B-mode Ultrasound Scanning Research Articles

Shockwave Lithotripsy: Instrumentation and Status in China

To introduce the physical background and technical characteristics of lithotripters made in China and to compare the efficacy of shockwave lithotripsy (SWL) for distal-ureteral stones between Chinese and Western lithotripters in consecutive use in our stone center. From December 1987 to December 2003, we used a series of four lithotripters to treat 1802 patients with distal-ureteral stones: the piezoelectric EDAP LT-01 with ultrasound B-mode scanning for localization (N = 179); the electrohydraulic JDPN-IV lithotripter using fluoroscopy, which is made in China (N = 294), the electromagnetic Dornier Compact S with fluoroscopy/ultrasound dual localization (N = 1105), and the Huikang MZ-SWL-V, which is an electromagnetic- and electrohydraulic-compatible machine with dual localization that is made in China (N = 224). The physical background and technical characteristics of Chinese lithotripters are different from those of Western machines, but the treatment strategies were identical in all series. In the EDAP LT-01 series, the retreatment rate was 35.2%, and the auxiliary procedure rate was 6.7%, bring the efficiency quotient (EQ) to 69%. In the JDPN-IV series, the retreatment rate was 27.6%, the auxiliary procedure rate 1.0%, and the EQ 74%. In the Dornier Compact S series, the retreatment rate was 12.9%, and auxiliary procedures were performed in 10.9%, for an EQ of 81%. In the Huikang MZ-SWL-V series, the retreatment rate was 20.1%, the auxiliary procedure rate was 4.9%, and the EQ was 80%. The fragmentation results of Chinese electrohydraulic and electromagnetic lithotripters are superior to those of the EDAP LT-01. Chinese lithotripters are inferior to the Dornier Compact S in the efficacy of stone fragmentation, but Chinese machines cause less pain than this lithotripter.

Sonomyography: Monitoring morphological changes of forearm muscles in actions with the feasibility for the control of powered prosthesis

Electromyography (EMG) has been widely used for the assessment of musculoskeletal functions and the control of electrical prostheses, which make use of the EMG signal generated by the contraction of the residual muscles. In spite of the successful applications of EMG in different fields, it has some inherent limitations, such as the difficulty to differentiate the actions of neighboring muscles and to collect signals from deep muscles using the surface EMG. The majority of current EMG controlled prostheses can only provide sequential on–off controls using signals from two groups of muscles, so the users are required to put many conscious efforts in monitoring the speed and range of motion of the terminal devices being controlled. Recently, many alternative signals based on the detection of dimensional changes of muscles or tendons during actions have been reported. The objective of this study was to investigate the potential of the dimensional change of muscles detected using sonography for musculoskeletal assessment and control. A portable B-mode ultrasound scanner was used to collect the dynamic ultrasound images of the forearm muscles of six normally limbed young adults and three amputee subjects. A motion analysis system was used to collect the movement of the wrist angle during the experiments for the normal subjects. It was demonstrated that the morphological changes of forearm muscles during actions can be successfully detected by ultrasound and linearly correlated ( R 2 = 0.876 ± 0.042, mean ± S.D.) with the wrist angle. We named these sonographically detected signals about the architectural change of the muscle as sonomyography (SMG). The mean ratio between the wrist angle and the percentage deformation of the forearm muscle was 7.2 ± 3.7°/% for the normal subjects. The intraclass correlation coefficient (ICC) of this ratio among the three repeated tests was 0.868. The SMG signals from the residual forearms were also successfully detected when the three amputee subjects contracted their residual muscles. The results demonstrated that SMG had potentials for the musculoskeletal control and assessment.

Desenvolvimento folicular no pós-parto de vacas da raça Gir tratadas com acetato de buserelina (GnRH) ou gonadotrofina coriônica humana (hCG)

Foram utilizadas 22 vacas da raça Gir (Bos indicus) em anestro pós-parto, amamentando e mantidas sob regime de pastejo. O padrão de crescimento folicular foi estudado em 15 animais, enquanto os outros sete foram utilizados somente no acompanhamento da resposta aos tratamentos hormonais. Ultra-sonografia em tempo real foi realizada diariamente, do quarto ao qüinquagésimo dia de lactação, por meio de aparelho equipado com probe de 5MHz. Nenhum animal apresentou estro, ovulação ou luteinização folicular durante o período de avaliação. Verificaram-se quatro a oito ondas foliculares surgindo em intervalos de seis a sete dias, cujo diâmetro máximo dos folículos dominantes e subordinados foi de 8,9±0,6 e 6,3±0,7mm, respectivamente. Aos 56 dias pós-parto, as 22 vacas foram divididas em dois grupos: 11 tratadas com 4,2 mig de acetato de buserelina e 11 com 3.000UI de hCG. A ovulação, regressão e luteinização folicular foram verificadas em animais dos dois tratamentos e uma nova onda folicular surgiu dentro de dois a três dias após a terapia hormonal. Corpos lúteos de menor tamanho e concentrações de progesterona abaixo de 1ng/mL indicaram baixa atividade luteal.

Bilateral visual field defects with optic disc drusen and secondary open angle glaucoma with PEX--clinical correlation with the HRA

Arcuate visual field defects are a typical sign of glaucomatous damage. Elevated intraocular pressure in combination with pseudoexfoliation syndrome (PSX) manifests the diagnosis glaucoma. Beyond this state, in microdiscs with optic disc drusen, the exact classification of the visual field defects is crucial. A 57-year-old male with pseudoexfoliation glaucoma was referred because of progressive glaucomatous visual field defects. The visual acuity was right 20/40 and left 20/25. Maximum intraocular pressure was 36 mm Hg. A simple optic nerve atrophy was diagnosed superonasally. The optic disc size was OD 2.24 mm(2) and OS 1.89 mm(2) (HRT I). An Ultrasound B-mode scan demonstrated the diagnosis of optic disc drusen. Over a follow-up of 1 year, a growth tendency was observed, especially in the superonasal quadrant. The mulberry-shaped surface of the drusen was visualized with infrared reflection images (HRA II, 830 nm). Confocal scanning laser ophthalmoscopy (HRA II, excitation 488 nm, 500 nm notch filter) showed an increased intrapapapillary autofluorescence (> 50 % papillary area: OD 1.67 mm(2), OS 1.26 mm(2)). This technique could detect drusen in areas that looked normal in classical retinoscopy. The differential diagnosis of arcuate scotomas includes simple optic nerve atrophy and glaucomatous optic nerve atrophy. Optic disc drusen in glaucoma eyes can obscure the main cause of progressive visual field loss. Superficial optic disc drusen can be measured planimetrically over the years. An adequate reduction of intraocular pressure should be realized in these eyes.

Impact of myocardial contrast echocardiography on vascular permeability: comparison of three different contrast agents

Microvascular permeabilization, petechial hemorrhage and premature ventricular contractions (PVCs) have been demonstrated in an in vivo rat model of myocardial contrast echocardiography (MCE). The purpose of this study was to compare these effects for three US Food and Drug Administration (FDA)-approved ultrasound (US) contrast agents (US CA): Optison®, Definity® and Imagent®. Evans blue dye, an indicator of microvascular permeability, and a contrast agent were injected IV in anesthetized rats suspended in a water bath to mimic scanning depths seen in clinical echocardiology. Diagnostic US B-mode scans with 1:4 end-systolic triggering were performed at 1.7 MHz using a cardiac phased-array scanhead to provide a short axis view of the left ventricle. To elicit readily measurable effects for comparisons, relatively high doses of the agent were used (50 to 500 μL kg −1 for Optison®, 25 to 200 μL kg −1 for Imagent®, 10 to 100 μL kg −1 for Definity®). Microvascular leakage was characterized by the area of Evans blue dye coloration on the hearts and by extraction of the dye from tissue samples. The number of petechia were counted on the epicardial surface of excised hearts. PVCs were counted from ECG traces recorded with the MCE images. Neither evidence of capillary leakage nor PVCs were seen in sham animals. Based on volume dose, Definity® MCE produced more microvascular leakage, but there was no apparent difference between the three agents' microvascular damage potential, which increased linearly with dose at low doses, when expressed in terms of the number of stabilized microbubbles. Definity® MCE resulted in fewer PVCs than the other agents. The effects increased strongly with peak rarefactional pressure amplitude, with apparent thresholds for petechiae at 0.4 MPa and for PVCs at about 1.0 MPa. These results should be of value for minimizing adverse potential in diagnosis and optimizing efficacy in therapeutic applications. (E-mail: douglm@umich.edu)

Effects of passive immunization of goats against inhibin on follicular development, hormone profile and ovulation rate

This study was conducted to investigate the effect of immunoneutralization against endogenous inhibin on FSH secretion and ovulation rate, with the aim of developing a new superovulation method using inhibin antiserum in goats. Two groups of goats received an i.v. injection of either 10 ml normal goat serum (control; n = 6) or 10 ml inhibin antiserum developed against [Tyr(30)]-inhibin alpha (1-30) (n = 6) 48 h before treatment with prostaglandin F(2alpha) (PGF(2alpha)). Blood samples were collected at 6 h intervals and ovaries were examined each day using a B-mode ultrasound scanner equipped with a 7.5 MHz transducer during the experimental period. Immunization against inhibin resulted in a four- to fivefold increase (P < 0.01) in plasma concentrations of FSH. After luteolysis, plasma concentrations of oestradiol increased markedly to reach a preovulatory peak, which was about two times higher (P < 0.01) than that of the controls. The treatment was accompanied by a significant increase in the total number of follicles of > or = 3 mm in diameter at 24 (8.2 +/- 0.4 in inhibin antiserum group versus 4.8 +/- 0.3 in control group) and 96 h later (13.5 +/- 1.0 in inhibin antiserum group versus 5.3 +/- 0.6 in control group). The ovulation rate was significantly (P < 0.01) higher in goats treated with inhibin antiserum (4.2 +/- 0.5; n = 6) than in control goats (1.8 +/- 0.3; n = 6). These results indicate that inhibin is an important factor in the regulation of FSH secretion in goats and demonstrate that passive immunization against inhibin at 48 h before treatment with PGF(2alpha) induces the development of more follicles and increases ovulation rate. Thus, inhibin antiserum treatment may be an alternative to the use of exogenous gonadotrophins for induction of superovulation in goats.

Effects of passive immunization of goats against inhibin on follicular development, hormone profile and ovulation rate

This study was conducted to investigate the effect of immunoneutralization against endogenous inhibin on FSH secretion and ovulation rate, with the aim of developing a new superovulation method using inhibin antiserum in goats. Two groups of goats received an i.v. injection of either 10 ml normal goat serum (control; n = 6) or 10 ml inhibin antiserum developed against [Tyr(30)]-inhibin alpha (1-30) (n = 6) 48 h before treatment with prostaglandin F(2alpha) (PGF(2alpha)). Blood samples were collected at 6 h intervals and ovaries were examined each day using a B-mode ultrasound scanner equipped with a 7.5 MHz transducer during the experimental period. Immunization against inhibin resulted in a four- to fivefold increase (P < 0.01) in plasma concentrations of FSH. After luteolysis, plasma concentrations of oestradiol increased markedly to reach a preovulatory peak, which was about two times higher (P < 0.01) than that of the controls. The treatment was accompanied by a significant increase in the total number of follicles of > or = 3 mm in diameter at 24 (8.2 +/- 0.4 in inhibin antiserum group versus 4.8 +/- 0.3 in control group) and 96 h later (13.5 +/- 1.0 in inhibin antiserum group versus 5.3 +/- 0.6 in control group). The ovulation rate was significantly (P < 0.01) higher in goats treated with inhibin antiserum (4.2 +/- 0.5; n = 6) than in control goats (1.8 +/- 0.3; n = 6). These results indicate that inhibin is an important factor in the regulation of FSH secretion in goats and demonstrate that passive immunization against inhibin at 48 h before treatment with PGF(2alpha) induces the development of more follicles and increases ovulation rate. Thus, inhibin antiserum treatment may be an alternative to the use of exogenous gonadotrophins for induction of superovulation in goats.

Porphyromonas gingivalis infection is associated with carotid atherosclerosis in non-obese Japanese type 2 diabetic patients

The aim of the present study was to investigate whether non-obese Japanese type 2 diabetic patients with porphyromonas gingivalis infection have atherosclerotic vascular diseases. A total of 134 non-obese Japanese type 2 diabetic patients (96 men and 38 women, aged 36 to 84 years, body mass index [BMI] 20.1 to 26.9 kg/m2) were studied. In conjunction with BMI, glycosylated hemoglobin (HbA1c), fasting glucose, and serum lipids (triglycerides, total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol) were measured. LDL cholesterol was calculated using the Friedewald formula. Using high-resolution B-mode ultrasound scan, we measured intimal medial thickness (IMT) in plaque-free segments of bilateral common carotid arteries, and the mean of IMT in 2 vessels was used for the analysis. Furthermore, we calculated the degree of stenosis in plaque segments of bilateral common carotid arteries. The degree of carotid atherosclerosis was expressed as a percentage ratio between the area of plaque and that of the lumen using the formula (Lumen Area Residual − Lumen Area)/Lumem Area × 100. Both the areas were automatically measured by the system on a frozen transverse scanning plane at the site of maximal narrowing. When 2 or more plaques were present in the vessel, only that causing the greatest degree of stenosis was considered for analysis. Values represent mean±SEM unless otherwise stated. Immunoglobulin G (IgG) titer against porphyromonas gingivalis was 245 ± 65 (mean ± 2 SD) in nondiabetic healthy subjects. In contrast, there was a wide variation in IgG titer against porphyromonas gingivalis in type 2 diabetic patients studied (range, 16 to 26,800). Thus, we classified our type 2 diabetic patients into 2 subpopulations according to the value of mean ± 2 SD (= 310) of nondiabetic healthy subjects: one with high IgG titer against porphyromonas gingivalis (>310) (1,422 ± 408) and the other with normal IgG titer against porphyromonas gingivalis (<310) (152 ± 10, P =.002). The populations did not differ with respect to age, sex, BMI, fasting glucose, HbA1c, serum triglycerides, total, HDL, and LDL cholesterol levels. Although the mean IMT in plaque-free segments was not different between the 2 groups (0.73 ±0.03 v 0.68 ± 0.02 mm, P =.098), the degree of stenosis in plaque segments was significantly higher in the high IgG titer group (12.0% ± 2.2%) than in normal one (5.5% ± 1.4%, P =.009). From these results, it can be concluded that porphyromonas gingivalis infection, although still a subclinical infection, is associated with atherosclerotic vascular disease in non-obese Japanese type 2 diabetic patients. Copyright 2003, Elsevier Science (USA). All rights reserved.

Carotid intima-media thickness is correlated with impairment of coronary flow reserve in hypertensive patients without coronary artery disease.

Hypertensive individuals occasionally experience angina-like chest pain despite having angiographically normal coronary arteries, and the etiology of this phenomenon has been suggested to be associated with depressed coronary flow reserve (CFR). Carotid intima-media thickness (IMT) assessed by ultrasound is correlated with not only cerebrovascular disease but also coronary artery disease and left ventricular hypertrophy (LVH). The aim of our study was to investigate the association between CFR and carotid IMT in patients with essential hypertension. We performed transthoracic Doppler recording of diastolic coronary flow velocity in the left anterior descending coronary artery at baseline and after maximal vasodilation by adenosine triphosphate infusion in 24 normotensive subjects and 125 hypertensive patients. CFR was defined as the ratio of hyperemic to basal averaged peak coronary flow velocity. Common cardiovascular risk factors, left ventricular mass index (LVMI), relative wall thickness (RWT), and carotid IMT were evaluated. The CFR of hypertensive patients (2.55 +/- 0.52) was significantly decreased compared with that of normotensive subjects (3.15 +/- 0.45). CFR showed a significant correlation with age, systolic blood pressure, RWT, and carotid IMT. Stepwise regression analysis revealed that, among carotid IMT, LVMI and RWT, only carotid IMT was a strong and independent parameter for predicting CFR in hypertensive patients. In conclusion, B-mode ultrasound scanning of the carotid artery seemed to be of clinical value in the screening of patients with LVH and impaired microcoronary circulation. These associations may explain the links between cardiac and cerebrovascular involvements in patients with hypertension.

Carotid intima media thickness and left ventricular changes in children with end-stage renal disease

To investigate the association between blood pressure and carotid intima-media thickness (IMT) in healthy adolescents.Study participants included 285 first-year high school students (mean age, 15.2 years) at a rural high school in Korea. Systolic and diastolic blood pressure (SBP and DBP) were measured with an oscillometric automated sphygmomanometer. The carotid arteries were evaluated with high-resolution B-mode ultrasound scanning. IMT value was determined with the average of the maximal IMT at each common carotid artery. Increased IMT was defined as sex-specific top quartile. The odds ratio (OR) for increased IMT per 1 SD increase of SBP and DBP was estimated after adjusting for age, sex, body mass index, waist circumference, fasting glucose level, and total/high-density lipoprotein cholesterol ratio.Adjusted OR for increased IMT was 1.70 (P = .003) per 12.4 mm Hg SBP and 1.25 (P = .125) per 7.0 mm Hg DBP. When the analyses were performed by sex, increased IMT was associated with both SBP (OR, 2.67; P = .003) and DBP (OR, 1.68; P = .019) in girls, but it was not associated with either SBP (OR, 1.46; P = .093) or DBP (OR, 0.99; P = .972) in boys.These results suggest that higher blood pressure level may be associated with increased carotid IMT in apparently healthy adolescents.

A review of the carotid and femoral intima-media thickness as an indicator of the presence of peripheral vascular disease and cardiovascular risk factors.

Peripheral vascular disease (PVD) is a common condition often associated with cardiovascular risk factors and events. With the aid of B-mode ultrasound scanning, evidence is emerging that these risk factors and events are significantly related to an increased carotid and femoral intima-media thickness (IMT). More importantly, treatment of these risk factors is associated with a decrease or a diminished progression of the IMT, paralleled by a reduction in cardiovascular events and an improvement in the symptoms associated with PVD. This evidence is particularly strong for lipid lowering therapy. Additional predictors of cardiovascular risk like the IMT, could now influence the decision to intervene with medication.

Pixel distribution analysis of B-mode ultrasound scan images predicts histologic features of atherosclerotic carotid plaques.

The correlation of B-mode ultrasonographic morphology with histologic characteristics of atherosclerotic carotid plaques remains ill-defined. The classification of plaques with recently reported measures of plaque echogenicity and heterogeneity has been unsatisfactory. We used computer-assisted duplex ultrasound (DU) scan image analysis to determine echogenicity of specific tissues in control subjects. This information was used to quantify each tissue in imaged carotid plaques with pixel distribution analysis (PDA). These objective observations then were quantitatively compared with plaque histology in symptomatic and asymptomatic patients. We performed standardized DU scanning of healthy tissues in 10 volunteer subjects and of 20 carotid artery plaques (7 symptomatic and 13 asymptomatic) in 19 patients with carotid stenosis. The plaques underwent histologic analysis after carotid endarterectomy. The grayscale intensity ranges of blood, lipid, fibromuscular tissue, and calcium were calculated in the control subjects. With computer-assisted image analysis, B-mode images of plaques were linearly scaled to normalize data. Pixel distribution within the images then was analyzed. The grayscale ranges of known tissues obtained from control subjects helped define the amount of intraplaque hemorrhage, lipid, fibromuscular tissue, and calcium within carotid plaque images. This analysis was correlated with tissue composition measurements on histologic sections of excised plaques. The median grayscale intensity (range) in control subjects was 2 (0 to 4) for blood, 12 (8 to 26) for lipid, 53 (41 to 76) for muscle, 172 (112 to 196) for fibrous tissue, and 221 (211 to 255) for calcium. PDA-derived predictions for blood, lipid, fibromuscular tissue, and calcium within carotid plaques correlated significantly with the histologic estimates of each tissue respectively (blood: P =.012; lipid: P =.0006; fibromuscular: P =.035; and calcium: P =.0001). A significantly higher amount of blood and lipid was seen within symptomatic plaques compared with asymptomatic ones (P =.0048 and P =.026, respectively). Conversely, a larger amount of calcification was noted within asymptomatic plaques (P =.0002). Computer-assisted PDA of DU scan images accurately quantified intraplaque hemorrhage, fibromuscular tissue, calcium, and lipid. Symptomatic plaques had lower calcium content but larger amounts of intraplaque hemorrhage and lipid. Quantitative PDA may be used to determine carotid plaque tissue composition to assist in the identification of symptomatic and potentially unstable asymptomatic plaques.

Large brachial artery diameter is associated with angiographic coronary artery disease in women

Background Noninvasive methods are needed for the identification of women at highest risk for coronary artery disease (CAD) who might benefit most from aggressive preventive therapy. Identification of brachial artery atherosclerosis, which correlates with coronary artery atherosclerosis, may be useful to estimate or stratify CAD risk. Because atherosclerosis disrupts the arterial architecture that regulates vessel size, we hypothesized that noninvasively measured large brachial artery diameter is a manifestation of atherosclerosis that is associated with angiographic CAD in women with chest pain. Methods We examined 376 women (mean age, 57.1 years) with chest pain in the National Heart, Lung, and Blood Institute's Women's Ischemia Syndrome Evaluation study who underwent B-mode ultrasound scan measurement of brachial artery diameter at rest and during hyperemic stress (to quantify flow-mediated dilation), quantitative coronary angiography, and risk factor assessment. Results Large resting brachial artery diameter was associated with significant angiographic CAD (3.90 ± 0.79 mm vs 3.52 ± 0.59 mm in women with CAD vs no CAD; P <.001). Impaired flow-mediated dilation, which correlated with resting diameter (r = −0.17; P =.001), was weakly associated with significant CAD (2.74% ± 7.11% vs 4.48% ± 9.52% in CAD vs no CAD; P =.046). After adjustment for age, body size, and CAD risk factors, women with large resting brachial artery diameters (>4.1 mm) had 3.6-fold increased odds (95% confidence interval, 1.8 to 7.1; P <.001) of significant angiographic CAD compared with those with small brachial arteries (≤3.6 mm). Conclusion Large resting brachial artery diameter is an independent predictor of significant CAD in women with chest pain. Therefore, a simple ultrasonographic technique may be useful in the identification of women with chest pain who are at increased risk for CAD. (Am Heart J 2002;143:802-7.)

Microalbuminuria is Related to Marked End Organ Damage in Previously Untreated, Elderly Hypertensive Patients

We wondered whether, in an elderly hypertensive population in a primary prevention setting, free from diabetes mellitus and clinical atherosclerosis, differences between end organ damage and microalbuminuria (MA) could be found using a lower level of urinary albumin excretion than that of classically defined MA. From a population survey of 173 previously untreated hypertensive patients (4 2 blood pressure systolic S 160 and h 220 mmHg, and/or diastolic S 95 and h 115 mmHg), mean age 67 - 4 years, were screened for MA (defined as albumin excretion between 20 and 300 mg/24 h). End organ damage was determined by B-mode ultrasound scanning echocardiography. Out of 173 hypertensives, 14 showed MA (8%). These hypertensives had a significantly higher intima media thickness (IMT; 1.01 - 0.21 vs 0.88 - 0.6 mm, p < 0.05) and increased left ventricular mass index (118 - 31 vs 103 - 22 g/m 2 , p < 0.05) than hypertensives without MA. Linear regression analysis showed that MA, age, male gender and diastolic blood pressure were independently related to IMT, while systolic blood pressure, male gender and body mass index were independently related to left ventricular mass. Even using lower levels of urinary albumin excretion rate, patients with MA had significantly higher IMT and increased left ventricular mass. Moreover, MA was independently related to IMT in these elderly hypertensives. These results suggest that the threshold value for MA should be reconsidered in hypertension.

Changes in the Cross-sectional Diameter of Muscle Ultrasonography between Relaxation and Maximum Voluntary Isometric Contraction in Normal Young Subjects

Ultrasonography is a non-invasive imaging technique that permits visualisation of muscle in real time. The purpose of this study was to investigate the changes in the cross-sectional-diameter (CSD) of the muscle ultrasonography of the rectus femoris and vastus intermedius muscles between maximum relaxation (MR) and maximum voluntary isometric contraction (MVIC). Thirty-eight normal young subjects (24 men and 14 women, mean age 21.87 years) participated in this study. A B-mode ultrasound scanner provided with a 7.5 MHz linear-array probe was used. The mean CSD of vastus intermedius and rectus femoris respectively during MR was 15.50 mm (SD 4.74) and 18.89 mm (SD 3.82) and during MVIC 21.74 mm (SD 4.55) and 25.54 mm (SD 5.89). Simultaneous with the MVIC a retroversion of the femoral bone, mean 9.85 mm (SD 4.38) was seen. A paired t-test (two-tailed) showed a significant increase of CSD from MR through MVIC in vastus intermedius and rectus femoris muscles (p = 0.0001). The mean MVIC:MR for vastus intermedius was 1.42 (SD 0.20) and for rectus femoris was 1.35 (SD 0.19). The results of this study suggest that the CSD parameter may be a valuable and quantitative measurement in muscle testing, showing the degree of muscle activity. However, further study of its relationship with force production is needed. Muscle ultrasonography is a potentially useful new technique for physiotherapists. Ultrasonography is a non-invasive imaging technique that permits visualisation of muscle in real time. The purpose of this study was to investigate the changes in the cross-sectional-diameter (CSD) of the muscle ultrasonography of the rectus femoris and vastus intermedius muscles between maximum relaxation (MR) and maximum voluntary isometric contraction (MVIC). Thirty-eight normal young subjects (24 men and 14 women, mean age 21.87 years) participated in this study. A B-mode ultrasound scanner provided with a 7.5 MHz linear-array probe was used. The mean CSD of vastus intermedius and rectus femoris respectively during MR was 15.50 mm (SD 4.74) and 18.89 mm (SD 3.82) and during MVIC 21.74 mm (SD 4.55) and 25.54 mm (SD 5.89). Simultaneous with the MVIC a retroversion of the femoral bone, mean 9.85 mm (SD 4.38) was seen. A paired t-test (two-tailed) showed a significant increase of CSD from MR through MVIC in vastus intermedius and rectus femoris muscles (p = 0.0001). The mean MVIC:MR for vastus intermedius was 1.42 (SD 0.20) and for rectus femoris was 1.35 (SD 0.19). The results of this study suggest that the CSD parameter may be a valuable and quantitative measurement in muscle testing, showing the degree of muscle activity. However, further study of its relationship with force production is needed. Muscle ultrasonography is a potentially useful new technique for physiotherapists.

Usefulness of carotid intima-media thickness measurement and peripheral B-mode ultrasound scan in the clinical screening of patients with coronary artery disease.

Previous observational studies have shown a relationship between carotid intima-media thickness (IMT) and coronary artery disease (CAD). In this study the authors evaluated the accuracy of the common carotid IMT measurement in predicting the presence and severity of CAD and the additional information offered by the detection of carotid, iliac, and lower limb plaques. One hundred and fifty consecutive patients were subjected to coronary angiography and carotid, iliac, and lower limb ultrasound scan. The mean value of six IMT measurements of the far wall of the common carotid artery was calculated in each patient. The mean IMT was significantly correlated to the number of stenosed coronary vessels (r = 0.43, p<0.001), although the positive and negative predictive value of mean IMT in identifying patients with CAD was low (81% and 46%, respectively). The combined information offered by IMT measurements and peripheral (carotid, iliac, and lower limb) plaque detection was then used to obtain the best multivariate regression model able to predict CAD status. The multivariate model showed a highly significant multiple correlation coefficient (r = 0.60, p<0.0001) and a sharp improvement in the negative predictive value (92%) with respect to the univariable model. B-mode ultrasound scan including common carotid IMT measurement and peripheral plaque detection may be of clinical value in the screening of patients with CAD.

The diameter of the common femoral artery in healthy human: Influence of sex, age, and body size

Purpose: To determine the relevance of dilatations of the common femoral artery (CFA), knowledge of the normal CFA diameter is essential. The diameter of the CFA in healthy male and female subjects of different ages was investigated. Methods: The diameter of the CFA was measured in 122 healthy volunteers (59 male, 63 female; 8 to 81 years of age) with echo-tracking B-mode ultrasound scan. The influence of age, sex, height, weight, body surface area (BSA), and systolic blood pressure was analyzed by means of a multiple regression model. Results: The CFA increased steadily in diameter throughout life. From 25 years onwards, the diameter was larger in men than in women. Significant correlations were found between the CFA diameter and weight ( r = 0.58 and r = 0.57 in male and female subjects, respectively; P < .0001), height ( r = 0.49 and r = 0.54 in male and female subjects, respectively; P < .0001), and BSA ( r = 0.60 and r = 0.62 in male and female subjects, respectively; P < .0001). Age and BSA were used to create a model for prediction of the CFA diameter ( r = 0.71 and r = 0.77 in male and female subjects, respectively; P < .0001). Conclusion: The diameter of the CFA increases with age, initially during growth but also in adults. This is related to age, body size, and sex—male subjects have larger arteries than female subjects. It is now possible to predict the normal CFA diameter, and nomograms that may be used in the study of aneurysmal disease are presented. (J Vasc Surg 1999;29:503-10.)

The Carotid Artery Intima-Media Thickness Measured with B-Mode Ultrasonography in Adult Volunteers

Objectives:The purposes of this study were 1) to correlate the carotid intima-medial thickness (IMT) with risk factors of atherosclerosis, 2) to demonstrate the standarized methods of B-mode ultrasound (US) scanning of carotid artery and IMT measurement. Materials and Methods:Bilateral carotid arteries of 95 adult volunteers were scanned using 12 MHz linear probe. The mean of bilateral IMT was regarded as the volunteer's IMT, which was measured on the far wall of distal common carotid artery. The normality test for measured IMT and corre- lation tests between IMT and various known risk factors of atherosclerosis including age, end-systolic blood pressure, end-diastolic blood pressure, fasting blood glucose level, body mass index, life-style data and lipid profiles were performed. Inter-observer and intra-observer variability were evaluated through correlation tests on 20 randomly sampled data. Results:The measured IMT showed normal distribution (mean=0.673 mm, SD =±0.1, p=0.494) and the 95th percentile was 0.830 mm. The systolic blood pressure (r=0.101) and body mass index (r=0.200) showed positive correlation but they did not show statistically significant relationships with IMT (p>0.05). The age showed statistically significant correlation (r=0.585, p<0.001), but the other risk factors did not show statistically significant correlation with IMT. The correlation coefficients of inter-observer and intra-observer variability on IMT measurement were 0.8770 and 0.9213, respectively. Conclusion:The diagno- stic criteria for early carotid atherosclerosis using B-mode US could be estimated from our data. Our measurem- ent protocols showed high reproducibility. The associations between most risk factors that did not show statisti- cally significant correlation in our study and IMT should be confirmed in a populationbased study. (Korean Circulation J 1999;29(11 :1201-1211

Out-of-Hospital Prophylaxis With Low-Molecular-Weight Heparin in Hip Surgery: The French Study—Venographic Outcome at 35 Days

Out-of-Hospital Prophylaxis With Low-Molecular-Weight Heparin in Hip Surgery: The French Study—Venographic Outcome at 35 Days

Variance components analysis of carotid and femoral intima-media thickness measurements

B-mode ultrasound intima-media thickness (IMT) measurements of carotid and femoral arterial walls are used in atherosclerosis studies. In this study, the components contributing to IMT measurement variability in males with coronary artery disease were investigated by means of repeated B-mode ultrasound scans and repeated off-line video image analyses. For statistical analysis, a mixed-model analysis of variance was used. From sonographer data, it was shown that human subjects and their arterial wall segments contributed 75% of the total IMT measurement variability in this population. Inter-sonographer variance contributed 25%. The intra-sonographer variance was negligible (<1%). In off-line image analysis, variance components due to subjects and segments, inter-analyst variance, and residual fluctuation were 88%, <1% and 11%, respectively. Intra-analyst variance was negligible (<1%). The major source of B-mode ultrasound IMT measurement variability finds its origin in subjects and their arterial walls. Although sonographers proved a lesser source of variability, in comparative studies they should enter a study well trained and should be randomly assigned to subjects. Follow-up examinations should preferably be done by the same sonographer. Off-line image analysis contributed little to IMT measurement variability.