiary perinatal pathology centre for Western Australia. Where available, autopsy findings were correlated with ultrasound and genetics. Results 147 autopsies from fetuses above 20 weeks gestation were performed during this period. One coronial case was not reviewed. Six cases had known chromosomal abnormalities. Of the remaining 140 autopsies, 125 (89%) reported abnormal findings and 101 (81%) of these provided additional information regarding the fetus or placenta. Fetal or placental pathology was not identified in only eight (6%) cases and seven (5%) of cases were of uncertain clinical significance. Discussion Despite significant advances in prenatal ultrasound and molecular diagnostic techniques, defining the cause of perinatal disease is challenging. Autopsy continues to be the gold standard for the investigation of perinatal disease, providing the opportunity to confirm diagnosis, find additional malformations or changing and broadening the range of diagnosis of perinatal pathology.

Ultrasound in rare diffuse liver disease.

Ultrasound is often the first imaging procedure performed in the evaluation of individuals with suspected or known liver disease. Despite technical advances in ultrasound techniques, sonographic detection and evaluation of diffuse liver disease still remains difficult. This is due to the fact that diffuse liver disease does not always cause distortion of the liver parenchymal texture, internal liver architecture, or shape of the liver. On the other hand, the size of the liver, the echo pattern of the hepatic parenchyma, the analysis of intrahepatic vessels and alterations in perihepatic structures and lymph nodes can be helpful sonographic parameters of diffuse liver disease. Until now, the sonographic appearance of some rare diffuse liver diseases is not well known. However, there are some typical sonomorphological signs that, once identified, can facilitate the differentiation between various diseases. The aim of this paper is to highlight some typical ultrasound findings of liver parenchyma and perihepatic lymph node structures in rare diffuse liver diseases based on a review of published data.

Risk assessment for epithelial ovarian cancer: Proposing a new approach to a deadly problem

Presently the majority of women diagnosed with epithelial ovarian cancer (EOC) have advanced stage disease (III–IV) with a poor 5-year survival rate (12–30 %). This significantly contrasts when early stage disease is detected, which has a 5-year survival rate approximating 90 %. Therefore, detection of early stage disease is critical to making an impact on outcome. By using genetic algorithms, modifications of transvaginal ultrasonography and use of novel biomarkers, we propose a risk assessment profile to identify at-risk women and enable ovarian cancer screening to become a reality. Such a novel algorithm starts by applying classic genetic pedigree assessment and uses a panel of multiple biomarkers that identify both phenotypic and genotypic expression of high-risk markers followed with conventional ultrasound and advanced ultrasound techniques such as microvascular contrast-enhancement as a secondary test. We presently employ a multidisciplinary program incorporating genetics, molecular biology, tumor immunology, gynecologic oncology and diagnostic imaging to identify asymptomatic high risk women.

Ultrasound elastography and contrast-enhanced ultrasound in infants, children and adolescents

ObjectiveTo describe prerequisites, use, and safety of ultrasound elastography and contrast-enhanced ultrasound in infants, children, and adolescents. MethodThis review deals with two latest developments in ultrasonography in children. The principle of strain elastography, transient elastography, and acoustic radiation force imaging is discussed, including limitations, and advantages of the different techniques in diagnosing focal and diffuse organ disease. The intravesical (contrast-enhanced voiding ultrasonography) and intravascular use of contrast-media to outline blood, and urinary flow is described, with special emphasis on indications, off-label use, and diagnostic gain. Examples of indications for performing the advanced ultrasound techniques are presented. Summary and conclusionLatest developments in ultrasound machine engineering, and the availability of contrast-media that interact with ultrasound waves allow for assessment of tissue stiffness/elasticity properties, blood, and urinary flow. Thereby ultrasound is capable not only to depict morphology, but gives the additional information on organ, and focal lesion perfusion, and urinary flow dynamics. The information gap to other cross-sectional techniques such as magnetic resonance imaging, that make potential harmful sedation, and anaesthesia in the youngest children necessary, thereby gets closer.

Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association.

The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin-twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

Improving the management and outcome in haemolytic disease of the foetus and newborn.

Improving the management and outcome in haemolytic disease of the foetus and newborn.

Thyroid ultrasound

Thyroid ultrasonography has established itself as a popular and useful tool in the evaluation and management of thyroid disorders. Advanced ultrasound techniques in thyroid imaging have not only fascinated the radiologists but also attracted the surgeons and endocrinologists who are using these techniques in their daily clinical and operative practice. This review provides an overview of indications for ultrasound in various thyroid diseases, describes characteristic ultrasound findings in these diseases, and illustrates major diagnostic pitfalls of thyroid ultrasound.

Prenatal ultrasound screening for orofacial clefts

To evaluate the sensitivity and specificity of ultrasound for detecting prenatal facial clefts in low-risk and high-risk populations. This study prospectively followed up a non-selected population, namely all pregnant women who underwent routine second-trimester prenatal ultrasound screening in the Utrecht region during the 2-year period from January 2007 to December 2008. A total of 35 924 low-risk and 2836 high-risk pregnant women underwent ultrasound screening. Orofacial clefts were present in 62 cases, an incidence of 1:624. The distribution of clefts was as follows: 18 (29%) cleft lip, 25 (40%) cleft lip with cleft palate, 17 (27%) cleft palate only, one median cleft and one atypical cleft. Of these, 38 (61%) were unilateral and 23 (37%) were bilateral. Thirty-nine per cent (24/62) had associated anomalies, with most chromosomal defects found in the cleft lip with cleft palate and cleft palate only groups. Cleft lip with or without cleft palate was detected prenatally in 38/43 cases, a sensitivity of 88%. No case of cleft palate only was detected prenatally. There were three false-positive cases, of which two were fetuses with multiple congenital deformities. Ultrasound screening has a high sensitivity for the detection of cleft lip with and without cleft palate in high-risk and low-risk pregnancies in our region, where well-trained sonographers carry out primary screening. The key to a high sensitivity of prenatal ultrasound is likely to be a combination of excellent training of sonographers, referral to specialized centers when a cleft is suspected, routine visualization of the fetal face and advances in ultrasound techniques.

WE‐A‐220‐01: Current Status of HIFU Therapy for Treatment of Benign and Malignant Tumors of the Abdomen, Pelvis and Bone

High‐intensity focused ultrasound (HIFU) is a noninvasive method currently being investigated to treat certain primary solid tumors, metastatic disease, and enhance drug delivery. The field of medicine is evolving towards increasing use of noninvasive and minimally invasive therapies such as HIFU. The application of HIFU for tumor therapy has recently been gaining momentum due to advances in imaging technology such as magnetic resonance thermometry and advanced ultrasound imaging techniques that permit real‐time monitoring of HIFU treatment effects. Currently, several commercially available HIFU devices are manufactured worldwide for treatment of a wide variety of both benign and malignant tumors including uterine fibroids, prostate cancer, pancreatic cancer, liver tumors, thyroid tumors and other solid tumors that are accessible to ultrasound energy. Although HIFU technology has been used clinically since the 1950ˈs it remains a new therapeutic technology requiring further laboratory and clinical evaluation. This presentation provides an overview of the current status of clinical applications of HIFU for benign and malignant tumors within the abdomen and pelvis as well as treatment of bone metastasis.Learning Objectives:1. Understand the mechanisms that HIFU induces a biologic effect2. Understand the current limitations of ultrasound and MR‐guided HIFU therapy3. Understand the anatomic requisites and limitations for HIFU therapy

Preterm birth: avenues for future study

Preterm birth (or birth before 37 completed weeks of gestation) is on the increase. However, very little evidence is currently available regarding its etiology, pathophysiology, screening and management strategies. Genetic epidemiologic studies to identify genes associated with preterm birth and identification of biomarkers that can be used in conjunction with advanced ultrasound screening techniques to find high-risk cases form the basis of future research into preterm birth. Based on findings from these studies, primary, secondary and tertiary prevention strategies can be devised and tested by means of multicenter randomized controlled trials.

Advanced Ultrasound Techniques for Breast Imaging

In the last 30 years, ultrasound (US) has become the most important adjunctive imaging modality for breast evaluation. The use of US for breast evaluation took off in the early 1980s with the introduction of digital technology, which delivered improved resolution over analog systems. 1 Since then, continued progress in transducer piezoelectric crystal development, signal processing and beam-forming technology has brought US examination of the breast from a tool for merely differentiating cystic from solid masses to a sensitive methodofdiagnosingmalignancyandacommonmethodfor guiding biopsies. In this work we discuss the advances that have become standard as well as innovations poised to further improve accuracy for breast lesion diagnosis.

Corroborative echocardiographic procedures: The multidisciplinary approach

Ultrasound evaluation of the hear t is primarily assessed using transthoracic echocardiography. There are limitations to this standard assessment and other advanced ultrasound techniques and tools are available. This article provides a basic introduction to three corroborative procedures (transoesophageal echocardiography, stress echocardiography and contrast echocardiography) which contribute to the overall ultrasound assessment of cardiac structure and function. Unlike standard transthoracic imaging these procedures use a multi-disciplinary team and therefore this article highlights these potential roles.

Atlas of Ultrasound- and Nerve Stimulation-guided Regional Anesthesia.

Mayo Clinic, Jacksonville, Florida. clendenen.steven@mayo.eduAtlas of Ultrasound- and Nerve Stimulation-guided Regional Anesthesia. By Ban C. H. Tsui, M.D. Consulting Editors: Vincent W. S. Chan, M.D., Brendan T. Finucane, M.B., B.Ch., Thomas Grau, M.D., Ph.D., and Anil H. Walji, M.D., Ph.D. New York, Springer Science+Business Media, 2007. Pages: 302. Price: $170.00.Regional anesthesia has made rapid advancement over the past 30 yr with the introduction of electrical stimulation to guide needle placement and the most recent addition of ultrasound. The key to a successful block is to deliver the local anesthetic to the target nerves. Atlas of Ultrasound- and Nerve Stimulation-guided Regional Anesthesia illustrates how to combine ultrasound and nerve stimulation to advance the art of regional anesthesia to a more scientific approach.The book’s first two chapters are brief introductions into the logistics of establishing a block room and garnering the supplies needed. They also include a comprehensive review of the physics of nerve stimulation and features of the equipment needed. The authors emphasize that nerve stimulation can be very helpful to novices as they learn to incorporate ultrasound into their regional practices, with the goal of confirmation that nerves on images and reactive to stimulation are actually nerves.Chapters 3 and 4 provide an elementary look at the ultrasound basics, including physics and workings of the ultrasound machine. These chapters provide guidance in choosing the correct ultrasound probe (linear vs. curved array), which is essential for obtaining adequate images that will identify nerves. Tissue sonoanatomy, required to identify the various structures within ultrasound images, is introduced. After identifying the nerve, one of the more difficult issues to learn is to track the needle to the target nerve. Practical tips are given to assist clinicians in observing and maintaining the trajectory of the needle. The author introduces a “training wheel” laser light attachment system that he has developed to aid the beginner in aligning the ultrasound beam with an in-plane technique in guiding the needle to the nerve.The remainder of the book is divided into chapters describing the most common regional blocks. The author is consistent with his stepwise approach to convey an easy and clear method in performing the various blocks with introduction of clinical anatomy followed by surface anatomy. Anatomical dissections, corresponding magnetic resonance imaging images, and ultrasound images are used for comparison to provide clinicians with a comprehensive view of anatomy. The message is clear that performing a successful regional block is dependent on a thorough understanding of anatomy. The chapters describe how to position the ultrasound probe to obtain the best images to perform the block. Comparison ultrasound scans of labeled and unlabeled images are educational tools used to learn the sonoanatomy of the different blocks. Appropriate motor responses to nerve stimulation are listed for each of the individual target nerves. Clinical pearls and troubleshooting suggestions are detailed at the end of each chapter.Chapter 16 explores the role of ultrasound with regional catheter placement and stimulating catheters. As the author notes, there is not an abundance of information in the literature regarding ultrasound guidance of catheters and stimulating versus nonstimulating catheters. The chapter is based primarily on the author’s clinical experience and gives several helpful suggestions on placement of catheters.One of the challenges of ultrasound imaging is learning sonoanatomy and being able to identify nerves. Examples of the ultrasound images throughout the book were adequate but challenging. In several of the images, it was difficult to clearly see the nerves, a problem that is unfortunately realistic and often the case when performing ultrasound-guided nerve blocks. For the beginner, it may be helpful to be able to compare both ideal and mediocre ultrasound images.In summary, the authors are to be congratulated for a well-designed book that explains their approach to performing regional blocks with the aid of nerve stimulation and ultrasound. The book offers an easy-to-follow stepwise introduction of ultrasound for beginners and several advanced ultrasound techniques for experienced clinicians. The book provides numerous practical suggestions on how to safely perform regional blocks with high success rates. This is an excellent resource for any clinician performing regional blocks.Mayo Clinic, Jacksonville, Florida.clendenen.steven@mayo.edu

Early impairment of myocardial function in young patients with β‐thalassemia major

One of the chief causes of death in patients with beta-thalassemia major (TM) remains heart failure due to iron overload. We investigated possible differences in myocardial function between a population of young asymptomatic patients with TM and healthy controls all of whom underwent an echocardiographic study, including tissue Doppler (TDI) and strain imaging (SI) analysis and cardiac magnetic resonance imaging (MRI). 30 young asymptomatic patients with TM (16 taking deferoxamine and 14 taking deferiprone) and 30 healthy subjects underwent a cardiac MRI with T2* technique and an echocardiographic evaluation including systolic myocardial velocities (Sm), early (Em) and late (Am) diastolic velocities and systolic strain (S) at the level of basal segments of the lateral left ventricle (LV), interventricular septum (Septal) and lateral right ventricle (RV) wall. The differences in T2* values and echocardiographic parameters were also compared in patients with TM subgrouped according to iron chelation therapy. The following TDI and SI measures were lower in patients than in controls: LV-Sm (P < 0.05), S-LV (P < 0.001), Septal-Sm (P < 0.05), Septal-Em (P < 0.001), S-Septal (P < 0.001), RV-Sm (P < 0.001), RV-Em (P < 0.001), RV-Em/Am (P < 0.05) and S-RV (P < 0.05). Myocardial function was better in the patients receiving deferiprone than those receiving deferoxamine. T2* values were higher in controls than in patients with TM and in those treated with deferiprone than those treated with deferoxamine. MRI data well correlated with SI parameters. Study underlines that, even in a population of young, asymptomatic and well-chelated patients with TM, there is an impairment of myocardial function and that this condition could be easily detected by more advanced ultrasound techniques such as TDI and SI. The better indices of myocardial function in patients treated with deferiprone clearly needs confirmation from larger prospective studies.

Doppler and harmonic ultrasound for hepatocellular carcinoma

Ultrasound (US) is the imaging method most frequently used for the detection and diagnosis of hepatocellular carcinoma (HCC). US image quality has greatly improved in recent years, with advances in transducer, beam-former technology and sophisticated image processing. In addition, the recent availability of US contrast agents including first- and second-generation contrast agents and the remarkable advances in US technology have led to the rapid development of new imaging methods such as low and high mechanical index (MI) imaging technology for the vascular phase and parenchymal phase of the liver. In terms of contrast agent, most reported studies in Asian countries have used a very fragile, first-generation microbubble agent. Nowadays, more stable,second-generation contrast agents are developing and used in clinical application to the liver. In the future, better results can be obtained in the diagnosis of HCC, decision of treatment method and assessment of therapeutic response if more durable contrast agents are used with advanced US techniques. In this article, the principles, methods, imaging findings and potential roles of new diagnostic US techniques with contrast agents in the diagnosis of HCC are discussed.

Prostate ultrasound---for urologists only?

The value of ultrasound (US) in the diagnosis of prostate cancer has dramatically increased in the past decade. This is mainly related to the increasing incidence of prostate cancer, the most common cancer in men and one of the most important causes of death from cancer in men. The value of conventional gray-scale US for prostate cancer detection has been extensively investigated, and has shown a low sensitivity and specificity. Therefore conventional gray-scale US is mainly used by urologists for guiding systematic prostate biopsies. With the development of new US techniques, such as color and power Doppler US, and the introduction of US contrast agents, the role of US for prostate cancer detection has dramatically changed. Advances in US techniques were introduced to further increase the value of US contrast agents. Although most of these developments in US techniques, which use the interaction of the contrast agent with the transmitted US waves, are very sensitive for the detection of microbubbles, they are mostly unexplored, in particular for prostate applications. Early reports of contrast-enhanced US investigations of blood flow of the prostate have shown that contrast-enhanced US adds important information to the conventional gray-scale US technique. Furthermore, elastography or ‘strain imaging’ seems to have great potential in prostate cancer detection. Since these new advances in US are very sophisticated and need a long learning curve, radiologists, who are overall better trained with these new US techniques, will play a more important role in prostate cancer diagnosis. Current trends show that these new US techniques may allow for targeted biopsies and therefore replace the current ‘gold standard’ for prostate cancer detection—the systematic biopsy. Consequently the use of these new US techniques for the detection and clinical staging of prostate cancer is promising. However, future clinical trials will be needed to determine if the promise of these new US advances of the prostate evolves into clinical application.

Cavitations in biological tissues

An important reason for the high popularity of diagnostic ultrasound is its lack of hazardous side effects. However, as described below, the probability of inducing undesirable thermal and mechanical effects in tissue increases with a rise in the output of diagnostic ultrasound machines. The use of increasing negative peak pressures of the applied ultrasound pulse enhances the risk of inducing cavitation inside the body. The potential damage of cavitation results from the dynamic, e. g. wild pulsation, and a collapse of bubbles in the respective sound field. The collapse, especially, releases a high amount of energy, related to secondary effects like shock waves, jet formation and the formation of free radicals. To estimate the likelihood of cavitation and ensuing mechanical biological effects the so-called mechanical index was defined. Nowadays, the mechanical index is displayed in real-time on modern diagnostic ultrasound machines. Echo-contrast agents play an increasing role in sonography. These stabilised gas particles increase the likelihood of cavitation formation and the occurrence of other biological side effects. The potential for mechanically induced side effects of diagnostic ultrasound was tested in many animal studies. As for the use of ultrasound for diagnostic purposes, adverse side effects, like haemorrhage or rupture of capillaries, were only observed in the presence of tissue-gas interfaces - as found in the lung or the intestine - or with high concentrations of contrast media. Even though no adverse effects of diagnostic ultrasound have been reported in humans, potentially damaging effect of advanced ultrasound techniques cannot be denied. Various ultrasound organizations, e.g. WFUMB, have therefore formulated recommendations for the safe use of diagnostic ultrasound.

New developments in ultrasonography for the detection of prostate cancer.

The introduction of contrast agents has changed the diagnostic role of ultrasonography dramatically. Advanced ultrasound techniques, although currently largely unexplored, especially for prostate applications, were introduced to improve, for example, differential diagnosis. Also, new technologies became available using the interaction of the angioemboli with the transmitted ultrasound waves, and sensitive methods to detect microbubbles were developed. As the traveling of microbubbles through the vascular system is a dynamic process, new information becomes available: when the concentration of the contrast agent can be determined as a function of time, a measure for the actual blood flow can be obtained that provides quantitative information. Initially developed to enhance the ultrasound examinations in cardiac applications, contrast agents can currently be found in radiologic applications as well. The first reports of enhanced Doppler examinations of prostatic blood flow have been published, and the results indicate that contrast agents are a promising addition to the conventional ultrasound examination. In this paper, we present a short overview of the status of transrectal ultrasound imaging in prostate cancer, background information on contrast agents and imaging modalities, and early results of enhanced Doppler studies of the prostate to identify cancer. The early results suggest the feasibility of using angioemboli to enhance ultrasound imaging of prostate diseases, and although many issues remain to be solved, angioemboli in combination with a dedicated imaging modality have the potential to improve the diagnostic application of ultrasound in evaluating the prostate for disease.

Book Review: Advances in Ultrasound Techniques and Instrumentation

Book Review: Advances in Ultrasound Techniques and Instrumentation

Advances in Ultrasound Techniques and Instrumentation.Clinics in Diagnostic Ultrasound

HomeRadiologyVol. 189, No. 3 PreviousNext ReviewsAdvances in Ultrasound Techniques and Instrumentation. Clinics in Diagnostic UltrasoundBernice CapustenBernice CapustenBernice CapustenPublished Online:Dec 1 1993https://doi.org/10.1148/radiology.189.3.802MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: Dec 1993 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 189, No. 3 Metrics Altmetric Score PDF download