A novel saline infusion sonohysterography-based strain imaging approach for evaluation of uterine abnormalities in vivo: preliminary results

In this article, we demonstrate the feasibility of saline infusion sonohysterography-based strain imaging for the determination of stiffness variations in uterine masses in vivo. Strain images are estimated using a 2-dimensional multilevel hybrid algorithm developed for sector array ultrasound transducers. Coarse displacements are initially estimated using envelope echo signals, followed by a guided finer displacement estimation using window lengths on the order of 6 wavelengths and 7 A-lines on radiofrequency data. Strain images are obtained by estimating displacement slopes using least squares estimation. In this prospective study, we show that stiffer masses such as fibroids appear darker or as regions with low strain on strain images and are thus clearly differentiated when compared to normal uterine tissue. A high strain boundary around stiffer masses referred to as a "halo" due to increased slipping or sliding of the mass during the applied deformation is also visualized. Uterine polyps, on the other hand, are visualized as masses that are brighter or regions with high strain when compared to the background myometrium, indicating the presence of a softer mass. Axial strain images provide additional new information that may supplement current clinical B-mode imaging used for the diagnosis of uterine abnormalities. Our results show the feasibility of improving clinical diagnosis based on strain imaging.     

Sonographic elasticity imaging of acute and chronic deep venous thrombosis in humans.

OBJECTIVE: The purpose of this study was to assess the ability of sonographic elasticity imaging to distinguish acute from chronic deep venous thrombosis (DVT). METHODS: Fifty-four patients, 26 with acute DVT and 28 with chronic DVT, were studied, and we analyzed the data in 46 patients, 23 with acute (mean age, 5.7 days) and 23 with chronic (>8 months) DVT. Scanning was performed with a 5-MHz linear array transducer during continuous freehand external deformation of each thrombus using the ultrasound scan head. The strains in the thrombi were normalized to the average strain between the skin surface and the back wall of the vein. Relative thrombus echogenicity was measured by comparing the echogenicity of the thrombus with that of the adjacent arterial lumen. Statistical analyses were performed with the Mann-Whitney U test and receiver operating characteristic analysis. RESULTS: The median normalized strain magnitude for the acute cases was 2.75, with an interquartile range of 2.4 to 3.71, whereas the median normalized strain magnitude for the chronic cases was 0.94, with interquartile range of 0.48 to 1.36. The difference was highly significant (P < 10(-7)). The area under the receiver operating characteristic curve (A(z)) was 0.97 +/- 0.02 (SE). The echogenicity difference between the populations was highly significant (P < 10(-5)), with A(z) of 0.92 +/- 0.04. The difference between the A(z) values was not significant (P > .05). CONCLUSIONS: In this population, sonographic elasticity imaging performs at least as well as thrombus echogenicity. Thrombus aging using elasticity imaging would be particularly helpful in evaluating symptoms in patients with post-thrombotic syndrome.     

急性肌肉拉伤的MRI应用进展

急性肌肉拉伤是一种急性间接肌肉损伤,常见于日常生活和运动中。仅根据临床症状和体格检查难以准确诊断。常规MRI软组织分辨率高,是急性肌肉拉伤诊断和预后评估的重要手段。近年发展的肌肉MR弹性成像、T2弛豫时间图、磁共振扩散加权成像、扩散张量成像和磁共振波谱具有从微观结构、病理和生理层面为急性肌肉拉伤的诊断提供定量、客观依据的潜力。作者对应用于急性肌肉拉伤的各项MRI技术进行综述。     

应变及应变率显像评价尿毒症性心肌病的心功能

目的探讨应变及应变率显像评价尿毒症性心肌病（尿毒症组）心功能的价值。方法应用应变、应变率显像、组织多普勒显像测量35例尿毒症性心肌病与30例正常人（对照组）左室各节段的应变（ε,包括εS和εE）、应变率（SR,包括SRS和SRE）,室壁运动峰值流速（V,包括VS和VE）。结果尿毒症组的εS、SRS、SRE、VS、VE明显低于对照组（t分别=2.45、2.09、5.31、4.26、4.63,P均〈0.05）;②εS、SRS、SRE和VS、VE呈直线正相关（t分别=4.78、5.63、5.05和4.31、4.91、5.05,P均〈0.05）;③εS、SRS、SRE评价心功能受损的敏性和特异性均高于参数VS（t分别=2.05、2.14、2.74和2.17、2.07、2.69,P均〈0.05）,SRS、SRE评价心功能受损的敏感性和特异性也均高于参数VE（t分别=2.08、2.15和2.11、2.07,P均〈0.05）。结论应变、应变率显像能较好地评价心肌局部收缩功能,对早期诊断尿毒症心肌病有较好价值,为临床综合治疗提供理论依据。     

Elastographic evaluation of the temporal formation of ethanol-induced hepatic lesions: preliminary in vitro results.

OBJECTIVE: The purpose of this study was to evaluate the temporal formation of ethanol-induced hepatic lesions using ultrasound elastography. METHODS: An in vitro porcine liver was used as the specimen, and 4 lesions were created by injection of 2 mL of ethanol. After the ethanol injection, freehand elastography of the lesion from an identical scan plane was obtained during a time series (with an interval of approximately 30 seconds in the first 2 minutes and 1 minute afterward) using a real-time ultrasound scanner. The area of the lesion in the elastographic sequences was calculated to depict the temporal formation of the lesion. RESULTS: The ethanol-induced lesion on elastography appeared as a low-strain region whose boundary was clear and irregular. The elastographic sequences obtained after the ethanol injection showed that the lesion formed quickly in the first 2 minutes and then changed little in shape. The area of the lesion grew notably in the first 2 minutes after ethanol injection, and then it reached a plateau of about 0.7 cm(2). CONCLUSIONS: Ultrasound elastography is capable of monitoring the temporal formation of ethanol-induced lesions and is a potential imaging modality to evaluate the response of percutaneous ethanol injection therapy.     

应变及应变率成像评估心肌桥患者局部心肌缺血的价值

目的探讨定量组织速度成像和应变及应变率评估冠状动脉心肌桥引起局部心肌缺血的临床价值。方法冠状动脉前降支心肌桥患者47例(心肌桥组)与冠状动脉正常者40例(对照组),测量前降支支配区域9个节段的收缩期峰值速度、峰值应变及应变率、舒张早、晚期峰值速度、舒张早、晚期峰值应变及相应的应变率。结果与对照组比较,心肌桥组前间隔各节段、前壁基底段及中间段、后间隔中间段收缩期峰值速度及峰值应变率明显减低(P<0.05);前间隔基底段和中间段舒张早期、晚期峰值速度及舒张早期峰值应变率明显减低(P<0.05);前壁基底段、前间隔各节段收缩期峰值应变,前壁、前间隔舒张晚期峰值应变明显减低、侧壁心尖段明显升高(P<0.05)。结论定量组织速度成像和应变及应变率可定量检测冠状动脉心肌桥引起的心肌缺血。     

扩散加权成像在宫颈癌诊断中的初步应用

目的：分析正常子宫宫颈3层结构及宫颈癌的扩散加权成像（DWI）特点，探讨其及相应的表观扩散系数（ADC）对宫颈癌的诊断价值。材料与方法：对15例非子宫疾病女性患者及12例宫颈癌患者在1．5TMR上行盆腔DWI成像。DWI序列的b值为0、800s／mm^2。在DWI及ADC图中观察正常宫颈的层次结构，并比较不同分层的ADC值；在DWI图像中测量宫颈癌病灶相对于闭孔内肌的信号强度比值（SIR），并与常规T1WI及T2WI同法获得的SIR比较；测量宫颈癌组织的ADC值并与对照组比较。结果：在对照组中有73％的病例（11／15）在DWI图像中可以分清宫颈的3层结构，而在ADC图中则为100％。3层结构的ADC值分别为（1．83±0．37）×10^-3、（1．23±0．24）×10^-3及（1．87±0．24）×10^-3mm^2，s（内膜层、结合带及肌层），3者间有显著差异。所有宫颈癌组患者的宫颈正常分层结构均消失，在DWI上均表现为弥漫高信号，ADC值为（0．86±0．08）×10—3mm^2／s，癌灶明显低于正常宫颈各层结构的ADC值。DWI、T1WI及T2WI图像中宫颈癌病灶相对于闭孔内肌的SIR分别为2．97±0．69、0．06±0．02及1．96±0．32，3者间有显著差异。结论：正常宫颈及宫颈癌在DWI及ADC图中均具有一定特征，其中DWI能较常规序列更加突出宫颈癌病灶，有助于准确诊断。     

In vitro strain measurement in the porcine antrum using ultrasound doppler strain rate imaging

Strain rate imaging (SRI) enables study of deformation in soft tissues. The aim of this study was to evaluate the accuracy of SRI in measuring strain in the porcine antral wall in vitro. An experimental set-up enabled controlled distension of a porcine stomach in a saline reservoir. Radial strain obtained by SRI was compared with radial strain calculated from B-mode ultrasonography. Circumferential strain obtained by SRI was compared with circumferential strain calculated from sonomicrometry. The agreement between radial strain values measured by SRI and B-mode, along and across several ultrasound (US) beams, using US frequency 6.7 MHz and strain length (SL) = 1.9 mm was = -1.0 +/- 12.1% and 0.5 +/- 13.4%, respectively (mean difference +/- 2SD%) and it was better than with SL 1.2 mm. Compared with sonomicrometry, SRI-determined circumferential strain using 6.7 MHz and SL = 1.9 mm was less accurate, whether averaging along or across several US beams (-9.2 +/- 46.7% and 13.8 +/- 51.2%, respectively). In conclusion, SRI gave accurate measurement of radial strain of the antral wall, but seemed to be less accurate for measurement of circumferential strain for this in vitro set-up.     

Renal sonography with 2-dimensional versus cine organ imaging: preliminary results.

OBJECTIVE: This pilot study was undertaken to determine whether cine organ imaging (COI) of the entire kidney yields a quicker and equally diagnostic study compared with traditional 2-dimensional (2D) scanning. METHODS: Fifty-seven adult patients referred for diagnostic renal sonography underwent 2D sonography followed by COI performed by a second sonographer, who was blinded to the results of the first examination. Images were interpreted blindly by 2 independent readers in 2 separate reading sessions divided into 2D or COI image sets for each patient. The acquisition time and interpretation time of each protocol were recorded. Images were scored for the percentage of kidney visualized and for the presence or absence of hydronephrosis, stones, cysts, and renal lesions (non-simple cysts and solid masses). RESULTS: The average acquisition time decreased from 13.3 to 10.5 minutes between 2D and COI studies, respectively (P = .02). The average image interpretation time increased 37 seconds (P < .0001). A greater percentage of parenchymal visualization was achieved with COI versus 2D imaging. There was no significant difference in detection of renal abnormalities (hydronephrosis, stones, renal cysts, and masses) between the 2 modes, although the detection of cysts on COI was equal to or greater than that on 2D imaging on a per-patient basis. CONCLUSIONS: Cine organ imaging decreased the acquisition time significantly while retaining and possibly improving diagnostic quality. The minimally increased interpretation time may be decreased in the future by fewer volume acquisitions per patient. Further investigations will be needed to assess the impact of color Doppler imaging in volumetric protocols as well as to compare renal lesion detection versus computed tomography and magnetic resonance imaging.     

A novel image formation method for ultrasonic strain imaging

This paper presents a new method for forming high-quality ultrasonic strain images. To achieve this goal, three radiofrequency echo frames are selected by an automated performance assessment method and used to generate two parent strain images located in the same physical grid from which a high quality composite strain image may be calculated by averaging. The automatic performance evaluation method combines the consistency among the two parent strain images and the accuracy of motion tracking into a single summary "displacement quality measure." The proposed algorithm is evaluated with datasets acquired from in vivo breast tissue data. Our results show that that the proposed strain formation method shows substantial potential to outperform other methods available in the literature.     

Initial clinical experience imaging scatterer size and strain in thyroid nodules.

OBJECTIVE: This article describes a new research ultrasound scanner that can be programmed to produce elastograms and backscatter parametric images in real time. Its performance was evaluated in a clinical setting. METHODS: Radio frequency data were acquired from 13 patients with thyroid nodules and from 4 normal thyroids, along with reference phantom data. Scatterer size was deduced by measuring the backscatter versus frequency and fitting data to a model. Strain was obtained by a cross-correlation method, comparing precompression and postcompression radio frequency signals. Scatterer size contrast was defined as the observed contrast between the "normal" and "abnormal" tissue in the same gland or, when considering diffuse conditions, by comparing with normal values. Strain contrast was estimated if abnormal and normal tissue was captured in the same palpation, that is, excluding diffuse disease, which was the case for 9 subjects. RESULTS: On scatterer size images, 4 nodules exhibited positive contrast versus the adjacent normal parenchyma, indicating larger scatterers. Five nodules were isoechoic, and 4 had negative contrast. Four nodules exhibited positive strain contrast, indicating that they were softer than the normal parenchyma. Two nodules had the same brightness, and 3 were darker than the background thyroid tissue on strain images. CONCLUSIONS: Contrast was observed between nodules and thyroid parenchymal tissue for both types of parametric images. Further work is needed to determine whether the diagnostic importance of these parameters in characterizing thyroid nodules might be worthwhile. Both modes must be of a sufficient frame rate to provide real-time feedback to operators, which will require further work.     

Vibrography during tumor neurosurgery.

OBJECTIVE: The aim of this study was to determine whether elastography, a sonographically based real-time strain imaging method for registering the elastic properties of tissue, can be used in brain tumor surgery. METHODS: A modification of classic elastography called vibrography was applied in these measurements with static compression replaced by low-frequency axial vibration. Twenty patients were examined with this technique during brain tumor surgery. A conventional sonographic system with a custom-designed radio frequency (RF) interface was used. The RF data were digitized with a 50-MHz, 12-bit peripheral component interconnect analog/digital converter for real-time or offline processing. Sonographic RF data were acquired with a 6.5-MHz endocavity curved array. A special applicator equipped with a stepping motor moved the ultrasonic probe and produced a low-frequency mechanical vibration of approximately 5 to 10 Hz with a vibration amplitude of 0.3 mm. RESULTS: Detection of tumors was possible in 18 of 20 cases. Brain tissue was normally color coded orange or red. Three major groups of tumors with different elastic properties relative to brain tissue could be differentiated. In 3 cases, the stiffness of the tumor was identical to that of brain tissue, but the tumors were surrounded by a thin yellow border. Six tumors displayed higher strain than brain, whereas 7 tumors exhibited lower strain than the surrounding cerebrum. Two patients could not be assigned clearly to either of these groups. CONCLUSIONS: These findings indicate that vibrography is a feasible imaging method for brain tumor surgery and may have numerous potential applications in neurosurgery if further improvements are made.     

正常人左室收缩功能的超声三维斑点追踪研究

目的运用三维斑点追踪成像技术(3D-STI)评价正常人左室短轴及长轴心肌应变特征,探讨其对正常人左室收缩功能的评判价值。方法健康志愿者45名,采集标准左室长轴心尖四腔、三腔切面左室全容积图像进行在线分析,自动计算左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)、左室短轴径向各水平收缩期峰值及平均应变、左室短轴环向各水平收缩期峰值及平均应变、左室长轴纵向各水平收缩期峰值及平均应变,分析各应变指标变化情况。结果正常人左室短轴径向各节段收缩期峰值及平均应变,基底水平较中间段水平增大(P<0.05),中间段水平较心尖水平增大(P<0.05),基底水平较心尖水平增大(P<0.01)。正常人左室短轴环向各节段收缩期峰值及平均应变,心尖水平较中间段水平增大(P<0.05),中间段水平较基底水平增大(P<0.05),心尖水平较基底水平增大(P<0.01)。正常人左室长轴纵向收缩期峰值及平均应变,心尖水平较中间段水平增大(P<0.05),中间段水平较基底水平增大(P<0.05),心尖水平较基底水平增大(P<0.01)。结论 3D-STI可无创、客观评价正常人在不同水平和不同节段径向、环向、纵向心肌应变,为定量评价正常人左室收缩功能提供了一种新的思路。     

Anthropomorphic phantoms for assessment of strain imaging methods involving saline-infused sonohysterography

Two anthropomorphic uterine phantoms were developed that allow assessment and comparison of strain imaging systems adapted for use with saline-infused sonohysterography (SIS). Tissue-mimicking (TM) materials consist of dispersions of safflower oil in gelatin. TM fibroids are stiffer than the TM myometrium/cervix, and TM polyps are softer. The first uterine phantom has 3-mm-diameter TM fibroids distributed randomly in TM myometrium. The second uterine phantom has a 5-mm and 8-mm spherical TM fibroid, in addition to a 5-mm spherical and a 12.5-mm-long (medicine capsule-shaped) TM endometrial polyp protruding into the endometrial cavity; also, a 10-mm spherical TM fibroid projects from the serosal surface. Strain images using the first phantom show the stiffer 3-mm TM fibroids in the myometrium. Results from the second uterine phantom show that, as expected, parts of inclusions projecting into the uterine cavity will appear very stiff, whether they are stiff or soft. Results from both phantoms show that although there is a five-fold difference in the Young's moduli values, there is not a significant difference in the strain in the transition from the TM myometrium to the TM fat. These phantoms allow for realistic comparison and evolution of SIS strain imaging techniques and can aid clinical personnel to develop skills for SIS strain imaging.     

Left ventricular function in professional football players evaluated by tissue Doppler imaging and strain imaging

Background Long-term regular exercise is associated with physiologic and morphologic cardiac alterations. Tissue Doppler Imaging(TDI) and Strain Myocardial Imaging(SI) are new tools in the evaluation systolic and diastolic myocardial function. We sought to compare TDI and SI findings in professional football players and age adjusted sedentary controls to assess the effect of regular athletic training on myocardial function. Methods Transthoracic echocardiography, M-mode, 2-D measurements, Doppler derived mitral-tricuspid annular velocities, reconstructed spectral pulsed wave tissue Doppler velocities, strain and strain rate imaging of seven different myocardial regions were obtained from 24 professional football players and age, sex and weight adjusted 20 controls. Results Age, body surface area, blood pressure and heart rate were comparable between 2 groups. Football players had significantly increased LV mass, mass index (due to both higher wall thickness and end-diastolic diameter), end-systolic and end-diastolic volume, left atrial diameter and decreased transmitral diastolic late velocity. In athletes TDI analysis showed significantly increased mitral annulus septal TDI peak early diastolic(e) velocity(0.22 ± 0.04 vs. 0.19 ± 0.04 m/s, P < 0.05), lateral TDI peak e velocity (0.19 ± 0.03 vs. 0.16 ± 0.02 m/s, P < 0.05) and lateral TDI e/a ratio (1.96 ± 0.41 and 1.66 ± 0.23, P < 0.05). In SI analysis mid septal walls (1.71 ± 0.23 in athletes and 1.49 ± 0.25 in controls, P < 0.05) and mid lateral walls (1.55 ± 0.28 and 1.34 ± 0.25 respectively, P < 0.05) peak systolic strain rate values differences were found to be increased in athletes. Conclusions Professional football playing is associated with morphologic alteration in left ventricle and left atrium and improvement in left ventricle diastolic function which can be detected by TDI. Strain rate imaging may be a new tool to define subtle change in systolic left ventricular function in “athletes heart” which cannot be determined in standard echocardiographic parameters.     

定量组织速度成像与应变、应变率成像对冠脉不同狭窄程度心肌缺血的评估

目的:探讨定量组织速度成像(QVTI)、应变(S)及应变率(SR)成像对冠脉不同狭窄程度的患者心肌缺血程度的评估.方法:以冠脉造影为诊断标准,冠心病患者79例,正常对照组30例.所有入选者均测量基底段、中间段及心尖段收缩期峰值速度(Vs)、收缩期峰值应变(Ss)及其应变率(SRs),舒张早期峰值速度(Ve)及舒张晚期峰值速度(Va)、舒张早期峰值应变(Se)、舒张晚期峰值应变(Sa)及相应的应变率(SRe、SRa).结果:冠脉重度狭窄组患者的基底段、中间段的Vs、SRs、Ss、Ve及SRe,心尖段的SRs、Ve及SRe,基底段的Va及Sa均较对照组明显减低,差异有显著性(P<0.05).结论:QVTI与S、SR能定量评估冠脉病变狭窄程度>75%的患者心肌缺血状况,对早期诊断冠心病提供更多的信息.     

犬椎间盘退变超声显像的初步实验研究

目的:明确应用超声显像评价椎间盘退变的可行性,为临床应用奠定基础。方法:对13只不同年龄犬腰骶部椎间盘进行离体超声扫查,根据椎间盘退变的病理基础对超声图像进行分析并将其分级。结果:超声图像大致分为4级退变阶段,纤维环与髓核在每个退变阶段的声像图上均有不同的特点。结论:超声能够清晰显示椎间盘组织的内部结构信息,反映其进行性退变的病理结构改变。     

经阴道实时三维子宫输卵管超声造影耐受性及造影相关疼痛因素王小倩,孙志伟,王琳,曹晓焱,温伊莉广东省深圳市福田区妇幼保健院超声科,广东深圳,518000

目的：探讨经阴道实时三维子宫输卵管超声造影(3D-HyCoSy)诊断时影响患者耐受性、相关疼痛的因素,为优化操作提升患者的舒适性提供参考。方法：选取我院自2015年3月-2016年3月间我院妇产科行经阴道实时三维子宫输卵管超声造影检查时伴疼痛的240例患者作为研究对象,分析造影耐受性差及疼痛相关原因。结果：影响受检者耐受性及疼痛相关因素包括紧张情绪、造影剂用量、宫颈通畅性、妇科炎症、造影管球囊大小等相关,数据对比差异有统计学意义(P<0.05)。结论：导致受检者耐受性差及疼痛的因素较多,因此应针对患者的情况采取相应的治疗干预,缓解患者的疼痛从而提升造影诊断的成功率。