All UL Systems - Scientific Article - Toshiba Publications & Clinical Evidence Radiology 2016

Toshiba
Publications
&
Clinical Evidence
Radiology
2014 - 2016
Table of Contents
Shear Wave ......................................................................................................................................... 6
Noninvasive Assessment of Liver Disease—Measurement of Hepatic Fibrosis Using Shear Wave
Elastography (SWE) ......................................................................................................................... 6
Superiority of a new shear wave elastography in evaluation of liver fibrosis ................................ 7
SMI ...................................................................................................................................................... 8
Superb microvascular imaging for the detection of parenchymal perfusion in normal and
undescended testes in young children ........................................................................................... 8
Superb Microvascular Imaging—A New Vascular Detecting Ultrasonographic Technique for
Avascular Breast Masses: A Preliminary Study ............................................................................... 9
Comparison of Superb Micro-Vascular Ultrasound Imaging (SMI) and Contrast-Enhanced
Ultrasound (CEUS) for Detection of Endoleaks After Endovascular Aneurysm Repair (EVAR). .... 10
The Diagnostic Value of Superb Microvascular Imaging (SMI) in Detecting Blood Flow Signals of
Breast Lesions................................................................................................................................ 11
A Novel Microvascular Flow Technique: Initial Results in Thyroids .............................................. 12
2090842 Feasibility of Superb Microvascular Imaging (SMI), an Advanced Noninvasive US
Technique, To Detect Vesicoureteral Reflux in Pediatric Patients Without Bladder
Catheterization or Contrast Use.................................................................................................... 13
Spoke-wheel sign of focal nodular hyperplasia revealed by superb micro-vascular ultrasound
imaging .......................................................................................................................................... 14
Superb Microvascular Imaging (SMI) and Detection of Low Grade Musculoskeletal Inflammation
....................................................................................................................................................... 15
Thyroid Evaluation with a Novel Microvascular Flow Technique ................................................. 16
Microvascular blood flow in the thyroid: Preliminary results with a novel imaging technique ... 17
Fusion ................................................................................................................................................ 18
Added Value of Multiparametric Ultrasonography in Magnetic Resonance Imaging and
Ultrasonography Fusion–guided Biopsy of the Prostate in Patients With Suspicion for Prostate
Cancer............................................................................................................................................ 18
Evaluation of MRI-US Fusion Technology in Sports-Related Musculoskeletal Injuries................. 19
Irreversible electroporation for nonthermal tumor ablation in patients with hepatocellular
carcinoma: initial clinical experience in Japan .............................................................................. 20
Accuracy and Safety of Ultrasound Fusion Versus CT Guided Abdominal Interventions ............. 21
Future Perspective in Abdominal Ultrasound ............................................................................... 22
Fly Thru .............................................................................................................................................. 23
Modified Date: February 16' Toshiba Publications and Clinical Evidence 2014 - 2016 2
Preliminary experience of a new perspective view technology for the detection of portal vein
thrombus in hepatocellular carcinoma patients ........................................................................... 23
(Correspondence) Virtual fetal laryngoscopy ............................................................................... 24
Future Perspective in Abdominal Ultrasound ............................................................................... 25
Strain Elastography ........................................................................................................................... 26
Strain ratio ultrasound elastography increases the accuracy of colour-Doppler ultrasound in the
evaluation of Thy-3 nodules. A bi-centre university experience .................................................. 26
The value of real-time ultrasound elastography in chronic autoimmune thyroiditis ................... 27
Q-Elastosonography of Solid Thyroid Nodules: Assessment of Diagnostic Efficacy and
Interobserver Variability in a Large Patient Cohort ...................................................................... 28
Two-Dimensional Ultrasound and Ultrasound Elastography Imaging of Trigger Points in Women
with Myofascial Pain Syndrome Treated by Acupuncture and Electroacupuncture: A Double-
Blinded Randomized Controlled Pilot Study ................................................................................. 29
Surgeon-performed Ultrasound Elastography in the Evaluation of Thyroid Nodules .................. 30
Correlation between semiquantitative sonoelastography and immunohistochemistry in the
evaluation of testicular focal lesions............................................................................................. 31
The Role of Ultrasographic Elastography in the Differential Diagnosis of Breast Masses and Its
Contribution to Classical Ultrasonographic Evaluation................................................................. 32
The Role of Elastosonography in the Differentiation of Parotid Gland Lesions: Report of Three
Cases and Review of the Literature............................................................................................... 33
Comparison of muscle-to-nodule and parenchyma-to-nodule strain ratios in the differentiation
of benign and malignant thyroid nodules: Which one should we use? ........................................ 34
CEUS .................................................................................................................................................. 35
Focal Lesions in Fatty Liver: If Quantitative Analysis Facilitates the Differentiation of Atypical
Benign from Malignant Lesions..................................................................................................... 35
Computer-aided diagnosis for estimating the malignancy grade of hepatocellular carcinoma
using contrast-enhanced ultrasound: an ROC observer study ..................................................... 36
Vesicoureteral refux detection in children: a comparison of the midline-to-orifice distance
measurement by ultrasound and voiding urosonography............................................................ 37
Contrast-enhanced ultrasonography with Sonazoid for diagnosis of gangrenous cholecystitis .. 38
Intracavitary Contrast-enhanced Ultrasonography to Detect Enterovesical Fistula in Crohn’s
Disease .......................................................................................................................................... 39
Feasibility of Using Volumetric Contrast-Enhanced Ultrasound with a 3-D Transducer to Evaluate
Therapeutic Response after Targeted Therapy in Rabbit Hepatic VX2 Carcinoma ...................... 40
Intraneural microvascular patterns of the median nerve assessed using contrast-enhanced
ultrasonography in carpal tunnel syndrome ................................................................................. 41
Differentiation of Atypical Hepatocellular Carcinoma from Focal Nodular Hyperplasia: Diagnostic
Performance of Contrast-enhanced US and Microflow Imaging .................................................. 42
Simplified approach for the assessment of kidney perfusion and acute kidney injury at the
bedside using contrast-enhanced ultrasound............................................................................... 43
Pancreatic congestion in liver cirrhosis correlates with impaired insulin secretion ..................... 44
Validation of Dynamic Contrast-Enhanced Ultrasound in Predicting Outcomes of Antiangiogenic
Therapy for Solid Tumors - The French Multicenter Support for Innovative and Expensive
Techniques Study .......................................................................................................................... 45
Kupffer-Phase Findings of Hepatic Hemangiomas in Contrast-Enhanced Ultrasound with
Sonazoid ........................................................................................................................................ 46
Focal nodular hyperplasia-like lesion of the liver with focal adenoma features associated with
idiopathic portal hypertension...................................................................................................... 47
Evaluation of contrast Sonazoid-enhanced ultrasonography for the detection of hepatic
metastases in breast cancer .......................................................................................................... 48
MicroPure.......................................................................................................................................... 49
The Diagnostic Value of Micropure Imaging in Breast Suspicious Microcalcificaion .................... 49
Radial sesamoid fracture of the second MCP joint – a case report .............................................. 50
The value of ultrasound in the diagnosis of limited scleroderma – a case report ........................ 51
Microcalcifications Versus Artifacts: Initial Evaluation of a New Ultrasound Image Processing
Technique to Identify Breast Microcalcifications in a Screening Population ................................ 52
MicroPure Imaging for the Evaluation of Microcalcifications in Gouty Arthritis Involving the First
Metatarsophalangeal Joint: A Preliminary Study.......................................................................... 53
ASQ .................................................................................................................................................... 54
Hepatic Steatosis: Assessment with Acoustic Structure Quantification of US Imaging ................ 54
Using Acoustic Structure Quantification During B-Mode Sonography for Evaluation of Hashimoto
Thyroiditis...................................................................................................................................... 55
Estimating steatosis and fibrosis: Comparison of acoustic structure quantification with
established techniques.................................................................................................................. 56
Assessment of liver fibrosis in chronic hepatitis B using acoustic structure quantification:
quantitative morphological ultrasound ........................................................................................ 57
Acoustic Structure Quantification Analysis of the Thyroid in Patients with Diffuse Autoimmune
Thyroid Disease ............................................................................................................................. 58
Non-invasive assessment of liver fibrosis using acoustic structure quantification: comparison
with transient elastography in chronic viral hepatitis .................................................................. 59
Impact Factors and the Optimal Parameter of Acoustic Structure Quantification in the
Assessment of Liver Fibrosis ......................................................................................................... 60
Acoustic structure quantification (ASQ): a new tool in sonographic examination of liver lesions in
hepatic alveolar echinococcosis .................................................................................................... 61
Clinical Applications .......................................................................................................................... 62
Case study to assess the safety of irreversible electroporation near the heart ........................... 62
Ultrasound-guided percutaneous tenotomy for the treatment of iliopsoas impingement: A
description of technique and case study ...................................................................................... 62
Quantification of Internal Carotid Artery Stenosis with 3D Ultrasound Angiography .................. 63
Isolated prenatal ultrasound findings predict the postnatal course in gastroschisis ................... 64
Shear Wave
Title Noninvasive Assessment of Liver Disease—Measurement of Hepatic Fibrosis
Using Shear Wave Elastography (SWE)
Author N Hotta
Published Open Journal of Medical Imaging (2016)
doi http://dx.doi.org/10.4236/ojmi.2015.53014
Abstract The evaluation of liver fibrosis is said to be one of the factors of the liver cancer
development. The noninvasive testing is considered for abdominal echography,
MRI, a blood marker in various ways. We announce the evaluation as an article
by liver fibrosis using the probe for the heart before, too. This time is shear
wave elastography using the echo probe for the abdomen (SWE). We used and
examined it in normal, chronic hepatitis patients with cirrhosis. We tried it, but,
in the patients with cirrhosis, there was no examination in the change in a value
after ascites time and ascitic drainage. The future examination thinks about a
comparison with the liver biopsy, the comparison with the liver fibrosis marker.
Also, we think that a malignancy and the benign differentiation should be
possible for a liver tumor.
Title Superiority of a new shear wave elastography in evaluation of liver fibrosis
Author H Iijima, M Yoshida, M Hashimoto et al.
Published Kanzo 2014; 55: 771―773
doi http://dx.doi.org/10.2957/kanzo.55.771
Abstract Shear wave with Smart maps (SwSm) installed on Aplio500 developed by Toshiba
Medical Systems Corp. allows us to estimate elasticity and visualize shear wave
propagation by displaying contour lines of the shear wave arrival time. The
usefulness of this device was compared with that of ACUSON (VTQ), Aixplorer
(SWE), FibroScan (TE). Fifty-one patients who received liver biopsy, or diagnosed
clinically as liver cirrhosis were studied. Correlation between the devices was
evaluated in 142 patients who were assessed fibrosis by more than two devices.
ROC analysis showed 0.950/0.943/0.913/0.923 in SwSm/VTQ/SWE/TE,
respectively. Correlations between the devices were 0.853/0.956/0.885, in SwSm
vs VTQ, SwSm vs SWE, SwSm vs TE, respectively. SwSm was superior to the other
devices studied here in a non-invasive assessment of liver fibrosis. Moreover,
Toshiba SwSm assures a reliable assessment by visualizing propagation of the
shear waves.
SMI
Title Superb microvascular imaging for the detection of parenchymal perfusion in
normal and undescended testes in young children
Author YS Lee, MJ Kim, SW Han et al
Published European Journal of Radiology
Volume 85, Issue 3, March 2016, Pages 649–656
doi http://dx.doi.org/10.1016/j.ejrad.2015.12.023
Abstract Objectives: To compare the detectability of perfusion difference between normal
and undescended testes (UDT) in young children using conventional Power
Doppler Imaging (PDI) and Superb Microvascular Imaging (SMI). Methods: We
prospectively performed testicular ultrasonography including PDI and SMI for the
evaluation of microvascular flow in young children. Microvascular flow was
categorized into four grades (grade 0–4). Statistical analysis was performed to
compare the differences between undescended and normal testes. Results: We
imaged 40 testes from 20 boys (age, 2–29 months). Testes sizes and volumes
were similar between the 29 normal and 11 UDT. PDI demonstrated low grade
flow in most normal (19/29) and UDT (11/11) without difference (P = 0.130).
However, SMI detected differences in flow grades between normal and UDT (P <
0.001). In univariate analysis, age (odds ratio [OR], 0.829; P = 0.012) and low grade
flow on SMI (OR of grade 0, 51.886 with P < 0.001 and OR of grade 1, 14.29 with
P = 0.017) were associated with UDT. These parameters were also significant in
multivariate analysis with larger area under the curve, compared with the results
using PDI (0.892 vs. 0.726, P = 0.002). Conclusions: SMI can detect perfusion
difference between normal and UDT in young children better than PDI.
Title Superb Microvascular Imaging—A New Vascular Detecting Ultrasonographic
Technique for Avascular Breast Masses: A Preliminary Study
Author J Zhan, XH Diao, JM Jin, L Chen, Y ChenS
Published European Journal of Radiology, Available online 18 January 2016
Abstract Objectives: Superb Microvascular Imaging (SMI) is a new vascular imaging
technique seeing a slower velocity that color Doppler flow image (CDFI) cannot.
The aim of this study is to evaluate the clinical value of SMI for detecting
penetrating vessels (PVs) in avascular breast lesions. Methods: Seventy-nine
patients with 82 breast lesions were examined by conventional ultrasound and
diagnosed as Breast Imaging Reporting and Data System (BI-RADS) level 3 or 4.
CDFI detected no PVs; subsequently, Power Doppler (PD), Advanced Dynamic
Flow (ADF), and SMI were performed to detect any PVs in the breast lesions.
Results: Compared with PD or ADF, SMI revealed significantly (P < 0.01) higher
median numbers of PVs in breast lesions. The area under the receiver operating
characteristic curve was 0.914 before the corrected classification versus 0.947
after the corrected classification (P < 0.05). Conclusions: SMI was helpful in the
differential diagnosis of benign versus malignant in avascular breast lesions,
especially those in BI-RADS category 4.
Title Comparison of Superb Micro-Vascular Ultrasound Imaging (SMI) and Contrast-
Enhanced Ultrasound (CEUS) for Detection of Endoleaks After Endovascular
Aneurysm Repair (EVAR).
Author M Gabriel, J Tomczak et al
Published Am J Case Rep. 2016 Jan 25;17:43-6.
doi http://www.ncbi.nlm.nih.gov/pubmed/26806053
Abstract BACKGROUND High-resolution contrast-enhanced ultrasound is one of methods
used in the detection and characterization of endoleaks, which is a frequent
complication after EVAR. A new technology provided by Toshiba's AplioTM 500
ultrasound system, called Superb Micro-Vascular Imaging (SMI), is dedicated
specifically to imaging very low flow states and appears to be a promising new
method for detection of endoleaks. CASE REPORT After endovascular treatment,
a 68-year-old patient who had stent-graft implantation underwent clinical
examinations, including contrast-enhanced ultrasound (CEUS), superb micro-
vascular imaging (SMI), and computed tomographic angiography (CTA), revealing
additional information about abnormal blood flow localized in the periphery of
the sack of the left common iliac artery aneurysm. By using CEUS and SMI, the
endoleak was clearly visible. CONCLUSIONS This case report illustrates the
potential clinical value of this advanced Doppler technology (SMI) and how it
could influence clinical management.
Title The Diagnostic Value of Superb Microvascular Imaging (SMI) in Detecting Blood
Flow Signals of Breast Lesions
Author Y Ma, G Li, J Li, W Ren
Published Medicine (Baltimore). 2015 Sep; 94(36): e1502.
doi http://dx.doi.org/10.1097/MD.0000000000001502
Abstract The correlation between color Doppler flow imaging (CDFI) and Superb
Microvascular Imaging (SMI) for detecting blood flow in breast lesions was
investigated, as was the diagnostic value of SMI in differentiating benign from
malignant breast lesions. These lesions were evaluated using both CDFI and SMI
according to Adler's method. Pathologic examination showed 57 malignant lesions
and 66 benign lesions. The number of blood vessels in a single mass was detected
by 2 techniques (SMI and CDFI), and the difference between the 2 values (SMI-
CDFI) was calculated. The optimal threshold for the diagnosis of malignant
neoplasms and the diagnostic performances of SMI, CDFI, and SMI-CDFI were
calculated. For the total lesions and malignant lesions alone, the difference
between SMI and CDFI for detecting blood flow was significant (P < 0.01), but the
difference was not significant for benign lesions (P = 0.15). The area under the
receiver operating characteristic curve was 0.73 (95% confidence interval [CI]:
0.64–0.82) for CDFI; 0.81 (95% CI: 0.74–0.89) for SMI; and 0.89 (95% CI: 0.82–
0.95) for SMI-CDFI. Furthermore, the modality of “SMI-CDFI” showed the best
diagnostic performance. SMI provides further microvessel information in breast
lesions. The diagnostic modality of “SMI-CDFI” can improve the diagnostic
performance of ultrasound in the differentiation between benign and malignant
masses.
Title A Novel Microvascular Flow Technique: Initial Results in Thyroids
Author P Machado, S Segal, A Lyshchik, F Forsberg et al
Published Ultrasound Quarterly, 2015
doi http://dx.doi.org/10.1097/RUQ.0000000000000156
Abstract To evaluate the flow imaging capabilities of a new prototype ultrasound (US) image
processing technique (superb micro-vascular imaging [SMI]; Toshiba Medical
Systems, Tokyo, Japan) for depiction of microvascular flow in normal thyroid tissue
and thyroid nodules compared with standard color and power Doppler US imaging.
Ten healthy volunteers and 22 patients, with a total of 25 thyroid nodules,
scheduled for US-guided fine needle aspiration were enrolled in this prospective
study. Subjects underwent US examination consisting of grayscale, color and
power Doppler imaging (CDI and PDI) followed by color and monochrome SMI and
pulsed Doppler. SMI is a novel, microvascular flow imaging mode implemented on
the Aplio 500 US system (Toshiba). SMI uses advanced clutter suppression to
extract flow signals from large to small vessels and depicts this information at high
frame rates as a color overlay image or as a monochrome map of flow. Two
radiologists independently scored still images and digital clips for overall flow
detection, vessel branching details and noise on a visual-analog scale of 1 (worst)
to 10 (best). For the volunteers SMI visualized microvasculature with significantly
lower velocity than CDI and PDI (P < 0.012). In all thyroid nodules, SMI
demonstrated microvascular flow with significantly higher image scores and
provided better depiction of the vessel branching details compared with CDI and
PDI (P < 0.0001). Clutter noise was significantly higher in monochrome SMI mode
than in the other modes, including color SMI (P < 0.001). The novel SMI mode
consistently improved the depiction of thyroid microvascular flow compared with
standard CDI and PDI.
Title 2090842 Feasibility of Superb Microvascular Imaging (SMI), an Advanced
Noninvasive US Technique, To Detect Vesicoureteral Reflux in Pediatric Patients
Without Bladder Catheterization or Contrast Use
Author S O'Hara, HK Kim, B Je et al
Published Ultrasound in Medicine and Biology , Volume 41 , Issue 4 , S61
doi http://dx.doi.org/10.1016/j.ultrasmedbio.2014.12.264
Abstract Objectives: The purpose of this study is to compare renal and bladder ultrasound
using a new FDA approved technology, superb microvascular imaging (SMI-US)
and fluoroscopic voiding cystourethrography (VCUG) to validate the feasibility
and evaluate the accuracy of SMI-US in detection of vesicoureteral reflux (VUR)
in pediatric patients. Methods: We retrospectively reviewed consecutive SMI-US
and VCUG done in 14 patients, age range from 2 weeks to 8 years, 9 male and 5
female. (Additional data will accrue until presentation.) SMI-US was performed
for both kidneys, 28 kidney ureter units (KUU) at the distal ureter near the
vesicoureteral junction and at each renal pelvis. Presence or absence of reversed
jet or swirl sign was evaluated at the distal ureter and renal pelvis respectively.
Presence of reversed jet sign and renal pelvic swirl sign was defined as reflux and
compared to the results of VCUG done on the same date. Results: Among 28
KUUs, 2 were considered nondiagnostic due to excessive patient motion. 16 did
not show any sign of reversed jet or swirl signs and none of them showed VUR on
VCUG. 6 showed sign of reversed jet sign or pelvic swirl sign and also showed
reflux on VCUG (2 grade 2, 2 grade 3, 1 grade 4, 1 grade 5). Discordant results,
negative SMI and positive VCUG, were seen in 4 of 26 units (3 grade 1, and 1 grade
2). There were no discordant cases of positive SMI and negative VCUG. In
summary: 22/26 (85%) concordant results, 4/26 (15%) discordant results, 2/28
(7%) non-diagnostic. Conclusions: We validated SMI-US in 26 KUUs and found
good correlation between the results of SMI-US and VCUG in detecting high grade
VUR. Discordant results were seen primarily in grade 1 reflux. We are actively
refining this technique and adjusting our imaging protocol to potentially decrease
invasive imaging studies requiring catheterization and radiation.
Title Spoke-wheel sign of focal nodular hyperplasia revealed by superb micro-
vascular ultrasound imaging
Author L Wu, HH Yen, MS Soon
Published QJM Jan 2015,
doi http://dx.doi.org/10.1093/qjmed/hcv016
Abstract Abstract not available.
Title Superb Microvascular Imaging (SMI) and Detection of Low Grade
Musculoskeletal Inflammation
Author A Lim, K Satchithananda, S Abraham, D Cosgrove et al
Published Radiological Society of North America 2014 Scientific Assembly and Annual
Meeting
doi http://archive.rsna.org/2014/14007205.html
Abstract PURPOSE: To assess the efficacy of Superb Microvascular Imaging (SMI) in
detecting low grade inflammation in joints and tendons compared with
conventional Power Doppler ultrasound (PDUS). METHOD AND MATERIALS:
SMI is a new and sensitive Doppler technology designed to detect slow flowing
microvasculature. We assessed it in patients who presented for routine MSK
ultrasound (Aplio 500, Toshiba Medical Systems). The grey-scale, PDUS and SMI
findings of each study were recorded on video clips. The joints and tendons which
demonstrated an abnormality or vascular signal on either grey-scale appearance,
PDUS or SMI were included in the analysis. Three radiologists with over 10 years
experience individually in MSK ultrasound assessed the images and scored
whether there were grey-scale changes, signal on PDUS and/or SMI within the
joints or tendons examined. If signal was detected on PDUS and SMI, they also
scored a four point scale comparing the two Doppler techniques (no difference,
mildly, moderately or markedly better). RESULTS: 50 cases have been analyzed
to date, comprising of 36 joints, 9 tendons, and 5 superficial lumps. In all cases,
patients were symptomatic with joint pain or a palpable lump and 12 had a history
of an inflammatory arthropathy. There was very good agreement between the
readers (Κappa = 0.85). 29 cases demonstrated vascular flow with both PD and
SMI while in 5 cases, no flow was detected with either technique. In 16 cases,
vascularity was detected with SMI but not with PDUS (Fisher's exact test: p = 0.02).
Out of the 29 patients with vascularity on SMI and PDUS, 3 showed no difference;
while SMI scored moderately or markedly better in 20 cases (Chi2: p<0.02). In 12
patients, the SMI findings altered patient management where they either received
an ultrasound guided steroid injection or started oral analgesia and/or disease
modifying treatment. CONCLUSION: SMI is a revolutionary Doppler technique
which not only improves the visualisation of the microvasculature but allows
detection of low grade inflammation not previously visualised with Power Doppler.
This has significant clinical impact leading to a change in management in 25% of
the patients in this study population. CLINICAL RELEVANCE/APPLICATION: The
improved sensitivity of SMI compared with the current "gold standard" Power
Doppler, allows the detection of low grade inflammation not possible with Power
Doppler which would significantly influence patient treatment.
Title Thyroid Evaluation with a Novel Microvascular Flow Technique
Author P Machado, S Segal, A Lyshchik, F Forsberg et al
Published Radiological Society of North America 2014 Scientific Assembly and Annual
Meeting
doi http://archive.rsna.org/2014/14013550.html
Abstract PURPOSE: To evaluate the flow imaging capabilities of a new prototype
ultrasound (US) image processing technique (SMI; Toshiba Medical Systems,
Tokyo, Japan) for depiction of microvascular flow in normal thyroid tissue and
thyroid nodules compared to standard color and Power Doppler imaging (CDI and
PDI). METHOD AND MATERIALS: SMI is a novel, microvascular flow imaging
mode implemented on the Aplio 500 US system (Toshiba). SMI utilizes advanced
clutter suppression to extract flow signals from large to small vessels and depicts
this information as a color overlay image or as a monochrome map of flow. Ten
(10) healthy volunteers and 22 patients, with 25 thyroid nodules, scheduled for US
guided fine needle aspiration were enrolled in this prospective study. Subjects
underwent US examination consisting of grayscale US, CDI and PDI followed by
color and monochrome SMI and pulsed Doppler. In the volunteers, pulsed Doppler
guided by the 4 flow modes determined the lowest velocity measurable within the
normal thyroid microvasculature and results were compared using a one-way
ANOVA. Two radiologists independently analyzed still images and digital clips
scoring overall flow detection, vessel branching details and noise on a subjective
scale of 1 (worst) to 10 (best). Scores were compared (on a per nodule basis)
using a non-parametric Wilcoxon signed rank test. RESULTS: For the volunteers
SMI captured microvasculature with lower velocity than CDI and PDI (2.2 ± 0.35
and 2.1 ± 0.32 cm/s vs. 2.6 ± 0.44 and 2.8 ± 0.77 cm/s; p < 0.012). In all cases
SMI showed microvascular flow with significantly higher image scores and
provided better depiction of the vessel branching details compared to CDI and PDI
(SMI scores > 5.4 and CDI/PDI scores < 4.9; p < 0.0001). Clutter noise was
significantly higher in monochrome SMI mode than in the other modes, including
color SMI (monochrome SMI scores < 4.5 while others were > 6.4; p < 0.001).
CONCLUSION: The novel SMI mode consistently showed more detailed thyroid
flow with smaller branches and lower velocities than CDI and PDI. CLINICAL
RELEVANCE/APPLICATION: This new flow mode may be useful for providing a
better understanding of the vascularity of thyroid nodules.
Title Microvascular blood flow in the thyroid: Preliminary results with a novel
imaging technique
Author F Forsberg, P Machado, S Segal et al
Published Ultrasonics Symposium (IUS), 2014 IEEE International 2014 Sep; p2237-2240
doi http://dx.doi.org/10.1109/ULTSYM.2014.0557
Abstract Nodules in the thyroid are present in 13-76 % of ultrasound (US) imaging
evaluations; although only 4-15 % are malignant. A better understanding of thyroid
nodule vascularity might be clinically helpful and the purpose of this study was thus
to determine the flow imaging capabilities of a new prototype US image processing
technique (SMI; Toshiba Medical Systems, Tokyo, Japan) for the depiction of
microvascular flow in normal thyroid tissue and thyroid nodules compared to
standard color and power Doppler imaging (CDI and PDI). SMI is a novel,
microvascular flow imaging mode implemented on the Aplio 500 scanner
(Toshiba). By analyzing clutter motion and using a new adaptive algorithm to
identify and remove tissue motion SMI is designed to improve the visualization of
microvascular blood flow. SMI depicts this information as a color overlay or as a
monochrome map of flow. Ten healthy volunteers and 22 patients, with 25 thyroid
nodules, were studied. Subjects underwent a thyroid US examination consisting of
grayscale US, CDI and PDI followed by color and monochrome SMI. In the
volunteers, pulsed Doppler guided by the 4 flow modes determined the lowest
velocity measurable within the normal thyroid. For the patient data, 2 radiologists
independently scored overall flow detection, vessel branching and noise on a
visual analog scale of 1 (worst) to 10 (best). In the volunteers color and
monochrome SMI captured microvasculature with lower velocities than CDI and
PDI (2.2 ± 0.35 and 2.1 ± 0.32 cm/s vs. 2.6 ± 0.44 and 2.8 ± 0.77 cm/s; p <; 0.012).
For all 25 nodules both readers found that color and monochrome SMI showed
more microvascular flow and provided better depiction of the vessel branching
compared to CDI and PDI (p <; 0.0001). Clutter noise was significantly higher in
the monochrome SMI mode than in the other 3 modes (p <; 0.001). Consequently,
initial results indicate that SMI can depict more detailed peri- and intra-nodul- r
thyroid microvascular flow than CDI and PDI.
Fusion
Title Added Value of Multiparametric Ultrasonography in Magnetic Resonance
Imaging and Ultrasonography Fusion–guided Biopsy of the Prostate in Patients
With Suspicion for Prostate Cancer
Author A Maxeiner, C Stephan, T Durmus, M Grigoryev, T Slowinskid, H Cash, T Fischer
Published Urology: Volume 86, Issue 1, July 2015, Pages 108–114
doi http://dx.doi.org/10.1016/j.urology.2015.01.055
Abstract PURPOSE: Multiparametric MRI of the prostate is a noninvasive diagnostic
method with high sensitivity and specificity for prostate cancer. The aim of this
study is to evaluate whether prostate cancer detection rates of transrectal
ultrasound (TRUS)-guided biopsy may be improved by an image fusion of state-
of-the-art ultrasound (CEUS, elastography) and MR (T2w, DWI) imaging.
MATERIALS AND METHODS: 32 consecutive patients with a history of elevated
PSA levels and at least one negative TRUS-guided biopsy with clinical indication
for a systematic re-biopsy underwent multiparametric 3 T MRI without endorectal
coil. MR data (T2w) were uploaded to a modern sonography system and image
fusion was performed in real-time mode during biopsy. B-mode, Doppler,
elastography and CEUS imaging were applied to characterize suspicious lesions
detected by MRI. Targeted biopsies were performed in MR/US fusion mode
followed by a systematic standard TRUS-guided biopsy. Detection rates for both
methods were calculated and compared using the Chi²-test. RESULTS: Patient
age was not significantly different in patients with and without histologically
confirmed prostate cancer (65.2 ± 8.0 and 64.1 ± 7.3 age [p = 0.93]). The PSA
value was significantly higher in patients with prostate cancer (15.5 ± 9.3 ng/ml)
compared to patients without cancer (PSA 10.4 ± 9.6 ng/ml; p = 0.02). The
proportion of histologically confirmed cancers in the study group (n = 32) of the
MR/US fusion biopsy (11/12; 34.4 %) was significantly higher (p = 0.01) in
comparison to the TRUS systematic biopsy (6/12; 18.8 %). CONCLUSION: Real-
time MR/US image fusion may enhance cancer detection rates of TRUS-guided
biopsies and should therefore be studied in further larger studies.
Title Evaluation of MRI-US Fusion Technology in Sports-Related Musculoskeletal
Injuries
Author M Wong-On, L Til-Pérez, R Balius
Published Advances in Therapy
June 2015, Volume 32, Issue 6, pp 580-594
doi http://dx.doi.org/10.1007/s12325-015-0217-1
Abstract Introduction: A combination of magnetic resonance imaging (MRI) with real-time
high-resolution ultrasound (US) known as fusion imaging may improve
visualization of musculoskeletal (MSK) sports medicine injuries. The aim of this
study was to evaluate the applicability of MRI-US fusion technology in MSK sports
medicine. Methods: This study was conducted by the medical services of the FC
Barcelona. The participants included volunteers and referred athletes with
symptomatic and asymptomatic MSK injuries. All cases underwent MRI which was
loaded into the US system for manual registration on the live US image and fusion
imaging examination. After every test, an evaluation form was completed in terms
of advantages, disadvantages, and anatomic fusion landmarks. Results: From
November 2014 to March 2015, we evaluated 20 subjects who underwent fusion
imaging, 5 non-injured volunteers and 15 injured athletes, 11 symptomatic and 4
asymptomatic, age range 16–50 years, mean 22. We describe some of the
anatomic landmarks used to guide fusion in different regions. This technology
allowed us to examine muscle and tendon injuries simultaneously in US and MRI,
and the correlation of both techniques, especially low-grade muscular injuries. This
has also helped compensate for the limited field of view with US. It improves spatial
orientation of cartilage, labrum and meniscal injuries. However, a high-quality MRI
image is essential in achieving an adequate fusion image, and 3D sequences need
to be added in MRI protocols to improve navigation. Conclusion: The combination
of real-time MRI and US image fusion and navigation is relatively easy to perform
and is helping to improve understanding of MSK injuries. However, it requires
specific skills in MSK imaging and still needs further research in sports-related
injuries.
Title Irreversible electroporation for nonthermal tumor ablation in patients with
hepatocellular carcinoma: initial clinical experience in Japan
Author K Sugimoto, F Moriyasu, Y Kobayashi et al.
Published Japanese Journal of Radiology, July 2015, Volume 33, Issue 7, pp 424-432
Abstract Purpose: This clinical study was conducted to evaluate the safety and short-term
outcomes of irreversible electroporation (IRE) for the treatment of patients with
hepatocellular carcinoma (HCC) in Japan. Materials and methods: The study was
designed in a prospective setting. Five patients (3 men and 2 women; mean age,
66.6 ± 5.8 years) with 6 HCCs were enrolled and treated using percutaneous
ultrasound (US)-guided IRE. Safety was assessed based on adverse events and
laboratory values. Local control was assessed using contrast-enhanced US with a
perflubutane microbubble contrast agent, contrast-enhanced multiphase CT, and
gadoxetic acid-enhanced MRI (EOB-MRI) at designated points. Results: The
tumors ranged in diameter from 11 to 28 mm (mean diameter, 17.5 ± 6.3 mm).
Five of the 6 tumors (83 %) were successfully treated, with no local recurrence to
date (mean follow-up 244 ± 55 days). In 1 lesion located in liver segment 1, residual
tumor was diagnosed at 7 days after intervention by follow-up EOB-MRI. No
serious complications related to the IRE procedure were observed. Conclusion
The results of this study suggest that image-guided percutaneous IRE can achieve
satisfactory local disease control, particularly for small HCCs, and is well tolerated
by patients.
Title Accuracy and Safety of Ultrasound Fusion Versus CT Guided Abdominal
Interventions
Author Y Ahmed, S Abboud, DA Nakamoto et al.
Published Ultrasound in Medicine and Biology Volume 41, Number 4S, 2015
Abstract Objectives: This retrospective study compares between the accuracy and safety
of ultrasound Fusion versus CT guidance in abdominal interventions; such as
image guided biopsy of the liver. Methods: Retrospective chart review A total of 60
male and female adult patient records between the age of 35 and 80, who: 1)
Expressed atypical/inconclusive findings on dynamic CT or MRI 2) Were deemed
challenging for ultrasound guided interventions secondary to body habitus or
presence of air or presence of intra-abdominal fluid collections 3) Had CT guided
biopsy and/or ultrsound Fusion biopsy in the last 5 years. Were selected in a
random fashion and put into two groups according to the type of guidance
(ultrasound fusion vs CT) used during the interventional procedure. Results: Our
preliminary data shows higher diagnostic accuracy (.93 %) when using ultrasound
fusion in comparison to CT guided interventions without contrast (90 %).
Complication rates are similar, around 2% of cases. Ultrasound fusion also has a
shorter procedure time and therefore, shows an improvement in patient
satisfaction. Financial gain associated with freeing the CT table for other studies
and radiation dose reduction for the patient and operator are likely significant but
not yet assessed. Conclusions: Ultrasound guided interventions are somewhat
difficult, especially if the operator is not experienced, or if there are limiting factors
like patients body habitus and interposing bowels/ air containing structures. In
these instances, CT guidance is preferred, however, it exposes patients to
significant radiation, contrast administration, lengthy procedure durations and
higher costs. Ultrasound fusion with previously acquired CT/MRI enables the
operator to bypass these challenges. Based on preliminary data, ultrasound fusion
technology provides a better alternative to CT guidance, in cases where using
ultrasound alone is not optimal to achieve safe and effective interventions.
Title Future Perspective in Abdominal Ultrasound
Author J Machi, F Moriyasu, S Arii, M Yano et al.
Published Abdominal Ultrasound for Surgeons 2014, pp 287-303
doi http://dx.doi.org/10.1007/978-1-4614-9599-4_23
Abstract Abdominal ultrasound is one of the most commonly used imaging methods
currently. It is different from other imaging such as computed tomography because
surgeons (especially abdominal surgeons, hepatobiliary pancreatic surgeons,
surgical oncologists, and minimally invasive surgeons) can and should perform
ultrasound examination by themselves.
Abdominal ultrasound, including transabdominal ultrasound, intraoperative
ultrasound, laparoscopic ultrasound, and endoscopic ultrasound, can provide
various types of diagnostic information which are otherwise not easily or practically
available. In addition, ultrasound can guide or assist various surgical procedures
such as needle biopsy and ablation of lesions in real time much easier than other
imaging methods. Advantages of transabdominal, intraoperative, and laparoscopic
ultrasound include high accuracy, safety, and speed, with comprehensive
anatomical information, dynamic blood flow information, and real-time guidance
capability, and these outweigh its disadvantages such as specific instrumentation
requirement and slow learning curve.
History of the use of ultrasound by surgeons, future perspective of surgeon-
performed ultrasound, learning of abdominal ultrasound in future, and new and
promising technology in abdominal ultrasound (including video clips) are described
in this chapter.
The use of abdominal ultrasound by surgeons is expected to increase along with
more formal training in ultrasound for surgeons. New ultrasound technologies such
as ultrasound contrast enhancement, 3/4-dimensional ultrasound, fusion
technique, elastic imaging, and quantitative ultrasound will be employed more
during future abdominal ultrasound and will facilitate interventional procedures.
Being like the surgeon’s stethoscope and versatile transabdominally and
intraoperatively, ultrasound is a valuable technique which is recommended to
master for surgeons in various fields to improve surgical decision-making and
surgical outcomes.
Fly Thru
Title Preliminary experience of a new perspective view technology for the detection
of portal vein thrombus in hepatocellular carcinoma patients
Author W Wang, GJ Liu, LD Che, XY Xie et al
Published Abdom Imaging. 2014 Dec;39(6):1145-52
Abstract OBJECTIVE: To assess the feasibility and efficiency of a perspective view
technology (Fly Thru) for the detection of portal vein tumor thrombus (PVTT) in
hepatocellular carcinoma (HCC) patients.
METHODS: Fly Thru was performed in 79 HCC patients. The images were
reviewed off-site for evaluation of the imaging quality and diagnosis. Pathology
and/or contrast-enhanced CT was used as the reference standard for PVTT. The
diagnostic quality of the images, presences of PVTT, and patency of the target
vessels were recorded by two-dimensional ultrasound (2DUS) and Fly Thru image.
The diagnostic performances of resident and staff radiologists were compared
between 2DUS with or without off-line Fly Thru.
RESULTS: Fly Thru was performed successfully in 43 of 79 patients (54.4%). The
Fly Thru Imaging quality was good in 30/43 patients (69.8%), suboptimal but
diagnostic in 10/43 (23.2%), and non-diagnostic in the remaining 3/43 (7.0%).
PVTTs were detected in 31 patients according to the reference standard, with 8 in
the main portal vein, 15 in the first branch, and 8 in the second branch of the portal
vein. The agreement was good between conventional 2DUS and Fly Thru (κ =
0.783, p = 0.000). There was a significant association between the quality and the
ability of Fly Thru in the detection of PVTTs (p = 0.001). The diagnostic
performance for both readers between 2DUS with or without Fly Thru showed no
statistically significant differences, except for the sensitivity for resident radiologist.
The sensitivity of 2DUS (71.0%, 22/31) for resident radiologists was lower than
that of Fly Thru as an adjunctive diagnostic tool (90.3%, 28/31) (p = 0.041).
CONCLUSION: Fly Thru is of diagnostic quality and can provide useful information
for the detection of PVTT in HCC patients.
Title (Correspondence) Virtual fetal laryngoscopy
Author D Pugash, FK Kozak, A Gagnon
Published Ultrasound Obstet Gynecol 2014; 43: 106–110
doi http://dx.doi.org/ 10.1002/uog.13218
Title Future Perspective in Abdominal Ultrasound
Author J Machi, F Moriyasu, S Arii, M Yano et al.
Published Abdominal Ultrasound for Surgeons 2014, pp 287-303
doi http://dx.doi.org/10.1007/978-1-4614-9599-4_23
Abstract Abdominal ultrasound is one of the most commonly used imaging methods
currently. It is different from other imaging such as computed tomography because
surgeons (especially abdominal surgeons, hepatobiliary pancreatic surgeons,
surgical oncologists, and minimally invasive surgeons) can and should perform
ultrasound examination by themselves.
Abdominal ultrasound, including transabdominal ultrasound, intraoperative
ultrasound, laparoscopic ultrasound, and endoscopic ultrasound, can provide
various types of diagnostic information which are otherwise not easily or practically
available. In addition, ultrasound can guide or assist various surgical procedures
such as needle biopsy and ablation of lesions in real time much easier than other
imaging methods. Advantages of transabdominal, intraoperative, and laparoscopic
ultrasound include high accuracy, safety, and speed, with comprehensive
anatomical information, dynamic blood flow information, and real-time guidance
capability, and these outweigh its disadvantages such as specific instrumentation
requirement and slow learning curve.
History of the use of ultrasound by surgeons, future perspective of surgeon-
performed ultrasound, learning of abdominal ultrasound in future, and new and
promising technology in abdominal ultrasound (including video clips) are described
in this chapter.
The use of abdominal ultrasound by surgeons is expected to increase along with
more formal training in ultrasound for surgeons. New ultrasound technologies such
as ultrasound contrast enhancement, 3/4-dimensional ultrasound, fusion
technique, elastic imaging, and quantitative ultrasound will be employed more
during future abdominal ultrasound and will facilitate interventional procedures.
Being like the surgeon’s stethoscope and versatile transabdominally and
intraoperatively, ultrasound is a valuable technique which is recommended to
master for surgeons in various fields to improve surgical decision-making and
surgical outcomes.
Strain Elastography
Title Strain ratio ultrasound elastography increases the accuracy of colour-Doppler
ultrasound in the evaluation of Thy-3 nodules. A bi-centre university experience
Author V Cantisani, P Maceroni, V D'Andrea, G Patrizi et al.
Published Ultrasound
European Radiology pp 1-9
Abstract Objectives: To assess whether ultrasound elastography (USE) with strain ratio
increases diagnostic accuracy of Doppler ultrasound in further characterisation of
cytologically Thy3 thyroid nodules. Methods: In two different university
diagnostic centres, 315 patients with indeterminate cytology (Thy3) in thyroid
nodules aspirates were prospectively evaluated with Doppler ultrasound and
strain ratio USE before surgery. Ultrasonographic features were analysed
separately and together as ultrasound score, to assess sensitivity, specificity,
positive predictive value (PPV) and negative predictive value (NPV). Receiver
operating characteristic (ROC) curves to identify optimal cut-off value of the
strain ratio were also provided. Diagnosis on a surgical specimen was considered
the standard of reference. Results: Higher strain ratio values were found in
malignant nodules, with an optimum strain ratio cut-off of 2.09 at ROC analysis.
USE with strain ratio showed 90.6 % sensitivity, 93 % specificity, 82.8 % PPV,
96.4 % NPV, while US score yielded a sensitivity of 52.9 %, specificity of 84.3 %,
PPV 55.6 % and NPV 82.9 %. The diagnostic gain with strain ratio was statistically
significant as proved by ROC areas, which was 0.9182 for strain ratio and 0.6864
for US score. Conclusions: USE with strain ratio should be considered a useful
additional tool to colour-Doppler US, since it improves characterisation of thyroid
nodules with indeterminate cytology.
Title The value of real-time ultrasound elastography in chronic autoimmune
thyroiditis
Author M S Menzilcioglu, M Duymus, G Gungor et al.
Published The British Journal of Radiology Volume 87, Issue 1044
doi http://dx.doi.org/10.1259/bjr.20140604
Abstract Objective: Chronic autoimmune thyroiditis (CAT) (chronic lymphocytic thyroiditis—
Hashimoto's thyroiditis), which is the most common inflammatory disorder of the
thyroid gland, causes hypothyroidism. Ultrasound elastography is a newly
developed sonographic technique that provides an estimation of tissue elasticity
by measuring the degree of tissue displacement under the application of an
external force. In this study, our aim was to evaluate the accuracy of strain index
ratio with real-time ultrasound elastography and to calculate the cut-off point for
the diagnosis of CAT. Our aim was also to lead further studies on other
pathological changes such as lymphoma, malign nodules etc. based on CAT by
using this cut-off point. The gains from this study and further studies will assist
clinical diagnoses and follow-up. Methods: Aplio™ 500 ultrasound machine
(Toshiba Medical Systems Co. Ltd, Otawara, Japan) with linear 4.8–11.0 MHz
transducers and elastography software was used. Routine B-mode (dimensions
and parenchymal echogenicity) ultrasound evaluation was performed prior to the
ultrasound elastography. Results:A total of 31 randomized patients (3 males, 28
females) with a mean age of 39.13 ± 10.16 years (range, 16–58 years) with CAT
and 21 healthy controls (6 males, 15 females) with mean age of 34.67 ± 16.31
years (range, 14–81 years) were prospectively examined. The mean values of
thyroid-stimulating hormone (TSH; normal TSH value is 0.27–4.20 IU ml−1) and
anti-thyroid peroxidase (anti-TPO; normal anti-TPO value is 0–34 IU ml−1) were
3.40 ± 2.70 and 373.66 ± 148.94 IU ml−1, respectively. No correlation was
detected between serum TSH and thyroid tissue strain index (Spearman r
coefficient of TSH was −0.290). Positive-sided correlation was detected between
anti-TPO values and thyroid tissue strain index ratio (Spearman r coefficient of
anti-TPO was 0.682). The median strain index ratio of patients with CAT
(1.39 ± 0.72) was significantly higher than the mean ratio of the controls
(0.76 ± 0.55). The area under the receiver operating characteristic curve was 0.775
(95% confidence interval). The optimal cut-off value (in which the sum of sensitivity
and specificity was highest) for the prediction of diffuse thyroid pathology was
0.677. For this cut-off ratio, thyroid stiffness had 96% sensitivity and 67%
specificity. A total of 30 of 31 patients (96%) and a total of 7 of 21 healthy controls
(33%) exceeded the cut-off points.Conclusion:The strain index ratio was higher in
CAT than in normal thyroid parenchyma in real-time ultrasound elastography.
Thus, it seems to be a useful method for the assessment of CAT with real-time
ultrasound elastography, and further studies assessing the correlation of
sonoelastography findings and histopathological subtypes of CAT would enrich the
findings of the present study. Advances in knowledge:In our study, we detected
the stiffness ratio of the thyroid tissue in patients with CAT. The cut-off value should
be helpful for diagnosis or follow-up of the recently developed lesions such as
lymphoma, malign nodule, etc. based on CAT. This study should also encourage
new studies about CAT and ultrasound elastography.
Title Q-Elastosonography of Solid Thyroid Nodules: Assessment of Diagnostic Efficacy
and Interobserver Variability in a Large Patient Cohort
Author V Cantisani, H Grazhdani, P Ricci et al.
Published European Radiology January 2014, Volume 24, Issue 1, pp 143-150
doi http://dx.doi.org/10.1007/s00330-013-2991-y
Abstract Objective: Evaluation of the diagnostic efficacy and interobserver agreement of Q-
elastography in the differentiation of benign from malignant thyroid nodules.
Methods: A total of 344 thyroid nodules in 288 patients were examined with grey-
scale and colour Doppler ultrasound (CDUS) and Q-elastography by two
independent operators. Nodules with hypoechogenicity, poorly defined margins,
microcalcifications, and intralesional vascularity were classified as suspicious.
Diagnostic performances of CDUS features and Q-elastography for predicting
thyroid malignancy were estimated using ROC analysis. Cytology or
histopathology was the reference standard. Interobserver agreement in the
evaluation of CDUS and Q-elastography was assessed using Cohen's k-statistic.
Results: Q-elastography showed excellent diagnostic performance for the
prediction of thyroid malignancy, with sensitivity of 93 % and specificity of 92 % for
operator 1 (best cutoff at 2.02), and sensitivity of 84 % and specificity of 79 % for
operator 2 (best cutoff at 1.86). Performance of Q-elastography was superior to
that of CDUS. Reproducibility of the findings was excellent for both Q-elastography
and CDUS features as assessed with Cohen's k, which was highest for strain ratio
measurements (0.95) and lowest for the echogenicity score (0.83).
Conclusions: Q-elastography showed excellent performance. It is a valid and
reproducible diagnostic method as well as a promising tool for identifying
suspicious solid thyroid nodules needing cytological assessment and surgery.
Title Two-Dimensional Ultrasound and Ultrasound Elastography Imaging of Trigger
Points in Women with Myofascial Pain Syndrome Treated by Acupuncture and
Electroacupuncture: A Double-Blinded Randomized Controlled Pilot Study
Author CEE Müller, MFM Aranha, MBD Gavião et al.
Published European Radiology January 2014, Volume 24, Issue 1, pp 143-150
doi http://dx.doi.org/10.1177/0161734614546571
Abstract Chronic pain has been often associated with myofascial pain syndrome (MPS),
which is determined by myofascial trigger points (MTrP). New features have been
tested for MTrP diagnosis. The aim of this study was to evaluate two-dimensional
ultrasonography (2D US) and ultrasound elastography (UE) images and
elastograms of upper trapezius MTrP during electroacupuncture (EA) and
acupuncture (AC) treatment. 24 women participated, aged between 20 and 40
years (M ± SD = 27.33 ± 5.05) with a body mass index ranging from 18.03 to 27.59
kg/m2 (22.59 ± 3.11), a regular menstrual cycle, at least one active MTrP at both
right (RTPz) and left trapezius (LTPz) and local or referred pain for up to six
months. Subjects were randomized into EA and AC treatment groups and the
control sham AC (SHAM) group. Intensity of pain was assessed by visual analogue
scale; MTrP mean area and strain ratio (SR) by 2D US and UE. A significant
decrease of intensity in general, RTPz, and LTPz pain was observed in the EA
group (p = 0.027; p < 0.001; p = 0.005, respectively) and in general pain in the AC
group (p < 0.001). Decreased MTrP area in RTPz and LTPz were observed in AC
(p < 0.001) and EA groups (RTPz, p = 0.003; LTPz, p = 0.005). Post-treatment SR
in RTPz and LTPz was lower than pre-treatment in both treatment groups. 2D US
and UE effectively characterized MTrP and surrounding tissue, pointing to the
possibility of objective confirmation of subjective EA and AC treatment effects.
Title Surgeon-performed Ultrasound Elastography in the Evaluation of Thyroid
Nodules
Author YC Chang, WC Lo, LJ Liao
Published Journal of Medical Ultrasound September 2014 Volume 22, Issue 3, Pages 145–
151
doi http://dx.doi.org/10.1016/j.jmu.2014.06.004
Abstract Background: Real-time ultrasound (US) elastography (USE) assesses lesion
stiffness and was reported as markedly accurate in thyroid nodule evaluation. The
aim of this study was to validate the effectiveness of head and neck surgeon-
performed USE in the evaluation of thyroid nodules. Methods: From January 2011
to November 2013, 308 patients with thyroid nodules who received traditional US,
USE, and US-guided cytology were reviewed. The nodules with cytology reports
that revealed Bethesda cytology levels of Thy 2, Thy 5, and Thy 6 were collected.
The characteristics of traditional US and USE were analyzed. Results: Univariate
analysis revealed that a set of characteristics including a larger transverse
diameter, taller-than-wide shape, margins, heterogeneous echotexture,
microcalcification, predominately solid echo structure, marked intranodular
vascular pattern and USE (an elastography score of III/IV vs. I/II) differed
significantly between malignancy and benignity (p < 0.05). Stepwise multivariate
logistic regression analysis showed that a taller-than-wide shape,
microcalcification, and USE were independent, significant factors in predicting
malignant nodular disease (p < 0.05) Conclusion: The results support the
hypothesis that USE is an independent factor in determining malignant thyroid
nodules.
Title Correlation between semiquantitative sonoelastography and
immunohistochemistry in the evaluation of testicular focal lesions
Author AL Pastore, G Palleschi, P Maceroni et al.
Published Cancer Imaging 2014 14:29.
Abstract Background: Sonoelastography is a novel and promising imaging tool, which has
been applied to breast, thyroid, and prostate tissues. The aim of this study was to
evaluate focal lesions of the testes with diameters of <10 mm using
sonoelastography, B-mode sonography (US), and colour Doppler ultrasonography
(CDU). Methods: Thirty patients who were referred to our outpatient clinics for
varicocoeles, scrotal pain, scrotal enlargements, epididymitis, palpable testicular
nodules, or infertility, were prospectively enrolled into this study. Ultrasound
evaluations had revealed that 27 subjects had focal testicular lesions with
diameters of <10 mm and 3 subjects had 10-mm spherical non-homogeneous
testicular nodules. All lesions were evaluated using semiquantitative
sonoelastography, and the patients underwent orchifunicolectomies. The testicular
lesions were examined histopathologically. The vascularization of the lesions and
the surrounding testicular parenchyma was evaluated by analysing the
immunohistochemical distribution of the cluster of differentiation 31 and by
calculating the vascular indices (VI). Potential associations between the strain
ratios (stiffness of the lesions) and the VI were tested. Results: Analyses of the
strain fields obtained using semiquantitative sonoelastography yielded different
values for the masses and the surrounding tissues, which led to significant
increases in the strain ratios. Sonoelastography upheld all of the diagnoses that
were suspected when the patients were physically examined, when the serum
markers were analysed, and after the patients had undergone US and CDU.
Histopathological examinations confirmed the neoplastic characteristics of these
masses. A significant inverse correlation was determined between the
sonoelastographic strain ratio and the VI (Pearson correlation coefficient, r, = −
0.93; P < 0.001). Conclusion: Our investigation shows that semiquantitative
sonoelastography may provide additional objective information to support the
algorithm used to diagnose testicular lesions. This might be of crucial diagnostic
importance for lesions with diameters of <10 mm, particularly if they are not
palpable, are negative for serum tumour markers, and if the findings from
ultrasonography and CDU are equivocal. The findings from semiquantitative
sonoelastography might indicate the need for surgical exploration. Further
investigations with larger numbers of patients are required to corroborate these
data and to support the use of semiquantitative sonoelastography in the evaluation
of testicular lesions.
Title The Role of Ultrasographic Elastography in the Differential Diagnosis of Breast
Masses and Its Contribution to Classical Ultrasonographic Evaluation
Author M Yağtu, E Turan, Ç Turan et al
Published J Breast Health 2014; 10: 141-146
doi http://dx.doi.org/10.5152/tjbh.2014.2024
Abstract Objective: The aim of this study was to understand the role of ultrasonographic
elastography method in the differentiation of breast masses and to assess its
contribution to classic ultrasonographic evaluation. Materials and Methods: In this
retrospective study, 76 breast masses in 76 patients were firstly evaluated by
conventional ultrasonography (U.S.) and scored according to breast imaging
report and data systems (BIRADS) and then evaluated with the Elastographic
method during the same session between January and December 2013 in our
hospital’s Radiology Department. Findings were compared with pathological
results. In statistical evaluation of the data, independent sample t tests were used
for variables between groups. Results: The mean strain ratio of benign masses
was 2.48±1.605 and strain score was 2.307±1.327. The mean strain ratio of
malignant masses was 5.546±1.434 and strain score was 4.458±0.721. The most
frequent benign masses were fibroadenoma and fibrocystic lesions. The most
common malignant lesion was invasive ductal carcinoma. When the cut-off value
for strain ratio was accepted as 4.009 in receiver operating curve (ROC) analysis
for the differential diagnosis of malignant breast masses, the sensitivity, specificity,
positive predictive value (PPV), and negative predictive value (NPV) were
calculated as 83.8%, 76.9%, 62.3%, and 90.7%, respectively. When the limit value
of strain patterns was accepted as scores 4 and 5, the sensitivity, specificity, PPV,
and NPV were calculated as 42.7%, 94.2%, 77.2%, and 78%, respectively. When
conventional ultrasonography (U.S.) findings were considered together with the
elastographic strain ratios the sensitivity, specificity, PPV and NPV were 87.5%,
71.1%, 58.3% and 92.5%, respectively. Conclusion: Elastography is not a method
that can replace conventional breast ultrasound for detecting breast cancer,
however it may be an adjunct to conventional ultrasound by increasing its
diagnostic power.
Title The Role of Elastosonography in the Differentiation of Parotid Gland Lesions:
Report of Three Cases and Review of the Literature
Author IG Tatar, O Ergun, A Kurt et al
Published Pol J Radiol. 2014; 79: 398–401
doi http://dx.doi.org/10.12659/PJR.891019
Abstract Background: The parotid gland is the mostly affected site among major salivary
gland tumors in up to 85% of cases. Preoperative knowledge of the tumour nature
is crucial since it influences the surgical procedure and patient’s morbidity,
especially the risk of facial nerve palsy. Ultrasonography is commonly used as the
first line imaging modality for the salivary gland lesions. A pitfall is that the
histologic pleomorphism often reflects an imaging pleomorphism. Case Report:
Herein we aimed to present the role of elastosonography in three parotid lesions:
a case of benign pleomorphic adenoma, a Wharthin’s tumour and a malignant
parotid tumour. Conclusions: Our findings show that malignant parotid lesion was
the stiffest lesion according to elastosonography. Wharthin’s tumour demonstrated
soft elastosonographic features. The pleomorphic adenoma was also interpreted
as stiff by elastosonography suggesting that the elastosonographic features of
pleomorphic adenoma may resemble those of malignant lesions limiting the utility
of the technique.
Title Comparison of muscle-to-nodule and parenchyma-to-nodule strain ratios in the
differentiation of benign and malignant thyroid nodules: Which one should we
use?
Author R Aydina, M Elmalib, A Polat et al
Published European Journal of Radiology Volume 83, Issue 3, Mar 2014, Pages e131–e136
Abstract Objective: The aim of this study is to investigate the diagnostic accuracy of muscle-
to-nodule strain ratio (MNSR) in the differentiation of benign and malignant thyroid
nodules and to see if there was a difference between MNSR and parenchyma-to-
nodule strain ratios (PNSR) in diagnosis. Methods: A total of 106 consecutive
patients (88 women and 18 men; age range 19–79 years) with thyroid nodules
were prospectively examined using ultrasound and sonoelastography before the
fine-needle aspiration biopsy. The mean MNSR and PNSR were calculated for
each nodule and the elasticity score was determined according to four-point
scoring system. Results: According to the four-point scoring system, 44 of the 83
benign nodules had a score of one or two while 22 of the 23 malignant nodules
had a score of three or four (p < 0.001). Using ROC analysis, the best cutoff point
for MNSR 1.85 and for PNSR 3.14 was calculated. The sensitivity and specificity
for the MNSR were 95.6%, 92.8%, respectively; for the PNSR were 95.6%, 93.4%,
respectively, when the best cutoff points were used (p < 0.001). The κ value for
the PNSR and MNSR methods was 0.87, which indicated an almost perfect
agreement (p < 0.001). Conclusions: Sonoelastography has a high diagnostic
accuracy in the differentiation of benign and malignant thyroid nodules. There was
no significant difference between MNSR and PNSR in the differentiation of benign
and malignant thyroid nodules. Therefore, we think that MNSR could safely be
used in situations where PNSR could not be used.
CEUS
Title Focal Lesions in Fatty Liver: If Quantitative Analysis Facilitates the
Differentiation of Atypical Benign from Malignant Lesions
Author QY Shan, LD Chen, LY Zhou, Z Wang, GJ Liu, XY Xie et al
Published Sci Rep. 2016; 6: 18640.
doi http://dx.doi.org/10.1038/srep18640
Abstract To evaluate the diagnostic performance of quantitative analysis as an adjunctive
diagnostic tool to contrast-enhanced ultrasound (US) for the differentiation of
atypical benign focal liver lesions (FLLs) from malignancies in fatty liver. Twenty-
seven benign FLLs and fifty-six malignant FLLs that appeared hyper-enhanced
during the arterial phase with washout in the portal or late phase in fatty liver
were analyzed. Chi-square tests and logistic regression were applied to identify
the specific features. Three sets of criteria were assigned: 1) all FLLs subjected to
routine contrast-enhanced US; 2) all FLLs subjected to quantification analysis and
contrast-enhanced US; and 3) parts of FLLs that could not be diagnosed using
contrast-enhanced US (n=66, 75.9%) but instead were diagnosed using
parametric features. The sensitivity, specificity, accuracy and area under the
receiver operating characteristic curve (AUC) of the three sets of criteria were
analyzed. The AUCs of the criterion set 2 were significantly higher than those of
criterion set 1 (0.904 versus 0.792, P=0.008). Criterion set 3 showed a relatively
high sensitivity (90.2%) with a relatively high AUC (0.845). The quantification
analysis offers improved diagnostic performance for the differential identification
of atypical benign FLLs from malignancies in fatty liver
Title Computer-aided diagnosis for estimating the malignancy grade of hepatocellular
carcinoma using contrast-enhanced ultrasound: an ROC observer study
Author K Sugimoto, J Shiraishi, H Tanaka, H Ijima, F Moriyasu et at
Published Liver International (2016)
doi http://dx.doi.org/10.1111/liv.13043
Abstract BACKGROUND AND AIMS: We are developing a computer-aided diagnosis (CAD)
system for estimating the malignancy grade of hepatocellular carcinoma (HCC)
using contrast-enhanced ultrasound (CEUS). In this study, observers estimated
the malignancy grade of HCC with and without the cues provided by CAD.
MATERIALS AND METHODS: Institutional review board approval was obtained
and informed consent was waived. A total of 232 histologically confirmed HCCs
were studied: 76 well-differentiated HCC (w-HCC), 133 moderately differentiated
HCC (m-HCC), and 23 poorly differentiated HCC (p-HCC). In this observer study,
CEUS vascular images acquired using the maximum intensity projection
technique were displayed together with static B-mode and Kupffer-phase
(defined as 10 minutes after injection) images. Five hepatologists independently
assigned confidence ratings for the malignancy grade of each HCC. Each
hepatologist first read each case without CAD and then immediately afterwards
with CAD. The observers' rating data were evaluated by multi-reader multi-case
receiver operating characteristic (ROC) analysis. RESULTS: The overall sensitivity
of our CAD system for discrimination between three histological differentiation
grades of HCC was 87.5% (203/232). For discrimination between w-HCC and m/p-
HCC, the mean area under the ROC curve (AUC) for the 5 observers was
significantly improved from 0.779±0.074 to 0.872±0.090 with CAD (p=0.0069).
For discrimination between m-HCC and p-HCC, the mean AUC was also
significantly improved from 0.713±0.107 to 0.863±0.101 with CAD (p=0.0321).
CONCLUSION: The use of our CAD system can significantly improve the diagnostic
performance of hepatologists in discriminating between three histological
differentiation grades of HCC using CEUS. This article is protected by copyright.
All rights reserved.
Title Vesicoureteral refux detection in children: a comparison of the midline-to-
orifice distance measurement by ultrasound and voiding urosonography
Author N Battelino, D Ključevšek, M Tomažič et al.
Published Pediatric Nephrology pp 1-8
Abstract Purpose: This prospective study investigated the ability of contrast-enhanced
ultrasonography (CEUS) with Sonazoid to diagnose gangrenous cholecystitis and
determined the inter-observer agreement. Methods: From September 2012 to
August 2014, 27 patients with acute cholecystitis underwent preoperative CEUS
(registration number 1277). After Sonazoid injection, harmonic imaging of the
gallbladder wall was performed, and the findings were recorded using movie
clips. The signal intensity was classified as absence (uncomplicated) or presence
of perfusion defects (gangrenous). The physician performing CEUS recorded the
findings immediately after the examination. Another physician (blinded to the
clinical information) then reviewed the movie clips and recorded the findings. The
final diagnosis was determined by histological examination in all 27 patients.
Results: The final diagnosis was gangrenous cholecystitis in 15 patients and
uncomplicated cholecystitis in 12. On CEUS examination, perfusion defects were
detected in 10 patients with gangrenous cholecystitis, giving a sensitivity of
66.7 %, specificity of 100 %, positive predictive value of 100 %, and negative
predictive value of 70.6 %. On review of the movie clips, these values were 73.3,
100, 100, and 75.0 %, respectively. The inter-observer agreement between
physicians was good (κ coefficient, 0.64). Conclusions: CEUS with Sonazoid is a
useful and reproducible modality for diagnosing gangrenous cholecystitis.
Title Contrast-enhanced ultrasonography with Sonazoid for diagnosis of gangrenous
cholecystitis
Author R Kawai, J Hata, N Manabe, H Imamura, A Iida et al.
Published J Med Ultrasonics pp 1-7
Abstract Purpose: This prospective study investigated the ability of contrast-enhanced
ultrasonography (CEUS) with Sonazoid to diagnose gangrenous cholecystitis and
determined the inter-observer agreement. Methods: From September 2012 to
August 2014, 27 patients with acute cholecystitis underwent preoperative CEUS
(registration number 1277). After Sonazoid injection, harmonic imaging of the
gallbladder wall was performed, and the findings were recorded using movie
clips. The signal intensity was classified as absence (uncomplicated) or presence
of perfusion defects (gangrenous). The physician performing CEUS recorded the
findings immediately after the examination. Another physician (blinded to the
clinical information) then reviewed the movie clips and recorded the findings. The
final diagnosis was determined by histological examination in all 27 patients.
Results: The final diagnosis was gangrenous cholecystitis in 15 patients and
uncomplicated cholecystitis in 12. On CEUS examination, perfusion defects were
detected in 10 patients with gangrenous cholecystitis, giving a sensitivity of
66.7 %, specificity of 100 %, positive predictive value of 100 %, and negative
predictive value of 70.6 %. On review of the movie clips, these values were 73.3,
100, 100, and 75.0 %, respectively. The inter-observer agreement between
physicians was good (κ coefficient, 0.64). Conclusions: CEUS with Sonazoid is a
useful and reproducible modality for diagnosing gangrenous cholecystitis.
Title Intracavitary Contrast-enhanced Ultrasonography to Detect Enterovesical Fistula
in Crohn’s Disease
Author Y Chen, R Mao, X Xie, B Chen, Y He, M Xu, Z Zeng, XY Xie et al
Published Gastroenterology (2015).
doi http://dx.doi.org/10.1053/j.gastro.2015.09.051
Abstract Enterovesical fistula is a relatively rare condition complicating Crohn’s disease
(CD) that often requires surgical treatment.1 Ascertaining the presence of fistula
and visualization of its anatomy are important for undertaking a decision for
surgery and may impact the operative strategy. However, conventional
radiographic studies often fail to demonstrate the fistula tract. Ultrasonography
(US), computed tomography (CT), and MRI have a high sensitivity and specificity
for the diagnosis of intraabdominal fistulas, with similar diagnostic accuracies.2
However, these methods may still fall short of detection of occult and complex
fistulas and/or delineating their tracts. Intracavitary contrast-enhanced US (IC-
CEUS) was recently proved useful for detecting biliary tract and perianal fistula by
locally injected contrast agent.3,4 Compared with CT and MRI, IC-CEUS has the
advantages of nonionizing radiation and cost efficacy. We describe the feasibility
of IC-CEUS for detection of enterovesical fistula in a patient with CD using surgery
as the reference standard.
Title Feasibility of Using Volumetric Contrast-Enhanced Ultrasound with a 3-D
Transducer to Evaluate Therapeutic Response after Targeted Therapy in Rabbit
Hepatic VX2 Carcinoma
Author J Kim, JH Kim, SH Yoon, WS Choi, YJ Kim, BI Choi et al
Published Ultrasound in Medicine & Biology
Volume 41, Issue 12, December 2015, Pages 3131–3139
Abstract The aim of this study was to assess the feasibility of using dynamic contrast-
enhanced ultrasound (DCE-US) with a 3-D transducer to evaluate therapeutic
responses to targeted therapy. Rabbits with hepatic VX2 carcinomas, divided into
a treatment group (n = 22, 30 mg/kg/d sorafenib) and a control group (n = 13),
were evaluated with DCE-US using 2-D and 3-D transducers and computed
tomography (CT) perfusion imaging at baseline and 1 d after the first treatment.
Perfusion parameters were collected, and correlations between parameters were
analyzed. In the treatment group, both volumetric and 2-D DCE-US perfusion
parameters, including peak intensity (33.2 ± 19.9 vs. 16.6 ± 10.7, 63.7 ± 20.0 vs.
30.1 ± 19.8), slope (15.3 ± 12.4 vs. 5.7 ± 4.5, 37.3 ± 20.4 vs. 15.7 ± 13.0) and area
under the curve (AUC; 1004.1 ± 560.3 vs. 611.4 ± 421.1, 1332.2 ± 708.3 vs. 670.4
± 388.3), had significantly decreased 1 d after the first treatment (p = 0.00). In the
control group, 2-D DCE-US revealed that peak intensity, time to peak and slope
had significantly changed (p < 0.05); however, volumetric DCE-US revealed that
peak intensity, time–intensity AUC, AUC during wash-in and AUC during wash-out
had significantly changed (p = 0.00). CT perfusion imaging parameters, including
blood flow, blood volume and permeability of the capillary vessel surface, had
significantly decreased in the treatment group (p = 0.00); however, in the control
group, peak intensity and blood volume had significantly increased (p = 0.00). It
is feasible to use DCE-US with a 3-D transducer to predict early therapeutic
response after targeted therapy because perfusion parameters, including peak
intensity, slope and AUC, significantly decreased, which is similar to the trend
observed for 2-D DCE-US and CT perfusion imaging parameters.
Title Intraneural microvascular patterns of the median nerve assessed using contrast-
enhanced ultrasonography in carpal tunnel syndrome
Author M Motomiya, T Funakoshi, N Iwasaki
Published J Hand Surg Eur Vol February 10, 2015
Abstract The aim of this study was to assess the feasibility of using dynamic contrast-
enhanced ultrasound (DCE-US) with a 3-D transducer to evaluate therapeutic
responses to targeted therapy. Rabbits with hepatic VX2 carcinomas, divided into
a treatment group (n = 22, 30 mg/kg/d sorafenib) and a control group (n = 13),
were evaluated with DCE-US using 2-D and 3-D transducers and computed
tomography (CT) perfusion imaging at baseline and 1 d after the first treatment.
Perfusion parameters were collected, and correlations between parameters were
analyzed. In the treatment group, both volumetric and 2-D DCE-US perfusion
parameters, including peak intensity (33.2 ± 19.9 vs. 16.6 ± 10.7, 63.7 ± 20.0 vs.
30.1 ± 19.8), slope (15.3 ± 12.4 vs. 5.7 ± 4.5, 37.3 ± 20.4 vs. 15.7 ± 13.0) and area
under the curve (AUC; 1004.1 ± 560.3 vs. 611.4 ± 421.1, 1332.2 ± 708.3 vs. 670.4
± 388.3), had significantly decreased 1 d after the first treatment (p = 0.00). In the
control group, 2-D DCE-US revealed that peak intensity, time to peak and slope
had significantly changed (p < 0.05); however, volumetric DCE-US revealed that
peak intensity, time–intensity AUC, AUC during wash-in and AUC during wash-out
had significantly changed (p = 0.00). CT perfusion imaging parameters, including
blood flow, blood volume and permeability of the capillary vessel surface, had
significantly decreased in the treatment group (p = 0.00); however, in the control
group, peak intensity and blood volume had significantly increased (p = 0.00). It
is feasible to use DCE-US with a 3-D transducer to predict early therapeutic
response after targeted therapy because perfusion parameters, including peak
intensity, slope and AUC, significantly decreased, which is similar to the trend
observed for 2-D DCE-US and CT perfusion imaging parameters.
Title Differentiation of Atypical Hepatocellular Carcinoma from Focal Nodular
Hyperplasia: Diagnostic Performance of Contrast-enhanced US and Microflow
Imaging
Author W Li, W Wang, GJ Liu, XY Xie et al
Published RSNA Radiology Ahead of printing
doi http://dx.doi.org/10.1148/radiol.14140911
Abstract Purpose: To evaluate diagnostic performance of contrast-enhanced (CE)
ultrasonography (US) and microflow (MF) imaging in differentiation of atypical
hepatocellular carcinoma (HCC) from focal nodular hyperplasia (FNH). Materials
and Methods: Institutional review board approval was obtained, and informed
consent was waived. A total of 103 patients (mean age, 43.9 years; age range, 17–
75 years) were included; 38 patients with HCC and 65 with FNH underwent CE US,
and vascular architecture pattern (VAP) and arrival time parametric (ATP) images
were analyzed. Resident and staff radiologists independently and retrospectively
reviewed CE US, VAP, and ATP images. χ2 test and logistic regression analysis
were applied to identify specific features of FNH or HCC on CE US and MF images.
To compare diagnostic performance of CE US with or without MF imaging, four
sets of criteria were assigned: (a) routine CE US alone, (b) VAP and CE US, (c) ATP
imaging and CE US, and (d) all three methods in combination. Sensitivity,
specificity, accuracy, and area under the receiver operating characteristic curve
(AUC) of resident and staff radiologists were analyzed. Cohen κ statistic was used
to assess agreement of CE US and MF imaging features between staff and
resident radiologists. Results: MF imaging offered significant improvements over
most detection rates achieved with routine CE US signs in both groups. For staff
radiologists, AUCs from criteria sets 3 (AUC = 0.873, P < .05) and 4 (AUC = 0.887,
P < .05) were significantly higher than AUC from criteria set 1 (AUC = 0.835). For
resident radiologists, specificity (71% and 69% vs 25%, P < .01) and accuracy (78%
and 79% vs 50%, P < .01) of criteria sets 3 and 4 were significantly higher than
those of criteria set 1. Moreover, AUCs for criteria sets 2 (AUC = 0.728, P < .05), 3
(AUC = 0.823, P < .01), and 4 (AUC = 0.857, P < .01) were significantly higher than
those for criteria set 1 (AUC = 0.667). Conclusion: When compared with routine
CE US, MF imaging can more effectively depict specific features and offers
improved diagnostic performance in the differentiation of atypical HCC from FNH,
especially when used by resident radiologists.
Title Simplified approach for the assessment of kidney perfusion and acute kidney
injury at the bedside using contrast-enhanced ultrasound
Author I Göcze, P Renner, BM Graf,et al
Published Intensive Care Medicine. February 2015, Volume 41, Issue 2, pp 362-363
Title Pancreatic congestion in liver cirrhosis correlates with impaired insulin secretion
Author T Kuroda, M Hirooka, M Koizumi,et al
Published Journal of Gastroenterology October 2014
Abstract Background: Although impaired glucose tolerance is common in cirrhosis, this
condition’s pathogenesis remains undefined. This study aimed to clarify
pathogenesis related to the pancreas in cirrhotic patients, and to evaluate
associations between insulin secretion and pancreatic congestion due to portal
hypertension. Methods: Pancreatic perfusion parameters were analyzed by
dynamic contrast-enhanced ultrasound (CE-US) in 41 patients (20 cirrhotic, 21
non-cirrhotic; age, 67.9 ± 13.3; female, 19), and prospectively compared to delta
C-peptide immunoreactivity (ΔCPR). In a separate study, a retrospective chart
review with human autopsy specimens was conducted, and vessels and islets of
the pancreas were analyzed in 43 patients (20 cirrhotic, 23 controls; age, 71.5 ±
11.6; female, 15). Results: In the CE-US study, the clinical characteristics
indicative of portal hypertension (e.g., ascites and varices) had significantly higher
incidences in the cirrhotic group than in the control group. Pancreatic drainage
times were greater in the cirrhotic group (p < 0.0001), and had a significant
negative correlation with ΔCPR (R = 0.42, p = 0.0069). In the histopathological
study, the islets were enlarged in the cirrhotic group (p < 0.0001). However, the
percentage of insulin-positive area per islet was decreased in the cirrhotic group
(p < 0.0001), and had a significant negative correlation with the wall thickness of
the pancreatic vein (R = 0.63, p < 0.0001). Conclusions: Pancreatic congestion
was present in cirrhotic patients. Moreover, pancreatic congestion and insulin
secretion were significantly correlated. This pathogenesis could be a key factor
underlying the development of hepatogenous diabetes in cirrhotic patients.
Title Validation of Dynamic Contrast-Enhanced Ultrasound in Predicting Outcomes of
Antiangiogenic Therapy for Solid Tumors - The French Multicenter Support for
Innovative and Expensive Techniques Study
Author N Lassau, J Bonastre, M Kind,et al
Published Invest Radiol. Dec 2014; 49(12): 794–800
doi http://dx.doi.org/10.1097/RLI.0000000000000085
Abstract Objectives: Dynamic contrast-enhanced ultrasound (DCE-US) has been used in
single-center studies to evaluate tumor response to antiangiogenic treatments: the
change of area under the perfusion curve (AUC), a criterion linked to blood volume,
was consistently correlated with the Response Evaluation Criteria in Solid Tumors
response. The main objective here was to do a multicentric validation of the use of
DCE-US to evaluate tumor response in different solid tumor types treated by
several antiangiogenic agents. A secondary objective was to evaluate the costs of
the procedure. Materials and Methods: This prospective study included patients
from 2007 to 2010 in 19 centers (8 teaching hospitals and 11 comprehensive
cancer centers). All patients treated with antiangiogenic therapy were eligible.
Dynamic contrast-enhanced ultrasound examinations were performed at baseline
as well as on days 7, 15, 30, and 60. For each examination, a perfusion curve was
recorded during 3 minutes after injection of a contrast agent. Change from baseline
at each time point was estimated for each of 7 fitted criteria. The main end point
was freedom from progression (FFP). Criterion/time-point combinations with the
strongest correlation with FFP were analyzed further to estimate an optimal cutoff
point. Results: A total of 1968 DCE-US examinations in 539 patients were
analyzed. The median follow-up was 1.65 years. Variations from baseline were
significant at day 30 for several criteria, with AUC having the most significant
association with FFP (P = 0.00002). Patients with a greater than 40% decrease in
AUC at day 30 had better FFP (P = 0.005) and overall survival (P = 0.05). The
mean cost of each DCE-US was 180€, which corresponds to $250 using the
current exchange rate. Conclusions: Dynamic contrast-enhanced ultrasound is a
new functional imaging technique that provides a validated criterion, namely, the
change of AUC from baseline to day 30, which is predictive of tumor progression
in a large multicenter cohort. Because of its low cost, it should be considered in
the routine evaluation of solid tumors treated with antiangiogenic therapy.
Title Kupffer-Phase Findings of Hepatic Hemangiomas in Contrast-Enhanced
Ultrasound with Sonazoid
Author K Sugimoto, F Moriyasu, K Saito et al
Published Ultrasound in Medicine & Biology Volume 40, Issue 6, June 2014, Pages 1089–
1095
Abstract The aim of this study was to assess quantitatively the Kupffer-phase enhancement
patterns of hepatic hemangiomas in contrast-enhanced ultrasound (CEUS) with
Sonazoid. A total of 46 patients with 46 hepatic hemangiomas (17.1 ± 6.2 mm in
diameter, 34 typical type and 12 high-flow type) underwent CEUS in the Kupffer
phase. The lesion-to-liver contrast ratio in the Kupffer phase was quantitatively
assessed for both types of hemangioma. Most of the hepatic hemangiomas,
whether or not they were the high-flow type, were iso- to hypo-echoic relative to
the surrounding liver parenchyma. The contrast ratio was –5.33 ± 6.70 dB for the
high-flow hemangiomas and −4.54 ± 6.28 dB for the typical hemangiomas. There
was no significant difference in contrast ratio between the two types of lesions (p
= 0.73). All of the hemangiomas, whether of typical or high-flow type, are iso- to
hypo-echoic relative to the surrounding liver parenchyma on Kupffer-phase
imaging.
Title Focal nodular hyperplasia-like lesion of the liver with focal adenoma features
associated with idiopathic portal hypertension
Author K Sugimoto, F Kondo,Y. Furuichi, F Moriyasu et al
Published Hepatology Research Volume 44, Issue 10, pages E309–E315, October 2014
doi http://dx.doi.org/10.1111/hepr.12273
Abstract Great progress has been made in the diagnosis of focal nodular hyperplasia (FNH)
and hepatocellular adenoma (HCA) in the last few years due to the use of
molecular criteria. This has allowed us to identify a new type of hepatic nodule.
In this case report, we present a male patient with a hepatic nodule associated
with idiopathic portal hypertension (IPH) pathologically exhibiting not only the
morphological features of FNH, such as ductular reactions, dilated sinusoids,
major vascular abnormalities and an immunohistochemical “map-like” pattern of
glutamine synthetase (GS), but also the immunohistological features of focal HCA,
such as strong expression of serum amyloid A and C-reactive protein and weak
expression of GS. As the final diagnosis, the nodule was identified as an FNH-like
lesion with focal inflammatory hepatocellular adenoma.
Title Evaluation of contrast Sonazoid-enhanced ultrasonography for the detection of
hepatic metastases in breast cancer
Author M Mishima, U Toh, N Iwakuma et al
Published Breast Cancer August 2014,
Abstract Background: The present study was aimed to evaluate the usefulness of contrast
Sonazoid-enhanced ultrasonography (US) for the detection of hepatic metastases
in breast cancer patients and compare the clinical efficacy and sensitivity of this
technique with conventional contrast unenhanced B-mode US in follow-up
examinations of breast cancer patients with liver metastasis. Methods: We
assessed a total of 84 hepatic tumors from 24 patients diagnosed with or
suspected of having metastatic cancer. These hepatic nodules were diagnosed
through imaging, including dynamic magnetic resonance imaging (MRI), contrast-
enhanced computed tomography (CECT) scan, B-mode US or contrast Sonazoid-
enhanced US (SEUS). Differences in the sensitivity between US and SEUS were
compared using MR imaging, CECT, and follow-up imaging. Results: A total of 79
nodules were diagnosed as metastatic tumors. The remaining nodules were
diagnosed as benign tumors (hepatic hemangioma: n = 3; local fatty change: n =
2). SEUS precisely detected the presence or absence of hepatic tumors in the 24
patients examined, showing a sensitivity of 98.8 % (83 of 84 lesions) for total
imaged solid liver lesions, with an accuracy of 98.7 % (78 of 79 lesions) for total
metastatic breast cancer lesions. In contrast, conventional B-mode US imaging
revealed hepatic tumor lesions at a sensitivity of 66.7 % (56 of 84 lesions) and an
accuracy of 64.6 % (51 of 79 lesions), respectively. Furthermore, the false positive
and false negative rates were, respectively, 6.33 and 29.1 % for B-mode US and 0
and 1.3 % for SEUS. Moreover, twenty-seven metastatic tumors and five benign
lesions (3 hemangiomas and 2 focal fatty changes/sparings) were imaged using
SEUS but not conventional B-mode US. Significant differences in diagnostic
accuracy rates between contrast Sonazoid-enhanced US and conventional B-
mode US were observed (Wilcoxon signed rank test: p = 0.0009). No severe
adverse events occurred during SEUS after the administration of Sonazoid, except
for a grade 1 skin reaction and nausea in one patient. Conclusion: These results
suggested that Sonazoid could be safely administrated to breast cancer patients
with liver metastatic disease. Thus, contrast Sonazoid-enhanced US is a feasible
and more effective method than B-mode US for the detection of hepatic
metastasis, particularly for small metastatic breast cancer lesions less than 14 mm
in diameter, showing significant high sensitivity and accuracy.
MicroPure
Title The Diagnostic Value of Micropure Imaging in Breast Suspicious
Microcalcificaion
Author R Tan, Y Xiao, Q Tang, Y Zhang, H Chen, X Fan
Published Academic radiology 22.11 (2015): 1338-1343.
doi http://dx.doi.org/10.1016/j.acra.2015.07.012
Abstract Rationale and Objectives: The purpose of this study was to evaluate the diagnostic
value of Micropure Imaging (MI) in breast lesions differentiation by comparison
with B-mode ultrasonography (B-US) and Doppler ultrasonography (DU). Materials
and Methods: A total of 135 consecutive patients (all females) with 135 suspicious
lesions were examined and skin marked by MI before mammotome biopsies. All
patients (age range, 20–86 years; mean age, 42.5 ± 15.6 years) were the first
onset, not in the pregnancy or lactation and had no history of radiation or
chemotherapy. The maximum diameter of lesions ranged from 0.2 to 9.6 cm
(average 1.98 ± 1.3 cm). Their final diagnoses were obtained by histologic
examination. The study protocol was approved by the hospital review board; each
patient gave written informed consent. Results: One hundred thirty-five breast
lesions were classified into 90 nonmalignant and 45 malignant types. To 86 breast
lesions with microcalcification, MI showed more microcalcification and coincided
better with pathology results than B-US did (P < .05). The specificity of MI was
higher than that of B-US and DU; the sensitivity of DU was significantly higher than
that of B-US and MI (P < .001). By combining B-US, DU, and MI, the detection
accuracy was 86.7%. Receiver-operator characteristic curves showed the area
under the curve of B-US, DU, and MI was 0.865, 0.934, and 0.923(P = .000),
respectively. Moreover, the interobserver agreements of MI were the highest,
0.922 (observer 1 vs. observer 2), 0.866 (observer 1 vs. observer 3), and 0.916
(observer 2 vs. observer 3). Conclusions: MI as an adjunct ultrasound modality
holds some promise in locating and differentiating breast lesions.
Title Radial sesamoid fracture of the second MCP joint – a case report
Author G Pracoń, M Walentowska-Janowicz et al
Published J Ultrason. 2015 Mar; 15(60): 96–101.
doi http://dx.doi.org/10.15557/JoU.2015.0008
Abstract A fracture of the sesamoid bone of the hand is rarely seen. In most cases, it is
strictly associated with the trauma. The patient complains of a long-lasting, due to
unclear diagnosis, painful swelling of the joint with an inability to flex the affected
finger. Limited blood supply makes the untreated fracture prone to avascular
necrosis. Thus, it is extremely important to make a proper diagnosis early. Bilateral
comparing the affected areas with ultrasonography seems to be the method of
choice. The treatment is conservative or surgical when needed. We present a case
of a radial sesamoid fracture of the second metacarpophalangeal joint without a
history of trauma.
Title The value of ultrasound in the diagnosis of limited scleroderma – a case report
Author G Pracoń, M Płaza et al
Published J Ultrason. 2015 Sep; 15(62): 326–331
doi http://dx.doi.org/10.15557/JoU.2015.0029
Abstract Systemic sclerosis, popularly referred to as scleroderma, is a chronic connective
tissue disease with present autoantibodies against platelet-derived growth factor
receptor. These antibodies activate directly fibroblasts causing the dermis and
internal organs’ fibrosis and vascular damage. Additionally, calcific collections,
including hydroxyapatite crystals, may develop in subcutaneous tissue and juxta-
articular soft tissue. Herein, we report a case of a 72-year-old woman, referred
by a rheumatologist for plain radiography and ultrasound examination of hands
due to pain and swelling of the fourth finger of the left hand. Dermal induration
affecting hands, especially fourth finger on the left side and the Raynaud
phenomenon were observed on physical examination. Furthermore, the patient
had noticed periodic discharge with a toothpaste consistency from a tiny fistula
localised in the vicinity of the fourth finger alterations. The paper emphasises a
possible application of the twinkling artefact and MicroPure option on ultrasound
examination in differential diagnosis of soft tissue calcifications. Making the
correct diagnosis can attribute to precise planning of surgical treatment.
Title Microcalcifications Versus Artifacts: Initial Evaluation of a New Ultrasound
Image Processing Technique to Identify Breast Microcalcifications in a Screening
Population
Author P Machado, JR. Eisenbrey, B. Cavanaugh, F Forsberg et al
Published Ultrasound in Medicine & Biology
Abstract A new commercial image processing technique (MicroPure, Toshiba America
Medical Systems, Tustin, CA, USA) that identifies breast microcalcifications was
evaluated at the time of patients' annual screening mammograms. Twenty women
scheduled for annual screening mammography were enrolled in the study. Patients
underwent bilateral outer-upper-quadrant real-time dual gray scale ultrasound and
MicroPure imaging using an Aplio XG scanner (Toshiba). MicroPure combines
non-linear imaging and speckle suppression to mark suspected calcifications as
white spots in a blue overlay image. Four independent and blinded readers
analyzed digital clips to determine the presence or absence of microcalcifications
and artifacts. The presence of microcalcifications determined by readers was not
significantly different from that of mammography (p = 0.57). However, the accuracy
was low overall (52%) and also in younger women (<50 years, 54%). In conclusion,
although microcalcifications can be identified using MicroPure imaging, this
method is not currently appropriate for a screening population and should be used
in more focused applications.
Title MicroPure Imaging for the Evaluation of Microcalcifications in Gouty Arthritis
Involving the First Metatarsophalangeal Joint: A Preliminary Study
Author L Yin, J Zhu, Q Xue et al
Published PloS one, 2014
doi http://dx.doi.org/10.1371/journal.pone.0095743
Abstract Objective: To assess the value of MicroPure, a new ultrasound image processing
technique, in identifying microcalcifications (formed by monosodium urate crystals)
in the first metatarsophalangeal joints attacked by gout compared to gray-scale
ultrasound images.Materials and Methods: Thirty-six patients who fulfilled the
study inclusion criteria underwent gray-scale ultrasound and MicroPure
examinations of the first metatarsophalangeal joints attacked by gout. Static
images of the target areas were acquired using gray-scale ultrasound and
MicroPure. Two independent and blinded investigators analyzed the images to
determine the number of microcalcifications and to score for image quality and
artifacts. Results: The two investigators observed significantly more
microcalcifications with MicroPure compared to gray-scale ultrasound (ρ<0.001).
The level of agreement between the investigators consistently increased from
gray-scale ultrasound to MicroPure imaging (gray-scale interclass correlation
coefficient of 0.69 vs. MicroPure interclass correlation coefficient of 0.81). One
investigator preferred the MicroPure image quality over gray-scale ultrasound
(ρ<0.001), but the other investigator disagreed (ρ<0.001). Both investigators
observed fewer artifacts with MicroPure than with gray-scale ultrasound (ρ<0.009).
Conclusion: MicroPure imaging identified significantly more microcalcifications
than gray-scale ultrasound.
ASQ
Title Hepatic Steatosis: Assessment with Acoustic Structure Quantification of US
Imaging
Author Son JY, Lee JY, Yi NJ, Lee KW, Suh KS, Kim KG, Lee JM, Han JK, Choi BI
Published Radiology. 2016 Jan;278(1):257-64
doi http://dx.doi.org/10.1148/radiol.2015141779
Abstract Purpose To investigate the diagnostic performance of acoustic structure
quantification (ASQ) for the assessment of hepatic steatosis by using hydrogen 1
((1)H) magnetic resonance (MR) spectroscopy as the reference standard and to
compare ASQ with hepatorenal ratio. Materials and Methods This prospective
study was approved by an institutional review board, and informed written consent
was obtained from all participants. ASQ and MR spectroscopy were performed in
89 participants (mean age, 41.48 years ± 14.16; 35 men, 54 women) without
history of chronic liver disease. Obtained were focal disturbance (FD) ratio by using
ASQ, hepatic fat fraction (HFF) by using MR spectroscopy, and hepatorenal ratio
by using a histogram. Correlation coefficient, intraclass correlation coefficient, and
receiver operating curve analyses were performed. Results FD ratio measured
with ASQ had a strong linear correlation with HFF measured with MR spectroscopy
after logarithmic transformation of both variables (r = -0.87; P < .001). By using
HFF of 5.79% as a cutoff value of 10% hepatic steatosis, 29 of 89 participants
(32.6%) were categorized into the group with hepatic steatosis of 10% or greater
(mean HFF, 13.18% ± 4.89). The area under curve of the FD ratio for diagnosing
hepatic steatosis 10% or greater was 0.959 (95% confidence interval: 0.895,
0.990) with sensitivity of 86.2% (95% confidence interval: 68.3%, 96.0%) and
specificity of 100% (95% confidence interval: 94.0%, 100.0%) by using a cutoff
value of 0.1; the area under curve and specificity of the FD ratio were significantly
higher than those of the hepatorenal ratio (respectively, 0.772 and 73.3%;
respective P values, .001 and <.001). Conclusion This pilot study in a cohort of
patients with hepatic steatosis without other parenchymal disease suggested ASQ
may be valuable for the quantification of hepatic steatosis and detection of hepatic
steatosis 10% or greater in living liver donors. (©) RSNA, 2015.
Title Using Acoustic Structure Quantification During B-Mode Sonography for
Evaluation of Hashimoto Thyroiditis
Author SJ Rhee, HS Hong, CH Kim, EH Lee et al
Published Journal of Ultrasound in Medicine 34.12 (2015): 2237-2243
doi http://dx.doi.org/10.7863/ultra.14.11077
Abstract Objectives—This study aimed to evaluate the usefulness of Acoustic Structure
Quantification (ASQ; Toshiba Medical Systems Corporation, Nasushiobara, Japan)
values in the diagnosis of Hashimoto thyroiditis using B-mode sonography and to
identify a cutoff ASQ level that differentiates Hashimoto thyroiditis from normal
thyroid tissue. Methods—A total of 186 thyroid lobes with Hashimoto thyroiditis
and normal thyroid glands underwent sonography with ASQ imaging. The
quantitative results were reported in an echo amplitude analysis (Cm2) histogram
with average, mode, ratio, standard deviation, blue mode, and blue average
values. Receiver operating characteristic curve analysis was performed to assess
the diagnostic ability of the ASQ values in differentiating Hashimoto thyroiditis
from normal thyroid tissue. Intraclass correlation coefficients of the ASQ values
were obtained between 2 observers. Results—Of the 186 thyroid lobes, 103
(55%) had Hashimoto thyroiditis, and 83 (45%) were normal. There was a
significant difference between the ASQ values of Hashimoto thyroiditis glands
and those of normal glands (P < .001). The ASQ values in patients with Hashimoto
thyroiditis were significantly greater than those in patients with normal thyroid
glands. The areas under the receiver operating characteristic curves for the ratio,
blue average, average, blue mode, mode, and standard deviation were: 0.936,
0.902, 0.893, 0.855, 0.846, and 0.842, respectively. The ratio cutoff value of 0.27
offered the best diagnostic performance, with sensitivity of 87.38% and
specificity of 95.18%. The intraclass correlation coefficients ranged from 0.86 to
0.94, which indicated substantial agreement between the observers.
Conclusions—Acoustic Structure Quantification is a useful and promising
sonographic method for diagnosing Hashimoto thyroiditis. Not only could it be a
helpful tool for quantifying thyroid echogenicity, but it also would be useful for
diagnosis of Hashimoto thyroiditis.
Title Estimating steatosis and fibrosis: Comparison of acoustic structure
quantification with established techniques
Author T Karlas, J Berger, N Garnov, F Lindner
Published World J Gastroenterol. 2015 Apr 28; 21(16): 4894–4902.
doi http://dx.doi.org/ 10.3748/wjg.v21.i16.4894
Abstract AIM: To compare ultrasound-based acoustic structure quantification (ASQ) with
established non-invasive techniques for grading and staging fatty liver disease.
METHODS: Type 2 diabetic patients at risk of non-alcoholic fatty liver disease (n
= 50) and healthy volunteers (n = 20) were evaluated using laboratory analysis
and anthropometric measurements, transient elastography (TE), controlled
attenuation parameter (CAP), proton magnetic resonance spectroscopy (1H-
MRS; only available for the diabetic cohort), and ASQ. ASQ parameters mode,
average and focal disturbance (FD) ratio were compared with: (1) the extent of
liver fibrosis estimated from TE and non-alcoholic fatty liver disease (NAFLD)
fibrosis scores; and (2) the amount of steatosis, which was classified according to
CAP values. RESULTS: Forty-seven diabetic patients (age 67.0 ± 8.6 years; body
mass index 29.4 ± 4.5 kg/m²) with reliable CAP measurements and all controls
(age 26.5 ± 3.2 years; body mass index 22.0 ± 2.7 kg/m²) were included in the
analysis. All ASQ parameters showed differences between healthy controls and
diabetic patients (P < 0.001, respectively). The ASQ FD ratio (logarithmic)
correlated with the CAP (r = -0.81, P < 0.001) and 1H-MRS (r = -0.43, P = 0.004)
results. The FD ratio [CAP < 250 dB/m: 107 (102-109), CAP between 250 and 300
dB/m: 106 (102-114); CAP between 300 and 350 dB/m: 105 (100-112), CAP ≥ 350
dB/m: 102 (99-108)] as well as mode and average parameters, were reduced in
cases with advanced steatosis (ANOVA P < 0.05). However, none of the ASQ
parameters showed a significant difference in patients with advanced fibrosis, as
determined by TE and the NAFLD fibrosis score (P > 0.08, respectively).
CONCLUSION: ASQ parameters correlate with steatosis, but not with fibrosis in
fatty liver disease. Steatosis estimation with ASQ should be further evaluated in
biopsy-controlled studies.
Title Assessment of liver fibrosis in chronic hepatitis B using acoustic structure
quantification: quantitative morphological ultrasound
Author Y Huang, Z Wang, B Liao, JY Liang, LY Zhou, XY Xie et al
Published European Radiology pp 1-8
doi http://dx.doi.org/10.1007/s00330-015-4056-x
Abstract Objectives: To prospectively investigate the usefulness of acoustic structure
quantification (ASQ) for noninvasive assessment of liver fibrosis in patients with
chronic hepatitis B (CHB). Methods: Consecutive patients with CHB scheduled for
liver biopsy or partial liver resection underwent standardized ASQ examinations.
The ASQ parameter, named focal disturbance (FD) ratio, were compared with
METAVIR scores. The analysis was based on receiver operating characteristic
(ROC) curves and multiple regression analysis. Results: A total of 114 patients
were enrolled in the final analysis. The area under the ROC curve for the FD ratio
was 0.84 for significant fibrosis (≥ F2), 0.86 for severe fibrosis (≥ F3), and 0.83 for
cirrhosis (= F4). The optimal cutoff values for the FD ratio were 0.25, 0.30 and 0.50
for fibrosis stages ≥ F2, ≥ F3 and = F4, respectively. The prevalence of a difference
of at least two stages between the FD ratio and the histological stage was 12.3 %
(14 of 114). The fibrosis stage (P < 0.001), degree of steatosis (P < 0.001) were
independent factors associated with the FD ratio. Conclusions: FD ratio should be
an effective noninvasive imaging biomarker for the assessment of liver fibrosis in
patients with CHB.
Title Acoustic Structure Quantification Analysis of the Thyroid in Patients with Diffuse
Autoimmune Thyroid Disease
Author S Zandieh, R Bernt, J Zwerina, J Haller, P Knoll et al
Published Ultrasonic Imaging April 8, 2015
Abstract The aim of this study was to assess whether acoustic structure quantification
(ASQ) can differentiate normal from pathological thyroid parenchyma in patients
with diffuse autoimmune thyroid disease (AITD). We evaluated 83 subjects (72
[87%] women and 11 [13%] men) aged 19 to 94 years with a mean age of 53 years.
We performed a prospective study (from March 2011 to November 2014) that
included 43 (52%) patients with chronic autoimmune thyroiditis (CAT), 22 (26%)
patients with Graves’ disease (GD), and 18 (22%) healthy volunteers. The ASQ
values were significantly lower in normal subjects than in subjects with CAT and
GD (p < 0.001). In contrast, the differences between the GD and the CAT patients
(p = 0.23) were not statistically significant. The optimal cutoff ASQ value for which
the sum of sensitivity and specificity was the highest for the prediction of diffuse
thyroid pathology was 103 (95% confidence interval = [0.79, 0.95]). At this cutoff
value, the sensitivity was 83% and the specificity was 89%. Our findings suggest
that ASQ is a useful method for the assessment of the thyroid in patients with
AITD.
Title Non-invasive assessment of liver fibrosis using acoustic structure quantification:
comparison with transient elastography in chronic viral hepatitis
Author TH Nam, BJ Park, DJ Sung et al
Published Abdom Radiol (2015)
Abstract Purpose: The purpose of this study was to evaluate the diagnostic efficacy of
acoustic structure quantification (ASQ) parameters [mode, average, and focal
distribution (FD) ratio] in the staging of hepatic fibrosis in patients with chronic
viral hepatitis and to compare it with transient elastography (TE) by using liver
biopsy as reference standard. Methods: We studied 62 patients with chronic viral
hepatitis. Each patient underwent ASQ evaluation and liver biopsy; 54 of these
patients received TE. Thirty-six participants without any liver disease were
enrolled as normal group, who also underwent ASQ evaluation and TE. All three
parameters of ASQ were compared with the histologic fibrosis grade according to
the METAVIR scoring (F0–F4). Statistical analysis was performed to investigate
the correlations and the diagnostic values of ASQ parameters and compare them
to TE. Results: All three ASQ parameters and TE were significantly correlated with
liver fibrosis stage. Of the ASQ parameters, the mode parameter showed the best
correlation (P < 0.001). On the area under the receiver operating characteristic
curve (AUROC), the mode parameter of ASQ analysis showed both significant
correlation and good accuracy for diagnosis of F ≥ 1, F ≥ 2, and F ≥ 3. These values
were significantly better than those of the average and FD ratio parameters in F
≥ 1 and F ≥ 2 (P < 0.05). There was no statistically significant difference in AUROC
between the mode parameter and TE in diagnosis of F ≥ 1, F ≥ 2, or F ≥ 3.
Conclusions: The mode parameter is the most reliable ASQ parameter,
comparable to TE, as a non-invasive method for the detection and grading of liver
fibrosis in patients with chronic viral hepatitis.
Title Impact Factors and the Optimal Parameter of Acoustic Structure Quantification
in the Assessment of Liver Fibrosis
Author Y Huang, GJ Liu, B Liao, XY Xie et al
Published Ultrasound in Medicine & Biology Available online 6 June 2015
Abstract The aims of the present study are to assess the impact factors on acoustic
structure quantification (ASQ) ultrasound and find the optimal parameter for the
assessment of liver fibrosis. Twenty healthy volunteers underwent ASQ
examinations to evaluate impact factors in ASQ image acquisition and analysis.
An additional 113 patients with liver diseases underwent standardized ASQ
examinations, and the results were compared with histologic staging of liver
fibrosis. We found that the right liver displayed lower values of ASQ parameters
than the left (p = 0.000–0.021). Receive gain experienced no significant impact
except gain 70 (p = 0.193–1.000). With regard to different diameter of involved
vessels in regions of interest, the group ≤2.0 mm differed significantly with the
group 2.1–5.0 mm (p = 0.000–0.033) and the group >5.0 mm (p = 0.000–0.062).
However, the region of interest size (p = 0.438–1.000) and depth (p = 0.072–0.764)
had no statistical impact. Good intra- and inter-operator reproducibilities were
found in both image acquisitions and offline image analyses. In the liver fibrosis
study, the focal disturbance ratio had the highest correlation with histologic fibrosis
stage (r = 0.67, p < 0.001). In conclusion, the testing position, receive gain and
involved vessels were the main factors in ASQ examinations and focal disturbance
ratio was the optimal parameter in the assessment of liver fibrosis.
Title Acoustic structure quantification (ASQ): a new tool in sonographic examination
of liver lesions in hepatic alveolar echinococcosis
Author TEM Kaltenbach, B Gruener, AS Akinli et al
Published Journal of Medical Ultrasonics October 2014, Volume 41, Issue 4, pp 445-453
Abstract Purpose: Qualitative and quantitative acoustic structure quantification (ASQ) is a
new, noninvasive sonographic imaging method based on B-mode. This
prospective clinical pilot study aims to answer the question whether delineation
and measurement of liver lesions in hepatic alveolar echinococcosis (HAE) can be
improved by ASQ. Furthermore, this is the first pilot study to explore how ASQ
parameters in HAE lesions develop. Methods: A total of 24 patients (male =
13/female = 11, mean age = 52 years (16–85), mean disease duration = 68 months
(1–334)) with HAE were examined with ASQ using a Toshiba Aplio 500 unit. ASQ
parameters were measured in HAE liver lesions and in adjacent non-tumor
parenchyma. Quantitative analysis was performed offline using ASQ quantification
software. Results: Subjectively parasitic tumors in HAE appear more prominent in
color-coded ASQ imaging, but the size of lesions measured in ASQ mode does
not differ from size measurements in B-mode. Median focal disturbance ratio (FD
ratio) in lesions was 3 (0.1–3), compared with 0.5 (0.1–1.8) in surrounding liver
parenchyma (p < 0.0001). Statistical comparison of other ASQ parameters (mode,
average, standard deviation) shows results that are similarly significant with p
values between p < 0.0001 and p < 0.0018. Conclusion: ASQ is a promising
sonographic method for examination and quantification of structural changes of
liver parenchyma in HAE lesions.
Clinical Applications
Irreversible electroporation (IRE)
Title Case study to assess the safety of irreversible electroporation near the heart
Author K Sugimoto, F Moriyasu, H Takeuchi et al
Published SpringerPlus 2015, 4:74
doi http://dx.doi.org/ 10.1186/s40064-015-0828-7
Abstract Introduction: Irreversible electroporation (IRE) is a promising technique for the
focal treatment of soft tissue tumors. Even though the local application of an
excessive electric field is a potential cause of cardiac arrhythmias, initial clinical
studies have shown that IRE is generally safe when cardiac gating is employed.
Case description: In this case report, we observed an episode of ventricular
extrasystoles without hemodynamic changes during which time the
synchronization device failed to operate properly, with pulses delivered not in the
absolute refractory period but in the relative refractory period. Discussion and
evaluation: At present, persons performing IRE must keep in mind that there is a
small but real risk of synchronization failure even when a cardiac synchronization
device is used. Conclusion: It is advisable to err on the side of caution when
treating lesions near the heart.
MSK
Title Ultrasound-guided percutaneous tenotomy for the treatment of iliopsoas

impingement: A description of technique and case study
Author M J Sampson, N Rezaian, JMK Hopkins
Published Journal of Medical Imaging and Radiation Oncology (Ahead of printing)
doi http://dx.doi.org/10.1111/1754-9485.12279
Abstract Iliopsoas impingement is a commonly recognised source of groin pain following
total hip replacement. When conservative measures fail, open or arthroscopic
iliopsoas tendon release can reliably alleviate pain and improve function. This
article describes an alternative ultrasound-guided percutaneous technique,
achieving iliopsoas tenotomy utilising a modified 18G coaxial needle and thus
minimising the morbidity and cost associated with an open or arthroscopic
procedure. This method proved successful with resultant complete resolution of
patient symptoms. To the knowledge of the authors, this is the first case of
ultrasound-guided percutaneous iliopsoas tenotomy for iliopsoas impingement
post total hip replacement.
3D
Title Quantification of Internal Carotid Artery Stenosis with 3D Ultrasound

Angiography
Author JO. Pelz, A. Weinreich, D. Fritzsch, D. Saur
Published Ultraschall in Med
doi http://dx.doi.org/ 10.1055/s-0034-1398749
Abstract Purpose: The aim of this study was to evaluate a new method of three-dimensional
ultrasound (3D-US) angiography of carotid vessels including 3D-US quantification
of internal carotid artery (ICA) stenosis (ICAS). Materials and
Methods: Two neurologists performed native ultrasound scans of the brain-
supplying carotid arteries in 73 probands (including 22 patients with 25 cases of
ICAS) using a Toshiba Aplio 500 ultrasound machine equipped with the 3 D
application of Curefab CS. Additionally, 25 probands underwent contrast-
enhanced magnetic resonance angiography (CE-MRA) of the neck vessels.
Results: The mean length of the proximal ICA was 32.1 mm ± 9.8 mm & 31.3 mm
± 9.0 mm (each n = 97). The interrater reliability (intraclass correlation, ICC) was
0.75 ± 0.23 for the common carotid artery (CCA, n = 90) and 0.78 ± 0.21 (n = 92) for
the ICA. The intermethod agreement between 3D-US angiography and CE-MRA
was 0.67 ± 0.19 (n = 45) & 0.66 ± 0.19 (n = 44) for the CCA and 0.79 ± 0.17 (n = 47) &
0.75 ± 0.19 (n = 46) for the ICA. Quantification of ICAS applying 3D-US in
comparison to 2D color-coded duplexsonography (2D-CDS) showed a moderate
to good intermethod agreement both by the Bland and Altman analysis and by ICC
(0.8 & 0.72; with each p < 0.001). The interrater reliability for quantification of ICAS
was 0.79; p < 0.001.
Conclusion: Native 3D-US angiography of carotid vessels shows good interrater
and intermethod agreement in comparison to CE-MRA. Together with a moderate
to good intermethod and interrater agreement in the quantification of ICAS, when
compared to 2D-CDS, 3D-US angiography is thus a promising complementary
imaging technique for carotid artery disease.
Pediatric
Title Isolated prenatal ultrasound findings predict the postnatal course in

gastroschisis
Author B Frybova, R Vlk, A Kokesova et al.
Published Pediatric Surgery International
April 2015, Volume 31, Issue 4, pp 381-387
Abstract Purpose: The aim of the study was to identify which prenatal ultrasonographic
findings in fetuses with gastroschisis correlate with complicated postnatal
outcome. Methods: Ultrasound findings at the 30th week of pregnancy and medical
reports were statistically analyzed to identify independent prenatal
ultrasonographic predictors of postnatal outcome. Results: Completed prenatal
data were gathered from 64 pregnancies. Prenatal intra-abdominal bowel
dilatation (cutoff 10 mm) correlated with the presence of atresia (p < 0.01), longer
administration of parenteral nutrition, extended hospital stay (median 53 vs. 21
days; 68 vs. 36 days, both p < 0.05), and greater number of additional surgical
procedures (p < 0.05). Infants with antenatal presence of thickened bowel wall
(greater than or equal to 3 mm) required longer administration of parenteral
nutrition (median 34 vs. 20 days; p < 0.01) and prolonged stay (median 44 vs. 37
days; p < 0.05). Presence of oligohydramnion (amniotic fluid index below 8 cm)
was connected with longer administration of parenteral nutrition in newborns
(median 30 vs. 16 days; p < 0.05). Conclusion: The isolated presence of
oligohydramnion with amniotic fluid index below 8 cm, thickened bowel wall equal
to or more than 3 mm and the prenatal intra-abdominal dilatation with 10 mm cutoff
had significant predictive value for the adverse postnatal outcome of patients with
gastroschisis.
Toshiba White papers:
1 Initial experiences of 3DSMI in Pediatric Radiology Sara M. O'Hara, MD Cincinnati U.S.A
Children’s Hospital
Medical Center
2 Seeing the Unseen Dr. Jiro Hata Kawasaki Medical Japan
Clinical advances and future directions of SMI School
3 The Use of SMI in Surveillance of Endovascular Prof. Neil Pugh Cardiff and Vale U.K.
Aneurysm Repair University Health
Board
4 Laparoscopic Liver Resection as a less Invasive Dr. Satoru Seo Graduate School of Japan
Treatment Option for Hepatocellular Carcinoma Medicine, Kyoto
University
5 Superb Micro-Vascular Imaging (SMI) in the analysis Dr Pascale Bach- Regional Maternity France
of fetoplacental microvascular blood flow Segura Hospital
6 Superb Micro-Vascular Imaging - A new tool for the Dr Steve McNally Head of Football U.K.
sports physician Medicine & Science
Manchester United
7 MicroPure Alleviates the Financial Burden of Breast Maria Stanczak, MS Thomas Jefferson U.S.A
Imaging Priscilla Machado, University
MD
Flemming Forsberg,
PhD
8 Easily Visualize Microcalcifications with Ultrasound Maria Stanczak, MS Thomas Jefferson U.S.A
Priscilla Machado, University
MD
Flemming Forsberg,
PhD
9 Detection of carotid plaque neovascularization with Yong Qiang Capital Medical China
Superb Micro-Vascular Imaging University
10 Roles of SMI in diagnosing liver disease and assisting Xie Xiaoyan The First Affiliated China
in the planning of Radio-frequency ablation Hospital of Sun Yat-
sen University
11 The clinical utility of SMI for assessing Adrian KP Lim, MD Imperial College U.K.
musculoskeletal inflammation: case study reports London and
Healthcare NHS
Trust
12 SMI - a new technique for the analysis of the T.Fischer, Institute of
microvascular tree in reactive and suspected G.Schafer, MD Radiology at Germany
malignant lymphadenopathy in advanced stages of Chariteplatz
malignant melanoma
13 Toshiba’s Superb Micro-vascular Imaging: A New Sara O’Hara, M.D., Cincinnati U.S.A
Problem-Solving Tool in Pediatric Radiology Children’s Hospital
Medical Center
14 Seeing the Unseen New techniques in Vascular Jiro Hata, Ph.D, MD, Kawasaki Medical Japan
Imaging - Superb Micro-Vascular Imaging School
15 Initial experience with a novel microvascular flow Priscilla Machado, Thomas Jefferson U.S.A
imaging technique M.D., University
Flemming Forsberg,
Ph.D.
16 MicroPure - a New Technology in Clinical Breast S. Anufrieva Central Clinical Russia
Care A. Blinov Hospital of the
A.Kuznetsov Russian Academy of
Sciences
17 Folow-up of aortic dissection with CEUS, Smart Maria Grigoryev Charité Campus Germany
Fusion and Fly Thru - A case report Thomas Fischer Mitte
18 Use of ultrasound elastography to characterize A.R. Zubarev
atherosclerotic plaques in carotid arteries I.V. Rychkova
M.B. Saratov
A,K, Demidova
N.V. Krivosheyeva
19 Approaches to the Diagnosis of Liver Fibrosis Hiroko Iijima Hyogo College of Japan
Medicine
20 Approaches to Liver Tumors Fuminori Moriyasu Tokyo medical Japan
Fuminori Moriyasu, MD, PhD, Tokyo Medical University
University, Tokyo, Japan
21 Improved Biopsy Confidence Using Toshiba's Smart Van Young St. Elizabeth U.S.A
Fusion Healthcare
22 Toshiba’s Smart Fusion: A Cost-effective Solution for Van Young St. Elizabeth U.S.A
Percutaneous Biopsy Guidance Tom Szostak Healthcare
23 Toshiba’s Superb Micro-vascular Imaging:A New Sara O’Hara MD Cincinnati U.S.A
Problem-Solving Tool in Pediatric Radiology Children’s Hospital
Medical Center

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Title Ultrasound-guided percutaneous tenotomy for the treatment of iliopsoas

Title Quantification of Internal Carotid Artery Stenosis with 3D Ultrasound

Title Isolated prenatal ultrasound findings predict the postnatal course in

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