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Zhang R, Li Y, Tang B, Luo Z, Li M. Predictive value of contrast-enhanced ultrasonography for the early diagnosis of renal dysfunction after kidney transplantation: A systematic review and meta-analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:1056-1065. [PMID: 39056502 DOI: 10.1002/jcu.23762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVES We aimed to evaluate the changes in renal cortical microperfusion and quantitative contrast-enhanced ultrasonography (CEUS) parameters after kidney transplantation, and to determine the evidence-based value of CEUS in predicting renal dysfunction. METHODS The Embase, MEDLINE, Web of Science, and Cochrane Library databases were searched for relevant studies published from 2000 to 2023 on the use of CEUS to assess the renal cortical microcirculation after kidney transplantation. Subject terms and related keywords were combined, and a meta-analysis and systematic review were performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS The search yielded six studies involving 451 patients with moderate to high overall quality. The peak intensity (standardized mean difference [SMD]: -0.64, 95% confidence interval [CI] -1.13 to -0.15, p = 0.01) of CEUS was significantly lower in patients with renal dysfunction than in those with stable renal function. However, the time to peak (SMD: 0.28, 95% CI 0.04 to 0.52, p = 0.02) was significantly shorter in patients with renal dysfunction than in those with stable renal function. The total renal cortical microperfusion and renal cortical perfusion intensity were decreased, and the perfusion time was prolonged, in patients with renal dysfunction after kidney transplantation. CONCLUSION CEUS parameters can reflect real-time changes in renal cortical microperfusion, thus providing a basis for the early diagnosis of renal dysfunction after kidney transplantation.
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Affiliation(s)
- Rong Zhang
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yini Li
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Bin Tang
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Zhijian Luo
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Mingxing Li
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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2
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Nam K, Torkzaban M, Shames JP, Liao L, Wessner CE, Machado P, Lyshchik A, Forsberg F. Characterization of Indeterminate Breast Lesions Based on Pressure Estimates by Noninvasive 3D Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00318-1. [PMID: 39237425 DOI: 10.1016/j.ultrasmedbio.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/15/2024] [Accepted: 08/10/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE To assess the ability of the pressure gradient between breast lesions and adjacent normal tissue estimated by 3D subharmonic-aided pressure estimation (SHAPE) to characterize indeterminate breast lesions. METHODS This prospective study enrolled patients scheduled for ultrasound-guided needle biopsies of a breast lesion. Before the biopsy, 3D SHAPE data were collected from the breast lesion during the infusion of an ultrasound contrast agent (Definity) as well as after clearance of the agent. Direct, invasive pressure measurements in the lesion and adjacent normal tissue were then obtained using an intracompartmental pressure monitoring system (C2DX) before tissue sampling as part of the biopsy procedure. The mean SHAPE gradient and invasive measurement gradient between the lesion and adjacent normal tissue were compared to the biopsy results. The SHAPE gradients were also compared to the invasive pressure gradients. RESULTS There were 8 malignant and 13 benign lesions studied. The SHAPE gradients and invasive pressure gradients were significantly different between the benign and malignant lesions (2.86 ± 3.24 vs. -0.03 ± 1.72 a.u.; p = 0.03 and 9.9 ± 8.5 vs. 20.9 ± 8.0 mmHg; p = 0.008, respectively). The area under the curves, specificities, and sensitivities for detecting malignancy by SHAPE gradients and invasive pressure gradients were 0.79 and 0.88, 77% and 92%, and 88% and 50%, respectively. A weak negative correlation was found between the SHAPE and invasive pressure gradients (r = -0.2). CONCLUSION The pressure gradient between a breast lesion and adjacent normal tissue estimated by 3D SHAPE shows potential for characterizing indeterminate breast lesions.
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Affiliation(s)
- Kibo Nam
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Mehnoosh Torkzaban
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason P Shames
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lydia Liao
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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Babaei S, Dobrucki LW, Insana MF. Power-Doppler Ultrasonic Imaging of Peripheral Perfusion in Diabetic Mice. IEEE Trans Biomed Eng 2024; 71:2421-2431. [PMID: 38442044 PMCID: PMC11292584 DOI: 10.1109/tbme.2024.3373254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVE We explored the capabilities of power-Doppler ultrasonic (PD-US) imaging without contrast enhancement for monitoring changes in muscle perfusion over time. METHODS Ischemic recovery was observed in healthy and type II diabetic male and female mice with and without exercise. In separate studies, perfusion was measured during and after 5-min ischemic periods and during four-week recovery periods following irreversible femoral ligation. A goal was to assess how well PD-US estimates tracked the diabetic-related changes in endothelial function that influenced perfusion. RESULTS The average perfusion recovery time following femoral ligation increased 47% in diabetic males and 74% in diabetic females compared with non-diabetic mice. Flow-mediated dilation in conduit arteries and the reactive hyperemia index in resistive vessels each declined by one half in sedentary diabetic mice compared with sedentary non-diabetic mice. We found that exercise reduced the loss of endothelial function from diabetes in both sexes. The reproducibility of perfusion measurements was limited primarily by our ability to select the same region in muscle and to effectively filter tissue clutter. CONCLUSIONS/SIGNIFICANCE PD-US measurements can precisely follow site-specific changes in skeletal muscle perfusion related to diabetes over time, which fills the need for techniques capable of regularly monitoring atherosclerotic changes leading to ischemic vascular pathologies.
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4
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Sun XX, Chai JY, Zhu XL, Wu SB, Wang H, Huang B. Real-time evaluation of active bleeding severity in soft-tissue hematomas via contrast-enhanced ultrasound: a case series. Quant Imaging Med Surg 2024; 14:6173-6179. [PMID: 39144018 PMCID: PMC11320527 DOI: 10.21037/qims-23-1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 07/02/2024] [Indexed: 08/16/2024]
Affiliation(s)
- Xi-Xi Sun
- Department of Ultrasound, Zhejiang Hospital, Hangzhou, China
| | - Jia-Yuan Chai
- Department of Ultrasound, Zhejiang Hospital, Hangzhou, China
| | - Xiao-Lu Zhu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Sheng-Bo Wu
- Department of Ultrasound, Zhejiang Hospital, Hangzhou, China
| | - Han Wang
- Department of Ultrasound, Zhejiang Hospital, Hangzhou, China
| | - Bin Huang
- Department of Ultrasound, Zhejiang Hospital, Hangzhou, China
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5
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Agarwal D, Hunt ML, Sridharan A, Larson AC, Rychik J, Licht DJ, Davey MG, Flake AW, Gaynor JW, Didier RA. Unique model of chronic hypoxia in fetal lambs demonstrates abnormal contrast-enhanced ultrasound brain perfusion. Pediatr Res 2024:10.1038/s41390-024-03206-3. [PMID: 38849480 DOI: 10.1038/s41390-024-03206-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Children with congenital heart disease (CHD) demonstrate long-term neurodevelopmental impairments. We investigated contrast-enhanced ultrasound (CEUS) cerebral perfusion in a fetal animal model exposed to sub-physiologic oxygen at equivalent levels observed in human fetuses with CHD. METHODS Fifteen fetal lambs [hypoxic animals (n = 9) and normoxic controls (n = 6)] maintained in an extrauterine environment underwent periodic brain CEUS. Perfusion parameters including microvascular flow velocity (MFV), transit time, and microvascular blood flow (MBF) were extrapolated from a standardized plane; regions of interest (ROI) included whole brain, central/thalami, and peripheral parenchymal analyses. Daily echocardiographic parameters and middle cerebral artery (MCA) pulsatility indices (PIs) were obtained. RESULTS Hypoxic lambs demonstrated decreased MFV, increased transit time, and decreased MBF (p = 0.026, p = 0.016, and p < 0.001, respectively) by whole brain analyses. MFV and transit time were relatively preserved in the central/thalami (p = 0.11, p = 0.08, p = 0.012, respectively) with differences in the peripheral parenchyma (all p < 0.001). In general, cardiac variables did not correlate with cerebral CEUS perfusion parameters. Hypoxic animals demonstrated decreased MCA PI compared to controls (0.65 vs. 0.78, respectively; p = 0.027). CONCLUSION Aberrations in CEUS perfusion parameters suggest that in environments of prolonged hypoxia, there are regional microvascular differences incompletely characterized by MCA interrogation offering insights into fetal conditions which may contribute to patient outcomes. IMPACT This work utilizes CEUS to study cerebral microvascular perfusion in a unique fetal animal model subjected to chronic hypoxic conditions equal to fetuses with congenital heart disease. CEUS demonstrates altered parameters with regional differences that are incompletely characterized by MCA Doppler values. These findings show that routine MCA Doppler interrogation may be inadequate in assessing microvascular perfusion differences. To our knowledge, this study is the first to utilize CEUS to assess microvascular perfusion in this model. The results offer insight into underlying conditions and physiological changes which may contribute to known neurodevelopmental impairments in those with congenital heart disease.
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Affiliation(s)
- Divyansh Agarwal
- Perelman School of Medicine, University of Philadelphia, Philadelphia, PA, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mallory L Hunt
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anush Sridharan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abby C Larson
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jack Rychik
- Perelman School of Medicine, University of Philadelphia, Philadelphia, PA, USA
- Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel J Licht
- Perelman School of Medicine, University of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marcus G Davey
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alan W Flake
- Perelman School of Medicine, University of Philadelphia, Philadelphia, PA, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J William Gaynor
- Perelman School of Medicine, University of Philadelphia, Philadelphia, PA, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ryne A Didier
- Perelman School of Medicine, University of Philadelphia, Philadelphia, PA, USA.
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Escobar-Huertas JF, Vaca-González JJ, Guevara JM, Ramirez-Martinez AM, Trabelsi O, Garzón-Alvarado DA. Duchenne and Becker muscular dystrophy: Cellular mechanisms, image analysis, and computational models: A review. Cytoskeleton (Hoboken) 2024; 81:269-286. [PMID: 38224155 DOI: 10.1002/cm.21826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/21/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
The muscle is the principal tissue that is capable to transform potential energy into kinetic energy. This process is due to the transformation of chemical energy into mechanical energy to enhance the movements and all the daily activities. However, muscular tissues can be affected by some pathologies associated with genetic alterations that affect the expression of proteins. As the muscle is a highly organized structure in which most of the signaling pathways and proteins are related to one another, pathologies may overlap. Duchenne muscular dystrophy (DMD) is one of the most severe muscle pathologies triggering degeneration and muscle necrosis. Several mathematical models have been developed to predict muscle response to different scenarios and pathologies. The aim of this review is to describe DMD and Becker muscular dystrophy in terms of cellular behavior and molecular disorders and to present an overview of the computational models implemented to understand muscle behavior with the aim of improving regenerative therapy.
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Affiliation(s)
- J F Escobar-Huertas
- Numerical Methods and Modeling Research Group (GNUM), Universidad Nacional de Colombia, Bogotá, Colombia
- Université de technologie de Compiègne, CNRS, Biomechanics and Bioengineering, Centre de Recherche Royallieu, Compiègne Cedex, France
| | - Juan Jairo Vaca-González
- Escuela de pregrado, Dirección Académica, Vicerrectoría de Sede, Universidad Nacional de Colombia, Sede la Paz, Cesar, Colombia
| | - Johana María Guevara
- Institute for the Study of Inborn Errors of Metabolism, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Olfa Trabelsi
- Université de technologie de Compiègne, CNRS, Biomechanics and Bioengineering, Centre de Recherche Royallieu, Compiègne Cedex, France
| | - D A Garzón-Alvarado
- Numerical Methods and Modeling Research Group (GNUM), Universidad Nacional de Colombia, Bogotá, Colombia
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Saway BF, Courtney J, Barley J, Frankel B, Hofstetter C, Kalhorn S. Contrast enhanced ultrasound for traumatic spinal cord injury: an overview of current and future applications. Spinal Cord Ser Cases 2024; 10:31. [PMID: 38664470 PMCID: PMC11045808 DOI: 10.1038/s41394-024-00644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Contrast-enhanced ultrasound (CEUS) is an imaging modality that has only recently seen neurosurgical application. CEUS uses inert microbubbles to intraoperatively visualize vasculature and perfusion of the brain and spinal cord in real time. Observation and augmentation of spinal cord perfusion is vital component of the management of traumatic spinal cord injury, yet there are limited imaging modalities to evaluate spinal cord perfusion. CEUS provides an intraoperative imaging tool to evaluate spinal cord perfusion in real time. The objective of this review is to evaluate the current literature on the various applications and benefits of CEUS in traumatic spinal cord injury. SETTING South Carolina, USA. METHODS This review was written according to the PRISMA 2020 guidelines. RESULTS 143 articles were found in our literature search, with 46 of them being unique. After excluding articles for relevance to CEUS and spinal cord injury, we were left with 10 papers. Studies in animal models have shown CEUS to be an effective non-invasive imaging modality that can detect perfusion changes of injured spinal cords in real time. CONCLUSION This imaging modality can provide object perfusion data of the nidus of injury, surrounding penumbra and healthy neural tissue in a traumatized spinal cord. Investigation in its use in humans is ongoing and remains promising to be an effective diagnostic and prognostic tool for those suffering from spinal cord injury.
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Affiliation(s)
- Brian Fabian Saway
- Medical University of South Carolina, Department of Neurosurgery, Charleston, SC, 29425, USA.
| | - James Courtney
- Florida State University College of Medicine, Tallahassee, FL, 32303, USA
| | - Jessica Barley
- Medical University of South Carolina, Department of Neurosurgery, Charleston, SC, 29425, USA
| | - Bruce Frankel
- Southern Illinois University School of Medicine, Department of Neurosurgery, Springfield, IL, 62702, USA
| | | | - Stephen Kalhorn
- Medical University of South Carolina, Department of Neurosurgery, Charleston, SC, 29425, USA
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8
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Li JJ, Boivin Z, Bhalodkar S, Liu R. Point of Care Abdominal Ultrasound. Semin Ultrasound CT MR 2024; 45:11-21. [PMID: 38056783 DOI: 10.1053/j.sult.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Abdominal pain is a common emergency department complaint, and point-of-care ultrasound (POCUS) of the abdomen is increasingly being utilized to evaluate clinical manifestations. It aids in accurate diagnoses and assists in procedures, particularly in emergency and critical care settings. Imaging is often required to confirm the etiology of abdominal pain. POCUS provides the benefit of avoiding radiation exposure and enables quicker diagnosis compared to computed tomography scans. There is growing evidence of the diagnostic accuracy for numerous abdominal POCUS applications, including appendicitis, intussusception, diverticulitis, gastric ultrasound and contrast-enhanced ultrasound.
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Affiliation(s)
- Jia J Li
- Yale New-Haven Hospital, New Haven, CT.
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9
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Kilpatrick H, Bush E, Lockard C, Zhou X, Coolbaugh C, Damon B. Quantitative Muscle Fascicle Tractography Using Brightness-Mode Ultrasound. J Appl Biomech 2023; 39:421-431. [PMID: 37793655 PMCID: PMC11304077 DOI: 10.1123/jab.2022-0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/01/2023] [Accepted: 07/17/2023] [Indexed: 10/06/2023]
Abstract
A muscle's architecture, defined as the geometric arrangement of its fibers with respect to its mechanical line of action, impacts its abilities to produce force and shorten or lengthen under load. Ultrasound and other noninvasive imaging methods have contributed significantly to our understanding of these structure-function relationships. The goal of this work was to develop a MATLAB toolbox for tracking and mathematically representing muscle architecture at the fascicle scale, based on brightness-mode ultrasound imaging data. The MuscleUS_Toolbox allows user-performed segmentation of a region of interest and automated modeling of local fascicle orientation; calculation of streamlines between aponeuroses of origin and insertion; and quantification of fascicle length, pennation angle, and curvature. A method is described for optimizing the fascicle orientation modeling process, and the capabilities of the toolbox for quantifying and visualizing fascicle architecture are illustrated in the human tibialis anterior muscle. The toolbox is freely available.
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Affiliation(s)
- Hannah Kilpatrick
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Emily Bush
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Carly Lockard
- Carle Clinical Imaging Research Program, Stephens Family Clinical Research Institute, Carle Health, Urbana, IL, USA
| | - Xingyu Zhou
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Carle Clinical Imaging Research Program, Stephens Family Clinical Research Institute, Carle Health, Urbana, IL, USA
| | - Crystal Coolbaugh
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bruce Damon
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Carle Clinical Imaging Research Program, Stephens Family Clinical Research Institute, Carle Health, Urbana, IL, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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10
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Bracco C, Gloria A, Contri A. Ultrasound-Based Technologies for the Evaluation of Testicles in the Dog: Keystones and Breakthroughs. Vet Sci 2023; 10:683. [PMID: 38133235 PMCID: PMC10747277 DOI: 10.3390/vetsci10120683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/11/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
Ultrasonography is a valuable diagnostic tool extensively used in the andrology of human and domestic animals, including dogs. This review aims to provide an overview of various technologies based on ultrasound, from the basic B-Mode ultrasonography to the more recent advancements, such as contrast-enhanced ultrasonography (CEUS) and ultrasound elastography (UEl), all of which are utilized in the evaluation of canine testicles. The review outlines the principles behind each of these technologies and discusses their application in assessing normal and abnormal testicular conditions. B-mode canine testicular ultrasonography primarily focuses on detecting focal lesions but has limitations in terms of objectivity. Other technologies, including Doppler ultrasonography, B-Flow, and CEUS, allow for the characterization of vascular patterns, which could be further measured using specific applications like spectral Doppler or quantitative CEUS. Additionally, ultrasound elastography enables the assessment of parenchyma stiffness both qualitatively and quantitatively. These ultrasound-based technologies play a crucial role in andrology by providing valuable information for evaluating testicular function and integrity, aiding in the identification of pathological conditions that may impact the health and quality of life of male dogs.
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Affiliation(s)
| | - Alessia Gloria
- Department of Veterinary Medicine, University of Teramo, Località Piano d’Accio, 64100 Teramo, Italy; (C.B.); (A.C.)
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11
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Liu L, Liu D, Hu Z, Wang X, Chao Y, Wu J, Yin W, Zhang H, Zhang L, He W, Zhu R, Xu Q, Yang R, Huo Y, Zhang Q, Liu H, Zhu W, Zhang Q, Li R. Renal hemodynamic evaluation protocol based on the pathophysiological mechanism of acute kidney injury: Critical Care UltraSound Guided-A (KI)BCDE. Ren Fail 2023; 45:2284842. [PMID: 37994455 PMCID: PMC11001348 DOI: 10.1080/0886022x.2023.2284842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
The multiple etiological characteristics of acute kidney injury (AKI) have brought great challenges to its clinical diagnosis and treatment. Renal injury in critically ill patients always indicates hemodynamic injury. The Critical Care UltraSound Guided (CCUSG)-A(KI)BCDE protocol developed by the Chinese Critical Ultrasound Study Group (CCUSG), respectively, includes A(KI) diagnosis and risk assessment and uses B-mode ultrasound, Color doppler ultrasound, spectral Doppler ultrasound, and contrast Enhanced ultrasound to obtain the hemodynamic characteristics of the kidney so that the pathophysiological mechanism of the occurrence and progression of AKI can be captured and the prognosis of AKI can be predicted combined with other clinical information; therefore, the corresponding intervention and treatment strategies can be formulated to achieve targeted, protocolized, and individualized therapy.
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Affiliation(s)
- Lixia Liu
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dawei Liu
- Department of Intensive Care Department, Peking Union Medical College Hospital, Beijing, China
| | - Zhenjie Hu
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoting Wang
- Department of Intensive Care Department, Peking Union Medical College Hospital, Beijing, China
| | - Yangong Chao
- Department of Critical Care Medicine, The First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Jun Wu
- Department of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanhong Yin
- Department of Intensive Care, West China Hospital, Sichuan University, Chengdu, China
| | - Hongmin Zhang
- Department of Intensive Care Department, Peking Union Medical College Hospital, Beijing, China
| | - Lina Zhang
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Wei He
- Department of Intensive Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ran Zhu
- Department of Intensive Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Qianghong Xu
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China
| | - Rongli Yang
- Department of Critical Care Medicine, The Central Hospital of Dalian, Dalian, China
| | - Yan Huo
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Zhang
- Department of Intensive Care Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Haitao Liu
- Department of Critical Care Medicine, The Fourth Hospital of Harbin Medical University, Harbin, China
| | - Weihua Zhu
- Department of Intensive Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qian Zhang
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rong Li
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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12
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Nong W, Huang Q, Gao Y. Development and validation of a nomogram for predicting prostate cancer based on combining contrast-enhanced transrectal ultrasound and biparametric MRI imaging. Front Oncol 2023; 13:1275773. [PMID: 38044995 PMCID: PMC10691548 DOI: 10.3389/fonc.2023.1275773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives This study was to explore the feasibility of combining contrast-enhanced transrectal ultrasound (CE-TRUS) with biparametric MRI (CEUS-BpMRI) score for diagnosing prostate cancer (PCa). Methods A total of 183 patients with suspected PCa who underwent multiparametric MRI (Mp-MRI) and CE-TRUS were included. CEUS-BpMRI score was developed based on the results of Mp-MRI and CE-TRUS. The diagnostic performance was evaluated by the area under the curve (AUC). The diagnostic efficacy of the CEUS-BpMRI score, BpMRI score, and PI-RADS v2.1 score were compared. Total patients were randomly assigned to a training cohort (70%) or validation cohort (30%). A nomogram was constructed based on univariate and multivariate logistic regression. The model was evaluated by AUC and calibration curve. Results The diagnostic performance of CEUS-BpMRI score (AUC 0.857) was comparable to that of PI-RADS v2.1 (AUC 0.862) (P = 0.499), and both were superior to Bp-MRI score (AUC 0.831, P < 0.05). In peripheral zone lesions with Bp-MRI score of 3, there was no statistically significant difference between PI-RADS v2.1 score (AUC 0.728) and CEUS-BpMRI score (AUC 0.668) (P = 0.479). Multivariate analysis showed that age, total prostate specific antigen/free prostate specific antigen (F/T), time to peak (TTP), and CEUS-BpMRI score were independent factors. The AUC of the nomogram was 0.909 in the training cohort and 0.914 in the validation cohort. Conclusions CEUS-BpMRI score has high diagnostic efficacy for diagnosing PCa. A nomogram model established by combining age, F/T, TTP, and CEUS-BpMRI score can achieve the best predictive accuracy for PCa.
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Affiliation(s)
- Wanxian Nong
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qun Huang
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yong Gao
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Zhang G, Liao C, Hu JR, Hu HM, Lei YM, Harput S, Ye HR. Nanodroplet-Based Super-Resolution Ultrasound Localization Microscopy. ACS Sens 2023; 8:3294-3306. [PMID: 37607403 DOI: 10.1021/acssensors.3c00418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Over the past decade, super-resolution ultrasound localization microscopy (SR-ULM) has revolutionized ultrasound imaging with its capability to resolve the microvascular structures below the ultrasound diffraction limit. The introduction of this imaging technique enables the visualization, quantification, and characterization of tissue microvasculature. The early implementations of SR-ULM utilize microbubbles (MBs) that require a long image acquisition time due to the requirement of capturing sparsely isolated microbubble signals. The next-generation SR-ULM employs nanodroplets that have the potential to significantly reduce the image acquisition time without sacrificing the resolution. This review discusses various nanodroplet-based ultrasound localization microscopy techniques and their corresponding imaging mechanisms. A summary is given on the preclinical applications of SR-ULM with nanodroplets, and the challenges in the clinical translation of nanodroplet-based SR-ULM are presented while discussing the future perspectives. In conclusion, ultrasound localization microscopy is a promising microvasculature imaging technology that can provide new diagnostic and prognostic information for a wide range of pathologies, such as cancer, heart conditions, and autoimmune diseases, and enable personalized treatment monitoring at a microlevel.
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Affiliation(s)
- Ge Zhang
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan 430080, People's Republic of China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, People's Republic of China
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, PSL University, CNRS, Paris 75015, France
| | - Chen Liao
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan 430080, People's Republic of China
- Medical College, Wuhan University of Science and Technology, Wuhan 430065, People's Republic of China
| | - Jun-Rui Hu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Hai-Man Hu
- Department of Electrical and Electronic Engineering, Hubei University of Technology, Wuhan 430068, People's Republic of China
| | - Yu-Meng Lei
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan 430080, People's Republic of China
| | - Sevan Harput
- Department of Electrical and Electronic Engineering, London South Bank University, London SE1 0AA, U.K
| | - Hua-Rong Ye
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan 430080, People's Republic of China
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Holmes LR, Garside JC, Frank J, Livingston E, Snyder J, Abu Khalaf N, Yuan H, Branca RT. In-vivo detection of white adipose tissue browning: a multimodality imaging approach. Sci Rep 2023; 13:15485. [PMID: 37726379 PMCID: PMC10509182 DOI: 10.1038/s41598-023-42537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
Detection and differentiation of brown fat in humans poses several challenges, as this tissue is sparse and often mixed with white adipose tissue. Non-invasive detection of beige fat represents an even greater challenge as this tissue is structurally and functionally more like white fat than brown fat. Here we used positron emission tomography with 18F-fluorodeoxyglucose, computed tomography, xenon-enhanced computed tomography, and dynamic contrast-enhanced ultrasound, to non-invasively detect functional and structural changes associated with the browning process of inguinal white fat, induced in mice by chronic stimulation with the β3-adrenergic receptor agonist CL-316243. These studies reveal a very heterogeneous increase in baseline tissue radiodensity and xenon-enhanced radiodensity, indicative of both an increase in adipocytes water and protein content as well as tissue perfusion, mostly in regions that showed enhanced norepinephrine-stimulated perfusion before CL-316243 treatment. No statistically significant increase in 18F-fluorodeoxyglucose uptake or norepinephrine-stimulated tissue perfusion were observed in the mice after the CL-316243 treatment. The increase in tissue-water content and perfusion, along with the negligible increase in the tissue glucose uptake and norepinephrine-stimulated perfusion deserve more attention, especially considering the potential metabolic role that this tissue may play in whole body metabolism.
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Affiliation(s)
- Leah R Holmes
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - John C Garside
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jonathan Frank
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Eric Livingston
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jonas Snyder
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Nada Abu Khalaf
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Hong Yuan
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Rosa T Branca
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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15
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Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med 2023; 82:e115-e155. [PMID: 37596025 DOI: 10.1016/j.annemergmed.2023.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 08/20/2023]
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16
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Sultan LR, Alves AGF, Morgan TA, Sridharan A, Batley M, Darge K, Sankar WN, Back SJ. A novel quantitative approach to evaluate femoral head perfusion by contrast-enhanced ultrasound: A pilot study in infants with developmental dysplasia of the hip. IEEE INTERNATIONAL ULTRASONICS SYMPOSIUM : [PROCEEDINGS]. IEEE INTERNATIONAL ULTRASONICS SYMPOSIUM 2023; 2023:10.1109/ius51837.2023.10307817. [PMID: 38264340 PMCID: PMC10805098 DOI: 10.1109/ius51837.2023.10307817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Avascular necrosis (AVN) is a major morbidity that can occur after surgical reduction of a hip with developmental dysplasia. Early detection of changes in femoral head perfusion during surgery may help detect a hip at risk for AVN and guide intraoperative management. Contrast-enhanced ultrasound (CEUS) can be employed for visualization of femoral head perfusion. In this study we evaluate a quantitative CEUS technique to assess femoral head perfusion pre- and post-surgical reduction. CEUS images were obtained following a bolus injection of an ultrasound contrast agent, prior to and again following surgical reduction and casting. An image processing technique called delta projection was used to quantify hip perfusion, measuring peak enhancement (PE) and perfusion index (PI). We analyzed CEUS images of the hips of eight patients, including seven females, whose ages ranged from 4 months to 1 year. In five hips, perfusion increased following surgery, with a mean pre-surgery PE of 6.7 ±2.5(± SE) and PI of 10.5 ±6.3; and a post-reduction PE of 13.1±6.1 (p=0.07) and PI of 14.2 ±6.2 (p=0.008). The change in contrast visualization was observed to be greater within the central aspect of the cartilaginous femoral epiphysis. The proposed technique can quantify pre- and post-surgical perfusion changes on CEUS images in patients with developmental dysplasia. This quantitative technique may provide a more objective and accurate assessment of changes in femoral head perfusion that may have the potential to be indicative of the risk of developing AVN.
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Affiliation(s)
- Laith R Sultan
- Children's Hospital of Philadelphia, Division of Body Imaging, Department of Radiology
| | - Andressa G F Alves
- Children's Hospital of Philadelphia, Division of Body Imaging, Department of Radiology
| | - Trudy A Morgan
- Children's Hospital of Philadelphia, Division of Body Imaging, Department of Radiology
| | - Anush Sridharan
- Children's Hospital of Philadelphia, Division of Body Imaging, Department of Radiology
| | - Morgan Batley
- Children's Hospital of Philadelphia, Division of Orthopedic Surgery, Department of Surgery
| | - Kassa Darge
- Children's Hospital of Philadelphia, Division of Body Imaging, Department of Radiology
- Perelman School of Medicine, University of Pennsylvania
| | - Wudbhav N Sankar
- Children's Hospital of Philadelphia, Division of Orthopedic Surgery, Department of Surgery
- Perelman School of Medicine, University of Pennsylvania
| | - Susan J Back
- Children's Hospital of Philadelphia, Division of Body Imaging, Department of Radiology
- Perelman School of Medicine, University of Pennsylvania
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He W, Wu Y, Gong C, Xu Y, Liu X, Xie X, Chen J, Yu Y, Guo Z, Sun Q. Contrast-enhanced ultrasonography for identifying acute kidney injury in brain-dead donors. Quant Imaging Med Surg 2023; 13:6014-6025. [PMID: 37711792 PMCID: PMC10498204 DOI: 10.21037/qims-23-207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023]
Abstract
Background Acute kidney injury (AKI) is frequently found in deceased donors; however, few studies have reported the use of imaging to detect and identify this phenomenon. The purpose of this study was to detect renal microcirculatory perfusion in brain-dead donors using contrast-enhanced ultrasonography (CEUS), investigate the value of CEUS in identifying AKI, and analyze the correlation between CEUS and preimplantation biopsy results and early post-transplant renal function of grafts. Methods This prospective study recruited 94 kidneys from brain-dead donors (AKI =44, non-AKI =50) from August 2020 to November 2022. The inclusion criteria were age ≥18 years and brain death. The exclusion criteria encompassed donors maintained with extracorporeal membrane oxygenation (ECMO) and the presence of irregular kidney anatomy. The mean age of the donors was 45.1±10.4 [standard deviation (SD)] years, and the majority were male (86.2%). CEUS was performed prior to organ procurement, and time-intensity curves (TICs) were constructed. The time to peak (TTP) and peak intensity (PI) of kidney segmental artery (KA), kidney cortex (KC), and kidney medulla (KM) were calculated using TIC analysis. Results Arrival time (AT) of KA (P<0.001) and TTP of kidney cortex (TTPKC) (P<0.001) of the non-AKI group were significantly shorter than those of the AKI group. The PI of the KA (P=0.003), KM (P=0.005), and kidney cortex (PIKC; P<0.001) of the non-AKI group were significantly higher than those of the AKI group. Multivariable logistic regression analysis showed that serum creatinine [odds ratio (OR) =1.06; 95% CI: 1.03-1.1; P<0.001], TTPKC (OR =1.38; 95% CI: 1.03-1.84; P=0.03), and PIKC (OR =0.95; 95% CI: 0.91-1; P=0.046) were the independent factors of AKI. The area under the receiver operating characteristic curve (AUC) for identifying AKI for TTPKC and PIKC was 0.73 and 0.71, respectively. TTPKC showed a weak correlation with interstitial fibrosis (r=0.23; P=0.03), PIKC showed a weak correlation with arterial intimal fibrosis ((r=-0.29; P=0.004) and arteriolar hyalinosis (r=-0.27; P=0.008), and PIKC showed the strongest correlation with eGFR on postoperative day 7 (r=-0.46; P=0.046) in the donor kidneys with AKI. Conclusions CEUS can be used to identify AKI in brain-dead donors. Furthermore, there is a correlation between CEUS-derived parameters and pretransplant biopsy results and early preimplantation renal function of grafts.
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Affiliation(s)
- Weiming He
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Yuqiang Wu
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Chaoyang Gong
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Yuguang Xu
- Ultrasound Imaging Department, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Xiaozhen Liu
- Ultrasound Imaging Department, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Xi Xie
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Jiazhen Chen
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Yi Yu
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Zhiyong Guo
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiang Sun
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
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Halder S, Patidar S, Chaudhury K, Mandal S. Artificial Intelligence Assisted Multi-modal Photoacoustic-Ultrasound Imaging for Studying Renal Tissue Function and Hemodynamics. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083231 DOI: 10.1109/embc40787.2023.10340096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Combined functional-anatomic imaging modalities, which integrate the benefits of visualizing gross anatomy along with the functional or metabolic information of tissue has revolutionized the world of medical imaging. However, such existing imaging modalities are very costly. An alternative option could be a hybrid modality combining contrast-enhanced ultrasound, doppler and photoacoustic imaging. In the current study, we propose an artificial intelligence assisted multi-modal imaging platform where we have used U-net model for segmenting the anatomical features from the ultrasound images obtained from an animal model study. The neural network has performed accurately for three different cases, each with a high dice score. The model was co-validated with doppler images. Further, blood perfusion and tissue oxygenation information from the predicted anatomical structures were also studied. The present findings confirm the feasibility of using this multimodal imaging modality facilitated by artificial intelligence for better understanding of the hemodynamics of the kidney.Clinical Relevance-A multi-modal imaging technique has been proposed which would provide anatomical and functional information to the clinicians for early detection and tracking of the disease prognosis. Unlike existing imaging modalities like PET-CT (Positron Emission Tomography- Computed Tomography), the proposed modality is much more costeffective and radiation free (non-ionizing nature).
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19
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Li Y, Chen L, Feng L, Li M. Contrast-Enhanced Ultrasonography for Acute Kidney Injury: A Systematic Review and Meta-Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2023:S0301-5629(23)00178-3. [PMID: 37391293 DOI: 10.1016/j.ultrasmedbio.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/09/2023] [Accepted: 06/02/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE The aim of the work described here was to provide an evidence-based evaluation of contrast-enhanced ultrasonography (CEUS) in acute kidney injury (AKI) and assess variations in renal microperfusion with CEUS quantitative parameters in patients at a high risk of developing AKI. METHODS A meta-analysis and systematic review were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the Embase, MEDLINE, Web of Science and the Cochrane Library databases were used to search the relevant articles systematically (2000-2022). Studies using CEUS to assess renal cortical microcirculation in AKI were included. RESULTS Six prospective studies (374 patients) were included. The overall quality of included studies was moderate to high. CEUS measures, maximum intensity (standard mean difference [SMD]: -1.37, 95% confidence interval [CI]: -1.64 to -1.09) and wash-in rate (SMD: -0.77, 95% CI: -1.09 to -0.45) were lower in the AKI+ group than in the AKI- group, and mean transit time (SMD: 0.76, 95% CI: 0.11-1.40) and time to peak (SMD: 1.63, 95% CI: 0.99-2.27) were higher in the AKI+ group. Moreover, maximum intensity and wash-in rate values changed before creatinine changed in the AKI+ group. CONCLUSION Patients with AKI had reduced microcirculatory perfusion, prolonged perfusion time and a reduced rising slope in the renal cortex, which occurred before serum creatinine changes. And they could be measured using CEUS, indicating that CEUS could help in the diagnosis of AKI.
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Affiliation(s)
- Yini Li
- Southwest Medical University, Luzhou, Sichuan Province, China.
| | - Lingzhi Chen
- Southwest Medical University, Luzhou, Sichuan Province, China
| | - Lu Feng
- Southwest Medical University, Luzhou, Sichuan Province, China
| | - Mingxing Li
- Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.
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20
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Song Y, Mei J, Xu D, Ma Y. Evaluation of Contrast-Enhanced Ultrasound in Diagnosis of Acute Kidney Injury of Patients in Intensive Care Unit. Int J Gen Med 2023; 16:2229-2236. [PMID: 37293520 PMCID: PMC10246748 DOI: 10.2147/ijgm.s403730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
Background Ultrasound can assess renal perfusion, but its role in the evaluation of acute kidney injury (AKI) is still unclear. This prospective cohort study was to investigate the value of contrast-enhanced ultrasound (CEUS) in the evaluation of AKI in intensive care unit (ICU) patients. Methods Fifty-eight patients were recruited from ICU between October 2019 and October 2020, and CEUS was used to monitor the renal microcirculation perfusion within 24h after admission. Parameters included rise time (RT), time to peak intensity (TTP), amplitude of peak intensity (PI), area under the curve (AUC), time from peak to one half (TP1/2) of renal cortex and medulla. Ultrasonographical findings, demographics, laboratory, etc were collected for further analysis. Results There were 30 patients in the AKI group and 28 patients in the non-AKI group. The TTP, PI, TP1/2 of the cortex and the RT, TTP, TP1/2 of the medulla in the AKI group were significantly longer than in the non-AKI group (P < 0.05);. The TTP (OR = 1.261, 95% CI: 1.083-1.468, P = 0.003) (AUCs 0.733, Sen% 83.3, Spe%57.1), TP1/2 (OR = 1.079, 95% CI: 1.009-1.155, P = 0.027) (AUCs 0.658, Sen% 76.7, Spe%50.0) of the cortex and RT (OR = 1.453, 95% CI: 1.051-2.011, P = 0.024) (AUCs 0.686, Sen% 43.3, Spe%92.9) of the medulla were related to the AKI. Eight new-onset AKI cases occurred in the non-AKI group within 7 days, the RT, TTP, TP1/2 of the cortex and medulla were significantly longer in the new-onset AKI group than in the non-AKI group (P < 0.05), but serum creatinine and blood urea nitrogen were no differences between groups (P > 0.05). Conclusion This study indicates CEUS can assess the renal perfusion in AKI. TTP and TP1/2 of the cortex and RT of the medulla can aid the diagnosis of AKI in ICU patients.
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Affiliation(s)
- Ye Song
- Department of Ultrasonography, Shanghai Pudong New Area Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, People’s Republic of China
| | - Jiangjun Mei
- Department of Ultrasonography, Shanghai Pudong New Area Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, People’s Republic of China
| | - Dongwei Xu
- Department of Critical Care Medicine, Shanghai Pudong New Area Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, People’s Republic of China
| | - Ying Ma
- Department of Ultrasonography, Shanghai Pudong New Area Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, People’s Republic of China
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de Maar JS, Zandvliet MMJM, Veraa S, Tobón Restrepo M, Moonen CTW, Deckers R. Ultrasound and Microbubbles Mediated Bleomycin Delivery in Feline Oral Squamous Cell Carcinoma—An In Vivo Veterinary Study. Pharmaceutics 2023; 15:pharmaceutics15041166. [PMID: 37111651 PMCID: PMC10142092 DOI: 10.3390/pharmaceutics15041166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023] Open
Abstract
To investigate the feasibility and tolerability of ultrasound and microbubbles (USMB)-enhanced chemotherapy delivery for head and neck cancer, we performed a veterinary trial in feline companion animals with oral squamous cell carcinomas. Six cats were treated with a combination of bleomycin and USMB therapy three times, using the Pulse Wave Doppler mode on a clinical ultrasound system and EMA/FDA approved microbubbles. They were evaluated for adverse events, quality of life, tumour response and survival. Furthermore, tumour perfusion was monitored before and after USMB therapy using contrast-enhanced ultrasound (CEUS). USMB treatments were feasible and well tolerated. Among 5 cats treated with optimized US settings, 3 had stable disease at first, but showed disease progression 5 or 11 weeks after first treatment. One cat had progressive disease one week after the first treatment session, maintaining a stable disease thereafter. Eventually, all cats except one showed progressive disease, but each survived longer than the median overall survival time of 44 days reported in literature. CEUS performed immediately before and after USMB therapy suggested an increase in tumour perfusion based on an increase in median area under the curve (AUC) in 6 out of 12 evaluated treatment sessions. In this small hypothesis-generating study, USMB plus chemotherapy was feasible and well-tolerated in a feline companion animal model and showed potential for enhancing tumour perfusion in order to increase drug delivery. This could be a forward step toward clinical translation of USMB therapy to human patients with a clinical need for locally enhanced treatment.
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Affiliation(s)
- Josanne S. de Maar
- Imaging and Oncology Division, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
| | - Maurice M. J. M. Zandvliet
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
| | - Stefanie Veraa
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
| | - Mauricio Tobón Restrepo
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
| | - Chrit T. W. Moonen
- Imaging and Oncology Division, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
| | - Roel Deckers
- Imaging and Oncology Division, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
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Wilsen CB, Patel MK, Douek ML, Masamed R, Dittmar KM, Lu DSK, Raman SS. Contrast-enhanced ultrasound for abdominal image-guided procedures. Abdom Radiol (NY) 2023; 48:1438-1453. [PMID: 36853392 DOI: 10.1007/s00261-023-03804-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Since FDA approval for contrast-enhanced ultrasound (CEUS), clinical applications have increased to include diagnostic imaging of hepatic, renal, and other abdominal lesions. The modality has also demonstrated utility in certain image-guided procedures. Intravascular ultrasound contrast agents use microbubbles to improve visibility of solid tumors. Lesions not well seen on grayscale or Doppler ultrasound may become amenable to CEUS-guided biopsy or ablation. MATERIALS AND METHODS This pictorial essay provides eleven examples to illustrate the current use of CEUS in a variety of abdominal image-guided procedures. Hepatic, renal, peritoneal, and soft tissue cases are presented. CONCLUSION CEUS can improve visualization and targeting in abdominal image-guided procedures, without nephrotoxicity or radiation exposure.
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Affiliation(s)
- Craig B Wilsen
- UCLA Department of Radiological Sciences, University of California Los Angeles, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Maitraya K Patel
- UCLA Department of Radiological Sciences, University of California Los Angeles, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Michael L Douek
- UCLA Department of Radiological Sciences, University of California Los Angeles, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Rinat Masamed
- UCLA Department of Radiological Sciences, University of California Los Angeles, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | | | - David S K Lu
- UCLA Department of Radiological Sciences, University of California Los Angeles, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Steven S Raman
- UCLA Department of Radiological Sciences, University of California Los Angeles, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
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Nauber R, Goudu SR, Goeckenjan M, Bornhäuser M, Ribeiro C, Medina-Sánchez M. Medical microrobots in reproductive medicine from the bench to the clinic. Nat Commun 2023; 14:728. [PMID: 36759511 PMCID: PMC9911761 DOI: 10.1038/s41467-023-36215-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Medical microrobotics is an emerging field that aims at non-invasive diagnosis and therapy inside the human body through miniaturized sensors and actuators. Such microrobots can be tethered (e.g., smart microcatheters, microendoscopes) or untethered (e.g., cell-based drug delivery systems). Active motion and multiple functionalities, distinguishing microrobots from mere passive carriers and conventional nanomedicines, can be achieved through external control with physical fields such as magnetism or ultrasound. Here we give an overview of the key challenges in the field of assisted reproduction and how these new technologies could, in the future, enable assisted fertilization in vivo and enhance embryo implantation. As a case study, we describe a potential intervention in the case of recurrent embryo implantation failure, which involves the non-invasive delivery of an early embryo back to the fertilization site using magnetically-controlled microrobots. As the embryo will be in contact with the secretory oviduct fluid, it can develop under natural conditions and in synchrony with the endometrium preparation. We discuss the potential microrobot designs, including a proper selection of materials and processes, envisioning their translation from bench to animal studies and human medicine. Finally, we highlight regulatory and ethical considerations for bringing this technology to the clinic.
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Affiliation(s)
- Richard Nauber
- Micro- and NanoBiomedical Engineering Group (MNBE) Institute for Integrative Nanosciences, Leibniz Institute for Solid State and Materials Research (IFW), 01069, Dresden, Germany
| | - Sandhya R Goudu
- Micro- and NanoBiomedical Engineering Group (MNBE) Institute for Integrative Nanosciences, Leibniz Institute for Solid State and Materials Research (IFW), 01069, Dresden, Germany
| | - Maren Goeckenjan
- Medical Clinic I, University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Martin Bornhäuser
- Medical Clinic I, University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Carla Ribeiro
- Micro- and NanoBiomedical Engineering Group (MNBE) Institute for Integrative Nanosciences, Leibniz Institute for Solid State and Materials Research (IFW), 01069, Dresden, Germany
| | - Mariana Medina-Sánchez
- Micro- and NanoBiomedical Engineering Group (MNBE) Institute for Integrative Nanosciences, Leibniz Institute for Solid State and Materials Research (IFW), 01069, Dresden, Germany. .,Chair of Micro- and NanoSystems, Center for Molecular Bioengineering (B CUBE), Dresden University of Technology, 01062, Dresden, Germany.
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Compressibility and porosity modulate the mechanical properties of giant gas vesicles. Proc Natl Acad Sci U S A 2023; 120:e2211509120. [PMID: 36649434 PMCID: PMC9942814 DOI: 10.1073/pnas.2211509120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Gas vesicles used as contrast agents for noninvasive ultrasound imaging must be formulated to be stable, and their mechanical properties must be assessed. We report here the formation of perfluoro-n-butane microbubbles coated with surface-active proteins that are produced by filamentous fungi (hydrophobin HFBI from Trichoderma reesei). Using pendant drop and pipette aspiration techniques, we show that these giant gas vesicles behave like glassy polymersomes, and we discover novel gas extraction regimes. We develop a model to analyze the micropipette aspiration of these compressible gas vesicles and compare them to incompressible liquid-filled vesicles. We introduce a sealing parameter to characterize the leakage of gas under aspiration through the pores of the protein coating. Utilizing this model, we can determine the elastic dilatation modulus, surface viscosity, and porosity of the membrane. These results demonstrate the engineering potential of protein-coated bubbles for echogenic and therapeutic applications and extend the use of the pipette aspiration technique to compressible and porous systems.
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Influence of Percutaneous Drainage Surgery and the Interval to Perform Laparoscopic Cholecystectomy on Acute Cholecystitis through Genetic Algorithm-Based Contrast-Enhanced Ultrasound Imaging. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:3602811. [PMID: 35942459 PMCID: PMC9356791 DOI: 10.1155/2022/3602811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/08/2022] [Accepted: 06/28/2022] [Indexed: 12/07/2022]
Abstract
To discuss the optimal interval time between genetic algorithm-based ultrasound imaging-guided percutaneous drainage surgery (PTGD) and laparoscopic cholecystectomy (LC), 64 cholecystitis patients were selected as the research objects and evenly divided into experimental group (intelligent algorithm was adopted to recognize patients’ ultrasonic images) and control group (professional doctors carried out diagnosis). 92 acute cholecystitis patients undergoing PTGD were divided into three groups. 30 out of the 92 patients received LC within 2 months and were defined as the early group. 32 were performed with LC within 2 to 4 months and were defined as the metaphase group. 28 underwent LC over 4 months and were defined as the late-stage group. The average operation time, the transition from LC to laparotomy, the average postoperative hospital stay, and the incidence of complications of the three groups were compared. The results revealed that the comparison of the diagnostic accuracy and comprehensive effectiveness between experimental group and control group demonstrated that the differences were statistically significant (
). When the optimal interval of implementing LC after PTGD was realized, the corresponding values of the early group were 88.5 minutes, 16.67%, 8.13 days, and 13.75%. Those of the metaphase group were 49.91 minutes, 3.13%, 4.97 days, and 9.52%. Those of the late stage group were 68.78 minutes, 10.71%, 7.09 days, and 11.96%. To sum up, the diagnostic accuracy and comprehensive effectiveness of intelligent algorithm were higher than those of conventional ultrasound, and the optimal interval time of implementing LC after PTGD was 2 to 4 months.
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Wahyulaksana G, Wei L, Schoormans J, Voorneveld J, van der Steen AFW, de Jong N, Vos HJ. Independent Component Analysis Filter for Small Vessel Contrast Imaging During Fast Tissue Motion. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:2282-2292. [PMID: 35594222 DOI: 10.1109/tuffc.2022.3176742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Suppressing tissue clutter is an essential step in blood flow estimation and visualization, even when using ultrasound contrast agents. Blind source separation (BSS)-based clutter filter for high-framerate ultrasound imaging has been reported to perform better in tissue clutter suppression than the conventional frequency-based wall filter and nonlinear contrast pulsing schemes. The most notable BSS technique, singular value decomposition (SVD) has shown compelling results in cases of slow tissue motion. However, its performance degrades when the tissue motion is faster than the blood flow speed, conditions that are likely to occur when imaging the small vessels, such as in the myocardium. Independent component analysis (ICA) is another BSS technique that has been implemented as a clutter filter in the spatiotemporal domain. Instead, we propose to implement ICA in the spatial domain where motion should have less impact. In this work, we propose a clutter filter with the combination of SVD and ICA to improve the contrast-to-background ratio (CBR) in cases where tissue velocity is significantly faster than the flow speed. In an in vitro study, the range of fast tissue motion velocity was 5-25 mm/s and the range of flow speed was 1-12 mm/s. Our results show that the combination of ICA and SVD yields 7-10 dB higher CBR than SVD alone, especially in the tissue high-velocity range. The improvement is crucial for cardiac imaging where relatively fast myocardial motions are expected.
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Methods to evaluate vascular function: a crucial approach towards predictive, preventive, and personalised medicine. EPMA J 2022; 13:209-235. [PMID: 35611340 PMCID: PMC9120812 DOI: 10.1007/s13167-022-00280-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/06/2022]
Abstract
Endothelium, the gatekeeper of our blood vessels, is highly heterogeneous and a crucial physical barrier with the ability to produce vasoactive and protective mediators under physiological conditions. It regulates vascular tone, haemostasis, vascular inflammation, remodelling, and angiogenesis. Several cardio-, reno-, and cerebrovascular diseases begin with the dysfunction of endothelial cells, and more recently, COVID-19 was also associated with endothelial disease highlighting the need to monitor its function towards prevention and reduction of vascular dysfunction. Endothelial cells are an important therapeutic target in predictive, preventive, and personalised (3P) medicine with upmost importance in vascular diseases. The development of novel non-invasive techniques to access endothelial dysfunction for use in combination with existing clinical imaging modalities provides a feasible opportunity to reduce the burden of vascular disease. This review summarises recent advances in the principles of endothelial function measurements. This article presents an overview of invasive and non-invasive techniques to determine vascular function and their major advantages and disadvantages. In addition, the article describes mechanisms underlying the regulation of vascular function and dysfunction and potential new biomarkers of endothelial damage. Recognising these biomarkers is fundamental towards a shift from reactive to 3P medicine in the vascular field. Identifying vascular dysfunction earlier with non-invasive or minimally invasive techniques adds value to predictive diagnostics and targeted prevention (primary, secondary, tertiary care). In addition, vascular dysfunction is a potential target for treatments tailored to the person.
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Kilic M, Scalzo F, Lyle C, Baldaranov D, Dirnbacher M, Honda T, Liebeskind DS, Schlachetzki F. A mobile battery-powered brain perfusion ultrasound (BPU) device designed for prehospital stroke diagnosis: correlation to perfusion MRI in healthy volunteers. Neurol Res Pract 2022; 4:13. [PMID: 35399083 PMCID: PMC8996400 DOI: 10.1186/s42466-022-00179-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/11/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Early prehospital stroke identification is crucial for goal directed hospital admission especially in rural areas. However, clinical prehospital stroke scales are designed to identify any stroke but cannot sufficiently differentiate hemorrhagic from ischemic stroke, including large vessel occlusion (LVO) amenable to mechanical thrombectomy. We report on a novel small, portable and battery driven point-of-care ultrasound system (SONAS®) specifically developed for mobile non-invasive brain perfusion ultrasound (BPU) measurement after bolus injection of an echo-enhancing agent suitable for the use in prehospital stroke diagnosis filling a current, unmet and critical need for LVO identification. METHODS In a phase I study of healthy volunteers we performed comparative perfusion-weighted magnetic resonance imaging (PWI) and BPU measurements, including safety analysis. RESULTS Twelve volunteers (n = 7 females, n = 5 males, age ranging between 19 and 55 years) tolerated the measurement extremely well including analysis of blood-brain barrier integrity, and the correlation coefficient between the generated time kinetic curves after contrast agent bolus between PWI and BPU transducers ranged between 0.89 and 0.76. CONCLUSIONS Mobile BPU using the SONAS® device is feasible and safe with results comparable to PWI. When applied in conjunction with prehospital stroke scales this may lead to a more accurate stroke diagnosis and patients bypassing regular stroke units to comprehensive stroke centers. Further studies are needed in acute stroke patients and in the prehospital phase including assessment of immediate and long-term morbidity and mortality in stroke. TRIAL REGISTRATION Clinical trials.gov, registered 28.Sep.2017, Identifier: NCT03296852.
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Affiliation(s)
- Mustafa Kilic
- Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, medbo Bezirksklinikum Regensburg, Universitaetsstr.84, 93053, Regensburg, Germany
| | - Fabien Scalzo
- Department of Neurology, UCLA Stroke Center and Brain Research Institute, 635 Charles E Young Drive South, Suite 116, Los Angeles, CA, 90095, USA
| | - Chandler Lyle
- BURL Concepts, Inc., 4901 Morena Boulevard Suite 703, San Diego, CA, 92117, USA
| | - Dobri Baldaranov
- Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, medbo Bezirksklinikum Regensburg, Universitaetsstr.84, 93053, Regensburg, Germany
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, 9860 Mesa Rim Road, San Diego, CA, 92121, USA
| | | | - Tristan Honda
- Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California Los Angeles, Ronald Reagan UCLA Medical Center, 300 Medical Plaza Driveway B200, Los Angeles, CA, 90095, USA
| | - David S Liebeskind
- Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California Los Angeles, Ronald Reagan UCLA Medical Center, 300 Medical Plaza Driveway B200, Los Angeles, CA, 90095, USA
| | - Felix Schlachetzki
- Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, medbo Bezirksklinikum Regensburg, Universitaetsstr.84, 93053, Regensburg, Germany.
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Bergner R, Splitthoff J, Wadsack D. Use of Contrast-Enhanced Ultrasound Sonography in Giant Cell Arteritis: A Proof-of-Concept Study. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:143-148. [PMID: 34702639 DOI: 10.1016/j.ultrasmedbio.2021.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
C-Reactive protein and erythrocyte sedimentation rate are crucial parameters used to monitor giant cell arteritis (GCA). Given that tocilizumab is approved for the treatment of GCA, these parameters are less sensitive because of the effects of interleukin-6 receptor blockade. Thus, the optimal method for monitoring GCA patients undergoing tocilizumab therapy, especially patients exhibiting a persistent thickened vessel wall in large vessels, remains unclear. Contrast-enhanced ultrasonography (CEUS) can increase the visibility of tissue perfusion by slow blood flow, which cannot be detected by power color doppler. We used CEUS to investigate patients with active and inactive GCA of the large vessels (active large vessel arteritis [aLVV]/inactive large vessel arteritis [iLVV]) who were not administered tocilizumab in this proof-of-concept study. After injection of the ultrasound contrast agent, the contrasted area (CA) of large vessels in a transverse section was calculated twice: first when the lumen was contrasted completely and once again 4-8 s later. We investigated the value of increase in CA that exhibited the best sensitivity and specificity for aLVV. Twenty-four patients were included in this study: 15 with aLVV and 9 with iLVV. The CA increased from 32.2 ± 16.8 to 52.5 ± 21.3 mm2 (p < 0.0001) in aLVV. The mean CA remained unchanged in iLVV. The best cutoff value to differentiate between aLVV and iLVV was a ≥25% increase in CA with a sensitivity and specificity of 91.7% and 100%, respectively. Our study indicates that CEUS can detect aLVV with high sensitivity and specificity. Incorporation of CEUS into routine clinical practice might result in a good method for monitoring disease activity in LVV in GCA patients. The limitation of our study was the small number of patients and the lack of investigator blinding to clinical data.
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Affiliation(s)
- Raoul Bergner
- Medizinische Klinik A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany.
| | - Jan Splitthoff
- Medizinische Klinik A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany
| | - Daniel Wadsack
- Medizinische Klinik A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany
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Dyrla P, Lubas A, Gil J, Saracyn M, Gonciarz M. Dynamic Doppler Ultrasound Assessment of Tissue Perfusion Is a Better Tool than a Single Vessel Doppler Examination in Differentiating Malignant and Inflammatory Pancreatic Lesions. Diagnostics (Basel) 2021; 11:2289. [PMID: 34943526 PMCID: PMC8700751 DOI: 10.3390/diagnostics11122289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
Dynamic tissue perfusion measurement (DTPM) and single vessel flow measurement (SVFM) were assessed in differentiating inflammatory and malignant lesions of the pancreas. Sixty-nine patients (age 62.0 ± 14.7; 33 Female and 36 Men; 40 with malignant and 29 with inflammatory lesions) in whom during the endoscopic ultrasound (EUS) of focal pancreatic lesions it was possible to adequately evaluate the flow in the color Doppler, and then perform a biopsy, were qualified for the study. The assessed DTPM parameters flow velocity (TFV), perfusion intensity (TPI), and resistive index (TRI) as well as the following SVFM parameters: flow velocity (FV), volume flow (VolF), and resistive index (RI) differed significantly between the malignant and inflammatory lesions (p < 0.005). TFV and TPI have slightly better discriminatory properties than the corresponding FV and VolF parameters (p < 0.10). Considering the Doppler parameters usually evaluated in a given method, the TPI = 0.009 cm/s (sensitivity 79%, specificity 92%, AUC 0.899, p < 0.001) was significantly better (p = 0.014) in differentiating between inflammatory and malignant pancreatic lesions in comparison to FV = 2.526 cm/s (sensitivity 79%, specificity 70%, AUC 0.731, p < 0.001). Tissue perfusion has better discriminatory properties in the differentiation of solid pancreatic lesions than the Doppler blood flow examination in the single vessel within the tumor.
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Affiliation(s)
- Przemysław Dyrla
- Department of Gastroenterology, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.G.); (M.G.)
| | - Arkadiusz Lubas
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, 04-141 Warsaw, Poland;
| | - Jerzy Gil
- Department of Gastroenterology, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.G.); (M.G.)
| | - Marek Saracyn
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, 04-141 Warsaw, Poland;
| | - Maciej Gonciarz
- Department of Gastroenterology, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.G.); (M.G.)
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Kuroda H, Abe T, Fujiwara Y, Nagasawa T, Suzuki Y, Kakisaka K, Takikawa Y. Contrast-Enhanced Ultrasonography-Based Hepatic Perfusion for Early Prediction of Prognosis in Acute Liver Failure. Hepatology 2021; 73:2455-2467. [PMID: 33151580 PMCID: PMC8252126 DOI: 10.1002/hep.31615] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Acute liver failure (ALF) is a rare but dramatic clinical syndrome characterized by massive hepatic necrosis leading to multiorgan failure. It is difficult to predict the outcomes in patients with ALF using existing prognostic models. We aimed to analyze hepatic perfusion using contrast-enhanced ultrasound and Doppler ultrasound in patients with ALF and investigate its utility as a prognostic biomarker. APPROACH AND RESULTS In this prospective observational study, 208 patients with acute liver injury/ALF were enrolled from 2015 to 2019. We evaluated 50 consecutive patients with ALF with Doppler ultrasound and contrast-enhanced ultrasound performed on admission. The cases were divided into the following two groups: survivors (recovered without surgical intervention) and nonsurvivors (died of ALF or underwent liver transplantation). The time to peak and peak intensity of hepatic artery, portal vein, hepatic vein, and liver parenchyma were calculated using the time-intensity curve analysis. The hepatic artery (HA) resistive index was calculated using the fast Fourier transform analysis of Doppler ultrasound. The time interval (TI) between the time to peak of HA and liver parenchyma (LP) was significantly shorter in the nonsurvivors than in the survivors (P < 0.0001). The area under the receiver operating curve values for TI (HA, LP), Japanese scoring system, HE prediction model, Model for End-Stage Liver Disease score, and King's College Hospital criteria for the prediction of poor prognosis were 0.953, 0.914, 0.861, 0.816, and 0.731, respectively. The most appropriate cutoff value of TI (HA, LP) was 6.897 seconds; the sensitivity, specificity, positive and negative predictive values were 94.4%, 90.6%, 85.0%, and 96.7%, respectively. CONCLUSIONS TI (HA, LP) accurately predicts the outcome in patients with ALF and may be useful in clinical decision making.
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Affiliation(s)
- Hidekatsu Kuroda
- Division of HepatologyDepartment of Internal MedicineIwate Medical UniversityYahaba‐choJapan
| | - Tamami Abe
- Division of HepatologyDepartment of Internal MedicineIwate Medical UniversityYahaba‐choJapan
| | - Yudai Fujiwara
- Division of HepatologyDepartment of Internal MedicineIwate Medical UniversityYahaba‐choJapan
| | - Tomoaki Nagasawa
- Division of HepatologyDepartment of Internal MedicineIwate Medical UniversityYahaba‐choJapan
| | - Yuji Suzuki
- Division of HepatologyDepartment of Internal MedicineIwate Medical UniversityYahaba‐choJapan
| | - Keisuke Kakisaka
- Division of HepatologyDepartment of Internal MedicineIwate Medical UniversityYahaba‐choJapan
| | - Yasuhiro Takikawa
- Division of HepatologyDepartment of Internal MedicineIwate Medical UniversityYahaba‐choJapan
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Improved Method of Contrast-enhanced Ultrasound examination of the Kidneys in Patients with Type 2 Diabetes Mellitus. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim of the research. Тo evaluate the diagnostic efficacy of the contrast-enhanced ultrasound examination of kidneys in patients with type 2 diabetes mellitus with a dose of 0.5 ml of contrast agent administered.Materials and methods. We examined 12 patients with a verified diagnosis of type 2 diabetes. The age of the examined patients was 31–59 years, the mean age was 49 ± 1.3 years. All patients underwent complex diagnostics, including ultrasound examination of the kidneys in B-mode with further renal vessels color Doppler imaging to assess vessels hemodynamics. A contrast-enhanced ultrasound examination of the kidneys was carried out using Sonovue contrast agent at the doses of 2.5 ml (according to the European Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound) and 0.5 ml (an improved technique of contrast agent intravenous bolus administration).Results. The improved technique (0.5 ml of contrast agent intravenous bolus administration) in comparison with the European Recommendations technique (2.5 ml of contrast agent intravenous bolus administration) used in patients with type 2 diabetes showed no or minor differences in the qualitative and quantitative indicators of contrast-enhanced ultrasound examination which did not affect the interpretation of the results.Conclusion. The improved contrast-enhanced ultrasound examination technique using 0.5 ml of a contrast agent showed its possibilities in diagnosing diabetic nephropathy in patients with type 2 diabetes, and also revealed the potential of an economically beneficial distribution of a contrast agent without losing the quality and information content of the study.
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Contrast-Enhanced Ultrasound (CEUS) in Non-Traumatic Abdominal Emergencies. Ultrasound Int Open 2021; 6:E76-E86. [PMID: 33728394 PMCID: PMC7954641 DOI: 10.1055/a-1347-5875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/01/2021] [Indexed: 02/08/2023] Open
Abstract
Conventional ultrasound imaging (US) is the first-line investigation in acute
non-traumatic abdominal emergencies, but sometimes it needs further
examinations, such as computed tomography (CT), to reach a certain
diagnosis. Contrast-enhanced ultrasound (CEUS), through injection of
contrast medium, may provide the radiologist with additional information
that could not be investigated with baseline US. It could help reach a
diagnosis and rapidly determine the proper therapy in an emergency setting.
The purpose of this review is to explain and illustrate the various
possibilities and limitations of CEUS in acute non-traumatic abdominal
diseases, in particular acute inflammation, parenchymal infarcts, and
hemorrhages.
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Houben AJ, Stehouwer CD. Microvascular dysfunction: Determinants and treatment, with a focus on hyperglycemia. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2020.100073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Frenzel F, Kubale R, Massmann A, Raczeck P, Jagoda P, Schlueter C, Stroeder J, Buecker A, Minko P. Artifacts in Contrast-Enhanced Ultrasound during Follow-up after Endovascular Aortic Repair: Impact on Endoleak Detection in Comparison with Computed Tomography Angiography. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:488-498. [PMID: 33358051 DOI: 10.1016/j.ultrasmedbio.2020.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
The study described here systematically analyzed how specific artifacts in contrast-enhanced ultrasound (CEUS) can affect the detection of endoleaks during follow-up after endovascular aortic repair (EVAR). Patients undergoing EVAR of atherosclerotic or mycotic abdominal aortic aneurysms using various standard and branched stent-graft material for visceral and iliac preservation were enrolled over 5 y and followed up with computed tomography angiography (CTA) and CEUS simultaneously. CEUS artifacts were frequently identified after EVAR procedures (59% of examinations) and were caused mainly by contrast agent, different prosthesis or embolization material and postinterventional changes in the aneurysm sac. This article describes how to identify important artifacts and how to avoid false-negative or false-positive interpretations of endoleaks. Despite artifacts, CEUS had higher sensitivity for endoleak detection after EVAR than CTA. CEUS was superior to CTA in the identification of late endoleaks type II and in follow-up examinations after embolization procedures, where beam-hardening artifacts limited CTA.
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Affiliation(s)
- Felix Frenzel
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany.
| | - Reinhard Kubale
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Alexander Massmann
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Paul Raczeck
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Philippe Jagoda
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Christian Schlueter
- Clinic for General, Abdominal and Vascular Surgery, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Jonas Stroeder
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Arno Buecker
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Peter Minko
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
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Glutig K, Alhussami I, Krüger PC, Waginger M, Eckoldt F, Mentzel HJ. Case Report: Report of 2 Different Cases of Ovarian Teratoma Evaluated by Dynamic Contrast-Enhanced Ultrasound. Front Pediatr 2021; 9:681404. [PMID: 34178898 PMCID: PMC8226026 DOI: 10.3389/fped.2021.681404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
Ovarian masses are not easily differentiated on transabdominal ultrasound in children. A useful supplement in various pediatric applications is dynamic contrast-enhanced ultrasound (dynCEUS). It can be performed quickly and easily. However, the literature for dynCEUS on pediatric ovarian masses is limited. We compared two cases with ovarian teratoma in which dynCEUS was a helpful additional tool.
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Affiliation(s)
- Katja Glutig
- Section for Pediatric Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Ilmi Alhussami
- Pediatric Surgery Clinic, University Hospital Jena, Jena, Germany
| | - Paul-Christian Krüger
- Section for Pediatric Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Matthias Waginger
- Section for Pediatric Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | | | - Hans-Joachim Mentzel
- Section for Pediatric Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
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Emanuel AL, Meijer RI, van Poelgeest E, Spoor P, Serné EH, Eringa EC. Contrast-enhanced ultrasound for quantification of tissue perfusion in humans. Microcirculation 2019; 27:e12588. [PMID: 31465606 PMCID: PMC7050534 DOI: 10.1111/micc.12588] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 12/17/2022]
Abstract
Contrast-enhanced ultrasound is an imaging technique that can be used to quantify microvascular blood volume and blood flow of vital organs in humans. It relies on the use of microbubble contrast agents and ultrasound-based imaging of microbubbles. Over the past decades, both ultrasound contrast agents and experimental techniques to image them have rapidly improved, as did experience among investigators and clinicians. However, these improvements have not yet resulted in uniform guidelines for CEUS when it comes to quantification of tissue perfusion in humans, preventing its uniform and widespread use in research settings. The objective of this review is to provide a methodological overview of CEUS and its development, the influences of hardware and software settings, type and dosage of ultrasound contrast agent, and method of analysis on CEUS-derived perfusion data. Furthermore, we will discuss organ-specific imaging challenges, advantages, and limitations of CEUS.
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Affiliation(s)
- Anna L Emanuel
- Department of Internal Medicine, Amsterdam University Medical Center, Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Rick I Meijer
- Department of Internal Medicine, Amsterdam University Medical Center, Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Erik van Poelgeest
- Department of Internal Medicine, Amsterdam University Medical Center, Location VU University Medical Centre, Amsterdam, The Netherlands.,Department of Physiology, Amsterdam University Medical Center, Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Pien Spoor
- Department of Physiology, Amsterdam University Medical Center, Location VU University Medical Centre, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam University Medical Center, Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Erik H Serné
- Department of Internal Medicine, Amsterdam University Medical Center, Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Etto C Eringa
- Department of Physiology, Amsterdam University Medical Center, Location VU University Medical Centre, Amsterdam, The Netherlands
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