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Hofmann AG, Mlekusch I, Wickenhauser G, Walter C, Taher F, Assadian A. Individualizing Surveillance after Endovascular Aortic Repair Using a Modular Imaging Algorithm. Diagnostics (Basel) 2024; 14:930. [PMID: 38732344 PMCID: PMC11082944 DOI: 10.3390/diagnostics14090930] [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: 03/15/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES Surveillance after endovascular aortic repair (EVAR) and fenestrated EVAR (FEVAR) is mainly directed by one-size-fits-all approaches instead of personalized decision making, even though treatment strategies and often endografts themselves are tailor-made to adjust for individual patients. We propose a modular imaging algorithm that escalates surveillance imaging based on invasiveness and need. MATERIALS AND METHODS In this retrospective observational study of single-center data, results of a modular imaging algorithm were analyzed. The algorithm is characterized by initiating the examination with standard B-mode then transitioning to Duplex ultrasound, B-Flow, and CEUS. Additional CT(A) studies are conducted where required. The study population included both patients receiving EVAR or FEVAR. A comparative analysis was conducted regarding endoleak detection. RESULTS The study population included 28 patients receiving EVAR and 40 patients receiving FEVAR. They accounted for 101 follow-up visits, which led to 431 distinct imaging studies. CEUS has the highest endoleak detection rate, followed by CTA and B-Flow. Duplex ultrasound and B-Flow resulted in 0 and 1 false positive cases, respectively, considering CEUS the reference standard. In a select group of six patients, CEUS was omitted after endoleaks were displayed by Duplex ultrasound or B-Flow, leading to a successful type II coiling and no aneurysm-related adverse events. CONCLUSIONS The proposed modular algorithm showed great potential to incorporate principles of personalized medicine in surveillance after endovascular aortic treatment. Since Duplex ultrasound and B-Flow rarely cause false positive endoleaks, more resource-intensive and invasive imaging studies such as CEUS and CTA can be omitted after positive identification.
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Affiliation(s)
- Amun Georg Hofmann
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria
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Miwa H, Sugimori K, Yonei S, Yoshimura H, Endo K, Oishi R, Funaoka A, Tsuchiya H, Kaneko T, Numata K, Maeda S. Differential Diagnosis of Solid Pancreatic Lesions Using Detective Flow Imaging Endoscopic Ultrasonography. Diagnostics (Basel) 2024; 14:882. [PMID: 38732296 PMCID: PMC11082975 DOI: 10.3390/diagnostics14090882] [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: 03/27/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
The differential diagnosis of solid pancreatic lesions (SPLs) using B-mode endoscopic ultrasonography (EUS) is challenging. Detective flow imaging (DFI) offers the potential for detecting low-flow vessels in the pancreas, thus enhancing diagnostic accuracy. This retrospective study aimed to investigate DFI-EUS findings of SPLs and analyze their differential diagnostic accuracy for pancreatic cancer. We included 104 patients with pathologically confirmed SPLs who underwent EUS between April 2021 and June 2023. Expert endosonographers, blinded to the patients' clinical data, evaluated images obtained through B-mode, eFLOW, and DFI-EUS. The frame rate and vessel detection sensitivity were compared between eFLOW and DFI, and the diagnostic criteria for pancreatic cancer were established. The visualization rate for vessels in SPLs was significantly higher with DFI-EUS (96%) compared to eFLOW (27%). Additionally, DFI showed a superior frame rate, sensitivity (99%), and accuracy (88%) for detecting pancreatic cancer, although with a modest specificity (43%). On DFI-EUS, characteristics such as hypovascularity, peritumoral vessel distribution, or spotty vessel form were suggestive of pancreatic cancer. DFI-EUS significantly improved the visualization of vascular structures within the SPLs, highlighting its efficacy as a diagnostic modality for pancreatic cancer.
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Affiliation(s)
- Haruo Miwa
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan (K.N.)
| | - Kazuya Sugimori
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan (K.N.)
| | - Shoichiro Yonei
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan (K.N.)
| | - Hayato Yoshimura
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan (K.N.)
| | - Kazuki Endo
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan (K.N.)
| | - Ritsuko Oishi
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan (K.N.)
| | - Akihiro Funaoka
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan (K.N.)
| | - Hiromi Tsuchiya
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan (K.N.)
| | - Takashi Kaneko
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan (K.N.)
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan (K.N.)
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University, Yokohama 236-0004, Japan;
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Weng C, Gu X, Jin H. Coded Excitation for Ultrasonic Testing: A Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:2167. [PMID: 38610378 PMCID: PMC11014118 DOI: 10.3390/s24072167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024]
Abstract
Originating in the early 20th century, ultrasonic testing has found increasingly extensive applications in medicine, industry, and materials science. Achieving both a high signal-to-noise ratio and high efficiency is crucial in ultrasonic testing. The former means an increase in imaging clarity as well as the detection depth, while the latter facilitates a faster refresh of the image. It is difficult to balance these two indicators with a conventional short pulse to excite the probe, so in general handling methods, these two factors have a trade-off. To solve the above problems, coded excitation (CE) can increase the pulse duration and offers great potential to improve the signal-to-noise ratio with equivalent or even higher efficiency. In this paper, we first review the fundamentals of CE, including signal modulation, signal transmission, signal reception, pulse compression, and optimization methods. Then, we introduce the application of CE in different areas of ultrasonic testing, with a focus on industrial bulk wave single-probe detection, industrial guided wave detection, industrial bulk wave phased array detection, and medical phased array imaging. Finally, we point out the advantages as well as a few future directions of CE.
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Affiliation(s)
| | | | - Haoran Jin
- The State Key Laboratory of Fluid Power and Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, China; (C.W.); (X.G.)
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Hofmann A, Mlekusch I, Wickenhauser G, Walter C, Falkensammer J, Assadian A, Taher F. Ultrasound Coded-Excitation Imaging for Endoleak Detection After Complex Endovascular Aortic Repair. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:429-437. [PMID: 37972197 DOI: 10.1002/jum.16374] [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: 10/11/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Several imaging modalities have been suggested for surveillance after fenestrated endovascular aortic repair in general and endoleak detection in specific. In the present project a coded excitation-based ultrasound (B-Flow) was investigated for endoleak detection after complex endovascular aortic repair. METHODS Patients post complex endovascular aortic repair (FEVAR or T/FEVAR) undergoing follow-up appointments including ultrasonography of the aorta at a vascular and endovascular surgery outpatient center were included in the study. B-Flow was compared with computed tomography angiography (CTA), Duplex ultrasound (DUS), and contrast-enhanced ultrasound (CEUS) regarding agreement and reliability for endoleak detection and characterization. RESULTS In total, 47 follow-ups were included. They accumulated in a total of 149 imaging investigations. Endoleaks were discovered in 44.7% of B-Flow studies and a majority of these endoleaks were classified as type II. Agreement between B-Flow and other imaging modalities was good (>80.0%) in general. However, with B-Flow 6 and 2 endoleaks would have been missed compared with CEUS and CTA, respectively. Regarding endoleak classification, B-Flow had a strong agreement (94.5%) with CEUS in detected cases. Furthermore, in a limited subset analysis, imaging findings were externally validated using findings from angiography. CONCLUSIONS Ultrasonography allows for endoleak detection and characterization without an invasive procedure or the use of potentially nephrotoxic contrast medium and can reduce radiation exposure. While CEUS mitigates issues of radiation and nephrotoxicity it still requires the intravenous application of contrast enhancers. Ultrasound coded-excitation imaging such as B-Flow could therefore further simplify endoleak surveillance after fenestrated endovascular aortic repair.
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Affiliation(s)
- Amun Hofmann
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria
| | - Irene Mlekusch
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria
| | - Georg Wickenhauser
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria
| | - Corinna Walter
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria
| | | | - Afshin Assadian
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria
| | - Fadi Taher
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria
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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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Hofmann AG, Klosz FR, Mlekusch I, Wickenhauser G, Walter C, Assadian A, Taher F. Endoleak Detection after Endovascular Aortic Repair via Coded-Excitation Ultrasound-A Feasibility Study. J Clin Med 2023; 12:jcm12113775. [PMID: 37297970 DOI: 10.3390/jcm12113775] [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: 03/24/2023] [Revised: 05/20/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Endoleaks are the most common complication after endovascular aortic repair (EVAR). Their correct identification is one of the main objectives of surveillance protocols after EVAR. So far, computed tomography angiography (CTA), contrast-enhanced (CEUS) and Duplex ultrasound (DUS), as well as magnetic resonance angiography, have been investigated for their ability to detect endoleaks. In general, all technologies have distinct benefits and disadvantages, with CTA and CEUS emerging as the reference standard for surveillance after EVAR. However, they are both contrast-enhancer-dependent, and CTA additionally exposes patients to ionizing radiation. In the present study, we investigated B-Flow, a type of coded-excitation ultrasound that was specifically designed to optimize the visualization of blood flow, for its ability to detect endoleaks, and compared its performance to CEUS, CTA, and DUS. In total, 34 patients were included in the analysis that accumulated in 43 distinct B-Flow investigations. They underwent a total of 132 imaging investigations. Agreement between B-Flow and other imaging modalities was high (>80.0%), while inter-method reliability can be interpreted as good. However, with B-Flow, six and one endoleaks would have been missed compared to CEUS and CTA, respectively. Regarding endoleak classification, all metrics were lower but retained an adequate level of comparison. In a subset of patients requiring intervention, B-Flow had 100% accuracy regarding both endoleak detection and classification. Ultrasonography enables endoleak detection and classification without the need for pharmaceutical contrast enhancement or radiation. Ultrasound coded-excitation imaging in the application of B-Flow could further simplify surveillance after EVAR by offering adequate accuracy without requiring intravenous contrast enhancement. Our findings may promote subsequent investigations of coded-excitation imaging for endoleak detection and classification in the surveillance after EVAR.
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Affiliation(s)
- Amun G Hofmann
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, 1160 Vienna, Austria
| | - Fabian R Klosz
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, 1160 Vienna, Austria
| | - Irene Mlekusch
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, 1160 Vienna, Austria
| | - Georg Wickenhauser
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, 1160 Vienna, Austria
| | - Corinna Walter
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, 1160 Vienna, Austria
| | - Afshin Assadian
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, 1160 Vienna, Austria
| | - Fadi Taher
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, 1160 Vienna, Austria
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Taher F, Hofmann A, Assadian A. Precision Medicine in Vascular and Endovascular Surgery. J Clin Med 2023; 12:jcm12031031. [PMID: 36769679 PMCID: PMC9917631 DOI: 10.3390/jcm12031031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Personalized medicine and precision medicine are terms often used to refer to treatment strategies tailored specifically to individual characteristics of patients, as opposed to a one-size fits all approach [...].
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Affiliation(s)
- Fadi Taher
- Correspondence: ; Tel.: +43-(14)-91504107
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