Richard G Barr

Northeast Ohio Medical University | NEOMED · Department of Radiology

Objectives: We evaluated whether lesion-to-fat ratio measured by shear wave elastography in patients with Breast Imaging Reporting and Data System (BI-RADS) 3 or 4 lesions has the potential to further refine the assessment of B-mode ultrasound alone in breast cancer diagnostics. Methods: This was a secondary analysis of an international diagnost...

Purpose: To determine the natural history and necessity of long-term follow-up of renal masses which do not demonstrate enhancement on contrast-enhanced ultrasound (CEUS). Methods: This retrospective single-center study was approved by our local IRB and is HIPAA compliant. Exactly 405 patients with 620 non-enhancing renal masses on CEUS from a p...

Ultrasonography is one of the key medical imaging modalities for evaluating breast lesions. For differentiating benign from malignant lesions, computer‐aided diagnosis (CAD) systems have greatly assisted radiologists by automatically segmenting and identifying features of lesions. Here, we present deep learning (DL)‐based methods to segment the les...

Despite its well-established benefits and a powerful body of scientific literature supporting the efficacy of contrast-enhanced ultrasound (CEUS), it has faced challenges in being fully adopted as a diagnostic and problem-solving tool within the USA. This effort, written by experts in performance of and interpretation of CEUS, acts as a roadmap, fo...

Background Breast ultrasound identifies additional carcinomas not detected in mammography, but has a higher rate of false-positive findings. We evaluated whether use of intelligent multi-modal Shear-Wave Elastography (SWE) can reduce the number of unnecessary biopsies without impairing the breast cancer detection rate. Methods We trained, tested,...

Objectives To define reference values for shear wave elastography (SWE) in unsuspicious axillary lymph nodes in patients undergoing breast ultrasound examination. Methods 177 clinically and sonographically unsuspicious axillary lymph nodes were prospectively evaluated with SWE using VTIQ (Virtual Touch Tissue Imaging Quantification) in 175 women....

Renal transplantation (RT) is the treatment of choice for end-stage renal disease, significantly improving patients' survival and quality of life. However, approximately 3-23% of patients encounter post-operative complications, and radiology plays a major role for their early detection and treatment or follow-up planning. CT and MRI are excellent i...

Purpose The aim of this study was to assess the diagnostic accuracy of 2-D shear-wave elastography (SWE) for differentiating benign and malignant breast lesions in women with abnormal findings on mammography. Methods Included in this review are studies of diagnostic accuracy published before June 2021, using 2-D SWE to evaluate female breast lesio...

Objectives AI-based algorithms for medical image analysis showed comparable performance to human image readers. However, in practice, diagnoses are made using multiple imaging modalities alongside other data sources. We determined the importance of this multi-modal information and compared the diagnostic performance of routine breast cancer diagnos...

Background: Breast ultrasound identifies additional carcinomas not detected in mammography, but has a higher rate of false-positive findings which result in more unnecessary breast biopsies. Shear-Wave Elastography (SWE), an ultrasound technique used to quantify the stiffness of a lesion, showed promising results to improve the diagnostic performan...

PurposeTo determine the indications for CEUS for renal mass evaluation.Methods This retrospective, single-center, IRB-approved, HIPAA compliant study analyzed data from 303 consecutive patients scheduled for a renal CEUS to determine the indications for the examination. A chart review was performed from 05/01/2020 through 05/31/2021 on all patients...

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, with an estimated prevalence of up to 30% in the general population and higher in people with type 2 diabetes. The assessment of liver fat content is essential to help identify patients with or who are at risk for NAFLD and to follow their disease over time...

Polyorchidism, a very rare congenital anomaly, refers to the presence of more than 2 testes. It is often associated with many other pathologies including cryptorchidism, varicocele, testicular malignancy, and inguinal hernias.In this report, we describe a 40-year-old man who presented with an intermittently painful left groin, initially appearing a...

Indeterminate renal masses are a common clinical problem. CEUS has several advantages to characterize both cystic and solid renal masses including thin slice thickness, excellent background subtraction, and real-time imaging with a high frame rate. The ultrasound contrast agents are not nephrotoxic and can be used in patients with renal insufficien...

Background Shear wave elastography (SWE) and strain elastography (SE) have shown promising potential in breast cancer diagnostics by evaluating the stiffness of a lesion. Combining these two techniques could further improve the diagnostic performance. We aimed to exploratorily define the cut-offs at which adding combined SWE and SE to B-mode breast...

Both strain elastography and shear wave elastography have been used to identify and guide biopsies for prostate cancer detection. Cancers tend to be stiffer than normal tissue allowing for their detection with elastography. The addition of either SE or SWE has been shown to increase the diagnostic yield when used in conjunction with conventional sy...

PurposeTo assess chronic liver disease (CLD) using multiparametric US in a private practice setting in a cohort of patients with increased skin-to-liver distance.Methods110 consecutive patients with increased skin-to-liver distance scheduled for US assessment of CLD were reviewed for study completion time, liver stiffness values (LS), attenuation i...

Ocular ultrasound is an invaluable tool for the evaluation of the eye and orbit. However, the eye and orbit are potentially sensitive to the thermal and mechanical effects of ultrasound. When performing B‐mode imaging, dedicated ocular settings should be used. If these settings are not available, limiting the acoustic output to Food and Drug Admini...

Objectives: To compare the estimates of attenuation coefficient (AC) for liver fat quantification between 2 Ultrasound systems and to evaluate the quality measure of a pre-released software. Methods: AC were obtained in 30 participants in this single-center IRB-approved, HIPAA compliant study. Images were obtained on the Philips Epiq Elite syste...

Although accurate detection of breast cancer still poses significant challenges, deep learning (DL) can support more accurate image interpretation. In this study, we develop a highly robust DL model that is based on combined B-mode ultrasound (B-mode) and strain elastography ultrasound (SE) images for classifying benign and malignant breast tumors....

Purpose In this prospective, multicenter trial we evaluated whether additional shear wave elastography (SWE) for patients with BI-RADS 3 or 4 lesions on breast ultrasound could further refine the assessment with B-mode breast ultrasound for breast cancer diagnosis. Materials and Methods We analyzed prospective, multicenter, international data from...

Recently a series of papers was introduced describing on “how to do” certain techniques. More specifically we published on how to perform strain imaging using the transcutaneous and endoscopic ultrasound approach and shear wave elastography (SWE). In the first part we describe how to optimize the examination technique, discussing normal values, pit...

Purpose The FUSION-X-US-II prototype was developed to combine 3D-automated breast ultrasound (ABUS) and digital breast tomosynthesis in a single device without decompressing the breast. We evaluated the technical function, feasibility of the examination workflow, image quality, breast tissue coverage and patient comfort of the ABUS device of the ne...

Background: Supplemental screening breast ultrasound (US) detects additional cancers in women with dense breasts but identifies many BI-RADS 3 lesions that result in short-term follow-ups and biopsies. Objective: To evaluate outcomes in patients recommended for return to routine screening for lesions assessed as BI-RADS 3 on supplemental automated...

New ultrasound methods that can be used to quantitatively assess liver fat content have recently been developed. These quantitative ultrasound (QUS) methods are based on the analysis of radiofrequency echoes detected by the transducer, allowing calculation of parameters for quantifying the fat in the liver. In this position paper, after a section d...

Background Hepatic steatosis is a condition frequently encountered in clinical practice, with potential progression towards fibrosis, cirrhosis, and hepatocellular carcinoma. Detection and staging of hepatic steatosis are of most importance in nonalcoholic fatty liver disease (NAFLD), a disease with a high prevalence of more than 1 billion individu...

Background Concerns over gadolinium (Gd) retention encourage the use of lower Gd doses. However, lower Gd doses may compromise imaging performance. Higher relaxivity gadobenate may be suited to reduced dose protocols. Purpose To compare 0.05 mmol/kg and 0.1 mmol/kg gadobenate in patients undergoing enhanced MRI of the central nervous system (CNS)....

Objectives The BI‐RADS© classification provides a standardized way to describe ultrasound findings in breast cancer diagnostics. However, there is little information regarding which BI‐RADS© descriptors are most strongly associated with malignancy, to better distinguish BI‐RADS© 3 (follow‐up imaging) and 4 (diagnostic biopsy) breast masses. Method...

We recently introduced a series of papers describing how to do certain techniques. This article is the first part of a review of shear wave elastography (SWE). It reports the principles and interpretation of the technique and describes how to optimize it. Normal values, pitfalls and artefacts for the examination of liver, breast. thyroid and saliva...

The diagnosis of prostate cancer (PCa) can be challenging due to the limited performance of current diagnostic tests, including PSA, digital rectal examination and transrectal conventional US. Multiparametric MRI has improved PCa diagnosis and is recommended prior to biopsy; however, mp-MRI does miss a substantial number of PCa. Advanced US modalit...

Ultrasound is very effective in performing procedures and assessment of complications in peritoneal dialysis. The ultrasound examination can be applied for preoperative assessment, during the peritoneal catheter placement, for the detection and monitoring of infection, as well as for the evaluation of the catheter malfunction. Despite being not onl...

Purpose: The FUSION-X-US-II prototype was developed to combine 3D-automated breast ultrasound (ABUS) and digital breast tomosynthesis in a single device without decompressing the breast. We evaluated the technical function, feasibility of the examination workflow, image quality, breast tissue coverage and patient comfort of the ABUS device of the n...

Computer-aided detection (CAD) of benign and malignant breast lesions becomes increasingly essential in breast ultrasound (US) imaging. The CAD systems rely on imaging features identified by the medical experts for their performance, whereas deep learning (DL) methods automatically extract features from the data. The challenge of the DL is the insu...

Background and objectives: The Breast Imaging Reporting and Data System (BI-RADS) has helped to standardize radiologic reports and assessment in breast cancer diagnostics. So far, BI-RADS consists of the sole, standardized description of images. Individual patient characteristics like disease and family history or age are no part of the current BI-...

Background and objectives: The Breast Imaging Reporting and Data System (BI-RADS) provides a standardized way to describe ultrasound images in breast cancer diagnostics. However, there is little information which descriptors are most strongly associated with malignancy and to which extend the single descriptors (tissue composition, shape, orientati...

Objectives To quantify the bias of shear wave speed (SWS) measurements between different commercial ultrasonic shear elasticity systems and a magnetic resonance elastography (MRE) system in elastic and viscoelastic phantoms. Methods Two elastic phantoms, representing healthy through fibrotic liver, were measured with 5 different ultrasound platfor...

Background: ultrasound-based shear wave elastography (SWE) can non-invasively assess prostate tissue stiffness. This systematic review aims to evaluate SWE for the detection of prostate cancer (PCa) and compare diagnostic estimates between studies reporting the detection of all PCa and clinically significant PCa (csPCa). Methods: a literature se...

Objective The FUSION-X-US-II prototype was developed to combine 3D automated breast ultrasound (ABUS) and digital breast tomosynthesis in a single device. We evaluated the performance of ABUS and tomosynthesis in a single examination in a clinical setting. Methods In this prospective feasibility study, digital breast tomosynthesis and ABUS were pe...

Contrast-enhanced ultrasound (CEUS) has become an established modality in various clinical indications for liver diseases. SonoVue®, a pure blood pure agent, and Sonazoid®, which exhibits an additional Kupffer phase, are contrast agents approved for liver imaging. This review discusses and compares the current clinical evidence for these two ultras...

On October 24, 2017, in Chicago, the Society of Radiologists in Ultrasound convened a panel of specialists in contrast-enhanced ultrasound (CEUS) to arrive at a white paper regarding the use of CEUS in noncardiac applications in North America. Recommendations are based on analysis of the current literature and common practice strategies. They repre...

Screening for breast cancer reduces breast cancer-related mortality and earlier detection facilitates less aggressive treatment. Unfortunately, current screening modalities are imperfect, suffering from limited sensitivity and high false-positive rates. Novel techniques in the field of breast imaging may soon play a role in breast cancer screening:...

The Society of Radiologists in Ultrasound convened a panel of specialists in contrast-enhanced ultrasound (CEUS) to produce a white paper on noncardiac CEUS in North America. The panel met in Chicago, Illinois, on October 24 and 25, 2017. The recommendations are based on analysis of current literature and common practice strategies and are thought...

In adults with chronic liver diseases, ultrasound and magnetic resonance shear wave elastography (SWE) can replace liver biopsy in several clinical scenarios. Several guidelines on the use of ultrasound SWE for the adult population have been published. However, the number of publications in the pediatric population is limited, and available guideli...

The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS), first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The previous updated editions of the guidelines reflected changes in the available contrast agent...

Objectives: Contrast enhanced ultrasound (CEUS) is now broadly used clinically for liver lesion detection and characterization. Obstacles to the efforts to quantify perfusion with CEUS have been the lack of a standardized approach and undocumented reproducibility. The use of multiple scanners and different analysis software packages compounds the...

Objective To compare the validity of Shear Wave Elastography (SWE) for the preoperative assessment of pathological complete response (pCR) to standard clinical assessment in breast cancer patients undergoing neoadjuvant chemotherapy (NACT). Materials and Methods This prospective, consecutive clinical trial was conducted under routine clinical prac...

The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast-enhanced ultrasound, first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology. The previous updated editions of the guidelines reflected changes in the available contrast agents and updated th...

Several guidelines have indicated that liver stiffness (LS) assessed by means of shear wave elastography (SWE) can safely replace liver biopsy in several clinical scenarios, particularly in patients with chronic viral hepatitis. However, an increase of LS may be due to some other clinical conditions not related to fibrosis, such as liver inflammati...

This multidisciplinary update of the Society of Radiologists in Ultrasound consensus statement on liver elastography incorporates the large volume of new information available in the literature since the initial publication. The recommended procedure for acquiring stiffness measurements is reviewed. There has been substantial improvement in the aco...

Purpose To evaluate the diagnostic performance of strain elastography (SE) and 2 D shear wave elastography (SWE) and SE/SWE combination in comparison with conventional multiparametric ultrasound (US) with respect to improving BI-RADS classification results and differentiating benign and malignant breast lesions using a qualitative and quantitative...

Objectives: There are conflicting results in the literature on the use of shear wave elastography of the kidney parenchyma to determine whether renal stiffness values are related to a disease process. This study was conducted to evaluate the raw data from 3 ultrasound systems and determine whether adequate displacement curves are obtained to accur...

Breast elastography has been available for more than 15 years but is not widely incorporated into clinical practice. Many publications report extremely high accuracy for various breast elastographic techniques. However, results in the literature are extremely variable. This variability is most likely due to variations in technique, a relatively ste...

Within the field of elastography, a relatively new approach analyzes the limiting case of shear waves established as a reverberant field. In this framework, it is assumed that a distribution of shear waves exists, oriented across all directions in 3D and continuous in time. The simultaneous multi-frequency application of reverberant shear wave fiel...

Objectives There is a significant learning curve in strain elastography. Uniform appropriate levels of stress must be applied for accurate elastograms. If the stress is not applied appropriately, inaccurate results will be obtained, particularly when strain ratios are being estimated. This paper describes a new technique which allows the real‐time...

Diffuse liver disease is a substantial world-wide problem. With the combination of conventional ultrasound of the abdomen and elastography-appropriate staging of the patient can be assessed. This information allows for the detection of fibrosis as well as prognosis, surveillance, and prioritization for treatment. With the potential for reversibilit...

Both strain elastography and shear wave elastography have been shown to have high sensitivity and specificity for characterizing breast lesions as benign or malignant. Training is important for both strain and shear wave elastography. The unique feature of benign lesions measuring smaller on elastography than B-mode imaging and malignant lesions ap...

Objective: Strain ratio (SR) is a semiquantitative parameter in differentiating benign from malignant tumors in breast ultrasound elastography. Currently, SR is computed manually and, thus, user dependent. The objective of this study was to evaluate the performance of a new tool assist strain ratio (ASR) and determine how it performs compared with...

The World Federation for Ultrasound in Medicine and Biology has produced these guidelines for the use of elastography techniques in liver diseases. For each available technique, the reproducibility, results and limitations are analyzed, and recommendations are given. This set of guidelines updates the first version, published in 2015. Since the pri...

With the recent FDA approval for characterization of focal liver lesions (FLL) in both pediatric and adult patients using Lumason (sulfur hexafluoride microbubbles), increased use of ultrasound contrast for routine clinical use is expected. This agent has been available for many years in Europe and Asia, and a large body of literature is available...

Chronic liver disease is a substantial world-wide problem. Its major consequence is increasing deposition of fibrous tissue within the liver leading to the development of cirrhosis with its consequences of portal hypertension, hepatic insufficiency, and hepatocellular carcinoma. The stage of liver fibrosis is important to determine prognosis, surve...