Three-dimensional ultrasound imaging

Freehand 3D Ultrasound Imaging Based on Probe-mounted Vision and IMU System

OBJECTIVES

Freehand three-dimensional (3D) ultrasound (US) is of great significance for clinical diagnosis and treatment, it is often achieved with the aid of external devices (optical and/or electromagnetic, etc.) that monitor the location and orientation of the US probe. However, this external monitoring is often impacted by imaging environment such as optical occlusions and/or electromagnetic (EM) interference.

METHODS

To address the above issues, we integrated a binocular camera and an inertial measurement unit (IMU) on a US probe. Subsequently, we built a tight coupling model utilizing the unscented Kalman algorithm based on Lie groups (UKF-LG), combining vision and inertial information to infer the probe's movement, through which the position and orientation of the US image frame are calculated. Finally, the volume data was reconstructed with the voxel-based hole-filling method.

RESULTS

The experiments including calibration experiments, tracking performance evaluation, phantom scans, and real scenarios scans have been conducted. The results show that the proposed system achieved the accumulated frame position error of 3.78 mm and the orientation error of 0.36° and reconstructed 3D US images with high quality in both phantom and real scenarios.

CONCLUSIONS

The proposed method has been demonstrated to enhance the robustness and effectiveness of freehand 3D US. Follow-up research will focus on improving the accuracy and stability of multi-sensor fusion to make the system more practical in clinical environments.

Development of Focused Ultrasound-Assisted Nanoplexes for RNA Delivery

RNA-based therapeutics, including siRNA, have obtained recognition in recent years due to their potential to treat various chronic and rare diseases. However, there are still limitations to lipid-based drug delivery systems in the clinical use of RNA therapeutics due to the need for optimization in the design and the preparation process. In this study, we propose adaptive focused ultrasound (AFU) as a drug loading technique to protect RNA from degradation by encapsulating small RNA in nanoliposomes, which we term nanoplexes. The AFU method is non-invasive and isothermal, as nanoplexes are produced without direct contact with any external materials while maintaining precise temperature control according to the desired settings. The controllability of sample treatments can be effectively modulated, allowing for a wide range of ultrasound intensities to be applied. Importantly, the absence of co-solvents in the process eliminates the need for additional substances, thereby minimizing the potential for cross-contaminations. Since AFU is a non-invasive method, the entire process can be conducted under sterile conditions. A minimal volume (300 μL) is required for this process, and the treatment is speedy (10 min in this study). Our in vitro experiments with silencer CD44 siRNA, which performs as a model therapeutic drug in different mammalian cell lines, showed encouraging results (knockdown > 80%). To quantify gene silencing efficacy, we employed quantitative polymerase chain reaction (qPCR). Additionally, cryo-electron microscopy (cryo-EM) and atomic force microscopy (AFM) techniques were employed to capture images of nanoplexes. These images revealed the presence of individual nanoparticles measuring approximately 100-200 nm in contrast with the random distribution of clustered complexes observed in ultrasound-untreated samples of liposome nanoparticles and siRNA. AFU holds great potential as a standardized liposome processing and loading method because its process is fast, sterile, and does not require additional solvents.

Ultrasound robotics for precision therapy

In recent years, the application of microrobots in precision therapy has gained significant attention. The small size and maneuverability of these micromachines enable them to potentially access regions that are difficult to reach using traditional methods; thus, reducing off-target toxicities and maximizing treatment effectiveness. Specifically, acoustic actuation has emerged as a promising method to exert control. By harnessing the power of acoustic energy, these small machines potentially navigate the body, assemble at the desired sites, and deliver therapies with enhanced precision and effectiveness. Amidst the enthusiasm surrounding these miniature agents, their translation to clinical environments has proven difficult. The primary objectives of this review are threefold: firstly, to offer an overview of the fundamental acoustic principles employed in the field of microrobots; secondly, to assess their current applications in medical therapies, encompassing tissue targeting, drug delivery or even cell infiltration; and lastly, to delve into the continuous efforts aimed at integrating acoustic microrobots into in vivo applications.

Pose Estimation of Ultrasound Probe Using CNN and RNN with Image Reconstruction Loss

It is necessary to estimate the pose of the probe with high accuracy to reconstruct 3D ultrasound (US) images only from US image sequences scanned by a 1D-array probe. We propose the probe pose estimation method using Convolutional Neural Network (CNN) with training by image reconstruction loss. To calculate the image reconstruction loss, we use the image reconstruction network which consists of an encoder that extracts features from the two US images and a decoder that reconstructs the intermediate US image between the two images. CNN is trained to minimize the image reconstruction loss between the ground-truth image and the reconstructed image. Through experiments, we demonstrate that the proposed method exhibits efficient performance compared with the conventional methods.

Full-visibility 3D imaging of oxygenation and blood flow by simultaneous multispectral photoacoustic fluctuation imaging (MS-PAFI) and ultrasound Doppler

We present a method and setup that provide complementary three-dimensional (3D) images of blood oxygenation (via quantitative photoacoustic imaging) and blood flow dynamics (via ultrasound Doppler). The proposed approach is label-free and exploits blood-induced fluctuations, and is implemented on a sparse array with only 256 elements, driven with a commercially available ultrasound electronics. We first implement 3D photoacoustic fluctuation imaging (PAFI) to image chicken embryo, and obtain full-visibility images of the vascular morphology. We obtain simultaneously 3D ultrasound power Doppler with a comparable image quality. We then introduce multispectral photoacoustic fluctuation imaging (MS-PAFI), and demonstrate that it can provide quantitative measurements of the absorbed optical energy density with full visibility and enhanced contrast, as compared to conventional delay-and-sum multispectral photoacoustic imaging. We finally showcase the synergy and complementarity between MS-PAFI, which provides 3D quantitative oxygenation (SO[Formula: see text]) imaging, and 3D ultrasound Doppler, which provides quantitative information on blood flow dynamics. MS-PAFI represents a promising alternative to model-based inversions with the advantage of resolving all the visibility artefacts without prior and regularization, by use of a straightforward processing scheme.

A theranostic 3D ultrasound imaging system for high resolution image-guided therapy

Microbubble contrast agents are a diagnostic tool with broad clinical impact and an increasing number of indications. Many therapeutic applications have also been identified. Yet, technologies for ultrasound guidance of microbubble-mediated therapy are limited. In particular, arrays that are capable of implementing and imaging microbubble-based therapy in three dimensions in real-time are lacking. We propose a system to perform and monitor microbubble-based therapy, capable of volumetric imaging over a large field-of-view. To propel the promise of the theranostic treatment strategies forward, we have designed and tested a unique array and system for 3D ultrasound guidance of microbubble-based therapeutic protocols based on the frequency, temporal and spatial requirements. Methods: Four 256-channel plane wave scanners (Verasonics, Inc, WA, USA) were combined to control a 1024-element planar array with 1.3 and 2.5 MHz therapeutic and imaging transmissions, respectively. A transducer aperture of ~40×15 mm was selected and Field II was applied to evaluate the point spread function. In vitro experiments were performed on commercial and custom phantoms to assess the spatial resolution, image contrast and microbubble-enhanced imaging capabilities. Results: We found that a 2D array configuration with 64 elements separated by λ-pitch in azimuth and 16 elements separated by 1.5λ-pitch in elevation ensured the required flexibility. This design, of 41.6 mm × 16 mm, thus provided both an extended field-of-view, up to 11 cm x 6 cm at 10 cm depth and steering of ±18° in azimuth and ±12° in elevation. At a depth of 16 cm, we achieved a volume imaging rate of 60 Hz, with a contrast ratio and resolution, respectively, of 19 dB, 0.8 mm at 3 cm and 20 dB and 2.1 mm at 12.5 cm. Conclusion: A single 2D array for both imaging and therapeutics, integrated with a 1024 channel scanner can guide microbubble-based therapy in volumetric regions of interest.

A real-time freehand 3D ultrasound imaging method for scoliosis assessment

Real‐time 3D ultrasound has gained popularity in many fields because it can provide interactive feedback to help acquire high‐quality images or to conduct timely diagnosis. However, no comprehensive study has been reported on such an imaging method for scoliosis evaluation due to the complexity of this application. Meanwhile, the use of radiation‐free assessment of scoliosis is becoming increasingly popular. This study developed a real‐time 3D ultrasound imaging method for scoliosis assessment based on an incremental imaging method. In vivo experiments involving 36 patients with scoliosis were performed to test the performance of the proposed method. This new imaging method achieved a mean incremental frame rate of 82.7 ± 11.0 frames/s. The high repeatability of the intra‐operator test (intraclass correlation coefficient [ICC] = 0.92) and inter‐operator test (ICC = 0.91) demonstrated that the new method was very reliable. The result of spinous process angles obtained by the new method was linearly correlated (y = 0.97x, R² = 0.88) with that obtained by conventional 3D reconstruction. These results suggested that the newly developed imaging method can provide real‐time ultrasound imaging for scoliosis evaluation while preserving the comparative image quality of the conventional 3D reconstruction method.

Modern Diagnostic Imaging Technique Applications and Risk Factors in the Medical Field: A Review

Medical imaging is the process of visual representation of different tissues and organs of the human body to monitor the normal and abnormal anatomy and physiology of the body. There are many medical imaging techniques used for this purpose such as X-ray, computed tomography (CT), positron emission tomography (PET), magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), digital mammography, and diagnostic sonography. These advanced medical imaging techniques have many applications in the diagnosis of myocardial diseases, cancer of different tissues, neurological disorders, congenital heart disease, abdominal illnesses, complex bone fractures, and other serious medical conditions. There are benefits as well as some risks to every imaging technique. There are some steps for minimizing the radiation exposure risks from imaging techniques. Advance medical imaging modalities such as PET/CT hybrid, three-dimensional ultrasound computed tomography (3D USCT), and simultaneous PET/MRI give high resolution, better reliability, and safety to diagnose, treat, and manage complex patient abnormalities. These techniques ensure the production of new accurate imaging tools with improving resolution, sensitivity, and specificity. In the future, with mounting innovations and advancements in technology systems, the medical diagnostic field will become a field of regular measurement of various complex diseases and will provide healthcare solutions.

Fast Iterative Integral Equation Solver for Acoustic Scattering by Inhomogeneous Objects Using the Butterfly Approximation

The acoustic scattering by highly inhomogeneous objects is analyzed by a method-of-moment solver for the volume integral equation. To enable the treatment of acoustically large scatterers of various topologies, the iterative numerical solution of the resulting system is accelerated via a kernel independent algebraic compression scheme: blocks of the hierarchically partitioned moment stiffness matrix are expressed in butterfly form that, for volume problems, scales favorably compared to the popular low-rank approximation. A detailed description of the algorithm, as implemented in this work, is provided. Validations of the numerical formulation, parameter tuning, and performance study of the fast method for acoustically large objects are presented, in various settings and for a range of examples, representative of biomedical and oceanographic applications.

Improvement of 3-D Ultrasound Spine Imaging Technique Using Fast Reconstruction Algorithm

Three-dimensional (3-D) freehand ultrasound (US) imaging has been applied to the investigation of spine deformity. However, it is a challenge for the current 3-D imaging reconstruction algorithms to achieve a balance between image quality and computation time. The objectives of this article are to implement a new fast reconstruction algorithm that can fulfill the request of immediate demonstration and processing for high-quality 3-D spine imaging, and to evaluate the reliability and accuracy of scoliotic curvature measurement when using the algorithm. The fast dot-projection (FDP) algorithm was applied for voxel-based nearest neighbor (VNN), multiple plane interpolation (MPI), and pixel nearest neighbor (PNN) protocols to reduce the reconstruction time. The 3-D image volume was reconstructed from the datasets acquired from scoliotic subjects. The computational cost, image characteristics, and statistical analyses of curve measurements were compared and evaluated among different reconstruction protocols. The results illustrated that the 3-D spine images using the FDP-MPI4 algorithm showed higher brightness (20%), contrast (14%), and signal-to-noise ratio (SNR) (26%) than FDP-VNN. The measurement performed by trainee rater exhibited significant improvement in measurement reliability and accuracy using FDP-MPI4 in comparison with FDP-VNN ( ), and the intraclass correlation coefficient (ICC) of interrater measurement increased from 0.88 to 0.96. The FDP-PNN method could acquire and reconstruct spine images simultaneously and present the results in 1-2 min, which showed the potential to provide the approximate real-time visualization for fast screening.

Bimodal Ultrasound and X-ray Bioimaging Properties of Particulate Calcium Fluoride Biomaterial

Ultrasound (US) and X-ray imaging are diagnostic methods that are commonly used to image internal body structures. Several organic and inorganic imaging contrast agents are commercially available. However, their synthesis and purification remain challenging, in addition to posing safety issues. Here, we report on the promise of widespread, safe, and easy-to-produce particulate calcium fluoride (part-CaF2) as a bimodal US and X-ray contrast agent. Pure and highly crystalline part-CaF2 is obtained using a cheap commercial product. Scanning electron microscopy (SEM) depicts the morphology of these particles, while energy-dispersive X-ray spectroscopy (EDS) confirms their chemical composition. Diffuse reflectance ultraviolet-visible spectroscopy highlights their insulating behavior. The X-ray diffraction (XRD) pattern reveals that part-CaF2 crystallizes in the face-centered cubic cell lattice. Further analyses regarding peak broadening are performed using the Scherrer and Williamson-Hall (W-H) methods, which pinpoint the small crystallite size and the presence of lattice strain. X-ray photoelectron spectroscopy (XPS) solely exhibits specific peaks related to CaF2, confirming the absence of any contamination. Additionally, in vitro cytotoxicity and in vivo maximum tolerated dose (MTD) tests prove the biocompatibility of part-CaF2. Finally, the results of the US and X-ray imaging tests strongly signal that part-CaF2 could be exploited in bimodal bioimaging applications. These findings may shed a new light on calcium fluoride and the opportunities it offers in biomedical engineering.

Inorganic chemoreactive nanosonosensitzers with unique physiochemical properties and structural features for versatile sonodynamic nanotherapies

The fast development of nanomedicine and nanobiotechnology has enabled the emerging of versatile therapeutic modalities with high therapeutic efficiency and biosafety, among which nanosonosensitizer-involved sonodynamic therapy (SDT) employs ultrasound (US) as the exogenous activation source for inducing the production of reactive oxygen species (ROS) and disease therapy. The chemoreactive nanosonosensitizers are the critical components participating in the SDT process, which generally determine the SDT efficiency and therapeutic outcome. Compared to the traditional and mostly explored organic sonosensitizers, the recently developed inorganic chemoreactive nanosonosensitizers feature the distinct high stability, multifunctionality and significantly different SDT mechanism. This review dominantly discusses and highlights two types of inorganic nanosensitizers in sonodynamic treatments of various diseases and their underlying therapeutic mechanism, including US-activated generation of electrons (e^-) and holes (h⁺) for facilitating the following ROS production and delivery of organic molecular sonosensitizers. Especially, this review proposes four strategies aiming for augmenting the SDT efficiency on antitumor and antibacterial applications based on inorganic sonosensitizers, including defect engineering, novel metal coupling, increasing electric conductivity and alleviating tumor hypoxia. The encountered challenges and critical issues facing these inorganic nanosonosensitzers are also highlighted and discussed for advancing their clinical translations.

Fast 3-D Velocity Estimation in 4-D Using a 62 + 62 Row-Column Addressed Array

This article presents an imaging scheme capable of estimating the full 3-D velocity vector field in a volume using row-column addressed arrays (RCAs) at a high volume rate. A 62 + 62 RCA array is employed with an interleaved synthetic aperture sequence. It contains repeated emissions with rows and columns interleaved with B-mode emissions. The sequence contains 80 emissions in total and can provide continuous volumetric data at a volume rate above 125 Hz. A transverse oscillation cross correlation estimator determines all three velocity components. The approach is investigated using Field II simulations and measurements using a specially built 3-MHz 62 + 62 RCA array connected to the SARUS experimental scanner. Both the B-mode and flow sequences have a penetration depth of 14 cm when measured on a tissue-mimicking phantom (0.5-dB/[ [Formula: see text]] attenuation). Simulations of a parabolic flow in a 12-mm-diameter vessel at a depth of 30 mm, beam-to-flow angle of 90°, and xy-rotation of 45° gave a standard deviation (SD) of (3.3, 3.4, 0.4)% and bias of (-3.3, -3.9, -0.1)%, for ( v_x , v_y , and v_z ). Decreasing the beam-to-flow angle to 60° gave an SD of (8.9, 9.1, 0.8)% and bias of (-7.6, -9.5, -7.2)%, showing a slight increase. Measurements were carried out using a similar setup, and pulsing at 2 kHz yielded comparable results at 90° with an SD of (5.8, 5.5, 1.1)% and bias of (1.4, -6.4, 2.4)%. At 60°, the SD was (5.2, 4.7 1.2)% and bias (-4.6, 6.9, -7.4)%. Results from measurements across all tested settings showed a maximum SD of 6.8% and a maximum bias of 15.8% for a peak velocity of 10 cm/s. A tissue-mimicking phantom with a straight vessel was used to introduce clutter, tissue motion, and pulsating flow. The pulsating velocity magnitude was estimated across ten pulse periods and yielded an SD of 10.9%. The method was capable of estimating transverse flow components precisely but underestimated the flow with small beam-to-flow angles. The sequence provided continuous data in both time and space throughout the volume, allowing for retrospective analysis of the flow. Moreover, B-mode planes can be selected retrospectively anywhere in the volume. This shows that tensor velocity imaging (full 3-D volumetric vector flow imaging) can be estimated in 4-D ( x, y, z, and t ) using only 62 channels in receive, making 4-D volumetric imaging implementable on current scanner hardware.

Wideband 2-D sparse array optimization combined with multiline reception for real-time 3-D medical ultrasound

Three-dimensional (3-D) ultrasound medical imaging provides advantages over a traditional 2-D visualization method. However, the use of a 2-D array to acquire 3-D images may result in a transducer composed of thousands of elements and a large amount of data in the front-end, making it impractical to implement high volume rate imaging and individually control all elements with the scanner. This paper proposes an original approach, valid for wideband operations centered on the design center frequency, to maintain a limited number of active elements and firing events, while preserving high resolution and volume rate. A 7 MHz 2-D array is composed of two circular concentric subparts. In the inner footprint the elements are distributed following a regular grid, while in the outer subpart a sparse non-grid solution is adopted. The inner circular dense array is composed of 256 elements with a pitch of 0.5λ. The overall footprint, delimited by the outer subpart, is equivalent to a 256-element array with a pitch of 1.5λ. All the elements of the inner subpart are activated in transmission. Following an optimization procedure, both subparts, including a subset of the elements placed in the inner footprint (i.e., sparse on-the-grid array) and the elements spread over the outer subpart (i.e., sparse off-the-grid array) are used to receive. A total number of 256 elements, defined by the sum of elements distributed in the inner and outer subparts, is fixed in reception. The proposed approach implies a multiline reception strategy, where for each transmission 3 × 3 firing events occur in reception. The sparse receive array is optimized by using a simulated annealing optimization. An original cost function is designed specifically to achieve successful results in wideband conditions. The receive array is optimized in order to obtain consistent results for different signal bandwidths of the excitation pulse. For all the desired bandwidths, the optimized array will provide the recovery of the lower lateral resolution of the transmission phase and, at the same time, a significant reduction of the undesired side lobe raised in the 3-D two-way beam pattern. The 3-D two-way beam pattern analysis reveals that the proposed solution is able to guarantee a lateral resolution of 1.35 mm at a focus depth of 25 mm for the three fractional signal bandwidths of interest (i.e., 30%, 50% and 70%) considered in the optimization process. The undesired side lobes are successfully suppressed especially when, as a consequence of the multiline strategy, non-coincident steering angles are used in transmission and reception. Moreover, thanks to the firing scheme adopted, a high-volume rate of 63 volumes per second may be achieved at the focus depth. The volume rate decreases to 32 volumes per second at twice the focal depth. Phantom image simulations show that the proposed method maintains a satisfactory and almost uniform image quality in terms of resolution and contrast for all the signal bandwidths of interest.

Polytetrafluoroethylene-like Nanoparticles as a Promising Contrast Agent for Dual Modal Ultrasound and X-ray Bioimaging

Various noninvasive imaging techniques are used to produce deep-tissue and high-resolution images for biomedical research and clinical purposes. Organic and inorganic bioimaging agents have been developed to enhance the resolution and contrast intensity. This paper describes the synthesis of polytetrafluoroethylene-like nanoparticles (PTFE≈ NPs), their characterization, biological activity, and bioimaging properties. Transmission electron microscopy (TEM) images showed the shape and the size of the as-obtained small and ultrasmall PTFE≈ NPs. Fourier transform infrared spectroscopy (FTIR) confirmed the PTFE-like character of the samples. X-ray diffraction (XRD) enabled the determination of the crystallization system, cell lattice, and index of crystallinity of the material in addition to the presence of titania (TiO₂) as the contamination. These findings were corroborated by X-ray photoelectron spectroscopy (XPS) that identifies the chemical states of the elements present in the samples along with their atomic percentages allowing the determination of both the purity index of the sample and the nature of the impurities. Additionally, diffuse reflectance ultraviolet-visible spectroscopy (UV-vis) was used to further assess the optical properties of the materials. Importantly, PTFE≈ NPs showed significant in vitro and in vivo biocompatibility. Lastly, PTFE≈ NPs were tested for their ultrasound and X-ray contrast properties. Our encouraging preliminary results open new avenues for PTFE-like nanomaterials as a suitable multifunctional contrast agent for biomedical imaging applications. Combined with suitable surface chemistry and morphology design, these findings shed light to new opportunities offered by PTFE nanoparticles in the ever-booming biomedical field.

An Angle-Independent Cross-Sectional Doppler Method for Flow Estimation in the Common Carotid Artery

The Doppler ultrasound is the most common technique for noninvasive quantification of blood flow, which, in turn, is of major clinical importance for the assessment of the cardiovascular condition. In this article, a method is proposed in which the vessel is imaged in the short axis, which has the advantage of capturing the whole flow profile while measuring the vessel area simultaneously. This view is easier to obtain than the longitudinal image that is currently used in flow velocity estimation, reducing operator dependence. However, the Doppler angle in cross-sectional images is unknown since the vessel wall can no longer be used to estimate the flow direction. The proposed method to estimate the Doppler angle in these images is based on the elliptical intersection between a cylindrical vessel and the ultrasound plane. The parameters of this ellipse (major axis, minor axis, and rotation) are used to estimate the Doppler angle by solving a least-squares problem. Theoretical feasibility was shown in a geometrical model, after which the Doppler angle was estimated in simulated ultrasound images generated in Field II, yielding a mean error within 4°. In vitro, across 15 short-axis measurements with a wide variety of Doppler angles, errors in the flow estimates were below 10%, and in vivo, the average velocities in systole obtained from longitudinal ( v=69.1 cm/s) and cross-sectional ( v=66.5 cm/s) acquisitions were in agreement. Further research is required to validate these results on a larger population.

Ultrasound Image Based Human Gallbladder 3D Modelling along with Volume and Stress Level Assessment

Purpose

Three-dimensional (3D) gallbladder (GB) geometrical models are essential to GB motor function evaluation and GB wall biomechanical property identification by employing finite element analysis (FEA) in GB disease diagnosis with ultrasound systems. Methods for establishing such 3D geometrical models based on static two-dimensional (2D) ultrasound images scanned along the long-axis/sagittal and short-axis/transverse cross-sections in routine GB disease diagnosis at the beginning of emptying phase have not been documented in the literature so far.

Methods

Based on two custom MATLAB codes composed, two images were segmented manually to secure two sets of the scattered points for the long- and short-axis GB cross-section edges; and the points were best fitted with a piecewise cubic spline function, and the short-axis cross-section edges were lofted along the long-axis to yield a 3D geometrical model, then GB volume of the model was figured out. The model was read into SolidWorks for real surface generation and involved in ABAQUS for FEA.

Results

3D geometrical models of seven typical GB samples were established. Their GB volumes are with 15.5% and − 4.4% mean errors in comparison with those estimated with the ellipsoid model and sum-of-cylinders method but can be correlated to the latter very well. The maximum first principal in-plane stress in the 3D models is higher than in the ellipsoid model by a factor of 1.76.

Conclusions

A numerical method was put forward here to create 3D GB geometrical models and can be applied to GB disease diagnosis and GB shape analysis with principal component method potentially in the future.

Acrania-exencephaly-anencephaly sequence phenotypic characterization using two- and three-dimensional ultrasound between 11 and 13 weeks and 6 days of gestation

The study presents a pictorial essay of acrania-exencephaly-anencephaly sequence using two-(2D) and three-dimensional (3D) ultrasonography, documenting the different phenotypic characterization of this rare disease. Normal and abnormal fetuses were evaluated during the first trimester scan. The International Society of Ultrasound in Obstetrics and Gynecology practice guidelines were adopted to standardize first trimester anatomical ultrasound screening. The guidelines outline the importance of systematic fetal head and brain examination including the formation of cranial bones, choroid-plexus and ventricles. Acrania-exencephaly-anencephaly sequence and/or other neural tube defects, such as meningoencephalocele, may be identified during a routine 11–14 week scan. Early first trimester detection of acrania-exencephaly-anencephaly sequence with the characterization of different related phenotypes, 2D and 3D ultrasound imaging as well as differential diagnosis are also presented in this pictorial essay. The main diagnostic ultrasound features of the disease may be characterized by findings of acrania with increased amniotic fluid echogenicity; “Mickey-Mouse” bi-lobular face, cystic, elongated, irregular and overhanging head morphology. Lightening techniques have also been added to 3D ultrasound to enhance anatomical details. Moreover, discordant amniotic fluid echotexture in the setting of twin pregnancies may be the first sign of acrania-exencephaly-anencephaly sequence. Extracranial malformations, aneuploidy and genetic syndromes associated with acrania-exencephaly-anencephaly sequence are also reported and described. First trimester neuroscan by an expert sonographer with appropriate training together with the application of standardized protocol are essential for a high detection rate of this rare type of neural tube defect malformation during a scan performed at 11 and 13 weeks and 6 days.

Experimental 3-D Ultrasound Imaging with 2-D Sparse Arrays using Focused and Diverging Waves

Three dimensional ultrasound (3-D US) imaging methods based on 2-D array probes are increasingly investigated. However, the experimental test of new 3-D US approaches is contrasted by the need of controlling very large numbers of probe elements. Although this problem may be overcome by the use of 2-D sparse arrays, just a few experimental results have so far corroborated the validity of this approach. In this paper, we experimentally compare the performance of a fully wired 1024-element (32 × 32) array, assumed as reference, to that of a 256-element random and of an “optimized” 2-D sparse array, in both focused and compounded diverging wave (DW) transmission modes. The experimental results in 3-D focused mode show that the resolution and contrast produced by the optimized sparse array are close to those of the full array while using 25% of elements. Furthermore, the experimental results in 3-D DW mode and 3-D focused mode are also compared for the first time and they show that both the contrast and the resolution performance are higher when using the 3-D DW at volume rates up to 90/second which represent a 36x speed up factor compared to the focused mode.

Lesion Segmentation in Automated 3D Breast Ultrasound: Volumetric Analysis

Mammography is the gold standard screening technique in breast cancer, but it has some limitations for women with dense breasts. In such cases, sonography is usually recommended as an additional imaging technique. A traditional sonogram produces a two-dimensional (2D) visualization of the breast and is highly operator dependent. Automated breast ultrasound (ABUS) has also been proposed to produce a full 3D scan of the breast automatically with reduced operator dependency, facilitating double reading and comparison with past exams. When using ABUS, lesion segmentation and tracking changes over time are challenging tasks, as the three-dimensional (3D) nature of the images makes the analysis difficult and tedious for radiologists. The goal of this work is to develop a semi-automatic framework for breast lesion segmentation in ABUS volumes which is based on the Watershed algorithm. The effect of different de-noising methods on segmentation is studied showing a significant impact ([Formula: see text]) on the performance using a dataset of 28 temporal pairs resulting in a total of 56 ABUS volumes. The volumetric analysis is also used to evaluate the performance of the developed framework. A mean Dice Similarity Coefficient of [Formula: see text] with a mean False Positive ratio [Formula: see text] has been obtained. The Pearson correlation coefficient between the segmented volumes and the corresponding ground truth volumes is [Formula: see text] ([Formula: see text]). Similar analysis, performed on 28 temporal (prior and current) pairs, resulted in a good correlation coefficient [Formula: see text] ([Formula: see text]) for prior and [Formula: see text] ([Formula: see text]) for current cases. The developed framework showed prospects to help radiologists to perform an assessment of ABUS lesion volumes, as well as to quantify volumetric changes during lesions diagnosis and follow-up.

Three-Dimensional Virtual Sonographic Cystoscopy for Detection of Ureterocele in Duplicated Collecting Systems in Children

OBJECTIVES

Ureterocele is a sac-like dilatation of terminal ureter. Precise anatomic delineation is of utmost importance to proceed with the surgical plan, particularly in the ectopic subtype. However, the level of ureterocele extension is not always elucidated by the existing imaging modalities and even by conventional cystoscopy, which is considered as the gold standard for evaluation of ureterocele. This study aims to evaluate the accuracy of three-dimensional virtual sonographic cystoscopy (VSC) in the characterization of ureterocele in duplex collecting systems.

METHODS

Sixteen children with a mean age of 5.1 (standard deviation 1.96) years with transabdominal ultrasonography-proven duplex system and ureterocele were included. They underwent VSC by a single pediatric radiologist. All of them subsequently had conventional cystoscopy, and the results were compared in terms of ureterocele features including anatomy, number, size, location, and extension.

RESULTS

Three-dimensional VSC was well tolerated in all cases without any complication. Image quality was suboptimal in 2 of 16 patients. Out of the remaining 14 cases, VSC had a high accuracy in characterization of the ureterocele features (93%). Only the extension of one ureterocele was not precisely detected by VSC.

CONCLUSIONS

The results of this study suggest three-dimensional sonography as a promising noninvasive diagnostic modality in the evaluation of ectopic ureterocele in children.

Freehand 3-D Ultrasound Imaging: A Systematic Review

Two-dimensional ultrasound (US) imaging has been successfully used in clinical applications as a low-cost, portable and non-invasive image modality for more than three decades. Recent advances in computer science and technology illustrate the promise of the 3-D US modality as a medical imaging technique that is comparable to other prevalent modalities and that overcomes certain drawbacks of 2-D US. This systematic review covers freehand 3-D US imaging between 1970 and 2017, highlighting the current trends in research fields, the research methods, the main limitations, the leading researchers, standard assessment criteria and clinical applications. Freehand 3-D US systems are more prevalent in the academic environment, whereas in clinical applications and industrial research, most studies have focused on 3-D US transducers and improvement of hardware performance. This topic is still an interesting active area for researchers, and there remain many unsolved problems to be addressed.

Three-Dimensional Computerized Model Based on the Sonourethrogram: A Novel Technique to Evaluate Anterior Urethral Stricture

PURPOSE

The sonourethrogram is a useful alternative to the traditional retrograde urethrogram to evaluate anterior urethral strictures. With the development of 3-dimensional reconstructive techniques 3-dimensional urethral imaging can provide more accurate and useful information to enable the surgeon to make the best surgical decisions. We evaluated the accuracy and efficacy of a 3-dimensional reconstructed digital model of the urethra based on the sonourethrogram to assess anterior urethral disease.

MATERIALS AND METHODS

A total of 50 patients with an anterior urethral stricture and 10 healthy volunteers were enrolled in this study from April 2014 to January 2017. All patients and volunteers underwent sonourethrogram and retrograde urethrogram. Three-dimensional urethral models were reconstructed based on the sonourethrogram. Stricture length and location on retrograde urethrogram or sonourethrogram based images were compared with those found at operation.

RESULTS

The 3-dimensional digital model revealed the entire anterior urethra, including the navicular fossa, and the penile and bulbar parts. The semitransparent model clearly demonstrated the structure of the corpus spongiosum and inside the urethral lumen. Further information on spongiofibrosis could also be seen in the 3-dimensional digital model. There was no significant difference in stricture length or location in the 3-dimensional model compared with retrograde urethrogram imaging and actual surgical findings. However, the latest technique could only reconstruct the short segment of the anterior urethra due to the probe width limitation.

CONCLUSIONS

The 3-dimensional computerized model based on the sonourethrogram is a novel and effective technique of evaluating anterior urethral strictures.

A Review on Real-Time 3D Ultrasound Imaging Technology

Real-time three-dimensional (3D) ultrasound (US) has attracted much more attention in medical researches because it provides interactive feedback to help clinicians acquire high-quality images as well as timely spatial information of the scanned area and hence is necessary in intraoperative ultrasound examinations. Plenty of publications have been declared to complete the real-time or near real-time visualization of 3D ultrasound using volumetric probes or the routinely used two-dimensional (2D) probes. So far, a review on how to design an interactive system with appropriate processing algorithms remains missing, resulting in the lack of systematic understanding of the relevant technology. In this article, previous and the latest work on designing a real-time or near real-time 3D ultrasound imaging system are reviewed. Specifically, the data acquisition techniques, reconstruction algorithms, volume rendering methods, and clinical applications are presented. Moreover, the advantages and disadvantages of state-of-the-art approaches are discussed in detail.

Materials Chemistry of Nanoultrasonic Biomedicine

As a special cross-disciplinary research frontier, nanoultrasonic biomedicine refers to the design and synthesis of nanomaterials to solve some critical issues of ultrasound (US)-based biomedicine. The concept of nanoultrasonic biomedicine can also overcome the drawbacks of traditional microbubbles and promote the generation of novel US-based contrast agents or synergistic agents for US theranostics. Here, we discuss the recent developments of material chemistry in advancing the nanoultrasonic biomedicine for diverse US-based bio-applications. We initially introduce the design principles of novel nanoplatforms for serving the nanoultrasonic biomedicine, from the viewpoint of synthetic material chemistry. Based on these principles and diverse US-based bio-application backgrounds, the representative proof-of-concept paradigms on this topic are clarified in detail, including nanodroplet vaporization for intelligent/responsive US imaging, multifunctional nano-contrast agents for US-based multi-modality imaging, activatable synergistic agents for US-based therapy, US-triggered on-demand drug releasing, US-enhanced gene transfection, US-based synergistic therapy on combating the cancer and potential toxicity issue of screening various nanosystems suitable for nanoultrasonic biomedicine. It is highly expected that this novel nanoultrasonic biomedicine and corresponding high performance in US imaging and therapy can significantly promote the generation of new sub-discipline of US-based biomedicine by rationally integrating material chemistry and theranostic nanomedicine with clinical US-based biomedicine.

Computational optical coherence tomography [Invited]

Optical coherence tomography (OCT) has become an important imaging modality with numerous biomedical applications. Challenges in high-speed, high-resolution, volumetric OCT imaging include managing dispersion, the trade-off between transverse resolution and depth-of-field, and correcting optical aberrations that are present in both the system and sample. Physics-based computational imaging techniques have proven to provide solutions to these limitations. This review aims to outline these computational imaging techniques within a general mathematical framework, summarize the historical progress, highlight the state-of-the-art achievements, and discuss the present challenges.

Ex Vivo HIFU Experiments Using a $32 \times 32$ -Element CMUT Array

High-intensity focused ultrasound (HIFU) has been used as noninvasive treatment for various diseases. For these therapeutic applications, capacitive micromachined ultrasonic transducers (CMUTs) have advantages that make them potentially preferred transducers over traditional piezoelectric transducers. In this paper, we present the design and the fabrication process of an 8 ×8 -mm 2 32 ×32 -element 2-D CMUT array for HIFU applications. To reduce the system complexity for addressing the 1024 transducer elements, we propose to group the CMUT array elements into eight HIFU channels based on the phase delay from the CMUT element to the targeted focal point. Designed to focus at an 8-mm depth with a 5-MHz exciting frequency, this grouping scheme was realized using a custom application-specific integrated circuit. With a 40-V dc bias and a 60-V peak-to-peak ac excitation, the surface pressure was measured 1.2 MPa peak-to-peak and stayed stable for a long enough time to create a lesion. With this dc and ac voltage combination, the measured peak-to-peak output pressure at the focus was 8.5 MPa, which is expected to generate a lesion in a minute according to the temperature simulation. The following ex vivo tissue experiments successfully demonstrated its capability to make lesions in both bovine muscle and liver tissue.

The reliability and validity of a clinical 3D freehand ultrasound system

BACKGROUND AND OBJECTIVE

Acquiring large anatomical volumes in a feasible manner is useful for clinical decision-making. A relatively new technique called 3D freehand ultrasonography is capable of this by combining a conventional 2D ultrasonography system. Currently, a thorough analysis of this technique is lacking, as the analyses are dependent on the software implementation details and the choice of measurement systems. Therefore this study starts by making this implementation available under the form of an open-source software library to perform 3D freehand ultrasonography. Following that, reliability and validity analyses of extracting volumes and lengths will be carried out using two independent motion-tracking systems.

METHODS

A PC-based ultrasonography device and two optical motion-tracking systems were used for data acquisition. An in-house software library called Py3DFreeHandUS was developed to reconstruct (off-line) the corresponding data into one 3D data set. Reliability and validity analyses of the entire experimental set-up were performed by estimating the volumes and lengths of ground truth objects. Ten water-filled balloons and six cross-wires were used. Repeat measurements were also performed by two experienced operators.

RESULTS

The software library Py3DFreeHandUS is available online, along with the relevant documentation. The reliability analyses showed high intra- and inter-operator intra-class correlation coefficient results for both volumes and lengths. The accuracy analysis revealed a discrepancy in all cases of around 3%, which corresponded to 3 ml and 1 mm for volume and length measurements, respectively. Similar results were found for both of the motion-tracking systems.

CONCLUSIONS

The undertaken analyses for estimating volume and lengths acquired with 3D freehand ultrasonography demonstrated reliable design measurements and suitable performance for applications that do not require sub-mm and -ml accuracy.

Enhanced volumetric visualization for real time 4D intraoperative ophthalmic swept-source OCT

Current-generation software for rendering volumetric OCT data sets based on ray casting results in volume visualizations with indistinct tissue features and sub-optimal depth perception. Recent developments in hand-held and microscope-integrated intrasurgical OCT designed for real-time volumetric imaging motivate development of rendering algorithms which are both visually appealing and fast enough to support real time rendering, potentially from multiple viewpoints for stereoscopic visualization. We report on an enhanced, real time, integrated volumetric rendering pipeline which incorporates high performance volumetric median and Gaussian filtering, boundary and feature enhancement, depth encoding, and lighting into a ray casting volume rendering model. We demonstrate this improved model implemented on graphics processing unit (GPU) hardware for real-time volumetric rendering of OCT data during tissue phantom and live human surgical imaging. We show that this rendering produces enhanced 3D visualizations of pathology and intraoperative maneuvers compared to standard ray casting.

Clinical Evaluation of a 3-D Automatic Annotation Method for Breast Ultrasound Imaging

The routine clinical breast ultrasound annotation method is limited by the time it consumes, inconsistency, inaccuracy and incomplete notation. A novel 3-D automatic annotation method for breast ultrasound imaging has been developed that uses a spatial sensor to track and record conventional B-mode scanning so as to provide more objective annotation. The aim of the study described here was to test the feasibility of the automatic annotation method in clinical breast ultrasound scanning. An ultrasound scanning procedure using the new method was established. The new method and the conventional manual annotation method were compared in 46 breast cancer patients (49 ± 12 y). The time used for scanning a patient was recorded and compared for the two methods. Intra-observer and inter-observer experiments were performed, and intra-class correlation coefficients (ICCs) were calculated to analyze system reproducibility. The results revealed that the new annotation method had an average scanning time 36 s (42.9%) less than that of the conventional method. There were high correlations between the results of the two annotation methods (r = 0.933, p < 0.0001 for distance; r = 0.995, p < 0.0001 for radial angle). Intra-observer and inter-observer reproducibility was excellent, with all ICCs > 0.92. The results indicated that the 3-D automatic annotation method is reliable for clinical breast ultrasound scanning and can greatly reduce scanning time. Although large-scale clinical studies are still needed, this work verified that the new annotation method has potential to be a valuable tool in breast ultrasound examination.

Accurate ultrasound imaging based on range point migration method for the depiction of fetal surface

PURPOSE

The purpose of this study is to evaluate the performance of a modified range point migration (RPM) method using a semi-broad transmit beam for fetal surface imaging.

METHODS

The conventional RPM method depicts accurate images of target surfaces by estimating the reflection point on a target surface from the path length of plural transmit-and-receive element combinations. However, the conventional RPM method depicts false images when echoes from different targets are received simultaneously. For the elimination of false images in the employment of the RPM method, we propose a modified RPM method with a semi-broad transmit beam to decrease the number of targets in each measurement region.

RESULTS

The modified RPM method depicted two acrylic cylinders of 2 cm in diameter with a root-mean-square error (RMSE) of 0.062 mm, where the RMSE of the migration method was 0.145 mm. The modified RPM method also succeeded in depicting a 7-month fetal phantom with a RMSE of 0.058 mm relative to a 3D image acquired using optical measurement.

CONCLUSION

This study shows the potential of the modified RPM method in achieving accurate surface imaging of multiple targets using a semi-broad beam, indicating that the method is suitable for fetal surface imaging.

Development of 3-D ultrasound system for assessment of adolescent idiopathic scoliosis (AIS): and system validation

Adolescent idiopathic scoliosis (AIS) is a common spinal disease and the prevalence of AIS is 2 to 4 % of the youngsters in the United States. Radiograph based Cobb's method is regarded as the gold standard. AIS patients normally have to undergo regular X-ray assessment every 4 to 6 months until skeletal maturity is reached. Because of radiation hazard, X-ray images cannot be taken frequently, and thus it is difficult to perform close monitoring for the disease progression and treatment outcomes. In this study, a free-hand 3D ultrasound imaging system has been successfully developed for the radiation-free assessment of AIS. A series of B-mode ultrasound images with their spatial information were exploited to form a spine model for measuring the spine curvature. Sixteen spine phantoms with different simulated deformity were scanned by both conventional X-ray imaging and the 3D ultrasound system. The results showed that there was a strong correlation (R(2) = 0.759) between the Cobb's angles obtained by the two methods. The results also demonstrated a very good intra- and inter-observer reproducibility with ICC of 0.99 and 0.89, repectively. The findings suggest that it is feasible to use 3D ultrasound imaging for the assessment of scoliosis and deserves further clinical tests on patients with spine deformity.

Ultrasound Volume Projection Imaging for Assessment of Scoliosis

The standing radiograph is used as a gold standard to diagnose spinal deformity including scoliosis, a medical condition defined as lateral spine curvature > 10°. However, the health concern of X-ray and large inter-observer variation of measurements on X-ray images have significantly restricted its application, particularly for scoliosis screening and close follow-up for adolescent patients. In this study, a radiation-free freehand 3-D ultrasound system was developed for scoliosis assessment using a volume projection imaging method. Based on the obtained coronal view images, two measurement methods were proposed using transverse process and spinous profile as landmarks, respectively. As a reliability study, 36 subjects (age: 30.1 ±14.5; male: 12; female: 24) with different degrees of scoliosis were scanned using the system to test the inter- and intra-observer repeatability. The intra- and inter-observer tests indicated that the new assessment methods were repeatable, with ICC larger than 0.92. Small intra- and inter-observer variations of measuring spine curvature were observed for the two measurement methods (intra-: 1.4 ±1.0° and 1.4 ±1.1°; inter-: 2.2 ±1.6° and 2.5 ±1.6°). The results also showed that the spinal curvature obtained by the new method had good linear correlations with X-ray Cobb's method (R2 = 0.8, p < 0.001, 29 subjects). These results suggested that the ultrasound volume projection imaging method can be a promising approach for the assessment of scoliosis, and further research should be followed up to demonstrate its potential clinical applications for mass screening and curve progression and treatment outcome monitoring of scoliosis patients.

Needle Trajectory and Tip Localization in Real-Time 3-D Ultrasound Using a Moving Stylus

Described here is a novel approach to needle localization in 3-D ultrasound based on automatic detection of small changes in appearance on movement of the needle stylus. By stylus oscillation, including its full insertion into the cannula to the tip, the image processing techniques can localize the needle trajectory and the tip in the 3-D ultrasound volume. The 3-D needle localization task is reduced to two 2-D localizations using orthogonal projections. To evaluate our method, we tested it on three different ex vivo tissue types, and the preliminary results indicated that the method accuracy lies within clinical acceptance, with average error ranges of 0.9°-1.4° in needle trajectory and 0.8-1.1 mm in needle tip. Results also indicate that method performance is independent of the echogenicity of the tissue. This technique is a safe way of producing ultrasonic intensity changes and appears to introduce negligible risk to the patient, as the outer cannula remains fixed.

Freehand three-dimensional ultrasound system for assessment of scoliosis

Background/Objective

Standing radiograph with Cobb's method is routinely used to diagnose scoliosis, a medical condition defined as a lateral spine curvature > 10° with concordant vertebral rotation. However, radiation hazard and two-dimensional (2-D) viewing of 3-D anatomy restrict the application of radiograph in scoliosis examination.

Methods

In this study, a freehand 3-D ultrasound system was developed for the radiation-free assessment of scoliosis. Bony landmarks of the spine were manually extracted from a series of ultrasound images with their spatial information recorded to form a 3-D spine model for measuring its curvature. To validate its feasibility, in vivo measurements were conducted in 28 volunteers (age: 28.0 ± 13.0 years, 9 males and 19 females). A significant linear correlation (R² = 0.86; p < 0.001) was found between the spine curvatures as measured by Cobb's method and the 3-D ultrasound imaging with transverse process and superior articular process as landmarks. The intra- and interobserver tests indicated that the proposed method is repeatable.

Results

The 3-D ultrasound method using bony landmarks tended to underestimate the deformity, and a proper scaling is required. Nevertheless, this study demonstrated the feasibility of the freehand 3-D ultrasound system to assess scoliosis in the standing posture with the proposed methods and 3-D spine profile.

Conclusion

Further studies are required to understand the variations that exist between the ultrasound and radiograph results with a larger number of volunteers, and to demonstrate its potential clinical applications for monitoring of scoliosis patients. Through further clinical trials and development, the reported 3-D ultrasound imaging system can potentially be used for scoliosis mass screening and frequent monitoring of progress and treatment outcome because of its radiation-free and easy accessibility feature.

Role of 3-D ultrasound in clinical obstetric practice: evolution over 20 years

The use of 3-D ultrasound in obstetrics has undergone dramatic development over the past 20 years. Since the first publications on this application in clinical practice, several 3-D ultrasound techniques and rendering modes have been proposed and applied to the study of fetal brain, face and cardiac anatomy. In addition, 3-D ultrasound has improved calculations of the volume of fetal organs and limbs and estimations of fetal birth weight. And furthermore, angiographic patterns of fetal organs and the placenta have been assessed using 3-D power Doppler ultrasound quantification. In this review, we aim to summarize current evidence on the clinical relevance of these methodologies and their application in obstetric practice.

A novel breast ultrasound system for providing coronal images: system development and feasibility study

Breast ultrasound images along coronal plane contain important diagnosis information. However, conventional clinical 2D ultrasound cannot provide such images. In order to solve this problem, we developed a novel ultrasound system aimed at providing breast coronal images. In this system, a spatial sensor was fixed on an ultrasound probe to obtain the image spatial data. A narrow-band rendering method was used to form coronal images based on B-mode images and their corresponding spatial data. Software was developed for data acquisition, processing, rendering and visualization. In phantom experiments, 20 inclusions with different size (5-20 mm) were measured using this new system. The results obtained by the new method well correlated with those measured by a micrometer (y=1.0147x, R(2)=0.9927). The phantom tests also showed that this system had excellent intra- and inter-operator repeatability (ICC>0.995). Three subjects with breast lesions were scanned in vivo using this new system and a commercially available three-dimensional (3D) probe. The average scanning times for the two systems were 64 s and 74 s, respectively. The results revealed that this new method required shorter scanning time. The tumor sizes measured on the coronal plane provided by the new method were smaller by 5.6-11.9% in comparison with the results of the 3D probe. The phantom tests and preliminary subject tests indicated the feasibility of this system for clinical applications by providing additional information for clinical breast ultrasound diagnosis.

The potential of transabdominal 3D color doppler ultrasonography for diagnosis of gastric varices

GOALS/BACKGROUND

To examine the potential of transabdominal 3-dimensional (3D) color Doppler ultrasonography (3D-US) as a noninvasive tool to characterize gastric varices.

STUDY

This was a prospective study in which endoscopy was performed on 107 patients with chronic liver disease. Among these patients, 70 (42 males, 28 females) had gastric varices (46 fundal varices, 24 cardia varices; 30 small, 28 medium, and 12 large), and the 37 patients (25 males, 12 females) without gastric varices served as controls. The 3D-US data and endoscopic findings were compared with respect to grade, location, and similarity of varices.

RESULTS

The sensitivity and specificity of the 3D-US technique to detect gastric varices were 88.6% (62/70) and 100% (37/37), respectively. Although all fundal varices appeared adjacent to the posterior gastric wall, cardia varices were detected separately from the wall with a mean distance of 21.2 mm. The vascular volumes (mL) were 0.84±0.71 in small varices, 5.52±3.81 in medium varices, and 10.9±6.3 in large varices, with significant differences between different grades. The best cutoff value to detect medium-grade/large-grade gastric varices was 2.0 mL, with 83.3% sensitivity and 95.8% specificity. Seventy-nine percent (55/70) of patients showed partial resemblance or better between the 3D images and the endoscopic findings with good interreviewer agreement.

CONCLUSIONS

3D-US can quantitatively characterize gastric varices noninvasively in terms of grade, location, and appearance. This approach has the potential to improve objectivity and reduce invasiveness in the management of gastric varices.

Three-dimensional contrast-enhanced sonography in the assessment of breast tumor angiogenesis: correlation with microvessel density and vascular endothelial growth factor expression

OBJECTIVES

The purpose of this study was to differentiate perfusion and vascular characteristics between benign and malignant breast lesions by 3-dimensional contrast-enhanced sonography and evaluate their correlation with microvessel density and vascular endothelial growth factor (VEGF) expression for further clinical exploration.

METHODS

Three-dimensional contrast-enhanced sonography was performed in 183 patients with breast lesions, and sonographic characteristics were carefully observed for further analysis. The mean microvessel density and VEGF expression were measured by immunohistochemical analysis.

RESULTS

Pathologic results showed 35 benign and 148 malignant cases. Malignancy and benignity differed significantly in peripheral vessel characteristics (number, distribution, course, degree of dilatation, and penetrating vessels), rim perfusion and coarseness degree, intratumoral perfusion type, and intratumoral vessel dilatation (P< .05) but not the presence of peripheral and intratumoral vessels and intratumoral perfusion (P > .05). The specificity of penetrating vessels was 88.6% for diagnosing malignancy. The sensitivity, specificity, and accuracy of rim perfusion coarseness were 90.2%, 70.4%, and 85.3% respectively. The sensitivity of the intratumoral perfusion type was 77.8%, whereas the specificity of intratumoral vessel dilatation was 88.9%. Microvessel density and VEGF expression were significantly correlated with perfusion and vascular characteristics (P < .05), except the presence of peripheral vessels, rim perfusion, and intratumoral perfusion (P> .05). The presence of intratumoral vessels was related to VEGF (P< .05) but not microvessel density (P > .05).

CONCLUSIONS

Three-dimensional contrast-enhanced sonographic characteristics were statistically different between benign and malignant breast lesions. Some of them also correlated significantly with microvessel density and VEGF expression and therefore have potential for objective evaluation of tumor angiogenesis.

A semi-automated 3-D annotation method for breast ultrasound imaging: system development and feasibility study on phantoms

Spatial annotation is an essential step in breast ultrasound imaging, because the follow-up diagnosis and treatment are based on this annotation. However, the current method for annotation is manual and highly dependent on the operator's experience. Moreover, important spatial information, such as the probe tilt angle, cannot be indicated in the clinical 2-D annotations. To solve these problems, we developed a semi-automated 3-D annotation method for breast ultrasound imaging. A spatial sensor was fixed on an ultrasound probe to obtain the image spatial data. Three-dimensional virtual models of breast and probe were used to annotate image locations. After the reference points were recorded, this system displayed the image annotations automatically. Compared with the conventional manual annotation method, this new annotation system has higher accuracy as indicated by the phantom test results. In addition, this new annotation method has good repeatability, with intra-class correlation coefficients of 0.907 (average variation: ≤3.45%) and 0.937 (average variation: ≤2.85%) for the intra-rater and inter-rater tests, respectively. Breast phantom experiments simulating clinical breast scanning further indicated the feasibility of this system for clinical applications. This new annotation method is expected to facilitate more accurate, intuitive and rapid breast ultrasound diagnosis.

Linear tracking for 3-D medical ultrasound imaging

As the clinical application grows, there is a rapid technical development of 3-D ultrasound imaging. Compared with 2-D ultrasound imaging, 3-D ultrasound imaging can provide improved qualitative and quantitative information for various clinical applications. In this paper, we proposed a novel tracking method for a freehand 3-D ultrasound imaging system with improved portability, reduced degree of freedom, and cost. We designed a sliding track with a linear position sensor attached, and it transmitted positional data via a wireless communication module based on Bluetooth, resulting in a wireless spatial tracking modality. A traditional 2-D ultrasound probe fixed to the position sensor on the sliding track was used to obtain real-time B-scans, and the positions of the B-scans were simultaneously acquired when moving the probe along the track in a freehand manner. In the experiments, the proposed method was applied to ultrasound phantoms and real human tissues. The results demonstrated that the new system outperformed a previously developed freehand system based on a traditional six-degree-of-freedom spatial sensor in phantom and in vivo studies, indicating its merit in clinical applications for human tissues and organs.