Conventional Ultrasound Mode Research Articles

Renal Masses With Equivocal Enhancement at CT: Characterization With Contrast-Enhanced Ultrasound.

The purpose of this article is to retrospectively investigate in two radiology centers the role of contrast-enhanced ultrasound in the characterization of renal masses with equivocal enhancement at CT (i.e., with a density increase of 10-20 HU between unenhanced and contrast-enhanced scans) not characterized with conventional ultrasound modes. Forty-seven renal lesions (range, 0.8-7.7 cm; average, 2.6 cm) with equivocal enhancement at CT underwent contrast-enhanced ultrasound using sulfur hexafluoride-filled microbubbles. Examinations were digitally recorded for retrospective blinded evaluation by two radiologists with 20 and 10 years' experience in urologic imaging. Histologic results were available for 30 of 47 (64%) lesions (25 primary malignant tumors, two metastases, and three primary benign lesions). Two lesions increased in size and complexity during the follow-up and were considered malignant. One Bosniak category III and 14 category IIF cysts were stable after a follow-up of at least 3 years and were considered benign. ROC curve analysis was used to assess the capability of contrast-enhanced ultrasound to differentiate benign from malignant lesions. Twelve likely complex cystic lesions at gray-scale ultrasound were cystic also on contrast-enhanced ultrasound and reference procedures. Eleven of 34 lesions that appeared solid at gray-scale ultrasound were cystic on contrast-enhanced ultrasound and reference procedures. One lesion considered likely solid by one radiologist and possibly cystic by the other was a solid tumor at contrast-enhanced ultrasound and histologic analysis. The diagnostic performance of contrast-enhanced ultrasound to characterize the lesions as benign or malignant was high for both readers (AUC, 0.958 and 0.966, respectively). Contrast-enhanced ultrasound is effective for characterizing renal lesions presenting with equivocal enhancement at CT.

The Use of CEUS in the Diagnosis of Retinal/Choroidal Detachment and Associated Intraocular Masses – Preliminary Investigation in Patients with Equivocal Findings at Conventional Ultrasound

To investigate whether contrast-enhanced ultrasound (CEUS) may help to diagnose retinal/choroidal detachment and may help to differentiate intraocular lumps in cases with equivocal features on conventional grayscale and Doppler modes. The institutional review board approved this retrospective study. The need for informed consent was waived. A computerized data search was performed in the database of our institution for patients with vitreous hemorrhage who underwent CEUS of the eye to assess retinal/choroidal detachment and/or associated masses. This process yielded a total of 31 patients (18 men, 13 women, age range: 39 - 88 years) in whom CEUS was performed because the findings on conventional grayscale and Doppler modes were equivocal. CEUS was performed using low acoustic power contrast-specific modes. A 2.4 - 4.8 mL bolus of SonoVue was injected, followed by a saline flush. All examinations were digitally recorded for retrospective analysis. Confirmation of CEUS findings was obtained at surgery (n = 20) or with binocular indirect fundoscopy performed after clearance of the ocular media (n = 11). Two readers with different levels of ultrasound experience independently reviewed the imaging features. A five-degree scale ranging from definitely absent (score 1) to definitely present (score 5) was used to assess the presence or absence of retinal/choroidal detachment on conventional ultrasound modes alone and with the addition of CEUS. ROC curve analysis was performed to assess the diagnostic accuracy of both methods. The inter-reader agreement was also evaluated. In patients with associated intraocular lumps, conventional Doppler modes and CEUS were used to differentiate non-tumor masses from tumor masses. According to the reference standard, 13 patients had retinal detachment, 4 had choroidal detachment, and 3 had both retinal and choroidal detachment. There were 8 associated intraocular lumps (4 subretinal hemorrhages, 3 malignant melanomas, 1 metastasis). The inter-reader agreement was good (K = 0.644) and very good (K = 0.833) for conventional modes and CEUS, respectively. The diagnostic performance of CEUS was high for both readers (area ± standard error under the ROC curve: 0.966 ± 0.031 and 0.900 ± 0.055 for readers 1 and 2, respectively). There were 2 false-positive results and 1 false-negative result in patients with proliferative diabetic retinopathy. CEUS was effective in differentiating subretinal hemorrhage from hypovascular tumors. CEUS can be used as a problem-solving technique when conventional ultrasound modes are not diagnostic for retinal/choroidal detachment and when intraocular lumps cannot be characterized as tumor or non-tumor masses on conventional modes. The evaluation of patients with proliferative diabetic retinopathy, however, may be problematic.

Color flow doppler ultrasonography in Hashimoto’s Thyroiditis

<p class="MsoNormal" style="text-align: justify; line-height: normal; margin: 0cm 0cm 0pt;">Objective: To evaluate if the vascularization patterns in the thyroid gland parenchyma by the conventional ultrasound mode B, and color Doppler ultrasonography correlated with the peak systolic velocity (PSV) of the inferior thyroid artery using pulsed Doppler in patients with Hashimoto’s thyroiditis (HT) in various stages. Methods: Patients with diagnosis of HT were enrolled in this prospective study in the period two years. Thyroid glands of all patients were evaluated with conventional ultrasound mode B, color-flow Doppler ultrasonography, and peak systolic velocity (PSV) of the inferior thyroid artery. Data were analyzed applying variance (ANOVA) and Pearson’s or Spearman’s correlation. Results: A hundred twenty patients (10 men and 110 women) were included in the study. Highly elevated PSV were associated with very lower thyroid echogenicity and heterogeneous pattern thyroid gland (p= 0.01) and intrathyroidal blood flow (p= 0.004). Conclusions: We conclude that evaluation the vascularization patterns of the thyroid gland parenchyma in patients with HT when compared to conventional ultrasound mode B, and with the PSV of the inferior thyroid artery by pulsed Doppler showed a high correlation. Probably this method could be recommend as a measure of thyroid blood flow as an essential part of evaluating ultrasonography in the HT.</p>

Torsional ultrasound mode versus combined torsional and conventional ultrasound mode phacoemulsification for eyes with hard cataract

PurposeTo compare torsional versus combined torsional and conventional ultrasound modes in hard cataract surgery regarding ultrasound energy and time and effect on corneal endothelium.SettingsKasr El Aini hospital, Cairo University, and International Eye Hospital, Cairo, Egypt.MethodologyNinety-eight eyes of 63 patients were enrolled in this prospective comparative randomized masked clinical study. All eyes had nuclear cataracts of grades III and IV using the Lens Opacities Classification System III (LOCS III). Two groups were included, each having an equal number of eyes (49). The treatment for group A was combined torsional and conventional US mode phacoemulsification, and for group B torsional US mode phacoemulsification only. Pre- and post-operative assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp evaluation, and fundoscopic evaluation. Endothelial cell density (ECD) and central corneal thickness (CCT) were measured preoperatively, 1 day, 7 days, and 1 month postoperatively. All eyes were operated on using the Alcon Infiniti System (Alcon, Fort Worth, TX) with the quick chop technique. All eyes were implanted with AcrySof SA60AT (Alcon) intraocular lens (IOL). The main phaco outcome parameters included the mean ultrasound time (UST), the mean cumulative dissipated energy (CDE), and the percent of average torsional amplitude in position 3 (%TUSiP3).ResultsImprovement in BCVA was statistically significant in both groups (P < 0.001). Comparing UST and CDE for both groups revealed results favoring the pure torsional group (P = 0.002 and P < 0.001 for UST; P = 0.058 and P = 0.009 for CDE). As for %TUSiP3, readings were higher for the pure torsional group (P = 0.03 and P = 0.01). All changes of CCT, and ECD over time were found statistically significant using one-way ANOVA testing (P < 0.001).ConclusionBoth modes are safe in hard cataract surgery, however the pure torsional mode showed less US energy used.

Research interface on a programmable ultrasound scanner

MotivationCommercial ultrasound machines in the past did not provide the ultrasound researchers access to raw ultrasound data. Lack of this ability has impeded evaluation and clinical testing of novel ultrasound algorithms and applications. ObjectivesRecently, we developed a flexible ultrasound back-end where all the processing for the conventional ultrasound modes, such as B, M, color flow and spectral Doppler, was performed in software. The back-end has been incorporated into a commercial ultrasound machine, the Hitachi HiVision 5500. The goal of this work is to develop an ultrasound research interface on the back-end for acquiring raw ultrasound data from the machine. MethodsThe research interface has been designed as a software module on the ultrasound back-end. To increase the amount of raw ultrasound data that can be spooled in the limited memory available on the back-end, we have developed a method that can losslessly compress the ultrasound data in real time. Results and discussionThe raw ultrasound data could be obtained in any conventional ultrasound mode, including duplex and triplex modes. Furthermore, use of the research interface does not decrease the frame rate or otherwise affect the clinical usability of the machine. The lossless compression of the ultrasound data in real time can increase the amount of data spooled by ∼2.3 times, thus allowing more than 6s of raw ultrasound data to be acquired in all the modes. The interface has been used not only for early testing of new ideas with in vitro data from phantoms, but also for acquiring in vivo data for fine-tuning ultrasound applications and conducting clinical studies. We present several examples of how newer ultrasound applications, such as elastography, vibration imaging and 3D imaging, have benefited from this research interface. Since the research interface is entirely implemented in software, it can be deployed on existing HiVision 5500 ultrasound machines and may be easily upgraded in the future. ConclusionsThe developed research interface can aid researchers in the rapid testing and clinical evaluation of new ultrasound algorithms and applications. Additionally, we believe that our approach would be applicable to designing research interfaces on other ultrasound machines.

Torsional mode versus conventional ultrasound mode phacoemulsification: Randomized comparative clinical study

To compare the intraoperative and short-term postoperative outcomes of cataract surgery performed with torsional mode and conventional ultrasound mode using the Infiniti Vision System (Alcon Laboratories). Cataract Service, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, Guangzhou, China. In this randomized comparative study, 525 eyes were assigned to phacoemulsification by torsional mode or conventional ultrasound (US) mode. The surgery was performed by an experienced surgeon, and the outcomes were evaluated by an examiner who was masked to treatment assignments. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), and surgical complications. Patients were seen 1, 7, and 30 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA) and the change in corneal clarity, central corneal thickness (CCT), and endothelial cell count. The US group had 262 eyes and the torsional group, 263 eyes. All patients completed the follow-up visits. In the eyes with nucleus density grades of 1, 2, 3, and 4, the mean UST was 10.25 seconds +/- 7.4 (SD), 25.14 +/- 5.5 seconds, 36.45 +/- 8.3 seconds, and 61.44 +/- 17.8, respectively, in the US group and 8.32 +/- 6.8 seconds, 18.45 +/- 7.2 seconds, 29.48 +/- 12.4 seconds, and 48.39 +/- 20.3 seconds, respectively, in the torsional group (P<.001); the mean CDE was 1.25 +/- 0.5, 4.18 +/- 1.2, 8.59 +/- 6.5, and 16.51 +/- 9.6, respectively, in the US group and 0.94 +/- 0.3, 3.13 +/- 2.7, 7.47 +/- 12.6, and 14.08 +/- 8.3, respectively, in the torsional group (P<.001). At 1 day and 7 days, the mean BCVA was 0.23 +/- 0.12 logMAR and 0.00 +/- 0.10 logMAR, respectively, in the US group and 0.18 +/- 0.11 logMAR and -0.08 +/- 0.05 logMAR, respectively, in the torsional group (P<.001). At 30 days, the mean BCVA was -0.10 +/- 0.07 logMAR and -0.12 +/- 0.06 logMAR in the US group and the torsional group, respectively (P>.01). At 1 day and 7 days, the mean CCT was 625 +/- 80 microm and 568 +/- 37 microm, respectively, in the US group and 601 +/- 35 microm and 559 +/- 40 microm, respectively, in the torsional group (P<.001). At 30 days, the mean CCT was 531 +/- 30 microm in the US group and 529 +/- 39 microm in the torsional group (P>.01). At 7 days and 30 days, the mean central corneal endothelial cell count was 2135 +/- 858 cells/mm(2) and 2084 +/- 527 cells/mm(2), respectively, in the US group and 2004 +/- 656 cells/mm(2) and 1953 +/- 615 cells/mm(2), respectively, in the torsional group (P<.001). The torsional mode may provide more effective lens removal with a lower level of phacoemulsification time and energy.