Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS.

Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some non-liver applications. Time has moved on, and the need for international guidelines on the use of CEUS in the liver has become apparent. The present document describes the third iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS) using contrast specific imaging techniques. This joint WFUMB-EFSUMB initiative has implicated experts from major leading ultrasound societies worldwide. These liver CEUS guidelines are simultaneously published in the official journals of both organizing federations (i.e., Ultrasound in Medicine and Biology for WFUMB and Ultraschall in der Medizin/European Journal of Ultrasound for EFSUMB). These guidelines and recommendations provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). They are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis and improve the management of patients worldwide.

High-throughput detection and sizing of individual low-index nanoparticles and viruses for pathogen identification.

Rapid, chip-scale, and cost-effective single particle detection of biological agents is of great importance to human health and national security. We report real-time, high-throughput detection and sizing of individual, low-index polystyrene nanoparticles and H1N1 virus. Our widefield, common path interferometer detects nanoparticles and viruses over a very large sensing area, orders of magnitude larger than competing techniques. We demonstrate nanoparticle detection and sizing down to 70 nm in diameter. We clearly size discriminate nanoparticles with diameters of 70, 100, 150, and 200 nm. We also demonstrate detection and size characterization of hundreds of individual H1N1 viruses in a single experiment.

Subsurface microscopy of integrated circuits with angular spectrum and polarization control.

We investigate the effect of an annular pupil-plane aperture in confocal imaging while using an NA increasing lens. We show that focal spot shape is highly sensitive to both polarization and angular spectrum of the incoming light. We demonstrate a lateral spatial resolution of 145 nm (lambda(0)/9) in the direction perpendicular to the polarization direction.

Applications of optical resonance to biological imaging and label-free protein microarrays.

We present biological imaging and sensing methods based on optical resonance and interference. In fluorescence microscopy, our nanoscale imaging capability sheds light onto conformational changes of DNA, DNA-protein complexes and polymer coatings on a solid surface. Interference measurements on a layered substrate yield a label-free sensing platform for protein binding in a high-throughput micro-array format.

Strong extinction of a far-field laser beam by a single quantum dot.

Through the utilization of index-matched GaAs immersion lens techniques, we demonstrate a record extinction (12%) of a far-field focused laser beam by a single InAs/GaAs quantum dot. This contrast level enables us to report for the first time resonant laser transmission spectroscopy on a single InAs/GaAs quantum dot without the need for phase-sensitive lock-in detection.

Optical determination of electron-phonon coupling in carbon nanotubes.

We report on an optical method to directly measure electron-phonon coupling in carbon nanotubes by correlating the first and second harmonic of the resonant Raman excitation profile. The method is applicable to 1D and 0D systems and is not limited to materials that exhibit photoluminescence. Experimental results for electron-phonon coupling with the radial breathing mode in 5 different nanotubes show coupling strengths from 3-11 meV. The results are in good agreement with the chirality and diameter dependence of the e-ph coupling calculated by Goupalov et al.

Phase-sensitive detection of dipole radiation in a fiber-based high numerical aperture optical system.

We theoretically study the problem of detecting dipole radiation in a fiber-based confocal microscope of high numerical aperture. By using a single-mode fiber, in contrast to a hard-stop pinhole aperture, the detector becomes sensitive to the phase of the field amplitude. We find that the maximum in collection efficiency of the dipole radiation does not coincide with the optimum resolution for the light-gathering instrument. The derived expressions are important for analyzing fiber-based confocal microscope performance in fluorescence and spectroscopic studies of single molecules and/or quantum dots.

Temperature dependence of the optical transition energies of carbon nanotubes: the role of electron-phonon coupling and thermal expansion.

Tunable Raman spectroscopy is used to measure the optical transition energies Eii of individual single wall carbon nanotubes. Eii is observed to shift down in energy by as much as 50 meV, from -160 to 300 degrees C, in contrast with previous measurements performed on nanotubes in alternate environments, which show upshifts and downshifts in Eii with temperature. We determine that electron-phonon coupling explains our experimental observations of nanotubes suspended in air, neglecting thermal expansion. In contrast, for nanotubes in surfactant or in bundles, thermal expansion of the nanotubes' environment exerts a nonisotropic pressure on the nanotube that dominates over the effect of electron-phonon coupling.

Application of the compound probability density function for characterization of breast masses in ultrasound B scans.

The compound probability density function (pdf) is investigated for the ability of its parameters to classify masses in ultrasonic B scan breast images. Results of 198 images (29 malignant and 70 benign cases and two images per case) are reported and compared to the classification performance reported by us earlier in this journal. A new parameter, the speckle factor, calculated from the parameters of the compound pdf was explored to separate benign and malignant masses. The receiver operating characteristic curve for the parameter resulted in an A(z) value of 0.852. This parameter was combined with one of the parameters from our previous work, namely the ratio of the K distribution parameter at the site and away from the site. This combined parameter resulted in an A(z) value of 0.955. In conclusion, the parameters of the K distribution and the compound pdf may be useful in the classification of breast masses. These parameters can be calculated in an automated fashion. It should be possible to combine the results of the ultrasonic image analysis with those of traditional mammography, thereby increasing the accuracy of breast cancer diagnosis.

Resonance Raman spectroscopy characterization of single-wall carbon nanotube separation by their metallicity and diameter.

Several techniques were recently reported for the bulk separation of metallic (M) and semiconducting (S) single wall carbon nanotubes (SWNTs), using optical absorption and resonance Raman spectroscopy (RRS) as a proof of the separation. In the present work, we develop a method for the quantitative evaluation of the M to S separation ratio, and also for the SWNT diameter selectivity of the separation process, based on RRS. The relative changes in the integrated intensities of the radial-breathing mode (RBM) features, with respect to the starting material, yield the diameter probability distribution functions for M and S SWNTs in the separated fractions, accounting for the different resonance conditions of individual SWNTs, while the diameter distribution of the starting material is obtained following the fitting procedure developed by Kuzmany and coworkers. Features other than the RBM are generally less effective for characterization of the separation process for SWNTs.

Measuring the uniaxial strain of individual single-wall carbon nanotubes: resonance Raman spectra of atomic-force-microscope modified single-wall nanotubes.

Raman spectroscopy is used to measure the strain in individual single-wall carbon nanotubes, strained by manipulation with an atomic-force-microscope tip. Under strains varying from 0.06%-1.65%, the in-plane vibrational mode frequencies are lowered by as much as 1.5% (40 cm(-1)), while the radial breathing mode (RBM) remains unchanged. The RBM Stokes/anti-Stokes intensity ratio remains unchanged under strain. The elasticity of these strain deformations is demonstrated as the down-shifted Raman modes resume their prestrain frequencies after a nanotube is broken under excessive strain.

Resonance Raman spectra of carbon nanotubes by cross-polarized light.

Resonance Raman studies on single wall carbon nanotubes (SWNTs) show that resonance with cross polarized light, i.e., with the E(mu,mu+/-1) van Hove singularities in the joint density of states needs to be taken into account when analyzing the Raman and optical absorption spectra from isolated SWNTs. This study is performed by analyzing the polarization, laser energy, and diameter dependence of two Raman features, the tangential modes (G band) and a second-order mode (G' band), at the isolated SWNT level.

Classification of breast masses in ultrasonic B-mode images using a compounding technique in the Nakagami distribution domain.

Classification of masses in ultrasonic B-mode images of the breast tissue using "normalized" parameters of the Nakagami distribution was recently investigated. The technique, however, did not yield performances that were comparable to those of an experienced radiologist, and utilized only a single image for tissue characterization. Because radiologists commonly use two to four images of a mass for characterization, a similar procedure is developed here. A simple summation of the normalized Nakagami parameters from two different images of a mass is utilized for classification as benign or malignant. The performance of the normalized Nakagami parameters before and after the summation has been carried out through a receiver operating characteristic (ROC) study. The bootstrap procedure has been utilized to compute the mean and SD of the ROC area, A(z), obtained for each parameter. It has been observed that combining normalized Nakagami parameters from two images of the mass may help to improve classification performance over that from utilizing the parameters of just a single image. The performance of this automated parameter-based approach appears to match that of a trained radiologist.

Computer aided classification of masses in ultrasonic mammography.

Frequency compounding was recently investigated for computer aided classification of masses in ultrasonic B-mode images as benign or malignant. The classification was performed using the normalized parameters of the Nakagami distribution at a single region of interest at the site of the mass. A combination of normalized Nakagami parameters from two different images of a mass was undertaken to improve the performance of classification. Receiver operating characteristic (ROC) analysis showed that such an approach resulted in an area of 0.83 under the ROC curve. The aim of the work described in this paper is to see whether a feature describing the characteristic of the boundary can be extracted and combined with the Nakagami parameter to further improve the performance of classification. The combination of the features has been performed using a weighted summation. Results indicate a 10% improvement in specificity at a sensitivity of 96% after combining the information at the site and at the boundary. Moreover, the technique requires minimal clinical intervention and has a performance that reaches that of the trained radiologist. It is hence suggested that this technique may be utilized in practice to characterize breast masses.

Contrast enhanced vascular three-dimensional ultrasound imaging.

In other imaging modalities three-dimensional (3D) data displays are well established; not so in ultrasound. Due to the real-time requirements of ultrasound the time available to compute 3D displays is limited, particularly when flow data is acquired with Doppler techniques. Consequently, it is only recently that improvements in computer processing power have resulted in useful vascular 3D ultrasound scans. Many manufacturers have now implemented free-hand 3D power Doppler capabilities on their scanners. However, to obtain flow signals from smaller vessels associated e.g., with tumor neovascularity, may very well require the introduction of a microbubble based ultrasound contrast agent into the blood stream. Given the up to 30 dB enhancement of Doppler signals produced by the contrast microbubbles quite spectacular vascular 3D images are feasible. Moreover, new contrast imaging techniques, such as harmonic imaging, have now permitted 3D vascular information to be acquired and displayed in grayscale with the associated improvement in resolution. In this paper we will review different aspects of contrast enhanced vascular 3D ultrasound imaging including implementation, contrast specific techniques and in vivo imaging.

Classification of ultrasonic B mode images of the breast using frequency diversity and Nakagami statistics.

The parameters of the Nakagami distribution have been utilized in the past to classify lesions in breast tissue as benign or malignant. To avoid the effect of operatorgain settings on the parameters of the Nakagami distribution, normalized parameters were utilized for the classification. The normalized parameter was defined as the ratio of the parameter at the site of the lesion to its average value over several regions away from the site. This technique, however, was very time consuming. In this paper, the application of frequency diversity and compounding is explored to achieve this normalization. Lesions are classified using these normalized parameters at the site. A receiver operating characteristic (ROC) analysis of the parameters of the Nakagami distribution has been conducted before and after compounding on a data set of 60 benign and 65 malignant lesions. The ROC results indicate that this technique can reasonably classify lesions in breast tissue as benign or malignant.

Effectiveness of the "teaching the teachers" diagnostic US training program.

RATIONALE AND OBJECTIVES: The "Teaching the Teachers" training program was meant to establish standardized ultrasound education programs worldwide, reaching the largest possible number of physicians. The authors performed this study to evaluate the results of this training. MATERIALS AND METHODS: An open-ended test question format (ie, uncued testing) that would evoke responses from physicians in a manner ensuring the highest fidelity with a real clinical setting was selected. An examination was administered at the beginning and the end of the program and then again 6 months later to assess baseline knowledge, changes in knowledge, and knowledge retention, respectively. RESULTS: Scores on entry and end-of-program examinations were available for 112 participants. The mean entry test score was 35%, and the mean end-of-program examination score was 73%. All changes in scores were statistically significant (P < .001) as determined with paired t tests. Follow-up examinations were available for 27 of the 112 participants at the time of the analysis. On these examinations, mean total test scores increased by nearly 4 percentage points. Although follow-up test scores were available for only 27 participants, these mean test scores were comparable to those reported for the entire group on the end-of-program examination. CONCLUSION: The examinations administered at the end of the 3-month program showed marked improvement compared with the baseline assessment. That this improvement remained stable over 6 months indicates the success of the educational process.

Contrast-enhanced power Doppler imaging of normal and decreased blood flow in canine prostates.

The purpose of this study was to investigate if Sonazoid, a new ultrasound (US) contrast agent, can improve the delineation of areas with normal and decreased blood flow in the prostate. Sonazoid was administered in the dose range of 0.00625-0.0375 microL microbubbles/kg into five anaesthetised mongrel adult male dogs. Transrectal power Doppler imaging of the prostate was performed in 2-D and 3-D with a C9-5 end-fire probe, using an HDI 3000 scanner. An area of decreased blood flow was created by inducing tissue ablation with a CL60 laser system, to mimic an avascular lesion. A subjective assessment of the intraprostatic vessels and the prostate vascular architecture was performed, with and without Sonazoid, before and after inducing the abnormal site. Visibility of the prostate blood flow improved following Sonazoid injection (p < 0.001). A symmetric, radial vascular pattern was identified in the normal prostate prior to tissue ablation, but only on the enhanced images. After tissue ablation, a disturbance of the normal vascular pattern and identification of areas with lack of blood flow was possible, following Sonazoid injection. Furthermore, the location and size of these areas were verified in all dogs by gross histology examination. Sonazoid enhances the visibility of the prostate vascular architecture and improves, thereby the delineation of areas with normal and decreased blood flow.

The role of contrast-enhanced sonography for radiofrequency ablation of liver tumors.

OBJECTIVE: To assess the feasibility and usefulness of contrast-enhanced sonography for tumor detection and guidance of liver VX2 tumor ablation and to evaluate post radiofrequency ablation effectiveness. METHODS: VX2 tumors were implanted into the livers of 6 rabbits. Both conventional and harmonic gray scale and power Doppler imaging were performed with a commercially available scanner to evaluate the liver tumors before and after intravenous injection of a sonographic contrast agent before and after radiofrequency ablation. Contrast-enhanced imaging was used to detect the tumors before ablation, to guide needle insertion, and to measure the ablation sites after radiofrequency ablation. Pathologic examination was performed for comparison. RESULTS: Three tumors were seen without contrast enhancement, whereas 10 tumors (<1 cm) were detected with contrast enhancement. Intentionally, 2 tumors were completely ablated and 5 tumors were partially ablated. In 3 cases, incompletely ablated tumors could only be identified on contrast-enhanced Doppler imaging by enhancing the detection of residual tumor vascularity. There was excellent concordance between sonographic imaging and gross pathologic findings. CONCLUSIONS: Contrast-enhanced sonographic imaging appears useful for detection of liver tumors and for guiding and monitoring tumor ablation therapies.

Tissue characterization using the continuous wavelet transform. Part II: Application on breast RF data.

In the first part of this work [16], a wavelet-based decomposition algorithm of the RF echo into its coherent and diffuse components was introduced. In this paper, the proposed algorithm is used to estimate structural parameters of the breast tissue such as the number and energy of coherent scatterers, the energy of the diffuse scatterers, and the correlation between them. Based on these individual parameters, breast tissue characterization is performed. The database used consists of 155 breast scans from 42 patients. The results are presented in terms of empirical receiver operating characteristics (ROC) curves. The results of this study are discussed in relation to the tissue microstructure. Individual estimated parameters are able to differentiate reliably between normal and fibroadenoma or fibrocystic or cancerous tissue (area under the ROC Az > 0.93). Also, the differentiation between malignant and benign (normal, fibrocystic, and fibroadenoma) tissue was possible (Az > 0.89).