Liver contrast enhanced ultrasound perfusion imaging in the evaluation of chronic hepatitis C fibrosis: preliminary results

We wanted to determine whether liver contrast-enhanced ultrasound (CEUS)–derived peak signal intensity (PSI) and peak signal intensity/time (PIT) predict liver fibrosis in chronic hepatitis C (CHC). Fortynine patients with CHC (METAVIR classification) and 10 control subjects were included in the study. After a bolus of 2.4 mL SonoVue (Bracco Imaging, Milan, Italy) solution was injected into a peripheral vein, the right lobe of the liver containing the right portal vein was scanned in a transverse section. Two-dimensional sonography was performed using the Philips iU22 ultrasound system (Philips Healthcare, Best, the Netherlands). A 1.0–5.0-MHz (C5-1) wideband convex transducer was used, applying the following settings in all cases. Regions of interest were manually drawn over the right liver lobe and over the portal vein (PV). Liver parenchyma PSI (LPpsi) and PIT (LPpit), portal vein PSI (PVpsi) and PIT (PVpit) were automatically calculated. dPSI was defined as the difference between PVpsi and LPpsi. A significant correlation was observed between PAPSI and fibrosis scores. When patients were stratified according to their LPpsi, a significant difference was achieved only between patients with fibrosis score 0–1 vs. 2–3 and 2 vs. 4. Statistically significant differences between all fibrosis scores, except 0 vs. 1 and 3 vs. 4 were observed when dPSI was used to stratify patients. Overall diagnostic accuracy of LPpsi and dPSI measurement for severe fibrosis by area under the receiving operator characteristic curve analysis was, respectively, 0.87 and 0.88.We suggest that liver CEUS perfusion could have the potential to be used as a complementary tool for the evaluation of liver fibrosis. However, further large-scale studies are required to accurately assess its accuracy in the evaluation of liver fibrosis

Ultrasound Perfusion Imaging for the Detection of Cerebral Hypoperfusion After Aneurysmal Subarachnoid Hemorrhage.

BACKGROUND Delayed cerebral ischemia increases mortality and morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Various techniques are applied to detect cerebral vasospasm and hypoperfusion. Contrast-enhanced ultrasound perfusion imaging (UPI) is able to detect cerebral hypoperfusion in acute ischemic stroke. This prospective study aimed to evaluate the use of UPI to enable detection of cerebral hypoperfusion after aSAH. METHODS We prospectively enrolled patients with aSAH and performed UPI examinations every second day after aneurysm closure. Perfusion of the basal ganglia was outlined to normalize the perfusion records of the anterior and posterior middle cerebral artery territory. We applied various models to characterize longitudinal perfusion alterations in patients with delayed ischemic neurologic deficit (DIND) across the cohort and predict DIND by using a multilayer classification model. RESULTS Between August 2013 and December 2015, we included 30 patients into this prospective study. The left-right difference of time to peak (TTP) values showed a significant increase at day 10-12. Patients with DIND demonstrated a significant, 4.86 times increase of the left-right TTP ratio compared with a mean fold change in patients without DIND of 0.9 times (p = 0.032). CONCLUSIONS UPI is feasible to enable detection of cerebral tissue hypoperfusion after aSAH, and the left-right difference of TTP values is the most indicative result of this finding

Demonstration of intrahepatic accumulated microbubble on ultrasound represents the grade of hepatic fibrosis

OBJECTIVES: To examine the feasibility of perflubutane-based ultrasound for grading hepatic fibrosis. METHODS: This prospective study included 202 subjects; main study (controls:33, F0–1:35, F2:26, F3:23, cirrhosis:29) and subsequent study (controls:16, F0–1:7, F2:20, F3:7, cirrhosis:6). Diagnostic abilities for assessing fibrosis grade were compared between contrast findings and FIB4 (age × AST/[platelet count × ALT(0.5)]). RESULTS: High-power emission produced an intrahepatic band-like structure, and the three-layer appearance was less frequent and monolayer appearance was more frequent in cirrhosis than controls/chronic hepatitis (P < 0.0001). Intensity difference at 15-min phase showed most significant correlation with fibrosis grade (ρ = 0.79, P < 0.0001), and the best areas under the receiver operating characteristic curves are 0.88 for marked fibrosis, 0.95 for advanced fibrosis and 0.97 for cirrhosis, which were significantly higher than those of FIB4, 0.85 for marked fibrosis, 0.89 for advanced fibrosis and 0.90 for cirrhosis. Sensitivity, specificity and efficiency of the intensity difference were 88%, 72% and 81% for marked fibrosis, 85%, 91% and 89% for advanced fibrosis and 97%, 90% and 91% for cirrhosis, respectively. The subsequent study validated the main study results; significant correlation between the intensity difference and the fibrosis grade (ρ = 0.73–0.77, P < 0.0001). CONCLUSIONS: Perflubutane-based ultrasound accurately predicts the grade of hepatic fibrosis. KEY POINTS: • The behaviour of intrahepatic microbubbles depends on the severity of hepatic fibrosis. • Layer enhancement pattern simply represents the degree of chronic liver disease. • Parenchymal intensity change due to high-power emission predicts the hepatic fibrosis grade

JACC Cardiovasc Imaging

OBJECTIVESThe study evaluated whether lipoprotein apheresis produces immediate changes in resting perfusion in subjects with severe hypercholesterolemia, and whether there is a difference in the response between peripheral and coronary microcirculations.BACKGROUNDLipoprotein apheresis is used in patients with severe hypercholesterolemia to reduce plasma levels of low-density lipoprotein cholesterol.METHODSQuantitative contrast-enhanced ultrasound perfusion imaging of the myocardium at rest and skeletal muscle at rest and during calibrated contractile exercise was performed before and immediately after lipoprotein apheresis in 8 subjects with severe hypercholesterolemia, 7 of whom had a diagnosis of familial hypercholesterolemia. Myocardial perfusion imaging was also performed in 14 normal control subjects. Changes in myocardial work and left ventricular function were assessed by echocardiography. Ex vivo ovine coronary and femoral artery ring tension assays were assessed in the presence of pre- and post-apheresis plasma.RESULTSApheresis acutely decreased low-density lipoprotein cholesterol (234.9 \ub1 103.2 mg/dl vs. 67.1 \ub1 49.5 mg/dl; p < 0.01) and oxidized phospholipid on apolipoprotein B-100 (60.2 \ub1 55.2 nmol/l vs. 47.0 \ub1 24.5 nmol/l; p = 0.01), and acutely increased resting myocardial perfusion (55.1 [95% confidence interval: 77.2 to 73.1] vs. 135 [95% confidence interval: 81.2 to 189.6] IU/s; p = 0.01), without changes in myocardial work. Myocardial longitudinal strain improved in those subjects with reduced pre-apheresis function. Skeletal muscle perfusion at rest and during contractile exercise was unchanged by apheresis. Acetylcholine-mediated dilation of ex vivo ovine coronary but not femoral arteries was impaired in pre-apheresis plasma and was completely reversed in post-apheresis plasma.CONCLUSIONSLipoprotein apheresis produces an immediate improvement in coronary microvascular function, which increases myocardial perfusion and normalizes endothelial-dependent vasodilation. These changes are not observed in the periphery. (Acute Microvascular Changes With LDL Apheresis; NCT02388633).P51 OD011092/ODCDC CDC HHS/Office of the Director/United StatesR35 HL135737/NHLBI NIH HHS/National Heart, Lung, and Blood Institute/United StatesR01 HL106579/NHLBI NIH HHS/National Heart, Lung, and Blood Institute/United StatesP01 HL136275/NHLBI NIH HHS/National Heart, Lung, and Blood Institute/United StatesR01 HL111969/NHLBI NIH HHS/National Heart, Lung, and Blood Institute/United StatesT32 HL094294/NHLBI NIH HHS/National Heart, Lung, and Blood Institute/United StatesR01 HL128550/NHLBI NIH HHS/National Heart, Lung, and Blood Institute/United StatesR01 HL078610/NHLBI NIH HHS/National Heart, Lung, and Blood Institute/United StatesR01 HL136098/NHLBI NIH HHS/National Heart, Lung, and Blood Institute/United StatesR01 HL130046/NHLBI NIH HHS/National Heart, Lung, and Blood Institute/United StatesR01 HL119828/NHLBI NIH HHS/National Heart, Lung, and Blood Institute/United StatesR01 HL120046/NHLBI NIH HHS/National Heart, Lung, and Blood Institute/United StatesK08 HL133493/NHLBI NIH HHS/National Heart, Lung, and Blood Institute/United States2020-08-01T00:00:00Z29909101PMC64580986559vault:3367

High-resolution Visualization of Intestinal Microcirculation using Ultra-microangiography in Patients with Inflammatory Bowel Disease: A Pilot Study

Background & Aims: Ultra-microangiography (UMA) is a novel Doppler technique with optimized wall filtering that provides high sensitivity to low-velocity blood flows and optimized visualization of microcirculation. The aim of this pilot study was to compare intestinal vascularization assessed by color Doppler signals (CDS) and UMA. Methods: We investigated intestinal vascularization using UMA and CDS in 13 patients with confirmed inflammatory bowel disease (IBD). A cohort of 28 patients without structural bowel disease served as the control. Results: Microcirculation and dysregulated microcirculation in patients without and with inflammatory bowel disease can be visualized and quantified using UMA. In 83 % of IBD patients and 76% of non-IBD patients, a high resolution of intestinal perfusion could be achieved using UMA. Conclusions: To the best of our knowledge, this is the first study to investigate intestinal vascularization using UMA in patients with and without structural bowel disease. Quantification and visualization of intestinal vascularization should be further investigated in prospective studies and could help guide our therapy of patients with IBD

Contrast-enhanced ultrasonography for the evaluation of liver fibrosis after biliary obstruction

AIM: To investigate perfusion change in contrast-enhanced ultrasonography (CEUS) to evaluate liver fibrosis based on biliary obstruction using an animal model. METHODS: New Zealand white rabbits (3-4 kg) underwent bile duct ligation to form a biliary obstruction model. We performed liver CEUS and laboratory tests on the day before the operation (day 0) and every 7 postoperative days until the rabbits were sacrificed. After CEUS, signal intensity of liver parenchyma with a time-intensity curve was analyzed. Perfusion parameters were automatically calculated from region-of-interests, including peak signal intensity, mean transit time, area under the curve and time to peak. Histological grades of liver fibrosis were assessed according to the Metavir score system immediately after sacrifice. Generalized estimating equations were used to analyze the association between liver fibrosis grades and perfusion parameters for statistical analysis. The perfusion parameters were measured on the last day and the difference between day 0 and the last day were evaluated. RESULTS: From the nine rabbits, histological grades of liver fibrosis were grade 1 in one rabbit, grade 2 and 3 in three rabbits each, and grade 4 in two rabbits. Among the four CEUS parameters, only the peak signal intensity measured on the last day demonstrated a significant association with liver fibrosis grades (OR = 1.392, 95%CI: 1.114-1.741, P = 0.004). The difference in peak signal intensity between day 0 and the last day also demonstrated an association with liver fibrosis (OR = 1.191, 95%CI: 0.999-1.419, P = 0.051). The other parameters tested, including mean transit time, area under the curve, and time to peak, showed no significant correlation with liver fibrosis grades. CONCLUSION: This animal study demonstrates that CEUS can be used to evaluate liver fibrosis from biliary obstruction using peak signal intensity as a parameter.ope

Ultrasonografi a przezczaszkowa wspomagana kontrastem w niedokrwiennym udarze mózgu

Ultrasonografia przezczaszkowa wspomagana kontrastemstanowi istotne narzędzie diagnostyczne u chorych z udaremmózgu. Zastosowanie kontrastów i związanych z nimi nowychmetod analizy sygnału umożliwiło uzyskiwanie większego odsetkaistotnych diagnostycznie obrazów w przypadku problemów technicznychlub u chorych z wysokiego stopnia zwężeniem tętnic,a także pozwoliło na nieinwazyjne wyselekcjonowanie chorychz mikrozatorowością. Ponadto środki kontrastowe mogą wspomagaćdziałanie trombolityczne rekombinowanego aktywatoraplazminogenu oraz umożliwiają ocenę perfuzji mózgu w ostrejfazie udaru. Prawdopodobnie będą mogły także przyczynić sięw przyszłości do prowadzenia terapii celowanej jako wektoryprzenoszące cząsteczki leków

Ultrasound and Microbubbles Mediated Bleomycin Delivery in Feline Oral Squamous Cell Carcinoma-: An In Vivo Veterinary Study

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

Ultrasound and Microbubbles Mediated Bleomycin Delivery in Feline Oral Squamous Cell Carcinoma-An In Vivo Veterinary Study

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

Дослідження ефективності критеріїв відбору у алгоритмі первинної селекції ознак в задачі класифікації патології печінки

Магістерська дисертація за темою «Дослідження ефективності критеріїв відбору у алгоритмі первинної селекції ознак в задачі класифікації патології печінки» виконана студентом кафедри біомедичної кібернетики ФСП Кожарою Катериною Миколаївноюм зі спеціальності 122 «Комп’ютерні науки» за освітньо-професійною програмою «Комп’ютерні технології в біології та медицині» та складається зі: вступу; 4 розділів (аналіз предметної області, методи реконструкції зображення, постановка задачі, аналіз ефективності відбору), розділу зі стартап проєкту, висновків до кожного з цих розділів; загальних висновків; списку використаних джерел, який налічує 30 джерела. Загальний обсяг роботи 95 сторінок. Обсяг роботи: 95 сторінок, 35 ілюстрацій, 30 джерел посилань. Актуальність теми. Діагностика захворювань печінки на ранніх стадіях допоможе більш якісно оцінити стан пацієнта та обрати якомога кращу лікувальну стратегію. Мета дослідження. Знаходження оптимального варіанту селекції ознак, для ефективного виконання задачі бінарної класифікації «норма -патологія» при дифузних захворюваннях печінки. Об’єкт дослідження. Зображення УЗД печінки. Предмет дослідження. Ефективність критеріїв відбору у алгоритмі первинної селекції ознак в задачі класифікації патології печінки. Методи дослідження. Методи селекції за критеріями внутрішньокласової дисперсії, міжкласової дисперсії, відношення внутрішньокласової і міжкласової дисперсій, кореляційний відбір ознак. Інструменти дослідження. Python, Anaconda, Jupyter Notebook.Master's dissertation on " Analysis of enrollment criteria efficiency in algorithm of the primary selection of indicators in the problematics of liver pathology classification" performed by Kozhara Kateryna, a student of the Department of Biomedical Cybernetics FBMI by specialty 122 "Computer Science" in the educational and professional program "Computer Technology in Biology and Medicine" and consists of an introduction, 4 chapters (subject area analysis, image reconstruction methods, problem statement, selection efficiency analysis), conclusions to each chapter, general conclusions and list of references that includes 30 points. The paper amounts to 95 pages. Paper size: 95 pages, 35 illustrations, 30 references. Relevance of the topic. Diagnosis of liver disease in the early stages will help to better assess the patient's condition and choose the best possible treatment strategy. Objective of the study. Знаходження оптимального варіанту селекції ознак, щоб можно було ефективно виконати задачу бінарної класифікації «Норма:Патологія». Object of study. Ultrasound image of the liver. Subject of study. The effectiveness of selection criteria in the algorithm of primary selection of traits in the problem of classification of liver pathology. Research methods. Intraclass variance, interclass variance, the ratio of intraclass and interclass variance, correlation selection of features. Research tools. Python, Anaconda, Jupyter Notebook