GE Logiq Research Articles

Evaluation of liver stiffness by 2D-SWE in combination with non-invasive parameters as predictors for esophageal varices in patients with advanced chronic liver disease

Background/aims: Esophageal varices (EV) are common complications in patients with advanced chronic liver disease (ACLD). Non-invasive parameters to exclude EV in patients with ACLD would be desirable. The aim of this study was the evaluation of liver stiffness measurement (LSM) using 2D-shear wave elastography (GE Logiq E9) and other non-invasive parameters as predictors for EV.Methods: Hundred patients with ACLD were enrolled. Abdominal sonography, including measurement of gall bladder wall thickness (GBWT), spleen diameter and LSM, gastroscopy and blood test results were evaluated. Statistical analyses were performed for the association between EV and non-invasive parameters.Results: Fifty-one per cent of the patients had EV. The mean LSM (14.6 kPa) and GBWT (3.88 mm) in the group with EV were significantly higher than in the group without EV (10.6 kPa; 2.94 mm; p < .01). Performing area under the receiver operating characteristic curve, LSM has a better diagnostic performance (0.781) than GBWT (0.707), spleen diameter (0.672) and platelet count (0.635). Combining LSM (cut-off 13.58 kPa) and GBWT (cut-off 3.07 mm) resulted in a sensitivity of 86.3% and a specificity of 71.4% for the presence of EV. A sensitivity of 100% (negative predictive value 1.0) was achieved at LSM >9 kPa or GBWT >4 mm. Following these criteria in our current study population, 18% of the gastroscopies could have been avoided.Conclusions: Combining LSM with non-invasive parameters, especially GBWT, improves the diagnostic accuracy for predicting EV. We suggest reconsidering screening gastroscopy in patients with ACLD who show LSM <9 kPa and GBWT <4 mm due to the very low risk of having varices.

Interpretability and generalizability of a one-dimensional convolutional neural network method for hepatic steatosis characterization

Nonalcoholic fatty liver disease (NAFLD) affects 25% of the population globally. We developed a one-dimensional convolutional neural network (1-D CNN) method for the ultrasound tissue characterization using radio-frequency (RF) data and demonstrated its potential for the liver fat classification and quantification. We investigate herein the interpretability and generalizability of the method to understand why it works, and whether the performance is affected by settings, transducers, and platforms. We studied under various conditions the performances of 1-D CNN for predicting steatosis using magnetic resonance imaging-estimated proton density fat fraction (MRI-PDFF) as reference (steatosis: PDFF > 5%). Three datasets were used, each containing ultrasound RF data acquired from adults and same-day MRI-PDFF estimates: (1) 200 normal and NAFLD participants scanned using the Siemens S2000 ultrasound system with the 4C1 transducer (1–4 MHz); (2) 87 participants with known/suspected NAFLD scanned using Siemens S3000 with the 4C1 and/or 6C1HD transducers (1.5–6 MHz); and (3) 46 participants with known/suspected NAFLD scanned using GE Logiq e9 with the C1-6 transducer (1–6 MHz). The 1-D CNN method is generalizable among various instrumentation settings (e.g., focal depth, time gain compensation), betweentransducers of similar frequencies, between platforms, but not between the fundamental and tissue harmonic image modes. [Work supported by R01DK106419.] Nonalcoholic fatty liver disease (NAFLD) affects 25% of the population globally. We developed a one-dimensional convolutional neural network (1-D CNN) method for the ultrasound tissue characterization using radio-frequency (RF) data and demonstrated its potential for the liver fat classification and quantification. We investigate herein the interpretability and generalizability of the method to understand why it works, and whether the performance is affected by settings, transducers, and platforms. We studied under various conditions the performances of 1-D CNN for predicting steatosis using magnetic resonance imaging-estimated proton density fat fraction (MRI-PDFF) as reference (steatosis: PDFF > 5%). Three datasets were used, each containing ultrasound RF data acquired from adults and same-day MRI-PDFF estimates: (1) 200 normal and NAFLD participants scanned using the Siemens S2000 ultrasound system with the 4C1 transducer (1–4 MHz); (2) 87 participants with known/suspected NAFLD scanned using Siemens ...

Ultrasound scan in planning surgery for cutaneous melanoma of the extremities

We performed a retrospective analysis of ultrasound scans in 42 patients with cutaneous melanoma of the extremities in planning the closure of skin defects with skin fascial island flaps supplied by perforating vessels. First, the primary melanoma focus was scanned by ultrasound to reveal characteristics of the skin, tumor and adjacent tissues. Then we detected perforating vessels to mark them and to select the sites for the island flaps. Ultrasound examination was performed using the IU 22 PHILIPS, GE Logiq E9 and Supersonic imagine AIxPLORER MultiWave Systems with linear multi-frequency sensors (517 MHz) in the B-mode, color and power Doppler to visualize the blood flow. We clarified the criteria of the necessary and sufficient parameters according to Doppler ultrasound visualization for surgical treatment of cutaneous melanoma of the extremities by the suggested method in preoperative period, as well as monitoring of the flap state after surgery. The transfer of flaps on perforating vessels did not cause blood flow disorders in them: the mean arterial blood flow velocity was 13.1 ± 4.7 cm/sec before surgery and 12.8 ± 5.4 cm/sec after it. The maximal venous flow velocity was on average 7.0 ± 1.3 cm/sec before surgery and 6.2 ± 0.8 cm/sec after it. Thus, triplex ultrasound significantly facilitates the selection and individual design of the flap with the inclusion of feeding vessels of sufficient potential, helps in planning the operation, reduces the risk of failure and improves the results of treatment. This method contributes to the radicalization of surgical intervention with a simultaneous decrease in the risk of postoperative complications and acceleration of medical and social rehabilitation of patients.

EchoScopy in scanning abdominal diseases; a prospective single center study.

The introduction of a new type of small handheld ultrasound device brings greater portability and affordability in a different setting. The basic ultrasound approach with these handheld devices has been defined by European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) as "EchoScopy". The current study aimed to assess the image quality, indications and limitations of a portable pocket "EchoScopy" performed first compared with a high-end ultrasound system (second) in abdominal diseases. Three hundred consecutive patients (158 males and 142 females, age 55±19 [18-96]) years) were included. The ultrasound examinations were performed firstly by an EchoScope (Vscan™ Dual Probe) and secondly with a high-end ultrasound system (HEUS, GE Logiq E9). Compared with the always excellent image quality using HEUS, the image quality of the EchoScope was graded as good, sufficient or non-sufficient. Out of all 300 patients, 221 had focal lesions, 31 patients were found with diffuse pathological findings, 20 with ascites, 25 after liver puncture and 45 without any pathological findings. The image quality of the pocket device was considered as being good or sufficient to delineate the pathology in 265/300 (88%). The detection rate of the EchoScope for abdominal focal lesion was 172/221 (78%). The higher frequency of the Dual Probe was helpful in 35/300 (12%). EchoScopy has proven to display sufficient image quality to answer specific questions, e.g., detection of ascites, splenomegaly, bile duct enlargement, hydronephrosis and other pathological findings which can be judged by "yes/no".

Ultrasound Study of First Trimester Bleeding

Objective: Bleeding during the first trimester of pregnancy is common and can be a sign of complication that often necessitates obstetric ultrasound for the assessment of the haemorrhage, and of fetal well being. The aim of this study was to determine the causes of first trimester bleeding on obstetrical ultrasound in our area. Method: It was a cross-sectional descriptive study during a six-month period from May to October 2017. All women who referred to the Regional center of medical imaging of Ngaoundere who agreed to participate in the study with first trimester bleeding were evaluated with clinical history and ultrasonography (US). Ultrasonographic exam was done via transabdominal or endovaginal approaches using GE LOGIQ 7 scanner brand. Microsoft Office Excel 2010 and SPHINX V 4.0 were used for data analysis. Results: A total of 121 of pregnant women who presented vaginal bleeding during the first trimester were enrolled into the study. These Ultrasound examinations represented 37.93% of all obstetric ultrasounds in the first trimester. The patients in this study ranged in age from 16 to 47 years with an average of 30 years. 50 (41.32%) were pregnant for the first time and 24 (19.83%) were primiparous. Mean gestational age was 9 weeks with the extremes of 5 and 12 weeks. 97 (80.2%) reported spontaneous bleeding while in 24 (18.8%) bleeding was mostly caused by sexual intercourse 11 (45.8%). Pelvic pain 91 (75.2%) was the most associated sign. 36 (29.8%) patients were diagnosed as threatened abortions. 27 (22.3%) were diagnosed with incomplete abortions. 4 (3.3%) cases showed an ectopic gestation. 9 (7.4%) cases showed complete abortions. Concordance between clinical diagnosis and ultrasound results was 84%. Conclusions: Bleeding in the first trimester of pregnancy is common in our area. Ultrasonography occupies a prominent place in the etiological diagnosis of bleeding in the first trimester of pregnancy; it is easy to find in most cases a responsible abnormality of bleeding.

Ultrasound elastography as a potential diagnostic aid in oral submucous fibrosis.

Background:Oral submucous fibrosis (OSMF) is a well-recognized “potentially malignant” disorder. It mostly affects the productive population of young adults and adolescents. The diagnosis of oral submucous fibrosis is primarily clinical and subjective. The only objective diagnostic method for OSMF is tissue biopsy. This study was conducted to find the potential use of ultrasound elastography to objectively quantify the clinical presentation in accordance with severity of the clinical condition in OSMF.Materials and Methods:The study sample consisted of 27 clinically diagnosed and staged participants with OSMF. Transcutaneous ultrasonography was done by a single operator on GE Logiq E9 machine with a 6–15 MHz linear matrix probe. Color-coded scheme was used to qualitatively grade the eight different zones of oral mucosa with the use of stress–strain elastography. The grades ranged from 0 to 5, where 0 represented artifacts and color range from red to blue corresponded to varying degree of increasing tissue stiffness. Clinical stage 1, 2, and 3 corresponded to mouth opening of >30 mm, 20–30 mm, and <20 mm, respectively. The summative elastography score range as follows: 8–10, 11–14, and ≥15 represented the respective degree of tissue stiffness from soft, mild stiff to severe stiff.Results:The results obtained by Pearson's correlation between the elastographic grading and clinical grading came out to be 0.007, and it was highly significant. The sensitivity and specificity of the diagnostic method were 90.9% and 20%, respectively.Conclusion:The advantages of ultrasound elastography as a diagnostic tool over the subjective clinical method of diagnosis and staging of OSMF looks promising. Further studies should be conducted with a suitable specific transducer probe and with quantitative diagnostic elastography method.

Passive hallux adduction decreases lateral plantar artery blood flow: a preliminary study of the potential influence of narrow toe box shoes

BackgroundBlood flow is essential in maintaining tissue health. Thus, compromised blood flow can prevent tissue healing. An adducted hallux, as seen inside a narrow shoe, may put passive tension on the abductor hallucis, compressing the lateral plantar artery into the calcaneus and restricting blood flow. The purposes of this study were to compare lateral plantar artery blood flow before and after passive hallux adduction and to compare blood flow with arch height.MethodsForty-five healthy volunteers (20 female, 25 male; age = 24.8 ± 6.8 yr; height = 1.7 ± 0.1 m; weight = 73.4 ± 13.5 kg) participated in this cross-over design study. Arch height index (AHI) was calculated, and blood flow measurements were obtained using ultrasound (L8-18i transducer, GE Logiq S8). The lateral plantar artery was imaged deep to abductor hallucis for 120 s: 60 s at rest, then 60 s of passive hallux adduction. Maximal passive hallux adduction was performed by applying pressure to the medial side of the hallux. Blood flow was calculated in mL/min, and pre-passive hallux adduction was compared to blood flow during passive hallux adduction.ResultsLog transformed data was used to run a paired t-test between the preadduction and postadduction blood flow. The volume of blood flow was 22.2% lower after passive hallux adduction compared to before (− 0.250 ± 0.063, p < 0.001). As AHI decreased, there was a greater negative change in blood flow. As baseline blood flow increased, there was also a greater negative change in blood flow.ConclusionsOur preliminary findings of decreased blood flow through passive hallux adduction indicate conditions that elicit passive hallux adduction (e.g. wearing narrow-toed shoes) may have important effects on foot blood flow. Individuals with lower AHI appear to have a greater risk of decreased blood flow with passive hallux adduction.

The anatomical relationship between the sural nerve and small saphenous vein: An ultrasound study of healthy participants.

Procedures involving the small saphenous vein (SSV) can result in sural nerve (SN) damage due to the proximity of the two structures. The relationship between the SN and SSV has previously been described in cadaveric studies with limited scope on surface landmarks. This study investigates the relationship between the SN and SSV in vivo through ultrasound. Transverse/short-axis ultrasound scans of 128 legs (64 healthy participants) were taken by a single observer using a GE Logiq e ultrasound system with a 5-13 Hz linear transducer (GE Logiq 12L-RS). The SN was identified and traced from the lateral malleolus to the popliteal fossa noting its course and proximity to the SSV. The distance between the SN and SSV was measured at points representing the distal 50% and 25% of the total leg length (the distance between the medial tibial condyle and the inferior edge of the medial malleolus). The SN and SSV were visualized in all participants regardless of BMI and atypical anatomical relationship were noted in 20.3%. The SN pierced the fascia in the distal 25.9% ± 5.3% of the total leg length. The distance between the SN and SSV was 4.06 ± 1.8 mm and 3.4 ± 1.4 mm in the distal 50% and 25% points of the total leg length, respectively. There was no significant effect of sex or body side. The SSV is a viable option for multiple vein harvest. Ultrasound visualization can be a beneficial tool for delineating variations of the SN in relation to SSV prior to surgery. Clin. Anat. 32:277-281, 2019. © 2018 Wiley Periodicals, Inc.

Investigating the time-lapsed effects of rigid cervical collars on the dimensions of the internal jugular vein.

Protocol advocates the use of rigid cervical collars (RCCs) in head trauma patients as they are at risk of concomitant cervical spine injury. Literature has shown RCCs to be a potential cause of venous outflow obstruction, changing internal jugular vein (IJV) cross-sectional area (CSA), and raising intracranial pressure (ICP). This study aims to investigate the effects of applying a RCC, for a period of four hours, on the dimensions of the IJV, in healthy participants. Seventeen participants (nine male, eight female) took part in this study. Circumference and CSAs of the IJV were measured bilaterally by a single observer using a GE LOGIQ e ultrasound system. Measurements were taken pre-RCC application, immediately after, every hour over four hours, and five minutes postcollar removal. The CSA of the IJV was 8.3 ±6.0 mm2 pre-RCC application. The CSA of the IJV doubled (18.92 ±10.55 mm2 ) after four hours and decreased back to 9.36 ±6.8 mm2 five minutes postcollar removal. The circumference of the IJV was 17.29 ±6.03 mm pre-RCC application, increasing to 20.34 ±5.59 mm by the end of the fourth hour and returning to 16.14 ±5.16 mm five minutes postcollar removal. Related-samples Friedman's ANOVA test showed statistically significant differences for both left and right CSAs and circumferences of the IJV measured across the four hours (P-value<0.05). Ultrasound assessment of CSA of the IJV may correlate with changes in ICP. Further studies may provide insight into the effects of collar design, and guide future trauma protocol to minimize intracranial pressure fluctuations. Clin. Anat. 32:196-200, 2019. © 2018 Wiley Periodicals, Inc.

169 Point-of-Care Ultrasound Diagnosis of Retrobulbar Hematoma in Cadaveric Models

Traumatic retrobulbar hematoma is an emergent condition which requires rapid diagnosis and immediate decompression to prevent vision loss. Ultrasound has been used in animal models, and numerous case reports have highlighted its use in the emergency medicine patient population. The objective of this study is to assess the ability of emergency medicine providers to diagnosis retrobulbar hematomas using point-of-care ultrasound. 20 cadaveric eyeballs were randomly selected to simulate a retrobulbar hematoma. 2-3cc of normal saline solution was injected through the medial aspect of the orbit directly into the retrobulbar space. Thirteen emergency medicine residents (each with <15 prior ocular scans), 1 Emergency Ultrasound fellow (>25 prior ocular scans) and 1 Emergency Ultrasound faculty (>25 prior ocular scans) participated in the study. The 4-12 MHz linear transducer on the GE logiq E was utilized. 4 of the 20 eyeballs had a retrobulbar hematoma. Point-of-care ultrasound had a sensitivity of 85% (95% CI 72.9 - 92.4), specificity of 89.1% (95% CI 84.3 - 92.6), positive predictive value of 66% (95% CI 54.4 - 76.3), and a negative predictive value of 95.9% (95% CI 92.2 - 98.0). Overall accuracy was 88.3%. The positive LR was 7.8 with a negative LR of 0.16. The Fisher's exact method calculated a 2-tailed P value of <0.0001. The average kappa measurement was 0.67 (95% 0.57 - 0.77). Individuals with >10 prior ocular scans had a sensitivity of 95% (95% CI 73.0 - 99.7). Emergency Ultrasound fellowship trained faculty had a sensitivity of 100%. Point-of-care ultrasound is a rapid, accurate imaging modality to diagnose retrobulbar hematomas. With additional ocular ultrasound experience, accuracy improves to near 100%.

Intra- and Inter-Observer Reproducibility of a 2-D Shear Wave Elastography Technique and the Impact of Ultrasound Experience in Achieving Reliable Data

The aim of the study described here was to evaluate the reproducibility of a new shear-wave elastography (SWE) technique, 2-D SWE.GE, and the impact of ultrasound experience in acquiring reliable measurements, as no official recommendations are available for this system. Elastographic measurements (EMs) were obtained in 60 patients using 2-D-SWE with the GE Logiq E9. Three examiners with different levels of experience in ultrasound-based elastography performed 10 valid EMs on each subject: a novice (C.P.) who had no experience in liver elastography and had performed fewer than 50 ultrasound examinations; an elastography expert (A.M.S.) who had more than 1 y of liver elastographic experience in four elastographic methods and had performed more than 1000 ultrasonography examinations; and an ultrasound expert (T.M.) who had no experience in liver elastography and had performed more than 1000 ultrasound examinations. Medians and interquartile ranges were calculated (m/s). We used the inter-class correlation coefficient and Bland–Altman plots with 95% lower and upper limits of agreement to assess the inter- and intra-observer reproducibility of 2-D-SWE.GE measurements. The final study group included 60 patients, 56.7% women and 43.3% men, with a mean age of 33.08 ± 13.83 y and mean body mass index of 22.85 ± 4.04 kg/m2. In this group, 73.3% were healthy volunteers and 26.7% had compensated liver cirrhosis. We did not find significant differences between EMs taken by the examiners overall and across study groups. The overall agreement between examiners was excellent: 0.915 (95% confidence interval [CI]: 0.870–0.946). The agreement between the novice and the experienced examiners, respectively, was good to excellent (novice and ultrasound expert: 0.908, 95% CI: 0.846–0.945; novice and elastography expert: 0.885, 95% CI: 0.808–0.931). The intra-observer reproducibility for each of the examiners was excellent; however, the inter-class correlation coefficients were higher for the examiners more experienced in elastography: 0.936 (95% CI: 0.896–0.963) versus 0.966 (95% CI: 0.943–0.980) versus 0.984 (95% CI: 0. 973–0.991). The good ICCs for the median values indicate that 2-D-SWE.GE is a reproducible method. Ultrasound experience did not significantly influence the results.

Does Shoulder Joint ROM Predict Medial Elbow Joint Space and UCL Thickness?

Baseball athletes, especially pitchers, are prone to ulnar collateral ligament (UCL) injuries of the elbow. It is well documented that baseball athletes typically exhibit an increase in shoulder external rotation range of motion (ERRM) and a decrease in internal rotation range of motion (IRRM) while maintaining total rotational range of motion (TROM) in the throwing extremity. Furthermore, loss of TROM and ERRM may be associated with increased risk for UCL injury. Ultrasound imaging allows clinicians to evaluate UCL thickness and medial joint space (MJS) opening non-invasively. PURPOSE: To examine if shoulder joint motion (ERRM, IRRM, TROM), predicts medial elbow joint space (MJS) opening and UCL thickness in asymptomatic collegiate baseball pitchers at the start of the pre-season. METHODS: Nineteen asymptomatic NCAA Division I collegiate baseball pitchers (age 20.4 ± 1.45 yrs) participated in this study. Ultrasound images were obtained of the medial joint space and UCL on the participant’s throwing arm using a GE LOGIQ e ultrasound unit. Participants were placed supine with a wedge placed underneath their pitching hand to maintain elbow position at 30 degrees. A 3 kg valgus force, as measured by a hand held dynamometer, was applied 20 cm distal to the medial epicondyle. Ligament thickness measurements were performed at the mid-substance of UCL and at the apex of the trochlea. Imaging measurements to evaluate MJS opening were performed from the apex of the trochlea to the apex of the ulna. Standard goniometric procedures were performed with the athlete supine to obtain ERRM, IRRM, and TROM values. Three stepwise linear multiple regression analyses were performed to determine if shoulder joint motion could predict UCL thickness and MJS. RESULTS: Shoulder joint range of motion did not significantly predict MJS [R2 = .05, F (2,16) = 0.44, p=0.65,], UCL thickness at the mid-substance [R2 = .01, F (2,16) = 0.12, p=0.89], or UCL thickness at the apex of the trochlea [R2 = .04, F (2, 16) = 0.36, p=0.70]. CONCLUSIONS: Measures of shoulder joint ROM do not predict MJS or UCL thickness in asymptomatic baseball pitchers at the start of the season. Further research is recommended to perform multiple imagining sessions throughout the competitive season to further evaluate relationships between shoulder ROM and medial elbow structures.

Influencing Factors of 2D Shear Wave Elastography of the Muscle - An Ex Vivo Animal Study.

ObjectiveTo evaluate measurement confounders on 2D shear wave elastography (2D-SWE) elastography of muscle.Materials and Methods Ex vivo , porcine muscle was examined with a GE LOGIQ E9 ultrasound machine with a 9 L linear (9 MHz) and C1-6 convex probe (operating at 2.5 or 6 MHz). The influence of different confounders on mean shear wave velocity (SWVmean) was analyzed: probes, pressure applied by probe, muscle orientation, together with the impact of different machine settings such as frequency, placement depth and size of region of interest (ROI). The mean of twelve repeated SWVmean measurements (m/s) and coefficient of variation (CV; standard deviation/mean in %) were assessed for each test configuration. ResultsReproducibility (CV) and maximum possible tissue depth of the linear probe were inferior to the convex probe. With the linear probe, there was a linear decrease of SWVmean with placement depth from 4.56 m/s to 1.81 m/s. A significant increase of SWVmean (p<0.001) was observed for larger ROI widths (range 3.96 m/s to 6.8 m/s). A change in the machine operation mode ('penetration' instead of 'general') led to a significant increase of SWVmean (p=0.04). SWVmean in the longitudinal direction of muscle was significantly higher than in cross section (p<0.001) (e. g. 4.56 m/s versus 3.42 m/s). An increase of linear probe pressure significantly increased muscle SWVmean from 5.29 m/s to 7.21 m/s (p<0.001).Conclusions2D-SWE of muscle is influenced by a wealth of parameters. Therefore, standardization of measurement is advisable before application in clinical research studies and routine patient assessment.

4:03 PM Abstract No. 218 Ultrasound to ultrasound fusion imaging with contrast-enhanced ultrasound during microwave ablation: feasibility study in a perfused porcine liver model

The purpose of the study is to test the feasibility of fusion of different phases of enhancement of intraprocedural contrast-enhanced ultrasound (CEUS) with real-time B mode ultrasound during microwave ablation in a machine-perfused porcine liver. Twelve, 4 cm (100 watt/5 minutes), microwave ablations were performed in four explanted perfused porcine livers, using the GE Logiq E9 with VNav platform, and the C 1-6 probe, enabling CEUS-Ultrasound fusion for guidance. Microbubbles were injected into the arterial and portal vasculature inflow of the perfused liver to display the macro- and micro-circulation with CEUS. A 7 cm sweep across the liver produced a volume set captured in the arterial phase (n = 6) or portal venous phase (n = 6) of contrast enhancement. This volumetric data set was then fused with the active real-time ultrasound image. A spherical marker circumscribing the region, determined to represent the “tumor” was placed. A portion of the encircled “tumor” volume is intentionally not ablated. Following ablation, a second bolus of ultrasound contrast is administered demonstrating continued perfusion of this region in the arterial phase. This volume is fused with real-time ultrasound to ablate this remaining enhanced area. Technical success was defined as the ability to fuse a volumetric image from one phase of the enhanced ultrasound or subsequent post-ablation CEUS with the active live ultrasound as well as the ability to localize the non-ablated, perfused area for additional ablation. 100% technical success was demonstrated. In all 12 ablations a region in the perfused liver was identified as a “target area” for ablation, seen during CEUS, and fused with the active ultrasound imaging to guide antenna placement. In all cases the post ablation CEUS, demonstrating remaining enhancement of the non-ablated region, was again fused with the active ultrasound image to redirect the antenna to this non-ablated tissue. This image fusion of different phases of CEUS with real-time ultrasound, using fusion/navigation, allows immediate evaluation of tumor perfusion and ablation for guidance with more complete tumor ablation.

A New Two-Dimensional Shear Wave Elastography for Noninvasive Assessment of Liver Fibrosis in Healthy Subjects and in Patients with Chronic Liver Disease.

To assess the performance of two-dimensional shear wave elastography (2D-SWE) on the GE LOGIQ E9 ultrasound system in a cohort of healthy subjects and to investigate its accuracy in the staging of liver fibrosis in patients with chronic liver disease (CLD) using liver biopsy as a reference standard. From October 2014 to June 2016, 54 healthy subjects and 174 patients with CLD were consecutively enrolled. Liver fibrosis stage was assessed by the METAVIR scoring system. 18 (10.3 %) and 17 (9.8 %) patients had advanced fibrosis and cirrhosis, respectively. The correlation of liver stiffness measurement (LSM) and continuous variable was assessed using the Spearman rank correlation. The accuracy of 2D-SWE was evaluated with areas under the receiver operating characteristics curves (AUROC). Reliable LSMs were obtained in all subjects. The interobserver agreement ICC was excellent: 0.847. In healthy subjects, gender, but not anthropometric and biochemical data, were correlated with LSM. In patients with CLD, LSM had a strong positive correlation with fibrosis stage (rho = 0.628; p > 0.001). The AUROC was 0.724 for mild fibrosis (F≥ 1), 0.857 for moderate fibrosis (F≥ 2), 0.946 for severe fibrosis (F≥ 3), and 0.935 for cirrhosis (F4). Likewise, good accuracy was observed in the HCV subgroup. The optimal cut-off value in differentiating healthy subjects from CLD patients with any fibrosis was 5.47 kPa with an AUROC of 0.875. 2D-SWE is a reliable and reproducible method to assess LSM with good diagnostic accuracy to assess liver fibrosis in patients with CLD.

Transabdominal Imaging of the Lumbar Spine with Portable Ultrasound

Abstract: Research investigating human transadominal ultrasound imaging of the intervertebral disc which first took place in the mid to late 1980’s, was limited by the technology of that time. Later transducer refinements, innovations in harmonic energy control and the digital change-over based on increasingly powerful computer platforms enabled progressive image enhancement with detailed imaging of deeper structures.&#x0D; With appropriate harmonic settings and probe selection, innovations in diagnostic ultrasound resolution now allow for more detailed anterior lumbar spine image capture even with portable machines.&#x0D; The images described in this paper may be the first published, high-resolution transabdominal images of the anterior lumbar spine captured with a portable ultrasound machine.&#x0D; Method: Using a both GE Logiq 9 with a 4C convex probe (1.5-4.5 MHz) and a GE Logiq E portable machine with a GE 4C-RS convex probe (2-5 MHz), transabdominal longitudinal and transverse paraspinal images of the lumbar spine were acquired in an asymptomatic subjects of normal body weight and habitus.&#x0D; Though the platform model offered somewhat higher resolution, the captured images obtained from the portable machine also demonstrated detailed anatomy of the anterior vertebral body and disc margin architecture. Transverse through images of the lumbar disc, spinal canal were also obtained, and as a side note the caudal nerve roots within the canal were also visualized.&#x0D; Conclusion: With careful machine settings and probe selection, detailed transabdominal lumbar spine image capture appears to be achievable even with a portable machines.

Repeatability of shear wave elastography in liver fibrosis phantoms-Evaluation of five different systems.

This study aimed to assess and validate the repeatability and agreement of quantitative elastography of novel shear wave methods on four individual tissue-mimicking liver fibrosis phantoms with different known Young’s modulus. We used GE Logiq E9 2D-SWE, Philips iU22 ARFI (pSWE), Samsung TS80A SWE (pSWE), Hitachi Ascendus (SWM) and Transient Elastography (TE). Two individual investigators performed all measurements non-continued and in parallel. The methods were evaluated for inter- and intraobserver variability by intraclass correlation, coefficient of variation and limits of agreement using the median elastography value. All systems used in this study provided high repeatability in quantitative measurements in a liver fibrosis phantom and excellent inter- and intraclass correlations. All four elastography platforms showed excellent intra-and interobserver agreement (interclass correlation 0.981–1.000 and intraclass correlation 0.987–1.000) and no significant difference in mean elasticity measurements for all systems, except for TE on phantom 4. All four liver fibrosis phantoms could be differentiated by quantitative elastography, by all platforms (p<0.001). In the Bland-Altman analysis the differences in measurements were larger for the phantoms with higher Young’s modulus. All platforms had a coefficient of variation in the range 0.00–0.21 for all four phantoms, equivalent to low variance and high repeatability.

Role of transperineal ultrasound in infective and inflammatory disorders.

Aims:To evaluate the role of transperineal ultrasound as screening tool in infective and inflammatory diseases of perianal region.Materials and Methods:Initially, clinical examination of the perineal region of patients (pts) for perianal external opening of tracts, swelling and tenderness is done. The perineal USG was performed using 2 -5 MHz sector probe and 7 -13 MHz linear probe on GE logiq P 5 ultrasound machine. Internal opening of any fistulous tract were described with clockwise position and tracts were traced upto their external opening and perifocal area were screened for any ramification. The Park et al. classification was used for classifying the tracts.Results:Out of 492 pts, 60 pts were normal, 257 pts had fistula, 114 pts had sinuses, 44 pts had only abscess without fistula or sinus and 17 pts had other pathologies with 95% sensitivity (Sn), 100% specificity (Sp) and Positive Predictive Value (PPV) and 95% Negative Predictive Value (NPV) for fistula and 94% Sn, 97% Sp, 89% PPV and 98% NPV for active sinuses and 98% Sp, 96% ppv and 100% NPV and Sn for abscesses.Conclusions:Transperineal Ultrasound should be performed as first line imaging modality for suspicion of low perianal fistula with high sensitivity, specificity, and negative predictive value at much lower cost and less time as compared to perineal MRI.

Interobserver Variation of the Bolus-and-Burst Method for Pancreatic Perfusion with Dynamic - Contrast-Enhanced Ultrasound.

Dynamic contrast-enhanced ultrasound (DCE-US) can be used for calculating organ perfusion. By combining bolus injection with burst replenishment, the actual mean transit time (MTT) can be estimated. Blood volume (BV) can be obtained by scaling the data to a vessel on the imaging plane. The study aim was to test interobserver agreement for repeated recordings using the same ultrasound scanner and agreement between results on two different scanner systems. Ten patients under evaluation for exocrine pancreatic failure were included. Each patient was scanned two times on a GE Logiq E9 scanner, by two different observers, and once on a Philips IU22 scanner, after a bolus of 1.5 ml Sonovue. A 60-second recording of contrast enhancement was performed before the burst and the scan continued for another 30 s for reperfusion. We performed data analysis using MATLAB-based DCE-US software. An artery in the same depth as the region of interest (ROI) was used for scaling. The measurements were compared using the intraclass correlation coefficient (ICC) and Bland Altman plots. The interobserver agreement on the Logiq E9 for MTT (ICC=0.83, confidence interval (CI) 0.46-0.96) was excellent. There was poor agreement for MTT between the Logiq E9 and the IU22 (ICC=-0.084, CI -0.68-0.58). The interobserver agreement for blood volume measurements was excellent on the Logiq E9 (ICC=0.9286, CI 0.7250-0.98) and between scanners (ICC=0.86, CI=0.50-0.97). Interobserver agreement was excellent using the same scanner for both parameters and between scanners for BV, but the comparison between two scanners did not yield acceptable agreement for MTT. This was probably due to incomplete bursting of bubbles in some of the recordings on the IU22.

Assessing UCL Width during Valgus Load for College Baseball Pitchers using Ultrasound Imaging

Injuries to the Ulnar Collateral Ligament (UCL) of the elbow are common in overhead throwing athletes. A repetitive valgus force during the throwing motion places significant stress on the UCL. More research needs to be conducted to investigate new methods to assess potential thickening of the anterior bundle of the UCL in order to understand ligament changes that may occur throughout the season. PURPOSE: To examine the reliability of ultrasound imaging measurements of UCL width at 2 different anatomical locations using 5Nm valgus stress; and to determine if a difference in ligament width exists between the two measurements 4 weeks apart within the season. METHODS: Thirteen Division I college men’s baseball pitchers participated with a mean age of 20.4 ± 1.45 SD) and body mass index (BMI) 24.56 ± 1.78 SD). Ultrasound images were obtained of the anterior band of the UCL on the participant’s throwing arm using a GE LOGIQ E ultrasound unit with a linear probe at 12Mhz. Participants were placed in a supine position with a wedge placed underneath their forearm to maintain their elbow position at a 30 deg. flexion angle. A 5 Nm valgus stress was applied 20 centimeters distal to the medial epicondyle. Measurements at the mid substance and the apex of the trochlea were taken at the beginning of the baseball season and then again 4 weeks later. Three images were measured during each session. RESULTS: Intra-rater reliability as expressed by ICC (3, 3) was .929 (SEM= 0.18mm) & .935 (SEM= 0.20mm) for the apex of trochlea measurement site and .861 (SEM= 0.22mm) & .920 (SEM=0.16mm) for the mid-substance measurement site, indicating excellent intra-rater reliability. There was no difference between the measurements obtained on the two testing dates (Apex of trochlea mean width 2.90mm & 2.92mm; t= -.155; p ≥ 0.05) and (Mid-substance mean width 4.49 mm & 4.44 mm; t= .571; p ≥ 0.05) CONCLUSIONS: Excellent intra-rater reliability was found at all four measurement sites. There was no significant difference in UCL width from the beginning of the season and one-month into the season. Further research is recommended to perform multiple imaging sessions throughout the year to determine the long term physiological effects of overhead throwing on the anterior band of the UCL and to study the connection between UCL width changes, tissue quality, and injury risk.