Tissue Echogenicity Research Articles

Grayscale histogram analysis to study the echogenicity and echotexture of the walls of the common carotid arteries of horses and mules

ABSTRACT: Visual inspection of ultrasound examination for assessment of echogenicity and echotexture of blood vessel tissues is a technique routinely used in medical practice in humans. However, simple visual inspection can lead to poor quality diagnoses and errors. The use of grayscale histogram (GSH) analysis has proved to be an efficient technique to quantify the region of interest, allowing minimization of image interpretation errors. This study aimed to evaluate and compare the echogenicity and echotexture of the walls of the common carotid arteries of healthy female horses and mules using the GSH technique and correlate them with age, body mass, and vessel diameters. B-mode ultrasound examinations were performed in the left and right common carotid arteries in three regions (cranial, middle, and caudal) in 11 horses and 11 healthy mules. The GSH of the animals showed heterogeneous walls, but did not differentiate statistically between female horses and mules. The Mean variable of the middle right, middle left and caudal right sides showed differences, more significant in the mules. On the middle right side, the Min variable was different, higher in the mules. On the middle and caudal left side, the variables Max and Mode showed higher values in the mules. For the mules, the age factor presented negative correlation with the Mean, Mode,, Mode(Count), and Mode(Count)/Count(%) variables, and the body mass factor presented negative correlation with the Mode, Mean and Max variables. For the female horses, the body mass factor showed positive correlation with the Mean and Mode variables. Echogenicity of the carotid artery walls differed between female horses and mules, whereas echotexture was heterogeneous and statistically similar among the animals. The age and body mass factors inversely influenced the echogenicity of the mules, but were not significant in the female horses, in which only the body mass factor positively influenced echogenicity.

The condition of mammary glands in women with diabetes mellitus type 1

Background. The pathogenesis of diabetic mastopathy is unknown. It is assumed that one of the important factors in the development of this disease may be hyperglycemia.
 The aim of this study was to evaluate the clinical manifestations and echographic features of the mammary gland structure in women with diabetes mellitus type 1.
 Materials and methods. The three groups of women were examined: group 1: women with type 1 diabetes, with the onset of the disease before menarche (n = 58); group 2: women with type 1 diabetes, with the onset of the disease after menarche (n = 56); group 3: women with fibrocystic mastopathy, without diabetes mellitus type 1 (n = 79). Mastalgia was evaluated using the visual analogue scale. The ultrasound examination of mammary glands was performed on day 5 to 7 of the menstrual cycle.
 Results. The patients of all groups complained of mastalgia. Mammary gland ultrasound revealed that the thickness of the glandular tissue in patients of the first group was significantly less than in the second and third group. The diameter of the milk ducts was also significantly different in patients in each study group. In the group of patients with fibrocystic mastopathy without diabetes mellitus type 1, the tissue echogenicity is average in 41.8% of subjects, with it elevated in 58.2% of individuals. Moreover, in groups of patients with diabetes, 90% of subjects have increased echogenicity of breast tissue.
 Conclusion. Diabetic mastopathy is characterized by a fibrotic echo version of the organ parenchyma, which can be caused by a violation of the mammary gland formation and function in patients with diabetes mellitus type 1.

Evaluation of sonographic parameters as prognostic risk factors in cats with pancreatitis - A retrospective study in 42 cats

Pancreatitis in cats can have different clinical courses. A range from asymptomatic or mild, unspecific clinical signs to severe disease with multi-organ dysfunction or even death has been described. It is sometimes difficult to evaluate the prognosis of the cat based on clinical findings, laboratory diagnostics and diagnostic imaging. There are only a few studies that have examined the outcome and prognostic factors for cats with pancreatitis. In cats presenting with signs of pancreatitis, the feline pancreatic lipase immunoreactivity (fPLI) and sonography are frequently used for establishing a diagnosis. Different sonographic parameters have been described to be asso ciated with pancreatitis. The aim of this retrospective study was to determine whether certain sonographic parameters correlate with the severity and the outcome of pancreatitis in the cat. In 42 cats, presented with at least two clinical signs consistent with pancreatitis and increased fPLI-values (> 5.3 µg/l), the following sonographic parameters were examined: thickness, surface and echogenicity of the pancreas, echogenicity of the peripancreatic fat tissue and the presence of ascites. Cats surviving the first 30 days were classified as survivors and those dying within 30 days as nonsurvivors. Sonographic changes were found in 33/42 cats (79 %). The most frequent sonographic abnormalities were hyper-echoic peripancreatic fat (55 %), hypoechoic pancreatic tissue (45 %) and a thickened pancreas (36 %). There was no significant correlation between sonographic changes and the outcome of the cats. No significant differences in the fPLI concentration were found between the two groups. The fPLI concentration correlated significantly with the prognosis. Neither the presence nor the intensity of the sonographic changes correlate with the outcome of cats with pancreatitis. Contrary to this, the fPLI value is a negative prognostic factor, as has been described previously.

Abdominal Fat Tissue Echogenicity: A Marker of Morbid Obesity.

Menopause-related changes may affect regional but also morphological characteristics of adipose tissue. We sought to assess the clinical value of echogenicity of subcutaneous adipose tissue (SAT) and preperitoneal adipose tissue (pPAT) in postmenopausal women without cardiovascular disease. In 244 consecutively recruited postmenopausal women, subclinical atherosclerosis was assessed in the femoral and carotid arteries by intima-media thickness (IMT) and atheromatous plaques using high-resolution ultrasonography. In 41 women with a second visit (median follow-up 41.5 months), carotid atherosclerosis was re-evaluated. Images of SAT and pPAT were ultrasonographically acquired, and their echogenicity was evaluated by grayscale mean (GSMn) using a dedicated software. A control group of 20 healthy premenopausal women was used for comparisons in fat echogenicity. SAT GSMn but not pPAT was higher in postmenopausal as compared with healthy premenopausal women and was independently associated with metabolic markers of adiposity including body mass index (BMI) and waist circumference (WC). SAT GSMn was associated with carotid IMT and the presence and number of atheromatous plaques [adjusted OR 2.44 and 2.32 per 1-SD increase in GSMn (95% CIs 1.55 to 3.93 and 1.55 to 3.45), respectively]. SAT GSMn conferred incremental value over traditional risk factors, insulin resistance, BMI, and WC for the detection of subclinical atherosclerosis. Increased baseline SAT GSMn was associated with increased rate of progression in carotid IMT. SAT echogenicity may serve as a qualitative marker of adiposity, conferring incremental clinical value over BMI and WC in postmenopausal women. Further investigation is warranted to assess the utility of ultrasonography-derived fat echogenicity as a screening method for morbid obesity.

P1565Abdominal tissue echogenicity in postmenopausal women. A novel marker of morbid obesity?

P1565Abdominal tissue echogenicity in postmenopausal women. A novel marker of morbid obesity?

Quantitative ultrasound imaging over the ischial tuberosity: An exploratory study to inform tissue health

BackgroundCharacterization of ischial tissue health using a standardized diagnostic ultrasound protocol capturing thickness and gray scale analysis has not been established. ObjectivesThis study evaluates inter-participant and inter-trial reliability of thickness and gray scale analysis of ultrasound images of tissues overlying the ischial tuberosity. It provides recommendations for the number of images required to minimize the standard error of measurement (SEM) and determines the number of images required for thickness, gray scale and contrast values that exceed an a-priori minimal detectable change (MDC) for repeated tissue assessment. MethodsBrightness mode ultrasound images using a 12 MHz linear probe were collected on the dominant limb in the side lying position for ten healthy participants and partitioned into three regions of interest: skin, subcutaneous tissue and muscle. Thickness and gray scale measures of skin, muscle and subcutaneous tissue were calculated using a customized MATLAB program. Contrast of each region of interest was calculated using the Gray Scale Level Co-Occurrence Matrix. Generalizability theory was used to quantify indices of dependability and corresponding SEMs and MDCs with 90% Confidence Intervals. ResultsParticipants accounted for most of the total variance (75.56% to 94.78%). Coefficient of dependability (ϕ) for thickness, grey scale and contrast measures was greater than 0.80 when more than two images were averaged. In order to detect a MDC of 21% in thickness and echogenicity measures, at least three images are required, while at least 5 images are required for a MDC of 25% for contrast measures. ConclusionsObtaining reliable thickness, echogenicity and contrast measures of tissue overlying the ischial tuberosity can be achieved from two ultrasound images by a single therapist on an individual participant however three and five images are required to use a MDC of 21% for thickness measures and MDC of 25% for contrast measures respectively.

B-mode ultrasound examination of canine mammary gland neoplastic lesions of small size (diameter < 2cm).

Ultrasonography is a valuable tool for the evaluation of neoplastic lesions in the dog and there is a growing interest in the use of this technique for the stadiation of canine mammary tumours. An accurate assessment of small sized nodules facilitates the stadiation of the mammary lesions and helps the clinician in the choice of the most indicated surgical therapy. The aim of this study was to identify those ultrasound criteria that may be useful in discriminating between benign and malignant lesions of small size (diameter smaller than 2cm). Sixty-two nodules, < 2cm in larger diameter, belonging to thirty-five bitches presented between January 2012 and February 2014 were evaluated. Tumours were observed by conventional ultrasound and assessed for: shape (regular-irregular), limit (defined-ill-defined), margins (regular-irregular), echogenicity (hypoechoic-isoechoic-hyperecoic), echotexture (homogeneus-heterogeneus), presence of hyperecoic halo, distal acoustic enhancement or shadowing and surrounding tissue alterations. Among the alterations in surrounding tissues, the disruption of the glandular tissue and the increase in echogenicity of the peritumoral tissues were assessed. Thereafter, bitches were subjected to mastectomy and nodules were evaluated histologically. None of the ultasound criteria considered in the current study showed a statistically significant relation with malignancy, except for the presence of alterations in the tissue surrounding the nodules. According to our results, this characteristic may indicate malignancy, however its subjectivity may affect the applicability in clinical practice. In conclusions, conventional ultrasound in bitches had a limited ability in discriminating benign and malignant mammary gland neoplastic lesions of small size (diameter < 2cm).

Decreased ultrasound echogenicity as a thyroid hypofunction marker and correlation with autoantibody levels

Background/Aim. The value of ultrasound in functional disorders can be significant. That is why the question arises on the use of ultrasound examination of thyroid gland and its echogenicity as a screening method in early detection of disfunctions, of the gland primarily subclinical and clinical forms of hypothyreoidism. The objective of this paper was to determine antibodies of thyroid peroxidase (anti-TPO) and thyroglobuline antibodies (anti-TG) increase frequency in relation to the character of ultrasound echogenicity as well as to estimate the frequency of subclinically and clinically obvious hypothyreoidism in relation to the changed echogenicity. Methods. Study included 656 patients in outpatient clinic during 2014. All examinees underwent ultrasound examination of thyroid gland, the blood was taken for determination of free thyroxine (FT4), thyroidstimulating hormone (TSH), anti-TPO and anti-TG. The patients were divided into two groups; the group A with normal echogenicity of thyroid gland tissue, and the group B with decreased echogenicity. The group B was divided into two subgroups, B1 with a mildly decreased and B2 with significantly decreased echogenicity. Results. TPO antibody, TSH and TG antibody positivity and their mean values in the group B were significantly higher, as well as in subgroups B1 and B2, in relation to the group A (p &lt; 0.001). In the group A, only 4 (1%) examinees were indicated with subclinical hypothyreoidism. In the group B, the sublinical hypothyreoidism was indicated in 42, while the clinical hypothyreoidism was indicated in 16 examinees. Fifty-eight (25%) examinees suffered from thyroid gland altered function. In the subgroup B1, 16 examinees were indicated with subclinical and 4 with clinical hypothyreoidism. Twenty (11%) examinees suffered from altered thyroid function. In the group B2, the subclinical hypothyreoidism was found in 26 examinees, while the clinical hypothyreoidism was found in 12. Thirty-eight (76%) examinees suffered from altered thyroid function. Conclusion. The ultrasound screening of thyroid gland plays an important role in early detection of thyroid disfunction, i.e., sublinical and clinical hypothyreoidism. Decreased ultrasound echogenicity represents the significant marker of altered thyroid gland function. In these persons we have determined the high percentage of subclinical and clinical hypothyreoidism frequency.

Use of Tissue Electric and Ultrasound Characteristics to Predict and Prevent Steam-Generated Cavitation During High-Power Radiofrequency Ablation.

Given a paucity of data, the aim of this study was to define predictors of steam pops (SPs) during open-irrigated radiofrequency ablation (RFA). SPs during RFA can lead to dire consequences, including perforation and stroke. In an exvivo bovine myocardium model, open-irrigated RFA was applied at 50 W for 60 s; intracardiac echocardiographic images for RFA with and without SPs was compared. Using an invivo porcine model, open-irrigated RFA was applied at 50 W for 60 s, and RFA parameters of SPs were analyzed. A retrospective analysis was performed of recorded SPs during clinical ablation procedures over a 1-year period. For RFA SPs, there was 32% greater intracardiac echocardiographic tissue echogenicity than for RFA without SPs (p< 0.001). In addition, RFA SPs had more rapid increases of tissue echogenicity, particularly in the last 5 s before SPs. Compared with RFA without SPs, RFA SPs had larger impedance reductions (33.0 ± 16.0 Ω vs. 23.0 ± 10.8 Ω; p=0.032). SPs were also associated with more rapid initial impedance reduction (1.40 Ω/s vs. 0.38 Ω/s for RFA withoutSPs; p= 0.001). Clinical SPs during ablation procedures had a significantly faster impedance reduction during the first 5 s of ablation compared with matched control ablations (15.7 ± 6.7 Ω vs. 8.1 ± 4.7 Ω; p< 0.0001). Certain echocardiographic and biophysical parameters during open-irrigated RFA are associated withincreased SP risks. These include greater tissue echogenicity, larger total impedance reduction, rapid rate ofinitialimpedance reduction, and rapid increase in tissue echogenicity.

Chemotherapy-Response Monitoring of Breast Cancer Patients Using Quantitative Ultrasound-Based Intra-Tumour Heterogeneities

Anti-cancer therapies including chemotherapy aim to induce tumour cell death. Cell death introduces alterations in cell morphology and tissue micro-structures that cause measurable changes in tissue echogenicity. This study investigated the effectiveness of quantitative ultrasound (QUS) parametric imaging to characterize intra-tumour heterogeneity and monitor the pathological response of breast cancer to chemotherapy in a large cohort of patients (n = 100). Results demonstrated that QUS imaging can non-invasively monitor pathological response and outcome of breast cancer patients to chemotherapy early following treatment initiation. Specifically, QUS biomarkers quantifying spatial heterogeneities in size, concentration and spacing of acoustic scatterers could predict treatment responses of patients with cross-validated accuracies of 82 ± 0.7%, 86 ± 0.7% and 85 ± 0.9% and areas under the receiver operating characteristic (ROC) curve of 0.75 ± 0.1, 0.80 ± 0.1 and 0.89 ± 0.1 at 1, 4 and 8 weeks after the start of treatment, respectively. The patients classified as responders and non-responders using QUS biomarkers demonstrated significantly different survivals, in good agreement with clinical and pathological endpoints. The results form a basis for using early predictive information on survival-linked patient response to facilitate adapting standard anti-cancer treatments on an individual patient basis.

Dermatofibroma: sonographic findings and pathologic correlation.

Background Ultrasound has been increasingly used for the evaluation of superficial soft tissue lesions. Dermatofibroma is one of the most common dermal lesions. Experiences in ultrasound examinations of dermatofibromas have been accumulated. Purpose To evaluate sonographic findings of dermatofibroma and to correlate them with pathologic findings. Material and Methods A total of 18 dermatofibromas in 15 patients were included. Sonographic findings were assessed for location, depth, size, shape, margin, spiculation, echogenicity, internal hyperechoic dots, change in echogenicity of adjacent soft tissue, and vascularity, by two musculoskeletal radiologists in consensus. Pathologic findings were evaluated by one pathologist. Ultrasonographic characteristics were correlated with the pathologic findings by discussion between one radiologist and one pathologist. Results On ultrasound, all lesions were found to be located in the dermis, and 14 lesions (78%) extended into the subcutaneous layer. Mean size was 7 mm (range = 3 to 10 mm). Characteristic findings were ill-defined margins (n = 15, 83%), spiculated margins (n = 12, 67%), change in echogenicity of adjacent soft tissue (n = 14, 78%), and no Doppler flow (n = 14, 78%). Histologically, depth, margin, and spiculation were correlated with sonographic findings. Reactive fibrosis and chronic inflammation were seen in adjacent dermis and subcutaneous fat layer of echogenicity change. Conclusion On ultrasound, dermatofibromas are usually visible as avascular dermal lesions with extension into the subcutaneous layer, and are characterized by ill-defined margins, marginal spiculation, and change in echogenicity of surrounding soft tissues.

Objective assessment of leg edema using ultrasonography with a gel pad.

Ultrasonography (US) is useful for visual detection of edematous tissues to assess subcutaneous echogenicity. However, visualization of subcutaneous echogenicity is interpreted differently among operators because the evaluation is subjective and individual operators have unique knowledge. This study objectively assessed leg edema using US with a gel pad including fat for normalization of echogenicity in subcutaneous tissue. Five younger adults and four elderly people with leg edema were recruited. We compared assessments of US and limb circumference before and after the intervention of vibration to decrease edema in younger adults, and edema prior to going to sleep and reduced edema in the early morning in elderly people. These assessments were performed twice in elderly people by three operators and reliability, interrater differences, and bias were assessed. For US assessment, echogenicity in subcutaneous tissue was normalized to that of the gel pad by dividing the mean echogenicity of subcutaneous tissue by the mean echogenicity of the gel pad. In younger adults, the normalized subcutaneous echogenicity before the intervention was significantly higher than that after the intervention. In elderly people, echogenicity indicating edema was significantly higher than that after edema reduction. Edema was detected with accuracy rates of 76.9% in younger adults and 75.0% in elderly people. Meanwhile, limb circumference could be used to detect edema in 50.0% of healthy adults and 87.8% of elderly people. The intra-reliability was excellent (intraclass correlation coefficient > 0.9, p < 0.01), and the inter-reliability was good (intraclass correlation coefficient > 0.7, p < 0.01) for normalized subcutaneous echogenicity. Bland-Altman plots revealed that inter-rater differences and systematic bias were small. Normalized subcutaneous echogenicity with the pad can sensitively and objectively assess leg edema with high reliability. Therefore, this method has the potential to become a new gold standard for objective assessment of leg edema in clinical practice.

Canine Fetal Peritonitis

Background: The occurrence of neonatal diseases and neonatal deaths in canines are considered higher in the first days of life of individuals and bacterial diseases are considered the second most common cause. Inflammation of the mesothelial lining of the abdominal cavity is referred peritonitis, which can be classified as primary or secondary and there is no description on the occurrence of canine fetal peritonitis in the veterinary literature. The objective of this study is to describe a case of canine fetus peritonitis, presenting abnormal sonographic findings of the fetus and abnormalities identified after birth that were not yet described in veterinary literature.Case: A female Poodle, six years of age, considered healthy and without clinical complications during the gestational period, was referred for sonographic evaluation at the end of the pregnancy, in order to evaluate of the fetal viability and estimate the gestational period. By ultrasound examination, two canine fetuses were identified and based on its morphogenesis and biparietal diameter, the estimated gestational age was approximately 58 days. On the individual examination of each of the fetus by ultrasound, it was found that one of them had normal sonographic findings and on the second canine fetus it was found an increase of the intra-abdominal echogenicity of tissues, loss of the sonographic definition of the intestinal loops and presence of laminar anechoic areas between the interfaces of organs, consistent with abdominal effusion. Parturition occurred the following day of the ultrasound examination no complications and with the birth of two canine fetuses. About six hours after birth, one of the neonates showed dyspnea, hypothermia, areas of ecchymosis, suffusion in the ventral abdominal region, icteric and pale mucous membrane and the presence of abdominal fluid and came to death about 30 min after. Cytological analysis of the sample revealed exuberant amount of erythrocytes, fibrin and leukocytes. Culture revealed infection by Staphylococccus aureus and Enterococcus sp. Presence of bloody fluid in the abdominal cavity was observed at necropsy, with yellowish parietal surface of the thoracic and abdominal cavities and petechiae on the lungs, heart, stomach surfaces and intestinal mucous membrane. Microscopically, the lungs showed extensive areas of parenchymal consolidation, vascular congestion and intense inflammatory infiltrate in the alveolar wall; the liver was characterized by vascular congestion, areas of degeneration of hepatocytes and presence of calcified foci, necrosis and inflammatory infiltrates. Associating the results and findings of the exams was possible to conclude the diagnostic of fetal peritonitis.Discussion: The visualization of abnormal findings in affected fetus by a gestational ultrasound exam makes this report inedited and relevant for veterinary obstetrics. This demonstrates the importance of ultrasound exam in pregnant bitches for early detection of maternal fetal diseases. Presence of abdominal fluid and increased mesenteric ochogenicity associated with loss of the intestinal loop definition corroborates with the clinical suspicion of peritonitis in fetus. Findings on the anatomopathological examination, cytology and culture allowed conclusion of the cause of death. Bacterial forms in the cytological smear supported the diagnostic suspicion of peritonitis. Gestational ultrasound exam performed in this report was essential for proper conduct of the pregnant bitch and viability of the fetuses, suggesting that the detected fetal abnormalities showed predictive value in the viability of diseased individual. This case report contributes with the description of canine fetal peritonitis.

Effects of selenium in patients with Graves’ disease treated with antithyroid drugs

Несмотря на противоречивые результаты недавно проведенных исследований селена (Se) при болезни Грейвса (БГ), адъювантная роль микроэлемента при данном заболевании продолжает исследоваться.&#x0D; Целью данной работы являлось изучение эффектов селенметионина в составе консервативной терапии БГ.&#x0D; Методы. В исследование были включены 28 пациенток в возрасте от 19 до 52 лет с впервые выявленной БГ легкого или среднетяжелого течения, которым планировалось проведение тиреостатической терапии в течение 12 мес. Пациентки были рандомизированы в две группы терапии: 1) тиреостатическая терапия + Se (200 мкг); 2) тиреостатическая терапия. Исходно и каждые 3 мес наблюдения оценивались показатели: ТТГ, св.Т4, св.Т3, АТ-ТПО и АТ-рТТГ, также проводилось УЗИ щитовидной железы (ЩЖ), оценивались объем и эхогенностьпаренхимы ЩЖ. Период наблюдения составил 18 мес (12 мес терапии, 6 мес наблюдения после отмены тиреостатической терапии, Se отменялся после 15 мес наблюдения).&#x0D; Результаты. В нашем исследовании не получено статистически значимых отличий между группами терапии БГ по скорости достижения эутиреоза, динамике показателей АТ-рТТГ и АТ-ТПО в течение всего периода наблюдения, частоте развития рецидива заболевания в течение 6 мес после отмены терапии.&#x0D; Выводы. Согласно данным нашего исследования, применение Se в фармакологических дозах (200 мкг в сутки) в рамках комплексной терапии БГ в течение 12 мес не приводило к статистически значимому эффекту в отношении клинических исходов БГ, а также не сопровождалось положительным “аутоиммунным” эффектом.

Empirical Mode Decomposition of Ultrasound Imagingfor Gain-Independent Measurement on Tissue Echogenicity: A Feasibility Study

Empirical mode decomposition (EMD) is an adaptive method for decomposing a signal into intrinsic mode functions (IMFs).This study explored using EMD of ultrasound imaging for gain-independent measurements on tissue echogenicity. The IMF-based echogenicity ratio (IER) was proposed using the first (C1) and second IMFs (C2) of ultrasound radiofrequency data. Experiments on lipid phantoms were conducted to investigate the practical performance of IER. Phantoms with lipid concentrations 0%–30% (n = 36) were scanned using a clinical ultrasound scanner to acquire the radiofrequency data under different gains (12–33 dB) for EMD and IER calculations. Experiments on a tissue-mimicking phantom were further performed using the same ultrasound system and data acquisition procedure to investigate the effect of ultrasound frequency on the IER at5–8 MHz.Experimental results showed that the IER measured under 33-dB gain decreased from 6.65 ± 0.23 to 3.97 ± 0.10 when the lipid concentrations were increased from 0% to 30%. When 12-dB gain was used, the IER decreased from 6.21 ± 0.29 to 3.39 ± 0.07. However, whenincreasing the frequency, the IER had a mean decreasing rate of −8.67% per MHz, which was lower than those of the C1 and C2 intensities.The proposed IER may allow gain-independent measurement on tissue echogenicity.

The Use of Acoustic Radiation Force Decorrelation-Weighted Pulse Inversion for Enhanced Ultrasound Contrast Imaging

The use of ultrasound imaging for cancer diagnosis and screening can be enhanced with the use of molecularly targeted microbubbles. Nonlinear imaging strategies such as pulse inversion (PI) and "contrast pulse sequences" (CPS) can be used to differentiate microbubble signal, but often fail to suppress highly echogenic tissue interfaces. This failure results in false-positive detection and potential misdiagnosis. In this study, a novel acoustic radiation force (ARF)-based approach was developed for superior microbubble signal detection. The feasibility of this technique, termed ARF decorrelation-weighted PI (ADW-PI), was demonstrated in vivo using a subcutaneous mouse tumor model. Tumors were implanted in the hindlimb of C57BL/6 mice by subcutaneous injection of MC38 cells. Lipid-shelled microbubbles were conjugated to anti-VEGFR2 antibody and administered via bolus injection. An image sequence using ARF pulses to generate microbubble motion was combined with PI imaging on a Verasonics Vantage programmable scanner. ADW-PI images were generated by combining PI images with interframe signal decorrelation data. For comparison, CPS images of the same mouse tumor were acquired using a Siemens Sequoia clinical scanner. Microbubble-bound regions in the tumor interior exhibited significantly higher signal decorrelation than static tissue (n = 9, P < 0.001). The application of ARF significantly increased microbubble signal decorrelation (n = 9, P < 0.01). Using these decorrelation measurements, ADW-PI imaging demonstrated significantly improved microbubble contrast-to-tissue ratio when compared with corresponding CPS or PI images (n = 9, P < 0.001). Contrast-to-tissue ratio improved with ADW-PI by approximately 3 dB compared with PI images and 2 dB compared with CPS images. Acoustic radiation force can be used to generate adherent microbubble signal decorrelation without microbubble bursting. When combined with PI, measurements of the resulting microbubble signal decorrelation can be used to reconstruct images that exhibit superior suppression of highly echogenic tissue interfaces when compared with PI or CPS alone.

Emergency ultrasonography of the gastrointestinal tract of children.

Ultrasonography (US) is widely used to evaluate most body parts in pediatric patients because it is simple, noninvasive, easy to use, and applicable in a wide variety of clinical situations. US is the modality of choice for the initial evaluation of acute abdominal pain in pediatric patients because of their small body habitus and the presence of less fat tissue in the abdominal wall and peritoneal cavity. The most important factor in performing pediatric emergency US is the graded compression technique and selection of the proper transducer. The careful evaluation of bowel wall thickening combined with ancillary findings such as fluid collection, increased echogenicity of the mesenteric fat tissue, enlarged lymph nodes, hyperemic bowel changes, and abnormal bowel peristalsis can increase the diagnostic capability of US.

Detection and characterization of murine colitis and carcinogenesis by molecularly targeted contrast-enhanced ultrasound.

AIMTo study mucosal addressin cellular adhesion molecule-1 (MAdCAM-1) and vascular endothelial growth factor (VEGF)-targeted contrast enhanced ultrasound (CEUS) for the assessment of murine colitis and carcinogenesis.METHODSC57BL/6 mice were challenged with 3% dextran sodium-sulfate (DSS) for three, six or nine days to study the development of acute colitis. Ultrasound was performed with and without the addition of unspecific contrast agents. MAdCAM-1-targeted contrast agent was used to detect and quantify MAdCAM-1 expression. Inflammatory driven colorectal azoxymethane (AOM)/DSS-induced carcinogenesis was examined on day 42 and 84 using VEGF-targeted contrast agent. Highly specific tissue echogenicity was quantified using specialized software. Sonographic findings were correlated to tissue staining, western blot analysis and immunohistochemistry to quantify the degree of inflammation and stage of carcinogenesis.RESULTSNative ultrasound detected increased general bowel wall thickening that correlated with more progressed and more severe DSS-colitis (healthy mice: 0.3 mm ± 0.03 vs six days DSS: 0.5 mm ± 0.2 vs nine days DSS: 0.6 mm ± 0.2, P < 0.05). Moreover, these sonographic findings correlated well with clinical parameters such as weight loss (r2 = 0.74) and histological damage (r2 = 0.86) (P < 0.01). In acute DSS-induced murine colitis, CEUS targeted against MAdCAM-1 detected and differentiated stages of mild, moderate and severe colitis via calculation of mean pixel contrast intensity in decibel (9.6 dB ± 1.6 vs 12.9 dB ± 1.4 vs 18 dB ± 3.33, P < 0.05). Employing the AOM/DSS-induced carcinogenesis model, tumor development was monitored by CEUS targeted against VEGF and detected a significantly increased echogenicity in tumors as compared to adjacent healthy mucosa (healthy mucosa, 1.6 dB ± 1.4 vs 42 d, 18.2 dB ± 3.3 vs 84 d, 18.6 dB ± 4.9, P < 0.01). Tissue echogenicity strongly correlated with histological analysis and immunohistochemistry findings (VEGF-positive cells in 10 high power fields of healthy mucosa: 1 ± 1.2 vs 42 d after DSS start: 2.4 ± 1.6 vs 84 d after DSS start: 3.5 ± 1.3, P < 0.01).CONCLUSIONMolecularly targeted CEUS is a highly specific and non-invasive imaging modality, which characterizes murine intestinal inflammation and carcinogenesis in vivo.

Transcranial Brain Sonography in Parkinson's Disease and Other Parkinsonian Disorders: a Hospital Study from Tuzla, Bosnia and Herzegovina.

Introduction:Transcranial sonography (TCS) is a relatively new ultrasound modality which could display echogenicity of human brain tissue through the intact skull. TCS may be useful in differentiation of idiopathic Parkinson’s disease (PD) from other parkinsonian disorders. Therefore, we studied different ultrasound markers by TCS in individuals with Parkinson’s disease.Patients and Methods:We performed TCS in 44 patients with PD and 22 patients with other parkinsonian disorders. Echogenic sizes of the substantia nigra (SN) and the lentiform nuclei (LN), as well as the width of the third ventricle and the frontal horns of the lateral ventricle, were measured. We also analyzed the echogenicity of the brainstem raphe (BR).Results:An unilateral hyperechogenic SN was observed in 31 (70%) patients with PD and only in 2 patients (9%) with other parkinsonian disorders (P<0.0001). Hyperechogenicity of the LN was no observed in patients with PD; however, it was present in 7 (32%) patients with other parkinsonian disorders (P=0.0002). Diameter of third ventricle (8.6+/-2.2 mm vs. 6.9+/-1.7mm, P=0.001), right (18.5+/-2.6 mm vs. 16.5+/-2.3 mm, P=0.003) and left frontal horn of lateral ventricle (19.0+/-3.7 mm vs. 16.2+/-2.6 mm, P=0.0006) was significantly wider in patients with other parkinsonian disorders compared with patients with PD. There was no difference in presence of hypoechogenic or interrupted BR in patients with PD and patients with other parkinsonian disorders (39% vs. 27%, P=0.4).Conclusion:TCS is a promising diagnostic technique and can be very helpful in differentiating between idiopathic Parkinson’s disease and other parkinsonian disorders.

Ultrasonographic Tissue Characterization of Kidneys in Patients with Unilateral Renal Artery Stenosis

Introduction Ultrasound tissue characterization (USTC) has been applied to B-mode images of normal, young and transplanted kidneys, carotid, and peripheral atherosclerosis and venous thrombosis. We analyzed USTC from both kidneys of patients with severe unilateral renal artery stenosis. Seven women and 11 men, 79 ± 9 standard deviation (range = 57–96) years of age, were included. Severe, unilateral, renal artery stenosis was based on renal artery peak-systolic velocity (PSV) &gt; 200 cm/sec and/or renal-aortic PSV ratio &gt; 3.5. This sample population, selected sequentially by date of ultrasonographic examinations requested, was heterogeneous: kidney lengths and resistivity indices varied from 6.7 to 13.4 cm and 0.45 to 0.85. Methods USTC was applied to images selected for kidney length measurements. Pixel brightness in the 0–255 range was rescaled to zero for black and 200 for fascia brightness. Gray-scale medians (GSM) of entire kidneys were estimated for statistical comparisons between: (a) kidneys ipsilateral to stenosis (KIS), (b) kidneys contralateral to stenosis (KCS), and (c) normal, young kidneys (KN), previously published GSM = 37 ± 6 (27–48). Results Two distinct KCS subgroups were identified: (1) near-normal GSM &lt; 54 (KCSN, n = 10, 56%); and (2) elevated GSM &gt; 60 (KCSH, n = 8, 44%). Subgroup increasing GSM order was (1) KN, (2) KCSN (47 ± 7, &gt; KN, p &lt; 0.002), (3) KIS-CN (59 ± 20, &gt;KCSN, p &lt; 0.003), (4) KIS-CH (73 ± 20, &gt; KCSN, p &lt; 0.007), and (5) KCSH (78 ± 17, &gt;KIS-CN, p &lt; 0.05). GSM was independent of kidney length or resistivity index, with Pearson correlation coefficients &lt; 0.5 for either KIS or KCS, respectively. Conclusions Tissue echogenicity, represented by GSM, was an independent variable characterizing effects of unilateral renal artery stenosis on the ipsilateral or on both kidneys.