B-mode Ultrasonography Research Articles

Influence of Dulaglutide on Serum Biomarkers of Atherosclerotic Plaque Instability: An Interventional Analysis of Cytokine Profiles in Diabetic Subjects-A Pilot Study.

Background and Objectives: The rise in global diabetes cases, reaching a staggering 529 million in 2021 from 108 million in 1980, underscores the urgency of addressing its complications, notably macrovascular ones like coronary artery, cerebrovascular, and peripheral artery diseases, which contribute to over 50% of diabetes mortality. Atherosclerosis, linked to hyperglycemia-induced endothelial dysfunction, is pivotal in cardiovascular disease development. Cytokines, including pentraxin 3 (PTX3), copeptin, lipoprotein(a) [Lp(a)], and matrix metalloproteinase-9 (MMP-9), influence atherosclerosis progression and plaque vulnerability. Inhibiting atherosclerosis progression is crucial, especially in diabetic individuals. Glucagon-like peptide 1 receptor agonists (GLP-1 RAs), increasingly used for type 2 diabetes, show promise in reducing the cardiovascular risk, sparking interest in their effects on atherogenesis. This study sought to examine the effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on biomarkers that indicate the instability of atherosclerotic plaques. These biomarkers include pentraxin 3 (PTX3), copeptin (CPC), matrix metalloproteinase-9 (MMP-9), and lipoprotein(a) [Lp(a)]. Materials and Methods: A total of 34 participants, ranging in age from 41 to 81 years (with an average age of 61), who had been diagnosed with type 2 diabetes mellitus (with a median HbA1c level of 8.8%), dyslipidemia, and verified atherosclerosis using B-mode ultrasonography, were included in the study. All subjects were eligible to initiate treatment with a GLP-1 RA-dulaglutide. Results: Significant reductions in anthropometric parameters, blood pressure, fasting glucose levels, and HbA1c levels were observed posttreatment. Moreover, a notable decrease in biochemical markers associated with atherosclerotic plaque instability, particularly PTX3 and MMP-9 (p < 0.001), as well as Lp(a) (p < 0.05), was evident following the GLP-1 RA intervention. Conclusions: These findings underscore the potential of GLP-1 RAs in mitigating atherosclerosis progression and plaque vulnerability, thus enhancing cardiovascular outcomes in individuals with type 2 diabetes mellitus.

Diagnostic performance of quantitative ultrasonography for hepatic steatosis in a health screening program: a prospective single-center study.

This study compared the diagnostic performance of quantitative ultrasonography (QUS) with that of conventional ultrasonography (US) in assessing hepatic steatosis among individuals undergoing health screening using magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) as the reference standard. This single-center prospective study enrolled 427 participants who underwent abdominal MRI and US. Measurements included the attenuation coefficient in tissue attenuation imaging (TAI) and the scatter-distribution coefficient in tissue scatter-distribution imaging (TSI). The correlation between QUS and MRI-PDFF was evaluated. The diagnostic capabilities of QUS, conventional B-mode US, and their combined models for detecting hepatic fat content of ≥5% (MRI-PDFF ≥5%) and ≥10% (MRI-PDFF ≥10%) were compared by analyzing the areas under the receiver operating characteristic curves. Additionally, clinical risk factors influencing the diagnostic performance of QUS were identified using multivariate linear regression analyses. TAI and TSI were strongly correlated with MRI-PDFF (r=0.759 and r=0.802, respectively; both P&lt;0.001) and demonstrated good diagnostic performance in detecting and grading hepatic steatosis. The combination of QUS and B-mode US resulted in the highest areas under the ROC curve (AUCs) (0.947 and 0.975 for detecting hepatic fat content of ≥5% and ≥10%, respectively; both P&lt;0.05), compared to TAI, TSI, or B-mode US alone (AUCs: 0.887, 0.910, 0.878 for ≥5% and 0.951, 0.922, 0.875 for ≥10%, respectively). The independent determinants of QUS included skinliver capsule distance (β=7.134), hepatic fibrosis (β=4.808), alanine aminotransferase (β=0.202), triglyceride levels (β=0.027), and diabetes mellitus (β=3.710). QUS is a useful and effective screening tool for detecting and grading hepatic steatosis during health checkups.

Reliability of Measuring Geniohyoid Cross-Sectional Area with B-Mode Ultrasound.

B-mode ultrasound is a safe noninvasive procedure that has been used to characterize aspects of the oropharyngeal swallow. The submental suprahyoid muscles are often investigated with ultrasound because of their contributions to hyolaryngeal elevation. There are several techniques for positioning the ultrasound transducer in the coronal plane, however, there is limited research on how reliability of measurement of the cross-sectional area (CSA) of the geniohyoid differs across transducer placement technique. This study examined three methods of transducer placement in the coronal plane by two examiners to determine the reliability of measurement of CSA of the geniohyoid muscle. Forty healthy adults participated in the study. Each participant's geniohyoid muscles were imaged using B-mode ultrasound under three transducer placement conditions in the coronal plane by two examiners. Geniohyoid CSA was measured from each ultrasound image. A three-way mixed-methods ANOVA was used to determine whether there were significant differences in geniohyoid CSA among transducer position conditions, trials, and examiners. There were significant differences among the transducer placement conditions, indicating that each condition was measuring a different portion of the muscle. There were no significant differences among repeated trials nor between examiners within each method of transducer placement. All three conditions of transducer placement were reliable at measuring geniohyoid CSA across trials and examiners. This study emphasizes the need for consistency of placement, whichever method is selected. It also highlights the need for researchers to provide a precise description of methods for positioning the transducer so that placement is reproducible.

In Vivo Assessment of Abdominal Aortic Aneurysm Wall Strain Using 2D and 3D B-Mode Ultrasound and Dynamic CT Scan

In Vivo Assessment of Abdominal Aortic Aneurysm Wall Strain Using 2D and 3D B-Mode Ultrasound and Dynamic CT Scan

Three-dimensional automated breast ultrasound – a supplemental screening tool

Background. Three-dimensional automated breast ultrasound (ABUS) is an innovative technology that allows global visualization of the breast and eliminates the operator-dependence of hand held ultrasound. Three-projection scanning during ABUS is provided by an ultra-long (15.4 cm) probe with a frequency of 14–16 MHz, and then the slices are reconstructed on a workstation. At the same time, high-frequency converters create high-resolution images. Through a special coronal projection, ABUS identifies variants of minimal, non-palpable breast cancer, including those with women with high mammographic breast density, which makes it a promising additional (supplemental screening) method of oncomammoscreening.Aim. To assess the use of ABUS as a supplemental screening tool in women with high mammographic breast density.Materials and methods. The study was conducted in 2018 at the N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia. As part of the study, 192 women underwent mammography, ABUS, and multiparametric ultrasound (B-mode, color Doppler, elatography) in standard manual mode.Results. In the course of the study, in 192 patients, mammography revealed 42 cases of breast cancer, while using the AUS and manual ultrasound, additionally were identified 9 cases of breast cancer. Also, the ABUS showed high accuracy in assessment of the distribution of breast cancer – multifocal, multicentric and bilateral.Conclusion. ABUS is a promising and highly effective diagnostic method in women with high mammographic breast density, with its advantages and disadvantages, which can be used in combination with mammography as a supplemental screening tool, especially in women at high risk of developing breast cancer.

Exploring the Relationship Between Serum Phosphate Levels and Carotid Intima-Media Thickness in Chronic Kidney Disease Patients: A Correlational Analysis.

Background Compelling observational data suggestthat heightened levels of fasting blood phosphate are linked to a higher likelihood of cardiovascular disease, spanning across both the general populace and individuals grappling with chronic kidney disease (CKD). This study aimed to explore the possible correlation between carotid intima-media thickness (CIMT) and blood phosphate levels among those afflicted with chronic renal dysfunction. Objective The primary goal of this study is to determine the potential association between blood phosphate levels and CIMT in patients with CKD. Methodology In the department of nephrology, prospective research was conducted among patients who had a history of CKD. Atotal of 30 patients were included, with 20 males and 10 females. Every case had a thorough physical examination and history. Every patient underwent a laboratory evaluation, which included measurements of the CIMT and renal function testing. At a distance of 1 cm from the carotid bulb, the CIMTwas measured using B-mode ultrasonography. After compilation, the data were examined. Results The majority of the patients, according to this study, were male and over 50 years old. The Stage II patients in the study had a higher mean systolic blood pressure; however, the difference was not statistically significant. Patients with Stage V (D) disease exhibited higher diastolic blood pressure, but not statistically significant. An increase in the mean serum creatinine level that was statistically significant was linked to Stage V (D) renal disease. A higher mean blood urea was linked to Stage V (D) sickness; however, this relationship was not statistically significant. There was no statistical difference in the mean serum calcium levelsbetween the different stages of renal disease. Higher mean blood phosphate levels were linked to Stage III renal disease, but not in a statistically meaningful way. Although it was higher in Stage IV kidney disease, the mean CIMT was not statistically significant between the stages of renal illness. Conclusions Although a positive correlation was shown, a direct relationship between serum phosphate levels was not established by this investigation. The severity of renal disease has been demonstrated to correlate with elevated serum phosphate levels.

Ultrasound-based jawbone surface quality evaluation after alveolar ridge preservation.

Bone readiness for implant placement is typically evaluated by bone quality/density on 2-dimensional radiographs and cone beam computed tomography at an arbitrary time between 3 and 6months after tooth extraction and alveolar ridge preservation (ARP). The aim of this study is to investigate if high-frequency ultrasound (US) can classify bone readiness in humans, using micro-CT as a reference standard to obtain bone mineral density (BMD) and bone volume fraction (BVTV) of healed sockets receiving ARP in humans. A total of 27 bone cores were harvested during the implant surgery from 24 patients who received prior extraction with ARP. US images were taken immediately before the implant surgery at a site co-registered with the tissue biopsy collection location, made possible with a specially designed guide, and then classified into 3 tiers using B-mode image criteria (1) favorable, (2) questionable, and (3) unfavorable.Bone mineral density (hydroxyapatite) and BVTV were obtained from micro-CT as the gold standard. Hydroxyapatite and BVTV were evaluated within the projected US slice plane and thresholded to favorable (>2200mg/cm3; >0.45mm3/mm3), questionable (1500-2200mg/cm3; 0.4-0.45mm3/mm3), and unfavorable (<1500mg/cm3; <0.4mm3/mm3). The present US B-mode classification inversely scales with BMD. Regression analysis showed a significant relation between US classification and BMD as well as BVTV. T-test analysis demonstrated a significant correlation between US reader scores and the gold standard. When comparing Tier 1 with the combination of Tier 2 and 3, US achieved a significant group differentiation relative to mean BMD (p=0.004, true positive 66.7%, false positive 0%, true negative 100%, false negative 33.3%, specificity 100%, sensitivity 66.7%, receiver operating characteristics area under the curve 0.86). Similar results were found between US-derived tiers and BVTV. Preliminary data suggest US could classify jawbone surface quality that correlates with BMD/BVTV and serve as the basis for future development of US-based socket healing evaluation after ARP.

Determining the ideal measurement site and respiratory condition for liver transient elastography: toward clinical practice standardization

ObjectivesLiver transient elastography (TE) has been endorsed by the WHO as the first-line diagnostic tool for liver diseases. Although unreliable and invalid results caused by intercostal space (ICS)-associated factors (including excessive subcutaneous fat and a narrow ICS relative to the transducer size) and operator inexperience are not uncommon, no standard guidelines for ideal probe placement are currently available. Herein, we conducted a prospective observational study to identify an ideal measurement site and respiratory condition for TE by characterizing anatomical and biomechanical properties of the ICSs using ultrasound B-mode and elasticity imaging.MethodsIntercostal ultrasound was performed pointwise at four specific sites in 59 patients to simultaneously measure the width, stiffness, and skin‒liver capsule distance (SCD) of the ICSs over the liver, under end-inspiratory and end-expiratory conditions. Intersections between the 8th ICS and anterior axillary line, the 7th ICS and anterior axillary line, the 8th ICS and mid-axillary line, and the 7th ICS and mid-axillary line were defined as Sites 1 to 4, respectively.ResultsResults indicated that Sites 2 and 3 presented greater intercostal width; Sites 3 and 4 displayed lower intercostal stiffness; Sites 2 and 3 exhibited a shorter SCD. The ICSs were significantly wider and stiffer at end-inspiration. Additionally, the liver was more easily visualized at Sites 1 and 3.ConclusionWe recommend Site 3 for TE probe placement owing to its greater width, lower stiffness, and smaller abdominal wall thickness. Performing TE at end-inspiration is preferred to minimize transducer-rib interferences. This study paves the way toward a standardized TE examination procedure.Critical relevance statementA standardized measurement protocol for WHO-recommended liver TE was first established to improve the success and efficiency of the examination procedure.Key PointsWHO-recommended TE is unreliable or fails due to intercostal space-related factors.The 8th intercostal space on the mid-axillary line and end-inspiration are recommended.This standardized protocol aids in handling challenging cases and simplifies operational procedures.Graphical

Identification of constitutive materials of bi-layer soft tissues from multimodal indentations

The personalisation of finite element models is an important problem in the biomechanical fields where subject-specific analyses are fundamental, particularly in studying soft tissue mechanics. The personalisation includes the choice of the constitutive law of the model's material, as well as the choice of the material parameters. In vivo identification of the material properties of soft tissues is challenging considering the complex behaviour of soft tissues that are, among other things, non-linear hyperelastic and heterogeneous. Hybrid experimental-numerical methods combining in vivo indentations and inverse finite element analyses are common to identify these material parameters. Yet, the uniqueness and the uncertainty of the multi-material hyperelastic model have not been evaluated. This study presents a sensitivity analysis performed on synthetic indentation data to investigate the identification uncertainties of the material parameters in a bi-material thigh phantom. Synthetic numerical data, used to replace experimental measurements, considered several measurement modalities: indenter force and displacement, stereo-camera 3D digital image correlation of the indented surface, and ultrasound B-mode images. A finite element model of the indentation was designed with either Ogden-Moerman or Mooney-Rivlin constitutive laws for both materials. The parameters' identifiability (i.e. the possibility of converging to a unique parameter set within an acceptable margin of error) was assessed with various cost functions formulated using the different synthetic data sets. The results underline the need for multiple experimental modalities to reduce the uncertainty of the identified parameters. Additionally, the experimental error can impede the identification of a unique parameter set, and the cost function depends on the constitutive law. This study highlights the need for sensitivity analyses before the design of the experimental protocol. Such studies can also be used to define the acceptable range of errors in the experimental measurement. Eventually, the impact of the evaluated uncertainty of the identified parameters should be further investigated according to the purpose of the finite element modelling.

Evaluation of thyroid congestion in patients with heart failure using shear wave elastography: An observational study.

Shear wave elastography (SWE) is a noninvasive method for measuring organ stiffness. Liver stiffness measured using SWE reflects hepatic congestion in patients with heart failure (HF). However, little is known about the use of SWE to assess other organ congestions. This study aimed to evaluate the utility of SWE for assessing not only the liver but also thyroid congestion in patients with HF. This prospective study included 21 patients with HF who have normal thyroid lobes (age: 77.0 ± 11.0, men: 14). Thyroid and liver stiffness were measured by SWE using the ARIETTA 850 ultrasonography system (Fujifilm Ltd., Tokyo, Japan). SWE of the thyroid was performed on B-mode ultrasonography; a target region was identified within a region of interest. SWE was performed in each lobe of the thyroid gland. Five measurements were taken at the same location and the averages were recorded for comparison. We investigated the relationship between SWE for evaluating thyroid stiffness and the clinical characteristics of patients with HF. SWE of the thyroid was significantly correlated with SWE of the liver (R = 0.768, P < .001), thyroid stimulation hormone (R = 0.570, P = .011), free thyroxine (R = 0.493, P = .032), estimated right atrial pressure (RAP; R = 0.468, P = .033), and composite congestion score (R = 0.441, P = .045). SWE may be useful for evaluating thyroid stiffness and assessing the degree of thyroid congestion. Thyroid congestion may reflect the elevation of RAP and cause thyroid dysfunction through organ congestion.

Artificial intelligence-based, semi-automated segmentation for the extraction of ultrasound-derived radiomics features in breast cancer: a prospective multicenter study

PurposeTo investigate the feasibility of an artificial intelligence (AI)-based semi-automated segmentation for the extraction of ultrasound (US)-derived radiomics features in the characterization of focal breast lesions (FBLs).Material and methodsTwo expert radiologists classified according to US BI-RADS criteria 352 FBLs detected in 352 patients (237 at Center A and 115 at Center B). An AI-based semi-automated segmentation was used to build a machine learning (ML) model on the basis of B-mode US of 237 images (center A) and then validated on an external cohort of B-mode US images of 115 patients (Center B).ResultsA total of 202 of 352 (57.4%) FBLs were benign, and 150 of 352 (42.6%) were malignant. The AI-based semi-automated segmentation achieved a success rate of 95.7% for one reviewer and 96% for the other, without significant difference (p = 0.839). A total of 15 (4.3%) and 14 (4%) of 352 semi-automated segmentations were not accepted due to posterior acoustic shadowing at B-Mode US and 13 and 10 of them corresponded to malignant lesions, respectively. In the validation cohort, the characterization made by the expert radiologist yielded values of sensitivity, specificity, PPV and NPV of 0.933, 0.9, 0.857, 0.955, respectively. The ML model obtained values of sensitivity, specificity, PPV and NPV of 0.544, 0.6, 0.416, 0.628, respectively. The combined assessment of radiologists and ML model yielded values of sensitivity, specificity, PPV and NPV of 0.756, 0.928, 0.872, 0.855, respectively.ConclusionAI-based semi-automated segmentation is feasible, allowing an instantaneous and reproducible extraction of US-derived radiomics features of FBLs. The combination of radiomics and US BI-RADS classification led to a potential decrease of unnecessary biopsy but at the expense of a not negligible increase of potentially missed cancers.

Intramuscular fat infiltration influences mechanical properties during muscle contraction in older women.

Although evidence suggests that intramuscular fat infiltration may influence muscle strength, the precise mechanisms remain unclear. This study aimed to determine whether intramuscular fat infiltration affects muscle mechanical properties during contraction and whether these mechanical properties mediate the relationship between intramuscular fat infiltration and muscle strength. Seventy-nine healthy older women aged 75.1±6.8 years were included in this study. The echo intensity (EI) of the vastus lateralis (VL) was measured as an intramuscular fat infiltration index using B-mode ultrasonography. Maximum voluntary isometric contraction strength (MVIC) was assessed using a dynamometer. The VL shear elastic modulus (G), a mechanical property index, was measured using ultrasound shear wave elastography under various muscle contraction conditions, at rest and at 15%, 30%, and 45% MVIC (G0, G15, G30, and G45). To evaluate the degree of increase in the shear elastic modulus with increasing muscle contraction intensity, the slope of the regression line (Gslope) between muscle contraction and shear elastic modulus was calculated for each participant. The results showed that EI was significantly associated with G30 and G45 but not with G0 or G15. The EI can significantly explain the inter-individual differences in Gslope. Mediation analysis revealed that the effect of EI on MVIC through Gslope was significant (indirect effect = -0.31, 95% confidence interval (-0.57, -0.12)). These findings suggest that a greater EI is associated with a lower G during muscle contraction. Furthermore, our results show that the relationship between EI and MVIC is mediated by Gslope.

Abstract PO2-07-08: The efficacy of an MRI/US fusion technique for MRI-detected lesions previously undetected by conventional B-mode second-look US

Abstract Introduction Breast magnetic resonance imaging (MRI) is performed for preoperative screening of breast cancer and surveillance of BRCA gene carriers, and some lesions, called MRI-detected lesions, can only be detected by MRI. When MRI-detected lesions are found, second-look ultrasound (US) is recommended as the first choice for confirmation. However, the detection of MRI-detected lesions by conventional B-mode (cB-mode) second-look US varies from institution to institution, and it is often difficult to ensure objectivity and reproducibility. We use an MRI/US fusion technique called real-time virtual sonography (RVS) for the detection of MRI-detected lesions. RVS uses a magnetic position tracking system to display real-time US images on the same monitor as MRI images. Few reports on second-look US using RVS have examined its detection rate of MRI-detected lesions and the histopathological results of these lesions. In this study, we retrospectively reviewed MRI-detected lesions identified by second-look US using RVS but not by cB-mode second-look US from January 2018 to December 2022, with the goal of evaluating these lesions’ pathological characteristics. Materials and methods Consecutive patients who had one or more MRI-detected lesions not detected by cB-mode second-look US were enrolled in this study between January 2018 and December 2021. Second-look US using RVS was conducted after an additional supine MRI with a body surface coil was performed. Results A total of 36 patients with 38 lesions were included in this study. The mean age was 54 years old (range: 31–76). We were able to detect 31 (82%) of the 39 MRI-detected lesions by second-look US using RVS. These lesions were characterized as follows: mass, 14; non-mass-enhancement (NME), 13; and focal, 4. US-guided biopsy or excisional biopsy was performed on all lesions, and 11 (35%) of 31 lesions were malignant. We were able to detect 14 (74%) of the 19 mass lesions, and 3 were malignant (invasive ductal carcinoma (IDC) [luminal A type] in all 3 cases). We detected 13 (93%) of the 14 NME lesions, and 7 were malignant: 6 were ductal carcinoma in situ (DCIS) (high grade, 3; intermediate grade, 2; and low grade, 1), and 1 was IDC (luminal A type). Finally, we were able to detect 4 (80%) of the 5 focal lesions, 1 of which was malignant (DCIS [low grade]). Of 22 patients aged 55 years or younger, 3 had malignant lesions (IDC [luminal A type] in 2, DCIS [high grade] in 1). Of 15 patients aged 56 years or older, 8 had malignant lesions (DCIS in 7 [high grade, 2; intermediate grade, 2; low grade, 1] and IDC [luminal A type] in 1). Conclusions In this study, second-look US using RVS identified 82% of MRI-detected lesions that were not identified with cB-mode second-look US. Of these MRI-detected lesions, 35% were malignant. These results suggest that second-look US using RVS is useful for identifying MRI-detected lesions that are not detected by cB-mode second-look US. Citation Format: Masayuki Saito, Hirona Banno, Yukie Ito, Mirai Ido, Manami Goto, Takahito Ando, Yukako Mouri, Junko Kousaka, Kmihito Fujii, Tsuneo Imai, Shogo Nakano. The efficacy of an MRI/US fusion technique for MRI-detected lesions previously undetected by conventional B-mode second-look US [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-07-08.

Abstract PO3-07-02: Radiomics Models for B-mode Breast Ultrasound and Strain Elastography to improve Breast Cancer Diagnosis (INSPiRED 005): An International, Multicenter Analysis

Abstract Background: Breast Elastography, a technique that quantifies tissue stiffness, has been evaluated to objectify and improve the performance of B-mode breast ultrasound. However, large prospective trials showed benefits in BI-RADS 4a breast masses only and a high operator dependency. Modern Artificial Intelligence techniques for automated image processing like radiomics, a technique where quantified features are extracted from images, may overcome these limitations. We aimed to develop and validate radiomics models based on B-mode and Strain Elastography (SE) images for patients with BI-RADS 3 or 4 breast masses and compare their performance to the respective human experts. Methods: This is a secondary analysis of an international, multicenter trial (NCT02638935), evaluating the performance of SE in women with BI-RADS 3 or 4 breast masses. Women were recruited at 12 institutions in 7 countries and underwent B-mode breast ultrasound as well as SE. B-mode images were saved and re-assed by three ultrasound readers ( &amp;gt;10 years of experience), resulting in three independent assessments and a final consensus assessment. SE was interpreted using the E-/B ratio. B-mode and strain images were manually segmented and quantitative radiomics features were extracted using pyradiomics. We used 10-fold cross-validation to build machine learning models (XGBoostTree, MARS) based on data of 11 of 12 study sites. The data of the 12th (largest) study site was used as external validation set. Performance metrics included sensitivity, specificity and area under the receiver operator characteristic curve (AUROC). Results: The study included a total of 1288 patients, 1206 with evaluable B-mode images and 1190 with evaluable Strain images. Mean age was 46.6 years (SD 16.02) and a total number of 29.0% (350 of 1206) and 28.9% (344 of 1190) breast masses were malignant in the B-mode and Strain cohort, respectively. Distribution of BI-RADS categories was 33.0%, 34.5%, 14.5%, and 18.0% for BI-RADS 3, 4a, 4b, and 4c, respectively. In the external validation set (n = 342), the B-mode radiomics model (XGBoostTree) achieved an AUROC of 0.86 (95% CI 0.82 to 0.90), with a sensitivity of 97.4% (95% CI 0.93 to 1.00, 113 of 116) and a specificity of 27.0% (95% CI 0.21 to 0.33, 61 of 226). The model showed equivalent performance compared to the three ultrasound readers (P = 0.133); see also Table 1. In the external validation set (n = 333), the Strain radiomics model (MARS) achieved an AUROC of 0.84 (95% CI 0.79 to 0.88), with a sensitivity of 100% (95% CI 47.0 to 58.0, 115 of 115) and a specificity of 25.5% (95% CI 0.22 to 0.34, 60 of 218). The model showed equivalent performance compared to the three ultrasound readers (P = 0.696) and performed significantly better compared to SE (P = 0.002); see also Table 1. Sensitivity of the strain model was descriptively higher (100% vs. 97.4%, see Table 1). Both models were well-calibrated. Conclusion: This is the largest development and validation study for radiomics models based on B-mode breast ultrasound and SE, to date. The radiomics models performed on par with human readers, with the strain radiomics model showing potential to identify initially missed carcinomas in BI-RADS 3 breast masses. Future implementation studies may evaluate the performance of these image analysis algorithms in clinical routine and their integration into the multi-modal breast cancer diagnostics process, including mammography and MRI. Table 1. Diagnostic performance metrics Citation Format: André Pfob, Tanja He, Lie Cai, Richard G. Barr, Volker Duda, Zaher Alwafai, Corinne Balleyguier, Dirk-André Clevert, Sarah Fastner, Christina Gomez, Manuela Goncalo, Ines Gruber, Markus Hahn, André Hennigs, Panagiotis Kapetas, Sheng-Chieh Lu, Juliane Nees, Ralf Ohlinger, Fabian Riedel, Matthieu Rutten, Benedikt Schaefgen, Anne Stieber, Riku Togawa, Mitsuhiro Tozaki, Sebastian Wojcinski, Cai Xu, Geraldine Rauch, Jörg Heil, Chris Sidey-Gibbons, Michael Golatta. Radiomics Models for B-mode Breast Ultrasound and Strain Elastography to improve Breast Cancer Diagnosis (INSPiRED 005): An International, Multicenter Analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-07-02.

Utility of Shear Wave Elastography for the Diagnosis of Plantar Fasciitis: Comparison Between Symptomatic and Asymptomatic Sides in Unilaterally Affected Patients.

Plantar fasciitis (PF) can cause pain in the heel, which can affect everyday activities. While it often resolves on its own, diagnosing PF to rule out other hind foot conditions by imaging modality in cases of recurrence can be difficult. Methods such as MRI and ultrasonography are helpful, but the use of elastography, specifically shear wave elastography (SWE), as a tool for diagnosing PF is being studied. This comparative observational studyincluded patients over 18 years presenting with unilateral hind foot pain who were investigated using SWE. Exclusions comprised those who were bilaterally affected and with foot deformities, trauma history, or prior injection therapy. Patients' AOFAS Ankle-Hindfoot Scores were assessed along with visual analog scale (VAS) scores, followed by SWE examination of both heels. The study found no significant difference in the plantar fascia thickness between affected and unaffected sides, with a mean thicknessof 4.3±0.8mm and 5.1±0.6mm, respectively. Shear wave velocity (SWV) was lower on the affected side, indicating reduced stiffness compared to the unaffected side. The Spearman rank test revealed strong direct correlations between SWV and both the VASand HF-AOFAS scores on the affected side. The study observed that SWEenhances B-mode ultrasonography in detecting early PFeven with normal plantar fascia thickness, offering a user-independent and reliable tool for treatment monitoring and correlation with functional and pain scores. Further research with larger populations can aid in developing a clinico-radiological classification system for PF, improving prognostication and treatment guidance.

Segmentation of bone surface from ultrasound using a lightweight network UBS-Net

Objective. Ultrasound-assisted orthopaedic navigation held promise due to its non-ionizing feature, portability, low cost, and real-time performance. To facilitate the applications, it was critical to have accurate and real-time bone surface segmentation. Nevertheless, the imaging artifacts and low signal-to-noise ratios in the tomographical B-mode ultrasound (B-US) images created substantial challenges in bone surface detection. In this study, we presented an end-to-end lightweight US bone segmentation network (UBS-Net) for bone surface detection. Approach. We presented an end-to-end lightweight UBS-Net for bone surface detection, using the U-Net structure as the base framework and a level set loss function for improved sensitivity to bone surface detectability. A dual attention (DA) mechanism was introduced at the end of the encoder, which considered both position and channel information to obtain the correlation between the position and channel dimensions of the feature map, where axial attention (AA) replaced the traditional self-attention (SA) mechanism in the position attention module for better computational efficiency. The position attention and channel attention (CA) were combined with a two-class fusion module for the DA map. The decoding module finally completed the bone surface detection. Main Results. As a result, a frame rate of 21 frames per second (fps) in detection were achieved. It outperformed the state-of-the-art method with higher segmentation accuracy (Dice similarity coefficient: 88.76% versus 87.22%) when applied the retrospective ultrasound (US) data from 11 volunteers. Significance. The proposed UBS-Net for bone surface detection in ultrasound achieved outstanding accuracy and real-time performance. The new method out-performed the state-of-the-art methods. It had potential in US-guided orthopaedic surgery applications.

Predictability of Cardiovascular Risk Scores for Carotid Atherosclerosis in Community-Dwelling Middle-Aged and Elderly Adults.

Background: The assessment of future risk of cardiovascular diseases (CVD) is strongly recommended for all asymptomatic adults without CVD history. Carotid atherosclerosis (CA) is a preclinical phenotype of CVDs. However, data on estimated future CVD risks with respect to preclinical atherosclerosis are limited. This community-based study aimed to assess the relationships between predicted CVD risks and CA. Methods: We enrolled 3908 subjects aged 40-74 years without CVD history and calculated their 10-year CVD risks using the Framingham Risk Score (FRS) and the Pooled Cohort Equations (PCE). Carotid plaque (CP) at the extracranial carotid arteries was determined by high-resolution B-mode ultrasonography and further classified into mild or advanced CA. Results: The means of FRS for CP-negative and mild and advanced CA were 9.0%, 14.4%, and 22.1%, respectively (p-value < 0.0001). The corresponding values for PCE score were 4.8%, 8.8%, and 15.0%, respectively (p-value < 0.0001). The odds ratios (ORs) of having CP per 5.0% increase in FRS and PCE score were 1.23 (95% CI, 1.19-1.28) and 1.36 (95% CI, 1.28-1.44), respectively. The corresponding values of having advanced CA were 1.24 (95% CI, 1.19-1.29) and 1.38 (95% CI, 1.30-1.48), respectively. Among the models of FRS or PCE plus other conventional CVD risk factors, the FRS + age model had the highest discrimination for the presence of CP (AUROC, 0.7533; 95% CI, 0.7375-0.7691) as well as for the presence of advanced CA (AUROC, 0.8034; 95% CI, 0.7835-0.8232). The calibration of the FRS + age models for the presences of CP and advanced CA was excellent (χ2 = 8.45 [p = 0.49] and 10.49 [p = 0.31], respectively). Conclusions: Estimated future CVD risks were significantly correlated with risks of having CA. Both FRS and PCE had good discrimination for the presences of CP and advanced CA.

Obesity-related reduced spirometry and altered breathing pattern are associated with mechanical disadvantage of the diaphragm

The aim of this study was to characterize the breathing patterns of individuals with obesity during routine activities such as sitting and standing, and to identify potential contributors to alterations in these patterns. Measurements performed in 20 male subjects with obesity (BMI, 31.8±1.5 kg/m2) and 20 controls (BMI, 23.5±1.4 kg/m2) included anthropometric parameters, breathing-patterns in sitting and standing positions, spirometry, maximal respiratory pressures, and diaphragm B-mode ultrasonography. Individuals with obesity exhibited lower tidal volume and increased respiratory rate to maintain a similar minute-ventilation (p<0.05). Subjects with obesity demonstrated impaired spirometry and respiratory muscle strength, with inspiratory functions being notably compromised (p<0.05). Individuals with obesity had a greater diaphragm thickness at end inspiration but lower thickening-fraction at end quiet and forced breathings and reduced diaphragmatic displacement and excursion during maximal breaths (p<0.05). BMI was negatively associated with all respiratory function markers (p<0.05). Individuals with obesity exhibit a higher respiratory rate but lower tidal volume, likely to accommodate decreased compliance and excess thoracic and abdominal fat, further hindering inspiratory function. Moreover, increased adiposity is associated with a thicker but weaker diaphragm, primarily due to the diaphragm's mechanical disadvantage rather than its intrinsic inability to generate force.

Role of Sonoelastography in Differentiating Benign and Malignant Breast Lesions: A Prospective Study Comparing Elasticity Contrast Index and Tsukuba Score

Introduction: Breast cancer is the most common cancer occurring in women globally which is potentially curable if detected early. Ultrasound elastography is a dynamic technique that estimates tissue stiffness to differentiate between benign and malignant masses. Our study aimed to determine and compare the diagnostic accuracy of B mode Sonography, Elasticity contrast index, and Tsukuba score in differentiating malignant and benign breast masses. Methods: This was a prospective cross-sectional study done including 110 lesions in 102 patients in the age group of 15-73 years. The solid breast lesions seen on sonography were categorized according to the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) and further evaluated with elastography using both Elasticity Contrast Index (ECI) and Tsukuba score with pathological diagnosis taken as the gold standard. The cut-off value of ECI was obtained. The diagnostic accuracy of B-mode sonography, ECI, and Tsukuba score was compared. Results: We found that B-mode sonography had a sensitivity of 85.7%, specificity of 100%, and accuracy of 96.9 %. The accuracy of Tsukuba scores for differentiating benign and malignant lesions was 81.2%. The cut-off value of ECI obtained was 2.8 and the accuracy was 81.8%. A statistically significant correlation (p &lt; 0.05) existed between sonographic diagnosis, ECI, and Tsukuba score. Conclusions: B mode sonography had the highest diagnostic accuracy while ECI and Tsukuba scores were comparable. ECI can be used for breast masses using a cut-off of 2.8 to differentiate benign from malignant.

Comparison of transient elastography and shear wave elastography in patients with MAFLD: A single-center experience.

Metabolic-associated fatty liver disease and liver fibrosis are intimately linked to insulin resistance, type 2 diabetes, obesity, and metabolic syndrome. Transient elastography (TE) and point shear wave elastography (pSWE) were used to measure liver stiffness in patients who met the ultrasound criteria for steatotic liver diseases (SLD). This study compared two methods for estimating liver stiffness in patients with SLD, which in turn correlated with liver fibrosis. Ultrasound B-mode imaging was used to identify SLD. In total, 250 MAFLD patients were recruited. Patient characteristics, laboratory investigations, and liver stiffness measurements using TE and pSWE were assessed on the same day. In the study, 56.0% of the patients were male, with a mean age of 41.5 ± 10.7 years. The correlation between TE and pSWE was significant (Spearman's r = 0.867*, p < 0.001). The Bland-Altman Plot analysis confirmed this, with 97.5% of variations in LSM falling within 95% agreement ranges. Cohen's κ was used to assess the agreement between TE and pSWE fibrosis stages, showing almost perfect agreement (83.5% kappa agreement) and a strong association between pSWE and TE in the assessment fibrosis stages. In patients with MAFLD, TE, and SWE are reliable methods for measuring liver stiffness and can be used as non-invasive screening tools for the assessment of fibrosis in SLD.