B-mode Ultrasound Scanning Research Articles

Ocular biometry in Gaddi breed goats of Himachal Pradesh

The echo-biometrical evaluation of normal eye was done in 20 Gaddi goats with the help of ultrasonography at Gaddi goat unit, CSK Himachal Pradesh Krishi Vishvavidyalaya, Palampur. Trans-corneal and trans-palpebral ultrasound scanning of the normal eye was done in standing position without any sedation or regional nerve block. Xylocaine ointment (5%) was used to desensitize the cornea and 2% lignocaine jelly was applied directly on the cornea to serve as a conductive medium for ultrasound waves in trans-corneal technique. B-mode ultrasound scan of the eyes was done in both the transverse and sagittal planes. Corneal thickness varied from 0.03 to 0.07 cm, aqueous chamber depth from 0.12 to 0.31 cm, lens thickness from 0.78 to 0.96 cm, lens diameter from 0.92 to 1.36 cm, vitreous chamber depth from 0.90 to 1.08 cm, eyeball diameter from 1.90 to 2.66 cm and eyeball length from 1.90 to 2.12 cm. There was no statistically significant difference between the echo-biometric parameters of the left and right eye in the present study.

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

Human Observer Sensitivity to Temporal Noise During B-Mode Ultrasound Scanning: Characterization and Imaging Implications.

This work measures temporal signal-to-noise ratio (SNR) thresholds that indicate when random noise during ultrasound scanning becomes imperceptible to expert human observers. Visible noise compromises image quality and can potentially lead to non-diagnostic scans. Noise can arise from both stable acoustic sources (clutter) or randomly varying electronic sources (temporal noise). Extensive engineering effort has focused on decreasing noise in both of these categories. In this work, an observer study with five practicing sonographers was performed to assess sonographer sensitivity to temporal noise in ultrasound cine clips. Understanding the conditions where temporal noise is no longer visible during ultrasound imaging can inform engineering efforts seeking to minimize the impact this noise has on image quality. The sonographers were presented with paired temporal noise-free and noise-added simulated speckle cine clips and asked to select the noise-added clips. The degree of motion in the imaging target was found to have a significant effect on the SNR levels where noise was perceived, while changing imaging frequency had little impact. At realistic in vivo motion levels, temporal noise was not perceived in cine clips at and above 28 dB SNR. In a case study presented here, the potential of adaptive intensity adjustment based on this noise perception threshold is validated in a fetal imaging scenario. This study demonstrates how noise perception thresholds can be applied to help design or tune ultrasound systems for different imaging tasks and noise conditions.

Correlation Between Common Carotid Artery Intima-Media Thickness and Lumbosacral Intervertebral Disc Degeneration

Background: Lumbosacral intervertebral disc degeneration (IDD) is a common cause of low back pain and has recently been attributed to ischemic causes. Magnetic resonance imaging (MRI) can accurately assess the presence and degree of IDD, while the common carotid artery (CCA) intima-media thickness (IMT) measured on ultrasound (US) has been accepted as a reliable imaging marker for the presence of atherosclerosis. Aim of the Study: To assess the association between CCA-IMT with the presence and grade of lumbosacral IVD as evident on MRI in patients with LBP. Patient and Methods: This cross-sectional study was done on 200 patients with LBP (115 females and 85 males) referred for lumbosacral spinal MRI at the MRI unit in AL-Sader Medical City for eight months duration. MRI examination involved L1/L2 ,L2/L3,L3/4 ,L4/L5 \& L5/S1 intervertebral discs levels. Patients with a history of lumbosacral surgery, trauma, or tumor were excluded. CCA-IMT was measured using a B-mode US scan, while the degree of IDD was assessed on MRI using I-V Pfirrmann's grading system. Results: Older age, male gender, higher body mass index, presence of cardiovascular comorbidities, and specific occupations were associated with a higher grade of IDD. However, the mean CCA-IMT was independently associated with the advancing grade of IDD at all levels with a statistically significant difference (P<0.001). A significantly larger mean CCA-IMT was found in relation to grade V (0.946 ±0.28), and the lowest mean was found in those with grade I (0.468 ±0.1). The grading of IDD was fair in the prediction of thicker CCA-IMT. Conclusion: IDD was directly correlated with CCA-IMT, and patients with higher grades of IDC tend to have thicker mean CCA-IMT. IDD may be a manifestation or predictor of atherosclerosis. However, future long-term cohort studies to assess causal association are recommended.

(156) Morphometrix Tissue Segmentation Technology as a Diagnostic Aid in the Evaluation of Vasculogenic Causes of Erectile Dysfunction

Abstract Introduction Morphometrix Imaging Technologies Inc. (MPX) Tissue Segmentation Technology (TST) isolates and processes the component of ultrasound reflective signals associated with coherent specular reflection at the liquid spaces in living tissue. The software identifies and quantifies the hypoechoic structures in B-Mode Ultrasound Scans produced by these reflections and thereby profiles liquid spaces in the tissue created by blood and lymphatic vessels as a proxy for vascular intensity. It then derives tissue segment counts (TSC) as a final quantification step. Unlike SHIM Scores, TST provides a quantitative assessment of the vascular health of the erectile tissue. Objective The goal of the study was to determine whether TSC can predict a response to regenerative treatments for ED. We retrospectively studied the efficacy of MPX TST in assessing the vascularity of the corpus cavernosa (CC) and compared the findings to SHIM scores before and after Shockwave therapy (SWT). MPX can assess penile vascularity in the flaccid state using TSC and can calculate cross-sectional area and volume. Methods Retrospective study of 57 men, average age 54.9 with ED. B-mode Ultrasound video scans were performed on the penis in the flaccid state before and after treatment completion and processed through MPX to obtain the TSC which were compared to IIEF-5 SHIM scores. A typical treatment involved multiple sessions of SWT and PRP penile injection. Subjects were divided into three groups based on response to treatment and correlation with SHIM Scores: Group 1 – Good Responders & Good Correlation with SHIMs, Group 2 – Poor & Non-Responders & Good Correlation with SHIMs, Group 3 – Good & Poor Responders & Non-Correlation with SHIMs. Results Overall we had an 80.7% correlation between TSC and the SHIM Score results. The average SHIM score increased to 15.9 from 10.6, (p<0.006). The average TSC in the left CC increased to 25 from 17.3, (p<0.002). The average TSC in the right CC increased to 24.7 from 17.9, (p<0.002). 54.9% (34 patients) were good responders and the SHIM scores correlated well with TSC. The average SHIM score increased to 17.5 from 10.8, (p<0.001). The average TSC in the left CC increased to 28.1 from 15.3, (p<0.001). The average TSC in the right CC increased to 31.2 from 17.1, (p<0.003). 21.1% (12 patients) were poor responders and the SHIM scores correlated well with TSC. The average SHIM score increased 10.3 from 9.4, (p<0.554). The average TSC in the left CC declined to 13.5 from 15.5, (p<0.559). The average TSC in the right CC declined slightly to 14.9 from 12.5, (p<0.268). 19.3% (11 patients) were a mixture of good and poor responders and the SHIM scores did not correlate well with TSC. The average SHIM score increased to 15.1 from 11.3, (p<0.103). The average TSC in the left CC declined to 25.5 from 26.8, (p<0.919). The average TSC in the right CC declined to 25.5 from 25.7, (p<0.975). Conclusions MPX tissue segmentation software can provide quantitative information about the vascularity of the corpus cavernosa and can differentiate responders to treatment from non-responders. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Morphometrix.

(126) Application of HIFEM Therapy Improves Orgasmic, Urinary and Erectile Function by Stimulation of Pelvic Floor Muscles

Abstract Introduction The weak pelvic floor in men contributes to various urological disorders. Treatment can be accomplished by strengthening the pelvic floor muscles (PFM) through pelvic floor muscle training. Nevertheless, such development of PFM is time-consuming and heavily dependent on the subject's ability to perform selective muscle contractions. An advantageous approach is the targeted stimulation of PFM which can be accomplished via electromagnetic stimulation. Particularly, the pelvic floor muscles can be non-invasively and selectively stimulated via the HIFEM field. This results in the natural development and rehabilitation of PFM, which, among other functions, plays a vital role in facilitating orgasmic, urinary and erectile function. Objective The aim of this study is to assess the safety and efficacy of the HIFEM pelvic procedure for the treatment of erectile dysfunction. Methods In this study, 28 males with a median age of 56 (30-72 years) were enrolled. The treatment was composed of ten weekly 28-minute sessions. Outcome measurements were collected via questionnaires and ultrasound imaging prior to and after the last treatment. To assess changes in erectile and sexual function, and prostate-related symptoms, the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) were used. Transverse B-Mode ultrasound video scans were recorded along the long axis of the penile shaft from the tip to the base with the penis in a flaccid state. A linear transducer was used, the depth was set at 2 cm, and the frame rate was approximately 30 frames per second. Separate video recordings of the left and right cavernosum were taken. The ultrasound scans were processed by the Morphometrix cloud-based algorithm. Adverse events were monitored during the study. Results All evaluation methods proved the efficiency of treatment on a statistically significant level. A significant improvement was detected in the majority (4 of 5) of the domains of IIEF, with the overall score improvement from a baseline value of 45.14±2.42 to 48.75±2.86 (+3.61 points). The most exceptional improvement was found in Sexual desire (+18.78%; p=1.06x10-3), Erectile dysfunction (+13.03%; p=5.7x10-4), and Orgasmic function (+10.69%; p=7.04x10-5) domains. The mean difference in the total score of the IPSS questionnaire reached -3.04 points (p=5.1x10-6), exceeding the corresponding minimal clinical difference (MIC=3 points). Overall, subjects, on average, shifted from moderately symptomatic (9.57±1.37 points) to mildly symptomatic (6.54±0.91 points). An increase in vascularity of both cavernosal was measured within 57% of patients who underwent ultrasound examination; specifically, a significant improvement was recorded in tissue segment count (TSC; +104%; p=1.17x10-4) and density (TSD; +81% p=2.20x10-3), pointing to better blood flow and delivery in examined tissues. No adverse event was observed. Conclusions The therapy administering HIFEM technology of the pelvic floor for selective PFM stimulation demonstrated significant improvement of erectile and orgasmic function and urinary symptoms. The questionnaire results corresponded with ultrasound measurements using a novel algorithm, identifying positive changes in the penile vascular system. Overall, the treatment may be considered a safe and a possible first-line solution for male patients suffering from dysfunctions linked to weakened pelvic floor muscles. Further investigation is needed. Disclosure Yes, this is sponsored by industry/sponsor: BTL. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: AFFIRM Science.

Optical coherence tomography-angiography for anterior uveal tract evaluation in normal subjects and in pathology

Purpose: to assess the potentials of optical coherence tomography-angiography (OCTA) in the evaluation of anterior segment (AS) uveal vessels in normal and pathological conditions.Material and methods. 20 healthy volunteers (40 eyes) with no ophthalmic pathology (the control group) and 85 previously untreated patients (85 eyes) with suspected tumors of the irido-ciliary area (the iris, the ciliary body and the peripheral sections of the choroid) were examined. All participants had optical coherence tomography (OCT) and OCTA of AS, with the qualitative assessment of scans (vessels pattern, lumen, tortuosity) and the quantitative assessment (vessel density index, VD%, for the affected zone). In ciliary body or choroid pathologies, VD index was measured for the conjunctiva in the focus projection. VD index included mean and local VD, as well as VD of perifocal tissues. In addition, B-mode ultrasound scanning and ultrasound biomicroscopy were performed.Results. OCTA scans in 4 sectors of the normal iris showed a predominantly radial pattern of conjunctival vessels positioning, with their lumen remaining the same along their entire visible length. The lowest VD value (38.5%) was registered in the temporal iris segment, while the highest (43.9%) was revealed in the inferior quadrant. In the iris tumors area, intrinsic vascularity molded in various vascular patterns was observed. Melanomas could be suspected because of the vessels oriented along the axis of the tumor and by non-uniform lumen of the vessels.Conclusion. AS-OCTA is an informative method for the visualization of iris vessels in normal conditions and in iris pathology and may be considered a valuable addition to the standard visualization techniques.

Correlation of Carotid Intima-Media Thickness with One-hour Postload Plasma Glucose (1h-PPG) in Overweight and Obese North Indian Adults

Background: Cardiovascular morbidities like arterial stiffness and atherosclerosis have a negative association with insulin resistance, which can be identified by carotid intima media thickness (CIMT) measurement. One-hour postload plasma glucose (1 h-PPG) is a novel marker for early identification of insulin resistance, but very few studies are available on its relationship with CIMT. Objective: To identify the correlation of CIMT with 1 h-PPG in overweight and obese adults without diabetes. Methods: Individuals not having known diabetes or other chronic illnesses were identified and subjected to the initial anthropometric analysis for body mass index (BMI) calculation. A standard oral glucose tolerance test was performed on individuals with a BMI of ≥25 kg/m2 for 1 h-PPG values, and a B-mode ultrasound scan of the neck was used for CIMT measurement. A Pearson’s correlation statistical test was applied for correlation identification. Results: A total of 94 nondiabetic individuals participated, of whom 55 (58.5%) were women. Mean age, BMI, and CIMT values of the study population were 38.8 (±8.09) years, 29.6 (±3.22) kg/m2, and 0.72 (±0.10) mm, respectively. Average 1 h-PPG levels were 150.7 (±21.11) mg/dl, and the Pearson’s coefficient ( r) value with CIMT was 0.5792 ( P < 0.05). Further, correlation analysis demonstrated an r-value of −0.0029 for BMI, −0.1293 for waist-hip ratio, −0.0047 for waist-height ratio, 0.3862 for glycated hemoglobin (HbA1c), and −0.2930 for 2 h-PPG. Conclusion: In euglycemic adults, the early insulin resistance defining parameter, i.e., 1 h-PPG levels had a consistent positive correlation with CIMT, which is a marker of the initial stages of atherosclerosis.

Analysis of Using Multi-Angle Conventional Ultrasound Scanning for Efficient 3-D Object Imaging

The purpose of this work is to examine the possibility of using multi-angle conventional ultrasound B-mode scanning in efficient 3-D imaging. In the paper, the volume of an object is reconstructed from vertical projections registered at fixed angular positions of the multi-element linear ultrasonic probe rotated in relation to the object submerged in water. The possible configurations are: vertical lateral, vertical top or vertical bottom. In the vertical lateral configuration, the ultrasonic probe acquires 2-D images of object’s vertical cross-sections, turning around its lateral surface. In the vertical top or bottom configuration, the ultrasonic probe acquires 2-D images of the object’s vertical cross-sections, turning on the horizontal plane over the top or under the bottom surface of the object. The method of recording 3-D volume of an object’s structure and reconstruction algorithm have been designed. Studies show the method in the vertical top or bottom configuration could be successfully applied to the effective 3-D visualisation of the structure of the female breast in vivo as the new complement ultrasonic imaging modality in the prototype of the developed ultrasound tomography scanner.

Abstract 10045: Higher Renal Vascular Resistance is Associated With Greater Body Mass Index in Children

Background: Obesity is associated with increased risk for cardiovascular and renal diseases, however, there has been little focus on renal vascular function. The purpose of this study is to assess renal vascular flow regulation and investigate their relation to cardiovascular risk factors in obese children. Methods: Noninvasive ultrasonographic measurements were made in 108 overweight/obese children aged 7 to 13 years (body mass index 18 to 33kg/m 2 ). Using color Doppler sonography, peak systolic (PSV), end-diastolic (EDV), and average peak flow (APV) velocities of renal artery were measured. Pulsatility index as a parameter of vascular resistance was calculated. Pulsatility index was defined as (PSV-EDV)/APV. Quantitative B-mode ultrasound scans were used to measure intima-media thickness and diameters of the common carotid artery. Plasma lipid concentrations, uric acid, homeostasis model assessment of insulin resistance, and high sensitivity C-reactive protein were assessed in the obese children. Results: Compared with overweight children with body mass index <25 kg/m 2 , pulsatility index in obese children with body mass index≥25 kg/m 2 was significantly higher (1.24 ±0.13 vs. 1.13 ±0.14 cm/sec, p < 0.01), because APV and EDV were significantly lower (35 ±3 vs. 38 ±7 cm/sec and 21± 3 vs. 25 ±5 cm/sec, p <0.05, respectively), although PSV was not significantly different. Pulsatility index correlated significantly with body mass index (r =0.58, p < 0.01), insulin (r = 0.24, p < 0.05), homeostasis model assessment of insulin resistance (r =0.25, p < 0.01), triglycerides (r = 0.26, p < 0.01), uric acid (r = 0.22, p < 0.05), systolic blood pressure (r = 0.31, p < 0.01), and carotid intima-media thickness (r = 0.36, p<0.01). Renal blood flow velocities did not correlate with high sensitivity C-reactive protein. Conclusions: The present study indicates that obesity can adversely affect renal vascular flow and resistance in children. Obesity-related insulin resistance may be a main risk factor for renal vascular flow changes. Obesity not only is a risk factor for later cardiovascular disease, but also is associated with significant impairment of renal arterial flow dynamics.

Evolocumab treatment reduces carotid intima-media thickness in paediatric patients with heterozygous familial hypercholesterolaemia

Abstract Background Familial hypercholesterolemia (FH) is characterised by high plasma levels of low-density lipoprotein cholesterol (LDL-C) and increased risk of premature atherosclerotic cardiovascular disease (ASCVD). Previous studies show that carotid intima-media thickness (cIMT) is increased in children with FH, an indicator of early ASCVD. Add-on treatment with the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, evolocumab, substantially reduced atherosclerotic lipid levels in children with heterozygous FH (HeFH) and was safe and well tolerated. The effect of evolocumab on cIMT in paediatric patients (pts) has not been investigated. Purpose To investigate the effect of evolocumab treatment on cIMT progression in paediatric pts with HeFH. Methods HAUSER-RCT was a multicenter, randomised, placebo-controlled study in which paediatric FH pts (ages 10–17 years) received monthly subcutaneous injections of evolocumab 420 mg or placebo. Of 157 pts, 150 continued to an open-label extension study (HAUSER-OLE) during which all received up to 80 weeks of monthly evolocumab 420 mg on top of stable background statin therapy. cIMT was measured by B-mode ultrasound scanning at baseline, week 24 of the RCT, and weeks 24, 48, and 80 of the OLE. cIMT was measured on anterior, lateral, and posterior imaging angles of the right and left common carotid artery. Mean thickness at each visit and mean changes from baseline were summarised by treatment received during the RCT and artery location. In addition, the largest measurements (anterior, lateral, or posterior) from a patient's left and right carotid artery were averaged to calculate a summary score. Results Mean baseline cIMT summary score was 0.568 mm (SD=0.06) for 46 placebo pts and 0.586 mm (SD=0.06) for 82 evolocumab pts. During the RCT, 37 placebo pts had a mean increase of 0.006 mm (SD=0.05) from baseline to week 24; in contrast, 76 evolocumab pts had a mean decrease of 0.003 mm (SD=0.05). Although this treatment group difference was not statistically significant (P=0.403), the pattern of increased cIMT for placebo and decreased cIMT for evolocumab was consistent across artery locations (Table). During the OLE, for pts who initially received placebo, mean cIMT summary score decreased by 0.019 mm (SD=0.04, n=34) from baseline to week 80 (P=0.007) (Figure). Pts who received evolocumab in both the RCT and OLE showed continued improvement during the OLE; at week 80, mean cIMT summary score decreased by 0.012 mm (SD=0.05, n=59) from baseline (P=0.067). For all pts at week 80 (n=128), the mean decrease in LDL-C from baseline was 35.3% (SD=28.0). Conclusions Open-label evolocumab treatment for up to 80 weeks led to reductions in mean cIMT. In this small sample of pts with FH, the data suggest that the addition of PCSK9 inhibition to background lipid-lowering therapy has the potential to reduce the risk of ASCVD progression and future cardiovascular events in this vulnerable paediatric population. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Amgen, Inc.

CONTRIBUTION OF MODE B ULTRASOUND IN THE MANAGEMENT OF CATARACTS IN BAMAKO

Introduction: Cataract is a frequent ocular pathology in the world. The aim of our work was to study the contribution of mode B ultrasound in the diagnostic and therapeutic management of cataracts in the radiology department of the medical clinic Marie Curie in Bamako. Material and Methods: This was a prospective, descriptive study carried out in the medical imaging department over a period of 2 years. Ocular examinations were performed exclusively with a B-mode ultrasound scanner by senior radiologists. All patients who performed an ocular ultrasound for the notion of cataract were included in the study. Socio-epidemiological data, clinical information and ultrasoundresultswereanalyzed. Results: We identified 75 cases of ocular ultrasound for cataract, i.e. 73.52% of the total ocular ultrasound performed (102 cases). The median age was 49.25 years with a male predominance in 68% of cases.The state of the posterior segment and the preoperative assessment for cataract represented the most frequent indication, respectively 40% and 29.33%. Ultrasound was pathological in 68% of cases. The most common pathology was clouding of the lens (cataract) in (36% of cases). The other pathologies found on ultrasoundwereretinaldetachment (17.33%) and intraocularhemorrhage (12%) and lens dislocation (2.67%). Conclusion: Ocular ultrasound is accessible in Bamako has allowed the study of the posterior segment of the eye in the diagnostic and therapeutic management of cataracts.

Multimodal system for optical biopsy of melanoma with integrated ultrasound, optical coherence tomography and Raman spectroscopy.

We introduce a new single-head multimodal optical system that integrates optical coherence tomography (OCT), 18 MHz ultrasound (US) tomography and Raman spectroscopy (RS), allowing for fast (<2 min) and noninvasive skin cancer diagnostics and lesion depth measurement. The OCT can deliver structural and depth information of smaller skin lesions (<1 mm), while the US allows to measure the penetration depth of thicker lesions (≥4 mm), and the RS analyzes the chemical composition from a small chosen spot (≤300 μm) that can be used to distinguish between benign and malignant melanoma. The RS and OCT utilize the same scanning and optical setup, allowing for co-localized measurements. The US on the other side is integrated with an acoustical reflector, which enables B-mode measurements on the same position as OCT and RS. The US B-mode scans can be translated across the sample by laterally moving the US transducer, which is made possible by the developed adapter with a flexible membrane. We present the results on custom-made liquid and agar phantoms that show the resolution and depth capabilities of the setup, as well as preliminary ex vivo measurements on mouse models with ∼4.3 mm thick melanoma.

Ultrasound Measurements of Rectus Femoris and Locomotor Outcomes in Patients with Spinal Cord Injury.

Patients with incomplete spinal cord injury have decreased mobility, and many do not recover walking ability. The purpose of this study was to investigate rectus femoris muscle thickness and echo intensity on ultrasound and functional outcomes in these patients. This was a prospective cohort study in an inpatient rehabilitation center, which recruited 40 consecutive patients with incomplete spinal cord injury. The patients underwent an ultrasound assessment at 6 weeks post-injury. Ultrasound measurements were performed using B-mode ultrasound scanning and standardized protocols. Functional outcomes on discharge, including Lower Extremity Muscle Score (LEMS), Functional Independence Measure (FIM), and Walking Index for Spinal Cord Injury II (WISCI II), were measured. Rectus femoris muscle thickness was significantly correlated with discharge LEMS (Spearman’s rho = 0.448; p = 0.004), FIM motor subscale (Spearman’s rho = 0.595; p < 0.001), FIM walk subscale (Spearman’s rho = 0.621; p < 0.001) and WISCI II (Spearman’s rho = 0.531; p < 0.001). The rectus femoris echo intensity was also significantly correlated with discharge LEMS (Spearman’s rho = −0.345; p = 0.029), FIM motor subscale (Spearman’s rho = −0.413; p = 0.008), FIM walk subscale (Spearman’s rho = −0.352; p = 0.026), and WISCI II (Spearman’s rho = −0.355; p = 0.025). We report that a relationship exists between rectus femoris muscle ultrasonographic characteristics and muscle function and ambulatory outcomes after inpatient rehabilitation. Ultrasound muscle measurements are potentially useful in assessing muscle wasting and function in patients with spinal cord injury.

A case report of retroperitoneal ectopic pregnancy with lymphatic migration after in vitro fertilization–embryo transfer: an explanation to embryo distant migration

To present a rare case of retroperitoneal ectopic pregnancy with lymphatic migration after invitro fertilization-embryo transfer (IVF-ET) and propose the possible explanation for embryonic migration. Illustrative video presentation. Images, videos (educational videos), and title slides were used to introduce the case of a patient with retroperitoneal ectopic pregnancy with lymphatic migration after IVF-ET and provide a potential explanation for embryo distant migration in the patient. This work was approved by the institutional review board. University hospital. A 32-year-old woman (gravida 2, para 0) with a history of right salpingectomy was admitted to the hospital 40 days after IVF-ET because of ectopic pregnancy for 1 day; the patient had secondary infertility for 6 years. Gynecologic examination indicated anterior 40-day uterus with no tenderness. A preoperative B-mode ultrasound scan showed that the endometrium was 23 mm, and there was no acoustic image of the pregnant sac in the uterine cavity. Magnetic resonance imaging showed that 1 oval signal measuring approximately 30 × 28 × 35 mm was detected at the gap between the aorta anterior to the third lumbar vertebra and inferior vena cava. The inferior vena cava could be seen on the rear right of the gestational sac, and the abdominal aorta could be seen on the rear left. Retroperitoneal ectopic pregnancy with lymphatic migration after IVF-ET was diagnosed using B-mode ultrasound, MRI, and pathology analysis and was removed laparoscopically. Mechanism analysis of distant ectopic migration in a patient receiving IVF-ET with a history of tubal surgery. The patient was diagnosed using B-mode ultrasound and MRI and underwent laparoscopic surgery to diagnose and remove the retroperitoneal ectopic pregnancy tissue. Further, the pregnancy lesion was completely removed using an ultrasonic knife. The pathological examination showed that the pregnancy tissue was located inside an enlarged lymph node surrounded by lymphoid tissue, and lymphocyte infiltration was also seen in the endometrial tissue, suggesting that the implanted embryo migrated to the retroperitoneum through the lymphatic channels. The patient successfully conceived through IVF-ET 1 year after the operation, and a full-term neonate was delivered by cesarean section. This case reinforces that in patients with a history of tubal surgery, whether unilateral or bilateral, clinicians should pay more attention to the possibility of retroperitoneal pregnancy after IVF-ET and to the follow-up of such patients. The pathological examination report provided evidence that lymphatic migration may be the possible mechanism of retroperitoneal ectopic pregnancy or embryonic migration after intrauterine placement.

Fabrication and Characterization of Tissue-Mimicking Phantoms for Ultrasound-Guided Cannulation Training.

Tissue-mimicking materials (TMMs) have been investigated and used for decades as imaging phantoms in various medical applications. They are designed and fabricated to replicate certain biological tissue characteristics, a process often dictated by the target application. Moreover, TMMs have been utilized in some medical procedural training requiring the use of imaging modalities. One potential application for TMMs is ultrasound-guided cannulation training. Cannulation is a procedure that requires a level of dexterity to gain vascular access using ultrasound guidance while avoiding complications like vessel laceration and bleeding. However, an ideal phantom for this application is yet to be developed. This work investigates the development and characterization of high-fidelity phantoms for cannulation training. The mechanical (shore hardness, elastic modulus, and needle-interaction forces) and acoustic (B-mode ultrasound scans) properties of candidate materials were quantitatively compared with biological tissue. The evaluated materials included ballistic gel, plasticized polyvinyl chloride (PVC), silicone, gelatin, agar, and polyvinyl alcohol (PVA)- cryogel. Mechanical testing demonstrated that each material could replicate the Shore hardness and elasticity characteristics of different biological tissues (skin, fat, and muscle), with PVA and PVC showing tunability by varying composition or fabrication processes. Shore hardness (OO-range) for PVA ranged between 6.3 ± 1.0 to 59.3 ± 2.6 and PVC from 4.8 ± 0.7 to 14.6 ± 0.8. Ultrasound scans of PVA were the closest to human scans, both qualitatively (based on experts' opinion) and quantitatively (based on pixel intensity measurements). Modified mixtures of PVA are found to best serve as high-fidelity cannulation phantoms. Alternatively, PVC can be used to avoid troublesome fabrication processes of PVA.

Ultrasound classification of breast masses using a comprehensive Nakagami imaging and machine learning framework

In this study we investigate the potential of parametric images formed from ultrasound B-mode scans using the Nakagami distribution for non-invasive classification of breast lesions and characterization of breast tissue. Through a sliding window technique, we generated seven types of Nakagami images for each patient scan in our dataset using basic and as well as derived parameters of the Nakagami distribution. To determine the suitable window size for image generation, we conducted an empirical analysis using 4 windows, which includes 3 column windows of lengths 0.1875 mm, 0.45 mm and 0.75 mm and widths of 0.002 mm, along with the standard square window with sides equal to three times the pulse length of incident ultrasound. From the parametric image sets generated using each window, we extracted a total of 72 features that consisted of morphometric, elemental and hybrid features. To our knowledge no other literature has conducted such a comprehensive analysis of Nakagami parametric images for the classification of breast lesions. Feature selection was performed to find the most useful subset of features from each of the parametric image sets for the classification of breast cancer. Analyzing the classification accuracy and Area under the Receiver Operating Characteristic (ROC) Curve (AUC) of the selected feature subsets, we determined that the selected features acquired from Nakagami parametric images generated using a column window of length 0.75 mm provides the best results for characterization of breast lesions. This optimal feature set provided a classification accuracy of 93.08%, an AUC of 0.9712, a False Negative Rate (FNR) of 0%, and a very low False Positive Rate (FPR) of 8.65%. Our results indicate that the high accuracy of such a procedure may assist in the diagnosis of breast cancer by helping to reduce false positive diagnoses.

Different Types of Ultrasound Probes Usage for Multi-Angle Conventional 3D Ultrasound Compound Imaging: A Breast Phantom Study

Three-dimensional automated breast ultrasound (ABUS) systems seem to offer excellent results in breast cancer screening tests and its early detection, comparable to handheld ultrasound B-mode scanning, with the benefit of saving physician time and reducing handheld ultrasound issues. Nevertheless, the ABUS systems are not very popular, due to the cost and very narrow application. The multi-angle conventional 3D ultrasound compound imaging method (MACUI) is intended for use with standard B-mode scanners in order to reduce cost but preserve the advantages of ABUS systems. The rotational probe movement is utilized in order to collect images for the three-dimensional reconstruction of the scanned tissue’s anatomy. The authors evaluate the capabilities to increase the scanned volume and quality of reconstructions, which are limited in current MACUI implementations, with a probe tilt and shift. The study shows and discusses the results of the imaging using different probes available for SmartUs Telemed B-Mode scanner at different scanning geometry in order to determine the capabilities of such an ultrasound imaging system. The results discussed in the paper highlight the benefits in quality improvement and scanning area obtained with tilted and shifted probes, as well as the advantages of using a relatively simple convex probe that does not incorporate software beam steering over more advanced devices.

3-D Ultrasonographic Quantification of Hand and Calf Muscle Volume: Statistical Shape Modeling Approach.

Accurate acquisition and segmentation of muscles are essential in 3-D freehand ultrasonography (US) to estimate in vivo muscle volume, but the source of segmentation inaccuracy in shape variation has never been the focus. This study was aimed at investigating reliability of 3-D US in the acquisition and segmentation for muscle volume of two muscles of different sizes and in identifying a primary source of measurement difference. The lateral gastrocnemius and flexor pollicis brevis of 12 healthy adults were assessed using freehand 3-D US scans. The motion-tracking data of the probe were synchronized with the B-mode ultrasound scan to reconstruct 3-D muscle volume. Statistical shape modeling was used to provide a spatial segmentation volume difference that further explains the variation around segmentation repeatability. The absolute difference of the flexor pollicis brevis was 3.5 percentage points greater than that for the lateral gastrocnemius. The highest measurement differences were observed when for inter-acquirer analysis. Statistical shape modeling revealed that the primary segmentation volume differences were at the muscle ends and edges, where the muscle interfaces with the surrounding muscles. Three-dimensional US is a reliable tool in the clinical setting, but care must be taken to ensure that acquisition and segmentation are consistent, particularly in a small muscle that interfaces with tendons and other soft tissues.

Carotid Ultrasound Boundary Study (CUBS): Technical considerations on an open multi-center analysis of computerized measurement systems for intima-media thickness measurement on common carotid artery longitudinal B-mode ultrasound scans

After publishing an in-depth study that analyzed the ability of computerized methods to assist or replace human experts in obtaining carotid intima-media thickness (CIMT) measurements leading to correct therapeutic decisions, here the same consortium joined to present technical outlooks on computerized CIMT measurement systems and provide considerations for the community regarding the development and comparison of these methods, including considerations to encourage the standardization of computerized CIMT measurements and results presentation. A multi-center database of 500 images was collected, upon which three manual segmentations and seven computerized methods were employed to measure the CIMT, including traditional methods based on dynamic programming, deformable models, the first order absolute moment, anisotropic Gaussian derivative filters and deep learning-based image processing approaches based on U-Net convolutional neural networks. An inter- and intra-analyst variability analysis was conducted and segmentation results were analyzed by dividing the database based on carotid morphology, image signal-to-noise ratio, and research center. The computerized methods obtained CIMT absolute bias results that were comparable with studies in literature and they generally were similar and often better than the observed inter- and intra-analyst variability. Several computerized methods showed promising segmentation results, including one deep learning method (CIMT absolute bias = 106 ± 89 μm vs. 160 ± 140 μm intra-analyst variability) and three other traditional image processing methods (CIMT absolute bias = 139 ± 119 μm, 143 ± 118 μm and 139 ± 136 μm). The entire database used has been made publicly available for the community to facilitate future studies and to encourage an open comparison and technical analysis (https://doi.org/10.17632/m7ndn58sv6.1).