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AIM: To evaluate the imaging characteristics of dense automatic real time B-scan optical coherence tomography angiography(DART-OCTA)in macular-involved branch retinal vein occlusion(BRVO)and the diagnostic value of capillary perfusion imaging in the macular area.METHODS: From June 2020 to December 2020, there were 51 cases of 51 eyes with BRVO diagnosed in Eye Hospital, Wenzhou Medical University. Imaging characteristics of the BRVO macular area were observed by fluorescein angiography(FA), optical coherence tomography angiography(OCTA)and DART-OCTA examination, respectively. According to the retinal capillary perfusion status, the included patients were divided into capillary and non-imaging groups, comparing the results of capillary perfusion imaging in the BRVO macular area among the three examination methods.Furthermore, quantitative analysis of capillary perfusion density in the lesion involved area and the lesion non-involved area was performed in DART-OCTA images. RESULTS: Patients with 51 eyes were included in this study, FA identified 10 eyes of capillary perfusion imaging, OCTA identified 14 eyes of capillary perfusion imaging, DART-OCTA identified 34 eyes of the capillary perfusion imaging.Comparison of the three test methods for capillary perfusion imaging findings in the BRVO macular area showed that DART-OCTA was more sensitive compared to FA and OCTA for capillary perfusion imaging in the ischemic area. In DART-OCTA examination, retinal capillary blood flow density was lower in the lesion-involved areas in both the capillary perfusion imaging group and the non-imaging groups(0.65±0.20/mm vs 1.16±0.31/mm,0.41±0.16/mm vs 1.06±0.38/mm, all P<0.0001).CONCLUSION: DART-OCTA can provide clearer tomographic imaging of retinal capillary perfusion. And the imaging with its observation of BRVO involving the macular area is least affected by macular hemorrhage and it is an important complementary method for BRVO patients with significant retinal hemorrhage.
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Objective:To explore the clinical value of a diagnostic system of ophthalmic B-scan ultrasound images based on deep convolutional neural network.Methods:A total of 3 600 ophthalmic B-scan ultrasound images of 1 278 patients with an average age of (49.32±7.69) years at the Eye Center of Renmin Hospital of Wuhan University from January 2018 to October 2020 were collected to build an image database.These B-scan images were labeled by three ophthalmologists.The database was divided into the training dataset of 2 812 images and the testing dataset of 788 images.The deep learning algorithm was used to build a diagnostic model, which can identify retinal detachment (RD), vitreous hemorrhage (VH) and posterior vitreous detachment (PVD), and the accuracy of the model was evaluated.Another 120 B-scan ultrasound images were collected for the human-computer comparison between the model and 3 senior ophthalmologists.Eight junior clinicians were selected to evaluate another 150 B-scan images with and without the assistance of the model, and the accuracy was analyzed to evaluate the effect of the model.This study adhered to the Declaration of Helsinki and the study protocol was approved by Renmin Hospital of Wuhan University (No.WDRY2020K-192).Results:The accuracy of the model for identifying normal fundus, RD, VH, PVD and other diseases were 0.954, 0.909, 0.881, 0.990 and 0.920, respectively.The accuracy of the model was similar to that of senior doctors, and the time the model used was almost half that of doctors.With the assistance of the model, the diagnostic accuracy of the 8 junior clinicians who participated in the training was significantly improved ( P<0.01). Conclusions:The accuracy of RD, VH and PVD identification of the intelligent evaluation system is good, and the system can improve the accuracy and efficiency of clinical examinations, and can better assist clinicians in clinical evaluation.
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As drug carriers, magnetic nanoparticles can specifically bind to tumors and have the potential for targeted therapy. It is of great significance to explore non-invasive imaging methods that can detect the distribution of magnetic nanoparticles. Based on the mechanism that magnetic nanoparticles can generate ultrasonic waves through the pulsed magnetic field excitation, the sound pressure wave equation containing the concentration information of magnetic nanoparticles was derived. Using the finite element method and the analytical solution, the consistent transient pulsed magnetic field was obtained. A three-dimensional simulation model was constructed for the coupling calculation of electromagnetic field and sound field. The simulation results verified that the sound pressure waveform at the detection point reflected the position of magnetic nanoparticles in biological tissue. Using the sound pressure data detected by the ultrasonic transducer, the B-scan imaging of the magnetic nanoparticles was achieved. The maximum error of the target area position was 1.56%, and the magnetic nanoparticles regions with different concentrations were distinguished by comparing the amplitude of the boundary signals in the image. Studies in this paper indicate that B-scan imaging can quickly and accurately obtain the dimensional and positional information of the target region and is expected to be used for the detection of magnetic nanoparticles in targeted therapy.
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Acoustics , Computer Simulation , Magnetics , Magnetite Nanoparticles , TomographyABSTRACT
Purpose: To ascertain if ultrasound (USG) B-scan examination of the optic nerve head (ONH) can be a useful tool to diagnose and quantify glaucomatous cupping. Methods: A cross-sectional observational study of 48 eyes of 48 patients with clear ocular media and cup-disc ratio of (CDR) ?0.6 were included. The disc was studied by + 90D examination, USG B-scan and ONH Optical coherence tomography (OCT) by three masked observers. Observer-1 assessed the clinical CDR, observer-2recordedopticcup diameter on USG B-scan and observer-3performed ONH OCT to note the software computed average CDR. Measurements of cupping obtained by these 3 methods were compared and their relative strengths determined. The interdependency between variables was further studied using regression analysis. Results: Clinically assessed disc ratios of 0.6, 0.7, 0.8, 0.9, and total corresponded to USG cup measures of 1.02 ± 0.11 mm, 1.23 ± 0.14 mm, 1.35 ± 0.072 mm, 1.45 ± 0.084 mm, 1.75 ± 0.15 mm and OCT average CDR of 0.62 ± 0.087, 0.68 ± 0.060, 0.75 ± 0.078, 0.81 ± 0.036, 0.89 ± 0.038, respectively. There was an excellent correlation between the three arms, with Pearson's co-efficient (r) of 0.87, P < 0.001 between clinical and USG cupping; r = 0.89, P < 0.001 between clinical and OCT cupping; and r = 0.88, P < 0.001 between USG and OCT cupping. A relation of y = 1.64x + 0.03 was obtained between them, where y stands for USG cup diameter and x stands for the observed clinical CDR. Conclusion: Ultrasonographic measurement of optic cup diameter corresponds well to clinical ONH cupping. Therefore, it can reliably be used in quantifying ONH cupping in cases of media opacities which preclude optic disc visualization.
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Quality assurance (QA) is the maintenance of a desired level of quality in a service, by means of attention to every stage of process of delivery. Correct image acquisition along with accurate and reproducible quantification of ophthalmic imaging is crucial for evaluating disease progression/stabilization, response to therapy, and planning proper management of these cases. QA includes development of standard operating procedures for the collection of data for ophthalmic imaging, proper functioning of the ophthalmic imaging equipment, and intensive training of technicians/doctors for the same. QA can be obtained during ophthalmic imaging by not only calibration and setting up of the instrument as per the manufacturer's specifications but also giving proper instructions to the patients in a language which they understand and by acquisition of good quality images. This review article will highlight on how to achieve QA in imaging which is commonly being used in ophthalmic practice.
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Purpose: The aim of this study was to compare the ultrasonographic optic nerve sheath diameter (ONSD) in different grades of papilledema and in controls and to evaluate ONSD in atrophic papilledema/optic atrophy when raised ICP was suspected. Methods: Prospective cross-sectional case–control study. Following an ocular examination, papilledema was graded clinically using modified Frisén's grading. An ultrasonographic cross section of the retrobulbar optic nerve was obtained with a posterior transverse scan. Independent t-test and analysis of variance were the statistical tools used in the study. Results: The study included 55 cases and 55 age- and gender-matched controls; mean (± standard deviation) age was 37.17 (±11.25) years and male: female ratio was 49:61. There was a statistically significant difference in the mean ultrasonographic ONSD between cases [4.89 (±0.65) mm] and controls [3.12 (±0.22) mm] (P < 0.001). There was a significant difference in the mean ONSD across Frisén's grades of papilledema (P < 0.001). The mean ONSD in atrophic papilledema was 6.2 (±0.75) mm. Conclusion: In the presence of symptoms, ultrasonographic ONSD >4 mm is diagnostic of papilledema. Ultrasonographic ONSD correlates well with the severity of papilledema and can be used to follow-up patients with chronically elevated ICP. It is useful in detecting raised ICP in the presence of optic atrophy and to distinguish true papilledema from pseudopapilledema.
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BACKGROUND: The purpose of this study is to assess the utility of ocular ultrasound B scan in the emergency at the first point of care for detecting posterior segment and orbital pathologies in cases of paediatric ocular emergencies. METHODS: A prospective observational study involving 122 paediatric patients presenting to eye emergency over a period of ninety days were assessed with ultrasonography for the posterior segment as well as orbital pathology whenever indicated. The ocular ultrasound was performed gently over closed eyelids. RESULTS: Posttraumatic globe injuries were the most common indication for posterior segment evaluation, which constituted 80 (65.57％) eyes. Among these 52 patients had an anechoic posterior segment and 28 patients had variable findings such as vitreous haemorrhage (8.19％), retinal detachment (6.55％), choroidal detachment (4.91％), posteriorly dislocated clear lens (0.81％) and retained intraocular foreign body (5.73％). Non-traumatic cases constituted around 42 (34.42％) eyes, which included corneal ulcer (7.37％), retinoblastoma (6.55％), endophthalmitis (4.91％), extraocular muscle cysticercosis (4.91％), orbital cellulitis (4.09％), periocular haemorrhage (2.45％), proptosis(1.63％), paediatric cataract (1.63％) and cryptophthalmos (0.81％). No adverse events of performing the ultrasound was noted. CONCLUSION: First point ultrasonography in paediatric ocular emergencies is a cheap, portable and an effective tool in the assertion of significant posterior segment and orbital diseases.
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Objective To observe the clinical efficacy of cupping in intervening non-alcoholic fatty liver disease (NAFLD), and further explore the possible mechanism. Method Fifty NAFLD patients were randomized into two groups: a treatment group (25 cases, intervened by cupping, Chinese medication, diet control and kinesiotherapy) and a control group (25 cases, intervened by Chinese medication, diet control and kinesiotherapy). They were observed for 6 months. Body weight, body mass index (BMI), abdomen circumference, hip circumference, arm circumference, thigh circumference, blood lipids [including total cholesterol (TC) and triglyceride (TG)], hepatic enzymes [including aspartate transaminase (AST) and alanine transaminase (ALT)], and B-scan ultrasound of liver were recorded before and after the treatment for statistical analysis. Result After 6-month treatment, the body weight, BMI, abdomen circumference, hip circumference, arm circumference, and thigh circumference were significantly improved in the two groups (P<0.05); some patients had their TC, TG, AST and ALT levels descended to the normal range and B-scan ultrasound of liver turned negative; the reduction of abdomen circumference in the treatment group was more significant than that in the control group (P<0.05). Conclusion Cupping plus Chinese medication, diet control and exercises can effectively improve clinical observation indexes of NAFLD, especially for those with central obesity.
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Purpose: To evaluate the role of echography in diagnosis and management of a diverse array of choroidal masses. Materials and Methods: Sixty-two cases of clinically suspected choroidal masses were prospectively analyzed with B-scan (10 Hz), A-scan, and ultrasound biomicroscopy (UBM) (50 Hz) after a meticulous history and ocular examination. Ancillary investigations and systemic evaluation were also done. Results: Based on clinical suspicion, acoustic features, response to treatment, and other ancillary tests combined together, the various masses were differentiated. The cases included in the study were as follows: n = 10 malignant melanomas, n = 16 metastasis and infiltrations, n = 9 hemangioma, n = 7 tuberculoma, n = 8 nonspecific inflammatory masses, n = 2 disciform plaques, n = 4 macular cysts or retinoschisis, n = 2 Coat’s disease, n = 1 melanocytoma, and n = 2 osteomas. Ultrasonography (USG) alone could identify n = 51 lesions, while UBM in combination with USG was needed in remaining 11 masses. Conclusion: Standardized echography is an important adjunct in the diagnosis and management of eyes with intraocular masses. A better understanding of the clinicopathological and echographic picture of the diverse lesions can help in detection, differentiation, diagnosis, proposing a therapeutic approach, and also monitoring response to treatment. Echography is essential to evaluate tumors for extrascleral and anterior segment extension.
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RetCam is an excellent screening tool for the detection of retinopathy of prematurity (ROP). However, affordability is a barrier when adopting the use of RetCam in developing countries. We aimed to describe different stages of ROP using ultrasonographic B-scan and to evaluate the association between funduscopic examinations and ultrasonographic B-scan findings in premature neonates with ROP in Malaysia. A descriptive cross sectional study was conducted in 90 eyes of 47 premature neonates with different stages of ROP in three tertiary hospitals in Malaysia. Experienced ophthalmologists performed detailed funduscopic examinations using binocular indirect ophthalmoscopy (BIO). A masked examiner performed a 10 MHz ultrasonographic B-scan evaluation with 12 meridian position images within 48 hours of clinical diagnosis. Data from the clinical examination and ultrasonographic findings were collected and analysed. We recruited 37 eyes (41.1%) with stage 1 ROP, 29 eyes (32.3%) with stage 2, 18 eyes (20.0%) with stage 3, and 3 eyes (3.3%) with stages 4 and 5 based on the clinical assessment. Ultrasonography correctly identified 3 (8.1%) stage 1 eyes, 17 (58.6%) stage 2 eyes, 13 (72.2%) stage 3 eyes, and 3 each (100%) of the stage 4 and 5 eyes. There was a significant association between the funduscopic signs and the ultrasound findings for stage 2 ROP and above (Fisher’s exact test, p <0.001). In conclusion, all stages of ROP were detected and described with a 10 MHz ultrasonic B-scan system. A significant association was observed between funduscopic signs and ultrasonographic findings in premature Malaysian neonates with stage 2 ROP and above.
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A 50 year-old male patient was referred to our clinic due to a floating mass in the right eye. The uncorrected visual aquity was 10 / 10 in both eyes.The patient did not have any systemic disorder and trauma history. His ophthalmological examination revealed an unremarkable anterior segment with no signs of inflammation. Indirect opthalmoscopy and posterior segment biomicroscopy performed with 90D lens was unremarkable in the left eye, while in the right eye a single oval cyst was identified floating freely in the vitreous. The cyst was partially masking the underlying retinal vasculature. B-scan ultrasound revealed an echo-free, round-shaped cyst that was free from surrounding vitreous strands or retina localised at the posterior vitreous. Fluorescein angiography (FA) ruled out the presence of intra and overlying vascularisation of the cyst. Indeed, FA showed a clear-edged hypofluorescence due to a pre-retinal masking effect. The indirect hemaglutinin tests of the patient for ecinococcus and cysticercosis were negative. Eosinophilia was not detected in the preripheral blood smear. Based on these findings the patient was diagnosed as primary vitreal cyst. The presented case was mild symptomatic so the patient was decided to be followed up without any treatment.
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Humans , Male , Middle Aged , Cysts/diagnosis , Diagnosis, Differential , Eye Diseases/diagnosis , Fluorescein Angiography , Fundus Oculi , Microscopy, Acoustic , Ophthalmoscopy , Visual Acuity , Vitreous Body/pathologyABSTRACT
La ecografía bidimensional y Doppler es la primera prueba a realizar en los pacientes con deterioro de la función del injerto renal de causa no aclarada. Ofrece información rápida sobre las características morfológicas relacionadas con el tamaño, grosor y ecogenicidad del parénquima, diferenciación corticomedular, obstrucción del flujo urinario, colecciones perirenales, características del flujo sanguíneo en el interior de las arterias y venas renales que son de especial importancia cuando se sospecha una enfermedad de causa vascular. El índice de resistencia tiene valor predictivo en la función del trasplante renal a largo plazo y en el diagnóstico de la nefropatía crónica del injerto. La ecografía constituye la modalidad imagenológica de elección para el diagnóstico precoz y seguimiento de las complicaciones clínicas y quirúrgicas del riñón trasplantado, lo cual contribuye al tratamiento oportuno de las complicaciones, la preservación del injerto y el mejoramiento de la calidad de vida del enfermo.
Doppler scanning and ultrasound B-scan are the first test to perform in patients with impaired renal implant function of unknown cause. It provides rapid information on morphological characteristics related to size, thickness and parenchymal echogenicity, corticomedullary differentiation, urinary outflow obstruction, perirenal collections and blood flow characteristics within the renal arteries and veins that are of particular importance when a disease of vascular cause is suspected. The resistance index has predictive value in long-term renal transplant function and in the diagnosis of the implant chronic kidney disease. Ultrasound constitutes the imaging modality of choice for the early diagnosis and monitoring the clinical and surgical complications of the transplanted kidney, which contributes to the early treatment of complications, implant preservation and improvement of the quality of patient's life.
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Blunt ocular trauma in the elderly can result in anterior dislocation of the crystalline lens into the subconjunctival space (phacocele). Although rare, this presentation can be missed, especially if the patient presents several days after the injury and if the lid is not everted on examination. While a careful clinical examination is adequate in the diagnosis, imaging techniques can be put to use for the accurate location of the associated sclera rupture. We report three cases of post-traumatic phacocele wherein ultrasound biomicroscopy (UBM) was compared to the anterior segment optical coherence tomography (AS-OCT) and B-scan ultrasonography (B-scan), in order to establish the best imaging tool for this condition. We concluded, based on image quality, that UBM could be the imaging modality of choice to aid in the diagnosis of phacocele.
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Aged , Anterior Eye Segment/injuries , Anterior Eye Segment/diagnostic imaging , Child , Diagnosis, Differential , Eye Injuries/complications , Eye Injuries/diagnosis , Female , Follow-Up Studies , Humans , Lens Subluxation/diagnosis , Lens Subluxation/etiology , Lens, Crystalline/injuries , Lens, Crystalline/pathology , Lens, Crystalline/diagnostic imaging , Microscopy, Acoustic/methods , Tomography, Optical Coherence/methodsABSTRACT
BackgroundThe morphological examination of macular disease is very important information for the early diagnosis.Spectral domain optical coherence tomography (SD-OCT) is a gold criteria in the diagnosis of macular diseases,but its clinical application is limited in the eyes with refractive medium opacity.The resolution ratio of conventional B-scan sonography is unsatisfactory.20 MHz B-scan sonography may be a new approach to maculopathy.ObjectiveThis study was to evaluate the clinical value of 20 MHz B-scan ultrasound by comparing morphological changes of different maculopathies observed by 20 MHz ultrasound and spectral-domain OCT.MethodsA prospective study was designed.51 eyes of 51 patients with macular diseases who were determined by Tianjin Medical University Eye Center were enrolled in this study.Spectral-domain OCT was used to image the macular area,and then the 20 MHz B-scan ultrasound was used to examine the same eye to assess the value of 20 MHz B-scan ultrasound diagnosis.The macular diseases were typed according to the OCT manifestation.The characteristics of 20 MHz ultrasound for the same maculopathy were analyzed.All the patients subscribe the informed consent before the study.ResultsIn 10 eyes with macular hole determined by spectral-domain OCT,shallow dome-shaped lesion with central hollow was exhibited on the ultrasound image.The macular edema,retinal neuroepithelium layer detachment and retinoschisis were found in 16 eyes,6 eyes and 4 eyes by spectral-domain OCT,but the 20 M Hz B-Scan ultrasound presented with the focal belt-shaped elevation with non-echo zone below.In contrast,in 15 eyes of retinal pigment epithelium detachment in OCT,spectral-domain OCT showed stronger and thicker belt-shaped echo.Conclusions20 MHz B-scan ultrasound has certain value in the diagnosis and differentiation for several common maculopathies.Although it is not accurate as OCT in recognizing diseases,it could play an important role in refractive media opacity eye.
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PURPOSE: To determine the proper time frame in which to assess retinal attachment status and to evaluate the superior retinal attachment status by performing B-scan ultrasonography in different positions on patients who have undergone pars plana vitrectomy and gas tamoponade. METHODS: In this prospective study, 23 patients (23 eyes) who had undergone pars plana vitrectomy and gas tamponade were investigated between June 2005 and February 2006. SF6 (18%) was injected into the vitreous cavity of 15 eyes, and C3F8 (14%) was injected into the vitreous cavity of 8 eyes. At postoperative day 1, day 3, week 1, week 2, and week 4, B-scan ultrasonography was performed in the supine, sitting, prone, right decubitus, and left decubitus positions. RESULTS: The proper time to evaluate the retinal attachment status was three days post-operatively in 10 eyes (66.7%) with SF6 (18%) injections and two weeks post-operatively in six eyes (75%) that had C3F8 (14%) injections. The superior retinal attachment status can be evaluated from the summation of B-scan ultrasonography results performed in the right decubitus and left ducubitus positions. CONCLUSIONS: The proper time to evaluate the retinal attachment status was related to the degree of the gas absorption when performing B-scan ultrasonography after pars plana vitrectomy and gas tamponade. To evaluate the entire retina, it is useful to perform B-scan ultrasonograhy in the prone, right decubitus and left decubitus positions.
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Air , Follow-Up Studies , Injections , Postoperative Period , Prospective Studies , Retina/diagnostic imaging , Retinal Diseases/surgery , Time Factors , Treatment Outcome , Vitrectomy/methods , Vitreous BodyABSTRACT
Objective To evaluate the risk factors,manifestation and utrasonography examination in the diagnosis of placental abruption.Methods The clinical data of 48 patients with placental abruptiontreated in our hospital from Jan. 1999 to Oct. 2006 were analyzed retrospectively. Results Premature delivery rate was 31.25%,the perinatal death rate was 10.42%,choke of neonaty rate was 16.3%,postpartum haemorrhage rate was 14.6%,uterine upoplexy rate was 4.17%,cesarean section rate was 52.1%,ultrasonography diagnosis rate was 28.6%.Conclusions The earlier diagnosis of placental abruption depends on comprehensive analysis risk factors,clinical symptoms and accessory examination such as ultrasonography.