GE Healthcare Research Articles

Comprehensive evaluation of right ventricular function in patients with acute pulmonary embolism

Objective. To study indices of right ventricular (RV) longitudinal deformation at transthoracic echocardiography (TTE) in patients with acute pulmonary embolism (APE), to determine their threshold values; to study indices of right ventricular-arterial coupling (RVAC) in patients with APE, to determine their threshold values.Methods. We examined 34 patients with acute massive and submassive pulmonary embolism. The diagnosis was made on the basis of computed-tomography pulmonary angiogram. The mean age was 61 ±13 years. Of these, 16 were women (47,1%) and 18 were men (52,9%). As a control group, 30 healthy individuals were examined: 14 males and 16 females. The mean age of the healthy individuals was 39±9,8 years. Echocardiography was performed on Vivid E95 (GE HealthCare, USA) with data postprocessing on EchoPak workstation. The indices of right ventricular (RV) systolic and diastolic function, the magnitude of global longitudinal deformation of the right ventricle (GLS RV) and longitudinal deformation of the right ventricular free wall (RVFWLS) were studied using two-dimensional speckle-tracking echocardiography. We studied indices of right ventricular-arterial coupling (RVAC). We determined the relationship of longitudinal deformation of RV and RVAC with other indices of its systolic function. Results. Mean values of traditional parameters of RV contractile function were within normal limits, whereas mean values of longitudinal strain in APE were significantly lower than normal. There was also a significant decrease ( P < 0,0001) of all measured parameters of right ventricular-arterial coupling in patients with APE in comparison with the control group.Conclusions. When longitudinal deformation parameters are included in the criteria of RV dysfunction in APE, its detectability increases from 26,47% to 61,77%. The revealed decrease of right ventricular-arterial coupling parameters in APE indicates a more frequent disturbance of the connection between RV and the small circle of blood circulation

Investigation Into the Subharmonic Response of Three Contrast Agents in Static and Dynamic Flow Environments Using a Commercially Available Diagnostic Ultrasound Scanner

ObjectiveThe objective of this study was to investigate the subharmonic response of Lumason (also known as SonoVue; Bracco, Milan, Italy) to static and dynamic ambient pressures, with a direct comparison to Sonazoid (GE HealthCare, Oslo, Norway) and Definity (Lantheus Medical Imaging, MA, USA). The subharmonic responses of contrast agents can be exploited to perform subharmonic-aided pressure estimation. MethodsThe subharmonic response of each ultrasound contrast agent was evaluated in both a static and dynamic tank using a commercially available Logiq E10 clinical ultrasound scanner (GE HealthCare) equipped with subharmonic imaging (SHI) and an acoustic power-optimization algorithm. A C1-6 curvilinear array that transmits at 2.5 MHz and receives at 1.25 MHz in SHI mode was used to acquire the subharmonic signals. Data was transferred offline into MATLAB (MathWorks) to perform linear regression analysis and statistical testing for significance of the slopes (i.e., agent sensitivity). ResultsSonazoid and Definity showed an inverse linear dependency between subharmonic signal and hydrostatic pressure at all pressure ranges (static and dynamic) tested, with maximum sensitivity under 50 mmHg in the static tank (−0.190 and −0.194 dB/mmHg for Sonazoid and Definity, respectively). Lumason exhibited a tri-phasic subharmonic behavior, beginning with a linear trend from 0 to 90 mmHg (sensitivity = 0.069 dB/mmHg), followed by a plateau from 100 to 130 mmHg, and an inverse linear trend from 140 to 200 mmHg (sensitivity = −0.137 dB/mmHg). ConclusionThe subharmonic response of Lumason is tri-phasic and differs from Sonazoid and Definity. Further investigation is needed to solidify understanding of the subharmonic behavior of Lumason to identify its usefulness for subharmonic-aided pressure estimation.

Validation of advanced hybrid SPECT/CT system using dynamic anthropomorphic cardiac phantom

ObjectiveMyocardial blood flow (MBF) assessment can provide incremental diagnostic and prognostic information and thus the validation of dynamic SPECT is of high importance. We recently developed a novel cardiac phantom for dynamic SPECT validation and compared its performance against the GE Discovery NM 530c. We now report its use for validation of a new hybrid SPECT/CT System featuring advanced cadmium zinc telluride (CZT) technology in a ring array detector design (StarGuide™, GE HealthCare).MethodsOur recently developed cardiac phantom with injected technetium-99m radiotracer was used to create physiological time activity curves (TACs) for the left ventricular (LV) cavity and the myocardium. The TACs allow the calculation of uptake rate (K1) and MBF. The StarGuide system was used to acquire and process the TACs, and these were compared to the TACs produced by the phantom and its mathematical model. Fifteen (15) experiments with different doses representing various MBF values were conducted, and a standard statistic tool was applied for significance.ResultsThe TACs produced by the StarGuide system had a significant correlation (p < 0.001) with the reference TACs generated by the phantom both for the LV (r = 0.94) and for the myocardium (r = 0.89). The calculated MBF difference between the system and the phantom was 0.14 ± 0.16 ml/min/g and the average relative absolute difference was 13.2 ± 8.1%. A coefficient of variance of ≤ 11% was observed for all MBF subranges. The regional uptake rate values were similar to the global one with a maximum difference of 5%.ConclusionsOur newly developed dynamic cardiac phantom was used for validation of the dynamic hybrid SPECT/CT CZT-based system (StarGuide™, GE). The accuracy and precision of the system for assessing MBF values were high. The new StarGuide system can reliably perform dynamic SPECT acquisitions over a wide range of myocardial perfusion flow rates.

Reliability of trans-cerebellar diameter for gestational age in comparison to crown rump length

Background and objective: accurate estimation of gestational age is important for perfect antenatal care, as many pregnant women may don’t know their last menstrual period &amp; not have a first-trimester ultrasound that is accurate in estimating the gestational age, and the routine fetal biometry in the second &amp; third trimesters may be unreliable for some reason. Therefore, it’s necessary to develop an ultrasonographic parameter capable of reliably estimating gestational age at any point during pregnancy. This study aims to compare the accuracy of trans-cerebellar diameter (TCD) in n 2nd and 3rd trimesters for the calculation of estimated gestational age with the first-trimester crown rump length (CRL) which is the most accurate measurement for the estimation of gestational age. Methods: This is a prospective study conducted in Erbil from the 1st of January 2021 to the 10thof August 2022. A total sample of 258 antenatal women was included. The ultrasound examination was performed by a GE Voluson ultrasound system (GE health care 2015) machine using a 3.5 MHZ curved transducer. The CRL was taken between 6-13 weeks of gestational age, and TCD between 15-38 weeks. TCD is measured by keeping the calibers on the outer margin of the cerebellar hemisphere. Data were analyzed using the statistical package for social science SPSS V. 26. Results: The mean transcerebral diameter during different gestational ages was 16.35 (±0.76) less than 18 weeks gestation, 21.48 (±1.7) between 18-25 weeks gestation, 28.03 (±1.79) between 25-32 weeks gestation, 35.52 (± 1.84) above 32 weeks gestation respectively. There is a statistically significant linear correlation between TCD and ECRL with (rho=0.992) (P &lt;0.001) Conclusion: The accuracy of the TCD in the second &amp; third trimester of pregnancy is comparable with the estimated CRL in the first trimester, so this will help us in the estimation of the gestational age for pregnant women with unknown LMP and unavailable first-trimester dating scan.

Comparison of adaptive imaging receiver coil and traditional coil for multiplexed sensitivity encoding diffusion-weighted imaging of the liver.

To compare the image quality and efficacy of the adaptive imaging receiver (AIR) coil (GE Healthcare) and the traditional coil for multiplexed sensitivity encoding diffusion-weighted imaging (MUSE-DWI) in the detection of focal liver lesions (FLLs). Two groups of MUSE-DWI were obtained. Image quality was qualitatively evaluated by 3 independent blinded radiologists on a 5-point scale, and quantitative parameters were calculated by measurements of the region of interest in the liver and FLLs. McNemar's test were used to compare the characteristics and detectability. Less image noise, sharper contours, milder susceptibility artefacts, and better liver lesion conspicuity were found by all radiologists in 60 livers with 140 FLLs with the AIR coil than with the traditional coil (reader average mean, 4.3-4.4 vs. 3.7-4.0, P < .001). The signal-to-noise ratio (SNR) of the liver was significantly higher with the AIR coil than with the traditional coil (right lobe: mean, 8.89 vs.7.76, P < .05; left lobe: mean, 7.14 vs.6.19, P < .001), and the SNR of FLLs (mean, 24.62 vs. 21.01, P < .001) and lesion-to-liver CNR (mean, 16.61 vs. 14.02, P < .001) exhibited significant differences between the AIR coil and the traditional coil. Besides, superior detection of FLLs was observed with the AIR coil compared to the traditional coil (95.7% [134/140] vs. 85.7% [120/140], P < .001). The AIR coil yields less noise, fewer distortions, better lesion detectability, higher SNR of the liver and FLLs, and improved lesion-to-liver CNR during liver MUSE-DWI. Thus, it is a feasible and effective scanning scheme in liver MRI. The AIR coil improves SNR and the quality of liver MR imaging compared with the traditional coil.

Aberration correction in 3D transthoracic echocardiography

Three-dimensional cardiac imaging has been available in the clinic for more than two decades. Continuous improvement in image quality has occurred in this period due to the development of probe technology and beamforming techniques. The purpose of this article is to quantitatively and qualitatively analyze the effect of a commercially available aberration correction algorithm on clinically acquired 3D transthoracic echocardiography (3D TTE) images. Clinical triplane and 3D volume cineloops of at least one cardiac cycle of pre-beamformed channel data were captured from 50 patients using a GE HealthCare Vivid E95 system with the 4Vc-D matrix array probe. This resulted in a total of 3200 vol and 3136 triplane frames. The data were post-processed with and without aberration correction. Quantitatively, assessed by an image quality parameter based on coherence, all recordings were improved by aberration correction compared to those without aberration correction. Triplane data obtained a larger improvement in image quality than volume data. Qualitatively, as demonstrated by case examples, aberration-corrected images appear sharper, have a brighter tissue signal compared to the cavity, and provide better delineation of cardiac structures. 3D rendering of valves can also be significantly improved. In general, aberration correction provides a systematic improvement in clinical cardiac triplane and 3D volume images.

The effect of reconstruction algorithms on semi-quantitative measurements in 18F-FDG PET/CT imaging.

This study was carried out to understand whether Q.Clear and ordered subset expectation maximization (OSEM), reconstruction algorithms used in fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) applications, and parameters such as time of flight (TOF) and point spread function (PSF) cause different results in semi-quantitative measurements. Raw PET data of 264 patients who were referred to 18F-FDG PET/CT imaging with the purpose of evaluation of known or suspicious malignant disease were reconstructed separately with Q.Clear (GE Healthcare), a BPL, an OSEM algorithm, PSF (SharpIR®) and TOF (VUE Point FX®) methods. Each patient's liver, mediastinal blood pool, metabolic tumor volume (MTV), total lesion glycolysis (TLG), and standardized uptake values (SUV) (SUVmax, SUVmean, and SUVpeak) of a total of 264 lesions selected from the patients were performed. β350+ToF yielded higher measurement results than all other variables for all of the lesion SUVmax, lesion SUVmean, L/AP SUVmax, and L/AP SUVmean parameters. OSEM+ToF and OSEM+TOF+PSF algorithms yielded higher mean and median SUVmax values for the reference structures (liver and mediastinum) and for lesions SUVmax and SUVmean values were statistically significantly lower than the β350+ToF method. The method with the lowest mean value for the L/Liver SUVmax variable was OSEM+ToF 4iter16ss (mean=1.76), while the method with the highest mean value was β350+ToF (mean=2.26). β350+ToF was the reconstruction method with the highest ratios for L/AP SUVmax and SUVmean for both lesions below and above 1 cm. β350+ToF algorithm had also statistically significantly higher results for these variables compared to all other parameters in malignant lesions. When comparing 18F-FDG PET/CT images, the use of different reconstruction algorithms may lead to misleading results, especially in the evaluation of response to treatment of malignancies.

Shear-wave elastographic imaging in choroidal melanomas: clinical and hemodynamic correlations.

This study evaluated the role of shear wave elastography imaging (SWEΙ) in uveal melanomas and the associations between SWEI and clinical and hemodynamic findings. Prospective, clinical study METHODS: Twelve patients with uveal melanomas, scheduled to undergo Ru-106 brachytherapy, were prospectively recruited from the Department of Ophthalmology of the University Hospital of Heraklion (September-December 2022). B-mode, hemodynamic and SWEI ultrasonography examinations were performed with the HiScan (OPTIKON 2000) and the LOGIQ E9 (GE Healthcare) sonographic systems, respectively. Differences in SWEI scores (kPa) between tumor (TS) and adjacent non-affected choroid (CS), as well as between TS and orbital fat (FS) were examined. Correlations between SWEI and intra-tumoral hemodynamic parameters, including peak systolic and end diastolic velocities and resistivity index (RI) were also examined. TS was significantly correlated with intra-tumoral RI (Pearson's bivariate correlation coefficient 0.681, p=0.015) and with maximal tumor height (Pearson's bivariate correlation coefficient 0.620, p=0.031). TS was significantly higher than both FS and CS scores (paired-samples t-test, p=0.003 and p=0.006, respectively). SWEI score is applicable as a quantitative biomechanical marker in the assessment of choroidal melanoma. Choroidal melanomas are stiffer than both adjacent choroid and orbital fat. Moreover, choroidal melanomas with higher RI as well as those with higher apical elevations display higher SWEI scores.

Performance evaluation of the 3D-ring cadmium–zinc–telluride (CZT) StarGuide system according to the NEMA NU 1-2018 standard

BackgroundThe application of semi-conductor detectors such as cadmium–zinc–telluride (CZT) in nuclear medicine improves extrinsic energy resolution and count sensitivity due to the direct conversion of gamma photons into electric signals. A 3D-ring pixelated CZT system named StarGuide was recently developed and implemented by GE HealthCare for SPECT acquisition. The system consists of 12 detector columns with seven modules of 16 × 16 CZT pixelated crystals, each with an integrated parallel-hole tungsten collimator. The axial coverage is 27.5 cm. The detector thickness is 7.25 mm, which allows acquisitions in the energy range [40–279] keV. Since there is currently no performance characterization specific to 3D-ring CZT SPECT systems, the National Electrical Manufacturers Association (NEMA) NU 1-2018 clinical standard can be tailored to these cameras. The aim of this study was to evaluate the performance of the SPECT/CT StarGuide system according to the NEMA NU 1-2018 clinical standard specifically adapted to characterize the new 3D-ring CZT.ResultsDue to the integrated collimator, the system geometry and the pixelated nature of the detector, some NEMA tests have been adapted to the features of the system. The extrinsic measured energy resolution was about 5–6% for the tested isotopes (99mTc, 123I and 57Co); the maximum count rate was 760 kcps and the observed count rate at 20% loss was 917 kcps. The system spatial resolution in air extrapolated at 10 cm with 99mTc was 7.2 mm, while the SPECT spatial resolutions with scatter were 4.2, 3.7 and 3.6 mm in a central, radial and tangential direction respectively. Single head sensitivity value for 99mTc was 97 cps/MBq; with 12 detector columns, the system volumetric sensitivity reached 520 kcps MBq−1 cc−1.ConclusionsThe performance tests of the StarGuide can be performed according to the NEMA NU 1-2018 standard with some adaptations. The system has shown promising results, particularly in terms of energy resolution, spatial resolution and volumetric sensitivity, potentially leading to higher quality clinical images.

A Comparative Study of Commercially Available Ultrasound Contrast Agents for Sub-harmonic-Aided Pressure Estimation (SHAPE) in a Bladder Phantom

ObjectiveThe goal of this study was to evaluate the performance of different commercial ultrasound contrast microbubbles (MBs) when measuring bladder phantom pressure with sub-harmonic-aided pressure estimation (SHAPE) methodology. We hypothesized that SHAPE performance is dependent on MB formulation. This study aimed to advance the SHAPE application for bladder pressure measurements in humans. MethodsUsing a previously designed and built bladder phantom, we tested four different commercial agents: Definity, Lumason, Sonazoid and Optison. A standard clinical cystometrogram (CMG) system was used to infuse a MB–saline mixture into the bladder phantom to measure pressure. Ultrasound imaging was performed using the GE Healthcare LOGIQ E10 scanner. ResultsAll agents showed a predicted inverse linear relationship between change in pressure and SHAPE signal. However, they differ from each other in terms of stability, linear correlation, sensitivity to pressure and error. Generally, Definity and Lumason showed the highest performance during the SHAPE-based bladder phantom pressure assessments. ConclusionOur results show that the SHAPE signal decreases as bladder phantom pressures increases, regardless of the agent or CMG phase, suggesting the possibility of using SHAPE for measuring bladder pressure without a catheter. However, the efficacy of SHAPE in measuring pressure varies by MB formulation. These observations support using Lumason and Definity in a human subject feasibility study as we advance toward a catheter-free solution for measuring voiding bladder pressure via SHAPE.

Artificial intelligence-derived left ventricular strain in echocardiography in patients treated with chemotherapy

Global longitudinal strain (GLS) is an echocardiographic measure to detect chemotherapy-related cardiovascular dysfunction. However, its limited availability and the needed expertise may restrict its generalization. Artificial intelligence (AI)-based GLS might overcome these challenges. Our aims are to explore the agreements between AI-based GLS and conventional GLS, and to assess whether the agreements were influenced by expertise levels, cardiac remodeling and cardiovascular diseases/risks. Echocardiographic images in the apical four-chamber view of left ventricle were retrospectively analyzed based on AI-based GLS in patients treated with chemotherapy, and correlation between AI-based GLS (Caas Qardia, Pie Medical Imaging) and conventional GLS (Vivid E9/VividE95, GE Healthcare) were assessed. The agreement between unexperienced physicians (“GLS beginner”) and experienced echocardiographer were also assessed. Among 94 patients (mean age 69 ± 12 years, 73% female), mean left ventricular ejection fraction was 64 ± 6%, 14% of patients had left ventricular hypertrophy, and 21% had left atrial enlargement. Mean GLS was − 15.9 ± 3.4% and − 19.0 ± 3.7% for the AI and conventional method, respectively. There was a moderate correlation between these methods (rho = 0.74; p < 0.01), and bias was − 3.1% (95% limits of agreement: -8.1 to 2.0). The reproducibility between GLS beginner and an experienced echocardiographer was numerically better in the AI method than the conventional method (inter-observer agreement = 0.82 vs. 0.68). The agreements were consistent across abnormal cardiac structure and function categories (p-for-interaction > 0.10). In patients treated with chemotherapy. AI-based GLS was moderately correlated with conventional GLS and provided a numerically better reproducibility compared with conventional GLS, regardless of different levels of expertise.

End-Tidal Control Versus Manual Control of Inhalational Anesthesia Delivery: A Randomized Controlled Noninferiority Trial.

Precise anesthesia delivery helps ensure amnesia, analgesia, and immobility. Conventionally, the end-tidal anesthetic concentration is maintained through manual adjustment of the fresh gas flow and anesthetic vaporizer output. Some anesthesia delivery systems can deliver and maintain clinician-selected end-tidal anesthetic agent (EtAA) concentration using a modified closed-loop system. We evaluated the performance of an End-tidal Control (EtC) system on the Aisys CS 2 anesthesia machine (GE HealthCare). We hypothesized EtC anesthetic delivery would be noninferior to manually controlled anesthetic delivery. The Multi-site Anesthesia randomized controlled STudy of End-tidal control compared to conventional Results (MASTER) Trial evaluated anesthetic delivery in 210 adult patients receiving inhaled anesthesia. Patients were randomized to either EtC or manual control (MC) anesthetic delivery. The primary objective was to determine whether, compared to conventional anesthesia practice, EtC achieves and maintains clinician-specified EtAA and end-tidal oxygen (Et o2 ) concentrations within defined noninferiority limits. Noninferiority was concluded if the lower limit of the 95% confidence interval (CI) of the difference between the percent duration within the acceptable range (5% of steady state or a margin of ~10% of each agent's minimum alveolar concentration) for EtC and MC was ≥ -5% for both EtAA and Et o2 . Secondary objectives included performance measures: response time: time required to attain 90% of the first desired EtAA, overshoot: amount the controller (or vaporizer delivery) exceeded the desired EtAA, and accuracy: average deviation from the desired EtAA. EtC achieved and sustained targeted EtAA and Et o2 concentrations within the noninferiority threshold. The EtAA was within 5% of the desired value 98% ± 2.05% of the time with EtC compared to 45.7% ± 31.7% of the time with MC (difference 52.3% [95% CI, 45.9%-58.6%], P < .0001). For Et o2 , EtC was within the noninferiority limit 86.3% ± 22.8% of the time compared with MC at 41% ± 33.3% ( P < .0001, difference 45.3% [95% CI, 36.1%-54.5%]). The median response time for achieving 90% of the initial EtAA desired value was 75 seconds with EtC and 158 seconds with MC ( P = .0013). EtC exhibited a median overshoot of 6.64% of the selected EtAA concentration, whereas MC often failed to reach the clinician's desired value. The difference in median percent deviation from desired EtAA value was 15.7% ([95% CI, 13.5%-19.0%], P < 0001). EtC achieves and maintains the EtAA and Et o2 concentration in a manner that is noninferior to manually controlled anesthesia delivery.

Task-based image quality assessment of an intraoperative CBCT for spine surgery compared with conventional CT

Purpose:To analyze the image quality of a novel, state-of-the art platform for CBCT image-guided spine surgery, focusing particularly on the dose–effectiveness compared with conventional CT (the gold standard for postoperative assessment). Methods:The ClarifEye platform (Philips Healthcare) with integrated augmented-reality surgical navigation, has been compared with a GE Revolution CT (GE Healthcare). The 3D spatial resolution (TTF) and noise (NPS) were evaluated considering relevant feature contrasts (200–900 HU) and background noise for differently sized patients (200–300 mm water-equivalent diameter). These measures were used to determine the noise equivalent quanta (NEQ) and observer model detectability. Results:The CBCT system exhibited a linear response with 50% TTF at 5.7 cycles/cm (10% TTF at 9.2 cycles/cm), and the axial noise power peaking at about 3.6 cycles/cm (average frequency of 4.1 cycles/cm). The noise magnitude and texture differed markedly compared to iteratively reconstructed CT images (GE ASiR-V). The CBCT system had 26% lower detectability for a high-frequency task (related to edge detection) compared with CT images reconstructed using the Bone kernel combined with ASiR-V 50%. Likewise, it had 18% lower detectability for low- and mid-frequency tasks compared with CT images reconstructed using the Standard kernel. This difference translates to 50%–80% higher CBCT imaging doses required to match the CT image quality. Conclusions:The ClarifEye platform demonstrates intraoperative CBCT-imaging capabilities that under certain circumstances are comparable with conventional CT. However, due to limited dose–effectiveness, a trade-off between timeliness and radiation exposure must be considered if end-of-procedure CBCT is to replace postoperative CT.

The utility of virtual monochromatic dual-energy computed tomography (DECT) in meniscal imaging: a technical evaluation.

To determine the feasibility of meniscal imaging using virtual monochromatic images obtained through dualenergy computed tomography (DECT) technique, and to determine which keV levels optimise contrast resolution. All DECT exams were performed on a Discovery CT750 HD system from GE Healthcare. Virtual monochromatic images were reconstructed at 40 keV, 73 keV, 106 keV, and 139 keV. Contrast resolution of the medial and lateral menisci using a 5-point Likert scale at each keV level was determined through a consensus agreement by 2 fellowship-trained musculoskeletal radiologists. Friedman's and Wilcoxon signed rank tests were used to compare visualisation scores across different keV levels. Seventeen knee exams from 10 patients met criteria for inclusion in the study. All patients included in the study cohort were male. The median age of patients was 46 years (interquartile range, 35-53 years). Virtual monochromatic images at 40 keV demonstrated highest contrast resolution of the menisci, with a statistically significant difference between contrast resolution scores at 40 keV and 76 keV, Friedman test: p < 0.0001. Meniscal imaging is feasible using DECT virtual monochromatic images at low keV levels. Improved contrast resolution at these specified KeV values could pave the way for further research in this field to determine its role in the future as an alternative option for assessment of the menisci in patients with contraindications to MRI or in the setting of a periarticular ferromagnetic foreign body obscuring the field of view.

P-761 Four-dimensional ultrasound using an electronic probe to guide embryo transfer: a feasibility study

Abstract Study question Is four-dimensional ultrasound (4D-US) guided embryo transfer feasible and safe? Summary answer 4D trans-abdominal US with electronic probe is feasible and safe and justifies a formal study for non-inferiority to two-dimensional ultrasound (2D-US) for embryo transfer guidance. What is known already The use of 2D-US to guide embryo transfer is the usual procedure (Eshre/ASRM guidelines, evidence A), and investigations of the benefits of 3D and 4D-US have been inconclusive. 3D-US can locate the embryo flash in the coronal plane immediately after performing embryo transfer but furnishes only retrospective information. 4D-US requires two operators at transfer, and there has been slow image acquisition and poor image quality, not allowing satisfactory comparison of accuracy and precision with other methods. Study design, size, duration Using a high-end ultrasound device (Voluson E10, GE Healthcare, Zipf, Austria) with an electronic 3D-4D probe (eM6C G2), a prospective observational trial with 29 women undergoing mock embryo transfer in a private infertility clinic was performed between October 2023 and January 2024. Exclusion of subjects included BMI greater than 35 (3 cases) and an intramural myoma that impeded 4D-US visualization (3 cases). Participants/materials, setting, methods Two operators expert in U/S performed each procedure. Electronic probe settings were adapted for each subject. To simulate the embryo transfer, a Wallace catheter containing air and fluid was inserted and monitored transabdominally by 4D-US using the electronic probe. The catheter was observed until it reached 1 cm from the fundus and the embryo flash (bubble) identified. Entrance through the cervix was controlled by 2D and 4D. Main results and the role of chance The following variables were recorded: age, BMI, cycle day, use of hormones, endometrial thickness, position of the uterus, presence of fibroids, image quality, difficulty of entrance, visualization of the cervix. The 23 subjects had the following characteristics: mean age 39±6.4, BMI 24.14±4.4. Image quality was optimal in 18 patients and due to a retroverted uterus was suboptimal in 5 subjects. Cannulation of the cervix was difficult in 1. Eight patients were on birth control pills and 15 were on day 6-10 of spontaneous cycles. The mean endometrial thickness was 7.13±3mm. Mean hysterometry was 7.10±0.9mm. Visualization of the cervix with 4D-US was good in 12 subjects, fair in 7 and poor in 4. Visualization of the catheter in the cavity with 4D-US was good in 16 subjects, fair in 2 and poor in 5. The embryo flash was adequately visualized by 4D-US in 18 subjects and less well in 5. Catheter position was correctly identified by comparison 3D-US in 20/23 subjects. There were no adverse effects during or following the procedure. Limitations, reasons for caution Patients with poor image quality, due to obesity, retroverted uterus or fibroids, are not candidates for this technique. The need for two operators limits the practicability of the procedure, increasing the need to show its superiority over the usual practice before it could be adopted clinically. Wider implications of the findings 4D-US for embryo placement is feasible and safe. Studies that compare the accuracy and precision of 4D-US vs 2D-US to guide embryo transfer and the cost/benefit ratio of 4D ultrasound guided embryo transfer are in order.. Trial registration number not applicable for non-clinical trials

Contrast-enhanced mammography versus conventional imaging in women recalled from breast cancer screening (RACER trial): a multicentre, open-label, randomised controlled clinical trial

Women recalled from breast cancer screening receive post-screening work-up in the hospital with conventional breast imaging. The RACER trial aimed to study whether contrast-enhanced mammography (CEM) as primary imaging instead of conventional imaging resulted in more accurate and efficient diagnostic work-up in recalled women. In this randomised, controlled trial (registered under NL6413/NTR6589) participants were allocated using deterministic minimisation to CEM or conventional imaging as a primary work-up tool in two general and two academic hospitals. Predefined patients' factors were reason for recall, BI-RADS score, and study centre. Primary outcomes were sensitivity and specificity. Secondary outcomes were the proportion of women needing supplemental examinations, and number of days until diagnosis. Between April, 2018, and September, 2021, 529 patients recalled from the Dutch screening program were randomised, 265 to conventional imaging and 264 to CEM. Three patients in the control arm had to be excluded from analysis due to a protocol breach. After the entire work-up, sensitivity was 98.0% (95% CI; 92.2-99.7%) in the intervention arm and 97.7% (91.8-99.6%) in the control arm (p=1.0), and specificity was 75.6% (72.5-76.6%) and 75.4% (72.5-76.4%, p=1.0), respectively. Based on only primary full-field digital mammography/digital breast tomosynthesis or CEM, final diagnosis was reached in 27.7% (73/264) in the intervention arm and 1.1% (3/262) in the control arm. The frequency of supplemental imaging was significantly higher in the control arm (p<0.0001). Median time needed to reach final diagnosis was comparable: 1 day (control arm: IQR 0-4; intervention arm: IQR 0-3). Thirteen malignant occult lesions were detected using CEM, versus three using conventional imaging. No serious adverse events occurred. Diagnostic accuracy of CEM in the work-up of recalled women is comparable with conventional imaging. However, work-up with CEM as primary imaging is a more efficient pathway. ZonMw (grant number 843001801) and GE Healthcare.

P-624 Description of antral follicle count in a population of healthy French women based on age, ultrasound technique, and clinical factors

Abstract Study question How is the age-specific reference range for antral follicle count in healthy French women correlated with clinical markers ? Summary answer AFC declines linearly with age is correlated with weight, hormonal contraception, cycles duration, but not BMI, smoking or infertility history. What is known already AFC is related to the number of primordial follicles within the ovaries and is a widely used marker for baseline assessment of ovarian reserve, but there are no standardized norms for AFC, and major differences between the nomograms published in recent years notably due to the improvement of ultrasound techniques. Moreover, most published data are based on infertile women. Several factors are postulated to have influence on AFC of which ethnic origin, yet the largest cohorts published recently are Asian and therefore do not apply to a Caucasian population. Study design, size, duration In this retrospective study we used data from 640 women who had undergone a Fertility Check Up in our center, from 2018 to 2023. This concept, unique in France, offers all women of reproductive age who wish to undergo a complete ultrasound examination to check for infertility risk factors, whatever their parental plans. Participants/materials, setting, methods 640 healthy French women undergoing a Fertility Check Up were recruited. All participants completed a questionnaire about demographics, medical and surgical history, obstetrical records, familial medical history and any usage of hormonal contraception. AFC was conducted via transvaginal ultrasound using a three-dimensional acquisition, by one of three trained operators, utilizing a Voluson E10 ultrasound machine (GE Healthcare). Operators employed either the sonoAVC option (semi-automatic technique) or a manual two-dimensional counting of the acquired 3D-dimensional volume. Main results and the role of chance The distribution of AFC by age were modelized by a numerical and a graphic nomograms. AFC demonstrated a linear decline with a decrease of 1.11 follicle (IC95% 0.98 - 1.24) per year of age. Age accounted for 12.5% of the variation (R2) in AFC. Linear regression analysis showed a significant negative correlation between AFC and women’s weight (p = 0.02), but not with BMI (p = 0.23), and a significant impact of hormonal contraception (p = 0.001), with an overall reduction of 6.6 follicles in AFC compared with the women without any hormonal contraception (IC95% 4.6 - 8.6). Short menstrual cycles were associated with lower AFC (p &amp;lt; 0.001), when long cycles and amenorrhea were significantly associated with higher AFC (p &amp;lt; 0.01). There was no impact of age of menarche, smoking, family history of POI, or of a history of infertility of more than one year. Multivariate analysis showed that AFC was significantly higher with 3D-manual versus automated-3D follicular counting, the difference averaged 3.59 follicles, reducing as AFCs became smaller. Limitations, reasons for caution We present data from Caucasian women using our ultrasound machines, but in practice, each sonographer must familiarize himself with the capabilities of his own machine. Furthermore, our study does not answer the question of AFC evolution over time, for a given patient. Wider implications of the findings Some questions remain unanswered, including the longitudinal trajectory of AFC within an individual and the impact of ethnic origin. Future longitudinal studies reporting the evolution of AFC with age and involving women of diverse ethnic backgrounds are needed. Ultimately, this study highlights the impact of ultrasound equipment and technique. Trial registration number Not applicable

Preliminary protocol for measuring the reproducibility and accuracy of flow values on digital PET/CT systems in [15O]H2O myocardial perfusion imaging using a flow phantom

BackgroundSeveral factors may decrease the accuracy of quantitative PET myocardial perfusion imaging (MPI). It is therefore essential to ensure that myocardial blood flow (MBF) values are reproducible and accurate, and to design systematic protocols to achieve this. Until now, no systematic phantom protocols have been available to assess the technical factors affecting measurement accuracy and reproducibility in MPI.Materials and methodsWe implemented a standard measurement protocol, which applies a flow phantom in order to compare image-derived flow values with respect to a ground truth flow value with [15O]H2O MPI performed on both a Discovery MI (DMI-20, GE Healthcare) and a Biograph Vision 600 (Vision-600, Siemens Healthineers) system. Both systems have automatic [15O]H2O radio water generators (Hidex Oy) individually installed, allowing us to also study the differences occurring due to two different bolus delivery systems. To investigate the technical factors contributing to the modelled flow values, we extracted the [15O]H2O bolus profiles, the flow values from the kinetic modeling (Qin and Qout), and finally calculated their differences between test-retest measurements on both systems.ResultsThe measurements performed on the DMI-20 system produced Qin and Qout values corresponging to each other as well as to the reference flow value across all test-retest measurements. The repeatability differences on DMI-20 were 2.1% ± 2.6% and 3.3% ± 4.1% for Qin and Qout, respectively. On Vision-600 they were 10% ± 8.4% and 11% ± 10% for Qin and Qout, respectively. The measurements performed on the Vision-600 system showed more variation between Qin and Qout values across test-retest measurements and exceeded 15% difference in 7/24 of the measurements.ConclusionsA preliminary protocol for measuring the accuracy and reproducibility of flow values in [15O]H2O MPI between digital PET/CT systems was assessed. The test-retest reproducibility falls below 15% in majority of the measurements conducted between two individual injector systems and two digital PET/CT systems. This study highlights the importance of implementing a standardized bolus injection and delivery protocol and importance of assessing technical factors affecting flow value reproducibility, which should be carefully investigated in a multi-center setting.

Salivary Gland Scintigraphy in Sjögren's Syndrome: A Retrospective Study of Diagnostic Accuracy and Correlation With Histological and Immunological Biomarkers.

Introduction Sicca syndrome, characterized by xerophthalmia and xerostomia, is associated with various autoimmune and non-autoimmune conditions, posing diagnostic challenges. Sjögren's syndrome (SS) is the most prevalent systemic autoimmune disease linked to sicca symptoms. This study evaluates the diagnostic accuracy of salivary gland scintigraphy (SGS) in distinguishing SS from non-Sjögren's sicca conditions, alongside other diagnostic tests. Methods A retrospective analysis was conducted at Hospital Universitario La Paz from December 2019 to March 2023, including 142 patients diagnosed with sicca syndrome. Correlations between qualitative and quantitative SGS data (GE Healthcare, Chicago, Illinois) and multiparametric sicca evaluations were assessed. Results Among the 142 patients, 84 (59.15%) were classified as having SS, with 55 (65.48%) seropositive for anti-Ro antibodies. Abnormal SGS results were found in 135 (95.07%) patients. Qualitative SGS categorized seven (4.93%) as mild, 53 (37.32%) as moderate, 50 (35.21%) as severe, and 21 (14.79%) as functionally annulled. Moderate or worse impairment had a sensitivity of 0.88 and a specificity of 0.17. Functional annulment had a sensitivity of 0.17 and a specificity of 0.97. Quantitative SGS using ejection fraction thresholds of ≤30% and ≤20% had sensitivities of 0.35 and 0.18 and specificities of 0.84 and 0.94, respectively. Quantitative SGS metrics correlated with unstimulated whole salivary flow (WUSF; 0.243; p=0.003) and inversely with lymphocytic infiltration (-0.281; p=0.001). The 2016 American College of Rheumatology/European League Against Rheumatism (ACR-EULAR) classification criteria for Sjögren's syndrome demonstrated an area under the curve (AUC) of 0.932, which improved to 0.951 with the inclusion of SGS parameters. Conclusions SGS is a significant diagnostic tool in the multiparametric evaluation of sicca syndrome, showing strong correlations with histological and immunological markers. Its integration into diagnostic criteria enhances the differentiation between SS and non-Sjögren's sicca conditions, suggesting its potential inclusion in future classification frameworks.

Fetal 24-Segment Sphericity Index and Ventricular Fractional Shortening Between 12 and 20 Weeks of Gestation.

Although the fetal sphericity index (SI) and fractional shortening (FS) of 24 transverse segments have been previously reported after the 20th gestational week, there have been no reports during the first and early second trimester. This study aimed to clarify the SI and FS of 24 transverse segments in normal fetuses before the 20th gestational week. A total of 101 normal fetuses aged between 12 and 20 gestational weeks were examined. The displacement of the ventricular endocardium during the cardiac cycle was computed using speckle-tracking software (GE Healthcare, Milwaukee, WI). We analyzed the length of 24 end-diastolic lateral segments and the end-diastolic basal (seg1-6)- middle (Seg7-15)-apical (Seg16-24) distribution from the base to the apex of each ventricle, according to the method described by DeVore et al. The SI and FS were computed for each of the 24 segments by dividing the mid-basal-apical length by the transverse size. The SI for each segment was independent of the gestational age. The SI of the right ventricle was significantly lower than that of the left ventricle for segments 1-14, suggesting that the right ventricle was more spherical than the left ventricle in the basal segment only. The FS of the right ventricle was significantly lower than that of the left ventricle in segments 1 to 2 and 13 to 24. The morphology of the ventricles before 20 weeks of gestation differs from that between 20 and 40 weeks of gestation. This difference may be related to myocardial densification or performance.