Real-time spatial compound imaging: application to breast, vascular, and musculoskeletal ultrasound

What is the place of ultrasound in MSK imaging?

During the past four decades, ultrasound has become popular as an imaging modality applied to the musculoskeletal (MSK) system, particularly outside the USA, due to its low cost, accessibility, and lack of ionizing radiation. A basic requirement in performing these examinations is to have a core group of radiologists and ultrasound technologists with expertise in MSK ultrasound. The extent to which ultrasound will be part of the imaging offered by a particular radiology practice or in an academic institution will vary according to expertise, availability, and reimbursements. A brief discussion of the technical capabilities of the current generation of ultrasound scanners will be followed by a description of some of the more prevalent MSK ultrasound imaging applications. The extent to which training to perform these exams within and outside of Radiology plays a role is discussed. Applications that are unique to ultrasound, such as dynamic evaluation of musculoskeletal anatomy and some, US-guided interventions are an important part of MSK imaging. Ultrasound is increasingly important in the assessment of superficial structures, such as tendons, small joints, and peripheral nerves. These applications help to establish the place of ultrasound as an important part of the Radiologists approach to MSK imaging. Outside of radiology, for a variety of clinical subspecialties, ultrasound already plays an integral role in MSK imaging.

Targeted Neonatal Echocardiography: Basics of Knobology 101

Targeted neonatal echocardiography (TNE) is essential when approaching hemodynamic instability in neonates. Competency in this field requires standardized training, including robust hands-on experience. Proficiency in understanding the key elements of ultrasound knobology is indispensable for optimal acquisition of imaging. This is a narrative review summarizing the key elements of knobology in TNE. Literature review was mainly done through PubMed. There was no funding allocated for the production of this manuscript. KEY POINTS: · Robust and structured training is essential. · Understanding knobology is required to achieve competency in TNE. · Optimizing knobology is critical for an accurate hemodynamic interpretation report.

Radiological Features of Male Breast Neoplasms: How to Improve the Management of a Rare Disease

The primary aim of our study was to assess the main mammographic and ultrasonographic features of invasive male breast malignancies. The secondary aim was to evaluate whether a specific radiological presentation would be associated with a worse receptor profile. Radiological images (mammography and/or ultrasound) of all patients who underwent surgery for male invasive breast cancer in our institution between 2008 and 2023 were retrospectively analyzed by two breast radiologists in consensus. All significant features of radiological presentation known in the literature were re-evaluated. Fifty-six patients were selected. The mean age at surgery of patients was 69 years (range: 35-81); in 82% of cases (46 patients), the histologic outcome was invasive ductal carcinoma. A total of 28 out of 56 (50%) patients had preoperative mammography; in 9/28 cases (32%), we found a mass with microcalcifications on mammography. The mass presented high density in 25 out of 28 patients (89%); the mass showed irregular margins in 15/28 (54%) cases. A total of 46 out of 56 patients had preoperative ultrasounds. The lesion showed a solid mass in 41/46 (89%) cases. In 5/46 patients (11%), the lesion was a mass with a mixed (partly liquid-partly solid) structure. We did not find any statistically significant correlation between major types of radiological presentation and tumor receptor arrangement. Knowledge of the main radiologic presentation patterns of malignant male breast neoplasm can help better manage this type of disease, which is rare but whose incidence is increasing.

Spatial Coherence Approaches to Distinguish Suspicious Mass Contents in Fundamental and Harmonic Breast Ultrasound Images

When compared to fundamental B-mode imaging, coherence-based beamforming, and harmonic imaging are independently known to reduce acoustic clutter, distinguish solid from fluid content in indeterminate breast masses, and thereby reduce unnecessary biopsies during a breast cancer diagnosis. However, a systematic investigation of independent and combined coherence beamforming and harmonic imaging approaches is necessary for the clinical deployment of the most optimal approach. Therefore, we compare the performance of fundamental and harmonic images created with short-lag spatial coherence (SLSC), M-weighted SLSC (M-SLSC), SLSC combined with robust principal component analysis with no M-weighting (r-SLSC), and r-SLSC with M-weighting (R-SLSC), relative to traditional fundamental and harmonic B-mode images, when distinguishing solid from fluid breast masses. Raw channel data acquired from 40 total breast masses (28 solid, 7 fluid, 5 mixed) were beamformed and analyzed. The contrast of fluid masses was better with fundamental rather than harmonic coherence imaging, due to the lower spatial coherence within the fluid masses in the fundamental coherence images. Relative to SLSC imaging, M-SLSC, r-SLSC, and R-SLSC imaging provided similar contrast across multiple masses (with the exception of clinically challenging complicated cysts) and minimized the range of generalized contrast-to-noise ratios (gCNRs) of fluid masses, yet required additional computational resources. Among the eight coherence imaging modes compared, fundamental SLSC imaging best identified fluid versus solid breast mass contents, outperforming fundamental and harmonic B-mode imaging. With fundamental SLSC images, the specificity and sensitivity to identify fluid masses using the reader-independent metrics of contrast difference, mean lag one coherence (LOC), and gCNR were 0.86 and 1, 1 and 0.89, and 1 and 1, respectively. Results demonstrate that fundamental SLSC imaging and gCNR (or LOC if no coherence image or background region of interest is introduced) have the greatest potential to impact clinical decisions and improve the diagnostic certainty of breast mass contents. These observations are additionally anticipated to extend to masses in other organs.

Feasibility of Encord Artificial Intelligence Annotation of Arterial Duplex Ultrasound Images

DUS measurements for popliteal artery aneurysms (PAAs) specifically can be time-consuming, error-prone, and operator-dependent. To eliminate this subjectivity and provide efficient segmentation, we applied artificial intelligence (AI) to accurately delineate inner and outer lumen on DUS. DUS images were selected from a cohort of patients with PAAs from a multi-institutional platform. Encord is an easy-to-use, readily available online AI platform that was used to segment both the inner lumen and outer lumen of the PAA on DUS images. A model trained on 20 images and tested on 80 images had a mean Average Precision of 0.85 for the outer polygon and 0.23 for the inner polygon. The outer polygon had a higher recall score than precision score at 0.90 and 0.85, respectively. The inner polygon had a score of 0.25 for both precision and recall. The outer polygon false-negative rate was the lowest in images with the least amount of blur. This study demonstrates the feasibility of using the widely available Encord AI platform to identify standard features of PAAs that are critical for operative decision making.

Deep Semi-Supervised Ultrasound Image Segmentation by Using a Shadow Aware Network With Boundary Refinement

Accurate ultrasound (US) image segmentation is crucial for the screening and diagnosis of diseases. However, it faces two significant challenges: 1) pixel-level annotation is a time-consuming and laborious process; 2) the presence of shadow artifacts leads to missing anatomy and ambiguous boundaries, which negatively impact reliable segmentation results. To address these challenges, we propose a novel semi-supervised shadow aware network with boundary refinement (SABR-Net). Specifically, we add shadow imitation regions to the original US, and design shadow-masked transformer blocks to perceive missing anatomy of shadow regions. Shadow-masked transformer block contains an adaptive shadow attention mechanism that introduces an adaptive mask, which is updated automatically to promote the network training. Additionally, we utilize unlabeled US images to train a missing structure inpainting path with shadow-masked transformer, which further facilitates semi-supervised segmentation. Experiments on two public US datasets demonstrate the superior performance of the SABR-Net over other state-of-the-art semi-supervised segmentation methods. In addition, experiments on a private breast US dataset prove that our method has a good generalization to clinical small-scale US datasets.

Enhanced Needle Visualization With Reflection Tuned Apodization Based on the Radon Transform for Ultrasound Imaging

In ultrasound (US)-guided interventions, accurately tracking and visualizing needles during in-plane insertions are significant challenges due to strong directional specular reflections. These reflections violate the geometrical delay and apodization estimations in the conventional delay and sum beamforming (DASB) degrading the visualization of needles. This study proposes a novel reflection tuned apodization (RTA) to address this issue and facilitate needle enhancement through DASB. The method leverages both temporal and angular information derived from the Radon transforms of the radio frequency (RF) data from plane-wave imaging to filter the specular reflections from the needle and their directivity. The directivity information is translated into apodization center maps through time-to-space mapping in the Radon domain, which is subsequently integrated into DASB. We assess the influence of needle angulations, projection angles in the Radon transform, needle gauge sizes, and the presence of multiple specular interfaces on the approach. The analysis shows that the method surpasses conventional DASB in enhancing the image quality of needle interfaces while preserving the diffuse scattering from the surrounding tissues without significant computational overhead. The work offers promising prospects for improved outcomes in US-guided interventions and better insights into characterizing US reflections with Radon transforms.

The Ultrasound Window Into Vascular Ageing: A Technology Review by the VascAgeNet COST Action

Non-invasive ultrasound (US) imaging enables the assessment of the properties of superficial blood vessels. Various modes can be used for vascular characteristics analysis, ranging from radiofrequency (RF) data, Doppler- and standard B/M-mode imaging, to more recent ultra-high frequency and ultrafast techniques. The aim of the present work was to provide an overview of the current state-of-the-art non-invasive US technologies and corresponding vascular ageing characteristics from a technological perspective. Following an introduction about the basic concepts of the US technique, the characteristics considered in this review are clustered into: 1) vessel wall structure; 2) dynamic elastic properties, and 3) reactive vessel properties. The overview shows that ultrasound is a versatile, non-invasive, and safe imaging technique that can be adopted for obtaining information about function, structure, and reactivity in superficial arteries. The most suitable setting for a specific application must be selected according to spatial and temporal resolution requirements. The usefulness of standardization in the validation process and performance metric adoption emerges. Computer-based techniques should always be preferred to manual measures, as long as the algorithms and learning procedures are transparent and well described, and the performance leads to better results. Identification of a minimal clinically important difference is a crucial point for drawing conclusions regarding robustness of the techniques and for the translation into practice of any biomarker.

Musculoskeletal ultrasound: a technical and historical perspective

During the past four decades, musculoskeletal ultrasound has become popular as an imaging modality due to its low cost, accessibility, and lack of ionizing radiation. The development of ultrasound technology was possible in large part due to concomitant advances in both solid-state electronics and signal processing. The invention of the transistor and digital computer in the late 1940s was integral in its development. Moore's prediction that the number of microprocessors on a chip would grow exponentially, resulting in progressive miniaturization in chip design and therefore increased computational power, added to these capabilities. The development of musculoskeletal ultrasound has paralleled technical advances in diagnostic ultrasound. The appearance of a large variety of transducer capabilities and rapid image processing along with the ability to assess vascularity and tissue properties has expanded and continues to expand the role of musculoskeletal ultrasound. It should also be noted that these developments have in large part been due to a number of individuals who had the insight to see the potential applications of this developing technology to a host of relevant clinical musculoskeletal problems. Exquisite high-resolution images of both deep and small superficial musculoskeletal anatomy, assessment of vascularity on a capillary level and tissue mechanical properties can be obtained. Ultrasound has also been recognized as the method of choice to perform a large variety of interventional procedures. A brief review of these technical developments, the timeline over which these improvements occurred, and the impact on musculoskeletal ultrasound is presented below.

Imaging of Muscle Injuries

Ultrasound (US) and MR imaging are the most common imaging modalities used to assess sports muscle injuries. The site of the muscle injury can be located at the peripheral aspect of the muscle (myofascial), within the muscle belly (musculotendinous), and with tendon involvement (intratendinous). Tears that affect the intramuscular tendon have a worse prognosis in terms of recovery time. US is an excellent method to evaluate muscle injuries, with high spatial and contrast resolution. MR imaging can be reserved for evaluation of professional athletes, surgical planning, differential diagnosis, and assessment of deep located and proximal muscle groups.

Ultrasound in the Differential Diagnosis of Medial Epicondylalgia and Medial Elbow Pain-Imaging Findings and Narrative Literature Review

Medial epicondylalgia (ME), commonly known as “the golfer’s elbow”, typically develops in individuals who perform repetitive forearm movements and weight-bearing activities. It accounts for up to 20% of all epicondylitis cases and is most prevalent in particular sports and occupations. Though the diagnosis can be made based on sole clinical examination, additional imaging might be essential for confirmation of medial epicondylitis and excluding other pathologies of the medial epicondyle region. US imaging, with a sensitivity and specificity of 95% and 92%, respectively, remains a practical and accessible alternative to MRI. However, its diagnostic efficacy highly depends on the operator’s experience and requires proper technique. This article describes the ultrasound examination and technique for adequate visualization of elbow joint structures. It also discusses the differential diagnosis of other common and less-known pathologies of the medial compartment of the elbow, including snapping triceps, medial collateral ligament injury, and cubital tunnel neuropathy.

Human skeletal muscle size with ultrasound imaging: a comprehensive review

Skeletal muscle size is an important factor in assessing adaptation to exercise training and detraining, athletic performance, age-associated atrophy and mobility decline, clinical conditions associated with cachexia, and overall skeletal muscle health. Magnetic resonance (MR) imaging and computed tomography (CT) are widely accepted as the gold standard methods for skeletal muscle size quantification. However, it is not always feasible to use these methods (e.g., field studies, bedside studies, large cohort studies). Ultrasound has been available for skeletal muscle examination for more than 50 years and the development, utility, and validity of ultrasound imaging are underappreciated. It is now possible to use ultrasound in situations where MR and CT imaging are not suitable. This review provides a comprehensive summary of ultrasound imaging and human skeletal muscle size assessment. Since the first study in 1968, more than 600 articles have used ultrasound to examine the cross-sectional area and/or volume of 107 different skeletal muscles in more than 27,500 subjects of various ages, health status, and fitness conditions. Data from these studies, supported by decades of technological developments, collectively show that ultrasonography is a valid tool for skeletal muscle size quantification. Considering the wide-ranging connections between human health and function and skeletal muscle mass, the utility of ultrasound imaging will allow it to be employed in research investigations and clinical practice in ways not previously appreciated or considered.

Moderner Ultraschall in der Diagnostik Neuromuskulärer Erkrankungen

Der neuromuskuläre Ultraschall hat sich in den letzten Jahren zu einem festen Bestandteil in der neurologischen Diagnostik entwickelt. Dazu tragen auch die fortwährende technische Weiterentwicklung der Methode und ihr unkomplizierter und nebenwirkungsfreier Einsatz direkt am Patienten bei. Im klinischen Alltag wird der Ultraschall in der Diagnostik und Differentialdiagnostik sowie in der Verlaufskontrolle traumatischer Nervenläsionen, sekundärer und dynamischer nervaler Kompressionssyndrome, hereditärer und akuter sowie chronisch autoimmuner Polyneuropathien, Motoneuron- und Muskelerkrankungen verwendet. Dabei spielt die Ultraschalldiagnostik auch zunehmend eine Rolle für Therapieentscheidungen, v.a. im Hinblick auf die operative Versorgung und den Einsatz oder die Fortführung immunmodulatorischer Medikamente. In den nächsten Jahren ist eine weitere interdisziplinäre Verbreitung und fortwährend zunehmende Standardisierung der Methode zu erwarten.

Multiperspective Bistatic Ultrasound Imaging and Elastography of the Ex Vivo Abdominal Aorta

Knowledge of aneurysm geometry and local mechanical wall parameters using ultrasound (US) can contribute to a better prediction of rupture risk in abdominal aortic aneurysms (AAAs). However, aortic strain imaging using conventional US is limited by the lateral lumen-wall contrast and resolution. In this study, ultrafast multiperspective bistatic (MP BS) imaging is used to improve aortic US, in which two curved array transducers receive simultaneously on each transmit event. The advantage of such bistatic US imaging on both image quality and strain estimations was investigated by comparing it to single-perspective monostatic (SP MS) and MP monostatic (MP MS) imaging, i.e., alternately transmitting and receiving with either transducer. Experimental strain imaging was performed in US simulations and in an experimental study on porcine aortas. Different compounding strategies were tested to retrieve the most useful information from each received US signal. Finally, apart from the conventional sector grid in curved array US imaging, a polar grid with respect to the vessel's local coordinate system is introduced. This new reconstruction method demonstrated improved displacement estimations in aortic US. The US simulations showed increased strain estimation accuracy using MP BS imaging bistatic imaging compared to MP MS imaging, with a decrease in the average relative error between 41% and 84% in vessel wall regions between transducers. In the experimental results, the mean image contrast-to-noise ratio was improved by up to 8 dB in the vessel wall regions between transducers. This resulted in an increased mean elastographic signal-to-noise ratio by about 15 dB in radial strain and 6 dB in circumferential strain.

Ultrasound Image Optimization for the Interventional Radiologist

Understanding the basics and nuances of the functionality of ultrasound (US) equipment and of its various knobs and modes will enable the interventional radiologist to acquire higher quality US images. This, in turn will potentially allow US-guided procedures to be performed safely, and with greater operator confidence, and may also allow certain procedures to be performed with US instead of CT or fluoroscopic guidance. In this article, we review the practical aspects of US image optimization for the interventional radiologist, including equipment and transducer selection, depth, focal zone and gain setting adjustment, as well as special considerations for imaging the obese patient. Color Doppler image optimization and recent developments in ultrasound imaging are briefly discussed.

Ultrasound Imaging in Sport-Related Muscle Injuries: Pitfalls and Opportunities

Muscle injuries occur frequently in athletes, accounting for more than one-third of sport-related trauma. Athletes most affected by these injuries are those practicing football and track and field, with hamstrings and gastrocnemius-soleus as the mainly involved sites. Muscle injuries lead to loss of competitions, long recovery times and risk of re-injury with a consequent increase of the management costs. It is therefore advisable to make an accurate and timely diagnosis to establish appropriate interventions for proper healing in the shortest time. In this context, ultrasound imaging is widely used for diagnosis of musculoskeletal disorders because of several advantages including absence of radiation, portability, good spatial resolution, and the ability to perform dynamic tests. The aim of this review is to address the role of US in the evaluation of athletes with muscle injuries. US may play a pivotal role for the management of sport-related muscle injuries because it is fast and relatively cheap, allowing dynamic muscle assessment and time series evaluation of the healing process.

Towards Clinical Application of Artificial Intelligence in Ultrasound Imaging

Artificial intelligence (AI) is being increasingly adopted in medical research and applications. Medical AI devices have continuously been approved by the Food and Drug Administration in the United States and the responsible institutions of other countries. Ultrasound (US) imaging is commonly used in an extensive range of medical fields. However, AI-based US imaging analysis and its clinical implementation have not progressed steadily compared to other medical imaging modalities. The characteristic issues of US imaging owing to its manual operation and acoustic shadows cause difficulties in image quality control. In this review, we would like to introduce the global trends of medical AI research in US imaging from both clinical and basic perspectives. We also discuss US image preprocessing, ingenious algorithms that are suitable for US imaging analysis, AI explainability for obtaining informed consent, the approval process of medical AI devices, and future perspectives towards the clinical application of AI-based US diagnostic support technologies.

Minimum Variance Combined With Modified Delay Multiply-and-Sum Beamforming for Plane-Wave Compounding

Plane-wave compounding is an active topic of research in ultrasound imaging because it is a promising technique for ultrafast ultrasound imaging. Unfortunately, due to the data-independent nature of the traditional compounding method, it imposes a fundamental limit on image quality. To address this issue, adaptive beamformers have been implemented in the compounding procedure. In this article, a new adaptive beamformer for the 2-D data set obtained from multiple plane-wave transmissions is investigated. In the proposed scheme, the minimum variance (MV) weights are applied to the backscattered echoes. Then, the final image is obtained by employing a modified version of the delay multiply-and-sum (DMAS) beamformer in the coherent compounding. The results demonstrate that the presented MV-DMAS scheme outperforms the conventional coherent compounding in both terms of resolution and contrast. It also offers improvements over the 2-D-DMAS and some MV-based methods presented in the literature, such that it achieves at least 20.9% enhancement in sidelobe reduction compared with the best result of MV-based methods. Also, by the proposed method, the in vivo study shows an improved generalized contrast-to-noise ratio (GCNR) that implies a higher probability of lesion detection.

United Wiener postfilter for plane wave compounding ultrasound imaging

Plane wave compounding (PWC) is a valid method for ultrafast ultrasound imaging. Its imaging quality depends on the beamforming method. The coherence factor (CF) and Wiener postfilter are effective signal processing schemes for aberration correction. However, the CF usually causes over-suppression and brings artifacts. Additionally, the conventional CF and Wiener postfilter cannot fully utilize the spatial coherence in the PWC, which limits the imaging performance and increases the computation. In this paper, we propose a united Wiener postfilter specially for the PWC. The signal and noise power are both estimated through the echo signal matrix, rather than array signal vectors. The method also accords with the theoretical relationship between the CF and Wiener. To evaluate the performance of the proposed method, we conduct simulations, phantom and in vivo experiments and make comparisons with the delay-and-sum (DAS), the CF, the generalized coherence factor (GCF), the conventional Wiener and the scaled Wiener beamformers. Results indicate that our method can offer the better resolution and contrast than the DAS and Wiener. It also solves the over-suppression drawback of the CF. Specifically, the contrast ratio and contrast-to-noise ratio achieve 26.7% and 25.2% improvements in simulations, 28.7% and 32.4% in phantom experiments, respectively. The proposed method also performs well in terms of the speckle signal-to-noise ratio and the generalized contrast-to-noise ratio. Consequently, we believe that the proposed method is effective in enhancing the imaging quality of the PWC.

Image Quality Enhancement Using a Deep Neural Network for Plane Wave Medical Ultrasound Imaging

Plane wave imaging (PWI), a typical ultrafast medical ultrasound imaging mode, adopts single plane wave emission without focusing to achieve a high frame rate. However, the imaging quality is severely degraded in comparison with the commonly used focused line scan mode. Conventional adaptive beamformers can improve imaging quality at the cost of additional computation. In this article, we propose to use a deep neural network (DNN) to enhance the performance of PWI while maintaining a high frame rate. In particular, the PWI response from a single point target is used as the network input, while the focused scan response from the same point serves as the desired output, which is the main contribution of this method. To evaluate the performance of the proposed method, simulations, phantom experiments and in vivo studies are conducted. The delay-and-sum (DAS), the coherence factor (CF), a previously proposed deep learning-based method and the DAS with focused scan are used for comparison. Numerical metrics, including the contrast ratio (CR), the contrast-to-noise ratio (CNR), and the speckle signal-to-noise ratio (sSNR), are used to quantify the performance. The results indicate that the proposed method can achieve superior resolution and contrast performance. Specifically, the proposed method performs better than the DAS in all metrics. Although the CF provides a higher CR, its CNR and sSNR are much lower than those of the proposed method. The overall performance is also better than that of the previous deep learning method and at the same level with focused scan performance. Additionally, in comparison with the DAS, the proposed method requires little additional computation, which ensures high temporal resolution. These results validate that the proposed method can achieve a high imaging quality while maintaining the high frame rate associated with PWI.

Shadow Estimation for Ultrasound Images Using Auto-Encoding Structures and Synthetic Shadows

Acoustic shadows are common artifacts in medical ultrasound imaging. The shadows are caused by objects that reflect ultrasound such as bones, and they are shown as dark areas in ultrasound images. Detecting such shadows is crucial for assessing the quality of images. This will be a pre-processing for further image processing or recognition aiming computer-aided diagnosis. In this paper, we propose an auto-encoding structure that estimates the shadowed areas and their intensities. The model once splits an input image into an estimated shadow image and an estimated shadow-free image through its encoder and decoder. Then, it combines them to reconstruct the input. By generating plausible synthetic shadows based on relatively coarse domain-specific knowledge on ultrasound images, we can train the model using unlabeled data. If pixel-level labels of the shadows are available, we also utilize them in a semi-supervised fashion. By experiments on ultrasound images for fetal heart diagnosis, we show that our method achieved 0.720 in the DICE score and outperformed conventional image processing methods and a segmentation method based on deep neural networks. The capability of the proposed method on estimating the intensities of shadows and the shadow-free images is also indicated through the experiments.

Micro Non-Uniform Linear Array (MNULA) for Ultrasound Plane Wave Imaging

Ultrasound plane wave imaging technology has been applied to more clinical situations than ever before because of its rapid imaging speed and stable imaging quality. Most transducers used in plane wave imaging are linear arrays, but their structures limit the application of plane wave imaging technology in some special clinical situations, especially in the endoscopic environment. In the endoscopic environment, the size of the linear array transducer is strictly miniaturized, and the imaging range is also limited to the near field. Meanwhile, the near field of a micro linear array has serious mutual interferences between elements, which is against the imaging quality of near field. Therefore, we propose a new structure of a micro ultrasound linear array for plane wave imaging. In this paper, a theoretical comparison is given through sound field and imaging simulations. On the basis of primary work and laboratory technology, micro uniform and non-uniform linear arrays were made and experimented with the phantom setting. We selected appropriate evaluation parameters to verify the imaging results. Finally, we concluded that the micro non-uniform linear array eliminated the artifacts better than the micro uniform linear array without the additional use of signal processing methods, especially for target points in the near-field. We believe this study provides a possible solution for plane wave imaging in cramped environments like endoscopy.

Deep Learning to Obtain Simultaneous Image and Segmentation Outputs From a Single Input of Raw Ultrasound Channel Data

Single plane wave transmissions are promising for automated imaging tasks requiring high ultrasound frame rates over an extended field of view. However, a single plane wave insonification typically produces suboptimal image quality. To address this limitation, we are exploring the use of deep neural networks (DNNs) as an alternative to delay-and-sum (DAS) beamforming. The objectives of this work are to obtain information directly from raw channel data and to simultaneously generate both a segmentation map for automated ultrasound tasks and a corresponding ultrasound B-mode image for interpretable supervision of the automation. We focus on visualizing and segmenting anechoic targets surrounded by tissue and ignoring or deemphasizing less important surrounding structures. DNNs trained with Field II simulations were tested with simulated, experimental phantom, and in vivo data sets that were not included during training. With unfocused input channel data (i.e., prior to the application of receive time delays), simulated, experimental phantom, and in vivo test data sets achieved mean ± standard deviation Dice similarity coefficients of 0.92 ± 0.13, 0.92 ± 0.03, and 0.77 ± 0.07, respectively, and generalized contrast-to-noise ratios (gCNRs) of 0.95 ± 0.08, 0.93 ± 0.08, and 0.75 ± 0.14, respectively. With subaperture beamformed channel data and a modification to the input layer of the DNN architecture to accept these data, the fidelity of image reconstruction increased (e.g., mean gCNR of multiple acquisitions of two in vivo breast cysts ranged 0.89-0.96), but DNN display frame rates were reduced from 395 to 287 Hz. Overall, the DNNs successfully translated feature representations learned from simulated data to phantom and in vivo data, which is promising for this novel approach to simultaneous ultrasound image formation and segmentation.

Ultrasound Image Optimization ("Knobology"): B-Mode

Ultrasound is a ubiquitous and indispensable diagnostic and therapeutic tool in medicine. Due to modern equipment and automatic image optimization, the introduction of ultrasound imaging currently requires only little technical and physical knowledge. However, in-depth knowledge of the device functions and underlying mechanisms is essential for optimal image adjustment and documentation. From a medical as well as an aesthetic point of view, the goal should always be to achieve the best possible image quality. The first part of this article provides an overview of the handling of ultrasound systems, fundamental adjustments, and their optimization in B-mode ultrasound.

Techniques for Improving Ultrasound Visualization of Biopsy Markers in Axillary Lymph Nodes

Objective:

Biopsy markers are often placed into biopsy-proven metastatic axillary lymph nodes to ensure later accurate node excision. Ultrasound is the preferred imaging modality in the axilla. However, sonographic identification of biopsy markers after neoadjuvant therapy can be challenging. This is due to poor conspicuity relative to surrounding parenchymal interfaces, treatment-related alteration of malignant morphology during neoadjuvant chemotherapy, or extrusion of the marker from the target. To the authors’ knowledge, the literature provides no recommendations for ultrasound scanning parameters that improve the detection of biopsy markers. The purpose of this manuscript is 3-fold: (1) To determine scanning parameters that improve sonographic conspicuity of biopsy markers in a phantom and cadaver model; (2) to implement these scanning parameters in the clinical setting; and (3) to provide strategies that might increase the likelihood of successful ultrasound detection of biopsy markers in breast imaging practices.

Materials and Methods:

An ex vivo study was performed using a phantom designed to simulate the heterogeneity of normal mammary or axillary soft tissues. A selection of available biopsy markers was deployed into this phantom and ultrasound (GE LOGIQ E9) was performed. Scanning parameters were adjusted to optimize marker conspicuity. For the cadaver study, the biopsy markers were deployed using ultrasound guidance into axillary lymph nodes of a female cadaver. Adjustments in transducer frequency, dynamic range, cross-beam (spatial compound imaging), beam steering, speckle reduction imaging, harmonic imaging, colorization, and speed of sound were evaluated. Settings that improved marker detection were used clinically for a year.

Results:

Sonographic scanning settings that improved biopsy marker conspicuity included increasing transducer frequency, decreasing dynamic range, setting cross-beam to medium hybrid, turning on beam steering, and setting speckle reduction imaging in the mid-range. There was no appreciable improvement with harmonic imaging, colorization, or speed of sound.

Conclusion:

On a currently available clinical ultrasound scanning system, ultrasound scanning parameters can be adjusted to improve the conspicuity of biopsy markers. Overall, optimization requires a balance between techniques that clinically increase contrast (dynamic range, harmonic imaging, and steering) and those that minimize graininess (spatial compound imaging, speckle reduction imaging, and steering). Additional scanning and procedural strategies have been provided to improve the confidence of sonographic detection of biopsy markers closely associated with the intended target.

Ultrasonography for diagnosis of peri-implant diseases and conditions: a detailed scanning protocol and case demonstration

OBJECTIVES

Ultrasonography has shown its promising diagnostic value in dental implant imaging research in the three treatment phases, namely, planning, intraoperative, and postoperative phase. With increasing awareness of peri-implant diseases and a lack of an efficient diagnostic method, the aim is to propose ultrasound imaging as a potential solution by providing a detailed scanning protocol and case demonstration.

METHODS

Ultrasound device specification and the setup for optimizing peri-implant tissue imaging was described. Two useful imaging modes, viz. B-mode and color flow, were introduced. Important anatomical structures for accurate diagnosis of peri-implant diseases were illustrated. Finally, a detailed scanning sequence was proposed.

RESULTS

Ultrasound images were acquired on live humans to exemplify the four peri-implant diseases and conditions, endorsed by the 2017 World Workshop organized by the American Academy of Periodontology and the European Federation of Periodontology. Ultrasound can provide not only cross-sectional anatomical images but also functional images (color flow images) that may be useful for evaluating the degree of peri-implant tissue inflammation.

CONCLUSIONS

High-frequency ultrasonography could be another cross-sectional imaging modality in adjunct to radiographs for diagnosing imminent peri-implant diseases and conditions that negatively influence quality of life of millions of patients with implants. This case study provides a framework for future related research work and clinical scanning guidelines.

Musculoskeletal ultrasound in children: Current state and future directions

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic inflammatory arthritides that if inadequately treated, may be associated with chronic disability and deformity. Early diagnosis and treatment initiation is essential in the management of patients with JIA. Conventional means of evaluation of disease presence, disease activity and response to therapy including physical exam, labs and x-rays are at times limited and may be insufficient in making an accurate assessment. Musculoskeletal ultrasound (MSUS) is a well-established modality that is patient and family-friendly, non-invasive, does not require sedation and can be performed at the bedside in real-time. MSUS offers information that cannot be attained by standard outcome measures, and may help to advance both diagnosis and treatment of patients with JIA ultimately improving patient outcomes. This review explores the background of MSUS and the current evidence to support its potential role as a diagnostic, disease activity monitoring and interventional tool.

Sonographic visibility of the main posterior ankle ligaments and para-ligamentous structures in 15 healthy subjects

The present article describes the ultrasound (US) appearance of ligaments and paraligamentous structures which are not included in standard US imaging of the ankle: the posterior inferior tibiofibular ligament (PITFL), the transverse tibiofibular ligament (TTFL), the posterior talofibular ligament (PTFL), the posterior intermalleolar ligament (PIL), the synovial recess (SR) of the posterior joint and the os trigonum (OT). Two skilled operators examined 15 ankles in 15 healthy volunteers. Correlation between thickness of the main ligaments and body mass index (BMI) was also analyzed. Compound and tissue harmonic imaging (THI) were carried out using 12-, 6-15- and 9-MHz linear probes. Exploration of the posterior ankle ligament complex is accurately described including correct ankle position, echogenicity, shape, direction and thickness. Both operators identified and measured the main ligaments (PITFL, TTFL and PTFL) in all volunteers (Intraclass Correlation Coefficient ranged from 0.8 to 1); both operators also detected SR and OT in 2/15 ankles and posterior intermalleolar ligament (PIL) in 5/15 ankles. Pearson's test showed a significant correlation (< 0.05) between TTFL thickness and BMI. Also, a dynamic study was carried out showing tension of the PTFL during dorsiflexion in 7/15 subjects. Our results highlight the potential role of accurate US imaging in detecting posterior ankle ligament involvement in acute and chronic traumas. To our knowledge, there are no previous articles in the literature dealing with this topic providing an accurate description of the US procedure, and in particular, no study has been carried out to identify OT.

Image quality evaluation of ultrasound imaging systems: advanced B-modes

The Quality assurance of ultrasound clinical imaging systems is essential for maintaining their performance to the highest level and for complying with the requirements by various regulatory and accrediting agencies. Although there is no standardization yet, most of the quality assessment procedures available in literature are proposed for B-mode and Doppler imaging. However, ultrasound imaging systems offer a variety of advanced imaging modes, besides B-mode and Doppler, which are primarily aimed at improving image quality. This study presents computer-based methods for evaluating image quality for the advanced imaging modes of ultrasound imaging systems: harmonic imaging, spatial compounding imaging, adaptive speckle reduction, and tissue aberration correction. The functions and parameters proposed for evaluating image quality are: grayscale mapping function, image contrast, contrast-to-noise ratio (CNR), and high-contrast spatial resolution. We present our computer-based methods for evaluating image quality of these modes with a number of probe and scanner combinations, which were employed to image targets in ultrasound phantoms. The functions and parameters here proposed in image quality performance evaluation are: grayscale mapping function, image contrast, CNR, and high-contrast spatial resolution. We show that these quantities could be useful in developing standardized methods for evaluating the advanced ultrasound imaging modes, especially when the advanced mode resulted in subtle visual differences.

Asymptomatic Complicated Cysts in Postmenopausal Women: Is Tissue Sampling Unnecessarily High?

RATIONALE AND OBJECTIVES

To determine the malignancy rate of complicated cysts in postmenopausal women and to discuss appropriate (Breast Imaging Reporting and Data System assessment and recommendation.

MATERIALS AND METHODS

This study was approved by our institutional review board and informed consent was waived. One hundred fourteen postmenopausal patients with 183 complicated cysts as defined by the newest Breast Imaging Reporting and Data System edition were identified retrospectively between January 2013 and December 2015 (to allow for 2 years follow-up period). One hundred eight complicated cysts were assessed as probably benign and 75 as suspicious. Prospective review of all images and pathology was performed and patient's age, breast density, risk factors, use of hormone replacement therapy, and family history of breast cancer were recorded. A total of 30 symptomatic patients and lesions not meeting criteria for complicated cysts were excluded from our cohort. Benignity was determined by aspiration, biopsy, resolution, recategorization to a simple cyst, or adequate follow-up.

RESULTS

None of our complicated cysts proved malignant. Fifteen of 108 probably benign complicated cysts were aspirated yielding benign fluid in 10 and 5 were biopsied yielding benign pathology (only 2 with atypical cells). Twenty-nine of 75 complicated cysts categorized as suspicious were aspirated and fluid was discarded in 25 and 4 sent for cytology yielding benign pathology. The other 41 complicated cysts thought to be suspicious were biopsied with benign pathology (only 1 atypical).

CONCLUSION

This study supports the use of a probably benign assessment of asymptomatic complicated cysts irrespective of age. The sensitivity for malignancy was 100% in our cohort.

Real-time H-scan ultrasound imaging using a Verasonics research scanner

H-scan ultrasound (US) is a new imaging technique that relies on matching a model that describes US image formation to the mathematics of a class of Gaussian-weighted Hermite polynomials (GH). In short, H-scan US (where the 'H' denotes Hermite or hue) is a tissue classification technique that images the relative size of acoustic scatterers. Herein, we detail development of a real-time H-scan US imaging technology that was implemented on a programmable US research scanner (Vantage 256, Verasonics Inc, Kirkland, WA). This custom US imaging system has a dual display for real-time visualization of both the H-scan and B-scan US images. This MATLAB-based (Mathworks Inc, Natick, MA) system includes a graphical user interface (GUI) for controlling the entire US scan sequence including the raw radio frequency (RF) data acquisition parameters, image processing, variable control of a parallel set of convolution filters used to derive the H-scan US signal, and data (cine loop) save. The system-level structure used for software-based image reconstruction and display is detailed. Imaging studies were conducted using a series of homogeneous and heterogeneous tissue-mimicking phantom materials embedded with monodisperse spherical US scatterers of size 15-40 µm in diameter. Relative to H-scan US image measurements from a phantom with 15 µm-sized scatterers, data from phantoms with the 30 and 40 µm-sized scatterers exhibited mean intensity increases of 5.2% and 11.6%, respectively. Overall, real-time H-scan US imaging is a promising approach for visualizing the relative size and distribution of acoustic scattering objects.

2-D Minimum Variance Based Plane Wave Compounding with Generalized Coherence Factor in Ultrafast Ultrasound Imaging

Plane wave compounding (PWC) is an effective modality for ultrafast ultrasound imaging. It can provide higher resolution and better noise reduction than plane wave imaging (PWI). In this paper, a novel beamformer integrating the two-dimensional (2-D) minimum variance (MV) with the generalized coherence factor (GCF) is proposed to maintain the high resolution and contrast along with a high frame rate for PWC. To specify, MV beamforming is adopted in both the transmitting aperture and the receiving one. The subarray technique is therefore upgraded into the sub-matrix division. Then, the output of each submatrix is used to adaptively compute the GCF using a 2-D fast Fourier transform (FFT). After the 2-D MV beamforming and the 2-D GCF weighting, the final output can be obtained. Results of simulations, phantom experiments, and in vivo studies confirm the advantages of the proposed method. Compared with the delay-and-sum (DAS) beamformer, the full width at half maximum (FWHM) is 90% smaller and the contrast ratio (CR) improvement is 154% in simulations. The over-suppression of desired signals, which is a typical drawback of the coherence factor (CF), can be effectively avoided. The robustness against sound velocity errors is also enhanced.

Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment

Calcific tendinopathy (CT) of the shoulder is a common, painful condition characterized by the presence of calcium deposits in the rotator cuff tendons. Current theories indicate that CT may be the result of a cell-mediated process in which, after a stage of calcium deposition, calcifications are spontaneously resorbed. However, in a minority of cases, this self-healing process is somehow disrupted, resulting in symptoms. Recent literature shows an emerging role of biological and genetic factors underlying CT. This new evidence could supplement the classic mechanical theory of rotator cuff tendinopathy complicated by calcium precipitation, and it may also explain why the majority of the therapies currently in use are only able to provide partially satisfactory outcomes. This review aims to summarize the current knowledge about the pathological processes underlying CT of the shoulder and thereby justify the quest for advanced biological treatments of this condition when it becomes symptomatic.

Towards Ultrasound Everywhere: A Portable 3D Digital Back-End Capable of Zone and Compound Imaging

Ultrasound imaging is a ubiquitous diagnostic technique, but does not fit the requirements of the telemedicine approach, because it relies on the real-time manipulation and image recognition skills of a trained expert, called sonographer. Sonographers are only available in hospitals and clinics, negating or at least delaying access to ultrasound scans in many locales-rural areas, developing countries-as well as in medical rescue operations. Telesonography would require an advanced imager that supports three-dimensional (3-D) acquisition; this would allow untrained operators to acquire broad scans and upload them remotely for diagnosis. Such advanced imagers do exist, but do not meet several other requirements for telesonography, such as being portable, inexpensive, and sufficiently low power to enable battery operation. In this work, we present our prototype of the first portable 3-D digital ultrasound back-end system. The prototype is implemented in a single midrange Xilinx field programmable gate array (FPGA), for an estimated power consumption of 5 W. The device supports up to 1024 input channels, which is state of the art and could be scaled further, and supports multiple image reconstruction modes. We evaluate the resource utilization of the FPGA and provide various quality metrics to ascertain the output image quality.

Specular Beamforming

Acoustically hard objects, such as bones, needles, or catheters, are poorly visualized in conventional ultrasound images. These objects behave like acoustic mirrors and reflect sound in specific directions. Soft tissue and diffusive reflectors scatter sound in a broad range of directions. Conventional delay-and-sum beamforming is based on the assumption of a purely scattering domain with relatively weak reflectivity. We present an adaptive beamforming technique that takes into account the physics of specular reflection. Patterns predicted by the law of reflection are detected across the pool of received data and used to enhance the visualization of specular energy. This technique can be applied to any synthetic imaging sequence. Here, it is applied to synthetic transmit aperture imaging. In vitro experiments show a clear improvement in target visibility and an increase of 30 to 60 dB in signal-to-noise ratio.

Full Angle Spatial Compound of ARFI images for breast cancer detection

Automated ultrasound breast imaging would overcome most of the limitations that precludes conventional hand-held echography to be an effective screening method for breast cancer diagnosis. If a three dimensional (3D) ultrasound dataset is acquired without manual intervention of the technician, repeatability and patient follow-up could be improved. Furthermore, depending on the system configuration, resolution and contrast could be enhanced with regard to conventional echography, improving lesion detectability and evaluation. Having multiple modalities is another major advantage of these automated systems, currently under development by several research groups. Because of their circular structure, some of them include through-transmission measurements that allow constructing speed of sound and attenuation maps, which adds complementary information to the conventional reflectivity B-Mode image. This work addresses the implementation of the Acoustic Radiation Force Impulse (ARFI) imaging technique in a Full Angle Spatial Compound (FASC) automated breast imaging system. It is of particular interest because of the high specificity of ARFI for breast cancer diagnosis, by representing tissue elasticity differences rather than acoustic reflectivity. First, the image formation process is analyzed and a compounding strategy is proposed for ARFI-FASC. Then, experimental results with a prototype system and two gelatin phantoms are presented: Phantom A with a hard inclusion in a soft background, and phantom B with three soft inclusions in a hard background and with three steel needles. It is demonstrated that the full angle composition of ARFI images improves image quality, enhancing Contrast to Noise Ratio (CNR) from 4.9 to 20.6 and 3.6 to 13.5 in phantoms A and B respectively. Furthermore, this CNR increase improved detectability of small structures (needles) with regard to images obtained from a single location, in which image texture masked their presence.

Spatial Angular Compounding of Photoacoustic Images

Photoacoustic (PA) images utilize pulsed lasers and ultrasound transducers to visualize targets with higher optical absorption than the surrounding medium. However, they are susceptible to acoustic clutter and background noise artifacts that obfuscate biomedical structures of interest. We investigated three spatial-angular compounding methods to improve PA image quality for biomedical applications, implemented by combining multiple images acquired as an ultrasound probe was rotated about the elevational axis with the laser beam and target fixed. Compounding with conventional averaging was based on the pose information of each PA image, while compounding with weighted and selective averaging utilized both the pose and image content information. Weighted-average compounding enhanced PA images with the least distortion of signal size, particularly when there were large (i.e., 2.5 mm and 7 (°)) perturbations from the initial probe position. Selective-average compounding offered the best improvement in image quality with up 181, 1665, and 1568 times higher contrast, CNR, and SNR, respectively, compared to the mean values of individual PA images. The three presented spatial compounding methods have promising potential to enhance image quality in multiple photoacoustic applications.

Detection of tissue coagulation by decorrelation of ultrasonic echo signals in cavitation-enhanced high-intensity focused ultrasound treatment

BACKGROUND

A noninvasive technique to monitor thermal lesion formation is necessary to ensure the accuracy and safety of high-intensity focused ultrasound (HIFU) treatment. The purpose of this study is to ultrasonically detect the tissue change due to thermal coagulation in the HIFU treatment enhanced by cavitation microbubbles.

METHODS

An ultrasound imaging probe transmitted plane waves at a center frequency of 4.5 MHz. Ultrasonic radio-frequency (RF) echo signals during HIFU exposure at a frequency of 1.2 MHz were acquired. Cross-correlation coefficients were calculated between in-phase and quadrature (IQ) data of two B-mode images with an interval time of 50 and 500 ms for the estimation of the region of cavitation and coagulation, respectively. Pathological examination of the coagulated tissue was also performed to compare with the corresponding ultrasonically detected coagulation region.

RESULTS

The distribution of minimum hold cross-correlation coefficient between two sets of IQ data with 50-ms intervals was compared with a pulse inversion (PI) image. The regions with low cross-correlation coefficients approximately corresponded to those with high brightness in the PI image. The regions with low cross-correlation coefficients in 500-ms intervals showed a good agreement with those with significant change in histology.

CONCLUSIONS

The results show that the regions of coagulation and cavitation could be ultrasonically detected as those with low cross-correlation coefficients between RF frames with certain intervals. This method will contribute to improve the safety and accuracy of the HIFU treatment enhanced by cavitation microbubbles.

CAROTID WALL MEASUREMENT AND ASSESSMENT BASED ON PIXEL-BASED AND LOCAL TEXTURE DESCRIPTORS

Aim of this paper is to develop an automated system for the classification and characterization of carotid wall status and to develop a robust system based on local texture descriptors. A database of 200 longitudinal ultrasound images of carotid artery is used. One-hundred images with Intima-Media Thickness (IMT) value higher than 0.8[Formula: see text]mm are considered as high risk. Six different rectangular pixel neighborhoods were considered: four areas centered on the selected element, with sizes [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text] pixels, and two noncentered areas with sizes [Formula: see text] pixels upwards and downwards. We have extracted various texture descriptors (31 based on the co-occurrence gray level matrix, 13 based on the spatial gray level dependence matrix, and 20 based on the gray level run length matrix (GLRLM) from neighborhood. We have used Quick Reduct Algorithm to select 12 most discriminant features from extracted 211 features. Each pixel is then assigned to the vessel lumen, to the intima-media complex, or to the adventitia by using an integrated system of three feed-forward neural networks. The boundaries between the three regions are used to estimate the IMT value. The texture features associated with GLRLM are found to be clinically most significant. We have obtained an overall classification accuracy of 79.5%, sensitivity of 87%, and specificity of 72%. We observed a unique classification pattern between low risk and high risk images: in the latter ones, a considerable number of pixels of the intima–media complex ([Formula: see text]) was classified as belonging to the adventitia. This percentage is statistically higher than that of low risk images ([Formula: see text]; [Formula: see text]). Locally extracted and pixel-based descriptors are able to capture the inner characteristics of the carotid wall. The presence of misclassified pixels in the intima–media complex is associated to higher cardiovascular risk.

Focal hepatic lesions characterisation by different sonographic techniques: a prospective analysis

INTRODUCTION

Ultrasound is usually the first diagnostic investigation for the assessment of liver lesions. Apart from conventional sonography (CS), new grey-scale sonographic techniques have been developed which have increased the application of ultrasound in liver imaging. The present study was undertaken to compare image quality of CS, real-time compound sonography (RTCS), tissue harmonic sonography (THS) and tissue harmonic compound sonography (THCS) in focal liver lesions.

MATERIALS AND METHODS

100 patients with focal hepatic lesions were enroled. Lesions were divided into solid and cystic group. Solid lesions were evaluated for lesion conspicuity and elimination of artefacts. For cystic lesions, lesion conspicuity, posterior acoustic enhancement and internal echoes within the lesion were evaluated. Grading was done using 3-5-point scales. Overall image quality was assessed depending on the total points.

RESULTS

78 solid and 22 cystic liver lesions were included. THCS showed superior results for lesion conspicuity, elimination of artefacts and overall image quality in solid lesions. RTCS showed similar results as THCS for lesion conspicuity and overall image quality in solid lesions. THS gave better results in cystic lesions for all imaging parameters. Results of THCS though slightly inferior, showed no significant difference from THS, in cystic lesions. CS was found to have least diagnostic value in characterisation.

CONCLUSIONS

For evaluation of focal hepatic lesions, a combination of compound and harmonic sonography, i.e. THCS, is the preferred sonographic technique.

Standard B-Mode Ultrasound Measures Local Carotid Artery Characteristics as Reliably as Radiofrequency Phase Tracking in Symptomatic Carotid Artery Patients

Local arterial stiffness can be assessed with high accuracy and precision by measuring arterial distension on the basis of phase tracking of radiofrequency ultrasound signals acquired at a high frame rate. However, in clinical practice, B-mode ultrasound registrations are made at a low frame rate (20-50 Hz). We compared the accuracy and intra-subject precision of edge tracking and phase tracking distension in symptomatic carotid artery patients. B-mode ultrasound recordings (40 mm, 37 fps) and radiofrequency recordings (31 lines covering 29 mm, 300 fps) were acquired from the left common carotid artery of 30 patients (aged 45-88 y) with recent cerebrovascular events. To extract the distension, semi-automatic echo edge and phase tracking algorithms were applied to B-mode and radiofrequency recordings, respectively. Both methods exhibited a similar intra-subject precision for distension (standard deviation = 44 μm and 47 μm, p = 0.66) and mean distension (difference: -6 ± 69 μm, p = 0.67). Intra-subject distension inhomogeneity tends to be larger for edge tracking (difference: 15 ± 35 μm, p = 0.04). Standard B-mode scanners are suitable for measuring local artery characteristics in symptomatic carotid artery patients with good precision and accuracy.

A Robotic Ultrasound Scanner for Automatic Vessel Tracking and Three-Dimensional Reconstruction of B-Mode Images

Locating and evaluating the length and severity of a stenosis is very important for planning adequate treatment of peripheral arterial disease (PAD). Conventional ultrasound (US) examination cannot provide maps of entire lower limb arteries in 3-D. We propose a prototype 3D-US robotic system with B-mode images, which is nonionizing, noninvasive, and is able to track and reconstruct a continuous segment of the lower limb arterial tree between the groin and the knee. From an initialized cross-sectional view of the vessel, automatic tracking was conducted followed by 3D-US reconstructions evaluated using Hausdorff distance, cross-sectional area, and stenosis severity in comparison with 3-D reconstructions with computed tomography angiography (CTA). A mean Hausdorff distance of 0.97 ± 0.46 mm was found in vitro for 3D-US compared with 3D-CTA vessel representations. To evaluate the stenosis severity in vitro, 3D-US reconstructions gave errors of 3%-6% when compared with designed dimensions of the phantom, which are comparable to 3D-CTA reconstructions, with 4%-13% errors. The in vivo system's feasibility to reconstruct a normal femoral artery segment of a volunteer was also investigated. These results encourage further ergonomic developments to increase the robot's capacity to represent lower limb vessels in the clinical context.

Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders

OBJECTIVE

To provide new epidemiological data regarding the prevalence, distribution and macroscopic features of shoulder rotator cuff calcific tendinopathy (calcific tendinopathy), and to identify the characteristics of calcific deposits associated with shoulder pain.

MATERIALS AND METHODS

Three hundred and two female volunteers (604 shoulders) who had been referred to a gynaecological clinic participated in the study. The subjects underwent a high-resolution ultrasonography of both shoulders, and those with a diagnosis of calcific tendinopathy compiled a standardized questionnaire relating to shoulder symptoms. We determined the prevalence of symptomatic and asymptomatic rotator cuff calcific tendinopathy, and compared differences in distribution and macroscopic features of the symptomatic and asymptomatic calcifications.

RESULTS

The prevalence of calcific tendinopathy was 17.8% (103 shoulders). Ninety-five shoulders (15.7%) were symptomatic; of these, calcific tendinopathy was found in 34 shoulders (33%) on imaging. Of the 509 asymptomatic (84.3%) shoulders, calcific tendinopathy was observed in 69 cases (67%). Among tendons, supraspinatus (53.4%) and infraspinatus (54.6%) were the most frequently involved. The majority of calcific deposits were of maximum diameter between 2 and 5 mm (77.9%), and were linear in form (69.9%). The involvement of multiple tendons and a location in the supraspinatus tendon were found to be significantly correlated with pain (p = 0.023, p = 0.043 respectively), as were age (p = 0.041) and an excessive body mass index (p = 0.024).

CONCLUSION

In this sample from the general population of working age females, both intrinsic factors (location in supraspinatus, multiple tendon involvement) and extrinsic variables (age, abnormally high BMI) were correlated with pain in calcific tendinopathy.

LEVEL OF EVIDENCE

Level III, cross-sectional study, prevalence study.

Ultrasound in Radiology: From Anatomic, Functional, Molecular Imaging to Drug Delivery and Image-Guided Therapy

During the past decade, ultrasound has expanded medical imaging well beyond the "traditional" radiology setting: a combination of portability, low cost, and ease of use makes ultrasound imaging an indispensable tool for radiologists as well as for other medical professionals who need to obtain imaging diagnosis or guide a therapeutic intervention quickly and efficiently. Ultrasound combines excellent ability for deep penetration into soft tissues with very good spatial resolution, with only a few exceptions (ie, those involving overlying bone or gas). Real-time imaging (up to hundreds and thousands of frames per second) enables guidance of therapeutic procedures and biopsies; characterization of the mechanical properties of the tissues greatly aids with the accuracy of the procedures. The ability of ultrasound to deposit energy locally brings about the potential for localized intervention encompassing the following: tissue ablation, enhancing penetration through the natural barriers to drug delivery in the body and triggering drug release from carrier microparticles and nanoparticles. The use of microbubble contrast agents brings the ability to monitor and quantify tissue perfusion, and microbubble targeting with ligand-decorated microbubbles brings the ability to obtain molecular biomarker information, that is, ultrasound molecular imaging. Overall, ultrasound has become the most widely used imaging modality in modern medicine; it will continue to grow and expand.

Plane wave compounding based on a joint transmitting-receiving adaptive beamformer

Plane wave compounding is a useful mode for ultrasound imaging because it can make a good compromise between imaging quality and frame rate. It is also useful for broad view ultrasound imaging. Traditional coherent plane wave compounding coherently sums the echo data of different steered transmitting waves as the output. The data correlation information of different emissions is not considered. Therefore, some adaptive techniques can be introduced into the compounding procedure. In this paper, we propose a Joint Transmitting-Receiving (JTR) adaptive beamforming scheme for plane wave compounding. Unlike traditional adaptive beamformers, the proposed beamforming scheme is designed for the 2-D data set obtained from multiple plane wave firings. It calculates both the transmitting aperture weights and the receiving aperture weights and then combines them into a 2-D adaptive weight function for compounding. Experiments are conducted on both simulated and phantom data. Results show that the proposed scheme has better performance on both point targets and cysts than the existing plane wave compounding approach. Because of the adaptive process in both apertures for compounding, an improved resolution is observed in both simulation and phantom studies. When the eigenanalysis is introduced, a contrast enhancement is achieved. For the simulated cyst, a contrast ratio (CR) improvement of 48% is achieved compared with the traditional plane wave compounding. For the phantom cyst, this improvement is 213.8%. The proposed scheme also has good robustness against sound velocity errors. Therefore, it is effective in enhancing the coherent plane wave compounding quality.

Motion estimation-based image enhancement in ultrasound imaging

High resolution medical ultrasound (US) imaging is an ongoing challenge in many diagnosis applications and can be achieved either by instrumentation or by post-processing. Though many works have considered the issue of resolution enhancement in optical imaging, very few works have investigated this issue in US imaging. In optics, several algorithms have been proposed to achieve super-resolution (SR) image reconstruction, which consists of merging several low resolution images to create a higher resolution image. However, the straightforward implementation of such techniques for US imaging is unsuccessful, due to the interaction of ultrasound with tissue and speckle. We show how to overcome the limit of SR in this framework by refining the registration part of common multiframe techniques. For this purpose, we investigate motion estimation methods adapted to US imaging. Performance of the proposed technique is evaluated on both realistic simulated US images (providing an estimated best-case performance) and real US sequences of phantom and in-vivo thyroid images. Compared to classical SR methods, our technique brings both quantitative and qualitative improvements. Resolution gain was found to be 1.41 for the phantom sequence and 1.12 for the thyroid sequence and a quantitative study using the phantom further confirmed the spatial resolution enhancement. Furthermore, the contrast-to-noise ratio was increased by 27% and 13% for simulated and experimental US images, respectively.