Feasibility study using multifocal Doppler twinkling artifacts to detect suspicious microcalcifications in ex vivo specimens of breast cancer on US.

Multifocal Doppler twinkling artifact (MDTA) imaging has shown high detection rates of microcalcifications in phantom studies. We aimed to evaluate its performance in detecting suspicious microcalcifications in comparison with mammography by using ex vivo breast cancer specimens. We prospectively included ten women with breast cancer that presented with calcifications on mammography. Both digital specimen mammography and MDTA imaging were performed for ex vivo breast cancer specimens on the day of surgery. Five breast radiologists marked cells that included suspicious microcalcifications (referred to as 'positive cell') on specimen mammographic images using a grid of 5-mm cells. Cells that were marked by at least three readers were considered as 'consensus-positive'. Matched color Doppler twinkling artifact (CDTA) signals were compared between reconstructed US-MDTA projection images and mammographic images. The median detection rate for each case was 74.7% for positive cells and 96.7% for consensus-positive cells. Of the 10 cases, 90% showed a detection rate of ≥ 80%, with 50% of cases showing a 100% detection rate for consensus-positive cells. The proposed MDTA imaging method showed high performance for detecting suspicious microcalcifications in ex vivo breast cancer specimens, and may be a feasible approach for detecting suspicious breast microcalcifications with US.

Real-Time Ultrasound Detection of Breast Microcalcifications Using Multifocus Twinkling Artifact Imaging.

Detecting microcalcifications (MCs) in real time is important in the guidance of many breast biopsies. Due to its capability in visualizing biopsy needles without radiation hazards, ultrasound imaging is preferred over X-ray mammography, but it suffers from low sensitivity in detecting MCs. Here, we present a new nonionizing method based on real-time multifocus twinkling artifact (MF-TA) imaging for reliably detecting MCs. Our approach exploits time-varying TAs arising from acoustic random scattering on MCs with rough or irregular surfaces. To obtain the increased intensity of the TAs from MCs, in MF-TA, acoustic transmit parameters, such as the transmit frequency, the number of focuses and f-number, were optimized by investigating acoustical characteristics of MCs. A real-time MF-TA imaging sequence was developed and implemented on a programmable ultrasound research system, and it was controlled with a graphical user interface during real-time scanning. From an in-house 3D phantom and ex vivo breast specimen studies, the MF-TA method showed outstanding visibility and high-sensitivity detection for MCs regardless of their distribution or the background tissue. These results demonstrated that this nonionizing, noninvasive imaging technique has the potential to be one of effective image-guidance methods for breast biopsy procedures.

Technology trends and applications of deep learning in ultrasonography: image quality enhancement, diagnostic support, and improving workflow efficiency.

In this review of the most recent applications of deep learning to ultrasound imaging, the architectures of deep learning networks are briefly explained for the medical imaging applications of classification, detection, segmentation, and generation. Ultrasonography applications for image processing and diagnosis are then reviewed and summarized, along with some representative imaging studies of the breast, thyroid, heart, kidney, liver, and fetal head. Efforts towards workflow enhancement are also reviewed, with an emphasis on view recognition, scanning guide, image quality assessment, and quantification and measurement. Finally some future prospects are presented regarding image quality enhancement, diagnostic support, and improvements in workflow efficiency, along with remarks on hurdles, benefits, and necessary collaborations.

3D microcalcification detection using a color Doppler twinkling artifact with optimized transmit conditions: Preliminary results.

PURPOSE: Mammography is the only method that has been proven to detect breast microcalcifications (MCs), but the sensitivity of mammography varies according to breast density. This paper proposes an ultrasound (US) color Doppler twinkling artifact (CDTA) method with optimized transmit conditions to identify breast MCs without ionizing radiation. METHODS: The transmit conditions for US color Doppler imaging (CDI) were optimized to enhance the sensitivity of the twinkling artifact (TA) that arises from random scattering on rough surfaces of breast MCs. To validate the proposed breast MC detection method, a chicken breast phantom with MC particles (groups of particles <400  µ m and <240  µ m ) was fabricated and scanned by a digital mammography system and an US research platform by an L11-5v linear array probe with a three-dimensional (3D) motion tracking system. RESULTS: From the phantom experiment, the proposed 3D CDTA imaging method with optimized transmit conditions (i.e., a center frequency of 5.0 MHz, an f-number of 1.3, and a peak negative pressure of 1.83 MPa) successfully detected all 16 MC particles, comparable to detection with mammography. For a human breast surgical specimen in the ex vivo study, all 10 MC clusters, marked by a radiologist on the mammogram, were identified with the proposed 3D CDTA imaging method. CONCLUSIONS: In the phantom and ex vivo breast specimen studies, the proposed 3D CDTA imaging method successfully detected MCs, and the spatial localization was highly correlated with the mammogram results. These results indicate that the proposed 3D CDTA imaging method has great potential for the detection of MCs without ionizing radiation.

Orthogonal Chirp Coded Excitation in a Capacitive Micro-machined Ultrasonic Transducer Array for Ultrasound Imaging: A Feasibility Study.

It has been reported that the frequency bandwidth of capacitive micro-machined ultrasonic transducers (CMUTs) is relatively broader than that of other ceramic-based conventional ultrasonic transducers. In this paper, a feasibility study for orthogonal chirp coded excitation to efficiently make use of the wide bandwidth characteristic of CMUT array is presented. The experimental result shows that the two orthogonal chirps mixed and simultaneously fired in CMUT array can be perfectly separated in decoding process of the received echo signal without sacrificing the frequency bandwidth each chirp. The experimental study also shows that frequency band-divided orthogonal chirps are successfully compressed to two short pulses having the -6 dB axial beam-width of 0.26- and 0.31-micro second for high frequency and low frequency chirp, respectively. B-mode image simulations are performed using Field II to estimate the improvement of image quality assuming that the orthogonal chirps designed for the experiments are used for simultaneous transmission multiple-zone focusing (STMF) technique. The simulation results show that the STMF technique used in CMUT array can improve the lateral resolution up to 77.1% and the contrast resolution up to 74.7%, respectively. It is shown that the penetration depth also increases by more than 3 cm.

Randomised clinical trial of five ear acupuncture points for the treatment of overweight people.

OBJECTIVE: To evaluate the efficacy of the five ear acupuncture points (Shen-men, Spleen, Stomach, Hunger, Endocrine), generally used in Korean clinics for treating obesity, and compare them with the Hunger acupuncture point. METHODS: A randomised controlled clinical trial was conducted in 91 Koreans (16 male and 75 female, body mass index (BMI)≥23), who had not received any other weight control treatment within the past 6 months. Subjects were divided randomly into treatment I, treatment II or sham control groups and received unilateral auricular acupuncture with indwelling needles replaced weekly for 8 weeks. Treatment I group received acupuncture at the five ear acupuncture points, treatment II group at the Hunger acupuncture point only and the sham control group received acupuncture at the five ear acupuncture points used in treatment I, but the needles were removed immediately after insertion. BMI, waist circumference, weight, body fat mass (BFM), percentage body fat and blood pressure were measured at baseline and at 4 and 8 weeks after treatment. RESULTS: For the 58 participants who provided data at 8 weeks, significant differences in BMI, weight and BFM were found between the treatment and control groups. Treatment groups I and II showed 6.1% and 5.7% reduction in BMI, respectively (p<0.004). There were no significant differences between the two treatment groups. CONCLUSIONS: This finding suggests that the five ear acupuncture points, generally used in Korean clinics, and the Hunger point alone treatment are both effective for treating overweight people.

Phospholipase D1 mediates bFGF-induced Bcl-2 expression leading to neurite outgrowth in H19-7 cells.

The purpose of the present study was to investigate the role of PLD (phospholipase D) in bFGF (basic fibroblast growth factor)-induced Bcl-2 expression and to examine whether overexpressed Bcl-2 influences neurite outgrowth in immortalized hippocampal progenitor cells (H19-7 cells). We found that Bcl-2 expression was maximally induced by bFGF within 24 h, and that this effect was reduced by inhibiting PLD1 expression with PLD1 small interfering RNA or by overexpressing DN (dominant-negative)-PLD1, whereas PLD1 overexpression markedly induced Bcl-2 expression. bFGF treatment activated Ras, Src, PI3K (phosphoinositide 3-kinase), PLCγ (phospholipase Cγ) and PKCα (protein kinase Cα). Among these molecules, Src and PKCα were not required for Bcl-2 expression. PLD activity was decreased by Ras, PI3K or PLCγ inhibitor, suggesting that PLD1 activation occurred through Ras, PI3K or PLCγ. We found that Ras was the most upstream molecule among these proteins, followed by the PI3K/PLCγ pathway, indicating that bFGF-induced PLD activation took place through the Ras/PI3K/PLCγ pathway. Furthermore, PLD1 was required for activation of JNK (c-Jun N-terminal kinase), which led to activation of STAT3 (signal transducer and activator of transcription 3) and finally Bcl-2 expression. When Bcl-2 was overexpressed, neurite outgrowth was stimulated along with induction of neurotrophic factors such as brain-derived neurotrophic factor and neurotrophin 4/5. In conclusion, PLD1 acts as a downstream effector of bFGF/Ras/PI3K/PLCγ signalling and regulates Bcl-2 expression through JNK/STAT3, which leads to neurite outgrowth in H19-7 cells.

SNR comparisons of beamforming strategies.

This paper defines the echo signal-to-noise ratio (eSNR) for pulse-echo systems that adapts to the effects of shift-varying impulse responses, spatiotemporal coding, and various beamformers. Measurement techniques using point targets or random scattering media can be interrelated for a broad range of experimental conditions through the eSNR. The eSNR definitions are also illustrated by comparing a spatial matched filter (SMF) beamformer to conventional dynamic receive focusing methods to evaluate performance based on resolution and sensitivity. Closed-form expressions are presented that predict eSNR gains from SMF approaches relative to other beamformers.

Beamforming using spatial matched filtering with annular arrays (L).

A linear array beamforming method for ultrasonic B-mode imaging using spatial matched filtering (SMF) and a rectangular aperture geometry was recently proposed Kim et al., [J. Acoust. Soc. Am. 120, 852-861 (2006)]. This letter extends those results to include circularly symmetric apertures. SMF applied to annular arrays can improve the lateral resolution and echo signal-to-noise ratio as compared with conventional dynamic-receive delay-sum beamforming. At high frequencies, where delay and sum beamforming is problematic, SMF showed greatly improved target contrast over an extended field of view.

Efficient array beam forming by spatial filtering for ultrasound B-mode imaging.

This paper proposes an efficient array beam-forming method using spatial matched filtering (SMF) for ultrasonic imaging. In the proposed method, ultrasonic waves are transmitted from an array subaperture with fixed transmit focus as in conventional array imaging. At receive, radio frequency echo signals from each receive channel are passed through a spatial matched filter that is constructed based on the system transmit-receive spatial impulse response. The filtered echo signals are then summed without time delays. The filter concentrates and spatially registers the echo energy from each element so that the pulse-echo impulse response of the summed output is focused with acceptably low side lobes. Analytical beam pattern analysis and simulation results using a linear array show that this spatial filtering method can improve lateral resolution and contrast-to-noise ratio as compared with conventional dynamic receive focusing (DRF) methods. Experimental results with a linear array are consistent but point out the need to address additional practical issues. Spatial filtering is equivalent to synthetic aperture methods that dynamically focus on both transmit and receive throughout the field of view. In one common example of phase aberrations, the SMF method was degraded to a degree comparable to conventional DRF methods.