Quantitative US Research Articles

Muscle thickness and echo-intensity changes of the quadriceps femoris muscle during a strength training program

IntroductionUltrasound (US) has an important role in musculoskeletal (MSK) evaluation, allowing the study of muscle morphology and function. Muscle thickness (MT) and muscle echo-intensity (EI) are two important parameters that may quantify muscle structural adaptations to a variety of stimuli. The aim was to explore the potential of quantitative US imaging for assessing the adaptations and responses of the muscle tissue to increased contractile activity using B-mode US. This study was centred on the quadriceps femoris muscle contractile activity on MT and EI. Methods and materialsTwenty-eight young male adults participated in the study, divided in a control group and two training groups performing concentric or eccentric strength training, respectively. The effect of a 15-week strength program was studied on MT and EI in several regions of the heads of the quadriceps femoris using B-mode US. All images acquisitions and measurements were done by the same experience sonographer. ResultsStrength training resulted in an increase of MT at all muscles and sites (p < 0.05), except the VM. Strength training failed in changing EI in most of the quadriceps femoris, except in the VI and some regions of the VL. No statistically significant differences were observed in our quantitative US parameters between concentric and eccentric training (p > 0.05). ConclusionThese results emphasise the value of MT as a quantifiable muscle US method for evaluating muscle adaptation to exercise training. However, the inconsistency of the EI values indicates that more studies are needed to develop it as an accurate diagnostic tool.

Quantitative US Elastography Can Be Used to Quantify Mechanical and Histologic Tendon Healing in a Rabbit Model of Achilles Tendon Transection.

Purpose To determine the time-dependent change in strain ratios (SRs) at the healing site of an Achilles tendon rupture in a rabbit model of tendon transection and to assess the correlation between SRs and the mechanical and histologic properties of the healing tissue. Materials and Methods Experimental methods were approved by the institutional animal care and use committee. The Achilles tendons of 24 New Zealand white rabbits (48 limbs) were surgically transected. The SRs of Achilles tendons were calculated by using compression-based quantitative ultrasonographic elastography measurements obtained 2, 4, 8, and 12 weeks after transection. After in vivo elastography, the left Achilles tendon was harvested for mechanical testing of ultimate load, ultimate stress, elastic modulus, and linear stiffness, and the right tendons were harvested for tissue histologic analysis with the Bonar scale. Time-dependent changes in SRs, mechanical parameters, and Bonar scale scores were evaluated by using repeated-measures analysis of variance. The correlation between SRs and each measured variable was evaluated by using the Spearman rank correlation coefficient. Results Mean SRs and Bonar scale values decreased as a function of time after transection, whereas mechanical parameters increased (P < .001). SR correlated with ultimate stress (ρ = 0.68, P <.001,) elastic modulus (ρ = 0.74, P <.001), and the Bonar scale (ρ = 0.87, P <.001). Conclusion Quantitative elastography could be a useful method with which to evaluate mechanical and histologic properties of the healing tendon. © RSNA, 2017 Online supplemental material is available for this article.

Ending Decades of Animosity: Framing 2014 Thaw in US-Cuba Diplomatic Relations in the Washington Post and Miami Herald

On December 17, 2014, US President Barak Obama and Cuban President Raul Castro simultaneously announced from Washington and Havana that their countries would resume diplomatic relations ended half a century ago. But how did the US press frame the detente? Exploratory and comparative in nature, the study mainly and inclusively examinesvia qualitative and quantitative analysis-the US press’s coverage of the restoration of US-Cuba diplomatic relations. It seeks out the themes in newspaper opinion items in the Miami Herald and The Washington Post to explain the American public’s position and interpretation of Obama’s new Cuba policy.

Peripheral Nerve Ultrasonography in Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Multifocal Motor Neuropathy: Correlations with Clinical and Neurophysiological Data.

Objective. This cross-sectional study analyzes the pattern of ultrasound peripheral nerve alterations in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN) at different stages of functional disability. Material and Methods. 22 CIDP and 10 MMN patients and a group of 70 healthy controls were evaluated with an ultrasound scan of the median, ulnar, peroneal, tibial, and sural nerves. Results were correlated with clinical disability scales and nerve conduction studies. Results. Patients with intermediate functional impairment showed relatively larger cross-sectional areas than subjects with either a milder (p < 0.05) or more severe impairment (p < 0.05), both in CIDP and in MMN. In addition, MMN was associated with greater side-to-side intranerve variability (p < 0.05), while higher cross-sectional areas were observed in CIDP (p < 0.05) and in nerve segments with predominantly demyelinating features (p < 0.05). Higher CSA values were observed in nerves with demyelinating features versus axonal damage (p < 0.05 for CIDP; p < 0.05 for MMN). Discussion and Conclusions. Greater extent of quantitative and qualitative US alterations was observed in patients at intermediate versus higher functional disability and in nerves with demyelinating versus axonal damage. CIDP and MMN showed differential US aspects, with greater side-to-side intranerve variability in MMN and higher cross-sectional areas in CIDP.

Quantitative Easing and US Stock Prices

Conventional wisdom is that unconventional monetary policy a.k.a. Quantitative Easing (QE) pursued by the Federal Reserve has helped sustain and even boost U.S. stock market prices in the aftermath of the Global Financial Crisis. By design, QE has supported long-term Treasury bond prices and put downward pressure on long term rates; however the link to stock prices is more complicated because other factors operate as well, e.g., the performance of stock markets in the rest of the world, US dollar performance, virtually zero fed funds rate via conventional monetary policy (independent of policies such as QE), and changes in the interaction between economic activity and credit conditions – as measured for instance by the high yield spread along the lines of the financial accelerator theory. This paper presents evidence that these other factors explain most of the variation in stock returns before and after the financial crisis with stable coefficients and that the different rounds of QE explain significantly some of the remaining variation in stock prices. A vector autoregression provides further evidence of the effects of QE on stock returns and its relative importance vis-a-vis other variables via a Pesaran-Shin generalized impulse-response analysis (invariant to the causality ordering). The evidence in this paper is consistent with the boost in stock prices after the Fed actually started tapering in January 2014 because the “fundamentals” were supportive of the stock market. Furthermore, if the positive effects of QE on the stock market are less strong than commonly believed, the negative effects from a gradual shrinking of the Fed’s balance sheet may not be as bad as commonly feared.

Gray-scale and color duplex Doppler ultrasound of hand joints in the evaluation of disease activity and treatment in rheumatoid arthritis.

AimTo evaluate the role of gray-scale and color duplex-Doppler ultrasound (CDUS) in diagnosis of changes of hand joints and assessment of treatment efficacy in patients with rheumatoid arthritis (RA) by comparing qualitative and quantitative US parameters with clinical and laboratory indicators of disease activity.MethodsUlnocarpal (UC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints in 30 patients with RA were examined by gray-scale and CDUS before and after six months of treatment. Morphologic and quantitative Doppler findings (synovial thickness, effusion quantity, vascularization degree, resistance index, velocities) were compared with clinical indicators of disease progression: disease activity score (DAS 28), Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP).ResultsClinical indicators changed significantly after treatment: ESR from 38.1 ± 22.4 mm/h to 27.8 ± 20.9 mm/h (P = 0.013), DAS 28 from 5.47 ± 1.56 to 3.87 ± 1.65 (P < 0.001), and HAQ from 1.26 ± 0.66 to 0.92 ± 0.74 (P = 0.030), indicating therapeutic effectiveness. In all MCP and UC joints we observed a significant change in at least one US parameter, in 6 out of 12 joints we observed a significant change in ≥2 parameters, and in 2 UC joints we observed significant changes in ≥3 parameters. The new finding was that the cut-off values of resistance index of 0.40 at baseline and of 0.55 after the treatment indicated the presence of active disease and the efficacy of treatment, respectively; also it was noticed that PIP joints can be omitted from examination protocol.ConclusionGray scale and CDUS are useful in diagnosis of changes in UC and MCP joints of patients with RA and in monitoring the treatment efficacy.

WE‐EF‐210‐05: Diagnosis and Quantification of Liver Steatosis with Quantitative Ultrasound Backscatter Technique

Purpose:Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States, affects 30% of adult Americans and may progress to more serious diseases. Liver biopsy is the standard method for diagnosing NAFLD. MRI can accurately diagnose and quantify hepatic steatosis but is expensive. Sonography with qualitative interpretation by radiologists is lower cost, more accessible but less sensitive for detection. The objective of this study, using MRI proton density fat fraction (PDFF) as reference, is to assess the accuracy for diagnosing and quantifying steatosis with two quantitative US parameters‐‐ backscatter coefficient (BSC) and attenuation coefficient (AC)‐‐derived from RF signals using the calibration phantom technique.Methods:We performed a prospective, cross‐sectional analysis of a cohort of adults (n=204) with NAFLD (MRI‐PDFF≥5%) and without NAFLD (controls). Subjects underwent MRI‐PDFF and BSC and AC US analyses of the liver on the same day. Patients were randomly assigned to training (n=102, mean age 51±17 years, mean body mass index 31±7 kg/m2) and validation (n=102, mean age 49±17 years, body mass index 30±6 kg/m2) groups; 69% of patients in each group had NAFLD.Results:BSC provided AUC 0.98 (95% CI 0.95–1.00, p&lt;0.0001) for diagnosis of NAFLD; the optimal BSC cut‐off provided sensitivity, specificity, positive and negative predictive values (PPV, NPV) of 87%, 91%, 95%, and 76%, respectively. AC provided AUC 0.89 (95% CI 0.81–0.96, p&lt;0.0001) for diagnosis of steatosis; the optimal AC cut‐off provided sensitivity, specificity, PPV, NPV of 80%, 84%, 92%, and 66%, respectively. BSC and AC both correlated significantly with MRI‐PDFF (P&lt;0.0001).Conclusion:QUS BSC and AC can accurately diagnose and quantify hepatic steatosis, using MRI‐PDFF as reference. With further validation, QUS may emerge as an inexpensive, widely available tool for NAFLD assessment.General support: NIH R01 CA111289, K23 ‐DK090303, AmerGastroAssoc Found, TF Williams Scholarship, S3000 scanner loaned by Siemens, Sucampo, JA Hartford Found, Atlantic Philanthropies Amer Gastroenterological Assoc. Agencies had no role in design/conduct of study, collection, management, analysis or interpretation of the data; preparation, review, or approval of the manuscript.

Evidence-based outcomes on diagnostic accuracy of quantitative ultrasound for assessment of pediatric osteoporosis - a systematic review.

Dual-energy absorptiometry (DXA) is the current reference standard for assessing pediatric osteoporosis; however due to its areal nature, it has limitations. Thus, quantitative ultrasound (QUS), a modality free of ionizing radiation, has been proposed as a potential surrogate for DXA. To semi-quantitatively assess the diagnostic accuracy of QUS for evaluating pediatric osteoporosis according to the U.S. Preventive Services Task Force guidelines. We retrieved articles on the diagnostic accuracy of quantitative US for assessing abnormal bone quality or quantity in patients of mean age ≤19years from MEDLINE, EMBASE and Cochrane Library CCTR databases. Evidences were analyzed for reliability, construct and criterion validity, and responsiveness of quantitative US, according to the following questions: (1) How reliable is the acquisition of QUS measurements? (2) Is QUS diagnostically accurate to characterize bone strength and quality in osteoporotic children? (3) Is QUS sensitive to detect changes in bone status over time? (4) Is QUS able to predict future skeletal fractures/degeneration? Three reviewers independently evaluated the quality of reporting and methodological quality using the Standards for Reporting of Diagnostic Accuracy (STARD) and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tools. Out of 262 retrieved references (215 unique), we included 28 studies (1,963 patients; 807 reported boys and 761 girls, others unspecified; reported mean age, 0-19 years). The mean quality of reporting score was "excellent" in 24/28 (86%) studies; 11/28 (39%) studies had "adequate" research design quality. There is no evidence of the diagnostic value of QUS at the present time despite the overall excellent and adequate research design quality of primary studies. Although QUS can produce reliable measurements, insufficient evidence has been reported to support other clinimetric properties of this technique.

A study of plaque vascularization and inflammation using quantitative contrast-enhanced US and PET/CT

BackgroundContrast-enhanced ultrasound (CEUS) is an in vivo methodology to quantify carotid plaque vascularization. Increased metabolism in plaques, measured as FDG uptake in PET/CT examination, has been associated with markers of inflammation in histological samples. In this study, we tested the association between FDG uptake and vascularization measured by CEUS to assess whether CEUS can be used as an in vivo marker of plaque vulnerability. MethodsAfter informed consent, subjects aged >60 years with carotid plaque height exceeding 2.5mm were recruited. CEUS was performed and analyzed using earlier described protocol and software, Contrast Quantification Program, which calculates the fraction of the plaque being contrast positive (CQP value). PET/CT examination was performed within 3 months of CEUS (median time 7 days). PET/CT images were acquired 90min after FDG injection (2.7MBq/kg). FDG uptake was measured as tissue background index (TBI), calculated using Spearman's rho as mean standard uptake value (SUV) of the plaque divided by mean SUV in the jugular vein (mean of 7 measuring points). Local ethics committee approved the study. ResultsWe recruited 13 subjects (5 women) with a mean age of 71 years, 6 had a history of stroke or TIA, 1 had a history of ipsilateral stroke. CQP values showed a significant, positive correlation with TBI of carotid plaques, r=0.67, p<0.02. ConclusionsPlaque vascularization measured by CEUS correlates positively with FDG uptake measured by PET/CT in humans. This indicates an association between vascularization and inflammation and/or hypoxia, supporting the use of CEUS as a non-invasive method to detect plaque vulnerability.

Peculiarities of Bone Regenerate Structural Condition in Patients with Achondroplasia and Congenital Varus Deformity

Peculiarities of osteogenesis course in patients with achondroplasia at crus lengthening and in patients with congenital varus deformity in the process of correction were studied using US methods. Qualitative and quantitative US criteria that characterized normal, high and low reparative osteogenesis activity were presented. It was established that distraction regenerate with low level of osteogenesis was characterized by delayed organotypical reconstruction and disturbance of microcirculatory bed formation. The necessity of dynamic US examination during the whole period of treatment was shown.

Quantitative and Objective US Parameters in Liver Cirrhosis and Their Correlation with the MELD Score

Quantitative and Objective US Parameters in Liver Cirrhosis and Their Correlation with the MELD Score

Quantitative ultrasound in the management of osteoporosis.

Bone mineral density (BMD) is one of the major determinants of bone strength and fracture risk (FR), but it is not the only determinant, and overlap exists in BMD values between patients with and without fractures. It is therefore important to improve the strategy in better detecting patients at high FR who will benefit from treatments (TT). Quantitative bone US(QUS) are portable and less expensive than DXA. Only few QUS measuring the heel have reached a sufficient level of validation to be routinely used. They usually measure the attenuation (BUA) and the velocity (SOS) of the US wave. It is well established that valid heel QUSs predict fragility fracture in PM women and men &amp;gt;65, independent of BMD. Then, heel QUS can be used in combination with other clinical risk factors (CRFs) in a model of risk assessment. Then, when DXA is available, the primary clinical use of heel QUS is to identify, in conjunction with CRF, a population at low FR in which no further diagnostic evaluation is necessary. On the other hand, if central DXA cannot be done, pharmacologic TT can be initiated if the probability, as assessed by heel QUS in conjunction with CRF, is sufficiently high.

Quantitative bone US measurements in neonates and their mothers

Factors that affect quantitative ultrasound (QUS) bone measurements have not been clearly defined for all clinical populations. To determine some technical and clinical aspects that may affect QUS bone measurement in the neonate-maternal dyad. Speed of sound (SOS) was measured at the radius and tibia using a commercial multisite axial transmission QUS instrument and three manufacturer-provided probes (CS, CR and CM). The study included 183 singleton neonates and 159 mothers. The type of probe, weight and edema significantly affected SOS measurements. In infants, the CS and CR probes measured SOS consistently at the tibia but not the radius. Gestational age was predictive of SOS from the CS probe and remained significant when race, gender, and birth weight were included. None of these parameters predicted SOS when using the CR probe. Maternal SOS at the radius and tibia was correlated with the CM probe. Maternal SOS was predicted by age but not by gravid status, number of living children, or race. There was no consistent correlation between maternal-infant dyad SOS measurements. Axial transmission SOS of bone varies with probe and site and is affected by technical and clinical factors. Valid data depend on documentation of the probes used and the clinical population studied.

High-resolution quantitative US and MR images for assessment of atherosclerotic plaque composition

High-resolution quantitative US and MR images for assessment of atherosclerotic plaque composition

Bone effects of transdermal hormone replacement therapy in postmenopausal women as evaluated by means of ultrasound: an open one-year prospective study.

To evaluate the effectiveness of transdermal oestrogen replacement therapy plus medrogestone (HRT) in postmenopausal bone loss prevention by means of US. We enrolled 112 healthy postmenopausal women in an open, prospective study. These women, after a gynaecological evaluation and an US assessment of the skeletal status, were advised to take cyclic sequential oestrogen/progestagen therapy: 50 microg/day of transdermal 17beta-oestradiol (Rotta Research Laboratorium) plus 5 mg/day of medrogestone, for 12 days per cycle (Wyeth-Ayerst). After 1 year we recalled these women: only 32 of them were taking HRT, while 49 had declined HRT without taking alternative therapies. The remaining women were excluded from the study as they were either unavailable for the check-up or they were taking prohibited therapies. We used DBM Sonic 1200 (Igea, Italy) to assess US parameter changes at phalanxes at enrollment and after 1 year. This device enabled us to evaluate US transmission velocity (AD-SoS) and US attenuation pattern (UBPS). In a previous study we had evaluated the intra- and inter-observer reproducibility of AD-SoS measurements (0.4 and 1.0% respectively). Using the same data we evaluated the intra- and inter-observer precision of UBPS. The UBPS intra-operator reproducibilities were 5.3% and 6.1% (for the 1st and the 2nd operator, respectively), while inter-observer precision was 8.8%. Both AD-SoS and UBPS significantly decreased in the non-user group(-0.7%, P < 0.001 and -14.3%, P < 0.001 respectively). In the user group AD-SoS showed a significant increase (+0.7%, P < 0.01), while a slight but significant decrease was observed for UBPS (-2.8%, P < 0.05). Our findings show that the effectiveness of transdermal HRT in slowing or even arresting postmenopausal bone loss can be monitored by quantitative US studies. The trend difference observed between AD-SoS and UBPS with and without therapy is at least partially explained by a different response to HRT with regard to bone density as well as structure.

Duplex Doppler sonography in renal parenchymal disease. Histopathologic correlation.

To evaluate the histopathologic changes influencing Doppler measurements of the resistive index (RI) in renal arteries in renal parenchymal diseases, 68 kidneys in 34 consecutive patients with various forms of renal parenchymal diseases were studied by duplex Doppler ultrasound (duplex US) immediately before percutaneous renal biopsy. The RI, renal length, and renal cortical echogenicity were correlated with the amount of glomerular, interstitial, and vascular changes graded on a scale from 0 to 100. The renal vascular resistance and therefore the RI are significantly correlated with the prevalence of arteriolosclerosis, glomerular sclerosis, arteriosclerosis, edema, and focal interstitial fibrosis. There was no significant difference of the RI in five groups of different renal parenchymal diseases. Of 34 patients, 24 presented with an RI less than 0.7, which was thought to be within the normal range so far. Additionally, the RI increases as the patient's age increases, due to higher incidence of arteriosclerosis. Of our patients, 44% presented with normal cortical echogenicity. Quantitative duplex US using the RI does not reliably distinguish different types of renal medical disorders.