Color Doppler Ultrasound Imaging Research Articles

Color Doppler ultrasound assessment of morphology and types of fistulous tracts in hidradenitis suppurativa (HS)

Fistulous tracts in hidradenitis suppurativa (HS) are key signs of severity and their clinical evaluation alone may be limited for assessing their presence and morphology. There is also a need to determine the factors that allow reversibility of the anatomic changes in HS. We sought to categorize fistulous tracts in HS. A retrospective study of color Doppler ultrasound images of cases with positive clinical and sonographic criteria of HS with fistulous tracts was performed. The sonographic staging of HS, location, and anatomic characteristics of the tracts were registered and graded. Statistical analysis for correlating variables was performed using bivariate and multivariate studies. In all, 52 patients presenting 96 fistulous tracts met the criteria. Morphology was defined and a sonographic classification into 3 types of fistulae was developed. Type 3 concentrated 71% of the cases presenting communicating tracts, and type 2, 29%. Types 2 and 3 represented 63% of patients with multiple fistulous tracts. Fistulous tracts types 2 and 3 were significantly correlated with age 35years or older and groin location. Ultrasound cannot detect lesions less than 0.1mm. Fistulous tracts in HS can be categorized using ultrasound, which may support earlier and more precise management.

Color Doppler Ultrasound Imaging in the Assessment of Iliac Endofibrosis.

Endofibrosis (EF) of the iliac arteries is a flow-limiting condition typically seen in highly trained endurance athletes. Thirty-seven athletes (74 limbs) were referred to our department with suspected EF. All patients had a pre- and postexercise color Doppler ultrasound (CDU) of the iliac arteries. Doppler waveform and peak systolic velocity (PSV) and end-diastolic velocity (EDV) were assessed pre- and postexercise. Endofibrosis was diagnosed with CDU in 24 athletes (29 limbs). Arterial wall and course abnormalities were detected at rest in 20 (67%) symptomatic limbs of athletes with and 4 (22%) symptomatic limbs of athletes without EF. Postexercise abnormal waveforms of the stenotic/damped type were seen in the iliac arteries in all 29 limbs of athletes diagnosed with EF. These waveform changes were accompanied by high PSV (>350 cm/s) and EDV (>150 cm/s), with (n = 10; 34%) or without (n = 19; 66%) the evidence of reduced arterial lumen caliber. Color Doppler ultrasound can be used to detect EF.

Three-Dimensional Field Optimization Method: Gold-Standard Validation of a Novel Color Doppler Method for Quantifying Mitral Regurgitation

Accurate diagnosis of mitral regurgitation (MR) severity is central to proper treatment. Although numerous approaches exist, an accurate, gold-standard clinical technique remains elusive. The authors previously reported on the initial development and demonstration of the automated three-dimensional (3D) field optimization method (FOM) algorithm, which exploits 3D color Doppler ultrasound imaging and builds on existing MR quantification techniques. The aim of the present study was to extensively validate 3D FOM in terms of accuracy, ease of use, and repeatability. Three-dimensional FOM was applied to five explanted ovine mitral valves in a left heart simulator, which were systematically perturbed to yield a total of 29 unique regurgitant geometries. Three-dimensional FOM was compared with a gold-standard flow probe, as well as the most clinically prevalent MR volume quantification technique, the two-dimensional (2D) proximal isovelocity surface area (PISA) method. Overall, 3D FOM overestimated and 2D PISA underestimated MR volume, but 3D FOM error had smaller magnitude (5.2±9.9mL) than 2D PISA error (-6.9±7.7mL). Two-dimensional PISA remained superior in diagnosis for round orifices and especially mild MR, as predicted by ultrasound physics theory. For slit-type orifices and severe MR, 3D FOM showed significant improvement over 2D PISA. Three-dimensional FOM processing was technically simpler and significantly faster than 2D PISA and required fewer ultrasound acquisitions. Three-dimensional FOM did not show significant interuser variability, whereas 2D PISA did. Three-dimensional FOM may provide increased clinical value compared with 2D PISA because of increased accuracy in the case of complex or severe regurgitant orifices as well as its greater repeatability and simpler work flow.

Ultrasound Diagnosis and Staging in Pediatric Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) can affect children, and ultrasound has been proven to be useful in diagnosis and staging. The sonographic characteristics of HS in children have not been reported. We studied color Doppler ultrasound images of children (≤15 years old; n = 12) with clinically and sonographically positive criteria for HS. Sonographic scoring of hidradenitis suppurativa (SOS-HS) was used to stage the cases sonographically. Subclinical pseudocysts were found in 92% of the cases, fluid collections in 83%, and fistulous tracts in 58%. Retained hair tracts in the fluid collections and fistulous tracts were present in 100% of patients; 67% of cases were SOS-HS stage II. In 92% of cases, management was modified after the ultrasound examination. In conclusion, ultrasound can be a reliable and safe imaging tool to support diagnosis and staging and may help in the noninvasive monitoring of treatment in children.

MP54-13 DETECTION AND ASSESSMENT OF HEMORRHAGIC KIDNEY INJURY CAUSED BY BURST WAVE LITHOTRIPSY USING ULTRASOUND AND MAGNETIC RESONANCE IMAGING

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy1 Apr 2016MP54-13 DETECTION AND ASSESSMENT OF HEMORRHAGIC KIDNEY INJURY CAUSED BY BURST WAVE LITHOTRIPSY USING ULTRASOUND AND MAGNETIC RESONANCE IMAGING Adam Maxwell, Wayne Kreider, Yak-Nam Wang, Philip May, Donghoon Lee, Joshua Park, Bryan Cunitz, Mathew Sorensen, Rajash Handa, Michael Bailey, and Jonathan Harper Adam MaxwellAdam Maxwell More articles by this author , Wayne KreiderWayne Kreider More articles by this author , Yak-Nam WangYak-Nam Wang More articles by this author , Philip MayPhilip May More articles by this author , Donghoon LeeDonghoon Lee More articles by this author , Joshua ParkJoshua Park More articles by this author , Bryan CunitzBryan Cunitz More articles by this author , Mathew SorensenMathew Sorensen More articles by this author , Rajash HandaRajash Handa More articles by this author , Michael BaileyMichael Bailey More articles by this author , and Jonathan HarperJonathan Harper More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.583AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Burst wave lithotripsy (BWL) is a new, noninvasive method to disintegrate urinary tract stones by focused ultrasound pulses rather than shock waves. In order to evaluate the safety of this technique, preclinical work is needed to identify the effects of the BWL exposures on kidney tissue. This study investigated the use of ultrasound (US) imaging for real-time detection of hemorrhagic injury during BWL, as well as magnetic resonance imaging (MRI) for post-treatment quantification of injury in comparison with a standard morphometric technique. METHODS BWL exposures were delivered to 21 sites in 4 pigs by 170 and 335 kHz focused ultrasound transducers. A midline incision was made to open the abdomen, and the transducer was coupled through a water-filled cone directly to the kidney. During treatment, synchronized B-Mode and color Doppler ultrasound imaging were employed to monitor the transducer focal region to detect BWL-induced cavitation associated with hemorrhagic injury. After treatment, kidneys were perfusion-fixed and extracted for analysis. A 3T MRI scanner (Achieva, Philips Healthcare, The Netherlands) was used to obtain T1-weighted, T2-weighted, and susceptibility-weighted images of each of the 8 fixed kidneys. Hemorrhagic injury was then identified and volumetrically quantified from the three scans using 3D segmentation. The injury was also quantified in 5 of the kidneys by an established morphometric analysis technique that has been used to quantify injury in shock wave lithotripsy research. The detection of cavitation on US imaging was correlated with MRI and morphometric results. RESULTS During exposures, cavitation was identified on US images as hyperechoic regions in kidney tissue on B-Mode imaging and highly elevated Doppler power in the focal zone. Injury was clearly demarcated on MRI as a hypointense region on T2-weighted images. All injured volumes were <2% of the functional renal volume, and <0.5% for exposures anticipated to be used for BWL, measured either by MR or the traditional quantification method. Detection of cavitation on US was consistent with presence/absence of injury on MR in 20 of 24 sites (including untreated locations), and with morphometric analysis in 14 of 15 sites. Identified lesions on MRI coincided with results of morphometric analysis in 13 of 15 sites. CONCLUSIONS Ultrasound imaging is a sensitive detector of cavitation onset during BWL and correlates well with the presence of hemorrhagic tissue injury. MRI is a promising method to identify and quantify hemorrhagic kidney injury for BWL. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e731 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Adam Maxwell More articles by this author Wayne Kreider More articles by this author Yak-Nam Wang More articles by this author Philip May More articles by this author Donghoon Lee More articles by this author Joshua Park More articles by this author Bryan Cunitz More articles by this author Mathew Sorensen More articles by this author Rajash Handa More articles by this author Michael Bailey More articles by this author Jonathan Harper More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Infiniti Plus ultrasound needle guidance system improves needle visualization during the placement of spinal anesthesia.

The Infiniti Plus ultrasound needle guidance system improves needle visualization during the placement of spinal anesthesia.

Non-contrast-enhanced imaging of haemodialysis fistulas using quiescent-interval single-shot (QISS) MRA: a feasibility study

To assess the efficiency of a novel quiescent-interval single-shot (QISS) technique for non-contrast-enhanced magnetic resonance angiography (MRA) of haemodialysis fistulas. QISS MRA and colour Doppler ultrasound (CDU) images were obtained from 22 haemodialysis patients with end-stage renal disease (ESRD). A radiologist with extensive experience in vascular imaging initially assessed the fistulas using CDU. Two observers analysed each QISS MRA data set in terms of image quality, using a five-point scale ranging from 0 (non-diagnostic) to 4 (excellent), and lumen diameters of all segments were measured. One hundred vascular segments were analysed for QISS MRA. Two anastomosis segments were considered non-diagnostic. None of the arterial or venous segments were evaluated as non-diagnostic. The image quality was poorer for the anastomosis level compared to the other segments (p<0.001 for arterial segments, and p<0.05 for venous segments), while no significant difference was determined for other vascular segments. QISS MRA has the potential to provide valuable complementary information to CDU regarding the imaging of haemodialysis fistulas. In addition, QISS non-enhanced MRA represents an alternative for assessment of haemodialysis fistulas, in which the administration of iodinated or gadolinium-based contrast agents is contraindicated.

Value of ultrasound elastography versus transrectal prostatic biopsy in prostatic cancer detection

ObjectiveTo detect the impact of ultrasound elastography in diagnosis of prostatic cancer, and to evaluate its capability in differentiating benign from malignant lesions. Materials and methodsFifty patients with different prostatic lesions suspicious for malignancy were included. All patients had a conventional B-mode ultrasound examination and color Doppler imaging, and then real time ultrasound elastography was performed in the same session. Finally, the results were compared to the histo-pathological results of those lesions. ResultsThe addition of Strain ratio parameter for evaluating the elastography images showed the highest sensitivity of 74.2%, specificity of 73.7% and accuracy of 74.0% at a best cutoff point of 5.5 between benign and malignant lesions. ConclusionBased on our results, prostate US combined with elastography can be a helpful tool for finding malignant lesions. Also it can help in targeting the biopsy site.

Blood flow assessed by color Doppler imaging in retinopathy of prematurity.

To quantify central retinal arterial and venous blood flow using ultrasound color Doppler imaging. In this prospective observational study, eyes of eight preterm infants with retinopathy of prematurity stage 2 and of eight preterm infants without retinopathy (gestational age <30 weeks, birth weight <1500 g) were evaluated by color Doppler imaging. Ocular blood flow velocities measured at 28±1 days of life did not differ significantly in the eyes of preterm infants who subsequently did and did not develop retinopathy. Development of retinopathy was associated with highly significant (P<0.0001 each) increases in central retinal vein maximum velocities (from 1.99±0.36 to 3.72±0.61 cm s(-1)), central retinal artery systolic flow velocities (from 6.44±1.52 to 9.87±1.99 cm s(-1)) and flow velocity integrals (from 1.27±0.30 to 2.17±0.50 cm) at 64±13 days of life. In infants without retinopathy, no significant changes were observed except for an increase in central retinal vein maximum velocities (from 1.96±0.22 to 2.62±0.44 cm s(-1), P=0.003). Retinopathy of prematurity appears to be accompanied by increased retinal blood flow.

Abstract P5-01-08: Single dose acute toxicity and long-term biodistribution of perfluoropentane loaded iron doped silica nanoshells

Abstract Background: Our lab has been focusing on developing a better method of localizing non-palpable breast cancers without wire or seed localization. Perfluoropentane (PFP) loaded Fe-SiO2 nanoshells have been developed as a color Doppler ultrasound contrast imaging agent which can act as small volume (100 ul) injectable stationary guide-marker for breast tumor resection. Preliminary experiments have demonstrated that the nanoshells can provide robust contrast for periods extending past 10 days in vivo in Py8119 epithelial breast tumor bearing mice with no adverse affect to the mice. Short-term biodistribution over 72 hours of nanoshells using In111 labeled nanoshells demonstrated with gamma scintigraphy that intravenously dosed particles primarily accumulate in the liver but some radioactive signal can be seen in the bladder. The long imaging lifetime of these nanoshells necessitates the need to study long-term toxicity and biodistribution. Materials and Methods: Fe-SiO2 nanoshells and Pure SiO2 nanoshells where synthesized via sol-gel method on polystyrene templates and then calcined to yield 500 nm hollow rigid nanoshells which were then filled with vaporized perfluoropentane. 100 ul of nanoshells at 4 mg/ml of the Fe-SiO2 nanoshells and at a dose of 2 mg/ml of pure SiO2 nanoshells were injected IV into healthy 8-week old Swiss white mice. The difference in mass dose was due to make the particle count between the two doses equivalent. Blood was collected weekly for serum chemistry and hematology. After 10 weeks mice were sacrificed, H&amp;E was performed on organs of interest as well as inductively coupled plasma optical emission spectroscopy (ICP-OES) for trace silicon determination for long-term biodistribution. Results: No significant effect due to the administration has yet been observed on the health of brain, lung, heart, kidney, liver, spleen or muscle tissue examined from these animals at a dose 4 mg/ml 100 ul of the Fe-SiO2 nanoshells and at a dose of 2 mg/ml of pure SiO2 nanoshells. Mouse weight steadily increased from 25.8 ± 2 grams to 30.7 ± 2.6 grams over the course of 10 weeks. Creatinine levels were detected at 0.2 ± 0.14 mg/dl indicating healthy renal function. Serum glutamic pyruvic transaminase (SGPT) was used as a measure of liver health, and SGPT values for both control (55.81 ± 6.31 U/L) and nanoshell injected mice (47.74 ± 11.04 U/L) are approximately the same over the course of 10 weeks indicating good liver health. Silicon content in mouse organs diminished over the course of 10 weeks by ICP-OES in both the Fe-SiO2 and pure SiO2 nanoshells. Conclusions: No indication of toxicity was observed from a 400 ug systemically administered dose of Fe-SiO2 nanoshells. Furthermore, the reduction of silicon content in the organs over the course of 10 weeks suggests a possible excretion pathway for silica or solid nanoparticulate materials. The efficacy in long term ultrasound contrast and high margin of safety indicates that this particle formulation is ready for phase 1 clinical trial in humans as a future method to localize nonpalpable breast cancers. Citation Format: Sarah L Blair, Alexander Liberman, Robert Viveros, Jacqueline Corbeil, Christopher V Barback, Robert F Mattrey, William C Trogler, Andrew C Kummel. Single dose acute toxicity and long-term biodistribution of perfluoropentane loaded iron doped silica nanoshells [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-01-08.

Non-stationary Clutter Rejection Based on Hankel-SVD for Ultrasound Color Flow Imaging

Effective rejection of the time-varying clutter originating from slowly moving vessels and surrounding tissues is very important for depicting hemodynamics in ultrasound color Doppler imaging. In this paper, a new adaptive clutter rejection method based on Hankel Singular Value Decomposition (Hankel-SVD) is presented for suppressing non-stationary clutter. In the proposed method, a Hankel data matrix is created for each slow-time ensemble. Then the orthogonal principle Hankel components can be obtained through the SVD of the Hankel data matrix. It achieves non-stationary clutter suppression by reconstructing the flow signal with only the high order principle Hankel components, which are estimated from the frequency content carried by the principle Hankel components. To assess its efficiency, the proposed Hankel-SVD based method is applied to synthetic slow-time data obtained from a Doppler flow model and carotid arterial complex baseband data acquired by a commercial ultrasound system (Sonix RP). The resulting flow and power images show that the proposed method outperforms the traditional IIR and polynomials regression filter in attenuation of high intense non-stationary clutter signal. It is also adaptive to highly spatially-varying tissue motion and can automatically select the order of the filter, which leads to improved distinguishing between blood and tissue regions compared to other eigen-based filters.

Comparative evaluation of advanced and conventional diagnostic AIDS for endodontic management of periapical lesions, an in vivo study.

To evaluate efficacy of Colour Doppler ultrasonography (CDUSG), direct digital radiography (DDR) and conventional radiography (CR) in diagnosis of periapical lesions and to clinically correlate treatment plan of periapical diseases. Thirty patients which were diagnosed with periapical lesions in anterior region by using both conventional and digital radiography were examined using colour doppler ultrasound imaging at the site of lesion. The images of each lesion were analysed by two endodontists and by an expert oral radiologist. A tentative differential diagnosis was agreed upon, based on certain principles discussed in article, then a diagnosis between cyst, granuloma and mixed lesions was made. Periapical lesions diagnosed as mixed lesions by colour doppler ultrasonography (CDUSG) were treated non-surgically whereas other periapical lesions were treated surgically. Tissues obtained during endodontic surgery were processed and examined for histopathological findings, and compared with the diagnosis made by ultrasound images. Statistical analysis was done with Chi-Square test and using one-way-Anova. The periapical lesions which were diagnosed as granuloma by ultrasonographic findings, was confirmed by the results of histopathological examination in all 16 surgically treated cases. The lesions in rest of the 14 cases which showed vascularity and were diagnosed as mixed lesions by ultrasonography, were treated non-surgically and had a favourable prognosis. CR and DDR facilitate diagnosis of the presence of periapical disease, but do not provide and information of its nature. CDUSG imaging facilitates accurate information on the pathological nature of the lesion and hence can lead to predictable treatment planning.

Grey-scale and colour Doppler ultrasound versus magnetic resonance imaging for the prenatal diagnosis of placenta accreta

Objective: To assess the effectiveness of grey-scale and colour Doppler ultrasound (US) versus magnetic resonance imaging (MRI) for the prenatal diagnosis of placenta accreta.Methods: A prospective observational study including a total of 74 patients with placenta previa and previous uterine scar (n = 74). Grey-scale and colour Doppler US was done followed by MRI by different observers to diagnose adherent placenta. Test validity of US and MRI were calculated. Maternal morbidity and mortality were also assessed.Results: A total of 53 patients confirmed to have placenta accreta at operation. The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US was 94.34, 91.67, 96.15 and 88% compared to 96.08, 87.50, 94.23 and 91.3% for MRI, respectively. The most relevant US sign was turbulent blood flow by colour Doppler, while dark intra-placental band was the most sensitive MRI sign. Venous thromboembolism (1.3%), bladder injury (29.7%), ureteric injury (18.9%), postoperative fever (10.8%), admission to ICU (50%) and re-operation (31.1%).Conclusion: Placenta accreta can be successfully diagnosed by grey-scale and colour Doppler US. MRI would be more likely suggested for either posteriorly or laterally situated placenta previa in order to exclude placental invasion.

Development and feasibility study of a two-dimensional ultrasonic-measurement-integrated blood flow analysis system for hemodynamics in carotid arteries.

Prevention and early detection of atherosclerosis are critical for protection against subsequent circulatory disease. In this study, an automated two-dimensional ultrasonic-measurement-integrated (2D-UMI) blood flow analysis system for clinical diagnosis was developed, and the feasibility of the system for hemodynamic analysis in a carotid artery was revealed. The system automatically generated a 2D computational domain based on ultrasound color Doppler imaging and performed a UMI simulation of blood flow field to visualize hemodynamics in the domain. In the UMI simulation, compensation of errors was applied by adding feedback signals proportional to the differences between Doppler velocities by measurement and computation while automatically estimating the cross-sectional average inflow velocity. The necessity of adjustment of the feedback gain was examined by analyzing blood flow in five carotid arteries: three healthy, one sclerosed, and one stenosed. The same feedback gain was generally applicable for the 2D-UMI simulation in all carotid arteries, depending on target variables. Thus, the present system was shown to be versatile in the sense that the parameter is patient independent. Moreover, the possibility of a new diagnostic method based on the hemodynamic information obtained by the 2D-UMI simulation, such as a waveform of the cross-sectional average inflow velocity and wall shear stress distributions, was suggested.

Automatic carotid centerline extraction from three-dimensional ultrasound Doppler images.

Vessel lumen centerline extraction is an important issue for the intra-operative guidance of endovascular instruments; furthermore, vessel centerline is often used as a reference position in many hemodynamic studies, especially in carotid arteries. In this work we propose an innovative method for the extraction of carotid vessels centerline from three-dimensional Color Doppler ultrasound images. The method was tested on carotid Color Doppler images of eighteen healthy subjects and validated by calculating the Euclidean distances between the centerlines detected by the algorithm and those manually annotated by two experts in the corresponding original US volumes. The results show that the proposed approach can accurately estimate the actual centerline with an average error of 1.08 ± 0.54 mm. Furthermore, the method is completely automatic and therefore suitable for the aforementioned purposes.

Development of Color Doppler Ultrasound Image-Text Management System

In this paper, the advantages and disadvantages of the existing ultrasonic image management system are analyzed, and also a multi-functional color Doppler ultrasound image-text management system is researched and developed in combination with the experience of color Doppler ultrasound doctors. With this system, the related operations such as color Doppler ultrasound images acquisition, processing, preservation, and medical records are implemented. In the design of the system, a professional acquisition card is used for implementing the acquisition of ordinary video signals. In the meantime, DICOM interface is designed using DICOM3.0 protocol for implementing multi-mode acquisition.

Doppler ultrasound findings correlate with tissue vascularity and inflammation in surgical pathology specimens from patients with small intestinal Crohn's disease.

BackgroundCrohn’s disease (CD) is routinely evaluated using clinical symptoms, laboratory variables, and the CD activity index (CDAI). However, clinical parameters are often nonspecific and do not precisely reflect the actual activity of CD small-intestinal lesions. The purposes of this prospective study were to compare color Doppler ultrasound (US) findings with histological findings from surgically resected specimens and confirm the hypothesis that color Doppler US can distinguish tissue inflammation and fibrosis.MethodsAmong 1764 consecutive patients who underwent color Doppler US examinations, 10 patients with CD (12 small-intestinal CD lesions) who underwent US examinations before elective small-intestine resection were evaluated in the present study. Areas of thickened intestinal walls were evaluated in terms of blood flow using color Doppler US imaging. The blood flow was semiquantitatively classified as “hyper-flow” and “hypo-flow” according to the Limberg score. Resected lesions were macroscopically and histopathologically processed. Inflammatory cell infiltration, fibrosis and vascularity were evaluated by myeloperoxidase (granulocytes), CD163 (macrophages), CD79a (B cells), CD3 (T cells), Masson’s trichrome (fibrosis), and factor VIII staining (vascular walls). All histopathological images were entered into virtual slide equipment and quantified using a quantitative microscopy integrated system (TissueMorph™).ResultsThere were no significant differences in disease features or laboratory findings between “hypo-flow” lesions (n = 4) and “hyper-flow” lesions (n = 8). Histopathologically, “hyper-flow” lesions showed significantly greater bowel wall vascularity (factor VIII) (p = 0.047) and inflammatory cell infiltration, including CD163 macrophages (p = 0.008), CD3 T cells, and CD79a B cells (p = 0.043), than did “hypo-flow” lesions. There was no apparent association between the blood flow and CDAI.ConclusionsIn this study, active CD lesions were macroscopically visible in surgical specimens of patients with increased blood flow on preoperative color Doppler US imaging. Additionally, these CD lesions exhibited significantly greater vascularity and numbers of inflammatory leukocytes microscopically. Color Doppler US may predict tissue inflammation and fibrosis in small-intenstinal CD lesions.

Development and external validation of new ultrasound‐based mathematical models for preoperative prediction of high‐risk endometrial cancer

To develop and validate strategies, using new ultrasound-based mathematical models, for the prediction of high-risk endometrial cancer and compare them with strategies using previously developed models or the use of preoperative grading only. Women with endometrial cancer were prospectively examined using two-dimensional (2D) and three-dimensional (3D) gray-scale and color Doppler ultrasound imaging. More than 25 ultrasound, demographic and histological variables were analyzed. Two logistic regression models were developed: one 'objective' model using mainly objective variables; and one 'subjective' model including subjective variables (i.e. subjective impression of myometrial and cervical invasion, preoperative grade and demographic variables). The following strategies were validated: a one-step strategy using only preoperative grading and two-step strategies using preoperative grading as the first step and one of the new models, subjective assessment or previously developed models as a second step. One-hundred and twenty-five patients were included in the development set and 211 were included in the validation set. The 'objective' model retained preoperative grade and minimal tumor-free myometrium as variables. The 'subjective' model retained preoperative grade and subjective assessment of myometrial invasion. On external validation, the performance of the new models was similar to that on the development set. Sensitivity for the two-step strategy with the 'objective' model was 78% (95% CI, 69-84%) at a cut-off of 0.50, 82% (95% CI, 74-88%) for the strategy with the 'subjective' model and 83% (95% CI, 75-88%) for that with subjective assessment. Specificity was 68% (95% CI, 58-77%), 72% (95% CI, 62-80%) and 71% (95% CI, 61-79%) respectively. The two-step strategies detected up to twice as many high-risk cases as preoperative grading only. The new models had a significantly higher sensitivity than did previously developed models, at the same specificity. Two-step strategies with 'new' ultrasound-based models predict high-risk endometrial cancers with good accuracy and do this better than do previously developed models.

Development of a Cancer Treatment with the Concomitant Use of Low-Intensity Ultrasound: Entering the Age of Simultaneous Diagnosis and Treatment.

In recent years, studies using ultrasound energy for cancer treatment have advanced, thus revealing the enhancement of drug effects by employing low-intensity ultrasound. Furthermore, anti-angiogenesis against tumors is now attracting attention as a new cancer treatment. Therefore, we focused on the biological effects and the enhancement of drug effects brought by this low-intensity ultrasound energy and reported on the efficacy against a uterine sarcoma model, by implementing the basic studies, for the first time, including the concomitant use of low-intensity ultrasound irradiation, as an expected new antiangiogenic therapy for cancer treatment. Furthermore, we have succeeded in simultaneously utilizing low-intensity ultrasound in both diagnosis and treatment, upon real time evaluation of the anti-tumor effects and anti-angiogenesis effects using color Doppler ultrasound imaging. Although the biological effects of ultrasound have not yet been completely clarified, transient stomas were formed (Sonoporation) in cancer cells irradiated by low-intensity ultrasound and it is believed that the penetration effect of drugs is enhanced due to the drug being more charged inside the cell through these stomas. Furthermore, it has become clear that the concomitant therapy of anti-angiogenesis drugs and low-intensity ultrasound blocks the angiogenic factor VEGF produced by cancer cells, inhibits the induction of circulating endothelial progenitor cells in the bone marrow, and expedites angiogenic inhibitor TSP-1. Based on research achievements in recent years, we predict that the current diagnostic device for color Doppler ultrasound imaging will be improved in the near future, bringing with it the arrival of an age of “low-intensity ultrasound treatment that simultaneously enables diagnosis and treatment of cancer in real time.”

Vein Visualization Using a Smart Phone With Multispectral Wiener Estimation for Point-of-Care Applications

Effective vein visualization is clinically important for various point-of-care applications, such as needle insertion. It can be achieved by utilizing ultrasound imaging or by applying infrared laser excitation and monitoring its absorption. However, while these approaches can be used for vein visualization, they are not suitable for point-of-care applications because of their cost, time, and accessibility. In this paper, a new vein visualization method based on multispectral Wiener estimation is proposed and its real-time implementation on a smart phone is presented. In the proposed method, a conventional RGB camera on a commercial smart phone (i.e., Galaxy Note 2, Samsung Electronics Inc., Suwon, Korea) is used to acquire reflectance information from veins. Wiener estimation is then applied to extract the multispectral information from the veins. To evaluate the performance of the proposed method, an experiment was conducted using a color calibration chart (ColorChecker Classic, X-rite, Grand Rapids, MI, USA) and an average root-mean-square error of 12.0% was obtained. In addition, an in vivo subcutaneous vein imaging experiment was performed to explore the clinical performance of the smart phone-based Wiener estimation. From the in vivo experiment, the veins at various sites were successfully localized using the reconstructed multispectral images and these results were confirmed by ultrasound B-mode and color Doppler images. These results indicate that the presented multispectral Wiener estimation method can be used for visualizing veins using a commercial smart phone for point-of-care applications (e.g., vein puncture guidance).