Duplex Imaging Research Articles

Finely tunable NIR‐II organic scaffolds for fluorescence/photoacoustic duplex imaging–guided noninvasive photothermal therapy of glioblastoma

AbstractOrganic agents possessing NIR‐II and photoacoustic duplex imaging capabilities, coupled with high‐efficiency photothermal conversion, offer significant potential for noninvasive and precise phototheranostics of glioblastoma, which is further augmented when these agents can concurrently exhibit tumor targeting and blood–brain barrier (BBB) permeability. This study reports a series of finely tunable NIR‐II molecular luminophores based on the aza‐BODIPY scaffold, featuring unique twisted and rotatable structures. They are further constructed to folate‐decorated polymeric nanoparticles, exhibiting remarkable NIR‐II/photoacoustic imaging performance and superior photothermal conversion efficiency (49.7%). Folate modification enables tumor targeting and BBB permeability through receptor‐mediated transcytosis, allowing for precise and efficient phototherapy in 4T1‐/glioblastoma‐bearing mice after a single intravenous injection and irradiation. This study presents a rational molecular engineering approach and a versatile structural scaffold for designing NIR‐II emitters with tailored photophysical properties and desirable phototherapeutic efficacy, thereby offering novel perspectives on the development of advanced depth imaging probes and brain tumor therapeutics.

8563 Pheochromocytoma Screening In A Patient With Neurofibromatosis Type I And Medication-Resistant Hypertension

Abstract Disclosure: E. Mora: None. A. Bolduc, MD: None. G. Elshimy: None. Title: Pheochromocytoma Screening in a Patient With Neurofibromatosis Type I and Medication-Resistant Hypertension Background: Patients with neurofibromatosis type I (NF1) have a higher risk of pheochromocytoma and it may be missed if no screening done, thus placing the patient at risk of stroke and/or myocardial infarction. The prevalence of pheochromocytoma in patients with NF1 is 2.9% according to a retrospective cohort study by Gruber et al. We present a case of biochemically silent pheochromocytoma in a patient with NF1 and resistant hypertension Clinical case: A 74-year woman with NF1 presented with episodic headaches and labile systolic blood pressure (BP) in the 170-200s mm Hg on three different antihypertensives consistent with pheochromocytoma. Initial tests for renal artery stenosis and pheochromocytoma showed normal plasma MN (0.43 nmol/L, n< 0.50 nmol/L) and NM (0.86 nmol/L, n< 0.90 nmol/L), and normal flow in both renal hila by color Doppler and no large suprarenal masses identified on retroperitoneal US. Duplex imaging of the bilateral kidneys showed no evidence of renal artery stenosis. CT of abdomen/pelvis with and without IV contrast showed a 1.6 cm nodule on Right (RT) adrenal gland that measured 36 HU on unenhanced phase with an absolute washout of 67%. No discrete nodule in Lt adrenal gland. Dotatate PET/CT revealed a Rt adrenal nodule with elevated asymmetric activity (measured 28.1 standardized uptake values (SUV), n for liver: max 12.3, spleen: max 23.5) relative to the normal physiologic activity of the Leftt adrenal gland, which is concerning for pheochromocytoma. The patient was then referred to our endocrine clinic for further evaluation 6 months after the initial presentation. Labs showed normal aldosterone (5.8 ng/dL, n≤39.2 ng/dL), cortisol (7.66 mcg/dL, n: 3.09-22.40 mcg/dL), ACTH (20 pg/mL, n: 7.2-63 (AM collection), and DHEA-S (28 mcg/dL, n:5.3-124 mcg/dL). Normal repeat plasma MN (0.38 nmol/L, n< 0.50 nmol/L) and NM (0.46 nmol/L, n< 0.90 nmol/L). Repeat CT adrenal washout redemonstrated 1.4 cm Rt adrenal nodule that measured 39 HU on non- contrast image with an absolute washout of 68%. Patient will have a surgical resection of the Rt adrenal biochemically silent pheochromocytoma next week and she has been receiving an alpha-blocker prior to surgery to decrease risk for labile BP. Discussion and Conclusion: This case illustrates how CT and DOtatate scan findings can alert providers to the presence of a pheochromocytoma, even in biochemically negative patients. We recommend pheochromocytoma screening in all patients with NF1 to prevent delayed diagnosis and complications of untreated pheochromocytoma. Presentation: 6/1/2024

Clinical Profile of Leg Symptoms and Reflux in the Legs From Varicose Veins Disease Reported at a Tertiary Healthcare Institute in Jharkhand, India.

Background Varicose veins, affecting 8-10% of the population, are categorized as primary or secondary, depending on the etiology. The aim of thestudy is to assess the clinical profile of leg symptoms and reflux in the legs of varicose veins disease among patients reported in a tertiary hospital. Patients and methods An institution-based cross-sectional exploratory study comprising 56 patients with reflux in legs of varicose veins disease selected through purposive sampling, conducted in the OPD (outpatient department), general surgery, AIIMS (All India Institute of Medical Sciences) Deoghar. The standardized study instrument includes the Aberdeen varicose veins questionnaire, and patients' symptoms and concerns questionnaire, followed by a brief clinical examination based on CEAP (clinical, etiological, anatomical, and pathophysiological)classification and VCSS (venous clinical severity score) for C5/6 and color-flow duplex imaging of both lower limbs. Descriptive and inferential statistics were used for data analysis using IBM SPSS Statistics for Windows, Version 23 (IBM Corp.,Armonk, NY). Results Bilateral presentation of the disease had been seen in 57.1% (n=32) participants, and the common history of present illness reported by participants included swelling along the veins (n=55, 98.2%), pain (n=51, 91.1%), and discoloration (n=33, 58.9%). The clinical grading revealed that most participants, i.e., 87.5% (n=49) had C2 and 75% (n=42) had C3 disease. The majority of participants 96.4% (n=54) suffered from primary varicose veins. Furthermore, all subjects exhibited superficial vein involvement, alongwith one individual having deep vein involvement and a few participants (n=35, 62.5%)having perforators. With this, the majority of participants (n=55, 98.2%) showed reflux pathology. Conclusion Varicose veins typically afflict men in their 40s and 50s who work in positions of extended standing. Limited awareness in the Santhal Pargana division, Jharkhand state, India may result in poor healthcare outcomes. Improving public awareness may help lessen disease-related consequences.

Popliteal Vein Entrapment as a Rare Form of Popliteal Entrapment Syndrome.

Popliteal entrapment syndrome (PES) describes a cluster of symptoms related to the compression of the neurovascular bundle in the popliteal fossa, most commonly involving the popliteal artery. In approximately 10-15% of the cases of popliteal entrapment syndrome, the popliteal vein is compressed. Symptoms of popliteal vein entrapment can mimic venous insufficiency or deep venous thrombosis, causing the diagnosis to be missed or delayed. Diagnosis of popliteal vein entrapment can be done with duplex imaging with flexion and extension maneuvers; however, venography is the gold standard for diagnosis. While popliteal vein entrapment is commonly associated with younger individuals, it may also be an underdiagnosed condition in older patients. We describe two cases of successful diagnosis and treatment of late-onset presentation of popliteal vein entrapment.

Comprehensive Management of Thrombosed Lower Extremity Venous Aneurysms: A Single-Center Retrospective Analysis and Insights Into Clinical Strategies.

Venous aneurysms are rare vascular abnormalities associated with venous thromboembolism. In this study, we presented our experience in managing thrombosed lower extremity venous aneurysms and evaluate the impact of vitamin D deficiency and genetic thrombophilic risk factors on patient management and outcomes. A single-center retrospective observational analysis was conducted on ten patients with thrombosed lower limb venous aneurysms who underwent surgical procedures at our hospital from July 2014 to February 2023. Collected data included venous duplex ultrasonographic imaging and laboratory tests including genetic thrombophilic risk factors and assessments of vitamin D levels. There were 5 males and 5 females. The mean age was 46.6 ± 12.1years. The aneurysms were located in the popliteal vein in three patients, the great saphenous vein in six, and the small saphenous vein in one. Venous duplex imaging revealed saccular aneurysms in eight patients and fusiform aneurysms in two, with a mean diameter of 37.2 ± 10.6mm, ranging from 23 to 52mm. Laboratory tests indicated vitamin D deficiency in all of the patients, and genetic thrombophilic risk factors were identified in two cases. Surgical interventions consisted of tangential excision with lateral venorrhaphy in three patients and total excision and ligation in seven patients. The postoperative period was favorable for all patients. Surgical treatment of thrombosed venous aneurysms in the lower extremities is essential to prevent complications such as thromboembolism. A comprehensive approach, including knowledge of genetic risk factors and vitamin D levels, may improve patient outcomes.

EasyPISA: Automatic Integrated PISA Measurements of Mitral Regurgitation From 2-D Color-Doppler Using Deep Learning

ObjectiveThe proximal isovelocity surface area (PISA) method is a well-established approach for mitral regurgitation (MR) quantification. However, it exhibits high inter-observer variability and inaccuracies in cases of non-hemispherical flow convergence and non-holosystolic MR. To address this, we present EasyPISA, a framework for automated integrated PISA measurements taken directly from 2-D color-Doppler sequences. MethodsWe trained convolutional neural networks (UNet/Attention UNet) on 1171 images from 196 recordings (54 patients) to detect and segment flow convergence zones in 2-D color-Doppler images. Different preprocessing schemes and model architectures were compared. Flow convergence surface areas were estimated, accounting for non-hemispherical convergence, and regurgitant volume (RVol) was computed by integrating the flow rate over time. EasyPISA was retrospectively applied to 26 MR patient examinations, comparing results with reference PISA RVol measurements, severity grades, and cMRI RVol measurements for 13 patients. ResultsThe UNet trained on duplex images achieved the best results (precision: 0.63, recall: 0.95, dice: 0.58, flow rate error: 10.4 ml/s). Mitigation of false-positive segmentation on the atrial side of the mitral valve was achieved through integration with a mitral valve segmentation network. The intraclass correlation coefficient was 0.83 between EasyPISA and PISA, and 0.66 between EasyPISA and cMRI. Relative standard deviations were 46% and 53%, respectively. Receiver operator characteristics demonstrated a mean area under the curve between 0.90 and 0.97 for EasyPISA RVol estimates and reference severity grades. ConclusionEasyPISA demonstrates promising results for fully automated integrated PISA measurements in MR, offering potential benefits in workload reduction and mitigating inter-observer variability in MR assessment.

The Impact of Symptomatic Chronic Venous Insufficiency (CVI) on Health-Related Quality of Life (HR Qol) in A Multi-Ethnics Society in a Developing Nation

INTRODUCTION: Chronic venous insufficiency (CVI) is a common condition especially among those of advance age that is often neglected. As the disease severity progresses, it increases the healthcare cost and resources required, while diminishing the quality of life of the persons. Health-related Quality of Life (HRQoL) among CVI patients begins to decline once the symptom starts to appear, and reduces it further as the symptoms worsens. MATERIALS AND METHODS: This is a prospective, multi-centred, cross-sectional study on consenting symptomatic CVI patients who presented to the International Islamic University of Malaysia (IIUM) teaching hospital in Pahang, Malaysia. The diagnosis of CVI was confirmed on duplex imaging. Clinical grading was performed using Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification. Patients completed generic validated Malay language Short Form 36 (SF36) HRQoL instrument. RESULTS: One hundred and ten patients (62% male) with a mean age of 57 years, Malays (60%), Chinese (25%) and Indian (15%) were recruited. The most frequent CVD symptoms reported were pain (42%). The clinical, aetiological, anatomical, and pathophysiological (CEAP) classification placed most patients in the C2 class (34%). Apart from partaking in social functions, all other elements of mental and physical health component of SF 36 showed a marked deterioration as the disease progressed. CONCLUSIONS: We found a significant decline in the HRQoL among symptomatic CVI patients presenting to IIUM hospital in a multi-ethnic developing country.

Absence of a Deep Vein and the Significance of Drainage from the Superficial Venous System

We submit a case of a 57-year-old man who presented to the Vascular Clinic seeking treatment for worsening varicosities in the left lower extremity. Specifically, these veins were located in the left lateral thigh. He had lost a considerable amount of weight and the varicosities had become more visible and painful. Duplex imaging was performed and revealed non-visualization of the left external iliac and common femoral veins. These findings were confirmed by both computed tomography (CT) imaging and lower extremity venography with fluoroscopy. It was deemed that the great saphenous vein was providing drainage from the limb and, therefore, should not be ablated. Duplex ultrasound was crucial in identifying the abnormal anatomy and planning the subsequent care of the patient. We are reporting this case because of its rarity and to provide awareness.

Multiple Renal Arteries in Live Donor Renal Transplantation and Impact on Graft Function and Outcome: A Retrospective Study

Objective: The objective of the study is to evaluate the outcomes of live-donor renal allografts with multiple and single renal arteries taking into consideration ischemia times, graft function, and other complications including vascular and urological. Materials and Methods: We conducted a retrospective study by analyzing a prospectively maintained database from January 2021 to December 2021 of all patients undergoing live-related renal allograft transplants at a tertiary care center in North India. A total of 239 live donor kidney transplants were performed during this period. Patients were divided into two groups – Group 1: Single artery single anastomosis and Group 2: Multiple arteries with two or more anastomoses. Duplex imaging of the graft was done at 6 months. Recipients were followed up for possible graft dysfunction, arterial insufficiency, and major urological complications. Results: Mean ischemia times in the two groups were 20.62 ± 1.05 and 30.45 ± 1.77 min, respectively. Failure to normalize creatinine (<1.2 mg/dl) within 72 h was seen in 6/183 and 3/56 (P > 0.05). Slow graft function was encountered in 6 cases in Group 1 and 3 cases in Group 2. Delayed graft function occurred in two patients in both groups. One-year graft survival among the groups was 5/183 and 2/56, respectively (P > 0.05). One patient from Group 1 developed transplant renal artery stenosis. Six patients from Group 1 developed ureteric complications. Conclusion: Donor grafts with multiple renal arteries may be accepted safely with careful surgical reconstruction and close surveillance posttransplant.

Iatrogenic bilocular femoral artery pseudoaneurysm in a patient with end-stage renal disease undergoing regular hemodialysis: An unexpected occurrence after a common procedure and surgical cure

Introduction: Pseudoaneurysms of the femoral artery can develop as an uncommon complication following penetrating trauma or arterial catheterization for cardiovascular procedures or hemodialysis. It is commonly diagnosed with color duplex imaging and usually a single pseudoaneurysm is present. Case Report: We present a 62-year-old woman with end-stage renal disease who developed a very rare bilocular pseudoaneurysm of the femoral artery caused by inadvertent puncture of the artery during elective hemodialysis which remained uneventful and undiagnosed until the pseudoaneurysm was itself punctured by the dialysis catheter iatrogenically and another large connecting pseudoaneurysm was formed above the initial one. Typical unilocular pseudoaneurysm presents as Yin-Yang sign on color duplex imaging but here bidirectional turbulent flow was seen as double Yin-Yang sign suggestive of bilocular pseudoaneurysm mimicking the shape of a snowman, hence Yin-Yang Snowman sign. The patient presented with signs and symptoms of rapid progression of the pseudoaneurysm resulting in femoral nerve compression with compromised skin viability. Therefore, surgical management was planned and the bilocular pseudoaneurysms were excised with repair of the femoral artery and then covered with vascularized rectus femoris muscle flap. Conclusion: An arterial pseudoaneurysm should be included in the differential diagnosis for a groin mass after femoral catheterization or other vascular procedures. A non-invasive imaging approach using color flow duplex sonography can be used with confidence and safety. But in complicated cases or cases with impending complications, surgical exploration and excision remains the mainstay of treatment.

Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis

BackgroundAcute stroke treatment with intracranial thrombectomy and treatment of ipsilateral carotid artery stenosis/occlusion (“tandem lesion”, TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high, and antiplatelet therapy (APT) preventing restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the safety and 90-day outcome of patients receiving TL treatment under triple-APT, focused on stent-patency and possible disadvantageous comorbidities.MethodsPatients receiving TL treatment in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All patients received intravenous eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Duplex imaging was performed 24 h after treatment, at discharge and 90 days, and digital subtraction angiography was performed if restenosis was suspected.Results176 patients were included. Periprocedural complications occurred in 2.3% of the patients at no periprocedural death, and in-hospital death in 13.6%. Discharge mRS score was maintained or improved at the 90-day follow-up in 86%, 4.54% had an in-stent restenosis requiring treatment at 90 days. No recorded comorbidity considered disadvantageous for stent patency showed statistical significance, the duration of the endovascular procedure had no significant effect on outcome.ConclusionIn our data, TL treatment with triple APT resulted in a low restenosis rate, low rates of sICH and a comparably high number of patients with favorable outcome. Aggressive APT in the initial phase may therefore have the potential to prevent recurrent stroke better than restrained platelet inhibition. Comorbidities did not influence stent patency.

Erythrocyte Membrane Camouflaged Nanotheranostics for Optical Molecular Imaging-Escorted Self-Oxygenation Photodynamic Therapy.

Hypoxic tumor microenvironment (TME) hampers the application of oxygen (O2)-dependent photodynamic therapy (PDT) in solid tumors. To address this problem, a biomimetic nanotheranostics (named MMCC@EM) is developed for optical molecular imaging-escorted self-oxygenation PDT. MMCC@EM is synthesized by encapsulating chlorin e6 (Ce6) and catalase (CAT) in metal-organic framework (MOF) nanoparticles with erythrocyte membrane (EM) camouflage. Based on the biomimetic properties of EM, MMCC@EM efficiently accumulates in tumor tissues. The enriched MMCC@EM achieves TME-activatable drug release, thereby releasing CAT and Ce6, and this process can be monitored through fluorescence (FL) imaging. In addition, endogenous hydrogen peroxide (H2O2) will be decomposed by CAT to produce O2, which can be reflected by the measurement of intratumoral oxygen concentration using photoacoustic (PA) imaging. Such self-oxygenation nanotheranostics effectively mitigatetumor hypoxia and improve the generation of singlet oxygen (1O2). The 1O2 disrupts mitochondrial function and triggers caspase-3-mediated cellular apoptosis. Furthermore, MMCC@EM triggers immunogenic cell death (ICD) effect, leading to an increased infiltration of cytotoxic T lymphocytes (CTLs) into tumor tissues. As a result, MMCC@EM exhibits good therapeutic effects in 4T1-tumor bearing mice under the navigation of FL/PA duplex imaging.

Outcome of varicose vein surgery in a general surgical unit

Background: Varicose veins are tortuous, widened veins in the subcutaneous tissues of the legs and are often easily visible. In our country, we do have not sufficient vascular surgery centers or vascular surgeons. So general surgeons have training in vascular surgery and performing operations of varicose veins. This study aimed to show the operative procedure, results of treatment in terms of symptom improvement, and complications of varicose vein surgery done by general surgeons in a rural medical college hospital in Bangladesh. Methods: This retrospective study was conducted at the Department of General Surgery in Sheikh Hasina Medical College, Jamalpur, Bangladesh from January 2017 to December 2022. A total of 20 patients were selected as study subjects by simple random sampling. Operative procedure depended upon pre-operative duplex imaging findings, and patients were kept under 6 months follow-up. The outcome was based on the cure and recurrence rate of varicose veins. Collected data were analyzed using descriptive statistics. Analysis of data was carried out by using a statistical package for social science (SPSS) 22.0 for Windows. After analysis, the data were presented in tables and charts. Results: It was observed that 3 (15.0%) patients experienced ulceration after surgical procedure, followed by 2 (10.0%) developed DVT, 1 (5.0%) patient had wound hematoma, and 1 (5.0%) patient showed recurrence. Concerning the outcome of varicose veins after surgical procedures, the majority (18,20.0%) of the patients showed complete cure, 1 (5.0%) patient presented with recurrence, and 1 (5.0%) patient developed complication. Conclusions: Despite the relatively low occurrence of complications and recurrence following surgery for varicose veins, the substantial 90% cure rate it offers is noteworthy. This study underscores the feasibility of conducting varicose vein surgery by general surgeons equipped with training in vascular surgery, ensuring safety and minimizing complications.

Initial description of the novel handheld wireless ultrasound device TE Air with Doppler and Color Duplex imaging.

To test and initially describe a new handheld wireless ultrasound technique (TE Air) for clinical use. In this pilot study, the new ultrasound device TE Air from Mindray was used to examine the hepatic and renal vessels of healthy volunteers for first impressions. The probe has a sector transducer with a frequency range of 1.8-4.5 MHz. The B-mode and color-coded doppler sonography (CCDS) scanning methods were used. A high-end device from the same company (Resona 9, Mindray) was used as a reference. The results were evaluated using an image rating scale ranging from 0 to 5, with 0 indicating not assessable and 5 indicating without limitations. Altogether, 61 participants (n = 34 female [55.7%], n = 27 male [44.3%]), age range 18-83 years, mean age 37.9±16.5 years) could be adequately studied using TE AIR and the high-end device. With one exception, the image quality score for TE Air never fell below 3 and had a mean/median scored of 4.97/5.00 for the B-mode, 4.92/5.00 for the color flow (CF) mode, and 4.89/5.00 for the pulse wave (PW) mode of the hepatic vein, 4.90/5.00 for the portal vein, 4.11/4.00 for the hepatic artery, and 4.57/5.00 for the renal segmental artery. A significant difference in the assessment of flow measurement of the hepatic artery and renal segmental arteries was found between TE AIR and the high-end device. TE Air represents a new dimension in point-of-care ultrasound via wireless handheld devices. Especially, its flow measurement ability offers a relevant advantage over other available handheld models. TE Air provides a formally sufficient image quality in terms of diagnostic significance.

DopUS-Net: Quality-Aware Robotic Ultrasound Imaging Based on Doppler Signal

Medical ultrasound (US) is widely used to evaluate and stage vascular diseases, in particular for the preliminary screening program, due to the advantage of being radiation-free. However, automatic segmentation of small tubular structures (e.g., the ulnar artery) from cross-sectional US images is still challenging. To address this challenge, this paper proposes the DopUS-Net and a vessel re-identification module that leverage the Doppler effect to enhance the final segmentation result. Firstly, the DopUS-Net combines the Doppler images with B-mode images to increase the segmentation accuracy and robustness of small blood vessels. It incorporates two encoders to exploit the maximum potential of the Doppler signal and recurrent neural network modules to preserve sequential information. Input to the first encoder is a two-channel duplex image representing the combination of the grey-scale Doppler and B-mode images to ensure anatomical spatial correctness. The second encoder operates on the pure Doppler images to provide a region proposal. Secondly, benefiting from the Doppler signal, this work first introduces an online artery re-identification module to qualitatively evaluate the real-time segmentation results and automatically optimize the probe pose for enhanced Doppler images. This quality-aware module enables the closed-loop control of robotic screening to further improve the confidence and robustness of image segmentation. The experimental results demonstrate that the proposed approach with the re-identification process can significantly improve the accuracy and robustness of the segmentation results (Dice score: from <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$0.54$</tex-math> </inline-formula> to <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$0.86$</tex-math> </inline-formula> ; intersection over union: from <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$0.47$</tex-math> </inline-formula> to <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$0.78$</tex-math> </inline-formula> ). <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —The Doppler signal is important for the diagnosis of vascular disease, e.g., peripheral arterial disease, in clinical practices, nevertheless it is not of similar significance for state-of-the-art robotic ultrasound (US) examination systems yet. This paper explores various neural network structures to effectively extract the blood vessels from US images by incorporating the Doppler signal into the segmentation process. The final DopUS structure with two encoders extracting differentiated information from two different inputs and fusing the latent feature representations in the bottleneck layer can also inspire other tasks like multi-senor fusion. In addition, this work developed a Doppler-based tracker to assess the quality of the segmentation results in real-time. The assessment is subsequently used for a quality-aware module that enables closed-loop control of the robotic screening. Preliminary physical experiments suggest that the quality-aware robotic screening system can improve the confidence and robustness of autonomous US examination results. In the future, the Doppler signal could also be used to support clinical diagnosis. We believe the proposed quality-aware autonomous screening system is important for the development of large-scale robotic US screening programs. It will not only benefit the examination of limb arteries but also other vascular structures, e.g., carotid or aorta.

Duplex Imaging Assessment of the Internal Mammary Arteries in Women after Unilateral Mastectomy and Radiotherapy for Breast Cancer

The effects of incidental radiation exposure on internal mammary arteries remain unclear. The present study was designed to test the hypothesis by comparing diameter and blood flow of the irradiated and nonirradiated internal mammary arteries, using Duplex ultrasound imaging. The study was designed as a single-center, transversal, comparative study. The main outcomes were diameter and volumetric blood flow of the internal mammary arteries. The Wilcoxon rank-sum test was used to assess the differences between the irradiated and nonirradiated internal mammary arteries with regard to the diameter and volumetric blood flow. The diameter (median [interquartile range]) of the irradiated internal mammary arteries (0.170mm [0.160, 0.180]) was smaller than that of the contralateral nonirradiated ones (0.180mm [0.170, 0.200], P<0.0001) and that of the internal mammary arteries in the control group (0.180mm [0.170, 0.190], P<0.0001). Similarly, blood flow (median [interquartile range]) of the irradiated internal mammary arteries (52.4ml/min [37.78, 65.57]) was smaller than that of the contralateral nonirradiated ones (62.7ml/min [46.87, 84.17], P<0.0001), as well as of the left (56.7ml/min [46.88, 72.58], P=0.02) and the right internal mammary arteries in the control group (61.0ml/min [47.47, 74.52], P=0 0.0009). The data indicate that the irradiated internal mammary arteries in patients with a history of total mastectomy followed by radiotherapy for breast cancer had significantly smaller diameter and blood flow compared to the nonirradiated internal mammary arteries.

Diameter and depth of femoral vessels by duplex ultrasound

Background: The anatomy of the femoral artery and vein plays an integral role in vascular access. Both technical feasibility and complication rates are associated with femoral vessel diameter and depth. The goal of this study is to establish normative values for common femoral artery (CFA) and vein (CFV) depth and diameter using a large, diverse patient population. Methods: A retrospective review of all patients undergoing lower extremity venous duplex imaging over a 1 year period were reviewed. Patients with inadequate imaging or with evidence of deep vein thrombosis were excluded. The index image of all studies was a non-compressed view of the common femoral vein at the saphenous-femoral junction. All measurements were taken from this still. Vessel diameters were measured from intima to intima. Depth was measured from skin to intima. BMI and BSA were calculated using standard formulas. Chi square was used for univariate analysis. Linear regression was used to establish correlation. Results: Over the 1 year period, 983 patients met criteria for inclusion. The majority were male (53%) with a mean age of 55. The patients were 47% white and 44% black. The majority had hypertension (53%). The mean BMI and BSA were 29 and 2, respectively. Mean CFA depth was 1.7 cm, while mean CFV depth was 1.8 cm. The mean CFA and CFV diameters were 0.9 and 1.1 cm, respectively. Amongst height, weight, BMI, and BSA, weight correlated best with CFA ( R = 0.548) and CFV ( R = 0.552) depth, while BSA correlated best for diameter for both CFA ( R = 0.390) and CFV ( R = 0.440). Conclusions: This study establishes mean diameters and depths for the common femoral artery and vein using a large, diverse patient group. BSA was most closely associated with vessel diameter, while weight was correlated with depth. This study provides normative diameter and depth values for the common femoral vasculature, which may assist in vascular access planning for providers.

Velocity changes in femoral vessel ultrasound with Doppler in Porcine hemorrhagic shock

Physician-directed point-of-care ultrasound (PoCUS) is routinely used to identify the etiology of shock and guide therapy in the ICU. We performed a preclinical study to determine what changes are manifested in the femoral vessels during hemorrhagic shock on Duplex imaging and to generate a femoral vessel sonographic profile over the time course of shock. A preclinical study in swine was performed using a convenience sample of animals that were being used in a Trauma Surgery training lab. The animals developed progressive unregulated hemorrhage during the lab. Six anesthetized swine underwent Duplex studies of the femoral vessels prior to any hemorrhage and at two time points after the start of hemorrhage. N/A. Femoral vessel imaging was performed using a portable ultrasound (Sonosite and Clarius). Femoral arterial peak systolic velocity decreased in all animals with hemorrhage, from a mean (SD) of 77 (27) cm/s pre-hemorrhage to 42 (17) and 32 (16) cm/s at the two post-hemorrhage time points. There were also changes to the arterial waveform morphology. Mean venous velocities also decreased with hemorrhage (20, 11, 7cm/s). Animals with severe hemorrhage had a cessation of venous flow during positive pressure ventilation. In this preclinical study, both femoral peak systolic velocity and venous velocity decreased with hemorrhage. Femoral vessels represent an easily accessible target for non-invasive hemodynamic monitoring. Changes in femoral vessel Duplex waveforms and velocities should be studied both in a larger sample of animals with controlled hemorrhage and in human trauma patients to determine whether changes appear in early hemorrhage, before the onset of clinically evident hemorrhagic shock.

Orbital blood vessels changes on color duplex imaging in diabetics with and without diabetic retinopathy

To compare changes in ophthalmic artery (OA) and its branches in diabetics with and without diabetic retinopathy (DR) using color duplex imaging (CDI), and to correlate these changes with the disease variables. 60 eyes of 60 diabetic patients were enrolled, divided into 3 groups: without DR (Group A), with Non-Proliferative DR (Group B) and with Proliferative DR (PDR) (Group C). Laboratory testing including HbA1c was done. Patients underwent CDI, by which OA, Central Retinal Artery (CRA) and Ciliary Arteries were identified; for each of them we measured Peak systolic velocity (PSV), End Diastolic velocity (EDV) and Resistivity Index (RI). Results were compared to clinical, laboratory and fundus examination. OA EDV was significantly lower and OA RI was found to be significantly higher in Group C (p = 0.027 and 0.025 respectively). CRA PSV and EDV were significantly lower in Group C (p = 0.017 and 0.001 respectively). PCA RI was significantly higher in Group C (p = 0.008). HbA1c was negatively correlated with CRA PSV (p = 0.041), also it was negatively correlated with CRA EDV (p = 0.0001), as well as with PCA EDV (p = 0.002). There was direct significant correlation between HbA1c and PCA RI (p = 0.012). Duration since diagnosis was negatively correlated with CRA EDV (p = 0.004). Multivariate linear regression showed that DR is an independent predictor for low OA EDV, high OA RI, low CRA EDV and high PCA RI. DR is an independent risk factor for orbital and ocular vessels flow alteration, thus can be used as a prognostic tool in diabetic patients. CDI can be reliably used in diabetics to predict early changes or progression of DR.

COMPARISON BETWEEN CONVENTIONAL HIGH LIGATION AND STRIPPING AND RADIOFREQUENCY ABLATION FOR GREAT SAPHENOUS VARICOSE VEINS

The prospective study was conducted from December 2022 to May 2023 to assess patient-based, radiological, and clinical outcomes after conventional surgery and radiofrequency ablation for great saphenous varicose veins. Patients were randomly divided to undergo conventional surgery or RFA. American Society of Anesthesiologists fitness grade, Venous Disability Score (VDS), Total Clinical Severity Score (TCSS), Michael's, and CEAP clinical classes were recorded. VEINES-QoL/Sym questionnaire and Aberdeen Varicose Vein Questionnaire were used to estimate baseline QoL. Patients were called for follow-up at the end of 1st and 5th week. The study was conducted on a total of 110 patients. Patients were randomly divided; 57 underwent RFA, and 53 underwent conventional surgery. Results showed that the difference between both groups regarding anesthesia induction, recovery, and discharge from surgery was insignificant. RFA had significantly longer total theater time compared to conventional surgery. Duplex imaging showed that RFA resulted in successful ablation except in two cases where veins had segmental brisk flow. These cases were retreated successfully. Conventional surgery only had the problem of incomplete stripping (6 cases). Post-operative pain, bruising, and the need for analgesia were significantly higher following conservative surgery. Patients in the RFA group returned to work and normal activities more quickly than the conventional surgery group. It is concluded that RFA had a longer intervention time but significantly better outcomes than conventional surgery.