Mode Ultrasound Scanning Research Articles

IMPACT OF MULLIGAN’S MOBILIZATION TECHNIQUE ON CORACOHUMERAL LIGAMENT THICKNESS IN PATIENTS WITH ADHESIVE CAPSULITIS

Background: Mulligan’s Mobilization with movement is one of the important physical therapy interventions in the management of adhesive capsulitis of shoulder. Increased coracohumeral thickness is a grave factor in the reduction of shoulder Range of motion and functional limitation in adhesive capsulitis. Very limited literatures are available in this regard. Aim: To identify the effectiveness of Mulligan’s Mobilization with movement on coracohumeral thickness in patients with adhesive capsulitis of shoulder. Study Design: Randomized controlled trial. Methods: One hundred and fifty patients with adhesive capsulitis were randomly divided into two groups, viz., group ‘A’ and group ‘B’. In group A, Mulligan’s mobilization with movement was administered for three weeks whereas in group ‘B’. Conventional physical therapy program was administered for a period of 3 weeks. Outcome measures: Coracohumeral thickness was evaluated by ‘B’ mode ultrasound scanning before and after therapy. The differences in the CHL thickness between groups was evaluated statistically by independent sample‘t’ test. Results: The mean improvement in the CHL thickness was significantly higher in Mulligan’s mobilization, mean diff. = 0.63, t = 50.05, p = 0.001 than in conventional treatment. Conclusion: It is concluded that Mulligan’s Mobilization with Movement is effective in reducing coracohumeral ligament thickness in patients with adhesive capsulitis. Keywords: Adhesive Capsulitis, Coracohumeral Thickness, Shoulder Abduction and External Rotation ROM, Mulligan’s Mobilization with Movement.

Clinical application of dynamic contrast enhanced ultrasound in monitoring the treatment response of chemoradiotherapy of pancreatic ductal adenocarcinoma.

To investigate the value of dynamic contrast enhanced ultrasound (D-CEUS) in monitoring the chemoradiotherapy (CRT) therapeutic response of local advanced pancreatic ductal adenocarcinoma (LAPC). From October 2017 to December 2018, 11 patients diagnosed as LAPC were included (7 men, 4 women; mean age: 61.1±8.6 years). The algorithm of CRT was as following: the radiotherapy dose was 50.4 Gy/28Fx with S-1 40 mg bid orally taken in radiotherapy day. Conventional ultrasound scan and CEUS were performed before and 4 weeks after CRT. All ultrasound examinations were performed by an ACUSON Oxana 2 ultrasound equipment (Siemens Medical Solutions, Germany) with a C 6-1 convex array transducer (1-6 MHz). Time intensity curves (TICs) were generated in the region of interests (ROIs) both in LAPC lesions and in its surrounding pancreas parenchyma by SonoLiver software (TOMTEC Imaging Systems). Quantitative perfusion parameters including maximum intensity (MI), rise time (RT), mean transit time (mTT) and time to peak (TTP) were analyzed and compared before and after CRT. No significant difference could be found by conventional B mode ultrasound scan after CRT. TICs of CEUS showed lower ascending and descending slopes rate after CRT. Among all perfusion quantitative parameters, MI decreased significantly after CRT (42.1±18.8% vs 27.8±17.2%, P < 0.05). Depending on its unique advantages as non-radiation, effective and convenient, D-CEUS analysis and quantitative parameters, particularly MI, has potential application value in following up of the CRT treatment response in LAPC patients.

Normal tolerance limits for side-to-side differences in diameters of major lower limbs arteries of 228 healthy subjects

PurposeTo determine reference values and tolerance limits of between-side differences for the calibers of the common femoral artery (CFA), superficial femoral artery (SFA), popliteal artery (PA), dorsalis pedis artery (DPA), and posterior tibial artery (PTA). Materials and methodsCalibers of arteries, defined as the largest distance between internal hyperechogenic lines of the intima-media complex of the arterial wall, were measured during the diastole phase determined from echo-tracking B mode ultrasound scanning and grey-scale ultrasound in 228 healthy volunteers aged 18–81 years (43.1 ± 16.7). ResultsThe mean, 95% confidence and tolerance limits covering 90% of population for left and right side of each artery were: CFA: 8.1 mm, 7.9–8.3 mm, 6.0–10.3 mm; 8.1 mm, 7.9–8.5 mm, 5.9–10.2 mm; SFA: 6.2 mm, 6.0–6.3 mm, 4.7–7.6 mm; 6.1 mm, 6.0–6.3 mm, 4.7–7.6 mm; PA: 6.1 mm, 6.0–6.2 mm, 4.6–7.6 mm; 6.1 mm, 5.9–6.2 mm, 4.5–7.6 mm; DPA: 2.0 mm, 1.9–2.0 mm, 1.2–2.7 mm; 2.0 mm, 1.9–2.0 mm, 1.2–2.8 mm; PTA: 2.1 mm, 2.0–2.1 mm, 1.4–2.8 mm; 2.1 mm, 2.1–2.2 mm, 1.4–2.8 mm, respectively. Tolerance limits for between-side differences and ratios were: CFA - 0.5–0.7 mm, 0.9–1.1; SFA - 0.5–0.6 mm, 0.9–1.1; PA - 0.5–0.5 mm, 0.9–1.1; DPA -0.4-0.4 mm, 0.8–1.2; PTA - 0.4–0.4 mm, 0.8–1.2. Regression analysis showed weight and age dependency of vessels diameters. There are no differences between men and woman in vessels size, except in DPA's, when body weight and age are taken into account in a regression analysis. ConclusionsWe estimated normal reference tolerance limits of side-to-side differences in diameters of lower limb arteries. The limits can inform an investigator what differences in diameters occur in healthy individuals, and hence can serve as cut-offs in diagnostic and screening strategies.

Detection of peripheral arterial disease using Doppler spectrogram based expert system for Point-of-Care applications

Peripheral arterial disease (PAD) is a common manifestation of cardiovascular diseases and more prevalent in underdeveloped countries. Ultrasound (US) is one of the preferred non-invasive diagnostic techniques for the evaluation of PAD. This work aims at achieving a low-cost PAD detection technique for mass screening. A computer aided diagnosis (CAD) method has been proposed based on the Doppler blood flow spectrograms of lower limb arteries. The proposed scheme initially removes noise from the spectrogram (350 × 175 pixels) and extracts the hemodynamic features which are generally independent of the Doppler angle. From these, best feature subsets are selected using the wrapper algorithm and supervised classifiers are developed in a machine learning framework to perform using 10-fold cross-validation technique. Overall, 334 arterial segments of 60 subjects are investigated where reference measurement is taken from the triplex mode US scanning. The quantitative assessment using random forest based classifier provides an accuracy of 84.37% and 87.93% for detecting the blood flow irregularities in above-knee and below-knee arterial segments, respectively. To classify the arterial diseases into normal, stenosis and occlusion categories, support vector machine (SVM) classifier is found to provide 97.91% accuracy on the unknown testing dataset. Moreover, variations of diagnostic parameters around the proximal and distal arterial segments define the zone of significant stenosis. The degree of stenosis is determined to quantify the severity of obstruction and the accuracy for stenosis greater than 50% is found to be 96.83%. Finally, smartphone application is implemented to provide a cost-effective, portable, user-friendly solution for Point-of-Care US system.

Design and application of pulse information acquisition and analysis system with dynamic recognition in traditional Chinese medicine.

To design the pulse information which includes the parameter of pulse-position, pulse-number, pulse-shape and pulse-force acquisition and analysis system with function of dynamic recognition, and research the digitalization and visualization of some common cardiovascular mechanism of single pulse. To use some flexible sensors to catch the radial artery pressure pulse wave and utilize the high frequency B mode ultrasound scanning technology to synchronously obtain the information of radial extension and axial movement, by the way of dynamic images, then the gathered information was analyzed and processed together with ECG. Finally, the pulse information acquisition and analysis system was established which has the features of visualization and dynamic recognition, and it was applied to serve for ten healthy adults. The new system overcome the disadvantage of one-dimensional pulse information acquisition and process method which was common used in current research area of pulse diagnosis in traditional Chinese Medicine, initiated a new way of pulse diagnosis which has the new features of dynamic recognition, two-dimensional information acquisition, multiplex signals combination and deep data mining. The newly developed system could translate the pulse signals into digital, visual and measurable motion information of vessel.

Microscopic observation of glass bead movement in soft tissue-mimicking phantom under ultrasound PW mode scanning.

Previous studies have demonstrated that stones and calcification in soft tissue show special enhancement in response to color flow (CF) or pulse Doppler (PW) mode ultrasound scan. This phenomenon is known as the "twinkling sign (TS)". The authors conducted an in vitro experiment to investigate the mechanism of TS occurrence by observing a glass bead in a transparent PVA-H soft tissue-mimicking phantom. The TS in PW mode showed a low-power and slow-velocity spectrum. At the same time, analysis of images by high-speed camera showed that the glass bead in the phantom oscillated following the pulse repetition frequency (PRF) of the PW mode ultrasound scan. The harmonic oscillations were confirmed, as well. The ultrasound radiation force-driven micro-oscillation possibly affects the ultrasound propagation around the scatterer and triggers random signals in the received echo signals. The results indicate that TS is a phenomenon based on complicated acoustic-mechanical interaction of multiple mechanisms. Further investigation is required for gaining a full understanding of the mechanism of TS occurrence and its clinical application.

Clinicopathological pattern and management of retinoblastoma in Kano, Nigeria

The aim of the study is to evaluate the pattern of presentation and the mode of management of retinoblastoma seen in Aminu Kano Teaching Hospital, Kano from 2001 to 2005. The clinic register was used to obtain the case folders of all children treated for retinoblastoma and this was used to obtain information on patient's age, sex, and clinical sign(s) at presentation such as orbital mass, leucocoria, proptosis, hyphaema without history of trauma, unexplained hypopyon, or uveitis. Also documented were X ray/B mode ultrasound scan findings, type of surgery performed, histological diagnosis, and adjuvant chemotherapy where applicable. Forty-two patients were reviewed, 15 males and 27 females (M: F = 1.0: 1.8). The age ranged between 2 and 6 years and the peak age of presentation was 3 years in 22 patients (52%). The tumor was unilateral in 40 patients (95%) and bilateral in 2 patients (5%). Most of the patients (46%) presented late with fungating orbital mass. Other signs include leucocoria 22%, proptosis 19%, hyphema 7%, Hypopyon 2%, squint 2%, and buphthalmos 2%. Thirty-one patients (74%) had exenteration and enucleation was performed in 11 patients (26%). The tumor was histologically confirmed in 41 patients (98%) and was poorly differentiated in 23 patients (55%), 1 patient (2%) had toxocara granuloma. Thirty-nine patients required adjuvant chemotherapy and only 2 received 6 (full) courses. Retinoblastoma, a treatable tumor is characterized by late presentation as illustrated in our study. There is need to create public awareness and educate mothers on this tumor so that there is early diagnosis, appropriate referral, and prompt treatment. The goal is to increase number of children successfully cured of this disease in our environment.

Early pregnancy diagnosis and embryonic and fetal development using real time B mode ultrasound in goats

Real time B mode ultrasound scanning was used for the diagnosis of early pregnancy and monitoring of embryonic and fetal development in goats. Estrus in 8 cyclic cross-bred does was synchronized using a single injection of PGF2α followed by mating with a buck. All the does were subjected to weekly transrectal (from day 14 of mating) and transabdominal ultrasonography (from day 28) up to the 4th month of gestation and once during the 5th month of gestation. Of the 8 animals, 6 does were confirmed pregnant. The embryonic vesicle was detected on day 21 and day 28 and the embryo proper on day 28, day 35 using the transrectal and transabdominal methods, respectively. Heart beat was observed as early as day 21 of gestation and it was recordable by day 28 using the transrectal approach. However, via transabdominal scanning the detection and recording of the heart beat was possible only on day 35 of gestation. Singles and twins were differentiated on day 35 and day 42 by the transrectal and transabdominal approaches, respectively. Placentomes as a circular ‘C’ shape structure was detectable on day 42 with an average diameter of 0.97 cm, using the rectal probe. Using the abdominal probe, placentomes were detectable on day 50 (average diameter of 1 cm of gestation). Skeletal structures such as the skull, rib cage and vertebral column were first viewed on day 56 in both approaches. A significant ( P < 0.001) high correlation ( r = 0.99) was recorded between the gestational age and head, thoracic and placentome parameters. It may concluded that the earliest identification of an embryonic vesicle (day 21) by transrectal scanning and confirmation of its viability by fetal heart beat (day 28) were the most reliable ultrasonographic features for early pregnancy diagnosis in goats. Transabdominal ultrasonographic measurements of placentome, head and thoracic diameter may be of use in the assessment of fetal age.

Expansion rates and outcomes for iliac artery aneurysms

Purpose: The expansion rates and outcomes of iliac artery aneurysms (IAAs) were determined. Methods: A retrospective chart review was conducted to identify patients in whom IAAs had been diagnosed between June 1990 and March 1999 in a vascular surgery service at a large university-affiliated Veterans Affairs medical center. The patients were veterans, 187 men and two women, in whom the diagnosis of an IAA was made, as defined by the Ad Hoc Committee on Reporting Standards of The Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter (IAA ≥ 1.5 cm). Expansion rates relative to the size of IAAs and clinical outcomes were noted for all patients. Results: One hundred eighty-nine patients (mean age, 72.3 ± 0.5 years) with 323 IAAs (mean size, 2.34 ± 0.7 cm) were found. The mean follow-up (96% of patients with B mode ultrasound scanning) period was 31.4 months, with each patient undergoing a mean of 4.2 studies. The 4-year life-table survival rate was 78.2%, with no patient deaths related to their IAAs. Symptoms were noted in six of 189 patients (3.1%; two ruptures, four chronic pain), who all had IAAs larger than 4 cm. IAAs were repaired in 34 of 189 patients (18%), in 25 of the 34 patients because of their associated abdominal aortic aneurysms and in nine of 34 patients because of their IAAs alone. All nine patients requiring operative treatment of indications related to the IAA had an IAA larger than 4 cm. Expansion rates were slow for IAAs smaller than 3 cm (0.11 ± 0.02 cm/year) and significantly greater ( P < .003) for IAAs 3 to 5 cm (0.26 ± 0.1 cm/year). The correlation between B mode ultrasound scanning and computed tomography scanning was excellent. The size of the IAAs was underestimated by 0.03 ± 0.06 cm by means of B mode ultrasound scanning. Conclusion: The IAAs followed up by this contemporary Veterans Affairs vascular surgery service were small, rarely caused symptoms or rupture, and expanded at a slow rate. IAAs smaller than 3 cm could be followed up safely on an annual basis with B mode ultrasound scanning. IAAs that are 3 cm or larger and smaller than 3.5 cm should be carefully followed with B mode ultrasound scanning at 6-month intervals, whereas elective repair should be considered for IAAs 3.5 cm or larger in good-risk patients. Based on this report and currently available evidence and recommendations, asymptomatic IAAs that are 4 cm or larger and all other symptomatic IAAs should be considered for operative repair. Also, the reported high rupture rate of IAAs that are 5 cm or larger mandates prompt operative repair. (J Vasc Surg 2000;31:114-21.)

Ultrasound of the pleura: An assessment of its clinical value

In a prospective study, A mode ultrasound scanning contributed to the diagnosis and management of 24 of 50 consecutive patients with pleural disease. In 30% of patients it was superior to radiology in clarifying the solid or fluid nature of a pleural opacity, and in 42% of patients it allowed selection of the most appropriate site for the aspiration of pleural fluid. The technique is simple and the apparatus is widely available. We believe that ultrasound is an important practical aid in the diagnosis and management of pleural disease.