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Hoferer I, Jourdain L, Girot C, Benatsou B, Leguerney I, Cournede PH, Marouf A, Hoarau Y, Lassau N, Pitre-Champagnat S. New calibration setup for quantitative DCE-US imaging protocol: Toward standardization. Med Phys 2023; 50:5541-5552. [PMID: 36939058 DOI: 10.1002/mp.16362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND The DCE-US (Dynamic Contrast-Enhanced Ultrasonography) imaging protocol predicts the vascular modifications compared with Response Evaluation Criteria in Solid Tumors (RECIST) based mainly on morphological changes. A quantitative biomarker has been validated through the DCE-US multi-centric study for early monitoring of the efficiency of anti-angiogenic cancer treatments. In this context, the question of transposing the use of this biomarker to other types of ultrasound scanners, probes and settings has arisen to maintain the follow-up of patients under anti-angiogenic treatments. As a consequence, radiologists encounter standardization issues between the different generations of ultrasound scanners to perform quantitative imaging protocols. PURPOSE The aim of this study was to develop a new calibration setup to transpose the DCE-US imaging protocol to the new generation of ultrasound scanners using both abdominal and linear probes. METHODS This calibration method has been designed to be easily reproducible and optimized, reducing the time required and cost incurred. It is based on an original set-up that includes using a concentration splitter to measure the variation of the harmonic signal intensity, obtained from the Area Under the time-intensity Curve (AUC) as a function of various contrast-agent concentrations. The splitter provided four different concentrations simultaneously ranging from 12.5% to 100% of the initial concentration of the SonoVue contrast agent (Bracco Imaging S.p.A., Milan, Italy), therefore, measuring four AUCs in a single injection. The plot of the AUC as a function of the four contrast agent concentrations represents the intensity variation of the harmonic signal: the slope being the calibration parameter. The standardization through this method implied that both generations of ultrasound scanners had to have the same slopes to be considered as calibrated. This method was tested on two ultrasound scanners from the same manufacturer (Aplio500, Aplioi900, Canon Medical Systems, Tokyo, Japan). The Aplio500 used the settings defined by the initial multicenter DCE-US study. The Mechanical Index (MI) and the Color Gain (CG) of the Aplioi900 have been adjusted to match those of the Aplio500. The reliability of the new setup was evaluated in terms of measurement repeatability, and reproducibility with the agreement between the measurements obtained once the two ultrasound scanners were calibrated. RESULTS The new setup provided excellent repeatability measurements with a value of 96.8%. Once the two ultrasound scanners have been calibrated for both types of probes, the reproducibility was excellent with the agreement between their respective quantitative measurement was at the lowest 95.4% and at the best 98.8%. The settings of the Aplioi900 (Canon Medical Systems) were adjusted to match those of the Aplio500 (Canon Medical Systems) and these validated settings were for the abdominal probe: MI = 0.13 and CG = 34 dB; and for the linear probe: MI = 0.10 and CG = 38 dB. CONCLUSION This new calibration setup provided reliable measurements and enabled the rapid transfer and the use of the DCE-US imaging protocol on new ultrasound scanners, thus permitting a continuation of the therapeutic evaluation of patients through quantitative imaging.
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Affiliation(s)
- Isaline Hoferer
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy Cancer Campus, Villejuif, France
- Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Laurene Jourdain
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy Cancer Campus, Villejuif, France
| | - Charly Girot
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy Cancer Campus, Villejuif, France
| | - Baya Benatsou
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy Cancer Campus, Villejuif, France
- Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Ingrid Leguerney
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy Cancer Campus, Villejuif, France
- Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Paul-Henry Cournede
- Université Paris-Saclay, CentraleSupélec, Laboratory of Mathematics and Computer Science (MICS), Gif-Sur-Yvette, France
| | | | - Yannick Hoarau
- Université de Strasbourg, CNRS, ICUBE UMR 7357, Strasbourg, France
| | - Nathalie Lassau
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy Cancer Campus, Villejuif, France
- Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
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Friedl S, Jung EM, Bergler T, Tews HC, Banas MC, Banas B, Putz FJ. Factors influencing the time-intensity curve analysis of contrast-enhanced ultrasound in kidney transplanted patients: Toward a standardized contrast-enhanced ultrasound examination. Front Med (Lausanne) 2022; 9:928567. [PMID: 36091698 PMCID: PMC9452686 DOI: 10.3389/fmed.2022.928567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/29/2022] [Indexed: 11/15/2022] Open
Abstract
Background Time-intensity curve analysis (TIC analysis) based on contrast-enhanced ultrasound (CEUS) provides quantifiable information about the microcirculation of different tissues. TIC analysis of kidney transplantations is still a field of research, and standardized study protocols are missing though being mandatory for the interpretation of TIC parameters in the clinical context. The aim of this study was to evaluate the impact of different sizes and forms of regions of interest (ROIs) on the variance of different TIC parameters and the level of interoperator variance between the different ROI methods in kidney transplantations. Methods In 25 renal transplanted patients, 33 CEUS of the transplanted kidney were performed, and TIC analysis with ROIs sized 5 mm2 (ROI5), 10 mm2 (ROI10), and ROIs circumscribing the outlines of anatomical regions (ROI Anat ) were analyzed based on CEUS examination. The TIC analysis was repeated by a second independent operator for ROI5 and ROI Anat . Results Statistical analysis revealed significant differences between TIC parameters of different ROI methods, and overall, the interoperator variance was low. But a greater ROI surface (ROI10) led to higher values of the intensity parameters A and AUC compared with ROI5 (p < 0.05). The difference in the ROI form led to high variation of certain TIC parameters between ROI5 and ROI Anat in the myelon [intraclass correlation coefficient (A, ICC = 0.578 (0.139-0.793); TIC parameter (TTP); and ICC = 0.679 (0.344-0.842) (p < 0.05)]. A mean variation of 1 cm of the depth of ROI5 in the cortex did not show significant differences in the TIC parameters, though there was an impact of depth of ROI Anat on the values of TIC parameters. The interoperator variance in the cortex was low and equal for ROI5 and ROI Anat , but increased in the myelon, especially for ROI Anat . Furthermore, the analysis revealed a strong correlation between the parameter AUC and the time interval applied for the TIC analysis in the cortex and myelon (r = 0.710, 0.674, p < 0.000). Conclusion Our findings suggest the application of multiple ROIs of 5 mm2 in the cortex and medulla to perform TIC analysis of kidney transplants. For clinical interpretation of AUC, a standardized time interval for TIC analysis should be developed. After the standardization of the TIC analysis, the clinical predictive value could be investigated in further studies.
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Affiliation(s)
- Sarah Friedl
- Department of Nephrology, University of Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Department of Radiology, Interdisciplinary Ultrasound, University of Regensburg, Regensburg, Germany
| | - Tobias Bergler
- Department of Nephrology, University of Regensburg, Regensburg, Germany
| | - Hauke C. Tews
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital, Regensburg, Germany
| | - Miriam C. Banas
- Department of Nephrology, University of Regensburg, Regensburg, Germany
| | - Bernhard Banas
- Department of Nephrology, University of Regensburg, Regensburg, Germany
| | - Franz Josef Putz
- Department of Nephrology, University of Regensburg, Regensburg, Germany
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Hwang M, Barnewolt CE, Jüngert J, Prada F, Sridharan A, Didier RA. Contrast-enhanced ultrasound of the pediatric brain. Pediatr Radiol 2021; 51:2270-2283. [PMID: 33599780 DOI: 10.1007/s00247-021-04974-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/10/2020] [Accepted: 01/14/2021] [Indexed: 12/16/2022]
Abstract
Brain contrast-enhanced ultrasound (CEUS) is an emerging application that can complement gray-scale US and yield additional insights into cerebral flow dynamics. CEUS uses intravenous injection of ultrasound contrast agents (UCAs) to highlight tissue perfusion and thus more clearly delineate cerebral pathologies including stroke, hypoxic-ischemic injury and focal lesions such as tumors and vascular malformations. It can be applied not only in infants with open fontanelles but also in older children and adults via a transtemporal window or surgically created acoustic window. Advancements in CEUS technology and post-processing methods for quantitative analysis of UCA kinetics further elucidate cerebral microcirculation. In this review article we discuss the CEUS examination protocol for brain imaging in children, current clinical applications and future directions for research and clinical uses of brain CEUS.
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Affiliation(s)
- Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Jörg Jüngert
- Department of Pediatrics, Friedrich-Alexander University Erlangen - Nürnberg, Erlangen, Germany
| | - Francesco Prada
- Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.,Focused Ultrasound Foundation, Charlottesville, VA, USA
| | - Anush Sridharan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Ryne A Didier
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Watson TA, Humphries PD. Invited Commentary: Role of Contrast-enhanced US of the Bowel in Pediatric Patients. Radiographics 2020; 40:1763-1765. [DOI: 10.1148/rg.2020200193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tom A. Watson
- From the Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, England
| | - Paul D. Humphries
- From the Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, England
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Evaluation of the Reproducibility of Bolus Transit Quantification With Contrast-Enhanced Ultrasound Across Multiple Scanners and Analysis Software Packages—A Quantitative Imaging Biomarker Alliance Study. Invest Radiol 2020; 55:643-656. [DOI: 10.1097/rli.0000000000000702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alberich-Bayarri Á, Tomás-Cucarella J, Torregrosa-Lloret A, Sáiz Rodriguez J, Martí-Bonmatí L. Optimisation of ultrasound liver perfusion through a digital reference object and analysis tool. Eur Radiol Exp 2019; 3:15. [PMID: 30945029 PMCID: PMC6447630 DOI: 10.1186/s41747-019-0086-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Conventional ultrasound (US) provides important qualitative information, although there is a need to evaluate the influence of the input parameters on the output signal and standardise the acquisition for an adequate quantitative perfusion assessment. The present study analyses how the variation in the input parameters influences the measurement of the perfusion parameters. Methods A software tool with simulator of the conventional US signal was created, and the influence of the different input variables on the derived biomarkers was analysed by varying the image acquisition configuration. The input parameters considered were the dynamic range, gain, and frequency of the transducer. Their influence on mean transit time (MTT), the area under the curve (AUC), maximum intensity (MI), and time to peak (TTP) parameters as outputs of the quantitative perfusion analysis was evaluated. A group of 13 patients with hepatocarcinoma was analysed with both a commercial tool and an in-house developed software. Results The optimal calculated inputs which minimise errors while preserving images’ readability consisted of gain of 15 dB, dynamic range of 60 dB, and frequency of 1.5 MHz. The comparison between the in-house developed software and the commercial software provided different values for MTT and AUC, while MI and TTP were highly similar. Conclusion Input parameter selection introduces variability and errors in US perfusion parameter estimation. Our results may add relevant insight into the current knowledge of conventional US perfusion and its use in lesions characterisation, playing in favour of optimised standardised parameter configuration to minimise variability.
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Affiliation(s)
- Ángel Alberich-Bayarri
- Biomedical Imaging Research Group (GIBI2^30), Hospital Universitari i Politècnic La Fe, Avda. Fernando Abril Martorell 106, Torre A, 46026, Valencia, Spain. .,Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, Valencia, Spain.
| | - Jose Tomás-Cucarella
- Biomedical Imaging Research Group (GIBI2^30), Hospital Universitari i Politècnic La Fe, Avda. Fernando Abril Martorell 106, Torre A, 46026, Valencia, Spain
| | | | - Javier Sáiz Rodriguez
- Department of Electronics Engineering, Polytechnics University of Valencia, Valencia, Spain
| | - Luis Martí-Bonmatí
- Biomedical Imaging Research Group (GIBI2^30), Hospital Universitari i Politècnic La Fe, Avda. Fernando Abril Martorell 106, Torre A, 46026, Valencia, Spain
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