Ultrasound in Medicine & Biology (ULTRASOUND MED BIOL )

Publisher: World Federation for Ultrasound in Medicine and Biology, Elsevier


Ultrasound in Medicine and Biology (UMB) is the official journal of the World Federation for Ultrasound in Medicine and Biology. The journal publishes original contributions on significant advances in clinical diagnostic, interventional and therapeutic applications, new and improved clinical techniques, the physics, engineering and technology of ultrasound in medicine and biology, and the interactions between ultrasound and biological materials, including bioeffects. Extended reviews of subjects of contemporary interest in the field are also published, in addition to occasional editorial articles, clinical and technical notes, letters to the editor and a calendar of forthcoming meetings. It is the aim of the journal fully to meet the information and publication requirements of the clinicians, scientists, engineers and other professionals who constitute the biomedical ultrasonic community. Visit the web site of the World Federation for Ultrasound in Medicine and Biology at: http://www.wfumb.org/ for more information, including affiliated organizations, congresses, newsletters and reports.

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: To gain better understanding of the detailed mechanisms of high-intensity focused ultrasound (HIFU) ablation for cardiac arrhythmias, we investigated how the cellular electrophysiological (EP) changes were correlated with temperature increases and thermal dose (cumulative equivalent minutes [CEM43]) during HIFU application using Langendorff-perfused rabbit hearts. Employing voltage-sensitive dye di-4-ANEPPS, we measured the EP and temperature during HIFU using simultaneous optical mapping and infrared imaging. Both action potential amplitude (APA) and action potential duration at 50% repolarization (APD50) decreased with temperature increases, and APD50 was more thermally sensitive than APA. EP and tissue changes were irreversible when HIFU-induced temperature increased above 52.3 ± 1.4°C and log10(CEM43) above 2.16 ± 0.51 (n = 5), but were reversible when temperature was below 50.1 ± 0.8°C and log10(CEM43) below –0.9 ± 0.3 (n = 9). EP and temperature/thermal dose changes were spatially correlated with HIFU-induced tissue necrosis surrounded by a transition zone.
    Ultrasound in Medicine & Biology 12/2014;
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    ABSTRACT: The purpose of this study was to measure changes in cardiac function as cardiomyopathy progresses in a mouse model of Duchenne muscular dystrophy using 3-D ECG-gated echocardiography. This study is the first to correlate cardiac volumes acquired using 3-D echocardiography with those acquired using retrospectively gated micro-computed tomography (CT). Both were further compared with standard M-mode echocardiography and histologic analyses. We found that although each modality measures a decrease in cardiac function as disease progresses in mdx/utrn–/– mice (n = 5) compared with healthy C57BL/6 mice (n = 8), 3-D echocardiography has higher agreement with gold-standard measurements acquired by gated micro-CT, with little standard deviation between measurements. M-Mode echocardiography measurements, in comparison, exhibit considerably greater variability and user bias. Given the radiation dose associated with micro-CT and the geometric assumptions made in M-mode echocardiography to calculate ventricular volume, we suggest that use of 3-D echocardiography has important advantages that may allow for the measurement of early disease changes that occur before overt cardiomyopathy.
    Ultrasound in Medicine & Biology 12/2014; 40(12):2857-2867.
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    ABSTRACT: Despite the availability of multiple ultrasound approaches to left ventricular (LV) flow characterization in two dimensions, this technique remains in its childhood and further developments seem warranted. This article describes a new methodology for tracking the 2-D LV flow field based on ultrasound data. Hereto, a standard speckle tracking algorithm was modified by using a dynamic kernel embedding Navier–Stokes-based regularization in an iterative manner. The performance of the proposed approach was first quantified in synthetic ultrasound data based on a computational fluid dynamics model of LV flow. Next, an experimental flow phantom setup mimicking the normal human heart was used for experimental validation by employing simultaneous optical particle image velocimetry as a standard reference technique. Finally, the applicability of the approach was tested in a clinical setting. On the basis of the simulated data, pointwise evaluation of the estimated velocity vectors correlated well (mean r = 0.84) with the computational fluid dynamics measurement. During the filling period of the left ventricle, the properties of the main vortex obtained from the proposed method were also measured, and their correlations with the reference measurement were also calculated (radius, r = 0.96; circulation, r = 0.85; weighted center, r = 0.81). In vitro results at 60 bpm during one cardiac cycle confirmed that the algorithm properly measures typical characteristics of the vortex (radius, r = 0.60; circulation, r = 0.81; weighted center, r = 0.92). Preliminary qualitative results on clinical data revealed physiologic flow fields.
    Ultrasound in Medicine & Biology 11/2014;
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    ABSTRACT: Multichannel analysis of dispersive ultrasonic energy requires a reliable mapping of the data from the time–distance (t–x) domain to the frequency–wavenumber (f–k) or frequency–phase velocity (f–c) domain. The mapping is usually performed with the classic 2-D Fourier transform (FT) with a subsequent substitution and interpolation via c = 2πf/k. The extracted dispersion trajectories of the guided modes lack the resolution in the transformed plane to discriminate wave modes. The resolving power associated with the FT is closely linked to the aperture of the recorded data. Here, we present a linear Radon transform (RT) to image the dispersive energies of the recorded ultrasound wave fields. The RT is posed as an inverse problem, which allows implementation of the regularization strategy to enhance the focusing power. We choose a Cauchy regularization for the high-resolution RT. Three forms of Radon transform: adjoint, damped least-squares, and high-resolution are described, and are compared with respect to robustness using simulated and cervine bone data. The RT also depends on the data aperture, but not as severely as does the FT. With the RT, the resolution of the dispersion panel could be improved up to around 300% over that of the FT. Among the Radon solutions, the high-resolution RT delineated the guided wave energy with much better imaging resolution (at least 110%) than the other two forms. The Radon operator can also accommodate unevenly spaced records. The results of the study suggest that the high-resolution RT is a valuable imaging tool to extract dispersive guided wave energies under limited aperture.
    Ultrasound in Medicine & Biology 11/2014; 40:2715-2727.
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    ABSTRACT: In the work described here, agreement between ultrasound and histologic measurements of enamel thickness in vitro was investigated. Fifteen extracted human premolars were sectioned coronally to produce 30 sections. The enamel thickness of each specimen was measured with a 15-MHz hand-held ultrasound probe and verified with histology. The speed of sound in enamel was established. Bland–Altman analysis, intra-class correlation coefficient and Wilcoxon sign rank test were used to assess agreement. The mean speed of sound in enamel was 6191 ± 199 m s−1. Bland–Altman limits of agreement were −0.16 to 0.18 mm when the speed of sound for each specimen was used, and −0.17 to 0.21 mm when the mean speed of sound was used. Intra-class correlation coefficient agreement was 0.97, and the Wilcoxon sign rank test yielded a p-value of 0.55. Using the speed of sound for each specimen results in more accurate measurement of enamel thickness. Ultrasound measurements were in good agreement with histology, which highlights its potential for monitoring the progressive loss of enamel thickness in erosive tooth surface loss.
    Ultrasound in Medicine & Biology 10/2014;
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    ABSTRACT: High-intensity focused ultrasound (HIFU) induces thermal lesions by increasing the tissue temperature in a tight focal region. The main ultrasound imaging techniques currently used to monitor HIFU treatment are standard pulse-echo B-mode ultrasound imaging, ultrasound temperature estimation and elastography-based methods. The present study was carried out on ex vivo animal tissue samples, in which backscattered radiofrequency (RF) signals were acquired in real time at time instances before, during and after HIFU treatment. The manifold learning algorithm, a non-linear dimensionality reduction method, was applied to RF signals which construct B-mode images to detect the HIFU-induced changes among the image frames obtained during HIFU treatment. In this approach, the embedded non-linear information in the region of interest of sequential images is represented in a 2-D manifold with the Isomap algorithm, and each image is depicted as a point on the reconstructed manifold. Four distinct regions are chosen in the manifold corresponding to the four phases of HIFU treatment (before HIFU treatment, during HIFU treatment, immediately after HIFU treatment and 10-min after HIFU treatment). It was found that disorganization of the points is achieved by increasing the acoustic power, and if the thermal lesion has been formed, the regions of points related to pre- and post-HIFU significantly differ. Moreover, the manifold embedding was repeated on 2-D moving windows in RF data envelopes related to pre- and post-HIFU exposure data frames. It was concluded that if mean values of the points related to pre- and post-exposure frames in the reconstructed manifold are estimated, and if the Euclidean distance between these two mean values is calculated and the sliding window is moved and this procedure is repeated for the whole image, a new image based on the Euclidean distance can be formed in which the HIFU thermal lesion is detectable.
    Ultrasound in Medicine & Biology 10/2014;
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    ABSTRACT: The aims of the study were, first, to assess whether myocardial ultrasound tissue characterization (UTC) in Becker muscular dystrophy (BMD) can be used to differentiate between patients with deletions and those without deletions; and second, to determine whether UTC is helpful in diagnosing the evolution of left ventricular dysfunction, a precursor of dilated cardiomyopathy. Both cyclic variation of integrated backscatter and calibrated integrated backscatter (cIBS) were assessed in 87 patients with BMD and 70 controls. The average follow-up in BMD patients was 48 ± 12 mo. UTC analysis was repeated only in a subgroup of 40 BMD patients randomly selected from the larger overall group (15 with and 25 without left ventricular dysfunction). Discrimination between BMD patients with and without dystrophin gene deletion was not possible on the basis of UTC data: average cvIBS was 5.2 ± 1.2 and 5.5 ± 1.4 dB, and average cIBS was 29.9 ± 4.7 and 29.6 ± 5.8, respectively, significantly different (p < 0.001) only from controls (8.6 ± 0.5 and 24.6 ± 1.2 dB). In patients developing left ventricular dysfunction during follow-up, cIBS increased to 31.3 ± 5.4 dB, but not significantly (p = 0.08). The highest cIBS values (34.6 ± 5.3 dB, p < 0.09 vs. baseline, p < 0.01 vs BMD patients without left ventricular dysfunction) were seen in the presence of severe left ventricular dysfunction. Multivariate statistics indicated that an absolute change of 6 dB in cIBS is associated with a high probability of left ventricular dysfunction. UTC analysis does not differentiate BMD patients with or without dystrophin gene deletion, but may be useful in indexing left ventricular dysfunction during follow-up.
    Ultrasound in Medicine & Biology 10/2014;
  • Ultrasound in Medicine & Biology 10/2014;
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    ABSTRACT: Alterations in the cerebral circulation time (CCT) are observed in several cerebrovascular diseases. We designed a new method of global CCT measurement using gray-scale contrast-enhanced ultrasound and studied healthy Chinese adults and patients with intracranial shunts. Eighty-one healthy volunteers and eight patients with intracranial shunt disease were enrolled. The contrast agent Sonovue was used. Perfusion in the carotid artery and internal jugular vein bilaterally was recorded. Start and peak filling CCTs were calculated and analyzed. Imaging of carotid vessels was uncomplicated in all patients. The bilateral start CCT was 6.23 ± 1.39 s in healthy patients. There were no significant differences within subgroups and contrast-dosage groups. In the patient group, the mean start CCT was 3.0 ± 0.56 s. There was a significant difference between the control and patient groups (p < 0.001). This new method using gray-scale contrast imaging can measure CCT and cerebral blood volume accurately. It can be used to visualize blood flow differences in real time and is less dependent on the training of the operator.
    Ultrasound in Medicine & Biology 10/2014;
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    ABSTRACT: The corneal endothelium sustaining the transparency of the cornea is a vulnerable cell layer. Thermal exposure during phacoemulsification is considered to be a potential cause of post-operative cell loss. Knowledge of the temperature rise and particularly of its dependence on region and system settings could deliver useful information about a potential correlation with cell damage. However, there exists a lack of understanding of the process and location of heat generation. Analytical calculations and experiments enabled the quantification of different mechanisms acting as heat sources during phacoemulsification. Heat generation caused by viscous friction was estimated using both an analytical approach and a numerical simulation. In contrast to absorption of sound and self-heating of the probe, this effect was ascertained to be the main heat source. Calorimetric measurement of the power input verified this modeling. On the basis of these results, the local temperature distribution inside a porcine eye was computed time dependently using the finite-element method. Two different amplitude settings were compared with respect to the temperature increase at the corneal endothelium. Various conclusions on the mitigation of thermal exposure during treatment can be drawn from this finite-element simulation.
    Ultrasound in Medicine & Biology 10/2014;
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    ABSTRACT: Diagnosis of Parkinson's disease (PD) can be difficult in the early stages of the disease. The aim of the study described here was to assess the correlation between transcranial sonography (TCS) and (123)I-FP-CIT ([(123)I]ioflupane, N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-[(123)I]iodophenyl)nortropane) SPECT (single photon emission computed tomography) findings and the diagnosis of PD. A total of 49 patients were enrolled in the study: 29 patients with PD, 7 patients with other parkinsonian syndromes, 11 patients with essential tremor and 2 with psychogenic movement disorder. Substantia nigra echogenicity was measured using TCS. SPECT was performed using DaTSCAN ([(123)I]ioflupane). TCS and SPECT findings were correlated in 84% of patients, with κ = 0.62 (95% confidence interval: 0.38-0.86). TCS-measured substantia nigra echogenicity and SPECT-measured striatal binding ratio were negatively correlated (r = -0.326, p = 0.003). TCS/SPECT sensitivity, specificity and positive and negative predictive values for the diagnosis of PD were 89.7%/96.6%, 60.0%/70.0%, 76.5%/82.4% and 80.0%/93.3%, respectively. Both positive TCS and SPECT findings correlated significantly with the diagnosis of PD (κ = 0.52, 95% confidence interval: 0.27-0.76, and κ = 0.69, 95% confidence interval: 0.49-0.90, respectively).
    Ultrasound in Medicine & Biology 10/2014; 40(10):2365-2371.
  • Ultrasound in Medicine & Biology 10/2014; 40(10):2543–2544.
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    ABSTRACT: When calcification, frequently found in both benign and malignant nodules, is present in thyroid nodules, non-invasive differentiation with ultrasound becomes challenging. The goal of this study was to evaluate the utility of elastography in differentiating calcified thyroid nodules. Consecutive patients (165 patients with 196 nodules) referred for fine-needle aspiration who had undergone both ultrasound elastography and B-mode examinations were analyzed retrospectively. Calcification was present in 45 benign and 20 malignant nodules. On 65 calcified nodules, elastography had 95% sensitivity, 51.1% specificity, 46.3% positive predictive value and 95.8% negative predictive value in detecting malignancy. Twenty-three of 45 benign calcified nodules were correctly diagnosed with elastography compared with 4 of 45 by B-mode ultrasound. Although it is difficult to differentiate benign and malignant calcified thyroid nodules solely with B-mode ultrasound, elastography has the potential to reduce the number of fine-needle aspiration biopsies performed on calcified nodules.
    Ultrasound in Medicine & Biology 10/2014;
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    ABSTRACT: This study was aimed at understanding the histopathologic changes that occur in the nasal mucosa of patients with perennial allergic rhinitis after high-intensity focused ultrasound (HIFU) treatment. Biopsy specimens of the inferior turbinate mucosa were taken from 11 PAR patients before, immediately after and 1 y after HIFU treatment. Morphometric analysis revealed that the density of eosinophils and other inflammatory cells increased immediately after treatment and then were decreased significantly 1 y post-treatment. Submucosal glands were swollen and venous sinusoids were dilated, but there was no statistically significant change in their density, immediately after treatment. However, both glands and venous sinusoids significantly decreased in number 1 y after HIFU treatment. The ciliated epithelium or basement membrane of the nasal mucosa was well preserved at all stages. In conclusion, HIFU is a tolerable and effective treatment to reduce inflammation of the inferior turbinate mucosa in patients with perennial allergic rhinitis.
    Ultrasound in Medicine & Biology 10/2014;
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    ABSTRACT: Abnormal blood flow is usually assessed using spectral Doppler estimation of the peak systolic velocity. The technique, however, only estimates the axial velocity component, and therefore the complexity of blood flow remains hidden in conventional ultrasound examinations. With the vector ultrasound technique transverse oscillation the blood velocities of both the axial and the transverse directions are obtained and the complexity of blood flow can be visualized. The aim of the study was to determine the technical performance and interpretation of vector concentration as a tool for estimation of flow complexity. A secondary aim was to establish accuracy parameters to detect flow changes/patterns in the common carotid artery (CCA) and the carotid bulb (CB). The right carotid bifurcation including the CCA and CB of eight healthy volunteers were scanned in a longitudinal plane with vector flow ultrasound (US) using a commercial vector flow ultrasound scanner (ProFocus, BK Medical, Denmark) with a linear 5 MHz transducer transverse oscillation vector flow software. CCA and CB areas were marked in one cardiac cycle from each volunteer. The complex flow was assessed by medical expert evaluation and by vector concentration calculation. A vortex with complex flow was found in all carotid bulbs, whereas the CCA had mainly laminar flow. The medical experts evaluated the flow to be mainly laminar in the CCA (0.82 ± 0.14) and mainly complex (0.23 ± 0.22) in the CB. Likewise, the estimated vector concentrations in CCA (0.96 ± 0.16) indicated mainly laminar flow and in CB (0.83 ± 0.07) indicated mainly turbulence. Both methods were thus able to clearly distinguish the flow patterns of CCA and CB in systole. Vector concentration from angle-independent vector velocity estimates is a quantitative index, which is simple to calculate and can differentiate between laminar and complex flow.
    Ultrasound in Medicine & Biology 09/2014;
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    ABSTRACT: In the study described here, we introduced a new ratio acquired with contrast-enhanced ultrasonography (CEUS): a liver parenchyma blood supply ratio that differentiates arterial and portal phases. Our purpose was to determine whether this ratio and other liver parenchyma perfusion parameters acquired with CEUS can be correlated with the severity of chronic liver disease. Twelve patients with non-cirrhotic chronic liver disease, 35 patients with cirrhosis (child class A: n = 10; child class B: n = 13; child class C: n = 12) and 21 healthy volunteers were examined by CEUS. Time-intensity curves were drawn for regions of interest located in liver parenchyma and right kidney cortex using QLAB quantification software. The arterial and portal phases were differentiated by the time to the maximum enhancement of right kidney and liver parenchyma perfusion data acquired from the time-intensity curves: the intensity of liver parenchyma perfused by hepatic arterial flow (Iap), the intensity of total perfusion of liver parenchyma (Ipeak), the intensity of liver parenchyma perfused by portal venous flow (Ipp) and the ratio of portal perfusion to total perfusion of liver parenchyma expressed by the parameters Ipp/Ipeak, Ipeak, Ipp and Ipp/Ipeak significantly decreased in patients with cirrhosis and in patients with non-cirrhotic chronic liver disease, whereas Iap increased. The parameters Ipp, Ipeak, Ipp/Ipeak and Iap correlated with the severity of chronic liver disease (r = -0.938, p < 0.001; r = -0.790, p < 0.001; r = -0.931 p < 0.001; r = 0.31, p < 0.05). The diagnostic accuracy rates for cirrhosis expressed as areas under receiver operating characteristic curves were 0.93 for Ipeak, 0.98 for Ipp, 0.98 for Ipp/Ipeak, and 0.69 for Iap. Liver parenchyma perfusion parameters obtained by CEUS were correlated with the severity of chronic liver disease and have the potential to assess cirrhosis non-invasively.
    Ultrasound in Medicine & Biology 09/2014;
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    ABSTRACT: Using ultrasound-targeted microbubble destruction (UTMD), we transfected both wild-type p53 (wtp53) and Rb94 genes into retinoblastomas (RBs) of nude mice to investigate the inhibitory role of these two genes in RB development. The 40 tumor-bearing mice, which had been established by sub-retinal injection of an HXO-Rb44 cell suspension, were randomly divided into five groups: blank control group (C); blank plasmid group (M); wtp53 plasmid group (p53); Rb94 plasmid group (Rb94); wtp53 + Rb94 plasmid group (p53 + Rb94). For preparation of the DNA-loaded microbubbles, a pre-determined amount of blank plasmid, pVIVO1-p53, pVIVO1-Rb94 or pVIVO1-p53-Rb94 was added and mixed with the microbubbles. Then, these DNA-loaded microbubbles were respectively transfected into the animal model by UTMD. Vascular endothelial growth factor level and microvessel density of the tumor were determined by immunohistochemical staining. Apoptosis of tissues was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling staining. Expression of wtp53 and Rb94 at both the gene and protein levels was detected by RT-PCR (reverse transcription polymerase chain reaction) and Western blot, respectively. Transfection of both genes had greater inhibitory effects on RB development and resulted in lower levels of vascular endothelial growth factor, lower microvessel density and more obvious apoptosis than single-gene transfection (p < 0.05). The results indicate that the transfection of both genes into the RB by UTMD more strongly inhibited RB growth than transfection of a single gene.
    Ultrasound in Medicine & Biology 09/2014;
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    ABSTRACT: The aim of the study is to assess the effects of vasoactive agents on the degree of contrast enhancement in experimental atherosclerotic plaque during contrast-enhanced ultrasonography (CEUS). Abdominal aortic atherosclerosis was induced in 25 New Zealand white rabbits by a combination of cholesterol-rich diet and balloon endothelial denudation. Standard ultrasonography and CEUS were performed at baseline and during intravenous infusion of noradrenaline or adenosine triphosphate (ATP). The degree of contrast enhancement of the plaque after injection of contrast material was quantified by calculating the enhanced intensity in the plaque. The infusion of noradrenaline induced significant increase in systolic blood pressure (84 ± 13 mm Hg vs. 112 ± 20 mm Hg, p = 0.011) and significant decrease in the enhanced intensity in the plaque (7.52 ± 1.32 dB vs. 5.88 ± 1.33 dB, p < 0.001) during CEUS. The infusion of ATP resulted in the significant decrease in systolic blood pressure (80 ± 13 mm Hg vs. 65 ± 11 mm Hg, p = 0.005) and increase in the enhanced intensity in the plaque (7.52 ± 1.32 dB vs. 8.84 ± 1.55 dB, p < 0.001) during CEUS. The degree of contrast enhancement within an experimental atherosclerotic plaque during CEUS can be influenced by vasoactive agents and hemodynamic status.
    Ultrasound in Medicine & Biology 09/2014;