Image Settings Affecting Nuchal Translucency Measurement Using Volume NT(TM) Software

PURPOSE: To evaluate the effects of the deviation from the mid-sagittal plane, fetal image size, tissue harmonic imaging (THI), and speckle reduction filter (SRF) on the measurement of the nuchal translucency (NT) thickness using Volume NT(TM) software. MATERIALS AND METHODS: In 79 pregnant women, NT was measured using Volume NT(TM). Firstly, the three-dimensional volumes were categorized based on the angle of deviation in 10degrees intervals from the mid-sagittal plane. Secondly, the operator downsized the fetal image to less than 50% of the screen (Method A) and by magnifying the image (Method B). Next, the image was magnified until the fetal head and thorax occupied 75% of the screen, and the NT was measured (Method C). Lastly, NT values were acquired with THI and SRF functions on, with each function alternately on, and with both functions off. RESULTS: The mean differences in NT measurements were -0.09 mm (p<0.01) between two-dimensional (2D) and a deviation of 31-40degrees and -0.10 mm (p<0.01) between 2D and 41-50degrees. The intraclass correlation coefficients (ICC) for 2D-NT and NT according to image size were 0.858, 0.923, and 0.928 for methods A, B, and C, respectively. The ICC for 2D-NT and NT with respect to the THI and SRF were 0.786, 0.761, 0.740, and 0.731 with both functions on, THI only, SRF only, and with both functions off, respectively. CONCLUSION: NT measurements made using Volume NT(TM) are affected by angle deviation from the mid-sagittal plane and fetal image size. Additionally, the highest correlation with 2D-NT was achieved when THI and SRF functions were used.

Current Trends in Breast Ultrasonography

In the last 30 years, technical improvements have directly contributed to expanding sonographic breast imaging applications into the most important adjunctive imaging modality for breast evaluation. Most of these advances have related to improvements in sonographic gray-scale image resolution and contrast, but some applications such as color Doppler imaging, elastography, optical imaging, or three-dimensional ultrasounds have resulted in sonographic information that is uniquely different from grayscale imaging. The current spectrum of new breast sonographic techniques not only offers information uniquely different from gray-scale imaging but also involves hardware advances that affect the method of image production. In this article, we discuss the current trends in breast ultrasonography focusing on the advances to further improve accuracy for breast lesion diagnosis.

Correlation between Stroke and Spontaneous Echo Contrast by Tissue Harmonic Imaging in Patients with Dilated Cardiomyopathy

BACKGROUND: Spontaneous echo contrast (SEC) has been considered as a predisposition to thromboembolism and cerebrovascular accident. However, there have been few reports on the prevalence and role of SEC in dilated cardiomyopathy (DCM). The aim of this study was to investigate the prognostic usefulness of SEC in predicting a stroke in patients with DCM. METHODS: Between October 2001 and January 2008, transthoracic echocardiography with tissue harmonic imaging (THI) was performed for recognition of SEC in patients with DCM. Patients were divided into 2 groups according to the presence of SEC. Clinical characteristic data, echocardiographic parameters were compared between two groups. RESULTS: In this retrospective study, 220 patients (136 men, age 62.8+/-15.4 years) with DCM (left ventricular ejection fraction 27.8+/-7.8%) were included. SEC in the left ventricle (LV) was observed in 24 patients (10.9%). Stroke occurred in 4 (16.7%) of patients with SEC and in 9 (4.6%) of patients without SEC. There were no differences in LA dimension (p=0.24) and LV end-diastolic dimension (p=0.88) between both groups. On univariate analysis, SEC and coronary heart disease at presentation had statistical significance of risk factors for stroke in these groups (p<0.05). On multivariate analysis, only SEC was an independent predictor for stroke (OR 4.393, 95% CI 1.116-17.290, p=0.03). CONCLUSION: These results suggest that SEC by THI through transthoracic echocardiography has a strong association with stroke in patients with DCM. Therefore, this study may help in the risk stratification of cardiac embolism in patients with DCM.

Clinical Application of Medical Ultrasonic Technique / 医疗卫生装备

The clinic main application of medical ultrasonic techniques are introduced,including ophthalmology,neurology,angiology,cardiopathy,digestive system,urology,gynaecology and obstetrics,and surgery. Four kinds of medical ultrasonic techniques in the value on the clinic diagnosis are important,namely transcranial color -coded duplex sonography(TCCD),tissue harmonic imaging(THI),three dimensional imaging(3D),and extended field Of view(EFV).

Ultrasound Evaluation of Normal and Abnormal Fetuses: Comparison of Conventional, Tissue Harmonic, and Pulse-Inversion Harmonic Imaging Techniques

OBJECTIVE: To determine the usefulness of tissue harmonic imaging (THI) and pulse-inversion harmonic imaging (PIHI) in the evaluation of normal and abnormal fetuses. MATERIALS AND METHODS: Forty-one pregnant women who bore a total of 31 normal and ten abnormal fetuses underwent conventional ultrasonography (CUS), and then THI and PIHI. US images of six organ systems, namely the brain, spine, heart, abdomen, extremities and face were compared between the three techniques in terms of overall conspicuity and the definition of borders and internal structures. RESULTS: For the brain, heart, abdomen and face, overall conspicuity at THI and PIHI was significantly better than at CUS (p < 0.05). There was, though, no significant difference between THI and PIHI. Affected organs in abnormal fetuses were more clearly depicted at THI and PIHI than at CUS. CONCLUSION: Both THI and PIHI appear to be superior to CUS for the evaluation of normal or abnormal structures, particularly the brain, heart, abdomen and face.

Value of Tissue Harmonic Imaging for the Left Ventricular Wall Imaging

BACKGROUND: Assessment of segmental wall motion is one of the most challenging tasks in echocardiography. The diagnosis of ischemic heart disease by echocardiography depends on the accurate detection of segmental wall motion abnormalities. However, echocardiographic regional wall motion analysis is impaired by incomplete endocardial definition due to obesity, chronic obstructive lung disease, etc. The purpose of this study was to examine the value of tissue harmonic imaging for endocardial border definition. METHODS: We recorded echocardiograms in 30 consecutive patients, in which more than one segment of left ventricule were poorly visualized, by ATL HDI 3000 and analyzed left ventricular segmental wall motion and then recorded echocardiograms again by tissue harmonic imaging (THI) technique. Endocardial border definition for each segment was graded from grade A to C (grade A in which endocardium is clearly visualized, grade B in which endocardium is poorly visualized and grade C in which endocardium is not seen). Densitometric analysis was perfromed in 10 randomly selected patients. Mean density and dynamic range in histogram were obtained at septum, posterior wall and left ventricle cavity on parasternal long axis view with both techniques. RESULTS: Among total 480 segments, 237 segments (49.4%) were categorized as grade A, 152 segments (31.7%) were categorized as grade B and 91 segments (18.9%) were categorized as grade C in fundamental modes. However, 380 segments (79.2%) were categorized as grade A, 75 segments (15.6%) were categorized as grade B and 25 segments (5.2%) were categorized as grade C in tissue harmonic modes. Visualization of 37.7% (181 segments/480 segments) of all segments was improved in tissue harmonic imaging, with 5.2% (25 segments/480 segments) improved from "not seen" to "clearly visualized". Of these improved 181 segments in THI, 105 segments (58%) were the lateral and anterior walls on apical views. In densitometric analysis of septum, wall density and delta density (wall densityLV cavity density) were significantly higher in THI than fundamental modes (p<0.05). But, W/C ratio (wall density/LV cavity density) was not different between two imaging modalities. In densitometric analysis of posterior wall, all parameters were not significantly different between two imaging modalities. Also, W/C ratio of dynamic range (posterior wall dynamic range/LV cavity dynamic range) was not significantly different between two imaging modalities. CONCLUSION: Tissue harmonic imaging has significant value in endocardial border definition in the patients with poor echocardiographic windows and appears promising with the added advantage of no requirement for intravenous access.