Real-time Spatial Compound Imaging Research Articles

Rapid, High Resolution Joint Ultrasound Reveals Frequent Discrepancies in the Clinical Management of Painful Joint and Tissue Events in Symptomatic Adults with Hemophilia

AbstractAbstract ▪625▪This icon denotes a clinically relevant abstract Introduction:There is little objective information about intra-articular bleeding patterns in progressive hemophilic arthropathy. When hemophiliacs present with joint pain or suspected tissue bleeding, clinical decisions are routinely based on subjective symptoms and findings including pain, decreased range of motion (ROM), warmth and swelling. These presentations are non-specific and may occur with bleeding or inflammation in hemophilic arthropathy. We hypothesized that routine clinical assessment is unreliable for diagnosis and management of joint pain in adult hemophiliacs, and that introduction of rapid, objective musculoskeletal ultrasound (MSKUS) imaging might differentiate intra-articular bleeds vs joint inflammation, and intra-muscular bleeds vs other regional pain syndromes. Methods:Rapid MSKUS as ‘point of care' testing at our Center in assessment of adult hemophiliacs with symptomatic joint or muscle pain. We used the GE Logiq e BT11 US-module with high frequency 8–13 MHz linear transducer and real time spatial compound imaging capability (resolution 135 um, comparable to T3MRI). Standardized imaging protocols (Querol F et al; Haemophilia 2012; 18:3;215–226) served to obtain gray scale (B-mode) and power Doppler examination. This technique can detect joint effusions as small as physiological amounts of joint fluid. Results:Fifteen spontaneous, non-traumatic painful episodes in 11 adults with hemophilia were evaluated (6 ankle, 7 knee, 2 muscle). Twelve of the 15 episodes were reported by the patient as bleeding and 3 as arthritis. Of 10 episodes of patient-perceived joint bleeding, only 3 were confirmed by US. One muscle bleed with a 2 inch increase in thigh circumference, indurated swelling and pain was rediagnosed as meralgia paresthetica without bleeding by US evaluation. The other 7 episodes of patient-perceived joint bleeding were due to synovitis (synovial thickening/swelling, synovial and joint fat pad hyperemia on power Doppler, and with or without simple effusion). In contrast, 2 of 3 perceived arthritis flares were reclassified as bleeds. Physician assessment of pain etiology was incorrect in 8 of 15 instances. Swelling, warmth and loss of ROM were present in 3 of 6 confirmed bleeding episodes, and in 6 of 9 confirmed non-bleeding episodes. In 3 of 6 confirmed bleeding episodes, simultaneous plasma factor activities were 5%, 8%, 28%. US findings led to a change of treatment in 14 of 15 episodes. Intensified clotting factor infusions for acute treatment or initiation/intensification of prophylaxis were started in 6 instances. Discontinuation or decrease of clotting factor and/or addition of joint steroid injections, anti-inflammatories or pain management were initiated in 8 instances. Patients reported major improvements in pain, swelling or ROM in 11 of 14 instances when management changed. Conclusion:We report significant discrepancies between MSKUS findings and patient/physician perceived classification of (sub)acute pain as bleeding, arthritis or intra-muscular bleed. Patients and physicians misclassified pain etiology for the majority of episodes based on symptoms and physical findings. Swelling, warmth and loss of ROM were present in approximately half of either confirmed bleeding or arthritic episodes, demonstrating that these findings are clinically not reliable. MSKUS-confirmed bleeding was present in half of the patients at plasma factor levels usually thought to protect against spontaneous bleeding. MSKUS changed treatment decisions for almost all episodes with prompt symptom relief in most patients. Results from this pilot study indicate that our understanding of symptoms and progression of adult hemophilic arthropathy, including protective clotting factor levels, is rudimentary. The current practice of prescribing clotting factor or conservative measures based on patient and physician perception alone is inadequate and may compromise outcomes for the rapidly growing adult population with hemophilia. Prospective studies evaluating MSKUS for the correct diagnosis of bleeding vs arthritis and more precisely directed therapy in hemophilic arthropathy is urgently needed. Disclosures:No relevant conflicts of interest to declare.

Evaluation of the Accuracy of Articular Cartilage Thickness Measurement by B-Mode Ultrasonography with Conventional Imaging and Real-Time Spatial Compound Ultrasonography Imaging

The present study aimed to quantify the thickness of articular cartilage (Tc) in vitro using both conventional and real-time spatial compound B-mode ultrasonography (US) with a clinically used transducer and to evaluate the accuracy of measurement by comparing the results with values obtained microscopically. Femoral condyle samples were obtained from a 6-month-old pig and a 3-year-old pig. B-mode US images with conventional imaging and real-time spatial compound imaging (RTSCI) of osteochondral blocks were acquired. Tc determined using US (Tc-US) was measured from line data parallel to US beam direction acquired from B-mode images with an objective method for determining cartilage surface and bone-cartilage interfaces at the peak brightness values. Tc was also determined under microscopy (Tc-optical) using the corresponding points from US measurement. Tc-US was compared with Tc-optical to assess accuracy. Tc-US correlated significantly with Tc in both conventional imaging and RTSCI (r = 0.961, 0.976, respectively). Bland-Altman plots showed mean differences between Tc-optical and Tc-US were −0.0073 mm and 0.0139 mm with standard deviations of 0.171 mm and 0.131 mm for conventional imaging and RTSCI, respectively. Our results show that Tc-US measurement using B-mode US allows accurate measurement of Tc. Considering correlation coefficients between Tc-US and Tc-optical, RTSCI US may offer higher accuracy for measuring Tc than conventional methods when an objective tissue border determination algorithm is used, even though both showed good accuracy in our study.

Dignitätskriterien der Mammasonografie unter Anwendung des Real-Time Compound Image in Kombination mit dem XRES Adaptiv Image Processing

The purpose of the study was to analyze sonographic criteria for the differentiation of benign and malignant breast lesions using real-time spatial compound imaging (CT) in combination with adaptive image processing (XRES). In a retrospective analysis of 460 patients, the sonographic criteria: shape, orientation, margin, echo pattern and posterior acoustic features were determined using CT and XRES. All investigations were performed using a 12MHz linear transducer. The findings were classified according to the DEGUM criteria analogous to BIRADS and were histologically confirmed by core needle or vacuum biopsy. Statistical analysis was performed using a Chi-square test, logistic uni- and multivariate regression analysis and an ROC-curve analysis to detect the false-positive rate. All investigated diagnostic criteria were significant in the descriptive analysis (Chi-squared). The multivariate analysis showed that the criteria of irregular shape versus round, and not circumscribed margin versus circumscribed margin as well as the posterior acoustic features of enhanced versus reduced have a significant influence on the prediction of a malignant finding. The univariate analysis also showed a statistical significance using the indifferent and not parallel orientation versus parallel. To attain a detection rate of >95%, a false-positive rate of 60% must be expected. This study shows that when using CT in combination with XRES, the analyzed sonographic criteria for the differentiation of benign and malignant breast lesions are still of diagnostic value. In particular, the shape, margin and posterior sonographic features are important.

Role of High-Resolution Ultrasonography Without and With Real-Time Spatial Compound Imaging in Evaluating the Injured Posterior Cruciate Ligament

Ultrasound Quarterly: June 2009 - Volume 25 - Issue 2 - p 75 doi: 10.1097/RUQ.0b013e3181a32249

Role of high-resolution ultrasonography without and with real-time spatial compound imaging in evaluating the injured posterior cruciate ligament: preliminary study

This study sought to compare high-resolution ultrasonography (HRUS) without and with compound imaging in evaluating the injured posterior cruciate ligament (PCL). Thirteen patients with a magnetic resonance imaging (MRI) diagnosis of PCL lesions (ten acute and three chronic) and 20 healthy controls underwent conventional and compound HRUS performed by the same radiologist who was blinded to the subjects' case-control status. The PCL was scanned in a longitudinal direction in all cases. HRUS images were assessed for PCL thickness by two other radiologists blinded to the number and type of PCL injury. PCLs were classified as normal or injured, and the latter as having acute or chronic injuries. Inter-method reproducibility of measuring PCL thickness was assessed on conventional and compound HRUS images. Complete agreement in classifying normal or injured PCL and acute or chronic PCL injuries was achieved. PCL thickness in volunteers was 4.5+/-0.7 mm on conventional images and 4.6+/-0.7 mm on compound images. On conventional and compound HRUS images, the thickness of acutely injured PCL was 9.1+/-1.5 mm and 9.2+/-1.7 mm, respectively, and that of chronically injured PCL was 7+/-0.9 mm and 7+/-0.8 mm. Inter-method reproducibility of PCL thickness measurements on conventional vs. compound HRUS images was 98.6%. HRUS is a reliable technique for studying the PCL and detecting PCL injuries.

Comparison of conventional ultrasound and real-time spatial compound imaging in evaluation of patients with severe peyronie's disease

Real-time spatial compound imaging (C-US) is an ultrasound (US) method which effectively reduces image artifacts and noise. In contrast to conventional techniques, multiple frames are acquired from different viewing angles and combined to form a single compound image. To evaluate whether C-US improves ultrasound evaluation of patients with severe Peyronie's disease. 60 consecutive patients with severe Peyronie's disease underwent conventional US and C-US after intracavernous prostaglandin E1 injection. Corresponding images of the same scan plane were obtained with both methods, and subjective image quality was scored retrospectively using a four-point scale by two blinded readers with different experience in penile imaging. Readers focused on evaluation of the tunica albuginea, plaques, involvement of the penile septum, and overall image quality. Also, presence of large albugineal calcifications or microcalcifications was considered. To assess intrareader agreement, both readers repeated evaluation after a 1-month interval. Statistical analysis was performed using the Wilcoxon signed-rank test and McNemar test. Weighted kappa values were calculated to assess intra- and inter-reader agreement. Average scores were significantly higher for reader 1 (P<0.001). Both readers rated C-US better (P<0.001) than conventional US. Despite higher image quality scores, C-US was as effective as conventional grayscale US in assessing involvement of the penile septum. No differences were found between the two methods for visualization of large calcifications, while microcalcifications were better visible with compound imaging. Intrareader agreement was higher for the more experienced reader 1. C-US is subjectively superior to conventional US in evaluating patients with severe Peyronie's disease.

State-of-the-art ultrasonography of hepatocellular carcinoma

Over the last few decades sonographic techniques have progressed remarkably. Recent advances in ultrasonography include harmonics, real-time spatial compound imaging, adaptive image processing, 3D power Doppler imaging and contrast-enhanced gray-scale harmonic ultrasonography. These advances have had positive effects on the diagnosis of hepatocellular carcinomas and on the evaluation of their responses to therapy. In this article, we review recent sonographic advances for the diagnosis and treatment of hepatocellular carcinomas and its typical imaging features.

Real-time spatial compound ultrasound imaging of skin.

The aim of our study was to evaluate the potential of real-time spatial compound imaging (RTSCI) in dermatology. An ATL 5000 SonoCT equipped with compact linear 15-7 MHz and linear 12-5 MHz transducers was obtained for skin visualization in a group of dermatological patients with various skin diseases. Thirty-four people participated: 21 patients with various skin diseases and 13 persons with normal skin. The mean age was 43.4 years. For many diseases, RTSCI gave useful information about the lesional structure, thickness and relationship with surrounding structures. RTSCI allows objective, accurate, noninvasive and easy measurements of several parameters of skin morphology. It is useful in clinical trials, for evaluation of the effects of therapy, for preoperative evaluation of dermatological lesions, and enables visualization of subclinical and deep lesions, giving physicians the possibility of starting treatment before disease intensity increases. However, even such highly advanced ultrasound cannot completely substitute the clinical dermatological approach and the occasional need for histological diagnosis. This new method may, however, become an important adjunct method for the study of skin lesions.

Application of adaptive image processing technique to real-time spatial compound ultrasound imaging improves image quality.

To assess the impact of adaptive filter postprocessing on quality of ultrasound images. Ultrasound images acquired with real-time spatial compound imaging (SonoCT imaging) were subsequently processed with an adaptive real time algorithm (XRES imaging). Conventional and XRES-processed images from abdominal, pediatric or small parts ultrasound explorations were compared. The delineation of borders, tissue contrast, amount of noise, and overall image quality were evaluated. Delineation of borders and tissue contrast were improved on all images (P < 0.05). The amount of noise was reduced (P < 0.05). The overall image quality was improved for abdominal, pediatric and small parts ultrasound explorations (P < 0.05). No image degradation was found. Adaptive processing provided better image quality without loss of clinically useful information.

Real-time spatial compound imaging in breast ultrasound

To determine the role of real-time spatial compound imaging in breast ultrasound (US), 38 patients with a total of 50 benign changes (fibroadenomas, cysts, lactiferous duct dilatation) underwent both conventional B-mode US and real-time spatial compound imaging under standardized examination settings. Subsequently, images were reviewed independently by three readers experienced in breast US and evaluated according to a multistage scoring system with regard to the presence of artefacts, delineation of boundaries and depiction of internal structures. With significant reader concordance, real-time spatial compound imaging was found to produce speckle reduction with improvement of tissue differentiation, increased conspicuity of low-contrast lesions, enhanced delineation of capsular margins and ducts, and improved depiction of internal architecture of solid lesions, as well as clearer visualization of cystic contents due to clutter reduction. Preservation of central acoustic enhancement and lateral edge shadowing in cysts and fibroadenomas, however, was recorded better in conventional imaging. (E-mail:s.pankl@telering.at)

Real-time spatial compound imaging improves reproducibility in the evaluation of atherosclerotic carotid plaques

Compound imaging has the ability of reducing speckle and clutter artifacts demonstrated in in vitro studies compared to conventional, single-angle imaging. We investigated intra- and interobserver agreement of 38 outlines of carotid artery plaque images acquired by these techniques, by measuring the overlapping area after repeated outlines. In general, both techniques showed good agreement. When considering the images with poorest overlap, compound imaging had a significant advantage over conventional imaging regarding both intra- and interobserver agreement. The interobserver variation for the overlapping area after two outlines was 20% for conventional technique and 10% for compound. The interobserver variation of the gray scale median value (GSM) for conventional technique ranged from −32 to +20 and from −6 to +6 for compound. Likewise, the coefficient of repeatability for the GSM value was 13 for conventional imaging and three for compound imaging, and interobserver variation for the GSM value for the overlapping area was 34% and 9% for conventional and compound technique. In conclusion, compound imaging improves intra- and interobserver agreement and reduces interobserver variation in the GSM value in a clinical setting. (E-mail: stko@gentoftehosp.kbhamt.dk)

Real-time spatial compound imaging: Application to breast, vascular, and musculoskeletal ultrasound

Real-time spatial compound imaging (SonoCT) is an ultrasound technique that uses electronic beam steering of a transducer array to rapidly acquire several (three to nine) overlapping scans of an object from different view angles. These single-angle scans are averaged to form a multiangle compound image that is updated in real time with each subsequent scan. Compound imaging shows improved image quality compared with conventional ultrasound, primarily because of reduction of speckle, clutter, and other acoustic artifacts. Early clinical experience suggests that real-time spatial compound imaging can provide improved contrast resolution and tissue differentiation that is beneficial for imaging the breast, peripheral blood vessels, and musculoskeletal injuries. Future development of real-time spatial compound imaging will help address the bulk of general imaging applications by extending this technology to curved array transducers, tissue harmonics, panoramic imaging, and three-dimensional sonography.

Real Time Spatial Compound Imaging in breast ultrasound: Technology and early clinical experience

No abstract available.